Podcasts about acog

There are so many factors as to why someone would take the IVF path, and so many factors in the process itself. So today's episode is all about In Vitro Fertilization (IVF)- why people choose it, what the process involves, and how to prepare the body and mind for that process. We'll also debunk common IVF myths, explore what to expect along the way, and shed light on so much more. Joining me today on Yoga|Birth|Babies is Dr. Aimee Eyvazzadeh, a fertility specialist in San Ramon, CA. Dr. Aimee earned her medical degree from UCLA, completed her OB-GYN residency at Harvard, and holds a fellowship in reproductive endocrinology and infertility, as well as a Master's in Public Health from the University of Michigan. A fellow of ACOG, she remains active in fertility research. Dr. Aimee is also the host of the top-rated podcast The Egg Whisperer Show- and a mother of four! I'm thrilled to welcome her to share her expertise on the world of IVF. Get the most out of each episode by checking out the show notes with links, resources and other related podcasts at: prenatalyogacenter.com Don't forget to grab your FREE guide, 5 Simple Solutions to the Most Common Pregnancy Pains HERE  If you love what you've been listening to, please leave a rating and review! Yoga| Birth|Babies (Apple) or on Spotify! To connect with Deb and the PYC Community:  Instagram & Facebook: @prenatalyogacenter Youtube: Prenatal Yoga Center Learn more about your ad choices. Visit megaphone.fm/adchoices

On March 7, 2025, we released an episode summarizing key aspects of a NEJM publication regarding male partner therapy for women with recurrent BV. Although that study had limitations, the results were very surprising. Now, on 10/16/25 (7 months later), the ACOG has a new Clinical Practice Update (CPU) on this very issue. In this episode we will briefly summarize that March 2025 NEJM publication and highlight the TWO updated clinical recommendations from the ACOG regarding male partner therapy for the prevention of BV in women. PLUS, we will briefly discuss why although male partner therapy should be considered, partner EPT is “not recommended” at this time by the ACOG. 1. ACOG CLINICAL PRACTICE UPDATE: Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence Obstetrics & Gynecology ():10.1097/AOG.0000000000006102, October 16, 2025. | DOI: 10.1097/AOG.00000000000061022. Chapa Clinical Pearls March 2025 Episode: https://open.spotify.com/episode/4sW9tTe9CdYVQsCRBjqQQP3. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med 2025;392:947–57. doi: 10.1056/NEJMoa2405404STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Thank you to everyone who tuned into my live video! Join me for my next live video in the app.Trigger Warnings: Trump Disbands CongressSources:Democracy Now!democracynow.org/2025/10/8/adel…“Scary Precedent”: GOP Blocks Rep.-Elect Adelita Grijalva from Taking Seat Amid Epstein Files FightRepresentative-elect Adelita Grijalva, who won a special election for a House seat in Arizona two weeks ago, has still not been sworn in to Congress. Republican Speaker of the House Mike Johnson is blaming the government shutdown for the delay, even though he previously expedited the swearing-in of multiple Republicans who won their special elections before election results were even in. It's more likely, say supporters, that Grijalva is being held up to prevent what she has pledged will be her first act in Congress: adding her name to and thus triggering a vote on California Congressmember Ro Khanna's bill for the public release of files related to the federal investigation of sex trafficker Jeffrey Epstein. “She needs to get sworn in today,” says Khanna, adding that every day Grijalva is not seated in the House “is breaking precedent and depriving people of who they voted for.” Grijalva says, “This is an incredibly scary precedent to set. If you don't agree with the politics of the speaker, then they can keep you out of your duly elected office.” Khanna and Grijalva also discuss the legacy of Grijalva's late father, the longtime Arizona Congressmember Raúl Grijalva; the Trump administration's crackdown on immigration; right-wing attacks on freedom of the press; and more.AP Newsapnews.com/article/house-…Speaker Johnson keeps the House away as he fights to end the government shutdownHouse members' absence during the government shutdown is creating a political dilemma for Republican Speaker Mike Johnson and is testing his leadership.Chicago Tribunechicagotribune.com/2025/10/10/mik…Speaker Mike Johnson keeps the House away as he fights to end ...Mike Johnson is the speaker of a House that is no longer in session.POLITICOpolitico.com/news/2025/10/0…Mike Johnson sticks to no-show shutdown strategy as ... - Politico“There is absolutely no reason for the House to be out of session,” GOP Rep. Kevin Kiley said. “It's embarrassing.'Democratic Erosion Consortiumdemocratic-erosion.org/2025/04/18/how…How to Erode a Democracy: Hungary's Illiberal Turn Under OrbánThis blog post examines how Viktor Orbán has used media control, legal manipulation, and populist nationalism to methodically destroy Hungary's democratic institutions and turn the nation into the first “illiberal democracy” in the EU.NPRnpr.org/2025/04/20/nx-…Hungary's Orban demonstrates how to dismantle democracy - NPRThe dismantling of Hungary's democracy is a point of fascination for political scientists around the world — including those advising the Trump administration.cnncnn.com/2020/03/30/eur…Hungarian parliament votes to let Viktor Orban rule by decree ... - CNNHungary's parliament has voted to allow Prime Minister Viktor Orban to rule by decree indefinitely, in order to combat the coronavirus pandemic, giving the populist leader extra powers to unilaterally…CNNcnn.com/2025/10/08/pol…Tempers flare between Democratic senators and Speaker Johnson over Grijalva's swearing in and shutdown strategyArizona's Democratic senators got into a hallway confrontation with Republican House Speaker Mike Johnson on Wednesday as the government shutdown's eighth day dragged on.RFKjr & Autism: I Wrote a Foreword Just for YouSourcesCounter/neutral positions from regulators and clinical bodies* European Medicines Agency (EMA), PRAC communications on paracetamol in pregnancy: EMA has stated available evidence does not establish a causal link; use remains appropriate when clinically indicated at the lowest effective dose. Overview page: https://www.ema.europa.eu/en/medicines/human/referrals/paracetamol* (If needed: EMA general paracetamol product information hub where PRAC updates are posted.)* American College of Obstetricians and Gynecologists (ACOG). ACOG Guidance: Acetaminophen use during pregnancy. ACOG states evidence of neurodevelopmental harms is inconsistent and methodologically limited; acetaminophen remains appropriate when indicated. Practice Advisory/FAQ landing: https://www.acog.org/womens-health/faqs/medication-safety-during-pregnancySystematic reviews/meta-analyses with nuanced conclusions* Alemany S et al. Prenatal and postnatal exposure to acetaminophen and ADHD and autism spectrum symptoms in childhood: meta-analysis/pooled observational evidence. European Journal of Epidemiology (2021). Publisher page (Springer): https://link.springer.com/article/10.1007/s10654-021-00757-3U.S. federal perspective* U.S. FDA Drug Safety (Acetaminophen use in pregnancy). FDA has not concluded causality with autism; advises using the lowest effective dose for the shortest duration. Consumer/Drug Safety hub: https://www.fda.gov/consumers/consumer-updates/acetaminophen-overdose-and-liver-injury-know-ingredients-your-medicine* For pregnancy-specific FDA language, see: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medication-use-during-pregnancy-and-lactationSupportive association signals (observational; not proof of causality, few supportive links exist)* Ji Y et al. Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. JAMA Psychiatry (2019). Link: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2753510Evidence on emotional and social pain blunting* Social pain/evaluative processing: Experimental psychology studies have reported that standard doses of acetaminophen can reduce the distress of social rejection and blunt affective evaluations, suggesting overlap between physical and social pain processing in the brain. These findings support the idea that acetaminophen influences affective components of pain perception, though effect sizes are modest and not uniformly replicated across all paradigms. pbs​* Risk of overgeneralization: While these lab findings are provocative, they do not establish acetaminophen as a mood treatment. Regulatory and clinical bodies do not recommend acetaminophen for depression, and evidence for sustained antidepressant benefit is lacking. pbs This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit johnnyprofaneknapp.substack.com/subscribe

Maternal safety changes when we stop relying on heroics and start building systems. We open the door to the 2025 APSF Stolting Conference series with a fast, practical tour of what truly reduces morbidity and mortality: collaboration across anesthesia, obstetrics, cardiology, and nursing; open‑source AIM bundles; early warning tools; and standards that compress time-to-treatment when minutes matter. Along the way, we confront the three deadly D's—denial, delay, dismissal—and replace them with teamwork, tools, timeliness, and trust.We dig into the history that got us here, from case reports and confidential inquiries to robust maternal mortality review committees and rapid-cycle data that power real change. Then, we zero in on the leading cause of pregnancy-related death—cardiovascular disease—and why risk spikes in the postpartum period. A vivid case of peripartum cardiomyopathy shows how quickly decompensation unfolds and why anesthesia must be in the room early: shaping plans, managing hemodynamics, placing monitors, coordinating with cardiology and OB, and, when needed, activating ECMO. We highlight actionable steps like antenatal anesthesia consults for high‑risk patients, postpartum telemetry monitoring, and pregnancy heart teams that make escalation the rule, not the exception.Progress is real for hemorrhage and hypertension, but disparities remain stark for Black, Hispanic, and Asian Pacific Islander patients. We talk about implicit bias, access, and respectful care, and we share multilingual urgent maternal warning signs so patients and clinicians recognize danger sooner. The ASA's recommendations give a clear roadmap for anesthesiologist leadership—on review committees, quality teams, simulation programs, and implementation of SOAP and ACOG frameworks—so that safety becomes predictable.If this conversation sparks ideas for your unit, we'd love to hear them. Subscribe, share with a colleague who works on labor and delivery, and leave a review telling us the one system change you'll champion this month.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/276-maternal-care-transformed/© 2025, The Anesthesia Patient Safety Foundation

On October 9, 2025, the ACOG released a clinical practice update (CPU) regarding Zouranolone and brexanolone. As postpartum depression is an area of continued research and need for therapeutics, any new clinical practice update on the subject is welcome. So what's new in this update?! Well…the answer will surprise you. Listen in for details on the CPU, and a mini-review of the concerns for Zuranolone. 1. ACOG CPU Oct 9, 2025: Zuranolone and Brexanolone for the Treatment of Postpartum Depression 2. ACOG PA Aug 2023: Zuranolone for the Treatment of Postpartum Depression 3. Clinical Practice Guideline No. 5, Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (Obstet Gynecol 2023;141:1262–88)STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Sometimes you hear something that makes you just stop and say, “What did you say?!”. Yep, in this episode we will give evidence-based answers to three questions that I heard TODAY that made me stop and ask, “What did you say?”. In this episode we will cover: 1. Umbilical cord blood collection from a monochorionic twin gestation, 2. Predictability of the mBPP compared to full BPP, and 3. Breastfeeding during postpartum cannabis use (this last one is not so intuitive as you would think, and there is new ACOG guidance on this which we will review). Listen in for details!1. ACOG PB 229; 20212. ACOG CC #10: Cannabis Use During Pregnancy and Lactation3. Kaufman DA, Lucke AM, Cummings JJ. Postnatal Cord Blood Sampling: Clinical Report.Pediatrics. 2025;155(6):e2025071811. doi:10.1542/peds.2025-071811.4. Simpson L, Khati NJ, Deshmukh SP, et al. ACR Appropriateness Criteria Assessment of Fetal Well-Being. Journal of the American College of Radiology : JACR. 2016;13(12 Pt A):1483-1493. doi:10.1016/j.jacr.2016.08.028.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In July 2023, the ACOG released a Practice Advisory stating, “Based on data on the benefit of adjunct HPV vaccination, ACOG recommends adherence to the current Centers for Disease Control and Prevention (CDC) recommendations for vaccinations of individuals aged 9–26 years, and to consider adjuvant HPV vaccination for immunocompetent previously unvaccinated people aged 27–45 years who are undergoing treatment for CIN 2+”. The possible beneficial effect of peri-treatment HPV vaccination goes back to the early 2010s. But science is always changing, and MEDICINE MOVES FAST. In September 2025, the Lancet's Obstetrics, Gynecology, and Women's Health journal published the VACCIN trial to test that guidance. These authors found that, “Although previous studies, including meta-analyses and observational studies, have shown that adjuvant HPV vaccination reduces the recurrence of cervical dysplasia after surgical treatment, our trial suggests that adjuvant HPV vaccination is not effective in reducing the recurrence of CIN 2–3 lesions, contradicting the conclusions of previous works”. They have also called for a REVISION to prior guidance. This is FASCINATING. Listen in for details. 1. ACOG PA July 2023, “Adjuvant Human Papillomavirus Vaccination for Patients Undergoing Treatment for Cervical Intraepithelial Neoplasia 2+”2. Adjuvant prophylactic human papillomavirus vaccination for prevention of recurrent high-grade cervical intraepithelial neoplasia lesions in women undergoing lesion surgical treatment (VACCIN): a multicentre, phase 4 randomised placebo-controlled trial in the Netherlands: https://www.sciencedirect.com/science/article/pii/S305050382500007X#:~:text=To%20our%20knowledge%2C%20this%20is,the%20conclusions%20of%20previous%20works.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

ACOG: Cannabis Harms PregnanciesVidcast:  https://www.instagram.com/p/DPa3nh4jPE_/Here's a warning from the American College of Obstetricians and Gynecologists.  Cannabis use, that is products that contain THC and CBD, during pregnancy or while you're breastfeeding increases your chances of delivering a baby prematurely with a low birth weight due to in-uteri growth retardation, requiring a NICU admission, and/or raising a baby with long-term neurological, cognitive, and behavioral issues. Cannabis also impacts you. The smoke and vapors harm lung tissues and lower your oxygen levels.  It can increase your risk of falling and trigger auto accidents.By cannabis I mean smoking, vaping, or munching on cannabis products.Why the alarm?  Over a recent 15 year period, cannabis use by pregnant women has more than doubled.  Now that these products are legal in more states, more women are using them to relieve their pregnancy-related issues including morning sickness, headache, back pains, fatigue, and emotional distress.Your medical teams are so worried about this that ACOG has directed them to ask you about cannabis use and give you practical and safe alternatives. They will not be drug testing you but rather counseling you. They will tell you to avoid cannabis products if you can and to minimize their use if your can't.For morning sickness: eat bland foods, keep hydrated with non-caffeinated beverages; eat dry foods such as crackers and cereal in he morning; and eat small meals every 3 hours rather than the traditional 3 meals a day. For breast pain: wear soft supportive bras and loose-fitting garments; wash your breasts gently; apply ice packs; and absorb leaking fluids with soft pads.For other body pains: find comfortable positions and change positions often; use a lumbar pillow when sitting; wear comfortable low-heeled shoes; wear support stockings; use heating pads and massage.For dizziness: move around while standing; if lying down, turn to your side as you rise; rise slowly.One more thing: Researchers at the University of Toronto testing 1050 egg bathing follicular fluid have shown that  cannabis diminishes fertility in women by triggering genetic misfires that lead to non-viable embryos.  Men…Cannabis has also been shown to reduce sperm count and viability.https://www.acog.org/news/news-releases/2025/09/acog-releases-new-recommendations-cannabis-use-pregnancy-lactationhttps://my.clevelandclinic.org/health/articles/pregnancy-painshttps://www.nature.com/articles/s41467-025-63011-2https://pmc.ncbi.nlm.nih.gov/articles/PMC7385722/#cannabis #THC #CBD #ACOG #pregnancy #NICU #eggs #spermcannabis, THC, CBD, ACOG, pregnancy, NICU, eggs, sperm

A breakthrough discovery in the 1970s was the determination of alpha-fetoprotein levels in the serum of pregnant women to detect fetuses with neural tube defects. In the case of high AFP values in maternal serum, amniocentesis was performed to determine the levels of AFP and acetylcholinesterase (AChE) in the amniotic fluid to confirm the diagnosis. Currently, the ACOG states that high-quality, second-trimester fetal anatomy ultrasonography is an appropriate screening test for NTDs where routinely performed for fetal anatomic survey at 18 to 22 weeks. If optimal images of the fetal spine, intracranial anatomy, or anterior abdominal wall are not obtained (eg, fetal position or maternal obesity), MSAFP should be performed to improve detection of NTDs (ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 2017). Some clinicians (as we do in our practice) order both fetal anatomy ultrasound and msAFP concurrently. What are the implications when the msAFP is elevated with a normal fetal anatomical survey? Where is this msAFP coming from? Listen in for details.1. ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 20172. Pregnancy Outcomes Regarding Maternal Serum AFP Value in Second Trimester Screening. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Journal of Perinatal Medicine. 2017;45(7):817-820. doi:10.1515/jpm-2016-0101.3. Głowska-Ciemny J, Szmyt K, Kuszerska A, Rzepka R, von Kaisenberg C, Kocyłowski R. Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women. J Clin Med. 2024 Jan 14;13(2):466. doi: 10.3390/jcm13020466. PMID: 38256600; PMCID: PMC10816536.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

ACOG, the American College of Obstetricians and Gynecologists, recently published EMS guidelines for treatment of hypertension in pregnancy/pre-eclampsia, eclampsia, and postpartum hemorrhage. Drs. Jenna White and Christopher Zahn join Dr Jarvis to discuss the science behind these recommendations as well as how to implement them into our practice. Citations:1. https://www.acog.org/programs/obstetric-emergencies-in-nonobstetric-settings2. Vuncannon, D. M.; Platner, M. H.; Boulet, S. L. Timely Treatment of Severe Hypertension and Risk of Severe Maternal Morbidity at an Urban Hospital. American Journal of Obstetrics & Gynecology MFM 2023, 5 (2), 100809. https://doi.org/10.1016/j.ajogmf.2022.100809.3. Gupta, M.; Greene, N.; Kilpatrick, S. J. Timely Treatment of Severe Maternal Hypertension and Reduction in Severe Maternal Morbidity. Pregnancy Hypertension 2018, 14, 55–58. https://doi.org/10.1016/j.preghy.2018.07.010.

Maternal perception of decreased fetal movement at term occurs in up to 15% of pregnancies and is a cause for maternal and provider concern. All maternal concerns of decreased fetal movement require an assessment of fetal wellbeing. But what about the patient with recurrent episodes of reduced fetal movements at term? Routine induction of labor is not supported solely for decreased fetal movement in a non-growth-restricted fetus, as increased intervention rates (including induction of labor and early term birth) have not demonstrated improved perinatal outcomes and may increase neonatal morbidity, such as respiratory distress and NICU admission. Some international sources (ISUOG) have recognized the cerebroplacental ratio (CPR) as a possible ultrasound tool to investigate possible early placental insufficiency before fetal growth restriction occurs. Is CPR helpful for decreased fetal movements at term? A new publication from the Lancet's new journal- Obstetrcis, Gynecology, and Women's Health- states that it is. Is the CPR ultrasound assessment recognized by the ACOG or SMFM? Listen in for details. 1. The cerebroplacental ratio: a useful marker but should it be a screening test? (2025): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.29154#:~:text=The%20ISUOG%20guidelines%20recommend%20using,after%2038%20weeks'%20gestation44.2. Turner JM, Flenady V, Ellwood D, Coory M, Kumar S.Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements.JAMA logoJAMA Network Open. 2021;4(4):e215071. doi:10.1001/jamanetworkopen.2021.5071.3. Cerebroplacental ratio-based management versus care as usual in non-small-for-gestational-age fetuses at term with maternal perceived reduced fetal movements (CEPRA): a multicentre, cluster-randomised controlled trial. https://www.sciencedirect.com/science/article/pii/S30505038250000204. Hofmeyr GJ, Novikova N. Management of Reported Decreased Fetal Movements for Improving Pregnancy Outcomes. The Cochrane Database of Systematic Reviews. 2012;(4):CD009148. doi:10.1002/14651858.CD009148.pub2.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

ACOG's 2025 consensus finally validates IUD insertion pain. Lisa breaks down what this means for practitioners and how to advocate for evidence-based pain management in cervical procedures. Follow this link to view the full show notes page! This episode is sponsored by Lisa's new book Real Food for Fertility, co-authored with Lily Nichols! Grab your copy here!  Would you prefer to listen to the audiobook version of Real Food for Fertility instead?

Teruel ha acogido esta mañana las Jornadas Técnicas del Porcino de Teruel, una cita que ha reunido a expertos, técnicos, representantes institucionales y profesionales del sector para analizar los principales desafíos y oportunidades que afronta la producción porcina en la provincia.  Esta mañana, también en Teruel, ha tenido lugar la primera jornada del programa Aula Reconecta, una iniciativa formativa gratuita que ofrece acompañamiento experto a personas con proyectos relacionados con la gestión forestal. También hoy se ha presentado el proyecto "Estudio Trufa Negra de Aragón y sus resultados", una iniciativa del Grupo de Cooperación Trufa Negra D'Aragón que busca dar a conocer las medidas puestas en marcha para fortalecer el mercado y consolidar las economías rurales. Repasaremos, como cada lunes y jueves, las últimas cotizaciones en la Lonja del Ebro y en la Lonja de Binéfar.

In his weekly clinical update, Dr. Griffin with Vincent Racaniello are dismayed about the recent attack on public health the firing of the director of the CDC as well as resignation of 3 others members of the agency's leadership, the continued Legionnaire's outbreak in Harlem, suspension of Ixchiq the Chikungunya virus attenuated infectious vaccine, the first US case of New World screwworm before Dr. Griffin deep dives into recent statistics on the measles epidemic, RSV, influenza and SARS-CoV-2 infections, the Wasterwater Scan dashboard, Johns Hopkins measles tracker, association Guillian-Barré syndrome with RSV vaccination, guidelines for using RSV vaccines, whether or not the NB.1.8.1 should be included in the fall 2025 vaccines, the American College Obstetricians and Gynecologists recommendations for the COVID, RSV and influenza vaccines, FDA approval letters for Pfizer, moderna and Novagax COVID vaccines including label changes for use in those between 5 through 64 years, where to find PEMGARDA, long COVID treatment center, where to go for answers to your long COVID questions, and contacting your federal government representative to stop the assault on science and biomedical research. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode White House Says New C.D.C. Director Is Fired, but She Refuses to Leave (NY Times) CDC director refuses to leave after White House order (BBC) Legionnaires' Disease: In Harlem(NYC Health) New York City Health Department Provides Update on Community Cluster of Legionnaires' Disease in Central Harlem(NYC Health: Promoting and protecting the City's health) FDA Update on the Safety of Ixchiq (Chikungunya Vaccine, Live) (FDA) Vimkunya (Bavarian Nordiac) U.S. and Panama for the control of the Screwworm pest (COPEG) Rare human case of flesh-eating parasite New World screwworm identified in US(CNN) USDA Announces Sweeping Plans to Protect the United States from New World Screwworm (USDA) HHS details New World screwworm response after human case(CIDRAP) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Tracking Measles Cases in the U.S. (Johns Hopkins) Weekly measles and rubella monitoring (Government of Canada) Measles (WHO) Get the FACTS about measles (NY State Department of Health) Measles (CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Measles (CDC Measles (Rubeola)) Measles vaccine recommendations from NYP (jpg) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts(ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) Influenza: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Relative effectiveness of high-dose versus standard-dose influenza vaccine against hospitalizations and mortality according to frailty score (JID) FDA-CDC-DOD: 2025-2046 influenza vaccine composition (FDA) RSV: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) ENFLONSIA: novel drug approvals 2025 (FDA) RSV-Network (CDC Respiratory Syncytial virus Infection) Vaccines for Adults (CDC: Respiratory Syncytial Virus Infection (RSV)) Evaluation of Guillain-Barré Syndrome (GBS) following Respiratory Syncytial Virus (RSV) Vaccination Among Adults 65 Years and Older (FDA) Economic Analysis of Protein Subunit and mRNA RSV Vaccination in Adults aged 50-59 Years (CDC: ACIP) Evidence to Recommendations Framework (EtR): RSV Vaccination in Adults Aged 50–59 years (CDC: National Center for Immunization and Respiratory Diseases) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) Respiratory Illnesses Data Channel (CDC: Respiratory Illnesses) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Antigenic and Virological Characteristics of SARS-CoV-2 Variant BA.3.2, XFG, and NB.1.8.1 (bioRxiV) Veering from CDC, ACOG recommends maternal vaccination against COVID-19 (CIDRAP) ACOG Releases Updated Maternal Immunization Guidance for COVID-19, Influenza, and RSV (American College of Obstericians and Gynecologists) COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care (American College of Obstericians and Gynecologists) Pfizer and BioNTech's COMIRNATY® Receives U.S. FDA Approval for Adults 65 and Older and Individuals Ages 5 through 64 at Increased Risk for Severe COVID-19 (Pfizer)  COMIRNATY approval letter (FDA) Moderna Receives U.S. FDA Approval for Updated COVID-19 Vaccines Targeting LP.8.1 Variant of SARS-CoV-2 (FEEDS) SPIKEVAX approval letter (FDA) Novavax's Nuvaxovid 2025-2026 Formula COVID-19 Vaccine Approved in the U.S (Novavax) NUVAXOVID approval letter (FDA) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Infusion center (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Drug interaction checker (University of Liverpool) Paxlovid (Pfizer) Infectious Disease Society guidelines for treatment and management (ID Society) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) Managing healthcare staffing shortages (CDC) Steroids,dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Reaching out to US house representative Letters read on TWiV 1248 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

Neste episódio, Camilla Luna, ginecologista, obstetra e conteudista do Portal Afya, aborda os principais destaques do ACOG 2025. A especialista ainda comenta sobre contracepção, infecções vulvovaginais complexas, abortamento de repetição e mais! Aperte o play e ouça agora!

Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary.• ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants• Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances in neonatal care• Systematic reviews show no difference between chlorhexidine and iodine for vaginal prep before hysterectomy• Conservative management of placenta accreta spectrum disorders shows improved outcomes over immediate cesarean hysterectomy• Labor arrest Cesareans have highest blood loss among non-accreta cesarean indications• New HPV testing terminology recommends "HPV detected" rather than "positive" to avoid relationship misunderstandings• USPSTF preeclampsia prevention guidelines classify 89% of pregnant women as aspirin candidates despite limited evidence• Endometrial sampling best practices include stepwise approach starting with ultrasound before considering hysteroscopyIn two weeks, Jacqueline Vidosch returns to discuss her son Noah who has trisomy 18, following a feature in the New York Times.00:00:00 Episode Introduction00:06:43 Post-Cesarean Antibiotics: Evidence Review00:17:11 Delayed Cord Clamping Updates00:22:13 Extreme Preterm Survival Case00:26:40 Vaginal Prep and Placenta Accreta Management00:30:11 Cesarean Blood Loss by Indication00:34:21 HPV Testing Language Changes00:37:45 Aspirin for Preeclampsia Prevention00:51:33 Endometrial Sampling QuestionFollow us on Instagram @thinkingaboutobgyn.

Recently, the American College of Obstetricians and Gynecologists rejected federal funding in response to the current US administration's polices. We talk about what this means.See omnystudio.com/listener for privacy information.

Send us a textNervous about a breech baby or C-section? Think again.Planning a VBAC? It deserves more than a footnote in your chart.In this episode, I'm joined (again!) by Dr. Elliot Berlin, DC — prenatal chiropractor, labor doula, and founder of the Informed Pregnancy Podcast & One Way or A Mother serial podcast. With over 50,000 pre- and postnatal patients treated, and more than 450 podcast episodes featuring celebrity moms, birth professionals, and real birth stories, Dr. Berlin is a leading voice in informed birth advocacy and evidence-based pregnancy care.We dive into ACOG guidelines on breech presentation, explore how to support vaginal breech birth, and break down some of the most persistent pregnancy myths still circulating today. Dr. Berlin also shares personal insights from his own fertility journey, and what he's learned from decades of working with families navigating everything from VBACs to cesarean births to home births and everything in between.Whether you're preparing for your first baby or your fifth, hoping for a VBAC, planning a home or hospital birth, or simply want to feel confident in your birth choices—this conversation will help you get clear, grounded, and informed.We talk about:The evolving conversation around vaginal breech birth and what the research says nowWhy storytelling is one of the most underrated tools for birth prepHow to stay informed and flexible—even when your birth plan shiftsThe expanding role of doulas in both hospital and out-of-hospital birthsWhy cesarean birth can be a powerful, empowering choice when it's supported with respect and intention

Join medical students Binal Patel and Aashka Sheth as they discuss adolescent gynecology with pediatrician Dr. Shreeti Kapoor.  Specifically, they will discuss: What exactly is adolescent gynecology. The proper approach to taking a comprehensive history for a pediatric patient with a gynecologic chief complaint. The various causes of dysmenorrhea in the early menarche period and its presentation. The diagnostic approach to dysmenorrhea in adolescents. The approach to treatment of dysmenorrhea in a pediatric population. And how to approach addressing safe sex practices and sexually transmitted infections with adolescents. References: 21 reasons to see a gynecologist before you turn 21. ACOG. (n.d.). https://www.acog.org/womens-health/infographics/21-reasons-to-see-a-gynecologist-before-you-turn-21   Adams Hillard P. J. (2008). Menstruation in adolescents: what's normal?. Medscape journal of medicine, 10(12), 295.  Breehl L, Caban O. Physiology, Puberty. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534827/  Centers for Disease Control and Prevention. (n.d.). About heavy menstrual bleeding. Centers for Disease Control and Prevention. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html  Primary dysmenorrhea in adolescents. UpToDate. (n.d.). https://www.uptodate.com/contents/primary-dysmenorrhea-in-adolescents?search=Primary+Dysmenorrhea+&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2  professional, C. C. medical. (2024, September 20). Pediatric gynecology. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24574-pediatric-gynecology  professional, C. C. medical. (2025, February 18). Puberty. Cleveland Clinic. https://my.clevelandclinic.org/health/body/puberty   Sachedin, A., & Todd, N. (2020). Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. Journal of Clinical Research in Pediatric Endocrinology, 12(1), 7–17. https://doi.org/10.4274/jcrpe.galenos.2019.2019.s0217   Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. (2020). Topics in Antiviral Medicine, 28(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC7482983/pdf/tam-28-459.pdf   UpToDate. (n.d.). Abnormal uterine bleeding in adolescents. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-adolescents-evaluation-and-approach-to-diagnosis?search=heavy%2Bbleeding&usage_type=default&source=search_result&selectedTitle=3~150&display_rank=3  

The American College of Obstetricians and Gynecologists released new clinical guidance on April 17, 2025 that recommends, as they see it, reimagining prenatal care in the U.S. Instead of the traditional 12–14 in‑person visits, ACOG now advocates for individualized prenatal care schedules—especially for average‑ and low‑risk patients—tailored based on medical, social, and structural determinants of health as well as patient preferences The guidance encourages early needs assessments (ideally before 10 weeks), shared decision‑making, coordination of social support resources, telemedicine, and group care modalities to reduce barriers and drive equity  Drawing on the PATH framework developed with the University of Michigan, ACOG presents sample visit schedules and monitoring strategies reflecting evidence that fewer visits—with flexible modalities—can maintain quality while improving access and patient experience As clinicans who have been offering unparalleled care for decades, find out what Dr. Abdelhak and his team at Maternal Resources think of groundbreaking this new update.    YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources . Instagram: Follow us for daily inspiration and updates at @maternalresources . Facebook: Join our community at facebook.com/IntegrativeOB Tiktok: NatureBack Doc on TikTok Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .

Delayed (AKA deferred) Cord Clamping (DCC) is extremely beneficial for both the preterm and term neonate. In September 2025, a new Clinical Practice Update (CPU) will be released by the ACOG regarding the amount of time DCC should be done for preterm newborns. This updates data from a Clinical Expert Series which was released in 2022, called “Management of Placental Transfusion to the Neonate”. Is the recommended amount of DCC 30 sec, 45 sec, or at least 60 seconds for preterm newborns? We will highlight this data in this episode. PLUS, we will very quickly summarize a separate yet related publication from JAMA Pediatrics regarding the use of supplemental O2 (100% PP face mask) during DCC for babies born at 22- 28 weeks. Listen in for details.1. ACOG CPU, Sept 2025: “An Update to Clinical Guidance for Delayed UmbilicalCord Clamping After Birth in Preterm Neonates”2. ACOG Clinical Expert Series, Management of Placental Transfusion to the Neonate”; 2022. 3. JAMA PEDIATRICS (July 21, 2025): https://jamanetwork.com/journals/jamapediatrics/article-abstract/2836681

OBGYN Briefs - Understanding the RUC's Role in Healthcare Costs Every procedure has a price, but how is it set? In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD, to discuss her work with the key organizations influencing medical billing and reimbursement. They explore Dr. Levy's extensive involvement with ACOG, AMA's CPT Editorial Panel, and the RBRVS Update Committee (RUC), offering an overview of the complex systems governing coding and reimbursement in medicine. From how new procedures receive codes to the financial impact on physicians, this brief offers valuable insights for OBGYN practitioners navigating the world of medical billing and coding. TIMESTAMPS 00:00 - Introduction  00:48 - Personal Anecdotes and Career Beginnings 02:01 - Understanding Medical Reimbursement 03:17 - Roles and Responsibilities in Medical Committees 05:34 - The Coding Process Explained 09:16 - The Role of the RUC and CPT Editorial Panel 15:16 - RVUs and Practice Expenses 17:48 - Final Thoughts CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

Send us a textMaking informed decisions for your newborn can feel like navigating a tidal wave of contradictory advice, especially when it comes to routine procedures like the vitamin K shot. As both a labor nurse who's cared for countless babies and a mom who's stood in your shoes, I created this episode to cut through the noise with evidence, empathy, and respect for your values.Vitamin K is essential for blood clotting, and all newborns—regardless of how healthy the pregnancy was—are born with extremely low levels, about 1/50th of what adults have. The vitamin K shot provides protection during those vulnerable first months when even a small internal bleed could become serious. While vitamin K deficiency bleeding is rare, occurring in roughly 1 in 6,000 babies who don't receive supplementation, it can be devastating when it happens.We dive deep into the questions parents really struggle with: If babies are born with low vitamin K, isn't that natural? What about ingredients like polysorbate 80? Doesn't breast milk provide everything babies need? Could oral vitamin K work instead? Will the shot disrupt those precious first bonding moments? Each concern is addressed with current research, practical experience, and an understanding that these questions come from a place of love and protection.Beyond just facts and figures, we explore the emotional and spiritual dimensions of this decision. For families wondering if interventions contradict their faith in God's design, we consider how human babies are uniquely dependent creatures—perfect but not complete—and how scientific advancements might be viewed as extensions of divine care rather than contradictions.The episode wraps with a practical decision-making framework called the BRAIN model (Benefits, Risks, Alternatives, Intuition, and what happens if you do Nothing), helping you sort through your options with clarity rather than fear. Whether you choose the shot, explore alternatives with medical guidance, or decide on another pa Join the Bump & Beyond Online Community for moms & moms-to-be! Coaching offerKelly Hof: Labor Nurse + Birth CoachBasically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!Support the showConnect with Kelly at kellyhof.com Join the Bump & Beyond Online Community!https://www.facebook.com/groups/bumpnbeyondGrab The Book of Hormones on Amazon!Medical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

Intrahepatic Cholestasis of Pregnancy (ICP) has dichotomous effects: Benign for the mother (although the itching it causes may be a qualify of life issue, yet potentially devasting for the child in-utero. In 2021, SMFM released Consult series 53 on the subject. This, together with the ACOG 's CO 831 (Medically Indicated Late Preterm and early term delivery) also from 2021 provide management options for ICP. However, this month- July 2025- Dr. Cynthia Gyamfi-Bannerman et al published a new proposed ICP classification and management schema that is easy to follow. Listen in for details. ​ SMFM CS #53,2021​ ACOG CO #831, 2021​ Sarker M, Ramos GA, Ferrara L, Gyamfi-Bannerman C. Simplifying Management of Cholestasis: A Proposal for a Classification System. Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4. PMID: 39631774

Stillbirth is one of the most devastating adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In March 2020, the ACOG released OCC #10, "Management of Stillbirth". Now, formally released July 2025, the SMFM has an updated checklist for stillbirth care, published in the journal Pregnancy. In this episode, we will highlight some nuances in this list. Listen in for details.​ SMFM Special Statement (July 2025): Society for Maternal-Fetal Medicine Special Statement: Checklists for management of pregnancies complicated by stillbirth.​ ACOG OCC 10; March 2020

"Failure to progress in labor. " Can we all agree this is a horrible name and can impact someone's view of their ability to give birth! For years, birthing people have been expected to follow “Freidman's Curve” a standard set by a trial of only 500 participants conducted nearly 50 years ago. Recently, ACOG has set new standards. Unfortunately many hospitals and practices have been slow to put these new standards into practice. In this episode of Yoga|Birth|Babies, I am thrilled to bring back board-certified, practicing OB/GYN and mom of 2, Dr. Nicole Calloway Rankins to discuss the parameters of “Failure to progress” and it's impact unplanned cesareans. Nicole lays out what is considered “normal labor” and why it's important not jump to declaring arrested labor before active labor starts at 6cm. She also shares factors that may be influencing longer labors and strategies care providers, nurses, and doulas have to help labor progress.  Resources: Due Dates & Induction with Dr. Nicole Calloway Rankins The Peanut Ball and the Pelvis with Cheri Grant The Peanut Ball Lady The VBAC Link The VBAC Calculator Get the most out of each episode by checking out the show notes with links, resources and other related podcasts at: prenatalyogacenter.com Don't forget to grab your FREE guide, 5 Simple Solutions to the Most Common Pregnancy Pains HERE  If you love what you've been listening to, please leave a rating and review! Yoga| Birth|Babies (Apple) or on Spotify! To connect with Deb and the PYC Community:  Instagram & Facebook: @prenatalyogacenter Youtube: Prenatal Yoga Center Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textWhen Alex Wachelka predicted her third baby would arrive on December 15th—despite professionals insisting otherwise—her intuition was right. But the path to that moment wasn't easy.After two very different births—one at a birth center and one rapid home birth—Alex expected another fast delivery. Instead, she faced twelve hours of annoying, spaced-out contractions that woke her up every 10 minutes. It wasn't until she voiced her frustration to her husband that everything shifted. In releasing her fears and feeling truly supported, her labor transformed—and her baby arrived just one hour later, exactly on the date she predicted.In this episode, Alex shares her third birth story and how it deepened her belief in the mind-body connection. She also talks about her work as an IBCLC and certified nutrition coach, helping moms with everything from breastfeeding challenges to postpartum recovery through programs like her “Boob Ease” mastitis support and “Baby's First Year” coaching.Whether you're preparing for birth or navigating motherhood, this conversation is a powerful reminder to trust your body, trust your instincts, and lean into support.Connect with Alex here: https://motherhoodbloomslactation.com/Order the Juice Plus supplements we talked about here:

The Bishop Score was originally developed in 1964 by Dr. Edward Bishop and remains the central assessment tool for determining the appropriateness of cervical ripening for labor induction. We have covered pharmacologic and mechanical methods of cervical ripening for labor induction many times in prior episodes. Ut now, in July 2025, there will be a new clinical practice guideline (#9) from the ACOG which has some notable items. Does the ACOG recognize COMBINATION mechanical and pharmacologic agents for cervical ripening for labor induction? What about outpatient cervical ripening? What are the recommended protocols for oral and vaginal prostaglandins? Listen in for details.

Send us a textNavigating the search for your perfect birth doula can feel overwhelming. How do you find someone who aligns with your vision, fits your budget, and helps you feel secure during one of life's most vulnerable moments?Drawing from over a decade of obstetric nursing experience, I'm breaking down everything you need to know about finding the right doula for YOU. This isn't about trends or checking boxes—it's about building a support system that honors your unique journey.We'll start by clarifying what doulas actually do (and don't do), and bust a few common myths. Whether you're planning an unmedicated birth, hoping for an epidural, or scheduling a cesarean, doulas support all birth paths—without judgment. They don't replace your partner or provider—they enhance your whole team.The key to finding your perfect match is understanding your own needs first. I'll walk you through powerful reflection questions about the energy you want in your birth space, how you handle stress, and the role you want your partner to play. That clarity becomes your compass during doula interviews.Worried about cost? I share practical strategies to make doula care more accessible, from payment plans to possible insurance or TRICARE coverage.Interviewing doulas doesn't have to feel awkward or scary. I give you thoughtful questions to ask about their approach, their experience with different birth scenarios, and how they work with hospital staff. Plus, I cover key red flags—so you don't end up with someone pushing their own agenda.Even if hiring a doula isn't an option right now, I'll offer supportive alternatives to help you feel calm and confident walking into birth.Your birth experience matters. Choosing support that fits you isn't being picky—it's powerful. Schedule a free Birth Vision Call at kellyhof.com and let's talk about creating the empowered experience you deserve. Coaching offerKelly Hof: Labor Nurse + Birth CoachBasically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!Support the showConnect with Kelly at kellyhof.com Join the Bump & Beyond Online Community!https://www.facebook.com/groups/bumpnbeyondGrab The Book of Hormones on Amazon!Medical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

It's interesting how, at times, different medical societies can look at the same data and arrive at different recommendations. It happens! In April 2025, the Society of Family Planning (SFP) released its new clinical recommendations for the medical management of early pregnancy loss (EPL), AKA miscarriage. This clinical guidance has 4 remarkably interesting differences when compared to the ACOG practice bulletin # 200 on early pregnancy loss. In this episode, we will review these 4 key differences and summarize the latest recommendations for the medical management of miscarriage. Listen in for details.

What Every Patient and Clinician Should Know About the 2025 Guidelines for IUD Insertion Pain ManagementFor years, patients have reported severe pain during IUD insertions—only to be told it's "just a pinch." Now, the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) have issued updated guidance that changes everything.This episode breaks down what's in the new guidelines, why it matters, and what's still standing in the way of better care.What We Cover in This EpisodeWhat ACOG and CDC now recommend for IUD pain reliefWhy misoprostol is no longer a routine optionHow reimbursement challenges affect what happens in the exam roomWhat to do if your provider isn't aware of the new guidelinesThe role of trauma-informed and shared decision-making modelsWhy this shift is critical for women's health equity and trustRelated ResourcesACOG Clinical Consensus on Pain Management (May 2025)CDC U.S. SPR Update (Aug 2024)Resources and episodes on Pelvic Health Recommended Books on Hormones and Menstrual Health **Top 50 Health Podcast of 2024** Want men to better understand how to you during your menopause journey! Tell us what you want them to know.If you're passionate about advancing women's health, there are many ways you can support and stay in touch with Fempower Health. Here's how:Subscribe and Listen: Tune in to new episodes every Tuesday by subscribing to the Fempower Health Podcast on Apple Podcast, Spotify or your favorite podcast platform. Your regular listenership is invaluable!Leave a Review: Help us grow by leaving a review on Apple, Spotify or your favorite podcast platform. Your feedback not only supports us but also helps others discover our podcast.Share with Others: Spread the word by sharing episodes with friends, family, or anyone interested in women's health. Every share helps!Engage in Discussions: Join the Fempower Health Women's Health Community. Learn more here. Find Us on Social: Follow us on LinkedIn, Instagram and TikTok, YouTube, for the latest updates and engaging content. Stay Informed: Sign up for our...

Send us a textThe birth plan has become a staple of pregnancy preparation, but most expectant parents are approaching it all wrong. What began as a revolutionary tool for restoring autonomy during the natural birth movement of the 1960s has too often devolved into a rigid checklist that sets birthing people up for disappointment and even trauma.I reframe how we think about birth plans, explaining that they were never meant to be a list of demands but rather a foundation for communication, informed choice, and emotional preparation. Drawing on wisdom from pioneers like Sheila Kitzinger and Penny Simkin, I reveal why the most powerful birth plans focus not on controlling external events but on cultivating internal strength.You'll discover the five most common birth plan mistakes and practical strategies for avoiding them—from treating the plan like an inflexible checklist to using it as a shield against your deepest fears. Through guided visualization exercises and nervous system training techniques, I introduce the concept of a "birth vision" that keeps you anchored in your power even when birth takes unexpected turns.Perhaps most powerfully, I draw parallels between birth and athletic performance, explaining why elite preparation involves not just visualizing your ideal scenario but training for every possible challenge. Just as no professional athlete enters competition without a coach, I share  why dedicated prenatal coaching helps birthing people show up with clarity, confidence, and the ability to stay grounded under pressure.Whether you're preparing for your first birth or looking to heal from a previous experience that left you feeling powerless, this episode offers a revolutionary approach to birth preparation that honors both the unpredictability of birth and your capacity to lead your experience with strength and grace. Ready to transform how you think about birth planning? Book a free birth vision call at kellyhof.com and start preparing not just for birth, but for one of life's most profound transformations. Coaching offerKelly Hof: Labor Nurse + Birth CoachBasically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!Support the showConnect with Kelly Hof!Grab The Book of HormonesMedical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

The menstrual cycle is a vital sign. So why isn't it treated like one? 10 years after ACOG said we should be assessing every teen girl's cycle… most clinicians still aren't doing it. We need to change that. Follow this link to view the full show notes page! This episode is sponsored by Lisa's new book Real Food for Fertility, co-authored with Lily Nichols! Grab your copy here!  Would you prefer to listen to the audiobook version of Real Food for Fertility instead?

Send us a textOne Way or a Mother is a new narrative podcast from Dr. Elliot Berlin, DC, host of The Informed Pregnancy Podcast. Each season is an intimate story of one woman, one pregnancy, and all of the preparations, emotions, and personal history leading up to the birth. Episodes feature the expectant mother along with her family, doctors, and birth work team.In season one of OWAM, we meet Arianna who is pregnant with her second baby after a traumatic first birth experience. Follow along over 10 episodes as we hear her tell her story. She's a mother of one who is seeking new resources and using learned life lessons to create a different, more positive birth experience for baby number two. Episodes feature Arianna and her inner circle including her mother, husband, doula, doctor, and other birth professionals who supported her process.One Way or a Mother is an Informed Pregnancy Media original series. Season one is presented by Mahmee.Expert care, every stage.Meet your team of doulas, nurses, lactation consultants, and more. One team caring for the whole you. Covered by most insurance plans. Check your eligibility today at mahmee.com.******One Way or a Mother is an Informed Pregnancy Media original series. Season one is presented by @joinmahmee.Curves ahead: Episodes 1-3 are now live wherever you listen!

Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.

Today's episode of TFB's Behind the Gun podcast features Bo and Aaron of Staker Precision, the small company behind the new Side ACOG Mount or SAM. The SAM somewhat reverses the roles of the offset red dot and primary optic and instead puts the magnified ACOG at a 36-degree offset for a quick boost in magnification over that of your normal red dot. Today both Aaron and Bo will share their origin story from conception, to prototyping and eventually to production and give us some insight into how the optic is meant to be used as well as clear up some misconceptions about its utility for longer range engagements.  Staker Precision Staker Precision on Instagram Staker Precision on YouTube

  In this Q&A episode, Dr. Rebecca Dekker answers questions submitted by EBB Pro Members—each exploring a different facet of evidence-based maternity care.   First, she explores the latest evidence on early induction for gestational hypertension, including findings from the WILL trial and other recent studies. What are the real risks and benefits of inducing labor at 37 or 38 weeks for gestational hypertension? And how should families weigh these decisions with their providers?   Next, Dr. Dekker shares new insights into the effectiveness of acupuncture and acupressure for labor pain, anxiety, and Cesarean recovery. From systematic reviews to randomized trials, the data is growing!   Finally, she looks into the evidence on interpregnancy intervals. What does the research say about the risks associated with short or long gaps between pregnancies? And how might this information apply to those who are pregnant again after a five-year or more break?   (00:00) Intro to Mini Q&A and EBB Pro Membership (02:17) Early Induction for Gestational Hypertension – What the Research Says (06:20) WILL Trial Findings and Recommendations from ACOG and NICE (08:23) Outcomes at 37 vs. 38 Weeks – Cesareans, NICU, and Respiratory Distress (10:15) Balancing Induction Timing and Risks of Continuing Pregnancy (11:03) Acupuncture and Acupressure – New Research and Applications (12:41) Studies on Pain, Anxiety, and Nausea During Labor and Cesareans (14:46) Acupuncture and Cesarean Recovery – Mobility and Pain Management (16:54) Interpregnancy Intervals – Definitions and Research Challenges (19:39) Risks of Short and Long Pregnancy Spacing (23:22) Global Perspectives and Meta-Analysis on Birth Outcomes (26:49) Public Health Implications and Final Thoughts   View the full list of resources and references on ebbirth.com.   For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Send us a textWhat's the one question every woman wants to answer when considering a VBAC? Is it safe for me and my baby? In today's episode, Cynthia & Trisha break down the available data on VBAC, why we should discard the term TOLAC, the actual risks of uterine rupture, whether induced with Pitocon versus a prostaglandin or having spontaneous labor versus expectant management. We present the few cases in which a woman should not choose to VBAC and help mothers understand their decisions should not be driven by statistics alone. If you are considering a VBAC, get a pen and paper and arm yourself with all the stats from this data-rich dialogue. Also: Let's get HavBAC to take! (Inside Joke -- you'll get it when you listen!)**********Watch the full videos of all our episodes on YouTube!**********Our sponsors:Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort.Needed -- Our favorite nutritional products for before, during, and after pregnancy. Use this link to save 20%DrinkLMNT -- Purchase LMNT with this unique link and get a FREE sample packENERGYbits--the superfood every mother needs for pregnancy, postpartum, and breastfeedingPrimally Pure: From soil to skin, primally pure products are made with down-to-earth ingredients that feel and smell like heaven for the skinUse promo code: DOWNTOBIRTH for all sponsors.Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Watch the full videos of all our episodes on YouTube! Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

In this episode of Health Matters, Dr. Mary Rosser, a gynecologist at NewYork-Presbyterian and Columbia, explains perimenopause, breaking down what symptoms are normal, when it's time to see a doctor, and the best options for managing some of the more challenging symptoms of perimenopause. ___Dr. Mary L. Rosser, M.D., Ph.D., NCMP is the Director of Integrated Women's Health at NewYork-Presbyterian/Columbia University Irving Medical Center and the Richard U. and Ellen J. Levine Assistant Professor of Women's Health (in Obstetrics and Gynecology) at Columbia University Vagelos College of Physicians & Surgeons. She joined the faculty of Obstetrics and Gynecology at Columbia University in April 2018 to provide routine gynecology care and to further develop a comprehensive well-woman program. She has been a practicing obstetrician gynecologist for more than 20 years, starting in private practice and then joining the faculty at Montefiore Medical Center in Bronx, NY. While at Montefiore, she created, launched, and led the forty-person Division of General Obstetrics and Gynecology. Dr. Rosser received her undergraduate degree at Emory University and a Ph.D. in Endocrinology at the Medical College of Georgia. She attended Wake Forest University School of Medicine and completed her residency at Emory University. She is also a NAMS Certified Menopause Practitioner, able to provide high-quality care for patients at menopause and beyond.Primary care and heart disease in women have always been areas of focus for Dr. Rosser. She conducted basic science research on heart disease during graduate school and was the Chair of the "Women & Heart Disease Physician Education Initiative" for District II of the American College of Obstetrics & Gynecology. She continues to conduct clinical studies around patient awareness and understanding of heart disease and well-woman care. Dr. Rosser serves on the Medical Leadership Team of the Go Red for Women movement of the American Heart Association and she is ACOG's liaison to the American College of Cardiology.___Health Matters is your weekly dose of health and wellness information, from the leading experts. Join host Courtney Allison to get news you can use in your own life. New episodes drop each Wednesday.If you are looking for practical health tips and trustworthy information from world-class doctors and medical experts you will enjoy listening to Health Matters. Health Matters was created to share stories of science, care, and wellness that are happening every day at NewYork-Presbyterian, one of the nation's most comprehensive, integrated academic healthcare systems. In keeping with NewYork-Presbyterian's long legacy of medical breakthroughs and innovation, Health Matters features the latest news, insights, and health tips from our trusted experts; inspiring first-hand accounts from patients and caregivers; and updates on the latest research and innovations in patient care, all in collaboration with our renowned medical schools, Columbia and Weill Cornell Medicine. To learn more visit: https://healthmatters.nyp.org

In August 2024, the CDC updated its MEC. This included a recommendation for local anesthesia for IUD/S placement and also had guidance regarding misoprostol for that procedure. Coming up in July 2025, the ACOG will officially release a new clinical consensus on “Pain Management for In-Office Uterine and Cervical Procedures”. Are these recommendations similar to the CDC's? What about misoprostol? Was the non-use of local anesthesia for these office-based procedures rooted in racism and sexism? Listen in for details.

Lily Nichols is a Registered Dietitian and the author three books designed to support healthy conception, birth and postpartum, including how to prevent and manage gestational diabetes.Her books are Real Food for Fertility (co-authored by Lisa Hendrickson-Jack), Real Food For Pregnancy and Real Food for Gestational Diabetes.Lily shares important information all women should know about optimizing their diet for fertility, pregnancy, and postpartum from a scientific perspective. Even for women who aren't currently in the pregnancy state of mind, knowing this information early on helps everyone to make better choices down the road.Connect with Lily Nichols lilynicholsrdn.com | InstagramLearn more The Institute for Prenatal Nutrition | Postpartum Recovery Meals | Fourth Trimester Soups and Stews Collection | Nutrition and Nourishment - The EssentialsResources HelloGaia Parenting Copilot | FREE DOWNLOAD Customizable Birth Plan | FREE DOWNLOAD Customizable Fourth Trimester PlanConnect with Fourth Trimester Facebook | InstagramWant trustworthy parenting data at your fingertips? Download HelloGaia Parenting Copilot for FREE today. The app uses reliable sources like ACOG, AAP, The Society for Maternal-Fetal Medicine. FREE app available now on Apple & Google Play

*Content warning: pregnancy and birth trauma, medical trauma and negligence. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. Markeda's Instagram:https://www.instagram.com/markedasimone/Moms Advocating for Moms Alliance:https://www.instagram.com/momsadvocatingformomsalliance/Dr. Shannon Clark's websitehttps://www.babiesafter35.com/Dr. Shannon Clark on TikTokhttps://www.tiktok.com/@babies_after_35Dr. Shannon Clark on Instagramhttps://www.instagram.com/babiesafter35/*Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ ACOG's Texas Levels of Maternal Care Verification Program: Quality Through Partnershiphttps://www.acog.org/news/news-articles/2018/09/texas-lomc-verification-program-quality-through-partnership A Comprehensive Case Report Emphasizing the Role of Caesarean Section, Antibiotic Prophylaxis, and Post-operative Care in Meconium-Stained Fetal Distress Syndromehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11370710/#:~:text=Meconium%2Dstainedamnioticfluid(MSAF)oftenleadstomore,andneonatalmortality%5B3%5D The Difference Between Health Equity and Equalityhttps://www.hopkinsacg.org/health-equity-equality-and-disparities/ EMTALA – Transfer Policyhttps://hcahealthcare.com/util/forms/ethics/policies/legal/emtala-facility-sample-policies/generic-emtala-transfer-policy-a.pdf How cuts at the National Institutes of Health could impact Americans' healthhttps://www.cbsnews.com/news/nih-layoffs-budget-cuts-medical-research-60-minutes/ Individualized, supportive care key to positive childbirth experience, says WHOhttps://www.who.int/news/item/15-02-2018-individualized-supportive-care-key-to-positive-childbirth-experience-says-who Is a HIPAA Violation Grounds for Termination?https://www.hipaajournal.com/hipaa-violation-grounds-for-termination/#:~:text=AHIPAAviolationcanbe,sanctionspolicyoftheemployer March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal Safety Series: Joint Commission Case Review Requirementshttps://www.greeley.com/insights/maternal-safety-series-joint-commission-case-review-requirements Meconiumhttps://my.clevelandclinic.org/health/body/24102-meconium Meconium Aspiration Syndromehttps://my.clevelandclinic.org/health/diseases/24620-meconium-aspiration-syndrome Meconium Aspiration Syndrome, Hypoxic-Ischemic Encephalopathy and Therapeutic Hypothermia-A Recipe for Severe Pulmonary Hypertension?https://pubmed.ncbi.nlm.nih.gov/38929252/#:~:text=Infantsbornthroughmeconium%2Dstained,ofthenewborn(PPHN) Medical Auditing Frequently Asked Questionshttps://www.aapc.com/resources/medical-auditing-frequently-asked-questions?srsltid=AfmBOooNLHrxkJi3hp2CO-3OkVj1heZAqWFVu7B-M8njnrJs8R78BBoM Midwifery continuity of care: A scoping review of where, how, by whom and for whom?https://pmc.ncbi.nlm.nih.gov/articles/PMC10021789/#:~:text=Midwife%2Dledcontinuitymodelsin,plausiblehypothesesrequirefurtherinvestigation National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case-control studyhttps://pubmed.ncbi.nlm.nih.gov/35233771/ Physiology, Pregnancyhttps://www.ncbi.nlm.nih.gov/books/NBK559304/ Pregnant women are less and less able to access maternity carehttps://www.nbcnews.com/health/health-news/pregnant-women-cant-find-doctors-growing-maternity-care-deserts-rcna169609 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Texas Occupations Code, Chapter 203. Midwives https://statutes.capitol.texas.gov/Docs/OC/htm/OC.203.htmTypes of Health Care Quality Measureshttps://www.ahrq.gov/talkingquality/measures/types.html#:~:text=Outcomemeasuresmayseemto,informationabouthealthcarequality The US has the highest rate of maternal deaths among high-income nations. Norway has zerohttps://amp.cnn.com/cnn/2024/06/04/health/maternal-deaths-high-income-nations U.S. maternal deaths doubled during COVID-19 pandemic, among other findings in new studyhttps://www.brown.edu/news/2025-04-28/maternal-mortality#:~:text=Maternalmortalityratesdeclinedagainin2022,dieeachyearintheUnitedStates What is ‘physiological birth'? A scoping review of the perspectives of women and care providershttps://www.sciencedirect.com/science/article/pii/S0266613824000482 World Health Organization, Maternal mortalityhttps://www.who.int/news-room/fact-sheets/detail/maternal-mortality Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Send us a text"Congratulations, you're both alive." This shockingly low bar for maternal healthcare success reveals everything wrong with how America treats new mothers. In this eye-opening conversation, Dr. Venice Haynes, Senior Director of Research and Community Engagement at United States of Care, shares the urgent mission behind the groundbreaking 100 Weeks Project - an initiative transforming postpartum care by acknowledging that maternal health needs extend far beyond delivery.Dr. Haynes pulls back the curtain on America's maternal health crisis, sharing both data and personal stories that highlight the dangerous gap in care during the postpartum period. Most new mothers don't see a healthcare provider between delivery and their six-week checkup, despite the fact that over 60% of maternal deaths occur within the first seven days after birth. This negligence reflects a healthcare system that continues to treat new mothers as afterthoughts.The cultural expectation of "toxic independence" compounds this crisis. Mothers are expected to handle everything themselves, creating a dangerous reluctance to seek help even when warning signs appear. Meanwhile, essential postpartum services like lactation consulting, pelvic floor physical therapy, and mental health support remain categorized as luxuries rather than necessities, placing them out of reach for many families.Through the 100 Weeks Project, Dr. Haynes and her team are working to fundamentally reimagine maternal care by 2030. By advocating for expanded Medicaid coverage, better employer policies, improved data collection, and innovative care models, they aim to create a future where maternal health is truly valued - not just for the six weeks after delivery, but for the entire journey through parenthood.What would it look like if we treated mothers like they matter? Listen now to discover how we can transform maternal care from a bare-minimum survival scenario to a truly supportive experience for all.Learn more here: https://100weeks.unitedstatesofcare.org/p/1 Coaching offerKelly Hof: Labor Nurse + Birth CoachBasically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!Support the showConnect with Kelly Hof!Grab The Book of HormonesMedical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

April was Cesarean Awareness Month — but the truth is, we need to be having this conversation all year long. Why? Because 1 in 3 births in the U.S. end in cesarean… and many of them happen after a mom has already labored unmedicated all the way to 10 cm.In this episode, we're talking about a trend I'm seeing more and more:

In this empowering episode, we invite you to get up close and personal with the part of your body that's about to do something extraordinary—birth your baby. Many parents enter labor feeling disconnected from their vaginas and pelvises, but our guest Britt Fohrman offers a different path—one grounded in awareness, preparation, and trust. Drawing from over two decades as a doula, yoga teacher, birth educator, and pleasure coach, Britt shares practical tools to help you prepare your vagina for birth with more ease, confidence, and connection. By deepening your relationship with your body, you not only support a smoother birth experience, but also lay a strong foundation for your baby's arrival and your own empowered parenting journey.Full show notes: fourthtrimesterpodcast.comConnect with Britt Fohrman brittfohrman.com | Instagram | Facebook | LinkedInBritt's Classes (Code is FOURTHTRIMESTER for 10% OFF for on-demand course) Preparing Your Vagina for Birth In person - San Francisco | Preparing Your Vagina for Birth On Demand | Yoga for Your Yoni | 7 Days to Becoming More Confident in Opening for Birth with Britt-Free Video Series | Practices for Body Awareness | Prenatal Partners Yoga and Massage: Conscious Connection for Birth and BeyondLearn more Somatic Experiencing Can Build Attachment Between Parent And ChildResources HelloGaia Parenting Copilot | FREE DOWNLOAD Customizable Birth Plan | FREE DOWNLOAD Customizable Fourth Trimester PlanConnect with Fourth Trimester Facebook | InstagramWant trustworthy parenting data at your fingertips? Download HelloGaia Parenting Copilot for FREE today. The app uses reliable sources like ACOG, AAP, The Society for Maternal-Fetal Medicine. FREE app available now on Apple & Google...

On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 publications in this episode.

*Content warning: medical trauma and neglect, threat of life, mature and stressful themes, pregnancy and infant loss. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ ACOG, Fetal Heart Rate Monitoring During Laborhttps://www.acog.org/womens-health/faqs/fetal-heart-rate-monitoring-during-labor Amniotomyhttps://www.ncbi.nlm.nih.gov/books/NBK470167/#:~:text=Amniotomy%2C%20also%20known%20as%20artificial,commonly%20performed%20during%20labor%20management. March of Dimeshttps://www.marchofdimes.org/peristats/about-us National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ The Second Trimesterhttps://www.hopkinsmedicine.org/health/wellness-and-prevention/the-second-trimester#:~:text=The%20second%20trimester%20is%20the,grow%20in%20length%20and%20weight. Stages of labor and birthhttps://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ What to Know About Cervical Dilationhttps://www.healthline.com/health/pregnancy/cervix-dilation-chart Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooThe Webby Awards (2025)Exciting news! Something Was Wrong is nominated for Best Crime & Justice Podcast at the 2025 Webby Awards. We'd love and appreciate your support—cast your vote today!https://vote.webbyawards.com/PublicVoting#/2025/podcasts/shows/crime-justice*Please note: the first airing of this episode stated that Rachel was a CNM, she is a CPM and LM so we corrected this error within an hour of release. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Is it possible to build muscle or strength during pregnancy? Dr. Shannon breaks down the current literature and suggests a strength-training and cardio routine to aim for during pregnancy. 0:00: Introduction to weight lifting during pregnancy5:00 ACOG exercise recommendations during pregnancy8:30: Resistance training during pregnancy 13:20: Is it possible to build muscle during pregnancy? 16:00: How to build muscle & strength during pregnancy 28:00: How to maintain muscle29:50: Signs and symptoms that you need to stop exercise 31:30: Recommended workout plan during pregnancy To take our free 35-minute Upper Body Build class taught by Dr. Shannon, visit portal.evlofitness.com.

Meagan welcomes Dr. Nicole Calloway Rankins, a board-certified OB/GYN, to discuss everything related to pregnancy, childbirth, and the VBAC experience. With over 23 years of experience and more than 1,000 deliveries, Dr. Rankins shares her insights on common questions and concerns from expectant mothers. From the importance of mindset during labor to understanding the implications of the word “allow” in provider-patient relationships, this episode is packed with valuable information. Don't miss out on Dr. Rankins' tips for a calm and confident birth, and learn how to advocate for yourself in the birthing process!Dr. Nicole Rankins' WebsiteNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength, It's Meagan, and I am so excited to be joining you today with our friend, Nicole Calloway Rankins. Dr. Nicole Calloway Rankins is incredible. We've been following her for a long time and have collaborated with her in the past and are so excited to be having her on the podcast today. Dr. Rankins is a board-certified practicing OB/GYN, wife, mom and podcast host here to help you get calm, confident, and empower you to have a beautiful birth you deserve. She was born into a family of educators, and she felt a pull to medical school the day she looked in the mirror and saw a vision of herself in a white coat. And get this, it all happened while she was studying to be an engineer. She says, "I know that sounds crazy, but that vision has led me to exactly where I am supposed to be today- serving pregnant women." She's delivered more than 1,000 babies and has de-mystified childbirth for thousands more through her 5-star rated All About Pregnancy and Birth Podcast which she's going be talking about a little bit more today. I'm so excited for her. She has over 2 million downloads and her online birth plan and childbirth education classes. You guys, she is really changing so much about the birth world. She's incredible. You're going to hear it today. I love chatting with her. You can find her at drnicolrankins.com and of course, we'll have all of her other podcasts and Instagram and all that in the show notes. So get ready, we're excited. We're going to be talking a little bit more about common questions for an OB/GYN, but then we're also going to be diving into questions from you personally. I reached out on Instagram and said, "Hey, what are your questions for this doctor?" She is so excited to answer them, and she did. We went through every single question that was asked on our Instagram community. I'm so excited. I'm going to get to the intro, and then we are going to start with Dr. Rankins. You guys, Dr. Rankins is back with us today and I'm so excited. Funny enough, I keep saying that you're back, but you've never done the podcast with us.Dr. Nicole Rankins: I don't think so. Yeah, I think we did a class.m: We did a class which was phenomenal and everyone ranted and raved about it. So we're back together ,but we have you for the first time on the podcast. So welcome. Dr. Nicole Rankins: Well, thank you. I'm excited to be here.Meagan: We just adore you and I love getting your opinion on things. I think from doulas, from midwives to OBs, we all have different opinions and experiences, and if there's anyone that has hands-on experience, it is you and a midwife, like someone who is physically handling.Dr. Nicole Rankins: Yep. I've done this a couple thousand times. Yes.Meagan: Versus my 300 and something verse.Dr. Nicole Rankins: Don't discount it. That's very excellent.Meagan: It's still super great, but when it comes to thousands and an understanding on an even deeper level, it's just so fun and it's a compliment to the podcast to have your expertise.Dr. Nicole Rankins: Yeah, I've been at this 23 years, so it's a long time.Meagan: And still going. It's still going.Dr. Nicole Rankins: Still going. Yes.Meagan: And okay, tell me we can edit this if you want, but you have a new podcast coming out. I do know it's not going to be by the time this airs. It's not going to be out just yet. But can you tell us a little bit more about it and where people can find this?Dr. Nicole Rankins: Yeah. So it's still going to be in the same feed. So if you subscribe to the old podcast, it's just going to change, keep the same feed, but it's going to have a new name and a bit of a new focus still related to pregnancy and birth, but it's just a bit tighter. I want to say the name so bad, but I'm not going to.Meagan: Okay. Don't let it out. We will find out it is released.Dr. Nicole Rankins: Yes.Meagan: Tell them where to follow right now.Dr. Nicole Rankins: Right now? Yeah, if you follow me on Instagram, even though I'm taking a Little break now, you'll get it there. But the podcast is called All About Pregnancy and Birth. Go ahead and subscribe, and you can be the first one to know when the first episodes come out. I just have lots of new ways to present information about pregnancy and birth and frameworks and things. Okay, I'll give a little hint. One of the first things I'm talking about is one thing that's so important to pregnancy and your birth experience is your mindset. So one of the things I created is this MAMA mindset framework. MAMA stands for meditation, affirmations, move your body, attitude of gratitudes. I have practices, exercises, and things we're going to talk about. That's just one little, tiny sliver of the things that I've been working on and writing, so it's just good, great stuff.Meagan: Yay. Oh my gosh. I'm so excited. That is even more applied with just birth in general. But VBAC, I feel like mindset attitude, and all these things that you were just saying, is so important because even though we're just moms going and having babies, we have some extra things that some extra barriers that sometimes we have to either break through or we run into.Dr. Nicole Rankins: Absolutely. Yeah. I mean, a calm mind creates a confident birth. So when you have that calm mind, that is the first step to helping you create a confident birth experience. So mindset is really important.Meagan: Yeah, it really is. Well, I'm excited to chat with you today, and I'm excited to listen to that sometime here in the near future and listen to more of what you are bringing to the table. Okay, so one of the questions that I would like to go over is the word "allow".What does the word "allow" mean? How does someone navigate something that maybe doesn't feel right for them? And on both sides-- Dr. Fox and I have talked about how sometimes it's not right for the provider. You're not the right patient for that provider because what you want is not comfortable with the provider and vice versa.But we often hear or actually more see it on The VBAC Link Community on Facebook. There are comments of, "My doctor said they will allow" or "My midwife said they'll allow me to." If so when you are saying that or maybe have you said that, what does that mean?Dr. Nicole Rankins: Yeah, I don't say that word.Meagan: Okay.Dr. Nicole Rankins: It's a word that should not be in the discussion about birth because allow implies a hierarchal relationship where I get to make the decisions about what does or does not happen in someone's pregnancy, birth, labor, body, and that is not true. You as the person giving birth are the one who ultimately makes the decisions, not your doctor or your midwife. We can't really allow anything. We're not your parents. Do you know what I mean? So "allow" shouldn't be part of the conversation. It's a left overturn from just a general patriarchal foundation of OB/GYN, particularly when men took over into the specialty and banished midwives is how that language came about is that we need to tell folks and we need to control. So it really shouldn't be the case, but it still hangs around. Words matter, and it's important. Even though people don't necessarily mean it with any sort of ill-intent or that they mean that they're trying to control you, and inherently sort of subconsciously implies that. So I strongly dislike the word "allow".Meagan: Yeah, I am with you too. As someone who has had that word happen to me, it made me feel like I had to do something to meet their standard quota to get that allowance.Dr. Nicole Rankins: Right.Meagan: That just didn't feel great.Dr. Nicole Rankins: Yeah. Yeah.Meagan: So if someone is saying that, are there any tips of advice that you would give?Dr. Nicole Rankins: Yeah, I mean, first off, if you hear it, that's a little notch of a red flag potentially that it's not going to be a shared decision-making process because really, it should be that my role is to give you information and share my expertise with you to help you come up with the best decision for yourself. That looks like various things for different people. Some people want tons of information. They want to think about it and then talk about it. Some people are like, "Just tell me what to do," which if that's what you want me to do, then I can do that too. So if you hear "allowed", then it's concerning that there may not be that shared decision-making. So that's a little bit of a red flag to know.But then to open it up for discussion, it kind of depends on what the situation is. So is it we don't allow you to eat or drink during labor or we don't allow TOLAC? Then the next question is really, why? Especially if it's something that's important for you, why? If you want to use the language back, you can even use it back. "But why is that not allowed? Why is that the case?" And then kind of take the discussion from there.Meagan: Yeah. I think asking the question just in general, "Why?" or "Okay, I hear you. Can you explain to me?"Dr. Nicole Rankins: Yes.Meagan: It really helps there be a discussion like you were saying. I feel like when it comes to birth, like you're saying, I'm not your parent, but it needs to be collaborative effort here. We're trusting you to help us with this really amazing event in our life, but at the same time, we have to have equal trust from you. It's this collaboration of like, let's talk about what we want this to look like.Dr. Nicole Rankins: Yeah. Definitely, tust and collaboration are key in order to have a great birth experience. And ideally, you want to try to work on that foundation during your prenatal appointments so that by the time you get to the hospital, you know that you're going to have that relationship actually, regardless of what doctors there or nurses say. You create this environment of trust and collaboration. So when you ask the question why, don't necessarily start off-- and this is part of the psychology of human behavior. You don't necessarily have to start off with, "Well, why?" attitude because advocacy is not about creating conflict or creating chaos. Advocacy is really about creating that collaboration and creating that trust. It's the end result. So start from a place of trying to connect. Ask, learn information, and then kind of go from there.Meagan: Yeah. Love that. Well, thank you. Okay. Fetal monitoring. I know this is actually going to be a question down the line, or maybe it's a little different, but fetal monitoring with VBAC in hospitals is typically required. Can we talk about the evidence on that of why? Why? Again, here's the question, why? Why is that done? Dive in deeper. We talk about that in our course. But I think it's so great to talk directly to an OB/GYN like you to understand your point of view.Dr. Nicole Rankins: Yeah. The reason that's the case is that one of the first signs of uterine rupture is going to be a change in the fetal heart rate. So that's why we always want to see the fetal heart rate because it's going to be the first indication that there's potentially an issue. So it's really that simple. It may even be potentially before you start having pain. Some people may or may not have bleeding, but fetal heart rate changes and pain are going to be the things that will clue us in and we don't want to miss that if it happens.Meagan: Yeah, so when a fetal heart changes, we know, through labor-- this is a spin-off of the question. We know babies' heart rates fluctuate up and down. Sometimes they might have a compression in the cord that causes the heart rate to go really down during the uterine contraction and that goes up, but it goes really down. It's like, oh, that's low, and then it goes right back up to its baseline. So what is a concerning fetal trace in this scenario?Dr. Nicole Rankins: Right, yeah. So this is the part where I have to say, this is the reason we do four years of OB/GYN residency, why we have to get take fetal heart rate monitoring training every couple of years to stay up on it. This isn't something that can be had in a subtle conversation because it's not just what you see in the moment, it's what you see in the moment. The things we look for in general are a baseline of the heart rate between 110 and 150, 160, roughly. We look for things called accelerations, decelerations, and the variability, which is like the squiggliness of it, that's the big picture. But when we look at it, it's like, okay. We assess it, and then we try to do some things to improve the heart rate. We look at how the heart rate looks over time. Has it gotten worse over time? If we do some things to get it better, then that's considered good. So we can't really say if you see this specific snapshot of a fetal heart rate, then that's going to be the thing that triggers things. It really just depends.Meagan: Makes total sense.Dr. Nicole Rankins: And it can also be contractions because sometimes if you're having too many contractions back to back and there's no time to get a break, so the baby's like, "Can I just have a minute to breathe in between these contractions, please?" So maybe we need to slow down the contractions. So really, it's a lot of things that go into it, and that's where our expertise comes in.Meagan: Yeah, it's a big math equation in a lot of ways when it comes to tracings and things like that. Okay.Dr. Nicole Rankins: I do want to say that a lot of times people think monitoring equals no movement. But more and more, hospitals these days have wireless monitoring so you're able to move. That's definitely a question you want to ask ahead of time if wireless monitoring options are available so that you're able to move around.Meagan: Yeah, yeah. Because they've got, at least I don't know if it's what it's called there, but we call it the Monica.It's just that little sandpaper on your belly and that's kind of nice. Sandpaper sounds harsh. It's a light little scrub so it gets the oils off your skin. So that's a really nice thing.Awesome. Okay. And then scar thickness. This is a really big one, and we've talked a little bit about it with Dr. Fox in the past. But scar thickness and double versus single stitch closure is a very, very common question that we are getting wondering about the evidence that shows that someone maybe shouldn't TOLAC or the evidence on thinner scars because it seems like it's becoming a new standard. It's coming in with the VBAC calculator. That is what we're seeing. It's like we're doing the VBAC calculator and we're measuring the scar and those kind of two things are becoming routine. And then of course, once we review OP reports. Double versus single.Dr. Nicole Rankins: Yeah. So the double versus single doesn't make a difference. So whether you had a double layer closure or a single layer closure, you're still a candidate for a VBAC. So that one is pretty easy. I don't even look at OP notes for double versus single layer. It really just needs to be a low transverse incision on the low part of the uterus. So that's that. As far as the scar thickness, the rationale behind that is that when the uterus ruptures, it literally just thins out. Thins out and thins out until it ruptures open generally. So when we're measuring this scar thickness, the physiology of it makes sense that if it's really thin and then you start to put the pressure of contractions on it, there may be a higher chance of it rupturing. Now, is there hard data that if it's this amount that is definitely going to rupture or you should or shouldn't TOLAC? Not necessarily. In our area, it's not routinely measured or talked about. It's not anything that we discuss, so it's not a routine part of practice, but that's the thought behind it. And typically it may come up if it's noticed, or if it's very noticeable. If the ultrasound, the maternal fetal medicine specialist or whoever does the ultrasound says, "This uterine scar, where it is, is really, really thin," and then it may come up. But in general, I don't see that come up very often.Meagan: Yeah, well, that's good. That's good to know. Yeah, it just seems. Yeah. Like, oh my goodness. Are you hearing that ding?Dr. Nicole Rankins: No.Meagan: Okay, good. I hope you're not hearing it. On my end, my computer keeps dinging, but it's on mute, so I'm not really sure what's going on. I'm having all the technical issues today.Anyway, that's really, really good to know though, because it is something that so many people are hyper-focusing on. Sometimes I think there are other things to hyper-focus on like our nutrition and finding that supportive provider and getting the education and really understanding the choice that we're making when we VBAC.Dr. Nicole Rankins: Yeah, definitely. I'm not focusing on it, so I don't think you should focus on it.Meagan:Yes, yes. But it is. I think it is probably hard for these people when they go to these visits. They're so excited. They want to have a TOLAC or a VBAC, and then they're like, "Oh well, we have to do these things first to see if you qualify."Dr. Nicole Rankins: And scar thickness is just not part of ACOG's recommendation. It's not part of what determines whether or not you can have VBAC.Meagan: I know. It shouldn't be anyway. Yes, yes, yes. But for some reason, we're still seeing it. So I think it's good to know that you guys, if you're having that, maybe just think twice about it.Dr. Nicole Rankins: Or get a second opinion.Meagan: Yeah, I was going to say, get a second opinion.Dr. Nicole Rankins: Yes.Meagan: Okay. So our community asked questions. I went on and said that we were going to have you on. And they were so excited and kind of just asked all of the questions. So one of the questions was, if you don't get an epidural for a VBAC and you need a C-section, will you have to be put fully out, so under general anesthesia?Dr. Nicole Rankins: Yeah, no. Not necessarily, and most likely not. Generally, as long as it's not an emergency, there's time to do a spinal. The difference between an epidural and spinal, the epidural is a catheter that stays in place and medicine continually gets fed through the catheter where a spinal is a one-shot dose of medicine that lasts for two to three hours. So as long as there's time and you can sit up for the spinal or they can lay you on your side for the spinal, then they can do the spinal for the C-section, and you don't have to do general. General anesthesia is only reserved for if it's truly an emergency and there's not enough time to do the spinal.Meagan: Right. And for this is another, I'm adding this. But epidural versus spinal longevity of effectiveness meaning like you're numb enough for them to perform the surgery.Dr. Nicole Rankins: Yeah. The spinal's going wear off.Meagan: Yeah. Quickly, but it's going to go on quicker. Right or no? Or deeper?Dr. Nicole Rankins: Yeah, it's a denser numbing than what you get with an epidural. When you get an epidural before, if you have an epidural and then you go to a C-section, then you just get a bigger dose of medicine that kind of mimics what you get through the spinal. So the thing about the spinal is that it's meant to cover a surgery, so it's going to be a larger dose of medicine, so you're going to be more numb because we don't actually want you to be completely numb during labor. The spinal is really just to make sure you're nice and is numb and don't feel the surgery.Meagan: And how long does it take to kick in to be numb enough? Like 20 minutes? 30?Dr. Nicole Rankins: Yeah, yeah. I would say it's actually pretty quickly. So yes, you're right. It can kick in a little bit faster than epidural because it's a lot more medicine. So typically, I would say within 5-10 minutes, you're going to start feeling numbness pretty quickly. But by the time we've laid you down, washed your belly, put in the catheter, done those things, then you're numb.Meagan: Yeah. So in that non-emergency situation, you're going to have plenty of time to be numb and not have to be put under general anesthesia. In an emergent situation, we have minutes. We have minutes to work with. How many minutes if we're having fetal distress? And obviously, it could vary for a lot of patients, I'm sure, but major fetal distress emergent like true emergent under general anesthesia. What are we looking at a timeframe before we get baby out before we're really concerned?Dr. Nicole Rankins: Yeah. I mean so if it's true, like an emergency, because a lot of people say they had an emergency C-section. It's actually not emergency. Meagan: Right. Baby was born two hours later. D; Yeah, or even 30 minutes later. So emergency is going to be like we're ripping the cords out of the wall. We're running down the hall to the operating room. When we get in the operating room, the heart rate is still in the 60s. So we want baby out in five minutes.Meagan: Okay.Dr. Nicole Rankins: We want baby out as quickly as possible, and the quickest way to get a baby out is general anesthesia and then go, if you don't already have a spinal.Meagan: Right. Perfect. That's also another common question of like, well, how long do I have if I don't have that? Because that's a big deciding factor for people with not wanting to go unmedicated or wanting to go to medicated but not wanting to be in an emergent situation. Those emergent situations, they happen. We can't sugarcoat it. They happen, but they are more rare. I love that you pointed that out. A lot of people say this was an emergent situation and we hear, well, then they went out and they came back, and 25-30+ minutes later, they had a baby.Dr. Nicole Rankins: That's not an emergency. As a matter of fact, emergency C-sections are fairly rare. Knock on wood, I can't remember the last time I've had to run somebody down the hall for a C-section.Meagan: And I call those crash like crash sections. Everybody crashes and goes. Yeah.Dr. Nicole Rankins: Mhmm. Mhmm. Things are moving so quickly.Meagan: Okay. So someone says, do I need an OB for a VBAC? I have lost all trusts in nurses and doctors after being forced into a C-section which breaks my heart that this question is a thing. I see it all the time. People have been "wronged" or bullied, and it shouldn't be that way. Dr. Nicole Rankins: It should not.Meagan: Sometimes it happens for whatever reason. But yeah, like do you have to have an OB? Obviously, we know the answer is no.Dr. Nicole Rankins: No, you can have a midwife. For sure.Meagan: But maybe I want to spin it to more of a positive. If we have an OB, how can we better establish a relationship with them so we're not in a situation in the end feeling pressured or bullied?Dr. Nicole Rankins: Yeah. And actually I want you to even back it up even further, and this is for anybody having a baby. What you want, you don't specifically want a midwife. You don't specifically want an OB. What you want is someone who's going to listen to you, respect your wishes and really center you in your birth experience. So yes, midwives are great at that, but sometimes midwives can be tricky too. The way that the reason I said that is because I know people who were like, "I had a midwife and I thought it was going to be great," and it wasn't. And they were hanging too much weight on that midwife hat.Meagan: The midwife word, yeah.Dr. Nicole Rankins: Yes, yes. So you really need to start with is this person listening to me and respecting me? So whether that's midwife or OB, okay?Meagan: Yeah.Dr. Nicole Rankins: So take that away first. And then if you have an OB, again because the midwife is also going to work with an OB, I'm assuming you're doing in the hospital, you want someone who is not just like, "Oh, if you go into labor, you can have a VBAC. I mean, I guess that's okay." Or you want somebody who's really actually supportive of it. I think you've used this language before, not just tolerant of VBAC that they actually you and don't just tolerate the possibility.Meagan: Yeah, I have kind of been thinking about that. Like we as doulas. It's like, oh, I want someone to advocate for me. That big word "advocate", and what does that look like? But in a lot of ways, I think that's what I want a supportive provider to do is advocate for me. Like I understand, validate me. I understand this is what you want, and we're going to do everything we can in our power to do this. If there's something along the way that is saying maybe we shouldn't, I will have that discussion with you. I will not just tell you what you have to do. Dr. Nicole Rankins: Exactly. Meagan: Again, it goes back to that conversation we were having in the beginning of that collaborative relationship. If that is there, I think you set yourself up for better expectations no matter who it is with an OB or a midwife.Dr. Nicole Rankins: Definitely. Definitely. Yeah.Meagan: Nurses can be tricky. We love our nurses. They're incredible, but sometimes they have opinions, and sometimes they come in and they put it on us.Dr. Nicole Rankins: Here's the thing that people don't realize. You can ask for a new nurse.Meagan: You can.Dr. Nicole Rankins: Yes you can. You can absolutely. There's always a charge nurse who's in charge of making patient assignments. You can ask to speak to the charge nurse, and you can get a new nurse. Don't feel bad or guilty or like you're hurting anybody's feelings. People will be fine. I promise you. They'll go home, and they'll keep going on about their lives if you ask for a new nurse. So I know it can be challenging, especially sometimes for women to speak up about things, and you're worried about hurting people's feelings and things like that, but you can always ask for a new nurse.Meagan: Absolutely. This is not related to birth, but I signed up with a personal trainer at my gym, and I was assigned to this amazing person, and she was great, but I realized a couple weeks into it that maybe we weren't the best fit for one another. I hesitated for two more weeks to say, "Hey, can I switch?" And now that I've switched, oh my gosh, it's the best decision I made, and I get to see her at the gym all the time. I went up to her and was like, "I love you. Thank you so much. This has been great, but this is what I'm doing." It was a wonderful breakup. You don't even have to break up with someone like that, though. You really don't. It doesn't have to be. I was so nervous, but this is your space. This is your birth. This is your experience. You have to protect it and keep it what you need. If someone's not jiving that or that nurse specifically, you can say, "Hey, thank you so much for your services, but I would like to switch." It's okay.Dr. Nicole Rankins: Definitely, Absolutely.Meagan: And you don't want to go back at the end of the day and be like, oh, I had this nurse, and it was the worst seven hours. That's not positive. We want to look at our birth with a positive view, not a negative view.Dr. Nicole Rankins: Yeah. And your nurse is going to be there way more than your doctor. Way more. You definitely want to be in sync with your nurse.Meagan: Yeah. And something else, too. I tell our clients all the time, our doula clients, like, "Hey, upon arrival, if we're not there, say, 'Hey, I would really love a nurse that fits in line with blah, blah, blah.'"Dr. Nicole Rankins: Exactly.Meagan: And a lot of times, they assign it right then, and you're like, "Oh my gosh, you guys are amazing. Thank you."Dr. Nicole Rankins: Yeah, exactly.Meagan: Okay, so next question. What should I consider if my goal would be to have a home birth? So from a hospital OB/GYN, where do you fit in that? What would you suggest? I know a lot of JOBs are like, "Don't go to home."D So yeah, so I personally I would TOLAC at home makes me nervous, but that's because I've seen uterine ruptures before and how quickly things can change. So but however, like in Canada, I think their specialty society guidelines support doing a TOLAC at home after one C-section. So it's not that it's unheard of, but I will say it makes me nervous. Now, if you do want to do it at home, then absolutely have someone who is experienced. This is not the time to have like a brand new midwife. I think you want to have somebody who has some experience in particular with looking for any signs and symptoms of when to go to the hospital. We also need a clear plan for hospital transfer and ideally, that midwife should have a relationship with the hospital so that she feels comfortable going to the hospital in a timely fashion. One of the things that I've seen unfortunately happened during my career with home births that have not turned out optimally is that people are afraid to go to the hospital, so they stay at home too often, and then by the time they get to the hospital it's a train wreck. That's not good for anybody involved. So you want it to be a situation where the midwife feels comfortable going to the hospital in a timely fashion. For example, I work with home birth me bias in my community. I have gone out to the birth centers and things and say, "Hey, if you want to transfer somebody, just let us know. Call."Meagan: I love that you've done that.Dr. Nicole Rankins: Yeah, it's, it's important. So call. Send the records. We have a really smooth process. Nobody bats an eye now when there's a transfer from home birth. Meagan: Oh good.D; So you really want to have those two things in place. A skilled midwife and a good backup plan, preferably with the relationship to the hospital.Meagan: I love that. Such great advice. That's awesome that you're doing that for your community. I just had an interview the other day with a VBAC mom who's toying with the idea, not sure where to go. She asked me and I was like, "Well, you could do dual care. You could establish a relationship with a provider. You can ask your provider out-of-hospital of choice if they do have that relationship," because I do think it is important because sometimes even the midwife is like, "I don't know where to go," so I love that you've done that and gone into the birth centers there. Okay. So we just talked about fetal monitoring, but one of the question was, is intermittent monitoring safe with VBAC just in general?Dr. Nicole Rankins: Yeah. It hasn't really been studied very much, and it's not going to be. That's the thing. It's just not something that anybody's going to sign up for and say, "Hey, you get monitoring. You don't get monitoring," and see what happens in assess that situation for VBAC. So I can't answer that question based on data. I will just say that in general, we want to do continuous monitoring.Meagan: Right. That makes sense. Okay, so small lumps under my C-section scar. What could that be? Would/could it impact the outcome of my VBAC?Dr. Nicole Rankins: It's probably scar tissue.Meagan: That's what I thought when I saw that question come in. I think that dials into like going and chatting with someone like askjanette or a pelvic floor PT or someone who can help massage that scar tissue because anytime we have a cut whether it be from a C-section or you fell and scraped your knee and cut your knee open on a rock or a twig, our body will develop scar tissue, and sometimes it clumps. Sometimes it gets that.Dr. Nicole Rankins: It's probably just scar tissue. And no, it should not impact your ability to have a VBAC.Meagan: Have you ever seen this within your TOLAC world, your VBAC world where sometimes we've got thicker scar tissue and sometimes there's separation within the scar tissue internally as babies coming down and making their way through or uterus is contracting? And so sometimes it can be like, oh my gosh, I've got this burning sensation in my scar which we hear, and it's like, that's concerning because we know that sometimes uterine rupture can be that feeling of burning sensation or pain, and usually that pain doesn't go away and just keeps improving. But have you ever seen that with someone and where they're like, "Oh, I've got this burning sensation," and could it be scar tissue stretching maybe?Dr. Nicole Rankins: Not that I can think of off the top of my head. Definitely, sometimes you have to be careful when you hear people say they're Having pain in their abdomen. Could it be scar tissue stretching? Possibly. That's definitely a possibility.Meagan: It's something that's crossed my mind, over all the years, especially as baby's coming down and putting that extra pressure there.Dr. Nicole Rankins: Right.Meagan: Okay. So again, yeah, this is something that we asked talked about earlier. So to what extent are decels considered normal in early and late labor? Dr. Nicole Rankins: We don't categorize decels based on the stage of labor necessarily. It's based on how they look, and again, over the course of how the tracing looks. Now sometimes right at the end, we're going to tolerate during pushing some decels, because you're pushing and squeezing, so there's going to be decels. So we may tolerate them more towards the end, but other than that, it really just depends.Meagan: Okay, that makes sense. I feel like sometimes as a doula, we're getting into that transition, almost pushing stage and they come in and they're like, "Hey, so we're wondering if maybe you're ready to push here soon or something's going on based off of some decels." Not that they were concerning, but they're seeing them. But really decels in general, overall, you're going to look at a whole versus one contraction or two contractions.Dr. Nicole Rankins: Yep.Meagan: Okay. PROM. So premature rupture of membranes and pre-e with VBAC it says is it still safe? I will answer from my own experience.Dr. Nicole Rankins: Yes, absolutely.Meagan: Yeah, but yeah, time too, with PROM So if we're not having labor begin or we're maybe contracting, like what's handled in that situation, especially knowing that in some hospitals around the world and in the US don't allow Pitocin?Dr. Nicole Rankins: Right, yeah.Meagan: Even though that's also not necessarily a contraindication.Dr. Nicole Rankins: Correct. So with PROM, so water breaking before labor starts, it's not as common, but it does happen. You can do expectant management and roughly within 24 hours, most people will start to go into labor on their own. So you can do expectant management, but Pitocin is actually quite safe in those circumstances. The risk of uterine rupture is low. So Pitocin can definitely be used. You just want to use it carefully.Meagan: Yeah. You mentioned that most people within 24 hours will start contracting and having labor, whether it be active at that point or not. But at what point could it be concerning? And maybe if we have GBS or something like that as a factor, would we be like, "Hey, we could keep waiting for the 24-hour mark," and that's not to go in and have a C-section, that's just maybe to augment. When would you encourage augmentation sooner?Dr. Nicole Rankins: So I'm a little bit of an outlier. I just offer the options, and we can talk about that it may take longer if you wait to augment and that's it. It may take longer, and that's it. That can potentially increase the risk of infection. But we don't really do time limits. I don't do 18 hours or 24 hours. I kind of pick. These are moments for us to have discussions about where things are. So definitely usually 6, 12, 18, 24 and just to touch base and see where things are and develop an ongoing plan. Not necessarily have a hard and fast rule that you have to be delivered or by a certain point makes sense.Meagan: And then preeclampsia. So we have seen this quite a bit in our community, on Facebook and on Instagram where they said, "Hey." There was a post just the other day that said, "Hey ladies, I just wanted to thank you so much for being here in this group. You guys have been amazing. Unfortunately, I have to sign off of this group because my provider said I have to have a C-section now because I've developed preeclampsia," so they didn't even offer the option to TOLAC or monitor. And everyone's like, "Wait, what?" This is a thing? So obviously, we know that we can, and everyone's numbers vary. If we've got severe preeclampsia and maybe that's not gonna be best for the stress of mom and baby and everybody, but do you have anything to say on that? I don't really know if I'm asking a question.Dr. Nicole Rankins: But yeah, no. You can definitely try for a TOLAC in the setting of preeclampsia. Now, if even in severe preeclampsia, it just may take longer. But if we're seeing that you're getting sicker and labor isn't progressing or the baby is under distress, then the safer thing may be a C-section. So if you have severe preeclampsia, for example, and it's affecting your liver and your levels of your liver enzymes are going up, up, up, up, up, and we're not close to delivery, then it's going to be safer for your health to expedite birth, and that's going to be a C-section. So it really depends.But the option of completely taking it off the table, that is not standard or that's not evidence-based.Meagan: Yeah, yeah. And for HELPP syndrome, where it's gone to that extreme. Now we've got platelet issues and things like that. Can someone with HELPP syndrome TOLAC or is that truly a better option to have a C-section?Dr. Nicole Rankins: I would actually prefer if someone ideally is in labor with HELPP syndrome. Actually, a vaginal birth is going to be safer because when your platelets are low and then we're adding surgery, the risk bleeding goes up.Meagan: That is what is so weird to me. My fifth birth was a HELPP syndrome. She was a VBAC, and they're like, "You have to have a scheduled C-section." But then we did all these transfusions and all these things and in my head, I was like, but isn't platelet meaning we have a higher risk of bleeding? But so yeah, that's another question.Okay, I think there's only one or two maybe. Oh, this is a really great question. Is it safe to TOLAC? So again, listeners, TOLAC, if that's new for you, is a trial of labor after Cesarean. I know I've thrown it out a couple times this podcast. After having a hemorrhage in a C-section. So had a C-section hemorrhaged. Now they're wanting to TOLAC. Is that considered safe?Dr. Nicole Rankins: Sure.Meagan: Okay.Dr. Nicole Rankins: Okay. I want to discourage people from using the word "safe" because I think what you really want to know is what are the risks of something happening again? So yeah, because what do you mean by safe?Meagan: Right.Dr. Nicole Rankins: What you really want to know is what are the risks of this thing happening again? So there are no identified increased risks in having a TOLAC after you had a postpartum hemorrhage during a previous C-section.Meagan: Okay, I love that. So that's good because I mean anytime anyone hemorrhages with birth, I feel like it's a little bit on everyone's radar.Dr. Nicole Rankins: Right. Okay, and then I have one more question for you before I let you go, and I don't know if it's Bandl's ring or Bandl's. How do you say that?Meagan: Yeah, Bandl's ring. What is a Bandl's ring for those who it's very new to, and then can you TOLAC or have a VBAC with Bandls ring?Dr. Nicole Rankins: It's a really tight ring of muscle in the uterus where it's just really tight, and it doesn't contract. I can only recall seeing it, like, once in 22 years, so it's not common.Meagan: It's more rare.Dr. Nicole Rankins: Yes, very rare. So it's just really hard to have a vaginal birth if there's a really tight ring of tissue that is preventing the uterus from opening. If the uterus can't open, then the baby can't come out. So that's the issue. It's not like we can release it or clear it up or anything. I don't know why. We don't know why it develops, but it's just, like anything, if it's tightly closed, it's really difficult to open.Meagan: Yeah. Okay. That makes so much sense. And is there a way to find out if we have that beforehand?Dr. Nicole Rankins: Not really.Meagan: Not really. Okay. And the signs of that Bandl's ring is just lack of progression it seems like.Dr. Nicole Rankins: Overall, it seems like lack of progression. And also, the baby usually doesn't come down in the pelvis.Meagan: Yes. Yeah. Okay. Thank you. That was a one-off random one that crossed my mind. I keep seeing that one too. Anything else that you'd like to touch on? I love all of your points of stop considering the word safe and talk about, what are the risks here? What do we need to know to make the best educated decision? Having a collaborative discussion and relationship with our provider. So many great points along the way. Anything else that you'd like to add or say to the community to someone who really is wanting to know all the information they can to VBAC and are unsure of which way to go?Dr. Nicole Rankins: I think that the best thing is just to really find a supportive provider, doctor, midwife, and do that in the prenatal appointments. Ask those questions early, and don't be afraid to change to someone else if you feel. And sometimes you may not have options, but if you have options, then find someone who is the most appropriate for you because that is going to be the thing that most sets you up for success. Oh, also, get a doula.Meagan: Hey. I love it. I will never not advocate for doula, but really, I mean, I love that you're pointing it out again. Before birth, early on, ask those questions. Always have a conversation with your provider. If something is switching, it's okay to switch. I know it's daunting. It is daunting. It really is. I didn't want to cheat. I felt I was cheating on this doctor. We had this relationship. I don't even know what I thought. I thought I was cheating on him by leaving him. And I didn't leave him, and I didn't find myself having the experience that I wanted or feel like I deserved. And, looking back, I probably should have switched. Well, I didn't. I have learned, but I don't want anyone else to be in that situation of, dang it, I saw all the red flags, and I didn't switch because I felt bad.Dr. Nicole Rankins: Yeah. Yeah. I don't mean to sound flippant, but I can guarantee you. Your doctor, if you leave, they're just gonna keep seeing patients. They're just going to go home and keep living their lives. It's going to be fine.Meagan: I know. I had a friend, and she was like, "Looking back, do you realize how it wouldn't have impacted his life at all?" And I was like, "Yes. But in my mind, I had a deeper connection."Dr. Nicole Rankins: I know. In the moment, you can't because you have that emotional connection, and you care about those things? So that's totally natural.Meagan: Yeah. And in a lot of ways, he was saying, "Yeah, sure. I'll support you." But then in a lot of other ways, he wasn't saying this with his words, but he was saying, "No, that's not my thing."Dr. Nicole Rankins: Right.Meagan: So, yeah, you deserve the best and keep doing your research. Find the provider. Get a doula, hands-down. Just a reminder, everybody, we have VBAC-certified doulas on our website all over the world. And yeah, thank you so much. You're the best. And everyone, go follow her podcast and wait it out for these new updates. Yes.Dr. Nicole Rankins: Yes, these new updates are so exciting. I'm so excited.Meagan: I'm so excited for you. That's so awesome. You are just incredible. We really enjoy you. So, thank you.Dr. Nicole Rankins: Thank you so much for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. 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