Podcasts about acog

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.

In this solo episode of Right to Life Radio, host John Gerardi dives into the pronatalism movement, addressing America's falling birth rates and their economic risks. He dismisses right-wing fixes like IVF and artificial wombs, pushing for more marriages to solve the issue—a solution at odds with the left's autonomy fixation and the right's individualism. Girardi also tears into a misleading Pulitzer-winning ProPublica story about Georgia's abortion laws and calls out ACOG for unclear miscarriage care guidance. He wraps up with concerns about Democrats targeting the Senate filibuster to pass abortion laws and wonders why Republicans don't act first.

“Se la prendo sto interrompendo una gravidanza?”È la domanda che in farmacia, al pronto soccorso o sui social accompagna quasi ogni richiesta di pillola del giorno dopo. Ma è davvero così?In questo episodio facciamo chiarezza, passando in rassegna:Come funzionano levonorgestrel e ulipristal — dalla finestra fertile al blocco dell'ovulazione.Quando inizia clinicamente la gravidanza: fecondazione, viaggio tubarico, impianto e comparsa dell'hCG.Le prove scientifiche: studi clinici, revisioni sistematiche e cosa dichiarano AIFA, FIGO, ACOG e le linee guida europee.Senza certezze assolute, ma con prove solide e buon senso, proveremo a fare chiarezza su un tema spesso più filosofico che scientifico.

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...

Send us a textFrom personal birth trauma to revolutionary solutions for laboring mothers—this conversation with Marya Eddaifi reveals how innovative manual techniques are changing birth outcomes worldwide. Marya's journey begins with her own disappointing cesarean birth in 1995, a catalyst that eventually led her to become a labor and delivery nurse determined to find better ways to support women through childbirth. After nearly 24 years in the US Air Force and experience across four countries, Marya's quest to understand why some labors stall led her to a profound discovery: the critical role of fascia—our body's connective tissue system—in birth progress.The conversation takes us through her revelations about positioning, manual techniques, and the strategic approach to helping babies navigate the maternal pelvis. With fascinating insights into techniques like side-lying release and Walchers position explained from both anatomical and practical perspectives, Marya breaks down complex biomechanics into actionable approaches that can help prevent cesarean deliveries.What makes this episode especially valuable is Marya's explanation of her groundbreaking Dysfunctional Labor Maneuvers (DLM) app—an affordable, accessible tool that brings her expertise to birth professionals and laboring parents worldwide. Through an innovative algorithm, the app provides customized guidance based on labor status, dilation, and specific challenges, with easy-to-follow video demonstrations for immediate application.Whether you're a birth professional seeking new tools for your practice or an expectant parent wanting to understand more options for labor support, this conversation offers a revolutionary perspective on addressing labor challenges through understanding the body's intricate design rather than defaulting to medical interventions. Mariah's passion for improving birth experiences while respecting individual needs shines through every minute of this enlightening discussion.Connect wi 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 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.

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.

Dual-PhD researcher Celeste Beck is a leading maternal health researcher at Heluna Health who just published a groundbreaking study on vitamin D and pregnancy.It turns out something as simple as your vitamin D levels could have a major impact on your pregnancy, postpartum recovery, and your baby's health. With over 15 years in public health and a dual PhD in Nutritional Science and Clinical and Translational Science, Celeste breaks down what every parent needs to know—how to recognize the risks of deficiency, when and how to supplement, and why this one nutrient can make a lifelong difference for your baby.If you're pregnant, postpartum, or supporting someone who is, this episode gives you the critical info your doctor might not be talking about - yet. Advocating for yourself with the right information empowers you and gives your baby the healthiest start possible.Full show notes fourthtrimesterpodcast.comConnect with Celeste Beck PhD LinkedInCeleste's research in the American Journal of Clinical Nutrition Maternal vitamin D status, fetal growth patterns, and adverse pregnancy outcomes in a multisite prospective pregnancy cohortLearn more Evidence Based Care for Improving Postpartum Recovery - Advice From Dr Rebecca Dekker | Morning Sickness Causes and Cures: Hyperemesis Genetic Link and Practical Advice from USC Geneticist Dr Marlena FejzoResources 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: 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.

Send us a textWhen Laci Tang experienced painful breastfeeding with her first child, she had no idea it would launch her into a career transforming how mothers receive lactation support. Her journey from anxious first-time mom to innovative IBCLC offers a much-needed blueprint for better postpartum care.Birthing at a midwifery center opened Laci's eyes to a different kind of care—one where she was listened to, believed, and supported in finding real solutions. After navigating tongue ties, low supply, mastitis, and then oversupply with her second baby, she realized how vital individualized support is for breastfeeding success.What makes her practice, Milk in Motion, stand out isn't just her expertise—it's her commitment to personalized care. “There has never been a single dyad, a mom and baby team, that has been exactly like the one before,” she says. Her innovative “pump bar” lets moms test different breast pumps before investing, solving a common frustration many face.Laci also speaks openly about her own postpartum anxiety—from intrusive thoughts to fears about her baby's safety—reminding moms they're not alone. Her story shows that mental health and feeding support go hand in hand.Whether you're expecting or currently struggling, Laci's story is proof that the right support can shift your journey from overwhelm to empowerment.Connect with Laci: https://www.milkinmotion.co/ Instagram: https://www.instagram.com/milkinmotion.co/ 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!Kelly Hof: Labor Nurse + Birth CoachBasically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.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.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Are you menopausal and have any of the following symptoms? Hot Flashes Night Sweats Dry Vagina Painful intercourse Dry skin Lack of sex drive Lack of motivation Fatigue Depression and or anxiety Change in body composition, with fat collection in the abdomen Loss of Muscle Mass and strength Irritability Inability to remember names and places Decreased ability to problem solve Insomnia Arthritis Body pain These are all symptoms we currently are aware of associated with menopause and low testosterone.  These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets. Menopause should be treated like an illness that is universal but more severe in some women compared with others.  If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment! However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don't seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal. Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn't consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it!  If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause). It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause.  These avoidable diseases of aging include: Osteoporosis leading to broken bones and spinal stenosis. Heart disease and stroke Diabetes Alzheimer's Dx and dementia Obesity Low muscle mass and inability to walk or move independently. Autoimmune diseases Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running Severe arthritis Gout Worsening depression and anxiety Frailty which is what causes most older people to be placed in a nursing home. Just think it is not fate that gives you these conditions.  It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control.  If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life. By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again.  My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking non-oral estrogen and testosterone for the rest of your life. Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system.

Send us a textDr. Elliot Berlin transforms how we view childbirth, challenging the check-box mentality that leaves many parents feeling they've failed when birth veers from their rigid plans. Through our conversation, he introduces a revolutionary alternative: approaching birth planning as a flow chart with multiple potential pathways rather than a single desired route.The discussion delves into the delicate balance between modern medical systems and our innate bodily wisdom. As Dr. Berlin explains, "You're not driving a precision automobile, you're in a hot air balloon" – a perfect metaphor for the need to surrender some control while maintaining agency during birth. His insights on choosing birth environments are particularly illuminating: "If you're buying a hospital ticket, you're going on a hospital ride," highlighting how critical it is to select providers and settings aligned with your birth philosophy.Perhaps most eye-opening is the exploration of how cultural disconnection from natural birth has left us with only dramatized media portrayals as reference points. This cultural void creates unnecessary fear and unrealistic expectations. Dr. Berlin compares it to forming impressions about air travel solely from disaster movies – we'd be terrified to fly if our only exposure came from Hollywood!The conversation also explores the disappearing art of vaginal breech delivery and how chiropractic care creates optimal conditions for babies to assume head-down positions naturally. Dr. Berlin's holistic approach addresses not just physical alignment but the emotional journey through pregnancy and birth.Whether you're planning your first birth or processing a previous experience, this episode offers profound wisdom to help you navigate choices with confidence and flexibility. Follow Dr. Berlin's new podcast "One Way or a Mother" for deep-dive birth stories told across multiple episodes, and explore resources at informedpregnancy.com.Check out Dr. Berlin on instagram: https://www.instagram.com/doctorberlin/ 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 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.

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.

Join me, Dr. Casey Grover, as I provide a comprehensive guide to treating opioid use disorder during pregnancy, examining evidence-based approaches that protect both mother and baby through critical periods of care. The statistics are sobering - opioid use disorder in pregnancy has more than doubled in recent years, with overdoses now a leading cause of pregnancy-associated death.• Two major medical societies (ACOG and ASAM) recommend treating with methadone or buprenorphine rather than attempting medication-free withdrawal• Buprenorphine shows slight advantages over methadone for pregnancy outcomes, but the best choice is whichever medication keeps the mother sober• Neonatal abstinence syndrome occurs when babies experience withdrawal after birth, but can often be managed with supportive care rather than medication• Medication dosages often need adjustment during pregnancy as increased blood volume dilutes medication concentration• Breastfeeding is compatible with both methadone and buprenorphine treatment• The postpartum period brings unique challenges that increase relapse risk, requiring enhanced support for new mothers• Two patient cases illustrate both successful treatment and the challenges of maintaining recovery while parenting a newbornVisit centralcoastoverdoseprevention.org to learn more about preventing overdose deaths in your community.To contact Dr. Grover: ammadeeasy@fastmail.com

In today's episode, I'm diving into a key consideration for VBAC planning...the timing and spacing between your c-section and VBAC.If you're planning a VBAC then understanding the spacing between births can make a big difference. I go over ACOG guidelines but also give some personal insight into the topic and remind you to trust your gut and intuition.https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/01/interpregnancy-carehttps://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-deliveryhttps://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-deliveryText Hannah!https://thehannahgill.com/giveaway First 3 Steps to VBAC Guide: https://www.thehannahgill.com/firststeps Quiz - Is Your Provider VBAC Supportive?: https://thehannahgill.com/quiz Doula VBAC and Repeat Cesarean Guide: https://www.thehannahgill.com/newdoulatips

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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

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The JournalFeed podcast for the week of Merch 10-14, 2025.Download the JournalFeed iPhone app!These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:When time is of the essence, as in ovarian torsion, furosemide plus fluid provides a quick, effective, noninvasive option for bladder filling to expedite ultrasound in pediatric patients.Friday Spoon Feed:In this new clinical practice guideline, the American College of Obstetrics and Gynecology (ACOG) recommends foregoing routine Rh screening and RhIg prophylaxis for patients less than 12 weeks gestation undergoing abortion or experiencing pregnancy loss.

Fasting during the lunar month of Ramadan (Feb 28 to March 30, 2025) is a core practice for Muslims across the world. During Ramadan, Muslims abstain from food and drink from dawn to sunset. However, during a singleton pregnancy, the ACOG recommends adding approximately 340 extra calories per day in the second trimester and 450 extra calories per day in the third trimester. Does fasting during Ramadan have negative perinatal outcomes due to the potential caloric restriction? In this episode, we will highlight a Clinical Opinion publication from AJOG (June 2023) to examine the data.

Infants born by vaginal birth are exposed to maternal vaginal bacteria, which are one of the contributing influences on the subsequent development of the infant's microbiome. This process is altered by cesarean delivery, which changes the initial microbiome of the neonate. It is theorized that infants born by cesarean delivery have an increased risk of chronic inflammatory conditions due to altered early-life microbiome colonization, with associated aberrant immune and metabolic development. Vaginal seeding is the practice of inoculating an infant born by cesarean section with a sampling of fluid, with the use of a guaze, from the vagina of the mother over the child's face, mouth, and nares. This is performed to introduce the neonate to the mother's vaginal flora for presumed better health outcomes. Although cautionary statements have been published about this practice, it remains very popular. In Feb 2025, a “viewpoint” was published in JAMA Pediatrics which has brough vaginal seeding back into the limelight. Does this work? What are the official statements about this from the ACOG and AAP? Is there a way to do this “safely”? We will cover this new publication, review the official professional society's statements….and more, in this episode.

Originally aired in June 2019 as our 73rd episode, we still often think back to this amazing first conversation we had with Dr. Stuart Fischbein and Midwife Blyss Young!Now, almost 6 years later, the information is just as relevant and impactful as it was then. This episode was a Q&A from our Facebook followers and touches on topics like statistics surrounding VBAC, uterine rupture, uterine abnormalities, insurance companies, breech vaginal delivery, high-risk pregnancies, and a powerful analogy about VBACs and weddings!Birthing Instincts PatreonBirthing BlyssNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hey, guys. This is one of our re-broadcasted episodes. This is an episode that, in my opinion, is a little gem in the podcast world of The VBAC Link. I really have loved this podcast ever since the date we recorded it. I am a huge fan of Dr. Stu Fischbein and Midwife Blyss and have been since the moment I knew that they existed. I absolutely love listening to their podcast and just all of the amazing things that they have and that they offer. So I wanted to rebroadcast this episode because it was quite down there. It was like our 73rd episode or something like that. And yeah, I love it so much. This week is OB week, and so I thought it'd be fun to kick-off the week with one of my favorite OB doctor's, Stuart Fischbein. So, a little recap of what this episode covers. We go over a lot. We asked for our community to ask questions for these guys, and we went through them. We didn't get to everything, so that was a bummer, but we did get to quite a bit. We talked about things like the chances of VBAC. We talked about the chances of uterine rupture and the signs of uterine rupture. We talked about inducing VBAC. We talked about uterine abnormalities, the desire of where you want to birth and figuring that out. And also, Blyss had a really great analogy to talk about what to do and how we're letting the medical world and insurance and things like that really contemplate where we or dictate where we are birthing. I love that analogy. You guys, seriously, so many questions. It's an episode that you'll probably want to put on repeat because it really is so great to listen to them, and they just speak so directly. I can't get enough of it. So I'm really excited for you guys to dive in today on this. However, I wanted to bring to your attention a couple of the new things that they've had since we recorded this way back when. I also wanted to point out that we will have updated notes in the show notes or updated links in the show notes so you can go check, them out. But one of the first things I wanted to mention was their Patreon. They have a Patreon these days, and I think that it just sounds dreamy. I think you should definitely go find in their Patreon their community through their Patreon. You can check it out at patreon.com, birthinginsinctspodcast.com and of course, you can find them on social media. You can find Dr. Stu at Birthing Instincts or his website at birthinginsincts.com. You can find Blyss and that is B-L-Y-S-S if you are looking for her at birthingblyss on Instagram or birthinblyss.com, and then of course, you can email them. They do take emails with questions and sometimes they even talk about it on their podcast. Their podcast is birthinginsinctspodcast.com, and then you can email them at birthinginsinctspodcast@gmail.com, so definitely check them out. Also, Dr. Stu offers some classes and workshops and things like that throughout the years on the topic of breech. You guys, I love them and really can't wait for you to listen to today's episode.Ladies, I cannot tell you how giddy and excited I have been for the last couple weeks since we knew that these guys were going to record with us. But we have some amazing, special guests today. We have Dr. Stuart Fischbein and Midwife Blyss Young, and we want to share a little bit about them before we get into the questions that all of you guys have asked on our social media platforms.Julie: Absolutely. And when Meagan says we're excited, we are really excited.Meagan: My face is hot right now because I'm so excited.Julie: I'm so excited. Meagan was texting me last night at 11:00 in all caps totally fan-girling out over here. So Dr. Stu and midwife Blyss are pretty amazing and we know that you are going to love them just as much as we do. But before we get into it, and like Meagan said, I'm just going to read their bios so you can know just how legit they really are. First, up. Dr. Stuart Fischbein, MD is a fellow of the American College of Obstetrics and Gynecology, and how much we love ACOG over here at The VBAC Link He's a published author of the book Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife, and a Mom. He has peer-reviewed papers Home Birth with an Obstetrician, A Series of 135 Out-of-Hospital Births and Breech Births at Home, Outcomes of 60 Breech and 109 Cephalic Planned Home and Birth Center Births. Dr. Stu is a lecturer and advocate who now works directly with home birthing midwives. His website is www.birthinginsincts.com, and his podcast is Dr. Stu's Podcast. Seriously guys, you need to subscribe.Meagan: Go subscribe right now to their podcast.Yeah. The website for his podcast is drstuspodcast.com. He has an international following. He offers hope for women who cannot find supportive practitioners for VBAC and twin and breech deliveries. Guys, this is the home birth OB. He is located in California. So if you are in California hoping for VBAC, especially if you have any special circumstance like after multiple Cesareans, twins or breech presentation, run to him. Run. Go find him. He will help you. Go to that website. Blyss, Midwife Blyss. We really love them. If you haven't had a chance to hear their podcast guys, really go and give them a listen because this duo is on point. They are on fire, and they talk about all of the real topics in birth. So his partner on the podcast is Blyss Young, and she is an LM and CPM. She has been involved in the natural birth world since the birth of her first son in 1992, first as an advocate, and then as an educator. She is a mother of three children, and all of her pregnancies were supported by midwives, two of which were triumphant, empowering home births. In 2006, Blyss co-founded the Sanctuary Birth and Family Wellness Center. This was the culmination of all of her previous experience as a natural birth advocate, educator and environmentalist. The Sanctuary was the first of its kind, a full-spectrum center where midwives, doctors, and other holistic practitioners collaborated to provide thousands of Los Angeles families care during their prenatal and postpartum periods. Blyss closed the Sanctuary in 2015 to pursue her long-held dream of becoming a midwife and care for her clients in an intimate home birth practice similar to the way she was cared for during her pregnancies. I think that's , why Meagan and I both became doulas. Meagan: That's exactly why I'm a doula. Julie: We needed to provide that care just like we had been cared for. Anyway, going on. Currently, Blyss, AKA Birthing Blyss, supports families on their journey as a birth center educator, placenta encapsulator and a natural birth and family consultant and home birth midwife. She is also co-founder of Just Placentas, a company servicing all of Southern California and placenta encapsulation and other postpartum services. And as ,, she's a co-host on Dr. Stu's Podcast. Meagan: And she has a class. Don't you have a class that you're doing? Don't you have a class? Midwife Blyss: Yeah. Meagan: Yeah. She has a class that she's doing. I want to just fly out because I know you're not doing it online and everything. I just want to fly there just to take your class.Midwife Blyss: Yeah, it's coming online.Meagan: It is? Yay! Great. Well, I'll be one of those first registering. Oh, did you put it in there?Julie: No, there's a little bit more.Meagan: Oh, well, I'm just getting ahead.Julie: I just want to read more of Blyss over here because I love this and I think it's so important. At the heart of all Blyss's work is a deep-rooted belief in the brilliant design of our bodies, the symbiotic relationship between baby and mother, the power of the human spirit and the richness that honoring birth as the rite of passage and resurrecting lost traditions can bring to our high-tech, low-touch lives. And isn't that true love? I love that language. It is so beautiful. If I'm not mistaken, Midwife Blyss's website is birthingblyss.com.Is that right? And Blyss is spelled with a Y. So B-L-Y-S-S, birthingblyss.com, and that's where you can find her.Midwife Blyss: Just to make it more complicated, I had to put a Y in there.Julie: Hey. I love it.Meagan: That's okay.Julie: We're in Utah so we have all sorts of weird names over here.Meagan: Yep. I love it. You're unique. Awesome. Well, we will get started.Midwife Blyss: I did read through these questions, and one of the things that I wanted to say that I thought we could let people know is that of course there's a little bit more that we need to take into consideration when we have a uterus that's already had a scar.There's a small percentage of a uterine rupture that we need to be aware of, and we need to know what are the signs and symptoms that we would need to take a different course of action. But besides that, I believe that, and Dr. Stu can speak for himself because we don't always practice together. I believe that we treat VBAC just like any other mom who's laboring. So a lot of these questions could go into a category that you could ask about a woman who is having her first baby. I don't really think that we need to differentiate between those.Meagan: I love it. Midwife Blyss: But I do think that in terms of preparation, there are some special considerations for moms who have had a previous Cesarean, and probably the biggest one that I would point to is the trauma.Julie: Yes.Midwife Blyss: And giving space to and processing the trauma and really helping these moms have a provider that really believes in them, I think is one of the biggest factors to them having success. Meagan: Absolutely. Midwife Blyss: So that's one I wanted to say before you started down the question.Meagan: Absolutely. We have an online class that we provide for VBAC prep, and that's the very first section. It's mentally preparing and physically preparing because there's so much that goes into that. So I love that you started out with that.Julie: Yeah. A lot of these women who come searching for VBAC and realize that there's another way besides a repeat Cesarean are processing a lot of trauma, and a lot of them realized that their Cesarean might have been prevented had they known better, had a different provider, prepared differently, and things like that. Processing that and realizing that is heavy, and it's really important to do before getting into anything else, preparation-wise.Meagan: Yeah.Midwife Blyss: One of the best things I ever had that was a distinction that one of my VBAC moms made for me, and I passed it on as I've cared for other VBAC mom is for her, the justification, or I can't find the right word for it, but she basically said that that statement that we hear so often of, "Yeah, you have trauma from this, or you're not happy about how your birth went, but thank God your baby is healthy." And she said it felt so invalidating for her because, yes, she also was happy, of course, that her baby was safe, but at the same time, she had this experience and this trauma that wasn't being acknowledged, and she felt like it was just really being brushed away.Julie: Ah, yeah.Midwife Blyss: I think really giving women that space to be able to say, "Yes, that's valid. It's valid how you feel." And it is a really important part of the process and having a successful vaginal delivery this go around.Dr. Stu: I tend to be a lightning rod for stories. It's almost like I have my own personal ICAN meeting pretty much almost every day, one-on-one. I get contacted or just today driving. I'm in San Diego today and just driving down here, I talked to two people on the phone, both of whom Blyss really just touched on it is that they both are wanting to have VBACs with their second birth. They were seeing practitioners who are encouraging them to be induced for this reason or that reason. And they both have been told the same thing that Blyss just mentioned that if you end up with a repeat Cesarean, at least you're going to have a healthy baby. Obviously, it's very important. But the thing is, I know it's a cliche, but it's not just about the destination. It's about the journey as well. And one of the things that we're not taught in medical school and residency program is the value of the process. I mean, we're very much mechanical in the OB world, and our job is to get the baby out and head it to the pediatric department, and then we're done with it. If we can get somebody induced early, if we can decide to do a C-section sooner than we should, there's a lot of incentives to do that and to not think about the process and think about the person. There's another cliche which we talk about all the time. Blyss, and I've said it many times. It's that the baby is the candy and the mother's the wrapper. I don't know if you've heard that one, but when the baby comes out, the mother just gets basically tossed aside and her experience is really not important to the medical professionals that are taking care of her in the hospital setting, especially in today's world where you have a shift mentality and a lot of people are being taken care of by people they didn't know.You guys mentioned earlier the importance of feeling safe and feeling secure in whatever setting you're in whether that's at home or in the hospital. Because as Blyss knows, I get off on the mammalian track and you talk about mammals. They just don't labor well when they're anxious.Julie: Yep.Dr. Stu: When the doctor or the health professional is anxious and they're projecting their anxiety onto the mom and the family, then that stuff is brewing for weeks, if not months and who knows what it's actually doing inside, but it's certainly not going to lead to the likelihood of or it's going to diminish the likelihood of a successful labor.Julie: Yeah, absolutely. We talk about that. We go over that a lot. Like, birth is very instinctual and very primal, and it operates a very fundamental core level. And whenever mom feels threatened or anxious or, or anything like that, it literally can st or stop labor from progressing or even starting.Meagan: Yeah, exactly. When I was trying to VBAC with my first baby, my doctor came in and told my husband to tell me that I needed to wake up and smell the coffee because it wasn't happening for me. And that was the last, the last contraction I remember feeling was right before then and my body just shut off. I just stopped because I just didn't feel safe anymore or protected or supported. Yeah, it's very powerful which is something that we love so much about you guys, because I don't even know you. I've just listened to a million of your podcasts, and I feel so safe with you right now. I'm like, you could fly here right now and deliver my baby because so much about you guys, you provide so much comfort and support already, so I'm sure all of your clients can feel that from you.Julie: Absolutely.Dr. Stu: Yeah. I just would like to say that, know, I mean, the introduction was great. Which one of you is Julie? Which one's Meagan?Julie: I'm Julie.Meagan: And I'm Meagan.Dr. Stu: Okay, great. All right, so Julie was reading the introduction that she was talking about how if you have a breech, you have twins, if you have a VBAC, you have all these other things just come down to Southern California and care of it. But I'm not a cowboy. All right? Even though I do more things than most of my colleagues in the profession do, I also say no to people sometimes. I look at things differently. Just because someone has, say chronic hypertension, why can't they have a home birth? The labor is just the labor. I mean, if her blood pressure gets out of control, yeah, then she has to go to the hospital. But why do you need to be laboring in the hospital or induced early if everything is fine? But this isn't for everybody.We want to make that very clear. You need to find a supportive team or supportive practitioner who's willing to be able to say yes and no and give you it with what we call a true informed consent, so that you have the right to choose which way to go and to do what's reasonable. Our ethical obligation is to give you reasonable choices and then support your informed decision making. And sometimes there are things that aren't reasonable. Like for instance, an example that I use all the time is if a woman has a breech baby, but she has a placenta previa, a vaginal delivery is not an option for you. Now she could say, well, I want one and I'm not going to have a C-section.Julie: And then you have the right to refuse that.Dr. Stu: Yeah, yeah, but I mean, that's never going to happen because we have a good communication with our patients. Our communication is such that we develop a trust over the period of time. Sometimes I don't meet people until I'm actually called to their house by a midwife to come assist with a vacuum or something like that. But even then, the midwives and stuff, because I'm sort of known that people have understanding. And then when I'm sitting there, as long as the baby isn't trouble, I will explain to them, here's what's going to happen. Here's how we're going to do it. Here's what's going on. The baby's head to look like this. It not going be a problem. It'll be better in 12 hours. But I go through all this stuff and I say, I'm going to touch you now. Is that okay? I ask permission, and I do all the things that the midwives have taught me, but I never really learned in residency program. They don't teach this stuff.Julie: Yeah, yeah, yeah, absolutely. One of the things that we go over a lot to in our classes is finding a provider who has a natural tendency to treat his patients the way that you want to be treated. That way, you'll have a lot better time when you birth because you're not having to ask them to do anything that they're not comfortable with or that they're not prepared for or that they don't know how to do. And so interviewing providers and interview as many as you need to with these women. And find the provider whose natural ways of treating his clients are the ways that you want to be treated.Dr. Stu: And sometimes in a community, there's nobody.Julie: Yeah, yeah, that's true.Meagan: That's what's so hard.Dr. Stu: And if it's important to you, if it's important to you, then you have to drive on. Julie: Or stand up for yourself and fight really hard.Meagan: I have a client from Russia. She's flying here in two weeks. She's coming all the way to Salt Lake City, Utah to have her baby. We had another client from Russia.Julie: You have another Russian client?Meagan: Yeah. Julie: That's awesome. Meagan: So, yeah. It's crazy. Sometimes you have to go far, far distances, and sometimes you've got them right there. You just have to search. You just have to find them.So it's tricky.Midwife Blyss: Maybe your insurance company is not gonna pay for it.Meagan: Did you say my company's not gonna pay for it?Midwife Blyss: And maybe your insurance company.Meagan: Oh, sure. Yeah, exactly.Midwife Blyss: You can't rely on them to be the ones who support some of these decisions that are outside of the standards of care. You might have to really figure out how to get creative around that area.Meagan: Absolutely.Yeah. So in the beginning, Blyss, you talked about noticing the signs, and I know that's one of the questions that we got on our Instagram, I believe. Birthing at home for both of you guys, what signs for a VBAC mom are signs enough where you talk about different care?.Dr. Stu: I didn't really understand that. Say that again what you were saying.Meagan: Yep. Sorry. So one of the questions on our Instagram was what are the signs of uterine rupture when you're at home that you look for and would transfer care or talk about a different plan of action?Dr. Stu: Okay. Quite simply, some uterine ruptures don't have any warning that they're coming.There's nothing you can do about those. But before we get into what you can feel, just let's review the numbers real briefly so that people have a realistic viewpoint. Because I'm sure if a doctor doesn't want to do a VBAC, you'll find a reason not to do a VBAC. You'll use the scar thickness or the pregnancy interval or whatever. They'll use something to try to talk you out of it or your baby's too big or this kind of thing. We can get into that in a little bit. But when there are signs, the most common sign you would feel is that there'd be increasing pain super-cubically that doesn't go away between contractions. It's a different quality of pain or sensation. It's pain. It's really's becoming uncomfortable. You might start to have variables when you didn't have them before. So the baby's heart rate, you might see heart rate decelerations. Rarely, you might find excessive bleeding, but that's usually not a sign of I mean that's a sign of true rupture.Midwife Blyss: Loss of station.Dr. Stu: Those are things you look for, but again, if you're not augmenting someone, if someone doesn't have an epidural where they don't have sensation, if they're not on Pitocin, these things are very unlikely to happen. I was going to get to the numbers. The numbers are such that the quoted risk of uterine rupture, which is again that crappy word. It sounds like a tire blowing out of the freeway. It is about 1 in 200. But only about 5 to 16%. And even one study said 3%. But let's just even take 16% of those ruptures will result in an outcome that the baby is damaged or dead. Okay, that's about 1 in 6. So the actual risk is about 1 in 6 times 1 in 200 or 1 in 1200 up to about 1 in 4000.Julie: Yep.Dr. Stu: So those are, those are the risks. They're not the 1 in 200 or the 2%. I actually had someone tell some woman that she had a 30% chance of rupture.Julie: We've had somebody say 50%.Meagan: We have?Julie: Yeah. Jess, our 50 copy editor-- her doctor told her that if she tries to VBAC, she has a 50% chance of rupture and she will die. Yeah.Meagan: Wow.Julie: Pretty scary. Dr. Stu: And by the way, a maternal mortality from uterine rupture is extremely rare.Julie: Yeah, we were just talking about that.Dr. Stu: That doctor is wrong on so many accounts. I don't even know where to begin on that.Julie: I know.Dr. Stu: Yeah. See that's the thing where even if someone has a classical Cesarean scar, the risk of rupture isn't 50%.Julie: Yep.Dr. Stu: So I don't know where they come up with those sorts of numbers.Julie: Yeah, I think it's just their comfort level and what they're familiar with and what they know and what they understand. I think a lot of these doctors, because she had a premature Cesarean, and so that's why he was a little, well, a lot more fear-based. Her Cesarean happened, I think, around 32 weeks. We still know that you can still attempt to VBAC and still have a really good chance of having a successful one. But a lot of these providers just don't do it.Dr. Stu: Yeah. And another problem is you can't really find out what somebody's C-section rate is. I mean, you can find out your hospital C-section rate. They can vary dramatically between different physicians, so you really don't know. You'd like to think that physicians are honest. You'd like to think that they're going to tell you the truth. But if they have a high C-section rate and it's a competitive world, they're not going to. And if you're with them, you don't really have a choice anyway.Julie: So there's not transparency on the physician level.Dr. Stu: So Blyss was talking briefly about the fact that your insurance may not pay for it. Blyss, why don't you elaborate on that because you do that point so well.Midwife Blyss: Are you talking about the wedding?Dr. Stu: I love your analogy. It's a great analogy.Midwife Blyss: I'm so saddened sometimes when people talk to me about that they really want this option and especially VBACs. I just have a very special tender place in my heart for VBAC because I overcame something from my first to second birth that wasn't a Cesarean. But it felt like I had been led to mistrust my body, and then I had a triumphant second delivery. So I really understand how that feels when a woman is able to reclaim her body and have a vaginal delivery. But just in general, in terms of limiting your options based on what your insurance will pay for, we think about the delivery of our baby and or something like a wedding where it's this really special day. I see that women or families will spend thousands and thousands of dollars and put it on a credit card and figure out whatever they need to do to have this beautiful wedding. But somehow when it comes to the birth of their baby, they turn over all their power to this insurance company.And so we used to do this talk at the sanctuary and I used to say, "What if we had wedding insurance and you paid every year into this insurance for your wedding, and then when the wedding came, they selected where you went and you didn't like it and they put you in a dress that made you look terrible and the food was horrible and the music was horrible and they invited all these people you didn't want to be there?"Julie: But it's a network.Midwife Blyss: Would you really let that insurance company, because it was paid for, dictate how your wedding day was? Julie: That's a good analogy.Midwife Blyss: You just let it all go.Meagan: Yeah. That's amazing. I love that. And it's so true. It is so true.Julie: And we get that too a lot about hiring a doula. Oh, I can't hire a doula. It's too expensive. We get that a lot because people don't expect to pay out-of-pocket for their births. When you're right, it's just perceived completely differently when it should be one of the biggest days of your life. I had three VBACs at home. My first was a necessary, unnecessary Cesarean.I'm still really uncertain about that, to be honest with you. But you better believe my VBACs at home, we paid out of pocket for a midwife. Our first two times, it was put on a credit card. I had a doula, I had a birth photographer, I had a videographer. My first VBAC, I had two photographers there because it was going to be documented because it was so important to me. And we sold things on eBay. We sold our couches, and I did some babysitting just to bring in the money.Obviously, I hired doulas because it was so important to me to not only have the experience that I wanted and that I deserved, but I wanted it documented and I wanted it to be able to remember it well and look back on it fondly. We see that especially in Utah. I think we have this culture where women just don't-- I feel like it's just a national thing, but I think in Utah, we tend to be on the cheap side just culturally and women don't see the value in that. It's hard because it's hard to shift that mindset to see you are important. You are worth it. What if you could have everything you wanted and what if you knew you could be treated differently? Would you think about how to find the way to make that work financially? And I think if there's just that mindset shift, a lot of people would.Meagan: Oh, I love that.Dr. Stu: If you realize if you have to pay $10,000 out of pocket or $5,000 or whatever to at least have the opportunity, and you always have the hospital as a backup. But 2 or 3 years from now, that $5,000 isn't going to mean anything.Julie: Yeah, nothing.Meagan: But that experience is with you forever.Dr. Stu: So yeah, women may have to remember the names of their children when they're 80 years old, but they'll remember their birth.Julie: Well, with my Cesarean baby, we had some complications and out-of-pocket, I paid almost $10,000 for him and none of my home births, midwives, doula, photography and videography included cost over $7,000.Meagan: My Cesarean births in-hospital were also more expensive than my birth center births.Julie: So should get to questions.Dr. Stu: Let's get to some of the questions because you guys some really good questions.Meagan: Yes.Dr. Stu: Pick one and let's do it.Meagan: So let's do Lauren. She was on Facebook. She was our very first question, and she said that she has some uterine abnormalities like a bicornuate uterus or a separate uterus or all of those. They want to know how that impacts VBAC. She's had two previous Cesareans due to a breech presentation because of her uterine abnormality.Julie: Is that the heart-shaped uterus? Yeah.Dr. Stu: Yeah. You can have a septate uterus. You can have a unicornuate uterus. You can have a double uterus.Julie: Yeah. Two separate uteruses.Dr. Stu: Right. The biggest problem with a person with an abnormal uterine shape or an anomaly is a couple of things. One is malpresentation as this woman experienced because her two babies were breech. And two, is sometimes a retained placenta is more common than women that have a septum, that sort of thing. Also, it can cause preterm labor and growth restriction depending on the type of anomaly of the uterus. Now, say you get to term and your baby is head down, or if it's breech in my vicinity. But if it's head down, then the chance of VBAC for that person is really high. I mean, it might be a slightly greater risk of Cesarean section, but not a statistically significant risk. And then the success rate for home birth VBACs, if you look at the MANA stats or even my own stats which are not enough to make statistical significance in a couple of papers that I put out, but the MANA stats show that it's about a 93% success rate for VBACS in the midwifery model, whereas in the hospital model, it can be as low as 17% up to the 50s or 60%, but it's not very high. And that's partly because of the model by which you're cared for. So the numbers that I'm quoting and the success rates I'm quoting are again, assuming that you have a supportive practitioner in a supportive environment, every VBAC is going to have diminished chance of success in a restrictive or tense environment. But unicornuate uterus or septate uterus is not a contraindication to VBAC, and it's not an indication of breech delivery if somebody knows how to do a breech VBAC too.Julie: Right.Dr. Stu: So Lauren, that would be my answer to to your question is that no, it's not a contraindication and that if you have the right practitioner you can certainly try to labor and your risk of rupture is really not more significant than a woman who has a normal-shaped uterus.Julie: Good answer.Meagan: So I want to spin off that really quick. It's not a question, but I've had a client myself that had two C-sections, and her baby was breech at 37 weeks, and the doctor said he absolutely could not turn the baby externally because her risk of rupture was so increasingly high. So would you agree with that or would you disagree with that?D No, no, no. Even an ACOG statement on external version and breech says that a previous uterine scar is not a contraindication to attempting an external version.Meagan: Yeah.Dr. Stu: Now actually, if we obviously had more breech choices, then there'd be no reason to do an external version.The main reason that people try an external version which can sometimes be very uncomfortable, and depending on the woman and her parody and certain other factors, their success rate cannot be very good is the only reason they do it because the alternative is a Cesarean in 95% of locations in the country.Meagan: Okay, well that's good to know.Dr. Stu: But again, one of the things I would tell people to do is when they're hearing something from their position that just sort of rocks the common sense vote and doesn't sort of make sense, look into it. ACOG has a lot. I think you can just go Google some of the ACOG clinical guidelines or practice guidelines or clinical opinions or whatever they call them. You can find and you can read through, and they summarize them at the end on level A, B, and C evidence, level A being great evidence level C being what's called consensus opinion. The problem with consensus, with ACOG's guidelines is that about 2/3 of them are consensus opinion because they don't really have any data on them. When you get bunch of academics together who don't like VBAC or don't like home birth or don't like breech, of course a consensus opinion is going to be, "Well, we're not going to think those are a good idea." But much to their credit lately, they're starting to change their tune. Their most recent VBAC guideline paper said that if your hospital can do labor and delivery, your hospital can do VBAC.Julie: Yes.Dr. Stu: That's huge. There was immediately a whole fiasco that went on. So any hospital that's doing labor and delivery should be able to do a VBAC. When they say they can't or they say our insurance company won't let them, it's just a cowardly excuse because maybe it's true, but they need to fight for your right because most surgical emergencies in labor delivery have nothing to do with a previous uterine scar.Julie: Absolutely.Dr. Stu: They have to do with people distress or placental abruption or cord prolapse. And if they can handle those, they can certainly handle the one in 1200. I mean, say a hospital does 20 VBACs a year or 50 VBACs a year. You'll take them. Do the math. It'll take them 25 years to have a rupture.Meagan: Yeah. It's pretty powerful stuff.Midwife Blyss: I love when he does that.Julie: Me too. I'm a huge statistics junkie and data junkie. I love the numbers.Meagan: Yeah. She loves numbers.Julie: Yep.Meagan: I love that.Julie: Hey, and 50 VBACs a year at 2000, that would be 40 years actually, right?Dr. Stu: Oh, look at what happened. So say that again. What were the numbers you said?Julie: So 1 in 2000 ruptures are catastrophic and they do 50 VBACs a year, wouldn't that be 40 years?Dr. Stu: But I was using the 1200 number.Julie: Oh, right, right, right, right.Dr. Stu: So that would be 24 years.Julie: Yeah. Right. Anyways, me and you should sit down and just talk. One day. I would love to have lunch with you.Dr. Stu: Let's talk astrology and astronomy.Yes.Dr. Stu: Who's next?Midwife Blyss: Can I make a suggestion?There was another woman. Let's see where it is. What's the likelihood that a baby would flip? And is it reasonable to even give it a shot for a VBA2C. How do you guys say that?Meagan: VBAC after two Cesareans.Midwife Blyss: I need to know the lingo. So, I would say it's very unlikely for a baby to flip head down from a breech position in labor. It doesn't mean it's impossible.Dr. Stu: With a uterine septum, it's almost never going to happen. Bless is right on. Even trying an external version on a woman with the uterine septum when the baby's head is up in one horn and the placenta in the other horn and they're in a frank breech position, that's almost futile to do that, especially if a woman is what I call a functional primary, or even a woman who's never labored before.Julie: Right. That's true.Meagan: And then Napoleon said, what did she say? Oh, she was just talking about this. She's planning on a home birth after two Cesareans supported by a midwife and a doula. Research suggests home birth is a reasonable and safe option for low-risk women. And she wants to know in reality, what identifies low risk?Midwife Blyss: Well, I thought her question was hilarious because she says it seems like everybody's high-risk too. Old, overweight.Julie: Yeah, it does. It does, though.Dr. Stu: Well, immediately, when you label someone high-risk, you make them high-risk.Julie: Yep.Dr. Stu: Because now you've planted seeds of doubt inside their head. So I would say, how do you define high-risk? I mean, is 1 in 1200 high risk?Julie: Nope.Dr. Stu: It doesn't seem high-risk to me. But again, I mean, we do a lot of things in our life that are more dangerous than that and don't consider them high-risk. So I think the term high-risk is handed about way too much.And it's on some false or just some random numbers that they come up with. Blyss has heard this before. I mean, she knows everything I say that comes out of my mouth. The numbers like 24, 35, 42. I mean, 24 hours of ruptured membranes. Where did that come from? Yeah, or some people are saying 18 hours. I mean, there's no science on that. I mean, bacteria don't suddenly look at each other and go, "Hey Ralph, it's time to start multiplying."Julie: Ralph.Meagan: I love it.Julie: I'm gonna name my bacteria Ralph.Meagan: It's true. And I was told after 18 hours, that was my number.Dr. Stu: Yeah, again, so these numbers, there are papers that come out, but they're not repetitive. I mean, any midwife worth her salt has had women with ruptured membranes for sometimes two, three, or four days.Julie: Yep.Midwife Blyss: And as long as you're not sticking your fingers in there, and as long as their GBS might be negative or that's another issue.Meagan: I think that that's another question. That's another question. Yep.Dr. Stu: Yeah, I'll get to that right now. I mean, if some someone has a ruptured membrane with GBS, and they don't go into labor within a certain period of time, it's not unreasonable to give them the pros and cons of antibiotics and then let them make that decision. All right? We don't force people to have antibiotics. We would watch for fetal tachycardia or fever at that point, then you're already behind the eight ball. So ideally, you'd like to see someone go into labor sooner. But again, if they're still leaking, if there are no vaginal exams, the likelihood of them getting group B strep sepsis or something on the baby is still not very high. And the thing about antibiotics that I like to say is that if I was gonna give antibiotics to a woman, I think it's much better to give a woman an antibiotics at home than in the hospital. And the reason being is because at home, the baby's still going to be born into their own environment and mom's and dad's bacteria and the dog's bacteria and the siblings' bacteria where in the hospital, they're going to go to the nursery for observation like they generally do, and they're gonna be exposed to different bacteria unless they do these vaginal seeding, which isn't really catching on universally yet where you take a swab of mom's vaginal bacteria before the C-section.Midwife Blyss: It's called seeding.Dr. Stu: Right. I don't consider ruptured membrane something that again would cause me to immediately say something where you have to change your plan. You individualize your care in the midwifery model.Julie: Yep.Dr. Stu: You look at every patient. You look at their history. You look at their desires. You look at their backup situation, their transport situation, and that sort of thing. You take it all into account. Now, there are some women in pregnancy who don't want to do a GBS culture.Ignorance is bliss. The other spelling of bliss.Julie: Hi, Blyss.Dr. Stu: But the reason that at least I still encourage people to do it is because for any reason, if that baby gets transferred to the hospital during labor or after and you don't have a GBS culture on the chart, they're going to give antibiotics. They're going to treat it as GBS positive and they're also going to think you're irresponsible.And they're going to have that mentality that of oh, here's another one of those home birth crazy people, blah, blah, blah.Julie: That just happened to me in January. I had a client like that. I mean, anyways, never mind. It's not the time. Midwife Blyss: Can I say something about low-risk?Julie: Yes. Midwife Blyss: I think there are a lot of different factors that go into that question. One being what are the state laws? Because there are things that I would consider low-risk and that I feel very comfortable with, but that are against the law. And I'm not going to go to jail.Meagan: Right. We want you to still be Birthing Bless.Midwife Blyss: As, much as I believe in a woman's right to choose, I have to draw the line at what the law is. And then the second is finding a provider that-- obviously, Dr. Stu feels very comfortable with things that other providers may not necessarily feel comfortable with.Julie: Right.Midwife Blyss: And so I think it's really important, as you said in the beginning of the show, to find a provider who takes the risk that you have and feels like they can walk that path with you and be supportive. I definitely agree with what Dr. Stu was saying about informed consent. I had a client who was GBS positive, declined antibiotics and had a very long rupture. We continued to walk that journey together. I kept giving informed consent and kept giving informed consent. She had such trust and faith that it actually stretched my comfort level. We had to continually talk about where we were in this dance. But to me, that feels like what our job is, is to give them information about the pros and cons and let them decide for themselves.And I think that if you take a statistic, I'm picking an arbitrary number, and there's a 94% chance of success and a 4% chance that something could go really wrong, one family might look at that and say, "Wow, 94%, this is neat. That sounds like a pretty good statistic," and the other person says, "4% makes me really uncomfortable. I need to minimize." I think that's where you have to have the ability, given who you surround yourself with and who your provider is, to be able to say, "This is my choice," and it's being supported. So it is arbitrary in a lot of ways except for when it comes to what the law is.Julie: Yeah, that makes sense.Meagan: I love that. Yeah. Julie: Every state has their own law. Like in the south, it's illegal like in lots of places in the South, I think in Washington too, that midwives can't support home birth if you're VBAC. I mean there are lots of different legislative rules. Why am I saying legislative? Look at me, I'm trying to use fancy words to impress you guys. There are lots of different laws in different states and, and some of them are very evidence-based and some laws are broad and they leave a lot of room for practices, variation and gray areas. Some are so specific that they really limit a woman's option in that state.Dr. Stu: We can have a whole podcast on the legal decision-making process and a woman's right to autonomy of her body and the choices and who gets to decide that would be. Right now, the vaccine issue is a big issue, but also pregnancy and restricting women's choices of these things. If you want to do another one down the road, I would love to talk on that subject with you guys.Julie: Perfect.Meagan: We would love that.Julie: Yeah. I think it's your most recent episode. I mean as of the time of this recording. Mandates Kill Medicine. What is that the name?Dr. Stu: Mandates Destroy Medicine.Julie: Yeah. Mandates Destroy Medicine. Dr. Stu: It's wonderful.Julie: Yeah, I love it. I was just listening to it today again.Dr. Stu: well it does because it makes the physicians agents of the state.Julie: Yeah, it really does.Meagan: Yeah. Well. And if you give us another opportunity to do this with you, heck yeah.Julie: Yeah. You can just be a guest every month.Meagan: Yeah.Dr. Stu: So I don't think I would mind that at all, actually.Meagan: We would love it.Julie: Yeah, we would seriously love it. We'll keep in touch.Meagan: So, couple other questions I'm trying to see because we jumped through a few that were the same. I know one asks about an overactive pelvic floor, meaning too strong, not too weak. She's wondering if that is going to affect her chances of having a successful VBAC.Julie: And do you see that a lot with athletes, like people that are overtrained or that maybe are not overtrained, but who train a lot and weightlifters and things like that, where their pelvic floor is too strong? I've heard of that before.Midwife Blyss: Yep, absolutely. there's a chiropractor here in LA, Dr. Elliot Berlin, who also has his own podcast and he talks–Meagan: Isn't Elliott Berlin Heads Up?Dr. Stu: Yeah. He's the producer of Heads Up.Meagan: Yeah, I listened to your guys' special episode on that too. But yeah, he's wonderful.Midwife Blyss: Yeah. So, again, I think this is a question that just has more to do with vaginal delivery than it does necessarily about the fact that they've had a previous Cesarean. So I do believe that the athletic pelvis has really affected women's deliveries. I think that during pregnancy we can work with a pelvic floor specialist who can help us be able to realize where the tension is and how to do some exercises that might help alleviate some of that. We have a specialist here in L.A. I don't know if you guys do there that I would recommend people to. And then also, maybe backing off on some of the athletic activities that that woman is participating in during her pregnancy and doing things more like walking, swimming, yoga, stretching, belly dancing, which was originally designed for women in labor, not to seduce men. So these are all really good things to keep things fluid and soft because you want things to open and release rather than being tense.Meagan: I love that.Dr. Stu: I agree. I think sometimes it leads more to not generally so much of dilation. Again, a friend of mine, David Hayes, he's a home birth guy in South Carolina, doesn't like the idea of using stages of labor. He wants to get rid of that. I think that's an interesting thought. We have a meeting this November in Wisconsin. We're gonna have a bunch of thought-provoking things going on over there.Dr. Stu: Is it all men talking about this? Midwife Blyss: Oh, hell no.Julie: Let's get more women. Dr. Stu: No, no, no, no, no.Being organized By Cynthia Calai. Do you guys know who Cynthia is? She's been a midwife for 50 years. She's in Wisconsin. She's done hundreds of breeches. Anyway, the point being is that I think that I find that a lot of those people end up getting instrumented like vacuums, more commonly. Yeah. So Blyss is right. I mean, if there are people who are very, very tight down there. The leviators and the muscles inside are very tight which is great for life and sex and all that other stuff, but yeah, you need to learn how to be able to relax them too.Julie: Yeah.Meagan: So I know we're running short on time, but this question that came through today, I loved it. It said, "Could you guys both replicate your model of care nationwide somehow?" She said, "How do I advocate effectively for home birth access and VBAC access in a state that actively prosecutes home birth and has restrictions on midwifery practice?" She specifically said she's in Nebraska, but we hear this all over the place. VBAC is not allowed. You cannot birth at home, and people are having unassisted births.Julie: Because they can't find the support.Meagan: They can't find the support and they are too scared to go to the hospital or birth centers. And so, yeah, the question is--Julie: What can women do in their local communities to advocate for positive change and more options in birth where they are more restricted?Dr. Stu: Blyss. Midwife Blyss: I wish I had a really great answer for this. I think that the biggest thing is to continue to talk out loud. And I'm really proud of you ladies for creating this podcast and doing the work that you do. Julie: Thanks.Midwife Blyss: I always believed when we had the Sanctuary that it really is about the woman advocating for herself. And the more that hospitals and doctors are being pushed by women to say, "We need this as an option because we're not getting the work," I think is really important. I support free birth, and I think that most of the women and men who decide to do that are very well educated.Julie: Yeah, for sure.Midwife Blyss: It is actually really very surprising for midwives to see that sometimes they even have better statistics than we do. But it saddens me that there's no choice. And, a woman who doesn't totally feel comfortable with doing that is feeling forced into that decision. So I think as women, we need to support each other, encourage each other, continue to talk out loud about what it is that we want and need and make this be a very important decision that a woman makes, and it's a way of reclaiming the power. I'm not highly political. I try and stay out of those arenas. And really, one of my favorite quotes from a reverend that I have been around said, "Be for something and against nothing." I really believe that the more. Julie: I like that.Midwife Blyss: Yeah, the more that we speak positively and talk about positive change and empowering ourselves and each other, it may come slowly, but that change will continue to come.Julie: Yeah, yeah.Dr. Stu: I would only add to that that I think unfortunately, in any country, whether it's a socialist country or a capitalist country, it's economics that drives everything. If you look at countries like England or the Netherlands, you find that they have, a really integrated system with midwives and doctors collaborating, and the low-risk patients are taken care of by the midwives, and then they consult with doctors and midwives can transfer from home to hospital and continue their care in that system, the national health system. I'm not saying that's the greatest system for somebody who's growing old and has arthritis or need spinal surgery or something like that, but for obstetrics, that sort of system where you've taken out liability and you've taken out economic incentive. All right, so how do you do that in our system? It's not very easy to do because everything is economically driven. One of the things that I've always advocated for is if you want to lower the C-section rate, increase the VBAC rate. It would be really simple for insurance companies, until we have Bernie Sanders with universal health care. But while we have insurance companies, if they would just pay twice as much for a vaginal birth and half as much for a Cesarean birth, then finally, VBACS and breech deliveries would be something. Oh, maybe we should start. We should be more supportive of those things because it's all about the money. But as long as the hospital gets paid more, doctors don't really get paid more. It's expediency for the doctor. He gets it done and goes home. But the hospital, they get paid a lot more, almost twice as much for a C-section than you do for vaginal birth. What's the incentive for the chief financial officer of any hospital to say to the OB department, "We need to lower our C-section rate?" One of the things that's happening are programs that insurance, and I forgot what it's called, but where they're trying, in California, they're trying to lower the primary C-section rate. There's a term for it where it's an acronym with four initials. Blyss, do you know what I'm talking about?Midwife Blyss: No. Dr. Stu: It's an acronym about a first-time mom. We're trying to avoid those C-sections.Julie: Yeah, the primary Cesarean.Dr. Stu: It's an acronym anyway, nonetheless. So they're in the right direction. Most hospitals are in the 30% range. They'd like to lower to 27%. That's a start.One of the ways to really do that is to support VBAC, and treat VBAC as Blyss said at the very beginning of the podcast is that a VBAC is just a normal labor. When people lump VBAC in with breech in twins, it's like, why are you doing that? Breech in twins requires special skill. VBAC requires a special skill also, which is a skill of doing nothing.Julie: Yeah, it's hard.Dr. Stu: It's hard for obstetricians and labor and delivery nurses and stuff like that to do nothing. But ultimately, VBAC is just a vaginal birth and doesn't require any special skill. When a doctor says, "We don't do VBAC, what he's basically saying, or she, is that I don't do vaginal deliveries," which is stupid because VBAC is just a vaginal delivery.Julie: Yeah, that's true.Meagan: Such a powerful point right there.Julie: Guys. We loved chatting with you so much. We wish we could talk with you all day long.Meagan: I would. All day long. I just want to be a fly on your walls if I could.Julie: If you're ever in Salt Lake City again--Meagan: He just was. Did you know about this?Julie: Say hi to Adrienne, but also connect with us because we would love to meet you. All right, well guys, everyone, all of our listeners, Women of Strength, we are going to drop all the information that you need to find Midwife Blyss and Dr. Stu-- their website, their podcast, and all of that in our show notes. So yeah, now you can find our podcast. You can even listen to our podcast on our website at thevbaclink.com/podcast. You can play episodes right from there. So if you don't know-- well, if you're listening to this podcast, then you probably have a podcast player already. But you know what? My mom still doesn't know what a podcast is, so I'm just gonna have to start sending her links right to our page.Meagan: Yep, just listen to us wherever and leave us a review and head over to Dr. Stu's Podcast and leave them a review.Julie: Subscribe because you're gonna love him, but don't stop listening to him us because you love us too. Remember that.Dr. Stu: I want to thank everybody who wrote in, and I'm sorry we didn't get to answer every question. We tend to blabber on a little bit asking these important questions, and hopefully you guys will have us back on again.Meagan: We would love to have you.Julie: Absolutely.Meagan: Yep, we will.Julie: Absolutely.Meagan: YeahClosingWould 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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Informed consent is much more than just a signature on a form—it's a conversation, a right, and a crucial part of making empowered decisions about your birth. But here's the truth: hospitals rarely provide true informed consent. They give you a watered-down version, leaving you with only the options they prefer.In this episode, we're breaking down:

Ladies, it's time to get real about women's health! In this episode of Power & Poised, we're diving deep into women's health with Dr. Hack, a leading expert in gynecology, Board-certified obstetrician, and professional speaker! We're breaking down the impact of AI-driven "medical" ads, uncovering the dark history of gynecology, and discussing why your period might be making you feel worse than it should. Plus, we're tackling a game of Fact or Fiction, debunking common myths like: Does boric acid cure STIs? Should you douche for better vaginal health? Tune in for an eye-opening conversation that every woman needs to hear. Every year on February 28 and March 1, the dates that bridge Black History Month and Women's History Month, ACOG formally acknowledges Betsey, Lucy, and Anarcha, the three enslaved Black women whose exploitation led to foundational advances in the field of obstetrics and gynecology that benefit millions of patients today: https://www.acog.org/about/diversity-equity-and-inclusive-excellence/betsey-lucy-and-anarcha-days-of-recognition Connect with Dr. Hack: Website: https://ladypartsdoctor.com/ Instagram: https://www.instagram.com/ladypartsdoc?igsh=MWhsdDd6Mmk2bHc1MA== Tiktok: https://www.tiktok.com/@ladypartsdoc?is_from_webapp=1&sender_device=pc Podcast: https://podcasts.apple.com/us/podcast/lady-parts-doctor/id1613851502?i=1000692437163

Exercise during pregnancy is evidence-based to reduce the risk of certain complications, support healthy weight gain, alleviate common pregnancy discomforts, and improve mental well-being. Despite these well-documented benefits, confusion remains about which exercises are safe and which should be avoided. Guidelines from organizations like ACOG tend to be broad and overly cautious, which may not always align with your fitness level or lifestyle. While prioritizing safety is important, finding a balanced approach that works for you is key. In this episode, we answer a listener's questions about working out during pregnancy, including cardio, HIIT, and strength training. Learn about the research, how to assess your comfort level, and how to make informed decisions about staying active during pregnancy.     Thank you to our sponsor   20% off Mommy Steps or Form insoles with the promo code FEET. Increased levels of the hormone relaxin during pregnancy can relax the ligaments in your feet, permanently changing your foot's shape and structure by causing your arches to collapse and over-pronation. This can lead to developing bunions, stress and inflammation on the tissue along the bottom of your feet, and even your feet increasing in size. In one study, 61% of participants had a measurable increase in foot length, and 22% reported going up a shoe size. The good news is that wearing insoles can support your arches and protect your feet from going up in size.     Read the full article and resources that accompany this episode.     Join Pregnancy Podcast Premium to access the entire back catalog, listen to all episodes ad-free, get a copy of the Your Birth Plan Book, and more.     Check out the 40 Weeks podcast to learn how your baby grows each week and what is happening in your body. Plus, get a heads up on what to expect at your prenatal appointments and a tip for dads and partners.     For more evidence-based information, visit the Pregnancy Podcast website.

Send us a textWhat if the journey from womanhood to motherhood offered more transformation than you ever imagined? Join us in a heartwarming episode with Khyati Desai-Seltzer, a mompreneur with a passion for social impact, as she recounts how her own birth stories, including an unexpected cesarean delivery, propelled her into a world of empowerment and community support for new parents. Dive into Khyati's personal experiences with the invaluable support of a doula, as she shares the challenges and triumphs of the fourth trimester. Her transformative path reshaped not only her personal life but also her professional endeavors, spotlighting the importance of advocacy and nurturing environments for mothers.Uncover the powerful benefits of baby massage, a practice Kiaty champions through her venture, Vyana Infant Massage. This episode offers a glimpse into the immediate and long-term advantages of fostering a touch-positive atmosphere, teaching consent, and nurturing healthy touch within families. From improved sleep for infants to stronger parent-child bonds and mental health support, Khyati's insights reveal how touch can transform emotional well-being and family dynamics. We also explore the broader societal impact of nurturing touch, emphasizing how it contributes to healthier relationships and emotional security from an early age.Our conversation with Khyati doesn't stop with individual practices; it extends into the broader need for community support. Drawing inspiration from global postpartum customs, we explore modern solutions that can help new mothers thrive, such as virtual villages and shared knowledge platforms. Highlighting the significance of self-advocacy and education in healthcare, we champion the idea of seasoned mothers mentoring newcomers, ensuring that no parent feels alone in their journey. This episode is an inspiring call to action, encouraging society to support new moms and celebrate the power of community, touch, and transformation in motherhood.Connect with Khyati at vyanainfantmassage.com 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 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 ACOG's PB 205 (2019; reaffirmed Aug 2024) states that "when compared with spontaneous labor, induced labor is associated with a lower likelihood of achieving VBAC". Additionally, that guidance states, "Several studies have noted an increased risk of uterine rupture in the setting of induction of labor in women attempting TOLAC". These are important observations to review with a patient. However, according to a study soon to be published in March 2025, based on US Vital Statistics birth certificate data, that may not be the case. YEP...Medicine Moves Fast. Listen in for details.

If you are looking for VBAC inspiration, Kelsey's episode is a MUST-LISTEN.Kelsey is a VBA2C mom and speech-language pathologist living in Erie, Pennsylvania. You will feel literal full-body chills as she tells her birth stories on the podcast today. As a first-time mom, Kelsey chose a Cesarean over physiological birth thinking it was the safer, easier route. But after experiencing the reality of two C-sections, she went from fearing vaginal birth to trusting in the labor process even more than her providers did. With her VBA2C, Kelsey got just about every type of pushback in the books. She was coerced, persuaded, questioned, and fear-mongered by multiple providers. Yet Kelsey was able to ground herself by listening to VBAC stories on The VBAC Link Podcast, seeking refuge in her doula and Webster-certified chiropractor, and connecting with other VBAC moms. Kelsey knew her body could do it. She just wanted a chance. Going up against a hospital practice that was saturated with skepticism, Kelsey's labor was beautifully textbook. Her labor progressed quickly, and her biggest baby yet came out in two pushes– “like butter” as described by her doula!VBAC-Certified Doula, Tara Van Dyke's WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have another amazing story for you today. And actually, it's stories. We have a VBA2C mama coming your way. And as you know, this is a hot topic because lots of people want to know if vaginal birth after two Cesareans is possible. So Kelsey will be sharing her stories with us today. But guess what, you guys, I have a co-host today and it's Tara. Hello, Tara Van Dyke.Tara: Hello. Hello.Meagan: She is one of our VBAC link doulas. As you probably heard back in 2024, we are going to randomly be having co-hosts from our VBAC Link doulas. I think it's so awesome to have them on. I love hearing the topics and things that they want to suggest to talk to you guys about because again, just like we talked about years ago, we just in Salt Lake City, Utah, can't share enough. And so we want other doulas from all over the world to share as well. So Tara, tell us more about where you're from and then your topic on partners and being prepared.Tara: Yes. So thank you for having me here with you. This is so fun to hear a story live. I'm a doula working in the Chicagoland suburbs. I've been doing that for 20 years and now moving to more of childbirth education as well as like a lower caseload of doula work partly because I just welcomed my first grandchild this week, so I want to be available in a different way in my life. Meagan: Congrats. Very valid. Tara: So I do a lot of childbirth education. But along the way, what's always been really important to me and I feel really passionate about is the partner connection with the person giving birth and their preparation. The research supports it too, that a prepared partner makes a really big difference in outcomes too. I know we talk a lot about doulas and increasing the positive outcomes of birth, and that's been shown over and over in studies, but the actual dream team is a doula and a prepared partner.Meagan: Yeah. I love that.Kelsey: I tell the dads who come to my classes that the doula is important, but we are replaceable in this situation. The partner is so important because of that connection because they bring the oxytocin. They bring the safety. They have that history with you already. And what even bumps that up to being really helpful in the birth room is their preparation and their understanding of what to expect and being completely on board. So theres lots of ways for partners to get prepared, but they get left out a lot. So I feel really strongly that partners are so much better in the birth room when they're not feeling anxious about what's going on, when they know what to expect and they have a few good tools in their pocket for how to help.Meagan: Oh yes, I could not agree more. I always talk about, I make things up, and I call it the doula sandwich. So it's just what I call it in my practice of my doula work. One bun has all the oxytocin and all the knowledge of who you are, and then the other side is the doula who has the education in birth work and the ideas of how to help navigate through the birth space, but also can then support the partner in doing that and educating the partner. So then, we've got two really great sides and then we sandwich the doula. We have great buns. We have really great buns. And we sandwich that mom together and with love and support and education and oxytocin. Like you said, it really creates that dream team. I love that so much. My husband didn't educate himself. He was just, "Okay fine, if you want a VBAC, go do it. You do the research." I did HypnoBirthing with my cousin who luckily was pregnant around the same time, but we did that together, and he just really didn't know. When I told him, "Hey, I want to VBAC after two caesareans out of the hospital," he was like, "Yo, what?" because he was uneducated. I truly feel that it is so powerful. That's why I encourage partners to take the VBAC course with, the mom or an education course in childbirth. Really understand what the mom is going through, but also know how you can help because I do feel like a lot of those dads kind of get shoved aside. They want to help, but they don't know how to help, and they don't really know what's going on. Is that noise good or is that noise bad?Tara: Yes. Yeah. And they're going through the birth, too. This is the birth of their child. So they can also feel, as far as traumatized, hopefully not trauma, but they can feel a lot more dissatisfied or upset by a birth if they didn't know that what was happening was normal. So it's good for them, too, to learn how to take care of themselves as well as their partner.Meagan: Love it so, so much. Everybody, get your partners educated. It is so, so important. Thank you so much for that tip. Meagan: Okay, Ms. Kelsey, it is your turn, my love.Kelsey: Okay, so as you know, I had a VBAC after two C sections which I didn't even know was a thing. You played such a huge part in giving me education and the motivation to pursue this. My story starts in October 2018. My husband and I found out we were pregnant with our first. It was really special because it was actually our two-year wedding anniversary. It was that morning that we found out and we had a special trip plans to Niagara Falls, just up in Canada. It's a special place for us. It was where he proposed to me. It was just a really special time. It was also kind of crazy because up until that point, up until just prior to that, we had been together eight years, and we didn't think we were interested in having kids. I'm so grateful that our mindset had shifted, but it was just kind of a lot at once. We had agreed that we did want to start a family, but it happened really quickly, and it was just a lot to process. I didn't educate myself at all about birth. My husband and I took a class in the hospital, but it was pretty much just how do you take care of a baby. It wasn't how to bring a baby into the world.Meagan: Yeah, yeah. Sometimes those can be a little more what to expect after than really what to expect during.Kelsey: Exactly. And, I don't know what it was. I don't know if I just couldn't really picture myself giving birth just because we had just kind of come into this or if I just was not believing in my body, but I just felt the opposite of a lot of people on this podcast. They say, "I never thought I would have a C section. I never expected that for myself." For me, I just went into it thinking I'm intimidated by all of this. A C-section sounds easier and I cringe saying that now. But, I just thought not having to go through labor and not having to push a baby out, I just always had that in my head. That comes into play with how my first ended up. I was told throughout my pregnancy that my baby was big and specifically it was driven home, "The head is big. The shoulders are big." They were telling me about shoulder dystocia, and I didn't know anything. So I'm thinking, oh my gosh, not only am I already intimidated by the idea of birth. I know nothing about birth, but now you're telling me I have this big baby. My OB was really telling me maybe a C-section should be considered. And then she threw it out there. "Well, we could induce 39 weeks and see how things go." And again, I was just trusting her. She had been my gynecologist since I was a teenager. To me, I thought, okay, that makes sense. Baby's big. And again, I hadn't done any research on my own. So we did what I referred to as a half-hearted induction. I feel like it was just done to humor everyone. Like, "Oh, we tried." But I went in the night before at 39 weeks on the dot. Nothing was going on with my cervix. Surprise, surprise at 39 weeks. They did Cervadil and I just lay in the bed. My husband and I watched the fireworks out the window. It was the fourth of July. We were just completely not prepared for anything. Just going along with this and thinking, oh, we'll just have a C-section tomorrow if this doesn't happen. They came in the morning and nothing had happened. So they were like, "Oh, well, we could start Pitocin. We could do this." I just wasn't interested in any of that. I wasn't motivated to have a vaginal birth. I guess that's okay. That's just where my head was at the time. I've accepted that's just where I was at. So we had the C-section. It was a surgery. Just being there and as baby comes out, just hearing everybody in the OR talk about, "Oh, look at her cheeks and look at the hair." It was minutes before I'm ever able to get a quick flash of her around the curtain before they swoop her off. It was just a weird experience, but it was all I knew. I was grateful that it went okay, but it just makes recovery so hard, so painful. When I think back to it, just think about just crying while my husband's trying to do my abdominal binder, not being able to get in and out of bed, struggling to breastfeed, even getting in a position of breastfeed with that searing surgical pain. We struggled, and I ended up exclusively pumping. So it was tough as a first-time mom just dealing with all of that. But again, I didn't know any different. I think that was a blessing that I didn't know what I was potentially missing. For my second birth, we knew he wanted more than one child. You just never know how things are going to happen. We just weren't trying to not get pregnant, and it happened right away. The babies were 16 months apart, so when I showed up to my appointment, my OB, the same one who had said, "You have this big baby, and you should have a C-section or induce at 39 weeks." Oh, the ARRIVE study was hot off the press at that point too. So he was excited to show me the ARRIVE study back.Meagan: Oh, yeah, but you're not even a first-time. I mean, you were a first-time vaginal mom. So the ARRIVE trial, you know. You've been with us. Hashtag eyeball.Tara: Yeah, yeah, it changes. It's changed everything.Meagan: It really has. And I don't know if it really has changed for the better in my opinion.Kelsey: So sorry, that was for my first birth. I forgot to mention.Meagan: Oh, oh, oh, sorry. Yes, that would make sense. Yes.Kelsey: So with the second, it was the same OB, and she's like, "Okay, since your births are so close together, you'll just be a repeat C-section. You can make appointments with me, and I'll do your surgery. Easy peasy." I'm thinking, oh, okay. That makes sense because she's talking about uterine rupture, and they're so close together and I didn't research on my own. Is there another option? How risky really is this compared to a repeat C-section? I just trusted her so much. I had been with her for so long. I figured she must have my best interests at heart.Meagan: Yeah.Kelsey: I didn't even think to myself, my own mother had a VBAC with a 13-month age gap. I was a C-section, and my brother was a VBAC at 13 months 30 years ago. Meagan: Uh-huh.Kelsey: You only know what you know at the time. And so even though I didn't look into it in the ways that I should have, I did know that I wanted the experience to be a little different. So I found out about gentle C-section which I think is a funny term. Meagan: I was happy to see that you could request a clear drape, and you could request not to be tied down to the table. We did implement a few of those things. I had the clear drape. It was nice to see her coming out just for a quick flash before they swooped her away. It was nice not to be completely-- I had one arm free which is funny these things that we consider luxuries when you're having a C-section. So it was a little bit better in that way, but there were things that were also worse. They couldn't get the needle in, and they had a resident doing things. I was having trouble. I was starting to pass out during. They were having to adjust. It was stressful in its own way. I had some things that were a little better. But also, it's just's a C-section. Also, during, my OB made a comment as she has me completely open, all seven layers of me. She said, "Yeah, who was it the did your last C-section?",I told her and she made no comment. I said, "Why are you asking me this as you're inside my uterus?" She said, "There's just more scar tissue than I would have expected." She said, "Hey, you can have another baby if you want, but just wait more time in between. Just not so close together." So that was something that got in my head too. Anyway, we thought there was no way we would ever have a third. It was really hard having two under two recovering from another C-section. It was November 2020, so it was the first COVID winter. It was cold. It was dark. Everything was closed down. Everybody was in masks. It was so depressing. It's like, postpartum isn't hard enough. As if two under two isn't hard enough, then adding COVID.Meagan: Yeah, adding zero support and zero resources. Yeah.Kelsey: Nowhere to get out and do anything. It was a bummer. So anyway, it was a lot, and we thought, no way are we ever going to have three. It was just a hard season. So I donated everything. I put all my carriers and all my stuff out on the porch and said, "Come get it," to the local moms group. I just couldn't see myself having a third. Well, then the years pass, and things get easier. You come into an easier season. All of a sudden, we're not dealing with diapers and bottles. It's like, we could leave the house. Things are opening back up. My husband and I had talked about a third and toyed around with the thought of it, but it's just hard to pull the trigger once you've come into this easy season. The thought of hitting the reset button is intimidating. But all it really took was watching him take down my youngest's crib with her. And it was like, okay, this is something that we want to do. It was a funny conversation that night. I said, "If we were to get pregnant this cycle, we would have a June baby, and that would be really nice." So that's what happened. I was playing it with my third. That's when I realized. I mean, I had thought about it, obviously, but I realized, oh, my gosh, I have to have another C-section, a third C-section. Talk about being years away from it and thinking about how you're all healed. It's been a few years, and to think about them cutting open again and just knowing what that entails, I was just in a whole different headspace. I was thinking, how is there a way that I can avoid this?Before my first appointments, I did a quick Google search, "vaginal birth after two C-sections" just to see if this was something anybody had done or was doing or was even possible. I was so excited to see that people were doing this. It looked like it was actually potentially a good possibility. So I was thinking, I've got to be the right candidate. I didn't even need those first C-sections. I knew this now, reflecting back. Yeah, I had my first screening where they do your intake, and they were asking a bunch of questions. And I had said at the RN, I said, "Would I be able to maybe have a vaginal delivery after two C sections?" And she was like, "Oh, they consider it after one, but once you've had two, you're a C-section for life."Meagan: Oh, jeez.Kelsey: Something about her saying that and the way that she said it, I went from being a little bit curious and oh, this might be good, to no, this is something I'm going to pursue. It just didn't feel right. She didn't know my history. She didn't know why I have my C-sections. So to tell me, "Oh, no. You need to have a third major surgery for sure. No option." Tara: It was this moment when it brings a fight out in you. Like, I am gonna do this now.Kelsey: I'll never forget how I felt at that moment. So I started to have my appointments with the OBs, and I would bring it up. Everything was perfect. It was going really smoothly. So the appointments would be like two minutes, and then at the end they'd say, "Do you have any questions or concerns?" And I'd say, "Yeah, I wanted to see what my options are for delivery." They were like, "Well, we decided as a practice to support VBAC after one C-section, but we actually have a policy against VBAC after two C sections."Meagan: How did I know that was coming? The policy, I swear, every time it's like, "We decided as a practice or as a practice, we--". It's always like, they created this stupid policy that actually is against evidence based care. But okay.Kelsey: I'm thinking to myself, so then what do you do? Anyway, I was just mind blown by that. I went to a couple of more appointments there. You'd go every month and they'd say, "Any questions?" I'd say, "Yes. I'm just really not feeling good about the idea of a third C-section." I said, "The risks of a third Cesarean intimidate me much more than doing a trial of labor." I've never given my body a chance. It's not like I've been through this before and things went wrong. I've never been given a fair chance. They were very nice, but they just look at me and smile and nod and say, "Well, it's gonna be okay. It's gonna be okay," and not even entertain the idea for a second. So I'm thinking to myself, okay. I've gotta figure something out. So at that point, when I had talked to a couple of providers, and they were all very consistent about, "Nope. Nope, not even going to entertain it," I knew something had to change. I'm reaching out. I'm searching in the local moms group about C-sections. Has anybody had a VBAC after two? It was crickets. Nobody was responding. I was looking back years trying to find anybody who had done this, in the area. Wat I was finding is, "No, it's not going to happen in Erie. You need to go to Pittsburgh or try a home birth." And I'm just really not comfortable with the home birth even though I know that's a perfect option for plenty of people.Meagan: It didn't feel right for you.Kelsey: Yeah. It just wasn't what I was feeling like I wanted to do. So I reached out, and I had not known anything about doulas until your podcast. I hardly even knew what they did before listening. I just searched "doulas in Erie." I called the first one I saw. I left a message that was probably pretty unhinged just like, "Help! What do I do? Is this something I can do?" She called back, and it was the first time that I had any validation at all. Up until then, it was just people telling me no, people telling me policies and not safe. It was the first time that I was heard. I was heard. She said, "There's really no reason why you can't have a chance. We'll figure this out." I kept doing my research. I dug really deep, and I found a few people who had referred to providers being supportive. I was reaching out. I was sending people DMs saying, "Hey, sorry to be huge creep, but can you tell me more about your experience?: I found out that at the other practice there were providers who would consider this. So it wasn't looking super promising, but it was better than where I was at. So I kind of took a chance. I switched practices at 28 weeks. Prior to that, I had an amazing appointment at 24 weeks. I had one last appointment at that office with the policy. He was amazing. If you could have just copied and pasted him, he was just like a midwife. I mean, he was very upset about the policy. He said, "How do you even enforce that?" He said, "What are we going to do? What are we going to do, strap you down and take you to the OR?" I wish that he had a podcast episode because he took so much time. He explained to me  the history of C-sections and how, in his words, the pendulum has swung so far from only doing C-sections when they were needed to they're safe now. Let's do them whenever we can. He talked about the whole policy thing and how they met as a group. He said, "Some of these younger JOBs have only been practicing now that C-sections are so common. They haven't seen the success." He said, "You have just as much of a chance of success as a 20-year-old walking off of the elevator because our C-section rate is so high. You have just as much of a chance." He laughed at the fact that macrosomia was in my chart, which I forgot to mention with my first. She was 9 pounds, 1 ounce. She was big.Meagan: Okay. I wanted to ask you though because they had said, "Oh, big baby, 16 months apart." I wanted to ask, but 9 pounds, 1 ounce is actually not macrosomia. It's a bigger baby, but it's not a huge baby.Kelsey: Exactly. It's not 12 pounds, which also, people have done. But anyway, he put so much wind into my sails, and he fully supported me switching. He said, "Honestly, I think this is great. I think this is the best option for you. You need to go for it." He said, "But if you were to stay here, you would face nothing but doubt and bullying and scary." He said, "If you were my wife, I would tell you to switch over to this other practice." So that's what I did. I also forgot to mention in my anatomy scan, the sonographer is going about doing it and she said, "Were your other babies big?" I'm like, no, we're not gonna start this. It was already with the big baby comments. So they had me do a growth scan to switch practices. It was refreshing to be in a place where they entertained the idea. They said that they decided as a practice to follow what ACOG says, but it was also very clear the difference between support versus tolerance. So although I was grateful that they were entertaining the idea, I still had, "Oh, 90th percentile. Oh, you've never labored before. You don't have a proven pelvis."Meagan: Proven pelvis. Tara: Yeah, proven pelvis.Meagan: There's a lot of eye rolls in this.Kelsey: Thank goodness, again, if it weren't for this podcast, all of those little comments would have swayed me. I would have said, "What am I doing? Listen to all these things they're saying. This isn't right for me." Once you know, it's just so hard to listen to the VBAC calculator. "Oh, let's just type your stuff in and see." I think it gave me, like 50% chance. Like, I don't know. So anyway, I'll get back on track. My low point was at 32 weeks. It was with my provider who was convincing me that a C-section or induction was right, and then telling me, "Oh, you'll just be a repeat. We'll schedule it." I was dreading my appointment with her. I knew that I needed to meet with her because she could possibly be the provider who was on call. I wanted to tell her what my plan was, and assess her thoughts. I thought that I was invincible because now I knew all of these things, and I wasn't going to let anybody bring me down. That appointment was pretty terrible. She came in hot. She said, "You're 32 weeks. Baby is 5 pounds, 4 ounces, and he's off the charts." She actually referred to him as massive. She said, "He's massive. He's huge." She said, "Put him in a room with 100 babies, and he is enormous."Meagan: Enormous. Tara: She's comparing him to other babies already. Meagan: And he's not even born. Tara: Can I just add a little tidbit here because there's so much talk in your story about the fear of big babies, and the research has shown that what leads to more problems or interventions in a birth with a big baby is not the actual size of the baby, but the provider's fear of the big baby. They're already getting themselves stirred up, and nothing has even happened. Kelsey: I was really discouraged by that because I had come across those facts too. And looking at the research and looking at what are the real risks of a big baby, that's actually just the providers. Yeah, se was just disgusted with my plan. She said, "Are you sure?" I said, "Yeah." I really stood my ground. I was so proud of how I stuck to my guns. She pulled out all the stops. She just kind of sighed and she said, "Okay." And then she pulled it out of me as I was  trying to justify. I said, "We're not sure how much we want to grow our family." I said, "If I have three C-sections, I'm not going to want a fourth." I said, "I just think it's worth a try." So she took that and she ran with it. She said, "Well, for what it's worth, I would rather do two more planned C-sections. I would do two more planned C-sections on you, and I wouldn't bat an eye. I'd rather do that than have you TOLAC." I thought, oh, my gosh. So again, I stood my ground. She went out. She was visibly upset. I was so proud of myself. But then I spiraled that whole day. It just chipped away at me all day. I came home.  I had been doing nightly walks religiously. That's when I would listen to The VBAC Link. That night, I didn't do my walk. I cried in my bed. I was just so upset. I spent the night then going through the groups I was in for VBAC after multiple Cesareans and The VBAC Link searching "big baby, big head circumference" and screen-shooting all of the success and all of the comments to fuel back my motivation. That was definitely the low point, but I did have some great meetings with providers. I was grateful that where I was living, I was able to find enough support where they would let me go for it. Once I got toward the end, there kept being the comments about "big baby". I had an OB do my final measurement and not tell me what it was. I said, "How is baby measuring? There is a lot of drama about baby being big." She was like, "Well, how big were your other two?" I said, "They were 9,1 and 8,4". My second was almost a full pound smaller. She said, "Oh, if you pushed those out, no problem. You don't have anything to worry about." I said, "That's where the drama was. I didn't push them out. I had C-sections." It was like she saw a ghost. She was like, "Oh, well that is drama." She was just beside herself. I say that story specifically because spoiler alert, she was the one who ended up delivering my baby.Meagan: Oh, really?Kelsey: To give a preface to that. She actually said, "Well, it is what it is." She just was very nervous and very upset. I said, "Have you never seen a VBAC after two C-sections? Have you seen that?" She said, "Well, yeah, but it's usually with people who have birthed vaginally before, and not with a big baby." That's what she said. Meagan: Oh my gosh. Kelsey: I just wanted to talk about that because she was the one who delivered Anyway, time went on. As I got to 39 weeks, I started to stand my ground a little bit more because they wanted to do cervical checks. They'd say, "Okay, undress for the provider." I just was like, "No, thank you. I'm good." I would have been really discouraged if they had come in and checked me. I know that got in my head with previous appointments with things that I didn't think would affect me. At 39 weeks, one of the providers who had been trying to talk about how big my baby was and persuade me to have an induction, she said, "What if we did a growth scan at 40 weeks, and you were measuring 10 pounds. Would that change your mind?" I was like, "No. I'm not doing a growth scan at 40 weeks. I've already done too many scans." So just right up until the end, they were trying to get me. They were talking about the size. Meagan: They were really trying to get you to cave. Kelsey: Yes. So after that appointment, because of my BMI, after 37 weeks and beyond, you have to have an NST and a BPP (biophysical profile) every week. Meagan: After 37 weeks?Kelsey: Starting at 37 weeks, you have to have both of those tests every week. It was just a new thing. I didn't do it with my last. Again, I'm worried about this. I know how the testing goes. Sure enough, I go. This is 39 weeks. I go for the biophysical profile, and they were like, "There is a lot of fluid. You have too much fluid." They were talking about all of the fluid. "Look, here are little flakes." They were talking about the fluid. I thought, I've made it this far. This is something that is going to make it a C-section.Baby wasn't also taking enough practice breaths for her which was frustrating. She even said, "I think he's sleeping, but I want to be on the safe side." I said, "I just had an appointment. She could hardly get his heart rate because he was moving so much." I had driven to Cleveland an hour and a half away the night before to go to a Noah Con concert. I felt him moving the whole time. I was like, "I'm pretty confident that he's okay. I was just checked by my OB five minutes ago." She wanted to send me. I wasn't going to mess around this far on, so I went to triage. They hooked me up to an NST. They wouldn't just let me do it in the office. I'm sitting there. Everything is perfect. The nurse comes in and said, "They're just going to place an IV." I stopped and said, "What did you say?" She said, "They're just going to place an IV." I said, "Why would they place an IV? Everything is looking good. I have grocery pickup in an hour. I'm not trying to be here for long." She said, "Just for access." I said, "No, thank you. Please let me out." That was weird.She said, "Okay. We're just going to watch you a little longer." Then this OB who I'd never seen before who was apparently just newer to the practice comes in. I'm like, "How are things going?" At this point, it had been 45 minutes. I'm trying to get out. He said, "Things are looking really good." I could see his wheels turning. He said, "But, since you are 39 weeks and you've had two C-sections, we can do a C-section for you today." Meagan: Oh my Santa. Tara: Here you go. How did you manage all of this pressure, Kelsey? It's extraordinary. Meagan: It is. Kelsey: I should mention that I had an amazing doula, so after these appointments, I would text her a paragraph. She was constantly lifting me back up. I was going to Webster chiropractic care. The chiropractor I saw, shout out to Tori, she's amazing. She's a doula also. She was pregnant going for her VBAC, so we would have these appointments, and it was a mini VBAC therapy session. We would talk about what we were up against, and just the different providers because she was going to the same practice as me. It was just so nice to have her. I was doing all of the things. The chiropractic care. I was eating the dates and drinking the tea because I wanted to know that if I was doing this, I was going to try everything and then I couldn't look back and say, "What if I would have done chiropractic?" Anyway, I basically tell him, "Get out of my room. I'm going." He just was awful. He did all of the scare tactics and all of the risks but none of the risks of a third C-section of course. Only the risks of the very low uterine rupture that he was hyping up. Anyway, that was bizarre, but again, I stood my ground. I was so proud, but then I got home, and I spiraled. I was packing my hospital bag. I was crying. I said to my husband, "I let them get in my head. I shouldn't even bother packing any of this stuff." I had the little fairy lights and things to labor. I was like, "I shouldn't even bother packing any of this VBAC stuff. They're just going to find some reason to do a C-section. Look at this. This whole time, they wanted to do the C-section." Again, another night of spiraling. As he left, he said, "They're going to want to see you tomorrow and repeat all of this testing." Meagan: For what? If everything was okay, what was the actual medical reason? Kelsey: Exactly. It was just out of spite because I shut him down. They were like, "They're going to want you to come back tomorrow." I'm like, "Okay. If it gets me out of here and gets you out of access to an IV and a C-section, fine." Meagan: Seriously. Kelsey: The next morning, I'm on my way to my appointment. I was on the phone with my mom and I told her, "I'm having these weird feelings I've never felt before. I don't know if maybe they're contractions." It was very strange. It was something I never felt. I never had a contraction and had never gone into labor. So I go to my appointment and passed the BPP with flying colors. I'm like, "Well, what about the fluid?" She's like, "Yeah, there's a lot of it, but it's fine." I got an 8 out of 8 score.  I go for the NST. Well now, baby's moving too much, so his heart rate, they can't keep it on because he's moving, and she kept having to move it. So again, I'm just very frustrated that I'm even there. I'm so close to the end. This is now 39 weeks and 4 days. And so the tech says, "I'm going to bring this to him. He might not like the drop offs, but I'll explain to him that the baby's moving a lot."I said, "Who's he? What OB is this?" She said the OB who was in triage the day before who tried to have me do the C-section and I was just like, "Oh my god. He's going to see my name and have any reason to send me back." Sure enough, he comes sauntering in the room and he says, "We meet again," as if I'm this problem child, as if I wasn't just having all these normal tests. He says, "I can't be confident that these aren't decals. You need to go back to triage." I was just again, so frustrated. It's like just a constant of all of these things coming up and none of it being real. It'd be different if it was like, oh, this was actually a risky thing. But again, I'm so close to the end. I know what I know. I knew that the OB that I had seen the day before in the office, I wanted to talk to her about the fluid because I had searched, and I saw that the polyhydramnios could actually be a thing. If your water breaks, there's the risk of cord prolapse. So I knew that that wasn't something that was completely to be ignored, so I wanted to talk to her more about that. I humored him, and I went in. Well, all the while, I'm feeling these sensations more and more consistently. They get me hooked up, and I explain the situation. I said that I was just here yesterday not really for a reason, but I'm back now also not really for a reason. They hook me up. Of course, everything looks good. But she's like, "Are you feeling these contractions?" I'm like, "Is that what they are?" I was excited. They were just cracking up because she's like, "These are pretty consistent and big contractions." I just couldn't believe it. I was just so excited my body was doing it. I'd only ever, at 39 weeks, been cut off and then never been given a chance. All I needed, I guess, was a few extra days. I'm just so excited that I'm having contractions. The nurses are laughing. "We've never seen somebody so excited to have contractions." Anyway, at that point, my OB comes in, the one who had been trying to get me to be induced. She's plenty nice, but the one who said about if we did a scan of 40 weeks and 10 pounds, would you reconsider? So she said, "Kelsey, do you know what I'm going to say? This is the second day you've been in here in two days." I'm like, "Yeah, but for nothing."Meagan: And because you asked me to come in here.Kelsey: Yeah, trying to humor everyone and see that yep, everything's fine. See? But again, I was having these contractions, and as I was there, picking up. She wanted to check me. I said, "Okay, I'll let you check me," because I'm having contractions I never have before, and I want to see what's going on. I went to the bathroom, and I had bloody show, which again, I had never had. So things are really happening. I come out and I told her, "There's blood and I'm having contractions." She's like, "Yay, let's check you," and I was 1 centimeter. She was one of the OBs who was comfortable with a balloon. So she said, "I'll tell you what. You've got a lot of fluid. Things are happening. Let's work on moving things along."Meagan: So she induced you?Kelsey: She wanted to.Meagan: She wanted to. Okay.Kelsey: So she's like, "Let's get you in. I'll do the balloon. We can get things going because you've got a lot of fluid. It's time, Kelsey." I'm like, "Okay." I said, "Well, I'm gonna go home."Meagan: Good for you, girl.Kelsey: Get my kids off with my mom and get my dog off. She sunk when I said that. I said, "I promise I'll come back. I'm not gonna run it. I'll come back just in a little while. Like, maybe this evening." But she said, "Okay, I'm here till 4:00, and then it's another OB coming on who won't want to do the balloon." So just come in before then. Of course, I wait until exactly 4:00. But as I was home, it just kept picking up, and I started timing. The app is like, "Go to the hospital. Go to the hospital." But I've also know from listening to this podcast that that happens. My husband's freaking out because he would see me stop and pause, and he's like, "Let's go. Let's get out of here." I was grateful that everything maintained through the car ride. I got there, and contractions were still happening. My doula met us there because I hear about people going too early and the contractions stop, and then there are problems there. Yeah, things just kept happening. We got in a room. My doula was amazing. We were just hanging out and just laughing. I couldn't believe just how happy I felt to feel my body doing it after all these years of just, "Your babies are too big, and you can't do this," and then all of this pregnancy saying that. It was just amazing.  I definitely had my guard up. The nurse was talking about the IV and the monitors, and especially with being overweight, I was worried about a wireless monitor. That happens. They can't get a good reading, and then they think baby's heart rate's dropping. I was just so worried about any reason, because I knew that they would. They would take it and run, so I was so grateful that the wireless monitoring worked perfectly. I was on my feet. Things just kept getting more intense, but I'm just laughing and smiling through it all. My doula was amazing. It was just such a great vibe in the room. My nurses were amazing. Every little thing that went right, I just embraced. I was so happy that this was happening. My water broke while I was on a video call with my friend. Again, it just like, "Oh, my gosh, my water broke. That's never happened." There was meconium in the water. So again, I'm like, oh, no. You know, any little thing. I was quickly reassured. It was very light. It wasn't anything to be worried about. I labored and stayed on my feet. My doula was amazing with suggesting things I never would have thought or never would have thought that I would enjoy. I was in the shower at one point on a ball. They had this little wooden thing with a hole in it so that it keeps the ball from slipping out and keeps the drain from plugging. I'm just listening to my guilty pleasure music while my husband's outside the shower eating a Poptart laughing. It was just such a funny thing. I was just so, so excited about it all. Things were really picking up. My water just kept breaking and breaking. I mean, it was true. I had so much fluid. It just was just coming out and coming out. I couldn't believe how much there was. I got into the bed on my side, my doula said, "Try to take a break," and then I felt a water balloon in me. I could feel it burst. Just when I thought surely I was out of fluid, it just gushed out. And then immediately it was like, "Oh, my gosh, this is really intense." I handled that for a while. I was squeezing the comb. I was working through contractions, but I tapped out at about 1:00 AM I'd say. So we got into the hospital around 4:00, and the time just flew. They came to do the epidural, and he put it in. I just kept waiting for relief because I felt like I just didn't have a break. They were kind of on top of each other. It was one of those things that if I knew I was only going to have to do that for a short amount of time, but just not knowing how long, I just felt like I was suffering through them at that point. I wasn't trying to be a hero. I was just trying to avoid what I know sometimes happens and just trying to avoid interventions as much as I could. I kept waiting for this relief because I'm like, "I think I just need to rest. I feel like I'm close." The last I've been checked, I was 5 centimeters, but that was before the water broke and before struggling through contractions for a while. I had no idea how dilated I was. The relief never came. I was hoping to be able to relax and maybe take a nap like sometimes I hear. I could still feel my legs. I could have walked around the room if I wanted. I kept pushing the button. I don't know if it was in the wrong spot or what happened. I don't know if maybe there was something that was working because instead of feeling crushing and just defeated through the contractions, I was feeling like I can survive that. I can get through them. There was just no resting, it was just still having to work through contractions. And then my doula at one point said, "Maybe we should call him in and have him redo it." But then I was in my head, "Well, what if he redoes it, and then I'm too numb and I can't push?" So I just went through it. I'm so glad that I did, because it wasn't long after that that I was checked, and I was 8 centimeters. My  nurse kept checking and there was a lot going on down there and a lot coming out. Eventually she checked me and she said, "Hi. Hi, buddy. I just couldn't believe it." She said, "Do you want to feel him?" I got to reach down and feel his head. It was just also surreal. She had me do a practice push once I was dilated enough, and she's like, "O, oh, okay, okay, okay." She said, "I'm gonna go make a phone call."Tara: Wow, that's impressive.Kelsey: And the OB came in. I forgot to say that when I got to the hospital, the OB who was gonna do the Foley balloon, I totally left this out. She checked me, and I was already 2 centimeters. She said, "Your body is doing it on its own. We're just going to let you go."Tara: That was my question, Kelsey. I was wondering this whole time if they did anything to augment. There was no Pitocin. This was all you? Kelsey: Yes. Yes. I can't believe it.Tara: That's amazing.Kelsey: I got there, and I got the monitor placed. She came in. She checked, and she said, "You're 2 centimeters. We're just going to let you go. We're going to let you do your thing." That was just music to my ears just knowing how things sometimes go. Also, the OB coming on, I had told you, was really nervous about my plan. My husband and I joked that she did something to calm herself down before she walked in because she was just like, "You know what? I'm going to do something crazy. I'm just going to channel my inner midwife and do something crazy and just let you go and leave you alone." My doula is like, "Good. Please let us go." Yeah, I forgot to mention that is not only did I not need the induction, but then I had the OB surrendering and saying, "Go ahead, just let's do it. It's fine." So she literally did not come in. I think was as far away as she could pretending it wasn't happening, I guess. When the nurse called her, she came in and she got her gloves on. I just kept waiting for something to happen still. I'd been so, so scared by providers this whole time. So I'm like, okay. She instructed me on how to push. We did it through one contraction, and his head came out. I was like, "Oh, my gosh. This is crazy," and then, during the second contraction, I did it again, and the rest of him came out. It was unbelievable. It was five minutes from start to finish. My doula described it like butter. He was 9 pounds, 3 ounces.Meagan: So biggest baby. OkayKelsey: Biggest baby, enormous head. I didn't have any tears. I had what the OB described as grazes, like little spots that were bleeding. She put one or two stitches on the walls from where there were these grazes and I can't even describe it. I was sobbing. I was like, "We did it. We did it." He came right to my chest and to get to see him, it was unbelievable. It all happened so fast. Going from not believing in my body and just going for these C-sections, I'm so glad I didn't know what I was missing because in that moment, I probably could have done this before. Again, I didn't know what I didn't know and who knows would have gone? But it was just unbelievable to be in a normal room to have him come out and just right to me where he belongs and getting to see him with his cord still attached and he's crying. It just was such a beautiful moment and I just couldn't believe that had after all of that, here he was. It was beautiful. They asked about cutting the cord, and we hadn't even discussed that. I was like, "Can I do it? I really want to do it." I wanted all the experiences that I could never have gotten in the OR. I cut his cord. My doula got an awesome picture of that. I was considering having that be my picture for the podcast. It was just unbelievable, and I was just so happy, too, that that OB was the one who was there because seeing how nervous she was, I'm so glad that she got to experience. Look what you almost deterred me from doing just seeing how perfect it was. Now I'm hoping that if somebody comes to her in the future, she'll remember and say, "Hey, we had this baby, and it was just such a great experience." I was just so grateful for every second. I couldn't believe how things ended up.Meagan: I am so happy for you. Like Tara was saying, I'm so impressed. Standing your ground the way that you stood your ground after just constant-- I'm gonna call it nagging. They were just nagging on you and trying so hard to use the power of their knowledge that we know that they hold. We as beings, and it's not even just in the birth world, just as humans, we have this thing where we have providers, and we know that they've gone through extensive amount of schooling and trainings, so it's sometimes easy as you said, you spiraled when you got back to spiral and be like, wow, they're just all pushing this really hard. Maybe I should listen. Tara, have you experienced this within supporting your clients or just your own personal experience?Tara: You mean the pushback from the providers?Meagan: Yeah, the pushback, and then for us, should we doubt our intuition? Should we doubt what we're feeling and go with what they're saying because they know more?Tara: Yeah, I mean, that's the hardest thing, because you hire them. Like you said with your first provider, you trusted her. You'd known her since you were young. You've built this trust. She's gone to school. It's so hard to stand up against that as just a consumer and as a person who cares about the health of your baby and your family. But then the multiple times that you had to stand up for yourself even in small things like not getting the IV, not getting the cervical exam, those are not small things. You were protecting yourself from having more of that pushback. I am amazed. We struggle with that as doulas too, because we're helping advocate for our clients. It sounds like your doula was a rock for you and a place to feel validated and heard. I'm so glad you had her.Kelsey: Me too. I say to my husband, "No offense, you're great, but what would be done without our doula?" I mean, she was unbelievable just bringing the positive energy. My husband and I were so nervous and we were so worked up. We were third-time parents, but it was our first time doing any of this. My husband wouldn't have really known. He's never seen it before. My doula, she's done this so many times. She was right in there with the massaging and the side-lying. She did the, she called it shaking the apples.Tara: Oh, yeah. Yeah, that's a good one. But Kelsey, it's against all odds. I just think it's amazing because we talk about the power of oxytocin and feeling safe and not having stress hormones going on, and you had all of that. You should be so proud of your body coming in in the nick of time and just proving against all of this. I'm just gonna go ahead and birth this baby, and a bigger baby than your other two which is such a triumphant moment.Meagan: Seriously.Kelsey: His head was 15 inches. That was another thing because they had talked about his head circumference being off the chart. That was another thing I had been searching is people who've had the big head circumference. Those groups, this podcast and just groups and having access to so many stories and people overcoming all of these obstacles because every time I came up against something, I had heard it before. I said, "Oh, this is something that I've heard time and time again with these stories. They make you feel like you're the only one with the big baby and, oh, this is a problem. But it's like, no. They're saying this to so many people. It was just amazing going into this being so informed and motivated and having that confidence that I never would have had. I just so grateful for this podcast and for all the information.Meagan: Well, thank you so much. It's one of the coolest things, I think, not only just the VBAC, but to see where you came from at the beginning of, "We're not having kids. Okay. We're having kids. Okay. This is what I'm thinking. I'm kind of scared of this. Let's do this. Okay. Doctor said this. Let's do this." to this. I mean, you came so talking about the pendulum, right? And what that provider was talking about. You came from one side over here to not even wanting kids or wanting a vaginal birth to swinging so far to the other side and advocating so hard for yourself and standing your ground. When we say that you should be proud, I am shouting it. Be proud of yourself. Girl, you are incredible. You are such a great example. Women of Strength, if you are listening right now, I want you to know that you can be just like Kelsey. You do not have to be bullied. You do not have to be nagged on every single time. Know what's right. Know your gut. Know your heart. Do what you need to do, and you can do it. You can do it. It is hard. I know it's hard. It is not easy, but it is possible. Girl, you're amazing. I thank you so much for sharing your story today and empowering all the Women of Strength who are coming after you and needing the same encouragement that you needed not even years ago. How old was your baby?Kelsey: So he is four months old.Meagan: Four months. Yeah, so a year ago when you were listening. I mean, really, so so amazing. Thank you so much. And Tara, it's always a pleasure. Thank you so much for being here. I couldn't agree more with your advice. Get your partners educated. Create that true dream team.Kelsey: Thank you.Tara: Congratulations, Kelsey.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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

One in five women in the U.S. have a BMI of 30 or more at the START of pregnancy. Around 1 in 5 women gain more than 40 pounds during pregnancy, which is more than any woman should gain. Only about one-third of women gain the recommended amount of weight during pregnancy. Gaining too much weight during pregnancy can increase the risk of HDP, GDM, fetal macrosomia, and can cause complications of birth, such as shoulder dystocia or preterm birth. Excessive weight gain during pregnancy can also increase the likelihood of postpartum weight retention. But what about stillbirth risk? Does excessive maternal weight gain during pregnancy increase still birth risk? The ACOG recommends antepartum fetal surveillance based on pre-pregnancy BMI. Why is maternal weight during pregnancy not an indication for an antepartum fetal surveillance? The data may surprise you! Listen in for details.

In 2013, The ACOG's Hypertension Task Force suggested that NSAIDS not be used in postpartum patients with hypertensive disorders of pregnancy due to theoretical concerns on BP aggravation. But “medicine moves fast”. In 2020, the ACOG “green lighted” ibuprofen use postpartum in these patients if no evidence of renal insufficiency was present. In episode, we will review a brand-new publication (soon to come out), in AJOG, released ahead of print on February 10, 2025. This study is a randomized trial also evaluating the effect of ibuprofen on blood pressure control in those with hypertensive disorders of pregnancy. Did they find something new? This highlights the importance of going through an entire study's materials and methods focusing on the years of patient recruitment to properly interpret results. Listen in for details!

Send us a textImagine facing the transformative journey of motherhood armed with the insights you wish you'd known before your first contraction. Our latest episode in the Birth Journeys podcast, part of the Pearls of Wisdom series, does just that by unwrapping the wisdom shared by mothers who've navigated the unpredictable, often challenging experiences of childbirth. We promise to equip you with not only practical tips on managing societal pressures and preconceived notions about natural birth, akin to preparing for a marathon, but also to highlight the significance of staying flexible with your birth plans and the supportive role of tools like epidurals.In candid conversations, we're joined by guests Emily Finnell, Natalie Davis, Stefanie Fernandes, and Alex Wachelka, who lay bare the emotional and psychological transitions they experienced during pregnancy and postpartum life. Their stories reveal the power of trusting one's instincts, embracing vulnerability, and overcoming the unrealistic expectations placed upon new mothers. You'll hear about the importance of self-belief, asking for help, and how these insights can serve as a comforting guide through the complexities of early motherhood, offering reassurance that you are not alone in this journey.As we navigate the early days of parenthood, Jenna Hodge, Amy Suzanne, and Marie Carle share invaluable lessons on self-compassion and balance. Their wisdom sheds light on life's temporary seasons, reminding us to focus on manageable aspects, trust the unfolding path, and cherish fleeting moments with our young ones. From the importance of rest to listening to our instincts, these conversations emphasize the beauty of imperfection in parenting and inspire confidence in trusting our inner voices throughout the adventure of raising children. Join us for a heartfelt exploration of motherhood's challenges and triumphs, as we learn to embrace the journey with courage and grace with additional wisdom from Neri Life Choma, Wendy Powell, Steph Sellen, Devin Garcia, Elise Nicole Kirkpatrick, Brigette Panetta, Maja Miller, Dr. Michelle Gerbi, Kiona Nessenbaum, and Emmy Kissinger. 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.

According to the ACOG, eclampsia is a low frequency, high acuity emergent condition. The rate of an eclamptic seizure is 1/200 in those with preeclampsia without severe features but is 4 fold higher ( 4/200 ) in those with preeclampsia with severe features. Traditionally, “textbook eclampsia” management did not include cranial imaging. However, that consensus is changing! In this episode, we will review data making the case for a standardized approach to eclampsia, which includes universal non-contract cranial CT after eclampsia. We will highlight a Clinical Expert Series ACOG publication from July 2024 as well as an upcoming publication from Pregnancy Hypertension in March 2025 which makes the strong case for this radiological diagnostic tool. Listen in for details.

Dr. Darrell Martin is an OB/GYN with four decades of expertise in women's health and the author of the bestselling memoir “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” In this episode, Dr. Martin and Meagan walk down memory lane talking about differences in birth from when he started practicing to when he retired. He even testified before Congress to fight for the rights of Certified Nurse Midwives and for patients' freedom to select their healthcare providers! Dr. Martin also touches on the important role of doulas and why midwifery observation is a huge asset during a VBAC.Dr. Martin's TikTokIn Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth RightsDr. Martin's WebsiteCoterie DiapersUse code VBAC20 at checkout for 20% off your first order of $40 or more.How to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. We have Dr. Darrell Martin joining us today. Dr. Martin hasn't really been in the OB world as of recently, but has years and years and over 5000 babies of experience. He wrote a book called, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” We wanted to have him on and talk just a little bit more about this book and his history. That is exactly what he did. He walked us down memory lane, told us lots of crazy stories, and good stories, and things they did along the way to really advocate for birth rights and midwives in their area. Dr. Darrell Martin is a gynecologist, a dedicated healthcare advocate with four decades of expertise in women's health, and the author of the bestselling memoir, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” His dedication to patient care and choice propelled him to testify before Congress, championing the rights of Certified Nurse Midwives (CNMs) and advocating for patients' freedom to select their healthcare providers. A standout moment in his career was his fervent support for nurse-midwifery in Nashville, Tennessee, showcasing his commitment to advancing the profession. Additionally, Dr. Martin takes great pride in having played a pivotal role, in like I said, more than 5,000 births, marking a legacy of life and joy he has helped bring into the world.Our interview was wonderful. We really walked down what he had seen and what he had gone through to testify before Congress. We also talked about being safe with your provider, and the time that he put into his patients. We know that today we don't have the time with our providers and a lot of time with OBs because of hospital time and restricting how many patients they see per day and all of those things. But really, he encourages you to find a provider who you feel safe with and trust. I am excited for you guys to hear today's episode. I would love to hear what your thoughts were, but definitely check out the book, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.”Meagan: Okay, you guys. I really am so excited to be recording with Dr. Martin today. We actually met a month ago from the time of this recording just to chitchat and get a better feel for one another. I hung up and was like, “Yes. Yes. I am so excited to be talking with Dr. Martin. You guys, he has been through quite the journey which you can learn a lot more about in more depth through his book. We are going to talk right there really quick. Dr. Martin, welcome to the show. Can we dive into your book very first? Dr. Darrell Martin: Surely. Thank you. Meagan: Yeah. I think your book goes with who you are and your history, so we will cover both. Dr. Darrell Martin: Okay, okay. Meagan: Tell us more. Darrell Martin's book is “In Good Hands”. First of all, I have to say that I love the picture. It's baby's little head. It's just so awesome. Okay, we've got “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” Just right there, that title is so powerful. I feel like with VBAC specifically, if we are going to dive into VBAC specifically, there are a lot of barriers that need to be broken within the world of birth. We need to keep understanding our birth rights. We also have had many people who have had their rights taken away as midwives. They can't even help someone who wants to VBAC in a lot of areas. A lot of power is in this book. Tell us a little bit more about this book and how it came about. Dr. Darrell Martin: Well, the book came because of patients. As I was heading into my final run prior to retirement, that last 6-8 months, and I use that term, but it shouldn't be patient. It should be client because patient would imply that they have an illness. Occasionally, they do have some problems, but in reality, they are first the client wanting a service. I thought my role as to provide this service and listen to them about what that was and what they wanted to have occur. In response to the question of what was I going to do when I retired, I just almost casually said, “I'm going to write a book.” The book evolved into the story of my life because so much of the patients and clients when they would come to me were sharing their life, and they were sharing what was going on in their life. Amazingly, it was always amazing to me that in 3 or 4 minutes of an initial meeting, they would sometimes open up about their deepest, darkest secrets and it was a safe place for them to share. I always was blown away with that. I respected that. Many times there were friends of my wife who would come in. I would not dare share a single thing notwithstanding the fact that there were HIPAA regulations, but the right thing was they were sharing with me their life. I thought, “I'm going to turn that around as much as I can by sharing my life with them.” It was an homage to that group of individuals so I would like them to see where I was coming from as I was helping them. That was the goal. That was the intent. Secondarily, for my grandchildren and hopefully the great-grandchildren that come whether I'm here or not because including them with that was the history of my entire American heritage and my grandfather coming over or as we would call him Nono, coming over to the United States and to a better place to better a life for his family. Our name was changed from Marta to Martin at Ellis Island. I wanted that story of his sacrifice for his family and subsequently my uncles' sacrifice and my parents' sacrifice for the priority they placed on families. That was for my children as well and grandchildren. There were a lot of old pictures that we had that we pulled out and that didn't occur in the book because there wasn't enough money to produce a lot of those pictures into the book, but they will be there in a separate place for my kids and grandkids. It was a two-fold reason to do the book. It started just as a narrative. I started typing away. The one funny ironic, and I don't know if ironic is the right word, story as I was growing up, is that people as my why I become an OB/GYN. I'm sure this was not the reason, but it's interesting as I reflected that growing up, it was apparently difficult for my mother to have me. I was her only child. She always would say I was spoiled nice, but I was definitely spoiled. When she was mad at me, the one thing she would say, and I didn't understand it until much later when I was actually probably in medical school, was that I was a dry birth and I was breech, and I just ruined her bottom. When she really got aggravated occasionally, she would say those little words to me as I was probably a teenager. Then on reflection, I became an OB/GYN so I really understood what she was saying then. Meagan: It was interesting that you said the words “dry birth” because my mom, when my water broke with my second, she was telling me that I was going to have this dry birth. She was like, “If you don't go in, you're going to have this dry birth.” So many people I have said that to are like, “What? I have never heard of that in my entire life,” and you just said that, so it really was a thing. It really was something that was said. Dr. Darrell Martin: Yes. It was a term back then in the late 40s to late 50s I guess. Meagan: Crazy. So you were inspired. You decided to do the OB route. Tell us a little bit of how that started and then how you changed over the years. Dr. Darrell Martin: Well, when I was in med school, and I went to West Virginia University Medical School, principally, it was fortunate because I would say in retrospect, they were probably lower middle class. I had the opportunity to go to West Virginia. Literally, my tuition per semester was $500. Meagan: Oh my gosh. Dr. Darrell Martin: My parents didn't have to dig into money they didn't have. They never had to borrow any money, so I was fortunate. I did have a scholarship to college. They didn't have to put out the money with the little they had saved. The affordability was there and never an issue. I went to West Virginia, and in my second year, I guess I connected a little bit with some of the docs and some of the chair of the department in West Virginia, Dr. Walter Bonnie, who I didn't realize at the time had left. He was the chairman of Vanderbilt before he was the chairman of West Virginia so now I understand why he was pointing me to either go to Vanderbilt or to Duke. I think I'm fortunate that I went to Vanderbilt. In spite of everything that happened, it was the path I was supposed to take. I did a little rotation as a 2nd-year medical student with some private OBs. I was just amazed. I was enthralled by the intervention of the episiotomies I observed. I said, “Well, you're going to learn how to sew.” What really struck me was that I went into this. I still can picture it. It was a large room where there were probably four or six women laboring. They had almost one of the baby beds. They had the thing where you can pull up the sides so someone couldn't get out of the bed. I couldn't figure out why someone in labor was like this. There was a lady there. I'll never forget. She had been given scopolamine which is the amnesiac which was often used where women sometimes don't even know where they are. They don't even have memory of where they are. She was underneath the bed on all fours barking like a dog. I asked him, “Why are you not going to let her husband in here?” They were saying things they probably shouldn't say under the influence of these crazy drugs. It made me start thinking even from that point on, “Why are they doing this? Why are they zapping them so much in the way of drugs?” Then I didn't see or understand fetal monitoring. We didn't have it at West Virginia. It came in my residency. It had just come in the first year prior to that, and the new maternal-fetal head at Vanderbilt brought in fetal monitoring. He had done some of the original research with Dr. Han at Yale. What I was doing a medical student during my rotations was sitting at the bedside. That's what we as medical students were responsible to do. Sit at the bedside. Palpate the abdomen. Sit with the fetoscope, the little one you stick around your head and put down, and count the heartbeats. We would be there six or eight hours. We were responsible for drawing all of the blood, but more importantly, we were there observing labor. Albeit, they weren't allowed to get up, but it was just the connection and I loved that connection. I loved that sense of connecting with people, and then that evolved into you connecting with them when they come back for their visits. I've had quite a few people who I've seen for 20, 30, 35 years annually. That became a much more than just doing a pelvic exam, blah, blah, blah. It became a connection. It was a communication of, “What's going on in your life? What's happening?” Meagan: A true friendship. Dr. Darrell Martin: Yes. Meagan: It became true friendships with these parents and these mothers. I think that says a lot about you as a provider. Yeah. That makes us feel more connected and safe. Dr. Darrell Martin: Yeah. I desperately miss that. I still miss that as a vocation and that connection. I would look forward to it. I would look on the schedule, “Who's coming in?” I could remember things about them that we would deal with for 15 years or more. One client of mine who, we would begin by, “How are you doing?” We would still go back to when her son was at a college in Florida and was on a bicycle and got hit and killed. We were relating and discussing that 15 years later. It was a place where she knew that we would go back to that point and talk a little bit about her feelings and it's much more important to me. If everything's fine doing a breast exam and doing a pelvic exam, listening to the heart and lungs, that's all normal and perfunctory. It's important, but what's really important is that connection. My goal also was, if I could, to leave the person as they went out the door laughing and to try to say something to cheer them up, to be entertaining, not to make light of their situation if obviously they had a bad problem, but still to say as they would leave with a smile on their face or a little laugh, but the funny one, I still remember this. We had instituted all of these forms. It would drive me crazy if I went to the doctor. We had all of these forms with all of these questions. They were repetitive every year. You just couldn't say that it was the same. She came in. She was laughing. She said, “These forms are crazy. It's asking me do I have a gun at home?” I said, thinking about it, in my ignorance, I hadn't reviewed every single question of these 15 pages that they were going to get. I'm sure it was about depression and to pick up on depression if they have a gun at home. She laughed. She said, “The young lady who was asking me the questions said, ‘Do you have a gun at home?' I said, ‘No, I have it right here in my purse. Would you like to see it?'” Meagan: Oh my gosh. Dr. Darrell Martin: So it was just joking about how she really got the person flustered who was asking the question. Sometimes we ask questions in those forms that are a little over the top. Meagan: Yeah. What I'm noticing is that you spent time with your patients not even just to get to know them, but you really wanted to get to know them. You didn't just do the checked boxes and the forms. It was to really get to know them. We talked about finding a good practice last time. What does that look like? What can we do? What are things to do? What is the routine that is normal for every provider's office or is there a normal routine for every provider's office? From someone coming in and wanting an experience like what you provide, how can we look for that? How can we seek that?Dr. Darrell Martin: Well, what you're saying and particularly when it evolves into having a chat, is first trust. you want to trust your provider. If you don't trust, you're anxious. We know that anxiety can produce a lot of issues. I would often tell a client who was already pregnant let's say as opposed to what should be done before they get pregnant. I would say they are getting ready to take a big test, and that test is having a baby. I said, “It's like a pass/fail. You're all going to pass. What do you want to have happen? You need to be comfortable and learn as much as you can and have people alongside you that you trust so that it is a great experience.” The second one, I'm sure you've seen this is that sometimes you just worry that people get so rigid in what they want, and then they feel like a failure if it doesn't happen. We want to avoid that because that can lead to a lot of postpartum depression and things that last. They feel like a failure. That should never happen. That should never happen. They should understand that they have a pathway and a plan. If they trust who's there with them, what ends up happening is okay. It's not that they've been misled which is then where the plan is altered by not a good reason maybe, but it's been altered and it really throws them for a loop. Meagan: Yeah. Dr. Darrell Martin: I think in preparation, first they've got to know what their surroundings are. They start off. Ideally, someone's thinking about getting pregnant before they get pregnant. I've had enough clients who, when we start talking about birth control, and I'll say, “Are you sexually active?” “Yes.” “Are you using anything for birth control?” “No, I don't want to use anything for birth control.” I said, “Do you want to get pregnant?” “No.” I said, “Well, that's not equal. A, you're not having intercourse and B, you're not using anything, so eventually, you're going to get pregnant. You need to start planning for that outcome, but the prep work ahead of time is to know your surrounding. You've got to know what you know and you've got to know what you want. You really should be seeking some advice of close friends who you trust who have been through and experienced it in a positive way. You've got to know what your town where you live is like. Is there one hospital or two hospitals? What are the hospitals like?” Someone told me one time that I should just write a book about what to do before you get pregnant. Meagan: Yeah, well it's a big deal. Before you get pregnant is what really can set us up for the end too because if we don't prep and we're not educating ourselves before, and we don't know what we're getting into, we don't know our options. That can set us up for a less-ideal position. Dr. Darrell Martin: Yeah. I think that's where the role of a doula can come into play. I hate to say it this way, but if they're going to go to the provider's office, they're not going to get that kind of exchange in that length of time to really settle in to what it is what that plan is going to be like. To be honest, most of the providers are not going to spend the time to do that. Meagan: Mhmm, yeah. The experience that you gave in getting to know people on that level is not as likely these days. OBs are limited to 7-10 minutes per visit?Dr. Darrell Martin: That's on a good day probably. Meagan: See? Yeah. Dr. Darrell Martin: You're being really kind right there. You're being really kind. It's just amazing. Sometimes you're a victim of your own success. If you're spending more time, and you're involved with that, then you've got to make a decision in your practice of how many people you're going to see. If you're seeing a certain amount, then the more you see, what's going to happen to them? You have control of your own situation, but then often you feel the need to have other partners and other associates, and then it gets too business-like. Smaller, to me, is better. The only problem with small with obstetrics is we know that if it's a solo practice, for example, someone will say, “I'm going to this doctor here because I want to see he or she the whole time.” I say, “You've got to think about that. Is that person going to be on-call 365 days a year?” Then what happens later on in the pregnancy when that becomes more of a concern to the client, they'll ask. They'll say, “Well, I'm on-call every Thursday and one weekend out of four.” They freak out. They get really anxious. “What's going to happen? I just know you.” They'll say, “I'm on-call on Thursday. I do inductions on Thursday.” So it leads into that path of wanting that provider. So then to get that provider, they're going to be induced. And we know that that at least doubles the rate of C-sections, at least, depending on how patient or not patient they are.Meagan: I was going to say they've got this little ARRIVE trial saying, "Oh, it doesn't. It lowers it. But what people don't really know is how much time these ARRIVE trial patients were really given. And so when you say that time is what is not given, but it's needed for a vaginal birth a lot of the times with these inductions.Dr. Darrell Martin: Yes, yes, if the induction is even indicated to begin with because the quality assurance, a lot of hospitals, you have to justify the induction. But it doesn't really happen that way. I mean, if there's a group of physicians that are all doing the same thing, they're not going to call each other out.Meagan: Yeah.Dr. Darrell Martin: It's just going to continue to happen is there're 39 weeks. I love how exactly they know how big the baby's going to be. But even more importantly, how big can this person have? I mean, there are no correlations. There are no real correlations. I can remember before ultrasound, we were taught pelvimetry. the old X-ray and you see what the inner spinous distance is, but you still don't know for sure what size has going to come through there.Meagan: Oh right. Well, and we know that through movement, which what you were seeing in the beginning of your OB days in your schooling, they didn't move. They put them in the bed. They put them in a bed and sat them in the bed. So now we're seeing movement, but there's still a lack of education in position of baby. And so we're getting the CPD diagnosis left and right and being told that we'll never get a baby out of our pelvis or our baby's too large to fit through it, when in a lot of situations it's just movement and changing it up and recognizing a baby in a poor position. An asynclitic baby is not going to have as easy as a time as a baby coming down in an OA, nice, tucked position. Right?Dr. Darrell Martin: Exactly. Exactly. There was the old Friedman Curve and if you went off the Friedman Curve, I was always remarked it's 1.2 centimeters, I think prime at 1.5 per hour. But I can never figure out what 0.2 two was when you do a pelvic exam. What is that really? Is the head applied against the cervix? So it's all relative. It's not that exact. But no, I think that if a person could find a person they trust who knows the environment, I think that's where the value of a really good doula can help because they're emotionally connected to the couple, but they're not as connected as husband and wife are or someone else.Meagan: Or a sister or a friend.Dr. Darrell Martin: Yes. And that may be their first shot at that sister of being in a room like that other maybe her own child. It's nice to have someone with a lot more experience that can stand in the gap when they're emotionally distraught, maybe the husband is. He's sweating it out. He's afraid of what he's going to say sometimes. And then she's hurting and she needs that person who can be just subjective to  stand in the gap for her when they're trying to push the buttons in the wrong direction or play on their emotions a little too much.Meagan: Yeah. I love that you pointed that out. We actually talked about that in our course because a lot of people are like, "Oh, no, it's okay. I can just hire my friend or my sister." And although those people are so wonderful, there is something very different about having a doula who is trained and educated and can connect with you, but also disconnect and see other options over here.So we just kind of were going a little bit into induction and things like that. And when we talked a couple weeks ago, we talked about why less is better when it comes to giving medicine or induction to VBAC or not. We talked about it impeding the natural process. Can you elaborate more on that? On both. Why less is more, but then also VBAC and induction. What's ideal for that? What did you use back then?Dr. Darrell Martin: Well, we're going back a long time.Meagan: No, I know, I know.Dr. Darrell Martin: We're going back a long time. See, that would be like what you just did was give me about three questions in one that would be like being on a defensive stand on trial. And then you're trying to figure out where the attorney going, and he sets you up with three questions in one, and then you know you're in trouble when he does that.Meagan: I'm finding that I'm really good at doing that. Asking one question with three questions or five questions?Dr. Darrell Martin: Yes.Meagan: So, okay, let's talk about less is more. Why is less more?Dr. Darrell Martin: Well, first of all, you can observe the natural process of labor. Anytime you intervene with whatever medication-wise or epidural-wise, you're altering the natural course. I mean, that to me it just makes sense. I mean, those things never occurred years ago. So you are intervening in a natural course. And you then have got to factor that in to see how much is that hindering the labor process? Would it have been hindered if you hadn't done that? If you'd allow them to walk, if you allowed them to move? The natural observation of labor makes a lot more sense than the intervention where you've then got to figure out, is the cause of the arrest of labor, so to speak, is it because of the intervention or was it really going to occur?Meagan: Light bulb.Dr. Darrell Martin: Yes.Meagan: That's an interesting concept to think about.Dr. Darrell Martin: Yeah. And you want to be careful because it's another little joke. I say you just don't want to give the client/patient a silver bullet. Often I've had husbands say, "Well, they don't need any medicines." You have to be careful what you're saying because you're not the one in labor. But I wouldn't say that quite to them. But they got the picture really quickly when their wife, their spouse, lashed back out at them.Meagan: Yeah.Dr. Darrell Martin: So you can come over here and sit and see how you like it. I can still remember doing a Lamaze class with Sandy, and we also did Bradley class because I wanted to experience it all. She was the first person to deliver at Vanderbilt without any medication using those techniques. And when we would do that little bit of teaching, I can remember doing that when they would try to show a guy by pinching him for like 30 seconds and increasing the intensities to do their breathing, maybe they should have had something else pinched to make them realize-- Meagan: How intense.Dr. Darrell Martin: Yeah. How intense it isMeagan: Yeah.Dr. Darrell Martin: We can't totally experience it. So we have to be empathetic and balance that. And that's where, to me, having that other person can be helpful because I'm sure that that person who is the doula would be meeting and with them multiple times in the antepartum course as opposed to they go into labor and if there's a physician delivery, chances are their support person is going to be a nurse they've never met before or maybe multiple ones who come in and out and in and out and in and out, and they're not there like someone else would be. To me that's suboptimal, but that's the way it works. And I observed the first birth. I didn't tell the people at the hospital for my daughter-in-law that I was an obstetrician.Meagan: And yeah you guys, a little backstory. He was a doula at his daughter-in-law's birth.Dr. Darrell Martin: Yes. But her first birth did not turn out that well at an unnamed hospital. She didn't want to come to my practice because they weren't married that long and that's getting into their business a little bit. Plus, she lived on the north side of town and I was on the south side. So she chose, a midwifery group, but the midwife was not in there very much. I mean, she was responsible. They were doing probably 15 to 20 births per midwife.Meagan: Wow.Dr. Darrell Martin: They were becoming like a resident, really. They were not doing anything a whole lot differently. And then she had a fourth degree, and she then, in my opinion, got chased out of the hospital the next day and ended up turning around a day later and coming back with preeclampsia. I heard she had some family history of hypertension. I had to be careful because I'm the father-in-law. I'm saying, "Well, maybe you shouldn't go home." And then she ends up going back. And she didn't have HELLP syndrome, but she was pretty sick there for a day or two. That was unfortunate because she went home, and then she had to go right back and there's the baby at home because the baby can't go back into the hospital. And so her second birth, because it was such a traumatic experience with the fourth degree, she elected to use our group and wanted one of my partners to electively section her. She did the trauma of that fourth degree. That was so great. So she did. But obviously, she had a proven pelvis because she had a first vaginal delivery. And then she came to me and she said, "I want to do a VBAC." And so I said, "Oh, that's great." And so one of my partners was there with her, but my son got a little bit antsy and a little bit sick, so he kind of left the room. I was the support person through the delivery. That was my opportunity to be a doula. And of course, she delivered without any medication and without an episiotomy and did fine. Meagan: Awesome.Dr. Darrell Martin: And a bigger baby than the one that was first time.Meagan: Hey, see? That's awesome. I love that.Dr. Darrell Martin: Yes.Meagan: So it happens.So we talked a little bit about midwives, and we talked about right here "A Doctor's Story of Breaking Barriers for Midwifery". Talk to us about breaking barriers for midwifery. And what are your thoughts one on midwives, but two, midwives being restricted to support VBAC?Dr. Darrell Martin: Okay, that's two questions again.Meagan: Yep. Count on me to do that to you.Dr. Darrell Martin: I'll flip to the second one there. I think it's illogical to not allow a midwife to be involved with a VBAC. That makes no sense to me at all because if anybody needs more observation in the birth process, it would potentially or theoretically actually be someone who's had a prior C-section. Right? There's a little bit more risk for a rupture that needs more observation, doesn't need someone in and out, in and out of the room. The physician is going to be required to be in-house or at least when we were doing them, they were required to be in house and there was the ability to do a section pretty quickly. But observation can really mitigate that rush, rush, rush, rush, rush. I've had midwives do breeches with me and I've had them do vaginal twins. If I'm there, they can do it just as well as I can. I'm observing everything that's happening and they should know how to do shoulder dystocia. One thing that you cannot be totally predictive of and doctors don't have to be in the hospital for the most part in hospitals. Hopefully, there probably are some where they're required, but it makes no sense and they're able to do those. So if I'm there observing because the hospital is going to require that, and I think that's not a bad thing. I never would be opposed or would never advocate that I shouldn't be there for a VBAC. But I think to have the support person and that be the midwife is going to continue and do the delivery, I think that's great. There's no logic of what they're going to do unless that doctor is just going to decide that they're going to play a midwife role and that they're going to be there in that room. They're advocating that role to a nurse or multiple nurses who the person doesn't know, never met them before, and so that trust is not there. They're already stressed. The family's stressed. There are probably some in-laws or relatives out there and they say, "Well, you're crazy. Why are you doing this for? Why don't you just have a section?" Everybody has an opinion, right? So there's a lot of family. I would observe that they're sitting out there and we've got into that even back then that's a society that some of them don't want to be there, but they feel obliged to be out there waiting for a birth to occur. Right. When four hours goes by, "Oh, oh, there must be a problem. Why aren't they doing something?" You hear that all the time. I try to say, "Well, first labor can be 16 to 20 hours." "16 to 20 hours?" and then they think, "I'm going to be here for that long."Meagan: Yeah.Dr. Darrell Martin: So there's always that push at times from family about things aren't moving quickly.Meagan: Right.Dr. Darrell Martin: They're moving naturally, but their frame of reference is not appropriate for what's occurring. They don't really understand. And so that's the answer. Yes. I think that it makes no sense that midwives are not involved. That does not make any sense at all.So the first part of the question was what happened with me and midwives?Meagan: Well, breaking barriers for midwifery. There are so many people out there who are still restricted to not be able to support VBAC. I mean, we have hospital midwives here in Utah that can't even support VBAC. The OBs are just completely restricting them. What do you mean when you say breaking barriers for midwifery and birth rights?Dr. Darrell Martin: Okay, what I meant was this is now in late 1970, 79, 80. And I'd observe midwifery care because as residents, we were taking care of individuals at three different hospitals, one of which was Nashville General, which was a hospital where predominantly that was indigent care, women with no insurance. And we had a program there with midwives.Dr. Darrell Martin: And so we were their backup. I was their backup for my senior residency, chief residency, and subsequently, as an attending because I was an attending teaching medical students and residents and really not teaching midwives, just observing them if they needed anything, within the house most of the time, principally for the medical students and the junior residents. But I saw their outcomes, how great they were. I saw the connection that occurred. We didn't have a residency program where you saw the same people every time then. It was just purely a rotation. You would catch people and it just became seeing 50 or 75 people and just try to get them in and out. But then you observe over here and watch what happens with the midwifery group and the lack of intervention and the great outcomes because they had to keep statistics to prove what they were doing. Right? Meagan: Yeah, yeah. I'm sure. Dr. Darrell Martin: They were required to do that, and you would see that the outcomes were so much better. Then it evolved because a lot of those women over the course of the years prior to me being there and has evolved while I was there, I was befriended by one midwife. She was a nurse in labor and delivery who then went on to midwifery school. We became really close friends. Her family and my family became very close. They had people, first of all, physicians' wives who wanted to use them and friends in the neighborhood who wanted to use them, but they had insurance and people that had delivered there who then were able to get a job and had insurance and wanted to use them again, but they couldn't at the indigent hospital. You had to not have insurance. So there was no vehicle for them in Nashville to do birth. We advocated for a new program at Vanderbilt where they could do that and at the same time do something that's finally occurring now and that's how midwives teach medical students and teach residents normal birth because that's the way you develop the connection that moves on into private practice is they see their validity at that level and that becomes a really essentially part of what they want to do when they leave. They don't see them as competition as much. Still, sometimes it's competition. So anyhow, at that point, our third hospital was relatively new. The Baptist private hospital run by the private doctors where the deliveries at that point were the typical ones with amnesiac, no father in the room, an episiotomy, and forceps. So when we tried to do the program, the chairman-- and we subsequently found some of this information out. It wasn't totally aware at the time. They were given a choice by the private hospital. Either you continue to have residents at the private hospital or you have the midwifery private program at Vanderbilt. But you can't have both. If you're going to do that, you can't have residence over here. So they were using the political pressure to stop it from happening. Then I said, they approached myself and the two doctors, partners, I was working with in Hendersonville which is a little suburb north of town. We had just had a new hospital start there and we were the only group so that gave us a lot of liberties. I mean, we started a program for children of birth with birthing rooms, no routine episiotomies, all walking in labor, and all the things you couldn't do downtown. Well, the problem was we wanted midwives in into practice but we didn't have the money to pay them. We were brand new. So we had a discussion and they said, "Well, we want to start our own business." And I said, "Oh." And I kind of joked, I said, "Well that's fine, I can be your employee then." And that was fine for us. I mean, we had no problem being their consultant because someone asked, "Well, how can you let that happen?" I said, "We still have control of the medical issues. We can still have a discussion and they can't run crazy. They're not going to do things that we don't agree with just because they're paying for the receptionists and they're taking ownership of their practice." So they opened their doors on Music Row in Nashville.Meagan: Awesome.Dr. Darrell Martin: But as soon as that started happening and they announced it, at that time, the only insurance carrier for malpractice in the state of Georgia was State Volunteer Mutual which was physician-owned because of the crisis so they couldn't get any insurance the other way a physician couldn't unless it was through the physician-owned carrier. Well, one of the persons who was just appointed to the board was a, well I would call an establishment old-guard, obstetrician/gynecologist from Nashville. And he said in front of multiple people that he was going to set midwifery back 100 years, and he was going to get my malpractice insurance. He was going to take my malpractice insurance away.Meagan: Wow.Dr. Darrell Martin: For practicing with midwife. And that was in the spring of the year. Well, by October of that year, he did take my malpractice insurance. They did.Meagan: Wow. For working with midwives? Dr. Darrell Martin: For risks of undue proportion. Yes. The Congressman for one of the midwives was Al Gore, and in December of that year we had a congressional hearing in D.C. where we testified. The Federal Trade Commission got involved. The Federal Trade Commission had them required the malpractice carrier to open their books for five years. And what that did was it stopped attacks across the United States. There were multiple attacks going on all across the country trying to block midwives from practicing independently or otherwise. And so from 1980-83, when subsequently a litigation was settled, the malpractice carrier, including the physicians who were involved, all admitted guilt before it went to the Supreme Court. I went through a few years there and that's where you see some of those stories where I was blackballed and had to figure out a place where I was going to work. I almost went back to school. This is a little funny story. I was pointed in the direction of Dr. Miller who was the head of Maternal Child Health at Chapel Hill University of North Carolina. I didn't realize that then two months later, he testified before Congress as well because he wanted me to come there. I interviewed and then I would get my PhD and do the studies that would disprove all the routine things that physicians were doing to couples. I would run those studies. It was a safe space. It was a safe place, a beautiful place in Chapel Hill. So he told me, he said, "You need to meet with my manager assistant and she'll talk to you about your stipend, etc." Now I had three children under four years of age.Meagan: Wow, you were busy.Dr. Darrell Martin: Well, the first one was adopted through one of the friends I was in school with, so we had two children seven months apart because Sandy was pregnant and had like four or five miscarriages before.Meagan: Wow.Dr. Darrell Martin: So I had three under four. So she proceeded to say, "Well Dr. Martin, this is great. Here's your stipend and I have some good news for you." I said, "Well, what's that?" He said, "Well, you're going to get qualified for food stamps." That's good news? Okay. So I'm trying to support my three children and my wife. I said, "I can't do that. As much as I would love to go to this safe place," and Chapel Hill would have been a safe place because it would have been an academia, but then I had to find a place to work. So it was just how through my faith, it got to the point where know ending up in Atlanta, I was able to not only do everything I wanted to do, but one of the midwives that I worked with, Vicki Henderson Bursman won the award from the midwifery college. And the year after, I received the Lewis Hellman Award for supporting midwives from ACOG and AC&M. But we prayed. We said, "One day we're going to work together." And this was 1980. In 93, when we settled the lawsuit, we reconnected. I was chairman of a private school, and we hired her husband to come to Atlanta to work at the school. Two weeks, three weeks later, I get a call from the administrator of the hospital in Emory who was running the indigent project at the hospital we were working at teaching residents. They said that they wanted to double the money. Their contract was up and they wanted double what they had been given. So the hospital refused and they asked me to do the program. We didn't have any other place to go. And then what was happening? Well, Rick was coming to Atlanta, but so was Vicki. So Vicki, who I hadn't worked with for 13 years, never was able to work, came and for the next 20 years, worked in Atlanta with me. And we did. She ran basically the women's community care project, and then also worked in the private practice. And then the last person, Susie Soshmore, who was the other midwife, really couldn't leave Nashville. She was much, much more, and rightly so, she was bitter about what happened and never practiced midwifery. Her husband was retiring. She decided since they were going to Florida to Panama City, that she wanted to get back and actually start doing midwifery, but she needed to be re-credentialed. So she came and spent six months with us in Atlanta as we re-credentialed her and she worked with us. So ultimately we all three did get to work together.Meagan: That's awesome. Wow. What a journey. What a journey you have been on.Dr. Darrell Martin: Yeah, it was quite a journey.Meagan: Yeah. It's so crazy to me to hear that someone would actively try to make sure that midwifery care wasn't a thing. It's just so crazy to me, and I think it's probably still happening. It's probably still happening here in 2024. I don't know why midwives get such a bad rap, but like you said, you saw with the studies, their outcomes were typically better. Dr. Darrell Martin: Yeah.Meagan: Why are we ignoring that?Dr. Darrell Martin: Doctors were pretty cocky back then. They may be more subtle about what they do now because to overtly say they're going to get your malpractice insurance, that's restricted trade.Meagan: Yeah. That's intense.Dr. Darrell Martin: Intense. Well, it's illegal to start with.Meagan: Yeah, yeah, yeah, right?Dr. Darrell Martin: If you attack the doctor, you get the midwife. They tried to attack the policies and procedures. That was the other thing they were threatening to do was, "Well, if you still come here, we're going to close the birthing room. We're going to require women to stay flat in bed. We require episiotomies. We require preps and enemas." Well, they wouldn't require episiotomies, but certainly preps and enemas and continuous monitoring just to make it uncomfortable and another way to have midwives not want to work there.Meagan:  Yes. I just want to Do a big eye-roll with all of that. Oh my goodness. Well, thank you so much for taking the time and sharing your history and these stories and giving some tips on trusting our providers and hiring a doula. I mean, we love OBs too, but definitely check out midwives and midwives, if you're out there and you're listening and you want to learn how to get involved in your community, get involved with supportive OBs like Dr. Martin and you never know, there could be another change. You could open a whole other practice, but still advocate for yourself.I'm trying to think. Are there any final tips that you have for our listeners for them on their journey to VBAC?Dr. Darrell Martin: Well, pre-pregnancy that next time around, we know very quickly that the weight of the baby is controlled by heredity which you really essentially have no control over that including who your husband is. If he's 6'5", 245, their odds are going to be that the baby might be a little bigger. However, you do have control what your pre-pregnancy weight is, and if you get your BMI into a lower range, we know statistically that the baby's probably going to be a little bit smaller, and that gives you a better shot. You don't have control of when you deliver, but you do have control of your weight gain during the pregnancy and you do have control of what your pre-pregnancy weight, which are also factors in the size of the baby. So control what you can control, and trust the rest that it's going to work out the way it should.Meagan:  Yeah, I think just being healthy, being active, getting educated like you said, pre-pregnancy. It is empowering to be educated and prepared both physically, emotionally, and logistically like where you're going, and who you're seeing. All of that before you become pregnant. It really is such a huge benefit. So thank you again for being here with us today. Can you tell us where we can find your book?Dr. Darrell Martin: Yeah, it's available on Amazon. It's available at Books A Million. It's available at Barnes and Noble. So all three of the major sources.Meagan:  Some of the major sources. Yeah. We'll make sure to link those in the show notes. If you guys want to hear more about Dr. Martin's journey and everything that he's got going on in that book, we will have those links right there so you can click and purchase. Thank you so much for your time today.Dr. Darrell Martin: Thank you. I enjoyed it and it went very quickly. It was enjoyable talking to you.Meagan:  It did, didn't it? Just chatting. It's so fun to hear that history of what birth used to be like, and actually how there are still some similarities even here in 2024. We have a lot to improve on. Dr. Darrell Martin: Absolutely, yes. Meagan:  But it's so good to hear and thank you so much for being there for your clients and your customers and patients, whatever anyone wants to call them, along the way, because it sounds like you were really such a great advocate for them.Dr. Darrell Martin: Well, we tried. We tried. It was important that they received the proper care, and that we served them appropriately, and to then they fulfill whatever dream they had for that birth experience or be something they would really enjoy.Meagan:  Yes. Well, thank you again so much.Dr. Darrell Martin: Okay, thank you. I enjoyed talking to you. Good luck, and have fun.Meagan: Thank you.Dr. Darrell Martin: Bye-bye.Meagan: Thank you. You too. Bye.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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is responsible for 9–30% of pregnancy-related mortality in high resource countries and remains a significant, increasing cause of severe maternal morbidity. Peripartum, 50% of VTE events occur in the postpartum interval, which has a 6-fold higher risk compared to antepartum. There is wide variation in LMWH pharmacological postpartum prophylaxis guidance. The RCOG, for example, recommends 10 days of LMWH for all postop CS patients unless it was elective, and additional risk factors exist. The ACOG uses a more selective approach. However, on Jan 16, 2025, a new multicenter retrospective study from the US is raising questions about the efficacy of postpartum VTE pharmacologic therapy. Is there really no need for pp VTE pharmacologic therapy? Or does the answer lie in the reality of VTE as a “low frequency, high acuity” event? Listen in for details!

This- is-CNN. No, that THAT CNN...This is Chapa News Network! WE have late-breaking news developments on 2 fronts: 1. The ACOG has released a clinical update (ACOG ROUNDS) in response to a recent study associating the RSV vaccine and GBS (we covered this study in a past episode). 2. The FDA has EXPANDED the label for an intranasal therapy for Treatment Resistant depression (TRD). Listen in for details.

Aisha's episode is full of wisdom and inspiration! With her first two births, Aisha worked so hard to deliver vaginally, but ultimately had two undesired Cesareans. She was told in the operating room that she had uterine dehiscence, was given a special scar, and should never try to deliver vaginally. But her intuition was telling her a different story. She dove into research. She found a community and listened to podcasts like The VBAC Link. She knew a VBA2C was possible, and she knew she had to try. Aisha's VBA2C journey involved interacting with supportive and very unsupportive providers, hiring a fantastic doula, being proactive with labor comfort measures, planning for the unexpected, staying firm in her desires, asynclitic positioning, and pushing her baby boy out in just 45 minutes with a nuchal hand!Aisha's WebsiteThe VBAC Link Blog: VBA2CNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. It's The VBAC Link, and we have a VBA2C story coming your way. Have you ever wondered what VBA2C means? If you haven't noticed, in the VBAC world, there are a lot of acronyms. VBA2C is one of them. That means vaginal birth after two Cesareans, meaning that you have had two Cesareans and want to go for a vaginal birth. Big question, what are the chances of having a vaginal birth after two Cesareans? Is it possible? The answer is simply, yes. It is totally possible. Myself and Aisha are living proof today that it is possible. In fact, your chances of a successful VBA2C are similar to those of just a VBAC with one Cesarean. ACOG recommends that VBA2C is a safe option, so today, I want to quickly go over a little bit more instead of a review about some education on vaginal birth after two Cesareans and share a little bit more of our blog. Like I said, ACOG recommends that vaginal birth after two Cesareans is actually a safe option. They say, “It is reasonable to consider women with two previous low transverse Cesarean deliveries to be candidates for TOLAC.” Now, again, there's another one of those acronyms. TOLAC- trial of labor after a Cesarean. I know that is triggering for some. It is pretty much just the medical term of saying that you are having a trial of labor after a Cesarean, so try not to let it impact you too much. But, “for TOLAC and to counsel them based off of the combination of other factors that affect their probability of achieving a VBAC.” There are lots of things that people might go look through to see if you are eligible for a VBAC after two Cesareans. Now, I'm sure you have probably heard this before, but proven pelvis. If you haven't had a proven pelvis, meaning that your baby has come out vaginally before you've had a vaginal birth or a Cesarean– now when I say this, sometimes we have a vaginal birth, then we will have two Cesareans, and someone wants to go for a VBAC again, so they would be considered a proven pelvis or cervix to a medical staff. But if you haven't had a “proven pelvis”, I hope you guys can imagine my air quotes right now, that doesn't mean that you shouldn't be considered as someone who should have a VBAC. It says in our blog, “More important to note, there is no mention of a requirement to have had that previous vaginal delivery.” I wanted to point out that it really is not a necessary thing. I hadn't had a vaginal birth before. My cervix also hadn't made it to 10 centimeters before, so just know that it is still possible. Quickly, there are things that you can do to reduce uterine rupture, and there are also things you can do to increase your chances of VBAC. Again, it's going to be in our blog. I'm going to send you over there after the episode so you can go and read more about it, but some of the things that you can do to minimize the risk of uterine rupture is staying away from induction. Now, can VBAC be induced? Yes, they can. Yes, yes, yes, yes, you can, so I don't want you to totally freak out right now. But, staying away from induction for VBAC is better than going to get induced. It does increase our chance of uterine rupture, and it does increase our chances of other things like interventions that are unnecessary. Unless it's absolutely necessary or totally desired, try to stay away from induction. Avoid augmentation of labor so things like Pitocin and other drugs to cause the uterus to contract more than it naturally would. Okay, let's see. Avoid providers who aggressively intervene or want to manage your labor or come at you with fearmongering tactics. You guys are going to hear some of that here, and honestly, I think it's a common thing with these stories. We are getting a lot of fearmongering here. Providers, if you are listening, knock it off. Goodness gracious, we do not need to add fear to something that has been looming over us because VBAC has such a bad rap in the world, and it's so scary. Again, air quotes, guys. Just stop with the fearmongering. Avoid providers who are going to build you up with things– I should say tear you down, but fill you up with things like, “Your baby is looking too big. I don't know. We should probably induce. I don't know if your baby is going to be able to come out because you are really small, and that baby is looking really big. Oh my gosh, you have to have an epidural. Oh my gosh, you have to have your baby by 39 weeks.” There are so many things. It's annoying. Okay, going back to avoiding rupture. Avoid or delay things like getting an epidural until at least the end if possible because we do know that sometimes when we get an epidural early in labor, it can bring things like interventions, and we are getting Pitocin that is too high and other things like that. There are so many other things here, you guys. I'm going to make sure that the link is in the show notes. I don't want to take too much of our time, so we can make sure that Aisha can share her beautiful VBAC after two Cesarean stories and all that she had done to lead up to this experience. You guys, it's a good one. Something that is very different about this episode is that she actually had a dehiscence with her second which in a lot of the studies and literature for rupture, a dehiscence is often confused or combined with uterine rupture.I really love that this is a different type of story here, so gear up and enjoy. All right, Aisha. Thank you again so much for being here. As we were talking about earlier, VBAC after two Cesareans is so highly requested in our community. So without further ado, I want to turn the time over to you. Aisha: Thank you so much for having me. This is surreal. I feel like this pushed me in some ways. It was a goal of mine. I'm like, “If I make it and do my VBAC after two Cesareans, I'm going to send my story to The VBAC Link.” Yeah. I've listened to you guys. It's been literally almost four years listening to you guys all of the time trying to visualize my birth after hearing other people's stories. It's such a blessing, and I'm honored to be here to be honest. Meagan: Well, thank you so much. Aisha: Of course. Yeah. I mean, if we start from the beginning with my whole birthing journey, I got pregnant in 2018. I really wanted to try out the whole natural route, so I went with a midwife here in Canada. It's covered by the government so whether you go to a midwife or OB/GYN, it's honestly the same thing. It depends on what type of care you want to have. I chose to go with the midwife, and I chose to give birth at a birthing center for my firstborn. Labor started. I never ended up giving birth naturally obviously. I ended up having a 60-hour labor. Yeah. After 60 hours, they declared me failure to progress, and I think my cervix was a bit swollen at that point. The baby had made the meconium in my tummy. Meagan: Oh, yeah. Stressing out is common. Babies poop sometimes, and it doesn't always mean an emergency or anything like that, but when it's happening and other things are happening–Aisha: Exactly. I think I started having a fever and other things like that. At that point, they came to see me. They were like, “Before things turn into an emergency, let's go and have a simple C-section.” I felt very defeated. I worked very hard for a natural birth. I did 40 of those 60 hours all-natural, but after seeing I wasn't progressing– when I was with my midwife, I was 2 centimeters after 40 hours, and at that point, I requested to be transferred to the hospital to get an epidural. When I got the epidural, it worked a little bit on half of my body, but I was having back labor. My baby was posterior, so it did not do much for those pains there. I can say in the moment, I was quite relieved to have the C-section, so everything could be over, but I know afterward, I know womanhood is not defined by how you birth your baby, but I think at that point because that's what I envisioned, I never envisioned a C-section ever in my life, and it affected me. It affected my self-esteem a little bit. Right after that, me being me, I'm such a planner and such a researcher. I researched to see if it's possible to have a vaginal birth after a Cesarean, and I discovered the whole VBAC world. I signed up in all of the Facebook groups that I could find about VBACs all around the world. I was reading stories. I discovered The VBAC Link at that point. I started listening to the podcast. I also requested, through my midwife, my notes to see what happened. Meagan: Your op reports. Yes. Aisha: I'm like, “Okay. I need to know why I had a Cesarean, why a Cesarean was made, etc.” I checked. I sat down with my midwife at six weeks postpartum. Honestly, it wasn't anything really. They just said it was failure to progress. I had dilated to a 7, and that was that. She was like, “Okay. You can come back when you get pregnant again. You need to wait 2 years or 18 months before you get pregnant again.” Meagan: Mhmm. That's very common.Aisha: That's what I did. I got pregnant when my firstborn, I think, was 15 months. I gave birth exactly two years later almost to the dot. That labor started. Everything was going great. I remember for that pregnancy, I tried to always sit leaning forward, doing all of those exercises because my baby was posterior. I wanted a good posture. I did all of the things. It was in winter here, and in winter, Canada is not the best. I wasn't walking as much and it was COVID too. It was the COVID lockdown. With my first, I was going to the mall a lot, but during the lockdown in 2021, all of the malls were closed. I wasn't going outside much, but I was doing rounds in my house going up and down the stairs and stuff like that. When labor started, I really tried to focus. I think I was doula-ing myself. I never got a doula, but I was doula-ing with all of my research what I knew to do. At some point, I felt like it was time to go to the midwife. I was going there. They checked me. I was at 2 centimeters again. After laboring for 15 hours, then I was a bit defeated. I was like, “No, the same story is going to happen twice.” I continued laboring there. At some point, the contractions were back-to-back with no breaks. At that point, I was like, “Let me be a smart girl and get the epidural again.” She checked me. I was at 3 centimeters. I wasn't progressing fast enough for me. I think I was just in too much pain. I wasn't getting any breaks.I went to the hospital. I think the car ride there did something because it was a 20-minute car ride from the birthing center to the hospital. I was 7 centimeters. Meagan: Whoa. You went from a 3 to a 7 in 20 minutes? Aisha: In 20 minutes. Then I was like, “Okay, it's happening.” I got there. My midwife had already called the hospital and sent my papers. The anesthesiologist was waiting for me. I got the epidural within 5 minutes. They checked me. I was at a 9. Yeah, it went really fast. I was like, “I'm getting this VBAC.” Everybody was excited. I was giggling and laughing. My midwife came in. We were waiting for the last little bit. They checked me. I was 9.5, but baby was stationed pretty high. They were like, “Okay, let's try to bring baby down.” They made me change positions, but as they were doing that, the baby's heart rate dropped. It wasn't picking back up. At that point, it turned into an emergency C-section. The doctor looked at me. She was like, “Your baby is in distress. We don't know why. Nothing is going on. Nothing is changing. We are bringing you to the OR and get baby out. We don't have a choice.” I was so sad. I was at 9.5. I was almost there, but it did not happen. When I was in the operating room, the doctor screamed to me, “Aisha, never do this again.” I'm like, “Why?” She never gave me any more explanation, so me being me, when I was done giving birth, I requested the notes again.Meagan: Hey, listen. This is what I would suggest for anybody and everybody who has had a C-section. Go get your notes. Go get your notes. Aisha: They give so much insight because nobody knows unless this is the only thing that remains with you. You don't have the people to talk to. I saw the notes. I saw that my C-section scar had started to open. I think they called it a dehiscence. Meagan: Dehiscence? It was past a window. It wasn't just stretched. It actually had dehissed. Aisha: Yes. My midwife was like, “Probably that's the reason why she told you to never do this again and not to go for a VBAC again because the uterus had started to open.” Because it had started to open, when she cut me up, it gave me a J-scar so my scar–Meagan: You have a special scar too. Aisha: I have a special scar too. At that point, I'm like, “Okay.” My midwife told me, “If you have a third baby, unfortunately here, we can only follow a VBAC after one Cesarean. We cannot follow a VBAC after two C-sections so you will have to go the OB/GYN route.” Then I got scared because I'm like, “My God, I'm going to have to go to the medical professionals. They're going to turn me down,” and stuff like that. Me being me, I contacted my own personal OB/GYN. I went to see her. I wasn't pregnant or nothing. I wasn't planned on being pregnant anytime soon, but I knew I wanted a third child. I went to him. I was like, “Listen. This is my story. This is my situation. I really want to try for a vaginal birth. I know it can happen.” I went on the Facebook groups again. I registered in all of the VBAC after multiple Cesareans. I went and checked VBAC special scars. I went into all of those groups. I saw it was possible. Women were doing it all over the world. I was like, “Why not me? My body is also capable. Plus, I got to 9.5. That means my body is working. I just had unfortunate circumstances.” That's what I thought. My doctor was like, “You know what? Get pregnant. Come back, and we'll talk about it.” She wasn't closed off to the idea. Fast forward, I got pregnant earlier in 2023. I lost that baby due to miscarriage. I got pregnant again in September. That was a surprise pregnancy. I wasn't really planning for it. When I got pregnant, I was like, “Okay, this is it. This is it. We're going to try to do everything we can to make it happen.” I know for the first 20 weeks, I also tried to relax and release. I felt like my body held so much tension, and I feel like that can hold up to birth. I was trying to go and deal with all of those traumas and things like that that I hadn't dealt with in my previous births. Meagan: Traumas, triggers, past experiences, the tension that is being harbored in our body. It's weird to think that, but really, we can harbor tension whether we relate to it as trauma or not, and it can really impact us. Aisha: It can really impact us. After my second birth, I had gone to pelvic floor therapy. I had been to that for a couple of months, then stopped 6 months prior to getting pregnant officially with my last baby. When I got pregnant, I went back to see my pelvic floor therapist. I'm like, “Listen. I'm pregnant. This is what we are planning. Right now, I just want to make sure that my muscles down there are okay. I want to do the exercises. I don't want to do too much, but just prep my body slowly and surely.” We did exercises. That was the first 20 weeks. The second 20 weeks, I'm like, “Okay. Now is the time to ask the questions.” I would see her every 6 weeks, and within those 6 weeks, every question that would come in my head, I would write in down in my notes and go and ask her the questions so she could answer. I asked her to review my op reports so I could have another opinion. I was asking her a lot of questions about VBAC after two Cesareans. I got that my doctor wasn't VBAC-friendly, but I think she's pro-women's choice. She goes with what you want, and she supports you wholeheartedly in your decisions. I remember asking her questions about VBACs after two C-sections. She kept telling me, “Aisha, I think you need to realize that new studies have shown that there is not much risk after one or two Cesareans. It's almost the same. The percentage doesn't go up. There's not much difference. If you've had a C-section, you have the same chances as if you've had a second C-section. That's what the studies are showing.”I asked her about my dehiscence, and she's like, “A lot of women who didn't have a C-section can have a dehiscence, but with some women, we don't see it because they're not getting opened up.” She's like, “It happens more than you think. It doesn't mean that it's because of your scar that you had the dehiscence. It could have been that's just how your body reacted.” After all of those affirmations, that reassured me a little bit. I was not risking my baby. At the same time, you read stories, and you just don't want to make foolish decisions even though in your heart, you know what you want. When you listen to the outside world, it can influence a little bit of how you are thinking, and you are trying to make a wise decision. That was me in that second part of my pregnancy. However, the one thing she told me was, “The one thing that can make or break your VBAC, though, is getting a doula.” Every time she would see me, she was like, “Did you get your doula? Did you get your doula? Did you get your doula?” So I went. I got a doula who also had a VBAC. It was very important to have someone who had the experience of having a VBAC. I feel like when your team knows how badly you want it and what it means to you, I feel like it changes a lot for your game. I remember having my little prebirth classes with her, and she kept telling me, “You need to build a team who believes in your goal more than you believe in your goal because at some point during the birth, you're going to doubt yourself, and you need people who are going to reinforce you with confidence and positivity.” Meagan: Positivity, yes. Aisha: Yes, and that you can do it and that your body was meant for this. Of course, within that too, we also prepped for the occasion of a possible C-section, how to have a gentle C-section, and things I wanted to have. For me, it was very important for me to see my baby's being born. That's something I never experienced with both of my daughters. I heard them cry, but it was this wall in front of me. I never saw them come out of me. We also prepped for that, but yeah. We did a lot of prepping. She suggested that I go see an osteopath. With my second daughter, and my first VBAC, I had seen a chiropractor, but she told me that an osteopath might help loosen up some muscles. I went to see that person. It felt good, then I did acupuncture at the same time which I think was maybe just to release and relax and let go. I think there were a lot of little things that I did in order to just not hold on to all of the stress– writing letters and closing up chapters. I feel like it allowed me to just let go of the traumas that I had. Fast forward to my due date for my second baby. I lose a good part of my mucus plug. I sent it to my doula. She was like, “Okay, I think your body is starting to work.” Now, I can say I was starting to have contractions, but my way that I think I handled this birth was denial. The whole time that I was having those contractions, I kept saying, “They are painful Braxton Hicks. They are painful Braxton Hicks, and that's what we are going to do.” I kept walking a lot and every day, I was taking an hour walk. During those hour walks, that's when I was listening to the podcast and listening to stories and literally looking for VBAC after two Cesarean stories and hearing what women went through and their tips and tricks. That happened at my 40-week due date. Then the contractions kept going. During the daytime, they would spread out a little bit. At night time, they would be every 10-15 minutes. They would wake me up from sleeping, so I knew deep down that something was going on, but I was not trying to put my heart into it. I'm like, “They are just Braxton Hicks.” That kept on going for two days. At 40 weeks and 3 days, I had my doctor's appointment. I remember waking up that morning and being like, “Oh, those Braxton Hicks are really pushing.” I remember my husband was like, “Do you think we should go and drop of the girls at their godmother's?” I'm like, “You know what? No. I don't think this is it.”I had my appointment that afternoon. I have a friend of mine who lives next to my doctor's office. She had a 6-month-old baby at that time. I'm like, “Let's drop the girls off at my friend's, then afterward, I can snuggle up the baby because I heard oxytocin might help everything get going.” I went to see my doctor. My doctor asked if I wanted to get checked. That's one thing too, I went through the whole pregnancy not wanting to get checked. I knew that dilation means nothing. Meagan: Yes. Aisha: There is also how effaced you are and the baby's station. Those are also other things that you must know. You can be at a 10 and be stationed at a -2. It doesn't mean your baby is still coming. There are a lot of little details that I discovered. Meagan: We don't talk about it. We don't talk about it. We focus so highly on that big 10 number when there is so much more. It's funny because with my clients, they'll be like, “Oh, I got checked, and I was only this centimeter.” I'm like, “I don't even care about the centimeter. What were you effaced?” They're like, “I don't know. They didn't say anything.” Next time you get checked, ask because that number is a cooler number. Let's get effaced. Let's do that. Even then, we know that can change. We can go from thick, hard, and posterior to completely open and thin. It all varies, and it varies quickly, but there are so many other things to focus on than just that big 10 number. Aisha: Exactly. That's why I never asked to get checked the whole time. I'm like, “I'm going to go like that without checking. That will be bad.” When I got there, my doctor knew. She was like, “You're not getting checked, right?” At every appointment, she would ask, and I'm like, “No, I'm not getting checked today.” She asked, “Are you having contractions?” I'm like, “I lost my mucus plug last night. I'm having painful Braxton Hicks.” She's like, “How painful?” I'm like, “Well, people contract and call it Braxton Hicks.” She's like, “Keep doing what you're doing, however, when you go to the hospital if ever you don't give birth by 41 weeks, we have to send you to do a non-stress test to the baby, and the hospital will read your report, and they're going to force you to have a C-section. Be ready.” She was prepping me. She was like, “I'm going to write in your file that it's VBAC after two Cesareans. We've talked about it. You're going to do a trial of labor. I'm letting it go.” She was okay with letting me to go at least 41+5 and 42 weeks. Meagan: Or what evidence shows, okay. Aisha: She wasn't giving me any stress. She told me that the one thing that was giving me confidence was the fact that my body went into labor twice, and my body knows what to do. I left that appointment. I went to my friend's house. I snuggled up with the baby. Every time I would take the baby, my contractions, the painful Braxton Hicks, would be every 5 minutes. They would come more often than not. The moment we left her house, I'm like, “Okay, I don't have the baby no more, but the painful Braxton Hicks keep going.” In the car ride, it was a 20-minute car ride to my house. I got to my house. I didn't say nothing to my husband. I took my daughters. I went to give them a bath. I was showering with them actually. It was a shower. I was showering with them. I was on my knees, and at some point, I had to stop and be like, “Okay. Those Braxton Hicks are quite painful.” I gave the girls a shower. I dressed them up. They went to bed. I came downstairs to my husband and was like, “You know what? Yeah. The Braxton Hicks are becoming more and more painful.” He was like, “Okay. Do you want me to pack up the car?” I'm like, “No, they are still Braxton Hicks. We are not there yet.” Then what really made me believe that I was in labor was whenever I am in labor are my bowel movements. I think my body releases and cleans out.Meagan: Common. That's very common. Aisha: I went to the bathroom twice in the span of 30 minutes. I looked at him, and I was like, “I think we're in labor.” That's the moment I used contractions for the first time. The contractions were there. I just went to the bathroom twice. Okay. Eat and drink because those are two things I never did with my previous labors. One thing my doula told me during the prep was, “You need to hydrate your body because the muscle that is dehydrated is a muscle that is going to contract even more. Maybe that's why you were contracting and your contractions with your second labor were back to back with no breaks.” I'm like, “Yeah, I wasn't drinking water. I was so dehydrated. My lips were all cracked. I was not drinking an ounce of water.” When my husband heard, “Okay, labor is starting,” we started drinking. I ate dinner. It was around 9:00 PM. We bought those maple waters because we heard maple water is filled with electrolytes. I started drinking that. Then we went upstairs. I'm like, “I'm going to get some rest and try to sleep a little bit since it's nighttime.” I went to bed. It wasn't comfortable. I stayed for 15 minutes, then I'm like, “Okay, I'm going to go in the shower.” My husband ran a shower. It wasn't helping. We ran a bath. I went in the bath. I stayed there for maybe 30 minutes. It was not comfortable, then I got up. I went to pee, and then I had my bloody show. Everything was out. I sent a photo to my midwife and my doula. She was like, “Okay. Get ready. I think your body is really doing a lot right now.” In my head, I'm like, “Since my body is doing its work right now, let me help it. I'm going to sit on the toilet.” I heard it's a dilation station, so I'm like, “I'm going to sit there, then hopefully, if I'm in pain, let me make it effective.” I go. I sit there. Believe me or not, that was the best position for me. Meagan: I loved it too. I loved it too. Aisha: I loved it. I was at peace. I had the light turned off, the rain sound going, and I was literally sleeping. When I say sleeping, I was snoring. I was waking up slightly just for contractions, then I was going back to bed. I never timed any of my contractions. We were not going to focus on timing. We were going to go with how we feel, and the sounds and stuff like that. Yeah. I stayed there, I think, for 2.5 hours or 3 hours on the toilet. Meagan: Wow.Aisha: It felt so good. I had a pillow. I slept there. At some point, you can hear in my sound that it was a bit more there. My doula was hearing me. She told my husband, “You know what? I think this is time. You guys need to pack up the kids and go to the hospital.” We are about 35-40 minutes away from the hospital, so we had quite a drive. My husband packed up the car, and around 2:00 AM, we left to the hospital. I remember prior to labor, I told myself, “I'm going to give myself a coping mechanism. As long as I'm home, I'm just going to do nothing and try to take it in.” Once I'm in the car, I bought those combs. I was going to have the combs in my hand for the car ride, then once contractions are really unbearable, I'm going to grab the second comb. In the car ride, I had that one comb. I took it.  We went to the hospital, but the contractions were so great. I had time to do curbside walking around the hospital when we got there. My girls' godmother came and met us at the hospital so we could transfer the girls. While they were doing that transfer, I was doing curbside walking. I was taking photos. I was like, “I need to take photos of my girls.” I was in such a happy mood. The contractions were spread out which was a first for me because with all of my other labors, the moment I got to the hospital, it was an emergency and I could not control myself. We got there. We got to the hospital. I was able to give them my name and fill out my papers. I was really clear-minded. I went into triage and I was a bit scared because with my other labors, when I got checked, I was at 1 centimeter or 2 centimeters. I was going to see what I am, but you know what? We can handle it because the contractions were still spread apart. If I was a 2, I would still be good. I lay down. I got checked, and they told me I was at 5 centimeters. I thought, “Oh my god.” I asked, “What is the station and how effaced am I?” Then they were like, “You are 80% effaced, and you're at the station -2.” I'm like, “Okay. This is it. We're doing it.” They were like, “We are admitting you. You're not going to go home.” I was so excited. However, that's when the battle started. They took my file and came back. Meagan: Darn it. Aisha: They said, “We see you had two Cesareans already. Usually, you need to have a C-section after two C-sections.” I'm like, “I discussed with my doctor, and she was okay with me doing a trial of labor. They were like, “Well, no. This is not usually how things go. We usually don't do that. There's a lot of risk for your baby.” I'm like, “Yeah. I know the risk and I'm okay with it. It's something my doctor and I discussed. We are very at peace with it.” Then they sent me the doctor on call. The doctor came, and she was like, “I need to explain to you the dangers of what you are about to do. Your baby might die when you have a second C-section.” Then they brought up the dehiscence. “After a trial of labor, you had a dehiscence. This is not good for your body to have a dehiscence. You are more prone to uterine rupture.” All of those notes were observed by my doctor, and she was completely fine with it. Literally, the doctor looked at me, and she was like, “I can see nothing I'm going to say will change your mind. You're quite informed.” I'm like, “Yeah.” She was like, “I'm going to have you sign these release papers so you can release the hospital of anything.” At that moment, you feel like you're doing something not great because you're like, “They're making me sign this paper.”Meagan: Yeah, you feel like you're pushing against everyone in the professional world who have done multiple years of school and what they are suggesting. It feels off. Aisha: It feels off, but you what? That's why I was talking about releasing and really listening to me. That made me feel so much more at peace because I'm like, “I have to listen to that voice inside. Aisha, you can do this. You have prepped for this literally for four years in the making since your first C-section. You're educated. You know the risks. This paper is not going to make the risks change. You were okay with it before they presented that paper to you. You can still be okay with it after.”They gave me the paper. I signed everything, and then they asked me, “Well, we need to keep you monitored, however. We need to keep you monitored, and we need to have the easy access port installed in case.”Meagan: The hep lock, mhmm.Aisha: I told them that I didn't want it because it wasn't in my birth plan. I was like, “I don't want that.” I also had a super cute pink, floral hospital gown. I was like, “I'm going to wear that. I don't want to wear their hospital gown.” I think it was just mentally to feel like you are the birther, and you are the principal actor in the event. I didn't want to feel like a patient.They came. They were like, “You need to change.” I'm like, “I don't want to change. I want to keep my gown.” I had to sign a release paper that it was okay if they cut off my gown. I said, “Listen, the gown is made for that. There are buttons all around the back, but if you have to cut it off, cut it off, but I'm keeping this on.” At the end, I felt like I had to be somewhat political a little bit and give them a little so they could stop bugging me because they were breaking my bubble with the constant questions and the constant arguing.Within all of that, I was still having contractions. I'm like, “You know what? I'm going to let them monitor the baby, and I'm going to let them do the easy port so they can stop casting their opinions on my VBAC.” I know my doula was a bit scared especially for the monitoring because they were like, “The second the heart rate drops, they're going to use it as a way to send you to the operating room.” I know the second they put the monitor on, the baby's heart rate went down during the contractions, and it went right back up after. One of the nurses was like, “See? Your baby's heart rate is already going down. This is why we need to keep it.” I had the doula on the other line. She was coming to the hospital. I asked, “The baby's heart is going down.” She was like, “Aisha, it's normal that your baby's heart rate is going down during a contraction. He's literally getting squeezed. It's just normal practice. If it comes back up, it's completely fine.” Every time, they would pass those comments. The baby's heart rate dropped a couple of times, probably 7-8 times over the whole labor process, but every time, they would make a comment, “Oh, see? It dropped again. Oh, see? It dropped again.” But it kept picking back up the whole time.Anyway, I got admitted to my room. They tried to do the easy access port. I have small veins, so it literally took the anesthesiologist to do it. The whole nursing team failed to do it. I kept telling them to do it in one spot that people usually have better luck. They did it everywhere else, and in the end, it was that part that functioned.By the time they did the easy port access, it was around 7:00 AM. I got to the hospital around 4:00. It was around 7:00 AM. I asked to be checked again because, at that point, I was doing dances. The contractions were so intense, I was not happy. I was not laughing no more. I was still having breaks between them, but it was really taking everything out of me. At that point, the whole time before that, I was really enjoying the contractions. They were coming. I was like, “Oh, this is nice. I'm getting to meet my baby.” I loved the feeling to be honest. People find me weird when I say that I love contractions, but at that point, it was not fun anymore. I was going against the wall and doing those squat dances and moving my body left to right. I requested doing a check. They checked me. They were like, “Oh, you're at 9.5 and 100%.” However, baby was still stationed at -2. I'm like, “Oh no, baby is pretty high up.” My doula and I started to do some positions to get baby down. We did those for 30 minutes, but like I said, the contractions were really, really, really pushing it. I requested to get checked again. I know my doula was like, “Nothing probably happened.” She was right. Nothing happened. It was still the same, 9.5 and effaced at 100%, and still stationed to -2. At that point, I'm like, “Okay, I'm going to request the epidural.” I was seeing stars. Every time I would go through a contraction, I would see stars. At that point, I was literally, I think, mentally checked out. I was fighting against the contractions because every time a contraction would start, I would tell myself, “Okay, now you need to survive this next one.” It was no longer about enjoying it. Meagan: Surviving it, yeah. Aisha: It wasn't, “You know what, Aisha? It's four breaths. Take four deep breaths and it's done.” It was more of a survival mindset. I was like, “I'm going to take the epidural and be calm and be good.” They came. They gave it to me. They gave me a very tidbit because I was still walking. I could still feel. Yeah. I was still walking with the epidural. I could still feel everything. It just took off the edge. I think the contractions and the pain was in the front of my belly, and the back pain was gone, but I could still feel the pressure. While the anesthesiologist was giving me the epidural, my body was starting to push. I would have that feeling and everything. I think he gave me a tiny bit. Anyway, the second epidural was done, it was already shift change, so the night nurses were gone. The new nurses were in, and I think when I say the team makes a difference, they were angels sent. They were so kind. My doula went to see who was the doctor on call for the daytime, and she came to see me. She was like, “If you didn't have your own personal OB/GYN, this is the one who you would have wanted to have. This one here, that doctor here.” Then she came. She was super happy.She was like, “Okay, I see you're trying for a VBAC. The whole floor, when I heard about your case, they were saying that you had a uterine rupture. I'm like, ‘That's not right. Her doctor wouldn't have let her do a trial of labor after a rupture.' I went through your file, and I saw that you only had a dehiscence. It's very common.” She literally repeated the same thing that my doctor said. She was like, “A lot of women who didn't even have a C-section end up having a lot of dehiscence. It's just that we never know because they are never opened for a C-section to mark it down.” She was like, “It's completely common. We're going to do this.” She was like, “You've been at 9.5 for 2-3 hours, and your baby's station hasn't descended. Let's see what's going on.” She brought an ultrasound machine, and she performed the ultrasound on me. She literally saw that it was the baby's head's position. His head was slightly crooked to the left. Meagan: Asynclitic, mhmm. Aisha: Exactly. That's when I'm telling you that I love these people. I'm still having butterflies thinking about them. They came with the Miles Circuit. They came with the sheet with the images, and they're like, “We're going to do those.” I'm like, “The Miles Circuit!” They're like, “Yes.” I'm like, “Oh my god. You guys are my people.” We started doing the Miles Circuit. I did every movement for 30 minutes. I held it for 30 minutes. I did the cowgirl, I think they call it. Meagan: The flying cowgirl. Aisha: Exactly. Then after that, they came back. My doctor thought the baby's position had changed, but my water hadn't broken yet. She was like, “I'm going to break your water. The worst case scenario is that your baby's heart doesn't handle it, but I think that's going to make us go to the next level.” She broke my water. Literally, within the time she broke it and went to check, I was ready to go. That was literally all it took. She was like, “Okay, we're going to start pushing.” I know in my birth plan, I said that I was not going to push on my back lying down. I went on my four knees. I went first in my knees. I was holding onto the bed, and I was pushing that way. But I was so tired. I hadn't eaten in a while. I was still drinking, so drinking was good, but I hadn't eaten. My doula gave me candy. That helped me, but I remember in that exact moment, in my thoughts, “Aisha, your baby did it. This is your time now to help your baby. This is it. You've waited four years for this moment. This is it. This is all you've wanted. You need to find strength somewhere and make it happen.” I looked at them. I'm like, “I'm going to lie down.” I laid down, and my doula gave me this blanket. They attached this. Meagan: Mhmm, some tug-of-war. You did some tug-of-war, mhmm. Aisha: I was pulling on it when I was pushing, and my mom and a nurse were pushing my legs up. Yeah, then I pushed. I pushed. I pushed, and at some point, my body was pushing automatically whenever the contraction would come. It would literally do that. I would bear down by myself. I know the doctor kept looking at me. She was like, “Wow. This is awesome.” Yeah. I think I pushed for 45 minutes, and then he was born. My husband is actually the one who caught the baby. Meagan: Oh, yay. Aisha: That's what we wanted. We caught him. We did not know the gender, so it was really fun to see that it was a boy after two daughters. Once he was born, they put him on my chest. Everybody was crying. I know the nurses were crying. The doctor was crying. I've never had a hug from a doctor, and she literally came to my bedside and hugged me. She was like, “This is the moment. We don't see this often, so thank you for letting us experience this.”I know for a lot of the nurses, it was almost the shift change. It was almost 3:00 PM when he was born. One of the nurses looked at me. She was like, “My shift is ending in about 30 minutes. I need to see this. I need to witness this happening.” Then, yeah. He was born, and I think I had a first-degree tear, but it was on the outer labia. It was because when he was born–Meagan: Superficial. Aisha: Yeah, he had his hand on his face like a Superman. Meagan: Oh my goodness, so you had a nuchal hand, too? Oh my gosh.Aisha: Yeah, in the photos of it, it's so precious. My doula took photos, and you can literally see his hand coming out. Yeah. It was great because that evening, that night, the doctor came back on her shift. She heard that I gave birth. She came to apologize, literally. She was like, “I heard that you gave birth vaginally. Congratulations. I'm so sorry for not supporting you in that sense. There is a risk, and not every woman ends up having great stories like yours.”Meagan: Oh gosh. Aisha: “But we are happy for you.” I was just happy that I proved them wrong and that I made history in that hospital having a VBAC after two Cesareans. It happens. It's possible. I'm just happy that I listened to that voice inside, and that all of the noise around me did not affect my initial desires. Meagan: Yeah, and overall, your final decision, right? We've talked about this. I call it static. There's a lot of static that, I feel like, looms over VBAC moms. At least it did for me, and I do see it sometimes with my clients. It's their friends, their family, their providers, or whoever it may be, they are looming with this unnecessary static. Aisha: Yes. Meagan: A lot of it is, “Well, there's risk and what if's.” Oh, you name it. So many of these things, and really, I took a whole bunch of notes of little nuggets of your story. I can relate in a lot of ways with your story. It's similar to mine with how things unfolded. From the very beginning, you started off right. You started off right. You found the provider. You found the team. You got the support. You got the education. You dove in, and like you said, this was four years in the making. It took you four years to learn and grow and have this experience that you wanted. Sometimes, it takes one time to try. I say “try” with quotes, but to go and have a trial of labor, and it maybe not work out like mine and your situation. And then, okay, we learned from those two situations. Now how can we learn and grow from those situations and change and develop this next situation? It's so weird. My mind right now is really heavy on my daughter's reflections. They do reflections at school. It's a big art thing. Her topic is overcoming imperfections. Sometimes, in the birth world and especially as women, as you were saying earlier in your story, we have this thing that if we don't do it this way or if it doesn't happen this way, maybe our motherhood is stripped away, or we failed, or our baby failed. We can go as far as our baby failed us or whatever it may be. Overall, no situation is perfect. There are just always imperfections, and what do we do with the situation to grow and transform?I mean, really. I went over some of it, and then just learning more about hydration and how important food is and fueling our bodies. Aisha: Yes, yes. It's a marathon. You cannot run a marathon without an ounce of water or without food. You see it when you see people doing half marathons. There are people on the sidelines giving them water. Meagan: They're fueling. Aisha: Right. They're fueling. It is important and necessary. Knowing that the providers, as much as yes, we do have faith in them, they are there to help us, and they are there. I don't want to say this in a bad way, but they are working with us and for us. Do you know what I mean? They don't have the final say. We have the final say. That doctor who was there, when I told you about the dream team, she never ever does hospital rounds. She usually just does prenatals. Even the nurses said, “We usually see her once or twice a year. She never comes.” That ended up being the one time a year that she came. She looked at me and said that she is a pro-choice woman. She was like, “When a woman makes a choice, even if they fail, she will be happier, and she will be able to cope with the results way better than if someone strips her of that choice and obliges her to do something she did not consent to do. The outcome of that will be way harder to overcome than if she is the one who made the decision regardless of the result. That is way better.” Meagan: It's so true. Aisha: I wholeheartedly believe that. I know I had to really see in myself if that doesn't work. I know sometimes, we go into labor very naively. I feel like every first-time mom and even second-time sometimes, that can happen especially if let's say you were going for a vaginal birth, then you have a C-section, then you're trying for another vaginal birth, it's still in some sense the first time that you are going to experience this sort of experience. You're still going into it naively and blindly. Like I said, I never knew a C-section could be an option. The second time, I'm like, “It cannot happen to me twice.” After it happened to me twice, I planned for it. I planned in the circumstance that there would be a C-section, what do I want to happen? I knew I had my guidelines, and at least it wouldn't be a shocker and a hard pill to swallow. I would have been okay because I had my trial of labor.At the end of the day, your baby does decide how they want to be born. I feel like one thing I would advise all mamas and even fathers or partners, we need to include them to that. I feel like talking to your baby makes a whole lot of a difference. I got that advice from my osteopath where he told me a story about his wife about to be wheeled into a C-section. He came. He spoke to their daughter who was in the womb. He was like, “This is your moment. You decide. If you want to go to a C-section, do it. If not, this is the moment to change things.” His wife ended up having a vaginal birth right at the moment that they were going to. I pulled my husband up at some point I remember when I was starting to push. He came and saw the baby, then he was like, “This is your moment. You decide how you want to be born. You choose, and your mama is going to help you do this.” I feel like having that communication, our babies sense everything, so being connected to that too is so important. It's so important. Meagan: Absolutely. Absolutely. Circling back really quickly, if we do all of the things, if we take the VBAC education course, listen to the stories, learn more, read more, learn the stats, hire the team, and all of the things, we do our fear clearing processing about past experiences and all of that, and then we go in and be fearmongered like they were trying with you, and fearmongering by definition is that “it causes fear by exaggerated rumors of impending dangers”. There were big things that were said, but if you hadn't done the research and the education, you easily may have been fearmongered. Sometimes, it's even easy to be fearmongered even with the education. I will say that straight up. When you are being told that your baby could die, that word is very, very triggering. But you were able to have the education and be like, “No. I understand what you are saying. I respect what you are saying. I am going to continue moving forward this way.” But if we would be fearmongered and not have the education and then later learn the education, overall, our experience and view and our feelings postpartum would be a little bit rougher because we are learning these things that we could have learned before. That's why education is one of the biggest tips that we can give because you need to be educated along the way because it is easy for someone to come in. Look at you, Aisha, “No, no, no, no.” How many times did you have to say, “I understand, but no, no, no, no.” It sucks that that's the reality, and trust me, it ticks me off so much. Aisha: It is. Meagan: I wish it would change, but if we aren't educated and armed with that team, with that power, with our experience, then we are more likely going to fold in those situations. Aisha: It is completely true. At some point, even one of the nurses told me when they were trying to do the easy port that I needed to stop moving because this was going to end up with a C-section, and they really need to do the easy port. I had to tell her to never repeat the word “C-section” in front of my face. It sucks that for women or people experiencing multiple Cesareans or even one Cesarean when they are trying to do a vaginal birth that they need to constantly fight for it. Meagan: Yes.Aisha: But you do need to stand your ground and really focus on what you want. The fears will come, but that's a moment where you need to rely on the education that you have and all of the process. You spent 9 months preparing yourself, and all of those months must count for something. You're not going to be that one person. That's what I was telling myself. In the case that yes, the unfortunate happens, I was at the best place at the best time, and I had the best team. That was my thing. I trusted in my team that everything would be fine. But no, definitely. Yeah. You need to believe in yourself and in your project. Meagan: Yes. Oh my gosh. Well, this episode is just jampacked with all of the nuggets of information, guidance, suggestions, and empowering feelings. Oh my gosh. Thank you so much for being here with us today and sharing with us your beautiful story.Aisha: Thank you. Thank you for having me. Thank you so much. It's a dream. Meagan: Oh my gosh. Well, congratulations again.Aisha: Thank you so much.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. Congratulations on starting your journey of learning and discovery with The VBAC Link.  Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Tachycardia in pregnancy is common and distinguishing between physiological and pathological causes can be a challenge. Plus, until recently, there had not been a well-defined or universally accepted definition of the upper limit of normal for heart rate in pregnancy. But a study published in 2020 from the Green Journal, from the NHS in London has shed light on this issue. The finding of persistent tachycardia beyond a certain rate (and we'll discuss that rate in this episode), regardless of symptoms, should prompt a search for potential etiologies and at least some basic investigations. Of course, any tachyarrhythmia in pregnancy causing hemodynamic instability requires urgent cardioversion as per adult life support guidelines. In 2023, The Heart Rhythm Society (HRS) developed expert consensus guidelines in collaboration with the American College of Cardiology (ACC), the ACOG, and the AHA to address arrhythmias in pregnancy. In this episode we will focus on and review maternal tachycardia. Does HR really increase by “10-20%” in pregnancy as we all were taught? What heart rate is generally considered evaluable? And what's the suggested evaluation? Listen in for details.

Katie has had a Cesarean (failure to progress), a VBAC, and most recently, an unmedicated breech VBAC!She talks about the power of mom and baby working together during labor. She is 4'10” and attributes so much of her first successful VBAC to movement. Katie's most recent baby was frank breech throughout her entire pregnancy. After multiple ECV attempts, she exhausted all options to seek out a vaginal breech provider. She was able to work with providers while still advocating for what felt right to her. Though there were some wild twists and turns, this breech vaginal birth showed Katie, yet again, just what her body is capable of! The VBAC Link Blog: Why Babies Go Breech & 5 Things You Can Do About ItThe VBAC Link Blog: ECV and BreechHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Julie: Welcome, welcome. You are listening to The VBAC Link Podcast. This is Julie Francom here with you today. I'm super excited to be sharing some episodes with you guys this year and helping out Meagan a little bit and keeping things rocking and rolling here at The VBAC Link. I am excited to be back, and I am especially excited to be joined by Katie today who has a really, really incredible story about her three births. Her first was a C-section. Her second was a VBAC, and her third was an unmedicated breech VBAC. I absolutely love hearing stories about vaginal breech birth because I feel like it's something that we need to bring back. It's only fair to offer people options when we have a breech baby. I don't think it should just be an automatic C-section. I'm excited to hear her story. I'm excited to hear her journey to find support in that regard. But first, I'm going to read a review. This review is actually from our VBAC Prep course. If you didn't know, we do have a course preparing you all about all of the things you need to know to get ready for birth after Cesarean. You can find that on our website at thevbaclink.com. But this review on the course is from Heather. She says, “This course was so helpful especially with helping to educate my husband on the safety of VBAC as he had previously been nervous about my choice. We watched all of the videos already, but will also be reviewing the workbook again right before birth. I highly recommend.”I absolutely love that review from Heather because I feel like we get a lot of these comments about people and their partners really being on board and invested after taking the VBAC prep course with their partners. This course is chock-full of information about the safety of VBAC, and different types of birth situations. It talks about different interventions and hospital policies that you might encounter. It talks about the history of VBAC. It talks about all of the statistics and information. It talks about mental prep, physical prep, and all of those things. There are videos. There is an over 100-page workbook. There are actual links to sources, PDFs of studies, and everything you can even imagine. It is in this course. I also highly recommend it. Anyway, thank you, Heather, for that review. All right, let's get rocking and rolling. I am so ready to hear all about Katie's birth stories. Katie is right here snuggling her sweet little baby with her. I cannot wait. I hope we get to hear some little sweet baby noises. They are kind of my favorite. But Katie, go ahead and take it away, my friend. Katie: Yeah, thanks so much for having me. I'm excited to be here and hopefully share some things that I would have loved to have shared with me. So let me just start from the beginning with my first baby 5 years ago. I was planning to have a birth. I wasn't quite sure what it would look like, but I thought I wanted unmedicated. It was my first baby, and I wanted to labor spontaneously. The labor was long, so 3+ days of labor. It ended in me getting to 10 centimeters and pushing. However, due to fatigue and the multiple interventions that I had and the cascade of interventions, I believe, resulted in a diagnosis of failure to progress so I had a C-section. It was, I would say, disappointing to me not because of anything except that I would have loved to continue on my path of vaginal delivery. That wasn't in the cards with this one for me. Then with my second 2.5 years later– oh, I should also say that I was at a teaching hospital. There were lots of people. They were very pro-intervention. You name it, I had it across those 3 days. So 2.5 years later when I got pregnant, I thought, “Okay. I know I want to attempt a VBAC.” My husband, my partner, was so on board. He got a shirt that said, “You've got this.” He was wearing it all of the time. We watched a ton of positive VBAC birth stories on YouTube. We listened to podcasts like this one. We followed all of the things on social media and prepared with an amazing doula. I went into spontaneous labor again and this time, I was sure I wanted– actually, I should say I had a membrane sweep, and then I went into spontaneous labor. I was sure I didn't want interventions for this one. My doula was on board. My partner was on board. I labored at home for quite a while. I came into the hospital. It was the same hospital. That doctor was not so supportive of me attempting a VBAC, however, another OB had said that because of our family planning, I said, “I think I want more kids,” another OB told that OB, “Hey, let's make it as safe as possible to do what she wants, so let her give it a try.” My doctor was semi-supportive, but I came in. I was 9 centimeters. It was unmedicated. I was in there for less than 3 hours. I pushed the baby out with a bar. I was squatting. They didn't even know the baby was out. In fact, the baby started crying, and it felt like minutes or hours in my mind, but it was just a couple of pushes. My doula said, “Baby out. Baby out.” Everyone rushed because they were so surprised because normally, I think, folks labor on their backs, and I had requested a bar. That was pretty amazing. It was just me and my son doing the thing. It was incredible. I remember that OB who was skeptical said, “You did it. You've changed my mind.” So that was exciting. 3 years later to now, I became pregnant with my third baby. I went in for my anatomy scan at 20 weeks, and the ultrasound tech said, “Baby is breech. No big deal. Tons of babies are breech.” Because I have some other health complications, I guess they deemed me as high risk. I went to multiple ultrasounds, so that means I get to see my baby once a month which also meant I continued to see that baby was breech each time. Each time, they kept saying, “Oh, don't worry. Plenty of time. Plenty of time to turn.” As we approached my due date, I was like, “I feel his head. I don't think he's going to turn.” So they started to let me know what type of breech he was. My baby was frank breech. There are a few different types of breech positions which I didn't know prior to this baby, but now I'm very well-versed in the different breech positions. Frank breech is basically a pike position. The feet are by the head, and his little rump was just hanging out in my pelvis. I was also hoping to birth at a birthing center with my doulas. This was different than that learning hospital that I shared because I just wanted a different experience where they were less pushy with interventions. I knew that with my last birth that they used the term “something pelvis”, but anyway, I was ready to do something different with less people in the room. However, when they found out that I was breech, I was told what I think is the stock option which was, “Hey, if baby stays breech, but don't worry, there's plenty of time and he'll probably turn, but this is what we'll do. We'll try an ECV, and if that doesn't work, we'll schedule your C-section. We'll give you an epidural, try the ECV one more time, and that way, you can go right into your planned C-section. But don't worry, we have time. The baby is going to turn.” I left and was like, “I don't want that. My baby is healthy. I'm healthy. I am on the fence about this plan.” Now, I'm 36 weeks so at 37 weeks, I go in. We have the ECV. They give me the shot to relax my uterus. The ECV is the external cephalic version where they put their hands and try to rotate the baby. It was unsuccessful. So I said, “Can we try again?” She looked at me like, “What?” She said, “We'll try again with that epidural when you schedule your C-section.” I said, “No, no, no, no, no. Can we try again?” This is where, I think, that advocacy and that information and research are so important. She said, “Sure. We can try it again.” We scheduled another ECV. I went back in, and it was also unsuccessful with her. She could tell at this point, I was grieving what I thought was the end of this journey for me, and also not necessarily on board with the protocol they had put in place. We planned. I said, “Hey, can I try a different provider?” I know that you can do up to four ECVS. I'm not suggesting that people do that. I just wanted to make sure that I did everything possible for me and baby to have a vaginal birth. They seemed pretty gung-ho about not delivering unless baby was head down. She said, “Sure. We can do that.” That was also unsuccessful. At this point, the OB said, and I appreciated this. They said, “I feel really uncomfortable delivering a breech baby. I think you should go to our sister hospital in a city away if you are considering breech because we don't have a NICU here.” That felt reasonable to me because I had said to her previously, “I hear you, and I hear that protocol with what you're suggesting. I also feel really healthy, and I will absolutely change course if me or baby's health is in jeopardy, but unless that is imminent, I consider breech a variation of normal,” so I didn't necessarily think that was the rationale for the C-section knowing what that recovery is like and knowing that I had a 5 and a 3-year-old back at home. Julie: Oh, I love that so much. I love that they gave you options, and they admitted that they weren't comfortable with it. So many times, doctors will be like, “We don't do breech here.” They don't tell you that it's because they haven't been trained or they're not comfortable with it or it's not safe, they just tell you that's not the protocol, and they don't offer you other options. I really love that, and I love the conversation you had where you were like, “I understand the risks, but however, this is how I feel.” I think that's a really healthy way to go about it on both sides. So, cool. Kudos to your provider. Katie: Yeah. Then that doctor suggested this. It was in the underground world. It wasn't like, “Go to the next place.” She also suggested, “Why don't you consult with UCSF?” That's the University of California San Francisco. That's maybe an hour and 20 minutes with traffic, and it can be up to 3 hours, but they do breech birth there. She referred me to have a consultation with UCSF to talk about breech birth which they are very comfortable with. The consultation was great. The people were really helpful. They also had a lot of requirements for me to deliver there. Those requirements were things like an anatomy scan to ensure that the head and rump sizes were comparable for safety of baby. They wanted me to do a pelvic pelvimetry MRI. Julie: Pelvimetry? Katie: Yes. They said, “You have a proven pelvis,” which is the word I couldn't remember earlier, but because I'm very short– I'm 4'10”--, they just wanted that in this case. I said, “Sure. I'll do all of the things if this is the place where I know I can make that birth plan with you and we can do it.” Then they said, “We also give you an epidural. You'll birth in a birthing room, then we'll transfer you to an OR. You'll have an epidural, and that's in case anything goes wrong.” I fully understand the risk and the why behind that, but given with my first baby, one of the interventions was the epidural and I labored on my back, I wasn't quite confident that was the way baby and I were going to do this because what I found in my second birth is me and baby working together and moving together was what, I think, was all of the difference in the world for us to be able to meet each other. That gave me a little bit of pause, but nonetheless, I was like, “Okay. They are being upfront with me about all of the things I need to do.” I had the anatomy scan. Rump to head ratio was 1:1. It looked great. They were scheduling this MRI for me to take. Now, keep in mind, I'm 38 weeks pregnant now. The other things I was concerned about, or more my husband I should say, was that San Francisco, like I said, is about an hour and 20 minutes away from me. With traffic, it can be 3+ hours. Julie: Oof. I've driven in San Francisco during traffic and let me tell you, it is a nightmare. Katie: Yeah. My husband was like, “What if you don't get there in time? How are we going to make this work?” These were all pauses that we had around it. Nonetheless, we were on this track and UCSF was so helpful and wonderful. I'm so grateful for my provider for recommending this consult. Then my doula, as well as other providers, started sharing information with me. I want to say it's an underground network of knowledge where people aren't advocating for vaginal birth on the record because either the hospitals don't want to or don't condone it for whatever reason. I guess you can guess the reasons whether it's money or policy or education and patriarchy, but there is definitely a need. Breech babies are born all of the time. They said, “There are three providers at that sister hospital (that my doctor had initially recommended that was 15 minutes away) who are experienced with breech.” I thought, “Okay. In the event of an emergency and I went into labor, that's where I want to go.” They had a NICU. They had all of the things that made me want to feel more at ease knowing that we were doing something new to me and to keep myself and my baby safe. I still told the UCSF doctors, “Don't worry. I know I'm 38 weeks, but my other babies came at 40 weeks and 1 day, so I've got 2 weeks. He's cooking for 2 more weeks.” Then, at 38 weeks– Julie: Third babies, man. Third babies. Katie: Right? At 38 weeks, 4 days, I wake up. I should say, sorry. The UCSF doctor also said one other thing to me. She said, “Please do one more ECV, and this time, do a spinal.” I was like, “Ugh, this sounds awful.” But I understood the rationale. The safest way to come out was head down. I wanted to compromise and do everything in my power to do that. She said, “Because they hadn't done a spinal previously, there's data that shows it's more successful.” She shared all of that research with me, so I requested that from my local doctor. My doctor was like, “We don't usually do this,” but to their credit said, “We will. We will absolutely do it.” Keep in mind, I went in. I was like, “I know that this baby is loving where they are at. They are not moving, but if I don't try it, I'll never know.” Knowing the risks of ECVs, and knowing all of these things, I did do that because it was a request of the hospital that was going to be potentially the hospital where I give birth, so I wanted to make sure to follow all of the things. I do that. It was also unsuccessful. Then, now fast forward to 38 weeks and 4 days, I wake up and it's been a couple of days since that ECV. The spinal they give you is on your back. I wake up and I have some stomach cramps. I thought, “Man, this is strange, but it's probably from the ECV,” because in the past, it did cause some cramping for me. Because I had the spinal, I wondered if perhaps it just was residual. In my past labors, all of my laboring started with my back. I had a little bit of back aching, but it was again, I chalked it up to the spinal and just recovering from that. I went about my day. It was right before Halloween. I'm telling my partner, “Let's carve pumpkins.” My 5-year-old had a soccer game. I'm trying to get him ready, and I keep getting these cramps. They start to be regular. I thought, “Oh.” I'm 90% sure I'm in labor. This labor just felt different. Maybe it was because it was a breech baby. Maybe it was because it was a third labor, who knows? But nonetheless, it took me a while to get there. Maybe I was thinking it wasn't happening and willing that 40-week mark. Nonetheless, I was laboring. I texted my doula, and I'm timing my contractions. We had agreed that she would come over earlier this time because the baby was breech. All of the doctors said, “Labor at home. Come in during active labor.” We agreed that I would come in earlier than I did last time because of the circumstances. She comes over. She says, “Where I'm laboring, if the contractions are feeling intense, however, I can talk and laugh in between them,” so we agreed that I might be 5 centimeters. I just started to think, “I've got to lie down. I feel super tired. I had this ECV. I want to keep my energy up,” thinking this could be a long labor. Let me eat something. Then she says, “Just go. Sit on the toilet because your body does something different.” I do that. It's 1:00 in the afternoon now, and my water breaks. My husband was packing the bags to get to the hospital thinking, “Where do we go? Do we go to UCSF? Do we go to that sister hospital?” I say, “My water is broken.” I have another contraction. She's watching it. She was like, “We've got to–”, and I started to feel nauseous which are all signs of labor. Julie: Good signs. Katie: Yes, so she was like, “Let's go. Let's go now.” We get in the car. I think this is funny. It's a little on the side, but my husband had set up the car seat right behind me. I'm laboring. I'm definitely contracting and trying to retract my seat. There is this car seat, so I just remember picking it up and tossing it across the side saying, “Why would you set this up here?” He's looking at me, “Oh, you are really in labor. This is clear.” I'm trying to lay down. He has the GPS set. I am in the car. We get going. It's now between 1:00 and 2:00 on a Saturday. There is a ton of traffic and construction. I'm looking at the GPS and I see 25 minutes to the sister hospital, and to San Francisco was 3 hours. We don't have 3 hours. My doula says, “Where are we going?” I say, “That sister hospital. Let's go.” I also happen to know that there are three doctors there through that grapevine and underground network who are experience at delivering breech babies there, so I thought the odds of me having one of them would be beneficial. I would much rather have had conversations with all of them, but I didn't plan to go there thinking I was going to go to UCSF. We get in the car and are driving in this traffic. I'm just looking at the GPS and at the time ticking down. I'm really quiet which was also strange because with my other births, I was super vocal. My husband and I were thinking, “I'm in labor, but maybe I'm just not as far along, even though my water broke.” I've never been quiet. I was dead silent through this whole thing just staring at this GPS. Then all of a sudden, we're going on a bridge called the Causeway and I looked at him, and I said, “I have to push right now.” Julie: No. Katie: He looks at me and says, “No,” which is not very much– he's a very supportive person. What he meant by this was that we didn't come this far to get this far. We're going to get to this hospital. We are driving, and I just remember internally that I was so quiet going inward. I was talking with my baby, talking with myself and saying, “Okay. We've got to get to the hospital. We didn't come this far to get this far. I'm not having a baby breech unassisted delivery.” That was not something that I was comfortable with. We get off the off-ramp, and we're finding the patient drop-off. I'm contracting and I see the sign, and my husband drives right by it. I look at him right after I contract and I say, “You drove right by the patient drop-off. You have to put on hazards. I have to get out now. I have to push.” He's like, “I can't. We're parking.” So he parked the car, and I was like, “What do you want me to do?” He says, “We've got to walk.” Keep in mind, the parking lot where he went is not right next door. It's a block and a half or two blocks away.Julie: No way.Katie: I just was like, “I can't do this. I can't do this.” He says, “Yes, you can. Yes, you can. You have got this.” So I was like, “Okay. I've got this.” I get up, and I walk. When I start contracting, I'm walking down this busy street. I said, “I have to poop.” I had this big contraction, and I think I possibly poop. I'm just looking at these cars thinking, “Why won't somebody stop and help me?” That's when I channeled back to this idea, at the end of the day, It's just you and your baby. You are the team. I contract. We are going. We finally get to the hospital. I have another contraction. I say, “Run in and tell them to help.” He does. I'm holding on to the railing. This lovely woman with her family sees me. She tells her 13-year-old son, “Get her!” I was standing by myself, definitely in labor.” She says, “Get her a wheelchair!” This amazing 13-year-old does just that as my husband runs back. He gets me this wheelchair. I'm sitting in it, but I can't sit down. Again, I think it's because I've had this bowel movement and maybe I'm in transition. I don't know. We get up and pass security, so security is yelling at us. My husband was like, “I've got to go. We've got to go.” We got to L&D and came in. This amazing nurse midwife welcomes us. I don't know if she saw me not sitting down all of the way in my wheelchair or what, but she yells, “Get her a room right now.” She says, “We're going to deliver this baby.” I say, “My baby is breech. Can you help?”She says, “Call this doctor.” My heart is so relieved because this is one of those three experienced doctors who I know is comfortable with breech delivering. He scrubs out of a C-section, I guess. She helps me take off my pants, and then realizes what I thought was poop was really– it's called rumping as a breech instead of crowning. She was like, “Change of plans. Get on all fours.” I just started laboring. The doctor comes in scrubbed out of that C-section. I know that the nurses are saying, “You're doing great. You're going to meet your baby,” and all of the things that are so wonderful. I couldn't speak more highly of the people in that room at that point. My doula joined us because it took her a minute to find us in all of the mayhem. He tells my partner, “Please make sure she goes on her back.” I had this vision of doing breech without borders on your hands and knees, but given that this doctor was very experienced with breech delivery through this underground network of knowledge, I was like, “Okay. We didn't come this far to get this far. I'll do whatever you want. Let's just see this baby.” I turn around after, my husband said, my baby was halfway out. He sees the legs drop which again, in a frank breech position, that happens. You see the rump, and then you see the back and the legs drop. He sees the rest of the body come out as I'm laboring on my back which I didn't do with my first. I wasn't actually, I didn't know if that was something my body was down for. But here I was delivering this breech baby. Of course, I should have known. Women are amazing. We do amazing things, and our bodies are built for this work. I labored, and then I felt him come out completely. I held my breath for a second because what I do know, and excuse me if this statistic isn't 100% accurate, but my understanding is that 1 out of 7 babies born head down might need resuscitation, but 1 out of 3 babies born breech might need resuscitation. So one of the things I was pausing for at this moment was to hear this sweet baby's voice, and so I just start hearing crying immediately. They tell me that his APGAR score was 9/8 which was exactly the same as my first VBAC. Julie: That's great!Katie: Yeah. They were like, “Baby is great. Baby is healthy.” They put him on me. I was trying to feed, but my cord was short, so low and behold, I have a feeling that the reason he was not interested in turning is because my cord was kind of short. He just was sitting fine where he was at with my posterior placenta up high. He and I sat and met each other. We celebrated. The doctor was so funny. He said, “You keep it interesting. You've had every kind of birth you could possibly have.” Julie: You keep it interesting. Katie: Yeah. Every type of birth you could possibly have. The nurses came in after. They said they wanted to come in and watch because they don't see this. They said, “This is amazing. We wanted to respect your privacy.” But they were so supportive of the whole thing. I just felt elated to have the people in the room and around me who believed in me and my baby as much as we believed in us to make it happen. I should say that I came in at 2:10 to this hospital. I delivered at 2:24. When I say it was fast and this was going quickly when all of those things happened, I wouldn't recommend any of those things. However, I think that advocacy and all of those things like knowing all of the data made me feel prepared to do that. That's my breech delivery story. Julie: I absolutely love that. I love that. I was like, “Aw, dang. Too bad she didn't have her baby in the car.” No, I mean that would not have been ideal for you, but it is a dream birth of mine. I mean, I would have loved to have my own baby in the car. It would have been amazing. I love the stories. One day, I dream of documenting a car delivery, but alas, here I am still waiting. But it's fine. Here's the cool thing. I really love how you navigated your birth. You sought out all of your options. You made a choice that you were comfortable with. You heard the risks that the doctors were telling you about. You acknowledged them, but you also stood up for yourself and your plan. I feel like when you can have that mutual respect where you can trust your provider and your provider can trust you, I feel like that's a great place to be. I love how you adapted and changed plans when needed, but you still stood firm for the things that you wanted. It doesn't always work out like that when you have to change plans, but I love that you had the plan and you navigated it with the twists and turns and all of the things that come with the unpredictabilities of birth. I love how you did all of that. I think it's really important and necessary to have strong opinions about how you want to birth. Like I said before, it doesn't always mean that the strong opinions that you have are going to hold true about what you actually end up getting. I think that the value in having those strong opinions about birth is the things that you learn along the way and the things that enable you to navigate through those changes of plans and things like that. I think that's really, really important for us to be able to have and do and be flexible. I do have a few different blog articles on our website related to breech babies. Now, there's one that is just recently published. It was a few months ago. Well, maybe it will almost be a year ago by the time this episode airs. It talks a lot about ECVs, the external cephalic version, in order to try and manually flip a breech baby. It talks about what ACOG recommends and ACOG's stance on it, things you can do, who is right for it, what may exclude you from having an ECV or attempting one and all of those things. It talks about the safety for VBAC and how it's performed, what it feels like, and all of those things. If you ever want to know about ECV, we have a blog for you. It's called ECV and VBAC: What you Need to Know. It goes into all of that stuff. I definitely recommend looking into it because like we said before, you don't really know your options until you have them, and the more information you have in your arsenal, the easier it's going to be for you to navigate those things. Basically, ECVs are pretty safe for most people. They have a success rate of 60% which is a really cool success rate. It's higher than 50%. You're more likely for it to work than not. Sometimes babies are breech for a reason, and they need to stay that way for some reason. There are really only a few things that exclude you which is excessive vaginal bleeding, placenta previa or accreta, if you have really low levels of amniotic fluid, fetal heart rate issues, if your water's already been born, sometimes providers won't do it that way, or if you have twins or multiples, I think that excludes you. It's listed here, and it makes sense. We've got lots of babies tangled up in there. It's absolutely safe for VBAC as well. We also have a couple more blogs about why babies go breech and some things that you can do about it. I'm sure, Katie, you probably tried all of these things, all of the Spinning Babies protocols, all of the forward-leaning inversions and things like that too that can help. There's another article in here about how to turn your breech baby– 8 ways to flip your baby. Like we said, sometimes babies are breech for a reason and they do not want to turn. I'm just really looking forward to the day where breech can be just a variation of normal again. The biggest problem is that our providers are not learning how to deliver breech babies. It does take a different skill in order to do that. You have to be really hands-off. You have to watch for certain things and depending on the type of breech, there are different techniques that you would use. Those techniques are not being taught. Kudos to your original provider who admitted that they were not comfortable or did not have the knowledge to feel comfortable in delivering a breech baby. I'm excited there are organizations called Reteach Breech, Breech Without Borders, and Dr. Stu. If you know Dr. Stu, he is leading a great mission to bring breech back so that women can have options for delivering their breech babies. So what happens if you don't know your baby is breech and your baby is delivered foot first? You can't just stop and go for a C-section right then. It's impossible. So to deliver breech babies safely no matter the circumstances, the knowledge there is important. I'm hoping that one day, that can be an option for anybody if they want that. All right, Katie, I'm so glad that you joined me today. It was so great hearing your story. I love how it all went. I do not pity you having to drive in San Francisco at traffic time. Yeah. I'm glad everything worked out. Katie: We ended up going to this other hospital closer. Julie: Yeah, yeah. But I mean just ever, not even in labor. Just ever. Katie: Yes. Yes. Julie: All right, Katie. Before we sign off, will you tell me, what is your best piece of advice for somebody preparing for a VBAC?Katie: Oh, I think it is so important to do two things. One, educate yourself and surround yourself around folks who are down with that education and believing in you and baby. What I mean by that is knowing what's happening so you can make those important decisions. You understand what consent looks like. You understand those risks. You understand all of the tips and techniques like in this case of breech and turning that baby, and then making sure that you also are advocating and you have people around you who are advocating, but not so stuck on that that you get stuck. You want to do what's best for you and the baby, but as you said, breech is a variation of normal. I think that being around people who are supportive of you, they don't necessarily have to agree with you, but they are working with you, is just so important to empower you because at the end of the day, it's you and baby doing the thing. People who believe in you as much as you believe in yourself and you believe in your baby are so important to get to that finish line in labor. Julie: Yes. I absolutely love that. You have to have people who believe in you and who are on your side and who will support you even if they don't necessarily understand your decisions. They trust you to make those decisions because that is a huge deal. Katie: And give you the information so that if the information you have is not full or complete, you can reevaluate. You don't know what you don't know until you know. I just think that you need to make sure you take it all in if you can unless you don't know your baby is breech and you find out when you are delivering and you make that snap decision, and it'll be great. Julie: Yes. No, I love that. There's something about people bringing you information especially in a respectful way because I feel like in today's world, when people disagree with others, it's very aggressive and condescending and judgmental. I think it's important that we can disagree respectfully but also bring information if you are concerned or if you have another point of view in a respectful way as well. I think it's received a lot better and I think that's where we can really bring that true change and sway people's opinions. It's if we do that in a respectful and understanding way. Yeah, I appreciate that. Good point, Katie. That was awesome. Okay, well thank you so much for sharing your story with me today. I cannot wait for the whole world to hear it. Katie: Thanks so much for allowing me the space to do it. I hope that women are able to explore their options and do what's right for them and their baby and their families. Julie: Yeah. 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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

In most regions of the United States, RSV season starts in the fall and peaks in the winter. In September 2023, the ACOG released a Practice Advisory recommending a single dose of Pfizer's RSV vaccine (Abrysvo) for eligible pregnant individuals between 32 0/7 and 36 6/7 weeks of gestation who do not have a planned delivery within 2 weeks, using seasonal administration, to prevent RSV lower respiratory tract infection (LRTI) in infants. This is recommended from September to January. Currently, the US recommendation is for this to be given once, with subsequent deliveries receiving neonatal Beyfortus in RSV season. The recommendation from NICE is to have this vaccination with every pregnancy. The prescribing information for Abrysvo includes a warning to inform patients that a numerical imbalance in preterm births in Abrysvo recipients (5.7%) occurred compared to those who received placebo (4.7%). This imbalance was only seen in trial participants residing in low- to middle-income countries with no temporal association to vaccination or association with other adverse events in the mother or the newborn. Now, that phase 3 clinical data has gone through peer review and is a new publication. This is the MATISSE global study and will be officially published in the Green Journal February 2025…but we will summarize the results NOW in this episode! Listen in for details.

Happy New Year, Women of Strength! Meagan and Julie share an exciting announcement about the podcast that you don't want to miss. While they chat about topics to look forward to this year, they also jump right in and share stats about cervical checks and duration between pregnancies. We can't wait to help you prepare for your VBAC this year!Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Julie: Ready? Meagan: Happy New– Julie: Oh, are we supposed to say it together? Oh, sorry. Okay, I'm ready. Let's go again. Meagan: No, you were just saying okay, but let's do it together. Okay, ready? Remember I did this last time? Julie: Okay, 1, 2, 3– Meagan and Julie: Happy New Year!Julie: No, it was not right. Meagan: Well, we're going to leave it. You guys, we've been trying to say Happy New Year at the same time. There is a delay, I'm sure, on both sides, but Happy New Year, you guys. Welcome to The VBAC Link. It is 2025, and we are excited for this year. Oh my goodness. Obviously, you have probably caught on that there is another voice with me today. Julie: Hello. Meagan: I have Julie. You guys, I brought Julie on today because we have a special announcement. I didn't let her get away for too long. I didn't want her to go. I couldn't. If you haven't noticed, I've been bringing her on. I'm like, “Can you do this episode with me? Do you want to do this episode with me? Do you want to do this episode with me?”And now, at least for the next little bit, she's going to be doing her own episodes. She is helping me out. Julie: Yeah. Meagan: We have been doing two episodes a week for almost a year now, and it's a lot. It's a lot. Julie: You have been such a champ. Meagan: Oh my goodness. So that's what we've been up to. I decided that Julie needed to help me. She was so gracious to say, “Yeah, I'll do it.” Get this, you guys. She was nervous the first time. Julie: I was like, “I don't know what I'm doing.”Meagan: But she totally does know what she's doing. But yeah, so you will be hearing every so often Julie's voice solo. She is going to be hosting the show solo, so you will be hearing a little bit of a new intro with her and I where we are both talking so you don't get confused, but I don't think it is very confusing. Julie has been with us since the very beginning because her and I created the company. It's been so fun to have her here, so thank you, Julie, for helping me out. Julie: You are always welcome. It's always a pleasure. Meagan: I'm trying to think. I want to talk about 2025 and some things that we have coming up as far as stories go. As a reminder, if you have not subscribed to the show, please do so. As you subscribe, it will send you the episodes weekly. Right now, like I said, we are doing two a week, so soak it all up. We have so many great stories. We have stories from OB/GYNs. They are doing Q&As. We have polyhydramnios. Julie: Polyhydramnios. Meagan: Yes. I always want to say dramnios. We are going to be talking about that because we have a lot of people who have been asking about more unique things. Poly is not necessarily unique, but it's not talked about, so we are going to talk about the high fluid, low fluid, unsupportive providers, and if you have been with us for a while, the biggest thing that we talk about is supportive providers. Julie: Mhmm.Meagan: Maybe it's not the biggest, but it's one of the biggest. We talk about finding a supportive provider all of the time. It is so important. Then we've got vaginal birth after multiple Cesarean, twin births, gestational diabetes, PROM– if you're new to that one, that is premature rupture of membranes meaning that the waters break, but labor doesn't quite kick in. Whave else do we have? We actually are going to do some re-airing. We are going to rebroadcast some of our older episodes that we just think are gems and wonderful or have connections with people like Ali Levine. She came back on recently and we want to bring back her episode. Dr. Stu– just some really great episodes from the past and thinking about how long ago that was, Julie– Julie: Oh my gosh. Meagan: As I've been going through these podcasts, holy cow. Some of these are in our 70's or there was actually one that was out 17th episode or something like that. Julie: We need to re-air the dad's episode. Do you remember that one time when we had all of those dads on? Meagan: Yes. Julie: That was so good. Meagan: That was so good. It was a lot of fun. Julie: You need to put that in a spot. It was so good. I remember, I can just be taken back to us in the studio recording and calling each of these dads. It was so cool. Meagan: It was. It was really fun to hear their take on it and their opinion of doulas, their opinion of VBAC, their opinion of birth and how they were feeling going into birth, and how they felt when their wives were like, “Hey, I want to do this.” Yeah. Do you know what? That's for sure. We will make sure that is re-aired as well because I do know that we get people saying, “Are there any episodes that can help my partner or my husband?” because they want to really learn how to get the support for them or help them understand why. Or Lynn. Guys, there are so many of these past episodes that we will be bringing back. Julie: Lynn's episode was so great. Meagan: That was so great. We're going to be having home births. Forceps– VBAC after forceps or failure to progress or failure to descend or big baby. We've got so many great things coming this year, so I'm really, really excited. I also wanted to share more about what we've going on the blog. We have had weekly blogs, so if you haven't already subscribed to our email list, go over to thevbaclink.com and subscribe. We send out weekly emails filled with tips or recent episodes. We have a lot of questions in The VBAC Link Community on Facebook. We see some repetitive questions in there, so we respond to those via email. Those are really good. We've got cervical checks. When is it good to do a cervical check? When is it not good? Julie: Umm, never? Meagan: When is it not good to do a cervical check? When are they really necessary? What do they tell us? We're going to be diving into that. We have a blog about that. Do you want to talk about that for a second, Julie? Let's talk about that. Julie: Okay. I understand that there is nuance. That's the thing about birth. There is nuance with everything. There is context with everything. It just reminds me of the recent election and things like that while we are recording. There are all of these one-liners are being thrown around on both sides. One sentence can be taken out of context in big ways when you don't have the context surrounding the sentence. For both sides, I'm not pointing fingers at anybody. I'm sorry if that's triggering for anybody. I know there are a lot of people upset right now. But the same thing with cervical checks. Isn't that true with all of life? All of life, all of birth, and all of VBAC, there is nuance and context that's important. I would say that most of the time, most of the time, cervical checks are not necessary. They only tell us where you've been. They don't tell us where you're going. They are not a predictor of anything. I've had clients get to 8 centimeters and not have a baby for 14 hours. No kidding. I've had clients push for 10 hours. I've had people hang out at 5 centimeters for weeks, then go into labor and have the baby super fast and also super slow. It doesn't tell us anything. However, there are times when it might be helpful. I use that really, really carefully because it can only give us so much information. I feel like sometimes the cervix can swell if you've been in labor for a really long time, or if the baby is in a bad position, so if labor has slowed or hasn't been progressing as much as expected– and I use that term very loosely as well. There might be a suspicion for cervical swelling. Having a cervical check can confirm that, and having a swollen cervix will change the direction of your care. I would say that maybe an important question to ask– and this is a good question for any part of your care– is, “How will this procedure, exam, intervention, etc. influence my care moving forward?” Because if it's not going to influence your care moving forward at all, then is it necessary? Meagan: Why do it?Julie: Right? So, a swollen cervix, maybe checking baby's position. You can tell if baby's low enough. You can see if their head is coming asynclitic or with a different type of presentation. Again, with a suspicion that it might be affecting labor's progress.Meagan: You can check if they are asynclitic. Julie: But, how would your care change if you find out that baby is asynclitic? What would you do if that is the result of the cervical check? If the answer is nothing, then I don't know. But also knowing that baby's position or knowing that you have a swollen cervix, there are things that you can do to help labor progress in the case of a malpositioned baby or for a swollen cervix. First of all, back off on Pitocin or take some Benadryl or things like that that can help with those things. But honestly, I think most of the time, cervical checks are another way for the system to chart and keep records, that they are doing their job, that things are happening normally (in air quotes, “normally”) so they can have their backs covered. It's really funny. There are other ways to tell baby's position. There are other ways to notice. Midwives, especially out-of-hospital midwives know all of these things. They can gather all of this data without cervical checks, without continous monitoring, and all of that stuff. But in the hospital setting, they can literally sit at a desk and watch you on the strip. That's the only way they know how to get information. They don't know how to palpate the belly. They aren't as familar with– I mean, probably nurses more so than OBs. Meagan: Patterns. Julie: Right? Labor patterns, the sounds, how mom is moving her body and things like that. Those are all things that you can use to tell where a laboring person is at in their labor without having to do cervical checks. But anyway, that was a long little tangent. Meagan: No, that's good. I love that you are pointing that out. Is it going to change your care? If you are being induced, a lot of times, they are going to want to do a cervical exam. You may want a cervical exam as well so you can determine what induction method is going to best fit your induction. Julie: Yeah, that's true. Meagan: Like starting that, but even before labor, I want to point out that when it comes to cervical exams, I see it time and time again within the community, within Instagram, within Utah here– we have birth forums here in Utah– I see it all of the time. “I am 38 weeks. I got checked to day. I am not dilated. It's not going to happen. My provider is telling me that my body probably doesn't know how to go into labor and that I should be induced or that my chances of going into labor by 40 weeks (that's a whole other conversation) is low because I'm not dilated yet at 38 weeks,” or they are the opposite and they are like, “I feel like I can't do anything because I'm walking around at 6 centimeters.”Then they don't go into labor. Julie: Baby will come right away as soon as labor starts. Meagan: Yeah, or the person who has been walking around at 38 weeks, 39 weeks, 40 weeks, 40.5 weeks at 0 centimeters has their baby before the person who has been walking around at 6 centimeters. It really doesn't tell you a whole lot other than where you are in that very minute and second that you are checked. Now, if it is something that is going to impact your care, that is something to consider. Also, if it's something that's going to impact your mental health, usually it's going to be negatively. Sometimes, it's positive, but I feel like we get these numbers in our head, and then we get them checked and– Julie: You get stuck on it, yeah. Meagan: You get stuck on it which is normal because of the way that we have been taught out in the birth world. Think about it also mentally. Is a cervical exam in this very moment to tell you where you are right now worth messing up your mental space? Maybe. Maybe not. That's a very personal opinion. But really, it's so important to know that cervical exams really just tell you where you are right now. Not where you're going to be, not where you're going to get– Julie: And not how fast you're going to get there either. I do not trust babies. I always say that. I do not trust babies. Meagan: You don't trust babies? Julie: They have a mind of their own. They are so unpredictable. Yeah, I don't trust them. I'll trust them after they are born, for sure. But before, no way dude. They trick me all of the time. I really appreciate how you brought up the induction thing because I feel like a cervical check at the beginning of an induction and after a certain amount of time that the induction is started is helpful information because it tells you where you started from. It tells you if the induction methods that they are using are working. I feel like that's helpful to know because you don't want to sit there with an induction method forever if it's not working. I feel like also, why the induction is being recommended is important too. If baby needs to come out fast because something is seriously wrong, then more frequent cervical checks or a more aggressive induction may be needed. But if it's something that you can wait a few days for, then is the induction really necessary. But that's really the context there too. Context and nuance, man. Meagan: Yep. I also think really quickly before we get off of cervical exams that if you are being induced, a cervical exam to assess if you are even in a good spot to induce, assuming that it is not an emergent situation where we have to have this baby out right now. You are like, “I want to get induced,” then you are maybe half a centimeter. Julie: The BISHOP score, yeah. You are low and closed and hard. Meagan: You're maybe 40% effaced. You're really posterior. You guys, that might be a really good indicator that it's not time to have a baby.Julie: Right. Meagan: There we go. Okay, so other things on the blog– preparing for your VBAC. We talk about that a lot. We also talk about that in our course, on the podcast, in the community, on Instagram, and on Facebook. That's a daily chat. We have blogs on that. Our favorite prenatal– you guys have heard us talk about Needed now for over a year. We love them. We truly, truly believe in their product, so we do have blogs on prenatal nutrition and prenatal care. What food, what drinks, and what prenatal you should take. Then recovering from a C-section– I think a lot of people don't realize that our community also has a whole C-section umbrella where we understand that there are a lot of different scenarios. Some may not choose a VBAC which is also a blog on how to choose between a VBAC and a Cesarean. They might not choose a VBAC or they might go for a VBAC and it ends in a repeat Cesarean, or they opt for an elective Cesarean. These are situations that lead to recovering from a Cesarean. We have blogs and a section in our course, and then we even have a VBAC– not a VBAC. Oh my gosh. I can't get Facebook and VBAC together. We have a CBAC Facebook group as well called The CBAC Link Community, so if you are somebody who is not sure or you maybe had a Cesarean or you are opting for a Cesarean, that might be a really great community for you. I believe that it's an incredible community. Let's see, the length between pregnancies is one. Do you want to talk about that?Julie: Oh my gosh. I see this so much. Meagan: Daily. Julie: People are asking, “How long should I wait? I want to have the best chances of a VBAC. How long should I wait before getting pregnant?” Or, “My doctor said I have to have 18 months between births and I will only be 17 months between births so it excludes me from VBAC.” Meagan: Well, and it gets confusing. Julie: Yes. It does get confusing. Meagan: Because is it between or is it conception? What is it? Julie: Right. Is it between births? Is it between conception? Is it from birth to conception? Birth to birth? Conception to conception? I don't think it's conception to conception, but thing is that everybody will have their thing. I hear it really commonly 18 months birth to birth. I hear 2 months birth to birth quite a bit. Meagan: 2 months? Julie: Sorry, 12 months. Meagan: I was like 2? I've never heard that one. Julie: 12 months birth to birth. Oh man. Meagan: 24 months. Julie: I need some caffeine. 2 years, not 2 months. 2 years between births. Meagan: 24 months. Julie: There are a whole bunch of recommendations. Here are the facts about it. The jury is still out about what is the most optimal time. There is one study. There are three credible studies that we link in our blog. There are three credible studies. One says that after 6 months, there's no increased risk of uterine rupture. So 6 months between– I'm sorry. 6 months from birth to conception. Meagan: Birth to conception. Julie: So that would be 15 months from birth to birth. There's another study that says 18 months from birth to birth, and there's another study that says 2 years from birth to birth. These are all credible studies. So, who knows? Somewhere between 15 months to 2 years. I know that the general recommendation for pregnancies just for your body– this is not talking about uterine rupture– to return to its– I wouldn't say pre-pregnancy state because you just don't really get back there, but for your body to be fully healed from pregnancy is a year after birth. From a year from birth to conception is the general recommendation. But we know that there is such a wide variety of stories. There is a lot of context involved. There are providers who are going to support you no matter your length. This is circling back to provider choice and why it's so important. If one provider says, “No,” and they want 2 years from birth to birth, then bye Felicia. Go find another provider because there is someone who is going to support you. There is someone who is going to do it rather than be like, “Oh, well, we will just let you try.” They are going to support you and be like, “Yeah. Here are the risks. Here is what I'm willing to do, and let's go for it.” I think that's really important as well. Meagan: Yeah, this is probably one of the most common questions. Sorry, guys. I was muted and chatting. It's one of the most common questions, and like she said, there are multiple studies out there. It's kind of a complicated answer because it could vary. Overall, the general studies out there are anywhere between 18 to 24 months. 24 months being what they are showing is probably the most ideal between birth to birth. A lot of people out there still think that it's birth to conception, so they have to wait 2 years before even trying to get pregnant. Then I mean, I got a message the other day from someone. They were like, “Hey, our hospital policy,” which I thought was interesting– not that she was saying this, but that it was a policy. “Our hospital policy is that if I conceive sooner than 9 months after a Cesarean, they will not accept me.” Julie: Boom. Go find another hospital. Meagan: I was like, okay. That's weird. Julie: I know. Meagan: And that's 9 months, so that would be 18 months from birth to birth. Julie: Right. Meagan: Then you can go to another provider, and they're different. This is my biggest takeaway with this. Look at the studies. We have them in our blog. They're there. Look at them. Tune into your intuition. What do you need for your family? What do you want for your family? What feels right for you? Julie: Yeah. Meagan: I mean, we have many people who have had VBACs before the 18th-month mark. Aren't you 15 months? Julie: No, mine was 23 months birth to birth. Meagan: Oh, birth to birth. Okay. I thought you were a little sooner. Julie: I conceived, what was that? Meagan: Mine was 22 and 23. I was a 22 and then my other one was 23, I think. It was something like that. It was right around 2 years. Tune into what it is. Yes, we say this, and someone has said, “Well, yeah. People have done it, but that's not what's recommended.” Okay, that's true. Julie: Yeah, recommended by who? Recommended by who? Because like I said, three different studies have three different recommendations. What does ACOG say? I don't think ACOG even has an official recommendation do they? Meagan: My mind says 24 months. Julie: I think they say something like a pregnancy window doesn't automatically exclude somebody from having a VBAC. Meagan: Yeah. You guys, we have that. We also have stories coming up with shorter durations. We have epidural blogs, and how to choose if you want an epidural or not, and then what happens when an epidural comes into play. Maybe I need caffeine too. I can't even speak. But when they come into play, and so many facts, stats, and stories on the blog and on the podcast. You guys, it's going to be a great year. It's 2025. I'm excited. I'm excited to have you on, Julie. It's going to be so great. I'm excited to bring some of our really old, dusty episodes back to life. Julie: Polish them up. Meagan: Yeah. I'm really excited about that. And then some of the weeks, we've been doing this since October, I think, we've got some specialty weeks where it's VBAC after multiple Cesarean week, and you'll have two back to back. We might have some weeks like that in there that have similar stories so you can binge a couple in a row that are something you are specifically looking for. Okay, as a reminder, we are always looking for a review. Before I let you go, you can go to Google at “The VBAC Link”. You can go to Apple Podcasts and Spotify. I don't know about Google Play. I actually don't know that because I don't have it. Julie: I don't think Google Play has podcasts anymore. But also, you can't rate it on Spotify. Meagan: You can rate it, but you can't review it. Julie: Oh, yeah. You can rate it, so you can give it 5 stars. That's right. Meagan: If you guys wouldn't mind, give us a review. If you can do a written review, that's great. Honestly, you can do stars then go somewhere else and do a written review. We love your reviews. They truly help. I know I've said this time and time again, but they help other Women of Strength find this podcast, find these inspiring stories, and find the faith and the empowerment and the education that they need and deserve. Thank you guys for sticking with us. Happy New Year again, and we will see you soon. Julie: Bye!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. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands