Podcasts about cnm

In this episode of The Birth Lounge podcast, host HeHe is joined by guest Marisa Huebsch to discuss the topic of shoulder dystocia, a rare but serious obstetrical emergency. HeHe and Marisa, a certified nurse midwife, explain what shoulder dystocia is, its causes, and how it can be resolved through various maneuvers. She emphasizes the importance of patient autonomy and informed decision-making during childbirth, particularly in high-stress situations like shoulder dystocia. They also delve into the risks of shoulder dystocia for both mothers and babies, including potential injuries and the importance of postpartum debriefing. The episode aims to demystify this complication, providing listeners with practical advice on staying in control and advocating for themselves during labor and delivery. 00:00 Introduction and Hospital Choices 01:38 Understanding Shoulder Dystocia 03:26 Preventing and Managing Shoulder Dystocia 03:42 Guest Introduction: Marisa Huebsch 06:21 Personal Experiences with Shoulder Dystocia 08:57 Detailed Maneuvers for Shoulder Dystocia 20:15 Induction and Shoulder Dystocia 25:48 Patient Autonomy and Birth Choices 42:46 Addressing Provider Self-Reflection and Bias 44:55 Handling Trauma and Patient Care 47:46 Navigating Patient Autonomy and Informed Consent 49:18 The Role of Providers in Birth Experiences 01:02:55 Managing Shoulder Dystocia Risks and Outcomes 01:15:15 Empowering Patients Through Education and Support 01:18:32 Final Thoughts and Resources   From Marisa:  I was a Labor and delivery nurse for 6 years, worked in 3 different facilities including high risk units and low risk units. I was also a nurse home visitor with Nurse Family Partnership where I worked with low income first time moms and babies throughout pregnancy and through the child's first 2 years. I am now a hospital based CNM in a high volume practice who collaboratively cares for low and high risk patients with a robust midwife team. My practice philosophy is all about empowering patients to be informed about their care, normalizing physiologic birth, and providing the midwifery care model to high risk patients. I have two children, one born in a hospital and one born at home (unusually LONG multip labor , educated by The Birth Lounge)   SOCIAL MEDIA: Connect with HeHe on IG Connect with HeHe on YouTube   Connect with Marisa on IG    BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!

Every pregnant person deserves the information—and support—they need to make truly informed decisions about labor induction. In this episode, Dr. Rebecca Dekker talks with Dr. Ann Peralta and Kari Radoff, CNM, co-creators of Partner to Decide, a nonprofit initiative improving decision-making in perinatal care. They discuss the creation of their free, multilingual decision aid that supports families in understanding their options around routine induction of labor—and empowers them to advocate for their values, preferences, and autonomy.   Ann shares how her own birth experience, shaped by access to education and privilege, sparked the creation of the tool. Kari offers insight into how the decision aid has changed conversations in clinical settings—bringing clarity, reducing bias, and fostering truly shared decision-making. Together, they illuminate how access to balanced information can reduce anxiety, improve trust, and shift the culture of perinatal care.   (03:02) What Is a Decision Aid and Why It Matters (07:12) Ann's Birth Story and the Origins of Partner to Decide (11:09) Gaps in Shared Decision-Making from a Provider's Perspective (14:24) Personal Values, Intuition, and Cultural Differences (18:19) Designing the Decision Aid with Equity and Accessibility (23:49) The Power of Absolute vs. Relative Risk in Birth Conversations (25:01) Surprising Patient Feedback: From Access to Empowerment (30:31) Provider Reflections and Challenging Bias (36:11) Why “Routine” Induction Language Matters (43:59) How to Respond to Pressure or Coercion Around Induction (46:16) How to Access the Free Decision Aid and Support New Tools   Resources Access the free Induction of Labor Decision Aid in seven languages: www.inductiondecisionaid.org Learn more about the nonprofit: www.partnertodecide.org 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.

Joshua Sparkes is a grower whose innovative, soil-centered approach blends regenerative principles with a deep reverence for the natural world. We dig into his unique style of farming, how it's shaped by observation and experimentation, and why it offers a glimpse into what must be the future of sustainable food production. Links The Collective at Woolsery Joshua Sparkes on Instagram Other episodes if you liked this one: If you liked this week's episode with Joshua Sparkes you might also enjoy this one from the archives:  Episode 328: Soil, Health & Nutrition Guest: Sam Hamrebtan Link: Roots and All Nutritional therapist and sustainable cooking expert Sam Hamrebtan explores the vital connection between soil and the nutrients in our food. As the founder of the Life Larder newsletter and Course Director at CNM's Natural Chef School, Sam brings a wealth of knowledge on how growing practices impact the quality of what we eat. Episode 306: The Soil Habitat Guest: Eddie Bailey Link: Roots and All Eddie Bailey, a geologist, organic no-dig gardener, and soil food web specialist who runs Rhizophyllia, discusses the soil food web, what inhabits the soil habitat, why soil health impacts plant health and ultimately our health, and what you can do to get the best out of your garden. Please support the podcast on Patreon

In this episode, we sit down with Dr. Elyse Martin, CNM, to explore the world of holistic health and wellness. From gut health and functional medicine to women's health and longevity, Dr. Martin sheds light on how a holistic approach can transform your well-being. We also dive into topics like the gut microbiome, dietary supplements, birth plans, and the role of midwives in modern healthcare. Don't miss this insightful conversation packed with actionable tips for a healthier, more balanced life!Find out more about us and what we do at https://otgfitness.com/Find out more about Elise and what she does at https://www.hivewomenswellness.com/

In this episode, Melissa Hasler, APRN, CNM, Director of Certified Nurse Midwifery at Fairview Health Services, discusses how Fairview is tackling the Black maternal health crisis by eliminating race-based screenings, rethinking care maps, and centering equity in prenatal and delivery care.

In this episode, Melissa Hasler, APRN, CNM, Director of Certified Nurse Midwifery at Fairview Health Services, discusses how Fairview is tackling the Black maternal health crisis by eliminating race-based screenings, rethinking care maps, and centering equity in prenatal and delivery care.

Sisters Of Sound, paroles de musiciennes est un podcast qui explore la place des femmes dans l'industrie musicale à travers des témoignages inspirants sous la forme d'une enquête réalisée par l'artiste Mythie. Au fil des épisodes, nous plongeons dans les pressions liées à l'âge, le sexisme persistant, le manque de légitimité, raconté par les musiciennes sur un ton intimiste et personnel. Des musiciennes talentueuses partagent leurs expériences personnelles, leurs stratégies de réussite et leurs luttes pour préserver leur santé mentale face au poids de l'industrie. La réalisatrice Mythie se place ici comme investigatrice, narratrice et productrice de la musique originale du podcast, apportant un regard de musicienne sur une enquête faisant écho à son parcours. Rejoignez-nous dans cette exploration fascinante de la place des musiciennes et découvrez comment elles brisent les barrières pour faire entendre leur voix et réaliser leurs aspirations artistiques.Saison 03 - Episode 03 : " Ça veut dire quoi réussir ? " :Après avoir identifié les injonctions et les embûches autour du mythe de l'artiste torturé et de la quête du succès, on va (enfin) imaginer d'autres manières de construire son parcours. Dans cet épisode, plusieurs artistes viennent redéfinir la notion de réussite et leurs attentes envers la profession, afin de créer de manière plus saine, en accord avec leurs valeurs. Et s'il n'y avait pas qu'un seul chemin ?Avec :Ian Caulfield, Mesparrow, Malé, Charlotte Savary, Marine Thibault, Paprika Kinski, Oaio, Lena Deluxe, Anouk Amati, Thérèse, DeLaurentis, Flore Benguigui, Geoffrey Sebille, Mara et Artie des Psychotics Monks, Sarah Maier, Nathalie Séjean, Jeanne Added, Seule Tourbe. Sisters of Sound est un podcast produit par le Grand Mix, scène de musiques actuelles de Tourcoing, et l'association Mermaids, avec le soutien du CNM, de la DRAC Hauts-de-France et de la Région Hauts-de-France. Réalisation, narration et musique originale : Mythie. Visuel : Bravo GinetteSi ce podcast vous touche, vous pouvez le faire vivre, en le partageant autour de vous, en venant échanger sur ces sujets sur la page instagram de mermaids @sisters-of-sound-podcast. Et si la musique vous a plu, vous pouvez retrouver Mythie sur les plateformes et réseaux sociaux @mythiemusic. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode, Elle and Vee go deep with Adam Darrow, the author of Seek the Risk: One Man's Journey Into Non-Monogamy. Described as a "firsthand recounting of a wide-open relationship, told with unflinching candor from the male perspective", Elle and Vee were struck by the relatability of Adam's ENM story in Seek the Risk, from the overthinking and jealousy to the adventurous sex and deep connection in his relationship. His firsthand account of how he worked through the challenging emotional moments of his relationship with "the wrong girl" is FULL of nuggets, many of which are mentioned in this deep, candid, vulnerable conversation.  Grab a pen and dig in :) What does Seek the Risk mean? "Experience hunting" rather than "trophy bagging". (2:52)Applying the Seek the Risk philosophy to CNM (consensual non monogamy). (6:49)Misalignment and shame: when one partner is the one who is pushing, and one is being pushed. Being mindful and careful about not shaming the “slower” partner. (9:23)The treasure you seek: when do you know it's growth vs. self-flagellation? (15:13)Tool #1: Creating a container to hear stories about your partner's sexual activities so you aren't blindsided by them. Asking for consent to share information. (18:30)Tool #2: Check-ins/debriefs. (23:37)Being triggered at a sex party and how to work through it. (25:36)Tool #3: “Take the cigarette break.” aka Not reacting in the moment. Notice your own growth! (31:22)Tool #4: Self-hypnosis aka “magical reframing”. (36:01)Tool #5: “Exist in the grey.” Don't act on emotions when spiraling out: sit with uncomfortable feelings. “Negative outcome fantasy.” (38:50)Imposter syndrome: how our childhood traumas show up in our adult relationships. (43:37)IFS: internal family systems and Aspecting (from ISTA). (49:52)Masculinity: Societal hypocrisies and submissive associations with pegging and anal play. (52:58)Final Nugget! (1:00:34)Where to find us, and how you can support us:Instagram: @girlsgonedeeppod Merch: girlsgonedeep.com/shop Woo More Play Affiliate Link: Support us while you shop! WHOREible Life: Get 10% off your deck with code GONEDEEP at whoreiblelife.com Instagram: @wlthegameContact: girlsgonedeep@gmail.com

« Le dernier outil qui va être indispensable pour les indépendants c'est d'avoir la main sur leur billetterie »

Sisters Of Sound, paroles de musiciennes est un podcast qui explore la place des femmes dans l'industrie musicale à travers des témoignages inspirants sous la forme d'une enquête réalisée par l'artiste Mythie. Au fil des épisodes, nous plongeons dans les pressions liées à l'âge, le sexisme persistant, le manque de légitimité, raconté par les musiciennes sur un ton intimiste et personnel. Des musiciennes talentueuses partagent leurs expériences personnelles, leurs stratégies de réussite et leurs luttes pour préserver leur santé mentale face au poids de l'industrie. La réalisatrice Mythie se place ici comme investigatrice, narratrice et productrice de la musique originale du podcast, apportant un regard de musicienne sur une enquête faisant écho à son parcours. Rejoignez-nous dans cette exploration fascinante de la place des musiciennes et découvrez comment elles brisent les barrières pour faire entendre leur voix et réaliser leurs aspirations artistiques.Saison 03 - Episode 02 : " Mais pourquoi tu fais pas The Voice ? " :Notre société adore les success story, mais qu'est-ce que ça veut dire exactement le succès ? Alors que la valeur d'une œuvre semble aujourd'hui se mesurer principalement à son nombre de likes et de streams, on va analyser dans cet épisode l'impact de cette quête insatiable sur les artistes, et les dangers de la comparaison et de la recherche de validation.Avec :Geoffrey Sebille, Daphné Swan, Sarah Maier, Mesparrow, Oaio, Mara des Psychotics Monks, Ian Caulfield, Paprika Kinski, Maude Alma, Thérèse, Nathalie Séjean, Emilie Simon et Malé. Sisters of Sound est un podcast produit par le Grand Mix, scène de musiques actuelles de Tourcoing, et l'association Mermaids, avec le soutien du CNM, de la DRAC Hauts-de-France et de la Région Hauts-de-France. Réalisation, narration et musique originale : Mythie. Visuel : Bravo GinetteSi ce podcast vous touche, vous pouvez le faire vivre, en le partageant autour de vous, en venant échanger sur ces sujets sur la page instagram de mermaids @sisters-of-sound-podcast. Et si la musique vous a plu, vous pouvez retrouver Mythie sur les plateformes et réseaux sociaux @mythiemusic. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

JKS 58  Celebate Swingers 2, The SequelWelcome back faithful listeners!April is STI awareness month so we wanted to get this episode out there.This episode, we do a little discussion about how things have been going and go back to last october and november before Mrs. Sting's breakup with her boyfriend, to disclose the most recent issue that has forced us to be Celebate again.We talk about STIs (big surprise) and getting tested.Mentioned in the episode...tellyourpartner.orgshamelesscare.comSee below for links to testing & STI information. Please reach out if you have something to say about this.We hope you enjoy the show!Thank You for listening, and "Just Keep Swinging"!You can reach Mr.Sting at @JKSwingingPod on Twitter or @justkeepswinging.bsky.socialemail at JustKeepSwingingPod@gmail.comIf you like our show and the perspective we provide, PLEASE give us a positive review on iTunes.  If you don't like us, say nothing and just move along .WE HIGHLY RESPECT THE FOLLOWING LIST OF CREATORS/ORGS(FYI-we do not generate any form of compensation from our show. We do it for love & caring for ourselves and others. The following are people we believe in.)We encourage you to visit OPEN The Organization for Polyamory and Ethical Non Monogamy https://www.open-love.org/follow @openloveorg Libertine Events Lifestyle vacations,https://libertineevents.com/  follow @PaloozaPodcast on social media or visit https://podcast-a-palooza.comwww.openingus.comhttps://beyondourbedroom.com/https://www.expansiveconnection.com/Average Swingers podcastSapphic Swingers podcastTwo or more to Tango podcastSwinger University podcastCasual Swinger podcast My Favorite app for building sex positive community & education is called Plura. you can find out more here...https://heyplura.com/faqFascinated about swinging and other kinds of open or sex positive relationships? Go listen to our friends at Normalizing Non Monogamy podcast. Join their community.  https://www.normalizingnonmonogamy.com/  and Bawdy Storytelling podcast https://bawdystorytelling.com/podcastHave you or a loved one contracted Herpes or another STI and are looking for resources on coping with your diagnosis? Search IG for Courtney Brame from the Podcast & Non-Profit "Something Positive for Positive People". A resource for fighting stigma and shame, while finding community & emotional healing for people living with Herpes & other STIs.visit https://www.spfpp.org/Other resources to consider...American Sexual Health association- ASHAsexualhealth.org @infoASHAThe- nationalcoalitionforsexualhealth.org @NCSH_stdcheck.com @STDcheck Shameless Care STI testing and meds www.shamelesscare.comOther notes: We recommend watching Embarrassing Bodies & Big Mouth on Netflix for relaxing the grip of stigma, fear and poor sexual & relationship education. 

In this episode, Lisa Paladino, CNM, IBCLC, explores the complex—and often controversial—challenges that lactation consultants face when assessing and managing tongue tie in infants. From inconsistent training and ambiguous assessments to provider disagreements and family pressures, Lisa breaks down the barriers to effective care and offers actionable strategies to overcome them.Key Topics Covered:Inconsistent Training & Guidelines: Education on tongue tie varies widely, leaving many professionals with limited or conflicting knowledge. Lisa stresses the need for specialized, evidence-based continuing education and peer collaboration to build confidence and competence.Challenges in Assessment: Accurate diagnosis requires more than a visual check—functional assessment is key. Lisa highlights the importance of understanding oral mechanics and using supportive and proven assessment tools. Interprofessional Disagreements: Differing views among health care providers can confuse families and complicate care. Lisa advocates for respectful, evidence-informed communication and building a trusted referral network.Parental Pressure for Immediate Answers: Families often seek quick fixes amidst feeding struggles. Lisa emphasizes the value of compassionate education, managing expectations, and offering follow-up support.Limited Access to Qualified Providers: A shortage of experienced tongue tie professionals can hinder timely treatment. Lisa encourages exploring virtual consults, maintaining referral lists, and advocating for increased local training.Takeaway: Navigating tongue tie assessment and treatment is both controversial and challenging—but with the right tools, education, and collaboration, lactation consultants can support families more effectively and confidently.Resources & Links Mentioned:

*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.

Homeopath Atiq Ahmad Bhatti joins us to share his expert advice on using homeopathy to support children's health and immunity. From colds and ear infections to teething, digestive upsets and skin complaints, Atiq explains how homeopathic remedies can gently ease symptoms and support the body's natural healing. Whether you're a parent searching for safe, natural options or simply curious about how homeopathy works, this episode offers practical guidance and insight. For more information and the show notes, head to the CNM podcast website. Stay updated by following CNM on:Website: https://www.cnmpodcast.com Instagram: https://www.instagram.com/collegeofnaturopathicmedicine/Facebook: https://www.facebook.com/CNM.UK/

Comment les artistes rap entreprennent-ils dans le contexte de l'industrie musicale du rap actuelle ?Le CNMlab, laboratoire d'idées du Centre national de la musique, vous invite à cette conférence de Tarik Chakor, maître de conférences en sciences de gestion, sur les parcours entrepreneuriaux d'artiste rap « en développement ». A partir d'entretiens et d'observations sur les moments clés de la vie d'artistes, il s'agit d'explorer l'évolution de la figure du rappeur et de la rappeuse en tant qu'acteurs économiques dans l'industrie musicale, et d'éclairer comment ces parcours entrepreneuriaux se développent entre passion, nécessités, obstacles et aventure collective.Ce talk est une présentation de la publication de Tarik Chakor dans le recueil Artistes et entrepreneuriat : vers de nouvelles formes d'organisation dans la musique édité par le CNM en octobre 2024. La conférence sera suivie d'un temps d'échange avec l'auteur.Modération par Tarik Chakor.Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

Sisters Of Sound, paroles de musiciennes est un podcast qui explore la place des femmes dans l'industrie musicale à travers des témoignages inspirants sous la forme d'une enquête réalisée par l'artiste Mythie. Au fil des épisodes, nous plongeons dans les pressions liées à l'âge, le sexisme persistant, le manque de légitimité, raconté par les musiciennes sur un ton intimiste et personnel. Des musiciennes talentueuses partagent leurs expériences personnelles, leurs stratégies de réussite et leurs luttes pour préserver leur santé mentale face au poids de l'industrie. La réalisatrice Mythie se place ici comme investigatrice, narratrice et productrice de la musique originale du podcast, apportant un regard de musicienne sur une enquête faisant écho à son parcours. Rejoignez-nous dans cette exploration fascinante de la place des musiciennes et découvrez comment elles brisent les barrières pour faire entendre leur voix et réaliser leurs aspirations artistiques.Saison 03 - Episode 01: " Faut-il souffrir pour créer ? " :Selon l'étude “Can music make you sick”, 70% des musicien·nes sont en souffrance psychique, c'est-à-dire trois fois plus que la population générale. Mais qu'est-ce qui nous abîme ? Est–ce le fait même d'être artiste, ou plutôt les conditions pour le devenir ? Dans cet épisode, on va parler du mythe de l'artiste torturé, des injonctions de l'industrie musicale et du découragement.Avec :Natacha Tertone, Paprika Kinski, Seule Tourbe, Emilie Simon, Ian Caulfield, Flore Benguigui, Charlotte Cegarra, Sarah Maier, Thérèse, Mara et Artie des Psychotics Monks, Mesparrow, Oaio, Marine Thibault, Lena Deluxe, Geoffrey Sebille. Sisters of Sound est un podcast produit par le Grand Mix, scène de musiques actuelles de Tourcoing, et l'association Mermaids, avec le soutien du CNM, de la DRAC Hauts-de-France et de la Région Hauts-de-France. Réalisation, narration et musique originale : Mythie. Visuel : Bravo GinetteSi ce podcast vous touche, vous pouvez le faire vivre, en le partageant autour de vous, en venant échanger sur ces sujets sur la page instagram de mermaids @sisters-of-sound-podcast. Et si la musique vous a plu, vous pouvez retrouver Mythie sur les plateformes et réseaux sociaux @mythiemusic. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

  Interview with Jackie Grigg, CNM, and Andie Wyrick, CNM, DNP, MSN. Also, joining us are Samantha Ranck, RN, SNM, and JacQue, Holistic Doula, Student Midwife and Student Herbalist. They will tell us about maternal and infant mortality in the … Continue reading →

Il tempo scorre sempre... non perdiamoci le puntate con le novità per imprese e professionisti... non rinunciamo ad un caffè.

Join me and Marianne Stroud, CNM for a discussion on the basics of giving birth at the Holy Family Birth Center.

Nutritional therapist and sustainable cooking expert Sam Hamrebtan explores the vital connection between soil and the nutrients in our food. As the founder of the Life Larder newsletter and Course Director at CNM's Natural Chef School, Sam brings a wealth of knowledge on how growing practices impact the quality of what we eat. Sam talks about  nourishing both the land and ourselves. Links The Life Larder On Instagram Other episodes if you liked this one: If you liked this week's episode with Sam Hamrebtan you might also enjoy this one from the archives:  257: Taste Your Garden This episode, my guest is qualified herbalist Meghan Rhodes. Meghan discusses how we can tap into our gardens for better health, why herbs are good for dealing with conditions that are manifestations of multiple problems, such as stomach issues, the 7 keys tastes you find in herbs and how you can get started on your own journey using herbs for wellbeing. 246: Urban Smallholding My guest this episode is urban smallholder Sara Ward. Sara runs Hen Corner, a backyard smallholding in London. Her website Hen Corner has a wealth of information on growing and making food, she runs courses, sells products from her bakery and has just published a book ‘Living the Good Life in the City'. I began by asking Sara what prompted her to follow in the wellie-prints of Barbara Good. Please support the podcast on Patreon

In today's episode, Dr. Karen DeCocker, PMHNP, DNP, CNM, joins the podcast to discuss the use of ketamine to treat depression and various other mental health issues. Dr. DeCocker is the Director of Advanced Practice Providers and Vice President of Clinical Services at Stella Mental Health. Here, she's on a mission to reframe the mental health care paradigm – emphasizing the need to treat brain health with the same level of importance as physical health… Dr. DeCocker provides individualized treatment recommendations across a wide range of advanced protocols, including dual sympathetic reset, ketamine infusions, integration therapy, and more. With more than 13 years of experience as a clinical professional and 30 years of experience in the non-profit and healthcare administration sectors, she has a proven track record of delivering results and fostering a culture of excellence and humanity.  Tune in to learn about: The importance of understanding what's at the core of our physical body symptoms.  A history of ketamine in the mental health sector.  The types of patients that ketamine treatment can work well for.  How ketamine is typically administered.  You can follow along with Dr. DeCocker and her work by visiting the Stella Mental Health website! Episode also available on Apple Podcasts: http://apple.co/30PvU9 Upgrade Your Wallet Game with Ekster!  Get the sleek, smart wallet you deserve—and save while you're at it! Use coupon code FINDINGGENIUS at checkout or shop now with this exclusive link: ekster.com?sca_ref=4822922.DtoeXHFUmQ5  Smarter, slimmer, better. Don't miss out!

Dr. Lonnie Morris, ND, CNM, is a midwifery trailblazer who has dedicated her career to advocating for women, advancing maternal health, and empowering families. She attended 7,000 births across her 45 year career. Join us as we dive into her inspiring path, the lessons she's learned, and the wisdom she has to share with midwives everywhere.Connect with Lonnie instagram: @lmcnmRecommended in the show: Nobody Told Me That by Ginger Breedlove

Naturopathic Doctor Lara Briden unpacks metabolic dysfunction and shares insights from her latest book, Metabolism Repair for Women. We explore why so many women struggle with metabolic health, how to support it naturally, and the key role hormones play. Lara debunks common myths and offers practical strategies to restore metabolic balance. Plus, we discuss how metabolic health changes over time and how women can adapt during perimenopause and menopause. For more information and the show notes, head to the CNM podcast website. Stay updated by following CNM on:Website: https://www.cnmpodcast.com Instagram: https://www.instagram.com/collegeofnaturopathicmedicine/Facebook: https://www.facebook.com/CNM.UK/

The Two Bobs episode 276 for Monday, March 3, 2025: What are The Bobs drinking? Rob enjoyed a Junk and Rubbish from Shorts. https://untp.beer/0e979182c9 Robert nursed a Big Hearted IPA from Bells. https://untp.beer/1wjQQ Follow us on Untapped at @RobFromTTB and @lowercaserobert or we'll plant a python in your house. A show about Florida Man® wants all of your craziest Florida Man® stories. https://www.miaminewtimes.com/arts/florida-man-show-wants-your-craziest-sunshine-state-stories-22548528 This week's CRAZY NEWS just got into an Oval Office altercation with the President while J. Vance licked the bottom his shoes. California wants to make Bigfoot its official mythical creature—because nothing says “state pride” like honoring a giant, hairy beast that spends its life dodging cameras like a drunk celebrity on a bender. https://www.abc10.com/article/news/local/california/california-bigfoot-state-mythical-creature/103-f323a5f5-f07f-47ae-a6e0-fa9119802e60 An Essex prankster turned special delivery into special diarrhea—right through the neighbor's letterbox. https://www.thesun.co.uk/news/33451283/neighbour-from-hell-poo-letterbox/ A couple's flight to Venice came with an unexpected upgrade—four hours next to a corpse. We'd take that over a screaming child any day. https://www.nbcnews.com/news/world/couple-forced-sit-dead-body-plane-4-hours-woman-dies-flight-rcna193617 A Georgia man went from toxic ex to full-blown supervillain, bombing a woman's home and plotting a python attack—because therapy was just too mainstream. https://www.cbsnews.com/news/stephen-glosser-sentenced-bombing-woman-home-plotting-python-attack-georgia/?ftag=CNM-00-10aac3a A forgetful man's free trial habit is catching up to him—much like all those auto-renew charges sneaking up to bite him in the anus. https://theonion.com/forgetful-man-playing-fast-and-loose-with-free-trials/ Please share the show with your friends, and don't forget to subscribe! Visit www.thetwobobs.com for our contact information. Thanks for listening! Leave us a message or text us at 530-882-BOBS (530-882-2627) Join us on all the social things: Follow us on Blue Sky Follow us on Twitter Check out our Instagram Find us on YouTube Follow Rob on Untappd Follow Robert on Untappd The Two Bobs Podcast is © The Two Bobs.  For more information, see our Who are The Two Bobs? page, or check our Contact page.  Words, views, and opinions are our own and do not represent those of our friends, family, or our employers unless otherwise noted.  Music for The Two Bobs was provided by JewelBeat.  

Guest: Jenna Clark, MSN, CNM, WHMP (Intermountain Health St. James Hospital)Working in partnership with Megan Bristol (Ep. 05), Jenna offers midwifery care at St. James Hospital. Learn what makes midwifery different from an OB approach, and how Jenna made her professional transition. https://doctors.intermountainhealth.org/provider/jenevieve-l-clark/2197973Connect with Healthy Mothers, Healthy Babies Website Facebook Instagram For statewide resources to support Montana families in the 0-3 years of parenting, please visit LIFTS ( Linking Infants and Families to Supports) athttps://hmhb-lifts.org/

EPISODE 262: Interview with Aasha T. Aasha T. is the Author of “The Empath is the Narcissist,” and an emotional and energetic intelligence expert. She has gone through her own experience with push/pull dynamic as both the avoidant and the anxiously attached to realize this is all about one thing: SOUL Vibes. This is where you become magnetic fast, and align to your desires (whatever those may be). If you get value out of the Loving Without Boundaries podcast, then consider becoming one of our patrons! Not only will you enjoy exclusive content made just for you, your support will also help us continue creating educational content while helping more people have a deeper understanding of consensual non-monogamy and healthy, sex positive relationships in general. https://www.patreon.com/lovingwithoutboundaries

Intermittent fasting expert Gin Stephens shares her transformative journey with fasting, offering a wealth of knowledge on how it works, its health benefits, and practical tips for integrating fasting into your life. We'll also debunk common misconceptions and dive into the research behind fasting. Whether you're new to fasting or looking to deepen your understanding, this episode is packed with valuable insights you won't want to miss! For more information and the show notes, head to the CNM podcast website. Stay updated by following CNM on:Website: https://www.cnmpodcast.com Instagram: https://www.instagram.com/collegeofnaturopathicmedicine/Facebook: https://www.facebook.com/CNM.UK/

In view of the numerous health problems Americans have that are related to sexual issues, I need to take a respectful and scholarly approach to discuss: sex, orgasms, and improving whole health through healthier sexual relations. Many of the topics today are taboo for some because of social beliefs or absolute embarrassment, but again, I'm sharing some insights and some of my reading research to help people understand what lies under so many health issues from weight loss to movement constrictions to mental health and more--and it's about sex--or the absence of it altogether. Take what works for you; discard what does not apply...and take care of yourself too. Here are the books I recommended at the end of the show:"Ending Female Pain: A Woman's Manual; The Ultimate Self-Help Guide for Women Suffering from Chronic Pelvic and Sexual Pain" by Isa Herrera, MSPT, CSCS (2009)"Women's Anatomy of Arousal" by Sheri Winston, CNM, RN, BSN, LMT (2017)"Tantric Intimacy" by Katrina Bos (2017)"Sandstone Seduction: Rivers and Lovers, Canyons and Friends" by Katie Lee (2004)"Maps to Ecstasy: teachings of an urban shaman" by Gabrielle Roth (1989)*"Sensual Orchids" photo by Ron Jones

JKS 57  Liar Liar Pants on FireWelcome back faithful listeners!Breaking up is hard to do....SOMETIMES!Why do people lie in the lifestyle?We dish on our latest experience of relationship development on our non-monogamous journey.Have you ever been lied to in the lifestyle? Have you ever lied to get something you wanted?Please reach out if you have something to say about this.We hope you enjoy the show!Thank You for listening, and "Just Keep Swinging"!You can reach Mr.Sting at @JKSwingingPod on Twitter or @justkeepswinging.bsky.socialemail at JustKeepSwingingPod@gmail.comIf you like our show and the perspective we provide, PLEASE give us a positive review on iTunes.  If you don't like us, say nothing and just move along .WE HIGHLY RESPECT THE FOLLOWING LIST OF CREATORS/ORGS(FYI-we do not generate any form of compensation from our show. We do it for love & caring for ourselves and others. The following are people we believe in.)We encourage you to visit OPEN The Organization for Polyamory and Ethical Non Monogamy https://www.open-love.org/follow @openloveorg Libertine Events Lifestyle vacations,https://libertineevents.com/  follow @PaloozaPodcast on social media or visit https://podcast-a-palooza.comwww.openingus.comhttps://beyondourbedroom.com/https://www.expansiveconnection.com/Average Swingers podcastSapphic Swingers podcastTwo or more to Tango podcastSwinger University podcastCasual Swinger podcast /https://www.casualtoys.com/My Favorite app for building sex positive community & education is called Plura. you can find out more here...https://heyplura.com/faqFascinated about swinging and other kinds of open or sex positive relationships? Go listen to our friends at Normalizing Non Monogamy podcast. Join their community.  https://www.normalizingnonmonogamy.com/  and Bawdy Storytelling podcast https://bawdystorytelling.com/podcastHave you or a loved one contracted Herpes or another STI and are looking for resources on coping with your diagnosis? Search IG for Courtney Brame from the Podcast & Non-Profit "Something Positive for Positive People". A resource for fighting stigma and shame, while finding community & emotional healing for people living with Herpes & other STIs.visit https://www.spfpp.org/Other resources to consider...American Sexual Health association- ASHAsexualhealth.org @infoASHAThe- nationalcoalitionforsexualhealth.org @NCSH_stdcheck.com @STDcheck Shameless Care STI testing and meds www.shamelesscare.comOther notes: We recommend watching Embarrassing Bodies & Big Mouth on Netflix for relaxing the grip of stigma, fear and poor sexual & relationship education. 

In this episode of The Wellness Way, I sit down with Nikki Roy, a mature student at the College of Naturopathic Medicine in London, who shares her extraordinary journey of self-healing. If you're thinking of studying naturopathy. Now is the time. And as a little bonus from me: Use the link on my website phillyjlay.com (in the ‘Shop Philly' section) and mention Philly J Lay your CNM ambassador to get a whopping £250 discount off your student fees! Through her journey, Nikki discovered the transformative power of Chinese medicine and acupuncture, leading her back to study these ancient healing arts. She now shares the incredible wisdom of Traditional Chinese Medicine (TCM) and how it can support skin health, emotional wellbeing, and overall vitality. This episode is packed with inspiration for anyone looking to take control of their health and explore natural alternatives for healing. Find Nikki here: INSTAGRAM: @nixiroy Find College of Naturopathic Medicine here:  https://www.naturopathy-uk.com/ambassador/?ambassadorid=C347286&utm_medium=link&utm_source=Ambassador&utm_campaign=250Voucher&utm_content=C347286

In this episode of The Wellness Way, I sit down with Nikki Roy, a mature student at the College of Naturopathic Medicine in London, who shares her extraordinary journey of self-healing. If you're thinking of studying naturopathy. Now is the time. And as a little bonus from me: Use the link on my website phillyjlay.com (in the ‘Shop Philly' section) and mention Philly J Lay your CNM ambassador to get a whopping £250 discount off your student fees! Through her journey, Nikki discovered the transformative power of Chinese medicine and acupuncture, leading her back to study these ancient healing arts. She now shares the incredible wisdom of Traditional Chinese Medicine (TCM) and how it can support skin health, emotional wellbeing, and overall vitality. This episode is packed with inspiration for anyone looking to take control of their health and explore natural alternatives for healing. Find Nikki here: INSTAGRAM: @nixiroy Find College of Naturopathic Medicine here:  https://www.naturopathy-uk.com/ambassador/?ambassadorid=C347286&utm_medium=link&utm_source=Ambassador&utm_campaign=250Voucher&utm_content=C347286

In this episode of Coming Together for Sexual Health, host Tammy welcomes Dr. Bethany Golden, a nurse midwife, to discuss the many ways midwives support sexual and reproductive health beyond childbirth. Bethany shares how midwives provide holistic, patient-centered care, including contraception, abortion, STI treatment, gender-affirming care, and primary healthcare for people of all genders and ages. She talks about studies that show that most midwives provide reproductive health services and almost half provide primary care: "...so this is a large portion of what we do. And so the public perception...is that we are doing pregnancy-related care. Again, that is part of what we do, but we spend a lot of time focused on other moments in people's lives."  Bethany also talks about her work with the Reproductive Health Service Corps, which is training more midwives and clinicians in abortion care. Tune in for an insightful conversation on reimagining reproductive healthcare for a more inclusive and equitable future.  Guest Bio:  Bethany Golden, RN, CNM (she/her), is a registered nurse and a certified-nurse midwife with deep clinical experience and knowledge of comprehensive reproductive health including abortion. As a clinician, consultant, and lecturer, and as part of research teams, she has worked in clinics, hospitals, universities, and villages in New York City, SF Bay Area, Chicago, Fiji, and Nicaragua. Most recently, as a member of the Future of Abortion Council's workforce committee and the policy advisor at Training in Early Abortion for Comprehensive Healthcare (TEACH), she initiated, co-developed, and advocated for the successful passage of bill AB1918. The law created the CA Reproductive Health Service Corps to train and diversify the entire health care team, which she currently co-directs at TEACH with Megan Kumar. Since 2002, she co-founded and continues to operate ICAS/Juntos Adelante, a not-for-profit that focuses on health and human rights in Nicaragua.  Read the transcript of the episode. Check out Bethany Golden's website  Connect with Bethany Golden on LinkedIn and Instagram  Bethany's Publication: Emerging approaches to redressing multi-level racism and reproductive health disparities  Related episodes of Coming Together for Sexual Health: Trauma-Informed Pregnancy Care with Becca Schwartz, LCSW & Abortion and Reproductive Justice Across State Lines  Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu   Don't forget to leave us a review on Spotify, or wherever you get your podcasts.   

Will Consensual Non Monogamy (CNM) ever replace traditional monogamy and marriage? I explore the concept of open relationships and polyamory, discussing its implications, challenges, and the reasons why traditional marriage remains prevalent. These are five different reasons CNM will never replace traditional marriage/relationships based on stats, research, and personal experience. I emphasize the emotional complexities involved in sexual relationships and the societal perceptions surrounding non-traditional arrangements. _____________________________ What Is Marriage Isn't Dead? Marriage Isn't Dead is an organization focusing on practical self-improvement advice for marriage, dating, career, work/life balance, entrepreneurship, parenting, and a healthy lifestyle. Check out “Marriage Isn't Dead” on all podcast platforms! YouTube: https://www.youtube.com/@MarriageIsntDead?sub_confirmation=1 Instagram: ⁠https://www.instagram.com/marriageisntdead/⁠ Facebook: ⁠https://www.facebook.com/profile.php?id=61555370507017⁠ Email: ⁠scott@marriageisntdead.com⁠ Chapters 00:00 Understanding Consensual Non-Monogamy (CNM) 02:29 #5: CNM Favors Women 04:50 #4: CNM Adds Complexity 07:26 #3: Flawed Family Dynamics 09:20 #2: Social Stigma of CNM 10:20 #1: Sex Is Complicated 12:45 Summary and My Thoughts

In this episode of The Penis Project Podcast, we're thrilled to welcome Dr. Justin Lehmiller, a renowned research fellow at the Kinsey Institute at Indiana University and one of the leading voices in the field of human sexuality. Dr. Lehmiller, author of Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life and The Psychology of Human Sexuality, shares groundbreaking insights into the fascinating world of sexual fantasies and desire.  Dr. Lehmiller discusses key findings from his research, including the results of the largest-ever survey of sexual fantasies in the United States, which reveals what Americans are fantasizing about and how these desires reflect societal shifts in attitudes toward sex and intimacy.  Topics Covered in This Episode:  Future Directions in Sexuality Research: Dr. Lehmiller highlights underexplored areas in the field and shares his vision for advancing the study of human sexuality.  Consensual Non-Monogamy: We dive into his research on CNM relationships and discuss the cultural and structural changes needed to support diverse relationship styles.  Cultural and Demographic Variations: Learn how factors like age, sexual orientation, and cultural norms shape the nature and prevalence of sexual fantasies.  Research Inspiration: Dr. Lehmiller shares what sparked his passion for studying human sexuality and how his role at the Kinsey Institute has influenced his work.  Sexual Fantasy Trends: Discover the societal and psychological insights behind the most common sexual fantasies, and how open communication about desires can strengthen relationships.  As the host of the Sex and Psychology blog and podcast, and a guest expert featured on platforms like Netflix's Sex, Explained, Dr. Lehmiller brings a wealth of knowledge, humor, and empathy to this thought-provoking conversation.  Tune in to uncover the science behind sexual desire and learn how to navigate your fantasies with greater confidence and understanding.  Links and Resources Mentioned in the Episode: Dr. Justin Lehmiller's Blog and Podcast: Sex and Psychology   Connect with Us:  Don't forget to subscribe to The Penis Project Podcast and leave a review! Share this episode with someone who could benefit from fantasy, doesn't everyone?  Websites:  https://melissahadleybarrett.com   Men's health only  https://rshealth.com.au/  All genders  http://www.menshealthphysiotherapy.com.au/  http://prost.com.au/     Facebook:  https://m.facebook.com/p/Melissa-Hadley-Barrett-100085237672685/  https://www.facebook.com/profile.php?id=100085146627814    Instagram:  https://www.instagram.com/melissahadleybarrett/  https://www.instagram.com/restorativehealth.clinic/  TikTok: @melissahadleybarrett  YouTube: Melissa Hadley Barrett  Linkedin:  https://www.linkedin.com/in/melissa-hadley-barrett/   TEDX  https://www.youtube.com/watch?v=IjHj1YTmLoA   

Today's Sponsor: 100 Daily Affirmations For Positivity & Confidencehttps://amzn.to/40vDvXRToday's Rundown:Trump Signs Executive Order to Release More JFK, RFK, and MLK Assassination Fileshttps://www.cbsnews.com/news/trump-announces-jfk-rfk-mlk-assassination-files-to-be-released/?ftag=CNM-00-10aag9b Judge Blocks Trump's ‘Blatantly Unconstitutional' Executive Order Aiming to End Birthright Citizenshiphttps://us.cnn.com/2025/01/23/politics/birthright-citizenship-lawsuit-hearing-seattle/index.html RFK Jr. Reveals Up to $1.2M in Credit Card Debt Despite $30M Net Worthhttps://abcnews.go.com/Politics/rfk-jr-reports-12m-credit-card-debt-30m/story?id=117995699 Hegseth Admits Paying $50,000 to Woman Who Accused Him of 2017 Assaulthttps://apnews.com/article/hegseth-sex-assault-payment-trump-6674cc8cfee654c374725948e01ff666 CNN Announces Layoffs Amid Schedule Revamp and Digital Strategy Shifthttps://www.cnn.com/2025/01/23/business/cnn-layoffs-digital-strategy/index.html Las Vegas Hotel Workers Union Ends Decades-Long Strike with New Casino Dealhttps://apnews.com/article/las-vegas-casino-strike-culinary-union-3c70eb64acf95c74fefeee9072734263 Kevin Costner's Horizon Chapter 2 Sets U.S. Premiere After 2024 Delayhttps://www.cbr.com/kevin-costner-horizon-chapter-2-us-premiere/ Emilia Pérez Leads 2025 Oscars with 13 Nominations, Wicked and The Brutalist Close Behindhttps://variety.com/2025/film/news/oscar-nominations-emilia-perez-wicked-the-brutalist-1236282041/    Website: http://thisistheconversationproject.com  Facebook: http://facebook.com/thisistheconversationproject  Twitter: http://twitter.com/th_conversation  TikTok: http://tiktok.com/@theconversationproject  YouTube: http://thisistheconversationproject.com/youtube  Podcast: http://thisistheconversationproject.com/podcasts            Become a supporter of this podcast: https://www.spreaker.com/podcast/things-you-might-not-have-heard--2318856/support.

EPISODE 260: Interview with Dean Robertson. Dean Robertson is a retired evangelical minister. He has spent his entire adult life in Christian ministry in various capacities, including Senior Pastor, Church Planter, Mission Director, Evangelist, Denominational Superintendent and keynote Convention Speaker. He is also a studious Biblical scholar. He has a Master's Degree in Intercultural Studies, and his International Ministry has taken him to many areas of the world. His is the author of “Sex Was God's Idea: An Honest Look at Biblical Sexuality and the Rightful Role of Women.” If you get value out of the Loving Without Boundaries podcast, then consider becoming one of our patrons! Not only will you enjoy exclusive content made just for you, your support will also help us continue creating educational content while helping more people have a deeper understanding of consensual non-monogamy and healthy, sex positive relationships in general. https://www.patreon.com/lovingwithoutboundaries

Naturopathic Nutritionist Jess Shand explores the vital role of hormones – those tiny yet powerful chemical messengers that significantly impact our health. She debunks common hormone myths, shares valuable insights into understanding your hormonal health, and offers practical tips to help you take control of your cycle. Jess also highlights the importance of a whole-body approach to balancing hormones and optimising overall wellbeing. Plus, she shares her inspiring personal health journey and gives us a sneak peek of her new book, The Hormone Balance Handbook. For more information and the show notes, head to the CNM podcast website. Stay updated by following CNM on:Website: https://www.cnmpodcast.com Instagram: https://www.instagram.com/collegeofnaturopathicmedicine/Facebook: https://www.facebook.com/CNM.UK/

Alex, Jesse and Mike continue CORNERFEST 2025! Video Link - https://youtu.be/4c6lMMcPxh8 MERCH - http://www.theyetee.com/collections/chilluminati Acorns - http://www.acorns.com/chill All you lovely people at Patreon! HTTP://PATREON.COM/CHILLUMINATIPOD Jesse Cox - http://www.youtube.com/jessecox Alex Faciane - http://www.youtube.com/user/superbeardbros Editor - DeanCutty http://www.twitter.com/deancutty Show art by - https://twitter.com/JetpackBraggin http://www.instagram.com/studio_melectro CORNERFEST 25 EPISODE B SHOW NOTES DMT LASER EXPERIMENT Danny Jones Podcast: https://www.youtube.com/watch?v=NJp2rASRKMc  Danny Goler: The Discovery https://www.youtube.com/watch?v=8bSbmn9ghQc The Passport by Chase Hughes https://www.goodreads.com/book/show/9243098-the-passport The Black Course: https://web.archive.org/web/20230207222835/https://training.chasehughes.com/black-2022 S James Gates on the Codes of Reality at Teilhard: https://teilhard.com/2013/06/21/superstring-theoretical-physicist-on-the-codes-of-reality/ S James Gates on Supersymmetry and Adinkra Symbols https://www.aaas.org/taxonomy/term/4/jim-gates-and-symmetry-space-and-time#:~:text=During%20the%20past%2020%20years,are%20kind%20of%20like%20genes. 1MARK, INC Wilson-Davis Memo: https://www.documentcloud.org/documents/6185702-Eric-Davis-meeting-with-Adm-Wilson/ 1MARK Reddit Post: https://www.reddit.com/r/UFOs/comments/1g8ywff/the_eric_davis_memo_mentions_a_company_called_1/?share_id=4wqxRqGTHMSUsyxKijJ3M&utm_content=2&utm_medium=ios_app&utm_name=ioscss&utm_source=share&utm_term=1  LTT by Bob Beckwith PDF: https://stealthskater.com/Documents/Beckwith_02.pdf Beckwith's Obituary: https://beckwithelectric.com/news/beckwith-electric-founder-robert-bob-beckwith-passes-a-tribute/  1Mark, Inc Site: https://www.1-mark.com/aboutus.shtml  Pokeland in Ventura: https://gopokeland.com/menu/ STICKER STAR The Deceased Soldier Sprite: https://static.wikia.nocookie.net/metroid/images/2/21/Super_Metroid_Kraid_Armor_Soldier.png/revision/latest?cb=20230618232126  Hell Valley Sky Trees: https://static.wikia.nocookie.net/gaming-urban-legends/images/d/d4/HellValleySkyTree.jpg/revision/latest?cb=20171209193845 WarioWare Get It Together Trailer at 36sec: https://www.youtube.com/watch?v=kD3myHu2XeA&t=36s Sticker Star Reddit Post: https://www.reddit.com/r/papermario/comments/189iy0w/i_cant_stop_thinking_about_this/?share_id=bky1zLD6PkH893295joD6&utm_content=1&utm_medium=ios_app&utm_name=ioscss&utm_source=share&utm_term=1&sort=new  Sticker Star Longplay: https://youtu.be/PXNOCFAqsQ4?si=fLbdjkNwZz3PepAE&t=36038  Shy Guy Jungle Wiki Page with Scrap Table: https://www.mariowiki.com/Shy_Guy_Jungle AI REPORTER Link to Skeet: https://bsky.app/profile/indyfromspace.bsky.social/post/3lbvsriwtys2s  Eliot on 60 Minutes: https://www.paramountplus.com/shows/video/63zx_Q4wugAEVTs1eFbtg4okb_tLTj9H/?ftag=CNM-00-10abb6c&nocache=1732685929354 Example Article: https://www.forbes.com/sites/lanceeliot/2023/11/26/about-that-mysterious-ai-breakthrough-known-as-q-by-openai-that-allegedly-attains-true-ai-or-is-on-the-path-toward-artificial-general-intelligence-agi/ Thanksgiving Article: https://www.forbes.com/sites/lanceeliot/2024/11/26/holiday-pro-tip-rely-on-chatgpt-ai-at-your-thanksgiving-table-to-ease-polarizing-arguments-and-achieve-a-peaceful-celebration/ WALKER AND RODAS Coop's Video: https://www.youtube.com/watch?v=S5moWsA92rI  Godlike Productions Forum Post: https://www.godlikeproductions.com/forum1/message2425072/pg1 The Interim Article: https://theinterim.com/issues/population/former-population-control-official-affirms-philippine-vaccine-scandal/  SOUTH 32 Post Starmen.net: https://forum.starmen.net/forum/General/Discussion/Mystery-of-south32 Elder's Vault video: https://www.youtube.com/watch?app=desktop&v=2UWRfFZOvUQ&t=305s  Swanaenae video: https://youtu.be/Lfqvni2gkgM South32 imdb: https://www.imdb.com/title/tt4544614/ Wired Article: https://www.wired.com/2003/02/xupiter-mongers-deal-spam-scams/ Buzzfeed News Article: https://www.buzzfeednews.com/article/craigsilverman/daniel-yomtobian-built-an-empire-on-dubious-online Luigi's YouTube Channel: https://www.youtube.com/@luigibian2903/videos

EPISODE 259: Interview with Kathy Labriola. Kathy Labriola is a nurse, counselor, and hypnotherapist in Berkeley, California. She has provided affordable mental health services to alternative communities for over 30 years. Kathy is author of four books on consensual nonmonogamy: “Love in Abundance: A Counselor's Advice on Open Relationships”, “The Jealousy Workbook”, “The Polyamory Break-up Book: Causes and Survival”, and “Polyamorous Elders: Aging in Open Relationships”. She has been a card-carrying bisexual and polyamorist for over 50 years. She is extra crunchy, rides a bike, lives in a housing cooperative, grows organic vegetables and raises chickens.  If you get value out of the Loving Without Boundaries podcast, then consider becoming one of our patrons! Not only will you enjoy exclusive content made just for you, your support will also help us continue creating educational content while helping more people have a deeper understanding of consensual non-monogamy and healthy, sex positive relationships in general. https://www.patreon.com/lovingwithoutboundaries

Today's Sponsor: Hostage Tapehttps://thisistheconversationproject.com/hostagetape    Today's Rundown:Former Sen. Kyrsten Sinema Faces Accusations of Misusing Campaign Funds for Luxury Travelhttps://www.yahoo.com/news/kyrsten-sinema-accused-misusing-campaign-092842762.html    Judge Blocks Release of Special Counsel Jack Smith's Report in Trump Documents Casehttps://www.cbsnews.com/news/trump-report-jack-smith-aileen-cannon/?ftag=CNM-00-10aag9b  Nexus Mods Removes Marvel Rivals Mods Featuring Trump and Biden Replacing Captain Americahttps://www.yahoo.com/tech/nexus-mods-removes-marvel-rivals-215812421.html  Rare Ski Patroller Strike at U.S.'s Largest Resort Causes Long Lines and Terrain Closureshttps://apnews.com/article/park-city-ski-patrol-strike-vail-resorts-2a5c8641f47af2654ed8b35d4c3e9114  Two Found Dead in JetBlue Landing Gear Compartment After Flight Landshttps://abcnews.go.com/US/dead-jetblue-landing-gear-compartment-florida/story?id=117410409  Sheel Seidler, wife of late Padres owner, sues in-laws for control of the teamhttps://us.cnn.com/2025/01/06/sport/san-diego-padres-seidler-ownership-lawsuit-spt/index.html Verizon Customers Feel Cheated by Payouts from $100M Settlementhttps://finance.yahoo.com/news/verizon-settlement-payments-customers-measly-191411160.html  Jennifer Lopez and Ben Affleck Finalize Divorce, Ending Their Marriagehttps://us.cnn.com/2025/01/07/entertainment/jennifer-lopez-ben-affleck-settle-divorce/index.html   Website: http://thisistheconversationproject.com  Facebook: http://facebook.com/thisistheconversationproject  Twitter: http://twitter.com/th_conversation  TikTok: http://tiktok.com/@theconversationproject  YouTube: http://thisistheconversationproject.com/youtube  Podcast: http://thisistheconversationproject.com/podcasts      Become a supporter of this podcast: https://www.spreaker.com/podcast/things-you-might-not-have-heard--2318856/support.

Dr. Lorraine and Dr. Brie join HeHe to discuss the critical and often overlooked topic of obstetrical violence. In this eye-opening episode, they break down what obstetrical violence is, its impact on women globally, including psychological trauma and avoidable morbidity, and how it violates human rights. The discussion highlights the importance of informed consent, respectful maternity care, and midwifery as potential solutions. The duo also emphasizes the need for systemic changes within the healthcare system to prevent obstetrical violence and improve maternal outcomes. Tune in to learn about practical steps women can take to avoid birth trauma and the crucial role of midwifery in transforming maternity care.   Understanding Obstetrical Violence Examples and Impact of Obstetrical Violence Legal Recourse and Advocacy The Iceberg Analogy and Measurement Tools Respectful Maternity Care and Systemic Issues Transparency and Hospital Reporting Midwifery Care and Trauma Prevention Systemic Obstacles and Solutions Navigating the Complexities of U.S. Healthcare Challenges Faced by Healthcare Providers The Impact of Insurance on Birth Choices Midwifery Care and Its Benefits Policy and Systemic Barriers The Role of Consumer Advocacy Future Directions and Solutions Connecting and Collaborating for Change Guest Bio: Lorraine M. Garcia, PhD, WHNP-BC, CNM does research on the problem of obstetric violence in the US maternity care system and the public health and ethical duties to implement solutions. She also works as a Certified Nurse Midwife with experience in home birth, birth center, and hospital-based care. Lorraine is a reproductive justice advocate and frames most of her research with critical lenses from healthcare systems science, structural and organizational theories, and social justice in nursing. Her perspective on the systemic, normalized abuse and mistreatment of childbearing people is aligned with advocacy workers, interdisciplinary scientists, and all interested and affected parties working to end obstetric violence and achieve birth equity.   Dr. Brie Thumm is an Assistant Professor at the University of Colorado College of Nursing. She has been practicing midwifery domestically and internationally since 2001 when she completed her Masters in the Science of Nursing at Yale University. She obtained her MBA in Healthcare Administration at Baruch College in New York City and her PhD in health systems research at University of Colorado College of Nursing. Her area of research is perinatal workforce development to address disparities in maternal health outcomes and improve the well-being of health care professionals. Prior to her current position, Brie provided care at Planned Parenthood of New York City, served as the Assistant Director of the Sexual Assault Response Team for the Manhattan public hospitals, conducted mental and behavioral health research at the Rocky Mountain Regional Veteran's Affairs Medical Center, and led the clinical and research arms of the Maternal Mortality Prevention Program at the Colorado Department of Public Health and Environment. She continues to practice clinically at Denver Health. SOCIAL MEDIA: Connect with HeHe on IG    Connect with Lorraine on IG  Connect with Lorraine on LinkedIn   BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS: Lorraine's website: https://www.makingbirthbettertogether.com/ Lorraine's Online Store:https://makingbirthbetterstore.com/ Use code    References: Association of Women's Health, Obstetric and Neonatal Nurses. (2022). Respectful maternity care framework and evidence-based clinical practice guideline. Nursing for Women's Health, 26(2), S1−S52. https://doi.org/10.1016/j.nwh.2022.01.001 Beck, C. T. (2018). A secondary analysis of mistreatment of women during childbirth in healthcare facilities. Journal of Obstetric Gynecologic and Neonatal Nursing, 47(1), 94−104. https://doi.org/10.1016/j.jogn.2016.08.015    Borges, M. T. (2018). A violent birth: Reframing coerced procedures during childbirth as obstetric violence. Duke Law Journal, 67(4), 827−862.    Carlson, N. S., Neal, J. L., Tilden, E. L., Smith, D. C., Breman, R. B., Lowe, N. K., Dietrich, M. S., & Phillippi, J. C. (2019). Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: A Consortium on Safe Labor study. Birth, 46(3), 487-499. https://doi.org/10.1111/birt.12405    Chadwick, R. (2021). The dangers of minimizing obstetric violence. Violence Against Women, 29(9), 1899−1908. https://doi.org/10.1177/10778012211037379    Cohen Shabot, S. (2021). Why ‘normal' feels so bad: Violence and vaginal examinations during labour: A (feminist) phenomenology. Feminist Theory, 22(3), 443−463. https://doi.org/10.1177/1464700120920764   Cooper Owens, D. (2017). Medical bondage: Race, gender, and the oigins of American gynecology. University of Georgia Press.    Crear-Perry, J., Correa-de-Araujo, R., Lewis Johnson, T., McLemore, M. R., Neilson, E., & Wallace, M. (2021). Social and structural determinants of health inequities in maternal health. Journal of Women's Health, 30(2), 230−235. https://doi.org/10.1089/jwh.2020.8882    Davis, D. A., Casper, M. J., Hammonds, E. & Post, W. (2024). The continued significance of obstetric violence: A response to Chervenak, McLeod-Sordjan, Pollet et al. Health Equity, 8, 513-518. https://www.liebertpub.com/doi/10.1089/heq.2024.0093   Davis, D. A. (2019). Obstetric racism: The racial politics of pregnancy, labor, and birthing. Medical Anthropology, 38(7), 560-573. https://doi.org/10.1080/01459740.2018.1549389 Garcia, L. M. (2020). A concept analysis of obstetric violence in the United States of America. Nursing Forum, 55(4), 654−663. https://doi.org/10.1111/nuf.12482    Garcia, L. M. (2021). Theory analysis of social justice in nursing: Applications to obstetric violence research. Nursing Ethics, 28(7−8). https://doi.org/10.1177/0969733021999767   Garcia L. M. (2023). Obstetric violence in the United States and other high-income countries: An integrative review. Sexual and Reproductive Health Matters, 31(1), 2322194. https://doi.org/10.1080/26410397.2024.2322194   Garcia, L. M., Jones, J., Scandlyn, J., Thumm, E. B., & Shabot, S. C. (2024). The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence campaign. International Journal of Nursing Studies, 160, 104911. https://doi.org/10.1016/j.ijnurstu.2024.104911   Hardeman, R. R., Karbeah, J., Almanza, J., & Kozhimannil, K. B. (2020). Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth. Healthcare, 8(1). https://doi.org/10.1016/j.hjdsi.2019.100367    Howell, E. A., & Zeitlin, J. (2017). Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Seminars in Perinatology, 41(5), 266−272. https://doi.org/10.1053/j.semperi.2017.04.002    Jolivet, R. R., Gausman, J., Kapoor, N., Langer, A., Sharma, J., & Semrau, K. E. A. (2021). Operationalizing respectful maternity care at the healthcare provider level: A systematic scoping review. Reproductive Health, 18(1), 194. https://doi.org/10.1186/s12978-021-01241-5   Julian, Z., Robles, D., Whetstone, S., Perritt, J. B., Jackson, A. V., Hardeman, R. R., & Scott, K. A. (2020). Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminars in Perinatology, 44(5). https://doi.org/10.1016/j.semperi.2020.151267   Logan, R. G., McLemore, M. R., Julian, Z., Stoll, K., Malhotra, N., GVtM Steering Council, & Vedam, S. (2022). Coercion and non-consent during birth and newborn care in the United States. Birth (Berkeley, Calif.), 49(4), 749–762. https://doi.org/10.1111/birt.12641   Margulis, J. (2013). The business of baby. Scribner.    Mena-Tudela, D., González-Chordá, V. M., Soriano-Vidal, F. J., Bonanad-Carrasco, T., Centeno-Rico, L., Vila-Candel, R., Castro-Sánchez, E., & Cervera Gasch, Á. (2020). Changes in health sciences students' perception of obstetric violence after an educational intervention. Nurse Education Today, 88, https://doi.org/10.1016/j.nedt.2020.104364   Morton, C. H., & Simkin, P. (2019). Can respectful maternity care save and improve lives?. Birth (Berkeley, Calif.), 46(3), 391–395. https://doi.org/10.1111/birt.12444   Neal, J. L., Carlson, N. S., Phillippi, J. C., Tilden, E. L., Smith, D. C., Breman, R. B., Dietrich, M. S., & Lowe, N. K. (2019). Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: A Consortium on Safe Labor study. Birth (Berkeley, Calif.), 46(3), 475–486. https://doi.org/10.1111/birt.12407   Nelson, H. O. (2022). Conflicted care: Doctors navigating patient welfare, finances, and legal risk. Stanford University Press.    Niles, P. M., Baumont, M., Malhotra, N., Stoll, K., Strauss, N., Lyndon, A., & Vedam, S. (2023). Examining respect, autonomy, and mistreatment in childbirth in the U.S.: Do provider type and place of birth matter? Reproductive Health, 20(1), 67. https://doi.org/10.1186/s12978-023-01584-1    Oparah, J. C., Arega, H., Hudson, D., Jones, L., & Oseguera, T. (2018). Battling over birth: Black women and the maternal health care crisis. Praeclarus Press.    Salter, C., Wint, K., Burke, J., Chang, J. C., Documet, P., Kaselitz, E., & Mendez, D. (2023). Overlap between birth trauma and mistreatment: A qualitative analysis exploring American clinician perspectives on patient birth experiences. Reproductive Health, 20(1), 63. https://doi.org/10.1186/s12978-023-01604-0    Scott, K. A., Britton, L., & McLemore, M. R. (2019). The ethics of perinatal care for Black women: Dismantling the structural racism in "Mother Blame" narratives. The Journal of Perinatal & Neonatal Nursing, 33(2), 108–115. https://doi.org/10.1097/JPN.0000000000000394   Smith, D. C., Phillippi, J. C., Lowe, N. K., Breman, R. B., Carlson, N. S., Neal, J. L., Gutierrez, E., & Tilden, E. L. (2020). Using the Robson 10-group classification system to compare cesarean birth utilization between US centers with and without midwives. J Midwifery Womens Health, 65(1), 10-21. https://doi.org/10.1111/jmwh.13035    Smith, S., Redmond, M., Stites, S., Sims, J., Ramaswamy, M., & Kelly, P. J. (2023). Creating an agenda for Black birth equity: Black voices matter. Health Equity, 7(1), 185−191. https://doi.org/10.1089/heq.2021.0156    Thumm, E. B., & Flynn, L. (2018). The five attributes of a supportive midwifery practice climate: A review of the literature. Journal of Midwifery & Women's Health, 63(1), 90−103. https://doi.org/10.1111/jmwh.12707    Thumm, E. B., & Meek, P. (2020). Development and initial psychometric testing of the Midwifery Practice Climate Scale. Journal of Midwifery & Women's Health, 65(5), 643−650. https://doi.org/10.1111/jmwh.13142    Thumm, E. B., Shaffer, J., & Meek, P. (2020). Development and initial psychometric testing of the Midwifery Practice Climate Scale: Part 2. Journal of Midwifery & Women's Health, 65(5), 651−659. https://doi.org/10.1111/jmwh.13160  Thumm, E. B., Smith, D. C., Squires, A. P., Breedlove, G., & Meek, P. M. (2022). Burnout of the U.S. midwifery workforce and the role of practice environment. Health Services Research, 57(2), 351−363. https://doi.org/10.1111/1475-6773.13922    Williams, C. R., & Meier, B. M. (2019). Ending the abuse: The human rights implications of obstetric violence and the promise of rights-based policy to realise respectful maternity care. Sexual and Reproductive Health Matters, 27(1). https://doi.org/10.1080/26410397.2019.1691899    Yarrow, A. (2023). Birth control: The insidious power of men over motherhood. Seal Press.    Zhuang, J., Goldbort, J., Bogdan-Lovis, E., Bresnahan, M., & Shareef, S. (2023). Black mothers' birthing experiences: In search of birthing justice. Ethnicity and Health, 28(1), 46−60. https://doi.org/10.1080/13557858.2022.2027885  

Today's Sponsor: Flowers Fast!https://thisistheconversationproject.com/flowersfast Today's Rundown:Fingerprints match between Luigi Mangione and prints found at scene of UnitedHealthcare CEO killing, police sayhttps://www.cnn.com/2024/12/11/us/unitedhealthcare-ceo-brian-thompson-shooter-wednesday/index.html   Trudeau says Americans are realizing Trump's tariffs on Canada would make life a lot more expensivehttps://apnews.com/article/canada-trudeau-us-trump-tariffs-f23417b8f6671adf6b4c908be630615f    Diddy accuser speaks out in 'anonymous' video detailing sexual assault allegationshttps://www.cnn.com/2024/12/11/entertainment/diddy-accuser-first-ever-interview/index.html   SiriusXM to Cut $200 Million in Costs, Pivot Resources Away From Streaminghttps://www.thewrap.com/siriusxm-strategic-plan-cost-cuts-streaming-pivot/   Trump to nominate Kimberly Guilfoyle for ambassador to Greecehttps://www.cbsnews.com/news/trump-kimberly-guilfoyle-greece-ambassador/?ftag=CNM-00-10aag9b    WNBA star Caitlin Clark named TIME Athlete of the Yearhttps://time.com/7200904/athlete-of-the-year-2024-caitlin-clark/  Woman who slept with 100 men in one day breaks down in tears as she reveals what happenedhttps://www.tyla.com/entertainment/celebrity/lily-phillips-100-men-day-documentary-645638-20241210   Jim Carrey is back with ‘Sonic the Hedgehog 3' and quips that he needs the moneyhttps://www.cnn.com/2024/12/11/entertainment/jim-carrey-sonic-hedgehog-3/index.html         Website: http://thisistheconversationproject.com  Facebook: http://facebook.com/thisistheconversationproject  Twitter: http://twitter.com/th_conversation  TikTok: http://tiktok.com/@theconversationproject  YouTube: http://thisistheconversationproject.com/youtube  Podcast: http://thisistheconversationproject.com/podcasts    Become a supporter of this podcast: https://www.spreaker.com/podcast/things-you-might-not-have-heard--2318856/support.

Deborah is a midwife, mother of 6, and grandmother who describes herself as "a birth junkie from birth!" Her journey to midwifery started as a young child who was magnestized to helping mothers and babies, then was refined across decades of supporting friends and family through their own pregnancies, births, and postpartum events. She is passionate about home birth, informed consent, and having authentic relationships with her clients and families that extend to friendships well after the babies are born. Her story traverses across the US and back a number of times as she completed midwifery training and found her place to put roots down for her own home birth practice in Southern Utah - Aravah Midwifery. Join us for another heartwarming hour of laughter, storytelling, wisdom, and of course, a journey to midwifery. Mentioned in this episode:- Birth with Insight | https://www.birthwithinsight.com/index.html | Marcy Kuntz, LDEM- Midwife to Be training | https://midwifetobe.com/- Three Rivers Midwifery | Cindy Wylie, CNM | https://www.threeriversmidwifery.com/- Mercy in Action Midwifery School | https://www.mercycollegeofmidwifery.edu/- Book: Anti-D Explained by Sarah Wickham | https://www.sarawickham.com/anti-d/sara w book- Aravah MIdwifery | https://www.aravahmidwifery.com/

In this conversation, Whitni Miller and Tuesday Feral discuss the challenges and strategies for non-binary and trans individuals in navigating pleasure and intimacy. They explore the impact of dysphoria on sexual experiences and the importance of finding ways to feel comfortable in one's body. They also discuss the use of accessories and clothing to affirm one's gender identity during sexual encounters. Communication and consent are emphasized as crucial in creating positive experiences, and the importance of individual preferences and authenticity in defining pleasure is highlighted. They also discuss the concept of gender dysphoria and how it can impact sexual experiences. They emphasize the need for trans-affirming and sex-positive support for individuals who may be struggling with their sexuality. They also address the issue of hyper-sexualization of trans people and the negative impact it can have on their self-esteem and relationships. Mx. Tuesday Feral, of Feral Resiliency, is a neurospicy educator, coach, therapist, and consultant. From creating and facilitating support programs, offering sexual health and gender exploration support as a coach, to working as a licensed counselor and sex therapist, Tuesday has been supporting trans and nonbinary folks and their families in Western North Carolina since 2008. With a unique, trauma informed, kink and CNM aware perspective, Tuesday also finds great fulfillment in teaching workshops and courses as well as providing consultation to individuals and groups who want to better support nonbinary and trans people in their work and their lives.Tuesday lives with their beloved feline companion in a small cabin surrounded by delightfully overgrown gardens, and in their free time they can be found gazing at the moon lovingly, tending their gardens and plants (and trying to outwit the resident groundhog to no avail), engaging in creative endeavors, dancing with abandon, nerding out about trauma and attachment or other topics of interest, and connecting with loved ones. Learn More From Tuesday: https://www.feralresiliency.com feralresiliency@gmail.com Follow Tuesday at: FB - @mxtuesday IN - @feralresiliency Other resources mentioned by Tuesday: https://tranzmission.org/ https://openpathcollective.org/ Learn More From Whitni: https://www.bde-moves.com Follow Whitni at: TikTok - @bdemoves IG - @bde.moves FB - groups/bdemoves YouTube - Podcast Channel = @BDE-Moves Old Channel = @BdeTalks

This week, we talked about pirates, escaped monkeys, Justice League, Absolute Superman, Penguin, Agatha All Along, udon mac & cheese, Analog 3d, the QoftheW, and more!   Salty Merch: https://www.teepublic.com/user/saltylanguagepods Our Patreon: Patreon.com/saltylanguage   Subscribe / rate / review us on Apple Podcasts!   Links: 1. Escaped monkeys https://www.cbsnews.com/news/monkeys-escape-south-carolina-research-facility-police-search/?ftag=CNM-00-10aab7e&linkId=645707041 2. Analog 3D https://www.gamespot.com/articles/analogue-fully-unveils-its-modernized-n64-preorders-go-live-october-21/1100-6527188/ QoftheW: Which animal do you think would throw the best party?   Visit us at: saltylanguage.com Apple Podcasts: https://podcasts.apple.com/us/podcast/salty-language/id454587072?mt=2 Spotify: https://open.spotify.com/show/3GnINOQglJq1jedh36ZjGC iHeart Radio: http://www.iheart.com/show/263-Salty-Language/ Google Play Music: https://play.google.com/music/listen#/ps/Ixozhhniffkdkgfp33brnqolvte Tony's YouTube channel: https://www.youtube.com/@allthebeers Bryan's YouTube channel: https://www.youtube.com/@IFinallyPlayed https://www.tiktok.com/@saltylanguage facebook.com/saltylanguage @salty_language / saltylanguage@gmail.com http://salty.libsyn.com/webpage  / http://www.youtube.com/user/SaltyLanguagePod Instagram/Threads: SaltyLanguage Reddit: r/saltylanguage Stitcher: https://www.stitcher.com/podcast/salty-language tangentboundnetwork.com Share with your friends!

Today's guest is Kristin Mallon, CNM, MS, RNC-OB, a board-certified nurse midwife, menopause, and feminine longevity expert, breast health expert, published author, and mother of four. She graduated from the University of California, Berkeley with a degree in Psychology and completed her Bachelor's degree in nursing at Johns Hopkins in Baltimore, MD. After completing her Master's degree in Science & Midwifery at New York University (NYU), she began practicing as a board-certified nurse midwife in private practice in Brooklyn, NY. In 2022, she co-founded Femgevity, a telemedicine company focused on menopause and feminine longevity, providing concierge care for women seeking personalized healthcare. As a California native, Kristin loves surf, snow, and hanging with her family in northern New Jersey. In our conversation, we discuss: The power of functional testing to optimize hormonal and overall health Changes during pregnancy and postpartum, especially what a woman might go through not only physically, but mentally and emotionally as well, and why having self-compassion during this time is so important The changes that are taking place during perimenopause and menopause, and how understanding your unique menstrual cycle can better support these changes, and whether cycle syncing is right for you Why Kristin believes so strongly in precision based nutrition and testing specifically to help navigate these life stages What you need to know about metabolism and muscle mass maintenance as you approach your 40s and 50s Gratisfied Healthified Online Magazine Instagram: @gratisfied @healthified Empower Bar Baking Mix  NEW Gratisfied Bars! Use the code HEALTHIFIED to save  ⁠Counting Colors Online Course ⁠ ⁠The Beauty of Blood Sugar Balance⁠

Rachel is a professor, an author, and a VBAC mom who is here to share her story from a traumatic C-section birth through a VBAC. This episode really dives deep into how picking the right provider is key to improving your chances for a VBAC. They give practical questions to ask your providers, more than just yes or no, to really get to know their birth philosophy and what qualifications and experiences your provider might have that would make them a better fit for VBAC chances. Rachel and Meagan also give a lot of validation and advice on how to start the process of overcoming birth trauma; it's reality and to not be ashamed of it. You're not alone. Through the many important messages of this episode, they both mention many times to trust your intuition. If something feels off, listen to that. And if a change in provider is necessary…it is never ever too late to change. Invisible Labor: The Untold Story of the Cesarean SectionHow to Naturally Induce LaborHow to Turn Prodromal Labor into Active LaborMembrane Sweeps for VBACHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello everybody! Welcome to the show! I am so honored to have Rachel Somerstein on with us today. She is a friend of ours from New York. She is a writer and an associate professor of journalism at SUNY New Paltz. She is an author of Invisible Labor: The Untold Story of the Cesarean Section.  And her writing has also appeared in the Boston Globe, The Guardian, The Washington Post, and Women's Health. She lives in Hudson Valley, NY with her husband and her two children and is here to share her stories with you today. Rachel had an unplanned Xesarean section with her first child and the experience was anything but routine. I know that there are many of us who have been through this journey and on this podcast, maybe listening today, that also had an unexpected experience and it may have left us with trauma, or doubt, or fear, or all the feelings, right? And so she is going to be talking to us today about her experiences, but then also we're going to talk about some guidance on how to find peace and to offer ourselves grace and to set ourselves up for a much better experience next time. We do have a review of the week, so I want to get into that and I'm going to turn the time over to Rachel.This review is by Deserie Jacobsen. The review title is “Thank You.” She actually emailed this in and it says, “This podcast and parents course is amazing. I am not a VBAC mom, but I have been listening since 2020. I binge listen near the end of every pregnancy to remind me of everything I need to remember in birth and process through my previous births. This time around I felt more prepared than ever before, having plans in place just in case. We were able to have a quick birth of my 5th baby. I love the education, passion, and love this podcast gives. I recommend it to everyone I know, and I have learned so much from it. I am so grateful for this podcast, thank you.”Thank you so much Deserie for your review! Seriously you guys, I just love hearing that people are finding the information that they need, they're finding community, they're finding that they can do this too. Just like them, and all these reviewers and all the people that have shared their stories and all these reviewers you guys can too. This birth, VBAC, is possible too. Better experience is possible. A healing CBAC; it's possible. You guys, all it takes is getting the information, the prep, finding the provider, to have a better experience.Meagan: Alright Ms. Rachel, welcome to the show and thank you again so much for being here with us. I kind of talked about this a little bit before we started recording about how I think your episode is going to be so powerful and deep and raw too. You've got these feelings and these words. I love it. I love reading your book and I can't wait to hear it from your own mouth. Which speaking of book, can we talk about that a little bit? What kind of just inspired you, jumpstarted you into writing a book about this?Rachel: Well, I'm a writer. And I wrote an essay about my birth about two years after I had my baby, my first birth, my C-section. And I realized I had a lot more to say and also I heard from a lot of moms when that came out and that made me start thinking that I think there was a bigger project. Meagan: Absolutely. And an amazing project that you completed.Rachel: Yes.Meagan: And remind everybody before we get into your stories where they can find your book. I actually have it here in my hands. It's Invisible Labor. So where all can they find that? And we'll make sure that we link it. Rachel: Sure, thank you! Yeah, so it's Invisible Labor: The Untold Story of The Cesarean Section. And you can get it on Amazon, you can get it from Barnes and Noble, you can get it from your local bookstore, you can get it as an audiobook? Or you can also get it as an ebook.Meagan: For the audiobook, did you record it?Rachel: I did not. The narrator is Xe Sands and she did a great, great job. It sounds excellent. Meagan: Awesome. We'll be sure to link that. I think it's definitely a book that everyone should check out. There's a lot of power in that book.Rachel: Thank you.Meagan: And it's not even just your story. I mean there's a ton. Like if you go through the note section there's a ton of research in there, and history and studies, and so many really great things. Well okay, let's hear about the story that started the inspiration and behind this amazing book.Rachel: Sure! Thank you. So like so many moms, I had an unplanned C-section that I was completely unprepared for, which is another reason I wanted to write this book because I think a lot of people go into pregnancy just assuming they're going to have a vaginal birth and like me, I didn't even read the parts of the books about C-sections, I skipped them. Because I was not going to have a C-section. Which is whatever, hindsight is everything, right? But I had a totally textbook pregnancy. I switched to a different group of midwives and OB's about halfway through because I just didn't have a connection I felt with the providers in the first one. And frankly, I didn't have a connection with the providers in the second one either, but by that point, I was like well whatever, it's fine. Which I think is actually, if I could go back and do it again I would have changed that. But you kind of are like, I don't want to, could I possibly change again? And I think that for people who are VBACing, yes you can and sometimes you actually really need to, even like late on in your pregnancy, people will switch groups or providers even late in the third trimester, so. Meagan: Even if you're changed already, you can do it multiple times.Rachel: Exactly.Meagan: It's not a bad thing to find the right provider for you. It's not. Rachel: It's not. And It's hard. And you can feel like, Oh my god. Am I really going to send all my records over? It can feel like so much effort and it can really be worth it. I just wanted to say that as someone who switched once and then was like, Okay, I'm done, and wished I'd switched again. So anyways, it was late in week 39 I went into prodromal labor but I didn't know that prodromal labor even existed because nobody told me about it.  And it was my first baby. So I was like is this labor? I think I'm having contractions, these are not Braxton Hicks. And in the end, we talked to the doula I was working with, and in the end they ended up petering out. And at that, I think that that for me marked the beginning of, this is not going to look like the way I had expected it to look. And again, hindsight is everything. What I wish I had known at the time– and I think this is really relevant to some VBAC moms is that sometimes prodromal labor means that your baby is not in the best position for having a vaginal birth. And I can't exactly say oh I would have done this or that differently if I'd known it, but it would have helped me understand what I was going into with the labor and the birth. So anyway, I eventually went into labor in the middle of the night. It was exactly my due date and I knew it was different. I could just feel this is labor. And I was really eager to get it going quickly. And again, I wish someone would have said, “Rachel, rest. It's early. You're going to need your strength. You're going to need your energy however your baby is born.” And instead I quite literally was running up and down the stairs of my house to try to push labor along. Which is, I have compassion for myself, I understand why I was doing that. What I really needed to do was get in the bath, or I don't know, lay over the birth ball. Watch a silly movie, right? The feelings I was having were real pain and I was scared. But you kind of can't run through this, especially a first labor as we all know, those take a long time, right?Meagan: Yeah. And if we were having prodromal labor, our body may be kicking into labor, but still might need some time to help that baby rotate and change positions. Rachel: Exactly, exactly. And this is the kind of education that is so missing from birth classes. And that is one reason why this kind of podcast is so helpful because that's how I learned about these different things. I didn't ever learn about them from a provider being like, “Let's talk about what will happen in your birth, and let's talk about why you had prodromal labor.”So anyway, we went to the doctors office where we met a midwife and my doula for a labor check. And I was hardly dilated, I was at a 2 but I was in extreme pain. And I have to say, I have a very, very high pain tolerance and I now know I was having back labor. Meagan: Baby's position.Rachel: Exactly. And the contractions were like boom boom boom boom. They were not, I didn't have any rest in between them. Which again, I think my baby was like I gotta get in the right position, this isn't working out, I'm freaking out, ah! Plus my mom is running around, ah! Right?Meagan: Yeah. Rachel: So we went to the hospital and I was checked in and the midwife who checked me in was like, “Oh you're actually not even 2 centimeters, you're just 1 centimeter dilated.” And they checked me because I was in so much pain I think. And I don't know that that was necessarily wrong,  but again, no one was sort of explaining, “Here's what we think is going on.” And it's partly because I believe those providers thought I was exaggerating what I was experiencing physically. They didn't know me. Well, they didn't know that I'm usually pretty stoic. They didn't know that I'm not a squeaky wheel. And I wasn't like screaming or crying or pounding. I was like quiet and I was like I'm in a lot of pain.Meagan: An intense quiet.Rachel: Intense quiet. Exactly. But that doesn't look like what we think pain looks like to people. And the fact is that people are very individual and how they express pain especially during labor where you're already kind of like leaving the regular plane of reality.Meagan: Yes. Rachel: So an important takeaway is like, even experienced providers cannot read your mind and make mistakes in assessing what's truly going on with you. And this comes up later in my second birth, but my husband now does a much better job of saying, “You might look at Rachel right now and think she looks like she's doing great, but this is what's really going on with her.” And he does that in a way that's not like he's speaking for me in a way that's annoying, but it's like I actually can't advocate for myself, I can't express this. So anyways, I asked for an epidural. They said that the anesthesiologist was busy. Which may have been true, but may have been they were trying to put me off because I was hardly dilated. And they told me to get in the birth tub. And I remember hanging over the side of the tub and staring at the clock on the wall and being like, I actually don't know if I'm going to survive this hour. I was just in so much pain. Incredible pain from back labor that was incessant. Eventually he showed up. They hooked me up to all the monitors. At that point, one of the nurses was like, “Oh, you are having monster contractions.” Like the contractions that were being measured were so intense they were going each time to the edge of what was measurable. And now that the computer said it it was like oh…Meagan: You're validated now. Rachel: Exactly. Right. And the anesthesiologist, it took him three tries to get the epidural working properly which would echo problems to come. But he did, and it took away the pain. And then I was just in the bed and kind of left there. And the nurses and the midwife did not use a peanut ball, they didn't move me around. And obviously, listen, I'm attached to the monitors. You know you cannot really move that well, the belt slips, and that increases the chances you'll have a C-section. And there are still things that can be done. It's not like you're a loaf of bread, you just lay in a bed. But they didn't do that stuff and I wasn't dilating. The nurse and doula eventually basically were like, “Well, we're going to go out for dinner and we'll be back in a few hours and we're going to give you this thing to sleep and if you haven't dilated by the time we get back you're going to have a C-section.” And at that point I was exhausted. It's evening now, I've been up since the middle of the night. I'm totally like, what is happening with this birth? No preparation; I took birth classes, I read books, no preparation suggested that this series of events could take place. I felt completely abandoned by my providers, including my doula who I was paying out of pocket. And one thing that came up at this time also was I had this colposcopy in college, like scraping of cervical cells. I didn't hide it from anybody, I was open. And the midwife said well maybe that's why you're not dilating is because of this colposcopy.Meagan: Do you think you got scar tissue?Rachel: That's what she said. And I remember at the time being like why are we only talking about this now? Why has nobody brought this up in any of the prenatal visits that I've done? And I felt blamed. This thing about your body is defective. After a few hours when the midwife and the doula came back and I rested and it was quiet, I had dilated to a 9. And I think what that's about is that I had been in too much pain to dilate. I was so frozen up and tense and also extremely scared.At this point people are like, “Oh wow.” And finally my water broke,y water hadn't broken. So you know, things are kind of continuing and I am starting to actually feel even more fear and my room is getting really crowded with people. And the midwife asks me to start pushing. And I was afraid and I was excited. They turned on the baby warmer, and they were like, “Okay, your baby is going to come out.” And I started to push but I couldn't feel what I was doing. I had no idea. And the midwife was like, “Do you have an urge to push?” And I was like, “No.” The epidural that hadn't gone well from the beginning had then come down with a very heavy hammer and I felt total numbness. It was not helpful. I needed someone to have turned it off or something, or turned it down so I could feel an urge to push and feel how to push, where to push, what muscles to use. And at a certain point I could tell something was going not right and it turned out that my baby was having heart rate decelerations. So just to sketch the scene. At this point it's 1 o'clock in the morning, I've been awake for 24 hours. I'm exhausted. My husband is exhausted. Neither of us has any idea that things could have gone like this. The midwife says I think it's time to do a C-section. And I don't disagree with her. I don't even know what to think at that point. I'm also feeling tremendous fear. I was like I'm afraid I'm going to die, I'm afraid my baby's going to die. And the overall sense in the room…and people were like, “Oh no, you're going to be fine”. And the sense in the room was that I was hysterical and I was not in my right mind. Which I wasn't in my right mind; I had been awake for a long time, I'd been trying to have this baby, nobody really told me what was going on and I felt totally unsupported. Actually, my response was completely reasonable given the circumstances and nobody really attended to that and saw that and recognized that as completely valid. Plus, I don't have evidence to stack this up absolutely, but I have since come to find out that there is a medication that some laboring women are given to help them rest and one of the side effects is an impending sense of doom. And I have a friend who had a baby at this same hospital and had the same response after having been given something to rest during her labor. I could go back and look at my records and I may do that but I'm like, well that would explain also why I had the response I did. Meagan: Mhmm.Rachel: Anyway, we go to the OR. I hunch my back for the spinal that the anesthesiologist has to do a couple of times to get it right. I'm still contracting at this point. My body is still like, Come on, let's get this baby out. Let's get this baby out. And I'm so uncomfortable. And you know that advice to not lay down flat on your back when you're pregnant, but that's what you have to do when you're in the OR. The whole thing felt like I was going to choke under my stomach and very exposed like you are in the operating room. Meagan: Yeah, it's cold and it's bright and you're very exposed. And you can't move your body normally, especially if you've had a spinal. Rachel: And also in retrospect, again I'm like I cannot believe that the first time I learned what happened in a C-section was in my C-section. I really should have at least learned about this even though it would have still been scary and I still would have been surprised. So when the OB goes to operate, he starts his incision and I say, “I felt that.” And he says, “You'll feel pressure.” And I say, “I felt that.” And he continues operating and I was not numb. I felt the operation. And according to his notes..parts of this I don't remember…but he wrote it down and my husband has also told me that I was screaming, my legs were kicking. There's no question that I was in tremendous pain. And I was moaning and it was horrible. And it was horrible for the people in the room too by the way.Meagan: I'm sure. Rachel: Right? Like it's really important to say that. My OB didn't listen to me. That is a super common thing that happens in healthcare, especially for women. Especially for pregnant women. He's not a sociopath. He didn't want to be evil, but he didn't listen and the consequences were so steep and so dire. And I think that it was traumatizing to him and I know it was traumatizing to some of the other providers in that room, the nurses to watch this. He kept going and when the baby was born, which I don't remember, apparently they held her up to my face and they put me under general anesthesia and sent my baby and my husband away and stitched me up. Then I woke up in recovery. The doula and the midwife had gotten the baby to latch while I was unconscious and were talking about me without knowing that I was awake about her latch which really, really bothered me because it just underscored how it felt like I was just a body. And even people who were supposed to be there to take care of me and be tender and advocates, I felt they disregarded me. And under other circumstances I really would have wanted to breastfeed my baby like right away. But I wasn't even there to say yes I want to do this or no I don't want to do this. It was a terrible birth and I would not wish it on anybody. Meagan: And I think, kind of talking about what you were just talking about with breastfeeding and stuff, these people in their hearts and in their minds were probably like this is what she would have wanted. We're trying to help. But in whole other frame of mind over here, I'm not present. I haven't said those things. And I know you're trying to help and I know that's where your heart is, but I'm not okay with this. Rachel: Totally.Meagan: And I think sometimes as doulas, as birth workers, as any one of you listening, remember that words matter. Actions matter. These moms' feelings matter and it's sometimes in our minds we're trying to do what's best, but it might not be. Rachel: Totally. Absolutely. Yes and I again, it's so important to point out. Yes they were coming from a good place. They really were coming from a good place. But it wasn't the way that I felt it or experienced it. Meagan: And it left you with trauma and angst and heartache. Rachel: Absolutely. Totally. Yeah. Meagan: Well that definitely sounds like a really rough birth. And it's so crazy because it's like you went from not progressing to baby in a poor position, to getting an epidural. I love that you talked about that. That can be an amazing tool. A lot of people are very against epidurals, and there are pros and cons with epidurals. We've talked about those. Fetal heart decels is one of them. I don't think, maybe in this situation it sounds like a lot of other things happened; baby's position being one of the biggest ones. But that can really be a tool that helps you just relax and be more present and have less trauma. We talk about this in my doula practice of where there's a difference between pain and suffering. And pain, progressive positive pain that's bringing our baby to us that's one thing. But when we're suffering and we're so tense that our body's not even able to try; that epidural could come into great play. But again, we're not that loaf of bread in a bed and it is important to move and rotate. And it doesn't have to be drastic. It doesn't have to be crazy big movements. Just subtle movements to change the dynamics of the pelvis and to encourage our baby to keep coming down. So there were so many things that just went poorly but also went well, and then poorly again and then well and then real poorly there at the end. Rachel: And I think like to your point, I went into my birth I should say, I was planning on having an unmedicated vaginal birth. I was like I'm not going to have an epidural. And I think that if my providers had different skills I would have, I may have been able to have that baby vaginally. And I say that based on what happened in my second birth. So it's not just like wishful thinking, right? And I'm really glad I had that epidural. I really needed that. I was suffering. The pain I was experiencing was not productive pain. And an epidural can help you with suffering, alleviate your suffering. But it can't and doesn't substitute for emotional support. And I think that's what was missing for me, throughout that first birth. Even if I had gone on to have ok fine, a cesarean, or even a vaginal birth, I still think I would have been like that wasn't a good birth because I didn't feel emotionally supported. And an epidural can't do that. Meagan: Yeah. No an epidural cannot do that. And I, for anyone listening who supports birth, or even who are going for a birth you kind of mentioned it. You're in this other land and sometimes it's hard to advocate and open. You might be thinking something and you might so badly want to say it. It's right here, coming out. And you can't say it for whatever reason. It's a weird thing, it doesn't make sense sometimes but it can happen. But really being heard, validated, understood; which are so many things you weren't. Right? And when we're not heard and when we don't feel safe, and we don't feel supported, those things leave us with PTSD. In fact there was, in your book, I'm just going to read it. It says, “2022 study by anesthesiology and obstetrics professor Joanna and colleagues found that what's important about women who feel pain during childbirth is how mothers feel about their pain. And how their providers communicate with them overall…”You were communicating, and no one was communicating to you. “...feeling positively about pain and heard by providers protects a mother from developing PTSD.” And I mean it goes on which is why you need to get the book so you can read more about it. Rachel: Yep. Meagan: But really, feeling heard. Rachel: It's not just crunchy whoo-hoo feels good, feels right, sounds good. It really matters. And I have to say that I'm participating in and helping to work with providers on designing some studies about providing different pain options for moms during C-sections. We literally had a conversation about this yesterday. And one of things we were talking about is it's not just the pain. It's not just pain relief. It's also being listened to. Because there will be people who are like, I might say I'm in pain, but that doesn't mean I need an epidural or want an epidural. But I'm feeling pain and I want to be heard and I want somebody to…even if you can't express this. You can't even express it because you're the one having labor. What you're needing is someone to see you and look you in the eye and be like you're going to be okay. And I think as mothers we totally are experienced with that all the time. When your child is hurt or sick, part of your job obviously is to get them the help they need, but it's also to assure them this nosebleed is going to end. You're not going to have a bloody nose for the rest of your life. Which, when you're going through something really hard you can sometimes forget, right? And you're pointing out from the studies this helps to prevent people in birth, in labor, from developing PTSD. The stakes are really high. They matter so much. Meagan: When you were just talking, I don't know if you saw my eyes kind of well up a little, but I connected a lot with my first birth when I was clinging to a bed, literally clinging. And I was looking at my husband and I'm like, “Do something!” I had a baby in a poor position. I was being jacked full of pitocin. My water had broken, there was a lot of discomfort going on. I had told him I didn't want an epidural and he's like what do you want me to do? And I was like I don't know, I just need something! And I was terrified and desperate. And he was just like… It wasn't fair for me to put him in that position either but at the same time he was like I don't know, I don't know what to do, right? And the nurses were just like we'll just get you an epidural. And I was like no, I don't want an epidural. And then it just was like epidural, just went down from there. And I wish so badly that there was something else. Let's get you out of the bed. Let's get you in the shower. Let's give you some nitrous. There was so much more that I could have had, but wasn't even offered. And I think too, I needed someone to tell me that nosebleed was going to end. Rachel: Yes. Meagan: And it was going to end and it was going to come back every five minutes and it was going to end again and I was going to be okay. And I was going to survive that. And just hearing you talk about that, why my eyes got all welly, is that I don't know if I realized how much that impacted me until just barely. And here I am, my daughter is almost 13.Rachel: Just like how powerful these things that, I don't know, this is part of why we have these conversations. They shed different corners of light on our experiences that it's like oh my gosh, I didn't even know I knew that. And that's so why we, even though I'm not postpartum immediately, it's valuable for me to talk about it too; to hear what you're saying, you know?Meagan: Yeah. Ah, so after a not-so-amazing experience, going into that postpartum, you've talked a little bit about that in your book. Well, not a little bit, you've talked about that a lot. Tell us about that journey and then what led you to deciding on VBAC and ultimately going and having a VBAC. Rachel: So I should say, I was really…Talk about not realizing things right away. It took me a long time to figure out how traumatized I had been by that birth. And I was about two years postpartum and I was having a procedure for something else and I just completely, I had a panic attack. I had never had a panic attack before, I didn't know what it was and couldn't have explained what was happening. And when the anesthesiologist who did this procedure was like have you ever had any issues with anesthesia, which is exactly the question that should be asked, and I had said what had happened he was so taken aback. He was shocked and didn't know what to say and walked out of the room.Not in the way of, I'm abandoning my patient, but just like from his perspective here's this kind of routine thing. This patient is crying and shaking and talking about this very traumatic incident which I had not talked about. I didn't go to therapy. I had talked about it with friends and my family, it wasn't a secret, but I felt a lot of shame. I felt like I must have been this total freak of a person that this had happened to me. And after that I remember saying to my husband, I just don't know if I'm ever going to be able to get over this trauma enough to have another baby. And I didn't even know if I wanted another baby, like separate from the trauma. In therapy I started to see that I felt very stuck in my life and that included how and whether to grow my family. And that was actually because of the traumatic birth. It just like made this big block. I think one thing that's important to think about for those who have had a traumatic birth is that sometimes that can show up in your life in ways that you don't expect. Meagan: Yes. Rachel: And so to be compassionate with yourself about that and also to be open to that. We're in the era of warnings and trigger warnings and those are important, but sometimes for a traumatized person the things that are triggering or activating are not what you would think. Like for me, I couldn't watch a scene of a hospital birth even if it was happy without getting very uncomfortable and having to walk away and there wouldn't be a content warning on that. So it's just to say be patient with yourself. Accept that…don't, I guess if you've had a traumatizing birth you don't have to struggle against these things. As horrible as they might feel, as uncomfortable as they might feel it's normal and it's ok and it shows up differently for everybody. Rachel: Yeah so I had this big question and then I was like ok, it took awhile for me to be like I do want to have another baby. But I wasn't ready emotionally. And so I waited. And then about, let's see, October of 2019, I was like I think that I'm ready to try to have another baby. And we had met this midwife who lived in our community, who my daughter actually made friends with her niece at our public pool which is so beautiful. I ran into her one night while she was walking her dog. She was like your husband shared a little bit with me, if you ever want to talk. And this, I feel like, I could not be more grateful that this person came into my life. She just is, her skills are phenomenal. Just as a clinician in terms of trauma-informed care, and I've felt safe enough going to her for prenatal care to decide that I was ready to get pregnant. My joke is that I should tour high schools and be like it only takes once to have unprotected sex to become a parent. And I was really lucky that I got pregnant right away and at that point I was 37. So I should say I had my first baby at 33 and I got pregnant again at 37. And that's not always the case for people. Obviously it can take a long time and especially after a C-section, secondary infertility is real. Meagan: It is. Rachel: Yeah. Not talked about enough. Really not talked about enough. Meagan: There's a lot of things, right, about C-sections that is not discussed about. For personal, for the mom, for the individual, the infertility, adhesions, all those things. Just the emotional and the physical. Then even the baby. There's risks for the baby, the allergies, the microbiome getting messed up. All the risks, it's just not discussed. Rachel: No, it's really not. And you kind of only find out later if you've had a C-section and you've had a problem down the road that you're like, maybe that's because of my C-section. It's ridiculous.So we got pregnant and I was not sure if I wanted to have a VBAC, but I started thinking about it from the beginning. And I also was like, if I don't have a VBAC how am I ever going to get myself into an OR, I just don't know. And I really think that VBAC is the under-discussed pain point for moms. And I'm preaching to the choir here but we're talking about half a million moms every year have to make this decision, if it's even available to them. Meagan: I was going to say, if it's even offered. Rachel: If it's even offered. Which is totally not a given. But theoretically, they do have this decision and I really have not…I should say, in the course of writing this book, but also just being a mom who had a bad C-section and then had a VBAC, I hear from people a lot about their journeys just like on the playground. Every person I've talked to, they agonize over it. No matter what they choose, no matter what. Why is that not talked about more? I mean that part of what this podcast is doing that's so important, but I still can't believe how under the radar it is, yet it's such a big deal when you're going through it. So anyway, I told myself I did not have to decide right away about a VBAC or a C-section. My midwife was like you can totally have a VBAC, you can totally have a C-section. Even if you have a C-section you can keep seeing me. I was worried like oh would I get bumped out of midwifery care. One of the things I'm really fortunate about and that I think is really good about that practice is that she has a very close relationship with one of the OB's there. Like they kind of share patients, I should say that. And that's because she's worked with him for a long time and he really respects her clinical skills and vice versa. The other thing about her that's unique and that I didn't know how important it is she's a Certified Nurse Midwife, so she attends births in the hospital. But she previously had been a homebirth practice and at a birth center as a CNM. So her skills are, like I said are phenomenal. A C-section is truly like we have to do this. I've run out of my bag of skills or like the baby or mom's health suggests that like we need to do this now. She worked with me to work with the scheduler so that I saw her for every visit which helped me to learn how to trust her and she didn't pressure me. Either way she was completely open. She also worked with me to make sure that I could see her for virtually every visit so that way she earned my trust. And I got to show her who I am. She got to understand me which was really important to the birth. Meagan: Yes, which I want to point out. There are a lot of providers these days that are working in groups. And I understand why they're working in groups. They're overworked, definitely not rested. There's reasons why, both midwives and OBGYNs are working in these big practices. But the thing is it's really nice to have that established relationship but for some reason specially for VBAC it's so important to have that one-on-one relationship. So if you can, during your search for finding providers, if you can find a provider that is going to be like Rachel's midwife where she's just like I want to get to know you, I want to establish this relationship. Yes, we have this OB over here but I want to be your person. I definitely think it's impactful.Rachel: I totally agree with you and I didn't even know that was possible. And she works for a big group and even so she told the schedulers, hey make sure you schedule her with me. She didn't just do that with me by the way, it wasn't just a special favor for this traumatized patient. And frankly it's better for the providers too because they're not coming in cold. Like ok who's this person, and she's saying this. And what's her prenatal care like? What's her pregnancy like? Of course they're looking at the notes, but it's not the same. Meagan: It isn't. And I love that she said that. But I also want to point out that you can request that. If you're in a group and you can connect whole-heartedly with someone and you feel it's definitely who you need, it's ok to ask hey. I know that I am supposed to meet Sarah Jane and Sally, but can I stay with whoever. And maybe you might not get every visit, but if you can get more visits than only that one? It's worth asking. Rachel: Totally. And also then you know their style. So like she was not an alarmist. Let's say I was over 35; I had to see a MFM just because of my age. That went fine, but if something had come up, like let's say I had a short cervix or there was something I found in an appointment with an MFM specialist I would know her well enough to take that to her to be like, put it to me straight. How worried should I be about this? As opposed to maybe this one's an alarmist, this one is more like ahh let me put this in…And the only way you're going to learn about that is from meeting with them again and again. And for VBAC that's so so important. Meagan: It is. It kind of reminds me of dating. It's weird. I had said this with my provider when I didn't switch. I was like, I feel like I'm breaking up with him. Like he's my second boyfriend, it's just weird. It's not really boyfriend but you know what I mean. But it is, we're dating them. And anyone, in my opinion, can come off really great for that first date because they're wanting to make that impression. They're wanting you to like them. But the more you get to know them, the more they may show their true colors. And you also may realize, I don't think I'm the right person for you. My desires aren't something that aligns with you and so I don't want to put you in this situation. And so if we date our providers, “date our providers,” a little bit more than just one time it really will help us know. And like you said, if something were to come up you could have that trusted person in your corner, which is so important for VBAC, that you can go to. Rachel: Totally. Yeah. So yeah, so pregnancy went well. And then right as I entered my third trimester it started to be COVID. Meagan: Mhmmm. The joys. Rachel: Nobody saw that coming. And then you know, things for the entire society obviously went completely off the rails. Obviously something like COVID is, we hope, not even once in a generation. Once in a hundred years experience. But given all the stuff that was up in the air, boy was I glad that there was one provider who I trusted. Who I could be like ok what do I do, what do I do. And I have to tell you that she and my daughter's pediatrician…I'm a professor. So I should say I'm in the classroom with young people who, you get sick a lot anyways. They're living in dorms, like they're not taking the best care of themselves. So COVID was circulating, and we live right outside New York City, COVID was circulating early here and I have a lot of colleagues that ended up getting it. And both my midwife and my child's pediatrician told me early you need to stop going in person, it's too dangerous for you. And I trust my daughter's pediatrician a lot, you know we have a nice relationship and I really trusted my midwife. Right? So I followed that advice and was really fortunate because boy. You know what you don't want while pregnant? COVID. And you know what you really didn't want? COVID in 2020 when you were pregnant and nobody knew anything, you know?Meagan: Right? Rachel: So, the blessing in disguise was that I was able to work from home. And it was super stressful because I had my daughter and my husband was here and you know, my husband is a photographer…I mean the funny thing is that I ended up, not my head but my body, being in these different photos he ended up taking and my belly was getting bigger and bigger and we kind of had to hide it. I'd be holding a book, or cleaning something. It was an absurd, crazy, isolating, scary, and also funny time. You know the blessing in disguise was that I wasn't on my feet as much and I think that that was really good for me as a pregnant person. There is also data that preterm birth went down during the lockdowns because people got to stay home and they don't necessarily get to do that leading up to birth, which tells us a lot about what we need and the rest we need and aren't getting. So anyway, at first everything went virtual and then when I started going in again for my appointments I had met the OB who works closely with my midwife. And we talked about what would happen if I went over 40 weeks. And he was like well, we're not going to automatically schedule a C-section, we would talk about potentially waiting or induction. And I really appreciated having that conversation with him because I understood where he was coming from and it wasn't again like we're going to schedule a C-section right now. So we know if you get to 40+3 and you haven't had the baby, bing bang boom. And that was very important information about his risk tolerance and his stance. Just like with my first birth I went into prodromal labor a few days before my due date. I had had a membrane sweep with my midwife. My in-laws came to stay with my daughter and we went to the hospital on a Saturday night. I didn't know this but my father-in-law told my husband I think she's getting ahead of her skis. And he was right in the end. So we get to the hospital and my contractions stop. And I'm like oh no. And my midwife was like, they put me on the monitor to get a strip which is like you know, what happens. Meagan: Normal.Rachel: And my midwife was like listen, your baby, he's not looking that good on the monitor. I want you to rest for a little bit and let's see. So I'll check back in with you in like half an hour. And I was so upset. I remember being like I can totally see where this is going to go and I had learned about VBAC in terms of like what could increase the chance of rupture or not and I was like I'm going to end up with another C-section and I'm going to be caught in the net. I didn't even have a shot, is what I felt. And then she came back half an hour later and she was like, “He looks great. I think he was just sleeping, and if you want to go home you can go home.”  And it was like 1 o'clock in the morning. And I was like, “I think we should go home.” I just felt like he's not ready. He's not ready to be born.  And remember, I trusted her so much. She would not tell me this if she thought that there was something…Meagan: If there was something wrong. Rachel: Exactly. She wasn't trying to be my friend. She was my provider. And so it felt really weird to leave and come home and not have a baby. And I thought was this the wrong thing to do, because I live like half an hour from the hospital, and was like no this is it.And then everything was quiet for a few days. And then just like my first labor, my daughter, I went into labor in the middle of the night and I had intense back labor, and I knew like this is the real deal, here we are. And this time I tried to rest. I did like cat/cow and just like anything, child's pose, just anything to feel more comfortable. And I called my midwife at 7 in the morning and she was like, “Okay, I want you to come in and be prepared to go into the hospital from this appointment.” So we did that and at that appointment, I had a headache, I had higher blood pressure, I was dilated to a 6, and she said to me, “Listen. Just so you know, they're not going to let you go home. You're going to the hospital, no matter what if your contractions stop or not whatever. This is what's happening because of how dilated you are, the fact that you have this headache, this BP readings, whatever.” And I was like that's completely reasonable, I felt that way too. You know what I mean? But I really appreciated she communicated that with me so clearly and explained why. So I planned initially to try to have an unmedicated, vaginal birth. My midwife and I had discussed these saline boluses you can have in your, by your, what's it called. Like the triangular bone in your back? I'm totally blanking. Meagan: Your sacrum?Rachel: The sacrum. Yeah, that that can alleviate some pain. And very quickly the pain was, I found it to be unbearable. And I asked for an epidural. And the anaesthesiologist came right away and did a very good job. And the nurses and the midwife who were at the hospital were using a peanut ball and helping me move and really supportive emotionally. And I was still really scared, right? Because I had had this terrible birth before, I thought something would happen to me. And nobody treated me like I was exaggerating or you know like, unreasonable. And that mattered a lot. And I think what's important is you shouldn't have to have gone through a bad birth for people then to take you at face value. With your first birth, it should be the standard for everybody. Meagan: Such a powerful saying right there. Rachel: And they were wonderful, truly, clinically and beside.Meagan: Good.Rachel: And then my midwife surprised me by showing up. She was not on call, she came in at like 9 o'clock, no she came in at like 5 o'clock, like once she'd seen her patients and I was just like oh my god,  so moved to see her. And you know, I was pretty far along at that point and she kind of helped me get into different positions and then it was like okay, it was time to push. And they had managed that epidural so I could feel when it was time to push, and I could feel how she and the nurse were telling me to like push here, right? Like use this, make this go. The pain was really intense but it wasn't suffering, like okay, I'm getting instruction. And as I was pushing I could feel that it wasn't going to work. I was like he's not, his head…I could just feel it. Apparently he was kind of coming and kind of going back up, like his head forward and back. And my midwife was like do I have permission from you to try and move his head? I think his head is not in the best position. And I said yes, and she tried to do it and she couldn't. Her fingers weren't strong enough and then she went to the OB and she told me this later.She said to him can you come and move his head? He'd been trained by midwives in the military, by the way, which is one reason his clinical skills are so amazing.Meagan: That's awesome. Okay.Rachel: Awesome. And at first he apparently was like, oh she's a VBAC, like I can't believe you're asking me to do this. And my midwife, again they trust each other right, and she was like the baby's doing great and the mom's doing great. I really think this is going to work. And he was like okay. So he came in, asked my permission, I said yes and he moved my son's head. My water had not broken again, right? So it's like the same thing as the first one. And once he got in position and I started pushing my water broke in an explosion all over my midwife. That's why they wear goggles, now I know. And she went and changed her clothes. I pushed for 45 minutes and then he came out.Meagan: Oh my gosh. Rachel: It was amazing and I felt so proud and I was completely depleted. I was so high and also so low. And I think what's amazing to me is that it was almost the same labor as my daughter, which just tells me that's how my body tends to do.Meagan: Your pelvis. And some babies need to enter posterior or even in a weird position to actually get down. So that can happen. Rachel: Thank you. And also my water didn't break until the very end so there was buoyancy to be moved, right? And again who knows what would have happened if I had been with this provider the first time. Like maybe these decels really meant that my daughter had to come out like then. That is possible. And that first team did not have the skills of the second team. None of this was even brought up, wasn't even a possibility. And I should say that first birth, I didn't even mention this. The OB that gave me that C-section, later told me that my daughter's head was kind of cocked when he took her out. Which suggests that it was just like my son. And how I'm grateful for my epidural. I'm grateful for, you know, all the things that technological kept me safe, but it was these skills of facilitating vaginal birth that made the difference for me to have that VBAC. Meagan: Absolutely. And the hardest thing for me is seeing that these skills are being lost. Rachel: Yes.Meagan: Or maybe it's not that they're being lost, they're being ignored. And I don't know which one it is. I really don't know because I see people using them. So I feel like it's got to be there. But then I go to other births and I'm like, wait what? You're not going to do anything to help her right here? Or you know, it probably could have been a vaginal birth if we had a provider come in and be like we have  a little asynclitic head, why don't we change into this position and let me see if I can just ever so slightly help this baby's head turn. It just isn't even offered. Rachel: Yes. Meagan: And that's something that I think needs to be added to questions for your provider. In the event that my baby is really low and coming vaginally, but is in a wonky position, what do you do to help my babys' position change to help me have a vaginal birth. And then even further what steps do you take past then if it doesn't work and my baby's so slow. Do we do assisted delivery? What do we do, let's have this conversation. So if it does come up, you're aware. Rachel: I love that. Meagan: I was going to say if your provider says, I don't know/I don't really help, then maybe that's not your right provider. Rachel: And I think what's so smart about that framing is that it's not putting the provider on the defensive of like, what's your training, right? Then it's like, what is your problem? But you're actually asking about their skills and you're asking about their approach, without coming from a place of seeming doubt. Just like, I'm just curious. Meagan: Yeah. Like what could I expect if this were to happen, especially if in the past. Say your C-section was failure to descend, mostly based off on position, we know that this is a big thing. But if your past cesarean was failure to descend, ask those questions to your provider. What steps can you take? What steps can we do together, you and I, to help this baby come out vaginally? Rachel: Totally. And I think also, that way, let's say the VBAC doesn't work out, you won't then be looking back over your shoulder and being like I should of/could of/why didn't I/if only. And you know, what do you want out of your birth experience? Well a lot, but part of it is a sense of peace. Right? That I did the best that I could. That my team did the best that they could.Meagan: Yes. Yeah and really interviewing your provider. Again, dating your provider and asking them the questions, learning more about them and what they do and their view. Taking out the yes and no questions and really trying to get to know this provider and letting them get to know you. I think it's just so impactful. I also, kind of like what you were saying with your first birth, also learning the other types of birth that could happen, you know learning about assisted birth. This is a new thing. Learning if assisted birth trumps a cesarean for you. Would you rather go for an assisted birth, even if it may end in cesarean, would you rather attempt that? Or would you just rather skip that and go right to the cesarean. Really educating yourself and trying not to push off the scary even though it can be scary. Rachel: Yes, yes. I love that you're saying this and I was just thinking about this and talking about this with a friend; there's stuff we hope doesn't happen. But not talking about it or thinking about it isn't going to protect us from it happening, it's just going to mean you're not prepared. Meagan: Yeah.Rachel: If it does happen. And yeah. Meagan: It's a disservice to ourselves. And it's weird. And it's hard to hear those stories. It's hard to hear the CBAC stories, it's hard to hear the uterine rupture stories that we do share on this podcast. Kind of what you're talking about the trigger warnings earlier, yeah it might be a trigger. It really might. But if we know all the signs of uterine rupture leading up to, we can be aware. And it's not something to hyperfocus on. We don't want it to be like oh my gosh I have this weird pain, right now, I don't know. It's not to make you scared, it really isn't. It's to just help you feel educated. Kind of what you were saying too. I don't know what a C-section looked like until I was in my own C-section. Rachel: Yeah. I've been talking about this recently with an anesthesiologist, some anti-anxiety medicine which you might get during a C-section, can cause memory loss. That's a side effect. So the time to decide…Let's say you're not planning on having a C-section. And then you're having a C-section and you're really anxious, really reasonable. The time to decide whether to take that anti-anxiety medicine which might cause memory loss; you should have an opportunity to reflect on that and talk about that  and think about that not only in the moment when you're scared and should I take it right now or not. Meagan: Yeah.Rachel: It's just like that's not a good way to make a decision, you know?Meagan: Yeah. And also learning about alternatives. Okay, these are the side effects of this medication, and I don't think I'm willing to accept that. So let's talk about other medications and those side effects so we can see if we can switch it up.  They have a whole bunch of things in their toolbox when it comes to medication. Rachel: Exactly. Meagan: For nausea. You know I had a medication and it affected my chest. It went all the way into my chest and I had to consciously focus on my chest moving. It was the weirdest feeling. Rachel: Terrifying, yeah. Meagan: I wish I would have known the alternatives to that. Right? So having these educated discussions, learning as much as you can. It's hard and it's scary and it's intimidating to not learn what you don't want. It's understandable, too.Rachel: Completely, completely. But that's informed consent, right? The risks, the benefits, the alternatives. And to go back to the anti-anxiety thing. You might be like okay, what could you do for me non-pharmacologically? Let's say I have a C-section and I'm feeling really anxious. Can I have a doula with me there who's giving me a massage? Can I have a doula there who's maybe put some lavender essence on a washcloth to hold to my nose. Can the anesthesiologist hold my hand and tell me it's going to be okay? And then you start actually opening up real options. Like wow I can have a doula with me?Meagan: Yes. That is something that I am very passionate about. We need to get doulas in the OR way more than we are. And I understand that it's like oh we don't have PPE, or oh it's an extra body, and oh it's a very big surgery, like I understand that. But I have been in the OR a good handful of times. And I understand my position in that room. I understand and respect my position in that room. And I always let an anesthesiologist know, if at any point something happens where I need to leave this room you just tell me. I will leave. No questions asked. But please let me be here with my client. Please let me stroke her hair. Please let me talk to her when dad goes over to baby so she's not alone. When you were put under general anesthesia to be there by your side, whether or not you were waking up in the OR. Because sometimes you could wake up sooner, or waking up in post-operative. Let's get these people here. Let's play music. Let's talk to them. Let's communicate the birth.I mean with my first C-section, they were complaining about the storm outside, they weren't even talking to me, right? And it would have impacted my birth in such a more positive light if I would have been talked to. And I wouldn't have felt like, what's going on. You know and all those things, you talked about it in your book. This drape that is separating us from our birth, it's just wild. So one of the questions we ask when you sign up to be on the podcast is topics of discussion that you would like to share, and one of those things is you said, why it's important to balance preparation for VBAC with an understanding of the systemic forces that promote C-sections. We're kind of talking about that, but do you have anything else to say on that? Rachel: I think that there is so much self-blame for having a C-section, when you wanted to have a vaginal birth. And go back to pain and suffering, that causes suffering. And it's heartbreaking to see that and to feel that. And when I think about it, I think what's important to keep in mind is like there are the particulars of your experience, right? Like your providers had the skills or didn't. They listened or they didn't. Your baby had decels or didn't. Like all that is real. And you're not the first or only person any of that is happening to. So why are we hooked up to electronic fetal monitoring, EFM, as soon as we walk into the hospital? Well that is because of how technology reigns supreme right now in every aspect of our society, but medicine too. And also that like it's an efficient system and medical birth, medicalized birth is all about efficiency and making as much money as possible frankly. Meagan: And there's even deeper history, we talk about that in our VBAC course, about why that was happening around cerebral palsy and what it actually did for cerebral palsy rates. All of these things. It's pretty fascinating when you get into it and understand one, why they do it and does it work? Does it make sense? They do it and just became practice and norm, but it did it actually impact the things that, okay how do I say this. Does it impact the things that they were originally creating it to impact? Rachel: Right. Totally. And it's actually the opposite; it was supposed to bring down the number of C-section rates, or the number of C-sections, when the number was like 4.5% in the early seventies and it's just gone in the opposite direction.There's so much evidence that you use it and it makes you more likely to have a C-section. And so yeah, okay, not your fault. That's the system. And I don't mean it in this way like, that's the system, give up, lay down, don't try to make your own feet, but also just to accept that that's what you're operating in and that's what your providers are operating in too. Right? Use it as a way to let go of the guilt and the shame and the, I messed up. My body messed up. Meagan: Yeah. Because there's so many of us that feel that. Rachel: Yes. Meagan: And it goes into the next topic they were saying that I think really can help us walk away with less of, I messed up. My body messed up. My baby failed me. You know whatever it may be. And doing effective research about the hospitals and their employment patterns and the chances of you even having a VBAC. That does kind of go into the balls in our court where we have to get the education and understand. But even when we do that, even when we don't have the best experience, in the end we're still going to look back at it as we did, WE did, the best we could. Right? And it takes less of that blame on us in a way because we know we did everything we could. Rachel: Yes.Meagan: And sometimes it just still happens. Even if you have the doula. Take the VBAC course. Read all the VBAC books, listen to all the podcasts, understand all the risks. Sometimes it still happens. Rachel: Totally. And I mean I think about in my case, like let's say my midwife hadn't come in for me and my OB hadn't been the one who had been attending that night, maybe I would have had a C-section. Because maybe the people there wouldn't have known how to effectively move my son's head. Even though I like did my best and that's okay. It has to be okay because you can't kind of change it. And again, not to be defeat-ist. But to find peace, just to find peace. Meagan: Yeah. I wish that for our VBAC community is finding peace and giving ourselves grace along our journeys. Because we've had 100's of podcast stories and there are so many of us who are still searching for peace. And still not offering ourselves grace, and putting that blame on us, or whatever, right? Everyone's so different and again, we talked about this earlier, it's just different. But I would love to see our community offering themselves more grace and finding more peace with their experiences along the way. And I don't exactly know what that healing looks like and how that peace is found. Do you have any suggestions on ways you have found peace with a very very very traumatic experience that not only led to trauma in that experience, but even in future procedures, in future experiences you know. Do you have any tips on just, guidance on finding peace? Rachel: I mean, I struggle with this still. And it sounds counterintuitive, but I think like not pushing away your feelings. And in the sense of not wallowing, but also not like struggling against them, trying to quiet them, make them be like ugh I hate this. Ugh I hate that I feel this way. Ugh if only I could get over it. So I'll say like, when I go to the doctor now, I get really scared especially if it's a new person and my blood pressure goes up and sometimes my heart rate goes up and it just sort of happens. And I hate it. And there are times when I'm like ugh I hate this part of me. I just hate it.But then when I'm kind of more accepting and it's like, this is how my body responds. It's understandable that this is how my body responds. And I take a Xanax actually. I say that to really take away the stigma I think that still exists around medical trauma and taking medication to manage your symptoms. I take a low dose Xanax before I go to see a provider and it helps me with my suffering. And also just like accepting. Because also there's this saying, if you struggle against the feelings of suffering, then you kind of suffer twice over. Right?Meagan: You do. Rachel: So I would say that, and then specifically for people who feel they had a traumatic experience, I've found EMDR treatment to be very effective, to deal with stuff in the body. That was pioneered more to deal with people who've been in like combat trauma, but it's very effective for traumatic birth. Tapping is another thing that can be very effective. And you can find that online, like there are different…Meagan: I was gonna say, you can go to YouTube and google trauma tapping or anything like that, and you can actually find some pretty great videos for free on how to do that. And it's pretty wild actually how well it works. Rachel: It really is. Meagan: Sometimes it's like wait, how is this working? It really does work. Rachel: Totally. And also I would say like in terms of again, peace, I think it's really important to speak openly about what has happened to you. And to the extent possible, we're conditioned to be like I'm just going to tie this up with a bow and it's okay. Someone says to you, you've expressed something hard, and they're like oh I'm so sorry and you're like it's okay, I'm going to be okay. Like you don't have to worry so much about reassuring your listener. You can be like yeah I had this C-section, and I'm still kind of upset about it. And yeah, that's how I feel. You don't have to self-qualify that. You know, but my baby is healthy. But I'm okay. But I love my baby. We do that; there's a lot of pressure to do that. And it's okay not to do that. It's okay to be like these are my feelings. And two things can be true at the same time. You can love your baby, and you can also be like I'm not that thrilled with the birth. Meagan: Awe yes. Julie and I have talked about that for years. They don't have to be separate. They can go together. You can love your baby and feel connected to your baby and really not like your birth experience. And you can also, we have found that people prep and then they have a vaginal birth and they're like I actually didn't really like that either. So you know, they don't have to just always be separate. You can be really happy and really be upset at the same time. It's okay to have those feelings, right? I have had things in my life where I've done something and I'm like dang. I really like how it turned out, but I hated the journey to getting there. And that's okay. So I love that you pointed that out. Rachel: Yes. or if you think about how you feel on your children's birthdays. So like I have very different feelings on my daughter's birthdays then my son's birthday. I had a good birth with my son. And it was good not because it was a VBAC, but because I was respected and I felt safe. That's what made that a good birth. Right? Just to be totally clear. I'm really glad I had a VBAC, I'm happy I got what

“Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention.”Paige Boran is a certified nurse-midwife from Fort Collins, Colorado. She and her colleague, Jess, practice independently at A Woman's Place. They have rights to deliver babies at the hospital but are not employed through the hospital system so they are not subject to physician oversight. Their patients benefit from a low-intervention environment within a hospital setting but without the restriction of hospital policies.Lily Wyn, our Content Creator and Social Media Admin, joins us today as well! Lily shares why she chose Paige to support her through her current VBAC pregnancy. Lily is a beautiful example of how to diligently interview providers, keep an open mind, process past fears with the provider you choose, and what developing a relationship looks like to create an empowering birthing experience. Paige shows us just how valuable midwifery care can be, especially when going for a VBAC. If you're looking for a truly VBAC-supportive provider, this is a great episode on how to do it! The VBAC Link's VBAC Supportive Provider ListA Woman's PlaceHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Paige: Yeah, so I'm a certified nurse-midwife. I work in northern Colorado in Fort Collins at A Woman's Place. We're a small midwifery-owned practice. Right now, there are just two CNMs. That's the whole practice. It's just me and my colleague, Jess, who owns it which is really cool because we get to push the boundaries because we are not really locked into the hospital system. We are able to catch babies there but we are not actually employed through the bigger hospital systems which is nice because we don't have that physician oversight and stuff like that. I think we are able to do a lot more and honor that midwifery care model which is really cool. Sometimes people feel locked into policies and their overseeing physician and things like that but when it's just two midwives, we get to do what we want and what feels best for the patient. I really like that. That was a big thing when I first got into the certified nurse midwifery world. I was like, where do I want to work? I had offers from bigger hospital systems and it just didn't feel like the right fit so working at a small, privately-owned practice felt like the right answer for me so I was able to practice in a way I felt was right for people. I didn't want to be locked in by a policy and overseeing physicians. I just wanted to grow with other midwives. Meagan: Yes. I love that so much. I don't know. Maybe I should say I know it feels to me– I don't know it as an actual fact, but that feels like a unique situation and a unique setup to me. We don't really have that that I know of here in Utah. We either have out-of-hospital CPMs or we have in-hospital CNMs who are just hospital. I know that one hospital system is trying to do the attached birth center, but it is still very different. They are still the hospital umbrella midwives I guess I could say. So is that unique or is that just something that feels like it?Paige: I think it's unique because where I came from in Florida, if you were a CNM, you 100% practiced in the hospital which we do but it was that you were owned by a larger group of physicians essentially. Florida was working towards independent practice when I was there. Colorado is an independent-practiced state for nurse practitioners which is really cool because we don't have to have that oversight. I don't know if Florida ever got there but I know it varies state to state on if you have to be overseen by a physician or not. Honestly, that's why a lot of people when they are ready to become a midwife, if they don't have independent practice rights as a CNM even if they are a nurse, they will go for a CPM which is a certified professional midwife because they actually have more autonomy to do what they want outside of the hospital because they are not bound by all of the laws and stipulations which is interesting. Meagan: Exactly. I think that's a big thing– the CPM/CNM thing when people are looking for midwives. Do you have any suggestions about CPM versus CNM? If a VBAC mom is looking at a CPM, is that a safe and reasonable option?Paige: Absolutely. Yes. I think CPMs and CNMs are both reasonable, safe options. They both have training in that. They both can honor your holistic journey. I would say the biggest thing is who you feel most connected to because I think trusting your team, you will have people who have the worst birthing outcome and horrible stories but they are like, “I look back and I feel so good about it because I trusted my team.” I think that is what's important. If a CPM seems like your person and that's who you are going to trust, then that's who you should go for whereas a CNM, if that seems like that's your person and who you trust, I think that would be a good route too. I think a lot of people think, “Oh, they do home births. They must catch babies in a barn and there is no regulation. Even sometimes when I say, “midwife,” people are like, “What? Do you dress like a nun and catch babies in a barn?”Meagan: Yes, this is real though. These are real thoughts. If you are listening, and not to make fun of you if you think this, this is a real thing. This is a myth surrounding midwifery care, especially out-of-hospital midwives where a lot of people think a lot of different things. Paige: Absolutely. Meagan: I think I had a chicken chaser or something where a dad was like, “Do you chase chickens?” I was like, “What?” He said, “Well, that's what the midwives do so that's what the doulas do.” I'm like, “What? No, we don't chase chickens.” Paige: That is such old-school thinking but realistically, midwives started in the home and that was their history. It's cool that they've been able to step into the hospital and bring some of that back into the hospital because I think that is needed. Meagan: It is needed, yeah. Paige: We are starting to see that physicians are starting to be a little bit more holistic and see things in the whole picture, but I'm glad that the midwives did step into the hospital because I think that needed to be there but I'm so glad that people are still doing it at home because I think that is such a good option for people. Meagan: Yeah, so talking abou the midwives in the hospital, a lot of people are talking about how they are overseen by OBs. Is this common? Does this happen where you are at? You kind of said you are separated but do the hospital midwives in your area or in most areas, are they always overseen by OBs? Paige: Not necessarily. It would vary state to state and hospital to hospital. We actually just got privileges and admitting privileges a couple of years ago. Actually, my boss, Jess, who owns the practice where I work, had worked in Denver where they were allowed to admit their patients and everything. They didn't have to have any physician oversight but when she was there, she had to have physician oversight. She was like, “It's an hour drive north, why would that make a difference?” It was the same hospital system so she fought when she bought the practice and the physician who owned it prior left, she was alone and she had to have that physician oversight so she fought for independent practice privileges and she got it. Some of the midwives at first weren't so happy about it because they had liked being overseen by the doctor and someone signing off on all of their things. Some of the midwives were like, “Finally. We should be able to practice independently.” It's going to vary at each place. But I think that's a good thing to ask, “If something is going wrong, will a physician just come unannounced into my room in the hospital?” That's not the case with ours. We have to invite them in and if we are inviting them in, we've probably had a conversation multiple times with the patient where it's like, we need to have this. Meagan: Yeah. For the patients who do have the oversight of the OBs, do you have any suggestions? I feel like sometimes, at least here in Utah with my own doula clients when we have that situation, it can get a little confusing and hard when we've got an OB over here saying one thing but then we've got a midwife saying another. For instance with a VBAC candidate, “Oh, you really have a lower chance of having a VBAC. I'll support it. I'll sign off, but you have a really low chance,” but then the midwife is like, “Don't worry about that. You actually have a great chance. It is totally possible.” It gets confusing. Paige: Yeah, and it's like, who do you trust in that scenario? I think that's where evidence comes in because I think midwives and physicians both practice evidence-based but some people may have newer evidence than others. I've worked with OBs who probably roll over in their grave when I say certain things because it wasn't the old way but it is the new way. If somebody can come in with their own evidence and they're like, “I've looked into this and I think I'm a good candidate for x, y, and z,” I think physicians respond well to that because they are like, “Okay, they've done their research. Maybe I need to do some research.” Meagan: Yeah. Paige: When they have that thought, they know that this is an educated person and I can't just say whatever I want and they're going to take my word as the Holy Bible. Meagan: Yeah. No, really. Exactly. It always comes down to education and the more information we can have in our toolbelt or in our toolbox or whatever it may be, it's powerful so I love that you point that out. I think it's also important to note that if you do have two providers saying different things, that it's okay to ask for that evidence. “Hey, you had mentioned this. Can you tell me where you got that from or why you are saying that?” Then you can discuss that with your other provider. Paige: Yeah, and following intuition too. I think you can have all of the evidence in the world. What is your gut telling you too? Who do you trust more and what feels right in your body in the moment? I think we are all experts of our own bodies and there's a lot that goes into a VBAC and stuff like that. It's more than just the evidence. People have to feel mentally and physically ready for it too. I wish more people focused sometimes on the mental and spiritual aspect of it because I think a lot of people get ready physically but maybe mentally they weren't prepared for the emotional switch there. Meagan: Totally. Thinking about that, Paige, I mean Lily, tell us a little bit about why you went the midwifery route. I know you really wanted to find the right provider. Lily: Yeah. So I think for me, I have always been drawn to midwifery care. I was a little bit of a birth nerd prior to even working for The VBAC Link or even having my own kiddos. Prior to my son, we had a miscarriage and an ectopic pregnancy so I experienced OB care with my ectopic. I was bounced around a lot in a practice and had OBs who were great and equally some OBs where it was such a rushed visit that I had an OB miss an infection in my incisions because my pain was dismissed and just some really tough stuff. When it came to getting our rainbow rainbow baby, I was like, I really don't want to be in a hospital at all. I want midwives. That's the route that we went. The very brief story of my son is that he flipped breech 44 hours into labor and that's when we legally had to transfer to the hospital and I had my Cesarean. So in planning my VBAC, I planned to go back to the birth center and was a little devastated when it was out of our financial means this time. I was so panicked. I remember texting you, Meagan, and being like, “What do I do? I can't be at the birth center anymore and I don't want to be in a hospital.” We interviewed another birth center that's about an hour away that is in network with our insurance and talk about trusting your gut, it just didn't feel right. It didn't feel warm and fuzzy. Those are the feelings I got with our first birth center. I loved them so much and I still do. Then I met with Paige and her practice partner, Jess, and I came in loaded to the teeth. I was prepared to fight with someone because that's what I had in my brain and that's what I expected. I sat down with them. They met me after hours after clinic. I sat down with my three pages of questions and by the way, if you are listening and you have questions, we have a great blog on it and some social media posts of the questions that I specifically used. We talked for over an hour and every question I asked, they just had the ultimate answer to. I felt so at peace after talking with both of them and I remember telling my husband going into it, “I'm really worried that I'm going to like these people because I don't want to deliver at a hospital and then I'm going to have to choose a far away birth center that is out-of-hospital or providers that I like but it's a hospital.” It just feels like everything has been serendipitous for us. Our hospital opened a low-intervention portion of their birth floor so I'll still get to have the birth tub and all of the things, but truly have just been blow away by Paige and have just buddied up. She's dealt with all of my anxiety in pregnancy and VBAC and all of my questions. It just feels like such holistic care compared to my experience with OBs in the past. Meagan: That is so amazing and I was actually going to ask how has your care been during this pregnancy? It sounds like it's just been absolutely incredible and exactly what you needed. I remember you texting me and feeling that, oh crap. I don't know what to do. What do I do? You know? I just think it's so great that you have found Paige. Did you say that Jess is your partner? Paige: Yes. Meagan: Jess, yeah. I'm so glad that you found them because it really does sound like you are exactly where you need to be. Lily: Yeah. It made a huge difference for me and I just tell Paige all the time I truly didn't know that care in a hospital setting could look the way that it does. I feel like I'm getting– I experienced birth center care. I had an out-of-hospital experience until we transferred and I can say with confidence that my care has been the same if not better with Paige and just having the conversations and the good stuff and feeling really safe and confident. One thing that they pointed out that I thought was great when I went in and asked all of my questions is that Jess looked at me and she was like, “Okay, it sounds like you have a lot of anxiety around hospital transfer.” And I did. With my son, that was my worst fear and it came true. I had a lot of anxious, what if I have to transfer? She was like, “The thing is there is no transferring. We can induce you if you need to be induced and we can come with you into the OR with your Cesarean if that ever happened to be another thing.” For me, that brought a lot of peace to know that no matter what, the provider that I know and feel comfortable with is going to be with me. I again, didn't expect to feel that way, but it's been a really great reassurance for me personally. Meagan: Yeah. It's the same with a doula. Knowing that there's someone in your corner that you know who you've established care with who can follow you to your birth with you in your journey is just so comforting. So Paige, I wanted to talk about midwifery care and also just lowering the chance of Cesarean. Sometimes people do choose midwifery care specifically because they are like, “I think I have a lower chance of a Cesarean if I go the midwifery route.” Can we talk to that a little bit?Paige: Yes, that's true. A lot of people know that there are benefits to midwives but I think when people think of midwives, it's just like, “Oh, it's just a better experience. I trust my team more.” That's definitely there. There have been studies and people felt more at peace and empowered through their birthing journeys with midwives than they did with OBs. It's been studied but there is also a decrease in C-section risk. Your C-section risk drops 30-40% when you have a midwife which I think is a pretty significant drop. Meagan: Yeah. Paige: Yeah, especially when we look at the United States at our birthing outcomes and birthing mortality and C-section rates, it is way too high for as developed of a country as we are. I think that's really where midwifery care is stepping in and starting to help lower those rates to get it down to where it should be. The World Health Organization has been nominating and promoting midwifery care because it really is the answer to how we get these C-section rates lowered and these bad outcomes lowered. Midwives also have lower chance of an operative vaginal birth. That would be with forceps or a vacuum or an episiotomy so lower chances of those things as well. Lower chance of preterm birth which is interesting and probably because one, we do take lower-risk people. I think that's true but also because we are looking at it holistically. We are looking at everything. We are not just looking at you as a sick person. A lot of people look at pregnancy as an illness and pregnancy is not an illness. It's just a natural part of life and we've got to look at the whole picture of life if we're just going to look at the one thing too. I think that helps to reduce preterm birth risk. We also have lower interventions just overall. We're more in tune with people's bodies and we want to honor what their bodies are meant to do. Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention. The midwifery model is so important. I think when you go to the traditional medical model, you look at the present illness so they see pregnancy as an illness. What can go wrong? Don't get me wrong. There are a sleu of things that can go wrong in pregnancy and you do have to watch for them. But I think with midwifery care, you know when to use your hands but you also know when to sit on them. Meagan: Yes. Oh my gosh. I love that so much. I feel like we need– we used to get quotes from our podcast episodes and turn them into t-shirts and I feel like that is a t-shirt podcast quote-worthy. Oh my gosh. It's a worthy quote. That is amazing and it's so true though. Paige: It is. Meagan: It's not to rag on OBs. You guys, OBs are amazing. They are wonderful. They do an amazing job. We love the. But there is something different with midwifery care. You mentioned preterm birth. I remember when I was going through my interview process to have my VBAC after two C-section baby and I finally established care mid-pregnancy because I switched. That was one of the things in the very beginning that my midwife was like, “Let's talk about things. Let's talk about nutrition. Let's talk about supplements. Let's talk about where you are at.” It was just honing in on that which I was surprised by because I figured she'd be like, “Let's talk about your history. Let's talk about this,” but it was like, “No. Let's talk about what we can do to make sure you have the healthiest pregnancy,” but also started commentingo n mental stuff. It helped me get healthy in my mind. I just would never have had that experience with OB where they wanted to learn what I was scared about and what I was feeling and all of those things. Not only was I learning how to nourish myself physically, but mentally and it was just a really big deal. I do feel like it played a big impact in my labor. Paige: Yeah. A lot of people discredit how much nutrition and debunking fears and stuff like that can go because I think a lot of that– I mean, we look at nutrition-wise and we could avoid almost all of preeclampsia with nutrition alone which is incredible. I'm like, “I really think you should read Real Food for Pregnancy and people are like, “Oh, but it's such a big book,” and I'm like, “But it's so important to know this information about what we should be putting in our bodies.” 100 grams of protein– you've already got it. Meagan: I want to see how many pages for it. It's got, okay. We've got 300 pages but it has recipes and all of these amazing things in the end so it's not even a full book. Paige: Yes. People are like, “Oh man, I don't know if I want to read the whole thing,” but I'm like, “It's so important.” I think when people do read it, they come back and are like, “Did you know that I could decrease my risk of this if I ate more Vitamin A?” I'm like, “Yes. That's why I wanted you to read this book.” It is a wealth of information and I have such healthier pregnancy outcomes when people follow that high protein diet and looking at micronutrients with their Vitamin A, their choline, and all sorts of things. Meagan: Yeah. All of the things that we talk about a lot here on the podcast because we are partnered with Needed and we love them so much because we talk about the choline and the Vitamin A and the Vitamin B's and the Vitamin D's. Lily Nichols, not this Lily on the podcast today, she also wrote Real Food for Gestational Diabetes and that's another really powerful book as well. But yeah. It's just hard because OBs don't tend to have the time. I think some OBs would actually love the time to sit down and dig deep into this but they don't have the time either. I do think that's a big difference between OBs and midwives. What does your standard prenatal look like? When a mom comes in, a patient comes in, what do you guys do through a visit? Paige: Yeah. We follow the standard what everywhere in America does like once a month roughly in the first trimester and second trimester then when you hit 28 weeks, every 2 weeks, and then when you hit 36 weeks, every week. If you go to 41, we'll see you twice in that week. We follow those stipulations but our appointments are a little bit longer. When you are in a big practice, a lot of time it's driven by RVU use so the more patients somebody can see, the more they are going to get paid and the bigger their bonus is at the end of year. A lot of people feel like they are running through the cattle herd and they've been in and out in 15 minutes if that. At my practice, it's a little bit different because we are not RVU based. We're not getting any bonus. We're not trying to see as many patients as we can. Will we ever be the richest at what we do? No, but that's okay with me and Jess. We are small on purpose and we love to take the time. At Lily's appointments, we always book her for at least 30 minutes because we know that me and her like to talk. We've done an hour for some people because we know there is always going to be that long conversation. Don't get me wrong though, that fourth mom whose had three vaginal births and going for her fourth, she may be like, “Paige, there's really nothing to talk about today and that's okay.” Sometimes they are 15 minutes. Sometimes they are 30. Sometimes they are an hour. Our first appointment is always an hour because there is just so much to dive into with how we can be preparing ourselves, what does your history look like especially if they are brand new to our practice and we've never met them before, starting to build that relationship early on. It just depends on how far along they are, who the person is, and those things. But I do like that I can spend as much time as I need. Sometimes I tell my people, “Bring a book because I tend to get behind because I tend to talk to people longer than I book for,” but that's okay. We know that we can do that because we are a smaller practice. I think when people are thinking about what kind of care they want, they should probably consider how are these people paid? Is it by how many they can see in a day? Because you're probably going to get a different level of care than a practice that isn't drive by those RVUs. Yeah, that's a really good point. I feel like my shortest visit with my midwife was 20 minutes. Paige: Yeah. Lily: Yeah. Meagan: Which to me is pretty dang long because when I was going with my other two daughters, I think it was probably 6-7 minutes if that with my provider. I mean, it was get in. My nurse would check my fundal height and all of that and then oh, the doctor will be in here. Then came in, quick out. Yeah. It is really, really different. Lily: I know for me too, I love that we don't just talk about nutrition and things like that but even in my last appointment, I was talking with Paige about the things that can be triggering coming back into labor and going back into a hospital so my ectopic pregnancy was at the hospital that I'll be delivering at and I had to go into the emergency room and the way that you go to labor and delivery after hours is through the ER so Paige and I were talking. She was like, “I can just meet you outside. We will badge you in and we will avoid the emergency room if that feels triggering.” It's just those things that you don't get with an OB necessarily to talk through tiny little triggers. They are probably generally less accommodating to those little things of, “Well that's just the standard. You're going to have to get over that and just go through the ED and come on up.” I think that's been huge. I also have a dear friend who is going to school to be an OB. I told Paige at my last appointment that she may possibly be at my birth. She's my crunchy friend so she'll be a great OB but I have such a desire to be like, “Come see a VBAC. Come see it so that you have it in your brain and you know that they can be safe and look at what can be done,” so I think that is so huge too as we continue to train and uplift our next generation of providers. What does that look like to show them? I think her internship or something is going to be a midwife and OB partnership practice which is really cool but I'm like, “Yes. Come. Come to my birth. Please. I want you to see all the things.” That's really cool too and that Paige is open to, “My friend might be there.” Meagan: Yeah. Paige: Bring whoever. Meagan: I love that. I love that you were pointing out too this next generation of providers. Let's see that birth and VBAC is actually very normal and very possible because there's a lot of people who have maybe seen trauma or an unfortunate situation which could have happened because we blasted them with interventions or could have happened out of a fluke thing. You don't know all of the time. But I do think if we can keep trying to get these providers, these new provider to see a different light, we will also see that Cesarean rate drop a little bit. We really, I always tell people that we have a problem. They're like, “It's really not that big of a deal.” I'm like, “No, it's a very big deal. It's a very, very big deal. We have a problem in this medical world.” I do believe that it needs to change and midwifery care is definitely going to impact that. I hope that what you were saying in the beginning how policies don't trump a lot of the midwives. I wanted to ask you. This isn't something we talked about, but is it possible to ask your midwife, “Hey, what policies do you lie under?” Is that appropriate? Paige: Yes. Actually, that was one of my favorite things when Lily came in to meet and greet us. She came and she was like, “What are the policies for a VBAC?” We dove into that. We've been diving into that and what are we going to be okay with and what are we not going to be okay with? That's the beauty is that I'm not employed by the larger hospital system that I work under so I feel like a policy is not a law. I feel like there is informed consent and I think informed consent is so important but at the same time, there is informed declination and you should be able to decline anything. That's true. We can never force anybody into surgery. We can never force anybody into anything. I think a lot of people aren't having those conversations where it's actually informed so then people are like, “Oh, they are just refusing everything.” I hate the word refuse because no, they are not refusing it. They are declining it because they are informed. They know the risk. They have all the information at their fingertips and they know that this is the best decision for them and their baby and we have to honor that. That's why I'm really glad that I'm able to practice in that way, but I do know I've met and I've worked with people who feel like they are boxed in and have to follow those policies. We've started to talk about what our policies are with TOLACs and VBACs and things like that. One of them is that they are supposed to have two IVs. I've already gone against that before and I've had a beautiful, unmedicated VBAC. She walked in. I said, “We've talked about it. She was also laboring outside when we talked about it. It's not an issue when you come in. You know what? When we get up there, I'm just going to tell them that you know why they recommend two IVs and you are declining.” She walks in and she's clearly going to have this baby within the hour. I told the nurse, “We're not doing the IVs. We've talked about it. We're going to decline them.” That was the end of the discussion. We didn't have to talk about it again which was nice. She shouldn't have had to advocate in that moment for herself. We've already had those conversations. Meagan: Yes. Paige: Another one is continuous monitoring and the whole idea is if you start to rupture, that's how we are going to catch it. The baby is going to tank and that's how we are going to save the baby's life. Don't get me wrong. I think continuous monitoring can be really valuable for a lot of things but it's actually not evidence-based. We have not improved neonatal outcomes with continuous fetal monitoring. We've talked about that with Lily and she's going to opt for intermittent oscillation and I think that's very appropriate because she plans to go unmedicated. Let's be honest, if you are unmedicated and your uterus starts to rupture, moms will tell me that something is not right. This is beyond labor. Her saying that and being aware of that, we would notice it a lot sooner than we would the baby tanking kind of thing. Meagan: Yeah. I do know that with uterine rupture, we can have decelerations but like you were saying, there's usually so many other signs before baby is actually even struggling and I know a couple of uterine rupture stories where providers didn't believe the mom that something was going on because that one thing wasn't happening. The baby wasn't struggling. Paige: Yes. Meagan: It's like, you guys! When it comes to continuous fetal monitoring in the hospital, people have to fight to have that intermittent. It's yeah. Anyway. These policies are not law. I love that you said that too. There's another t-shirt quote. Paige: I think people should start asking if they are planning a VBAC, start asking what is the policy and start thinking, is that what they want? I do have some moms who are like, “No, I want the two IVs because it's hard for me to get a stick,” and they need that backup in case. That makes them feel more at peace but other people are like, “It makes me feel like a patient. I don't like it.” People don't like needles and that's okay. They have that right to say no. I tell people that in a true emergency, we will get an IV in you if something really, really bad were to be happening. That's part of training if somebody walks in off the street. We're not going to be like, “Oh, when was the last time you ate? Sorry, you can't have the surgery.” We know something bad is happening right now. We will get the IVs. We will do all of the things. Getting the IVs really won't save as much time as people think it will. Meagan: Yeah, and there are other things. Say we are having our baby and we are having higher blood loss than we would like or we have some concern of some hemorrhaging, there are other things that we can do. We can put Pitocin in a leg. We can do Cytotec rectally. There are things that we can do. We can get that baby to our breast and start stimulating and try to help that way. There are things that we can do while we are waiting for an IV, right? Paige: Yes. I tell people that all the time. Most of the postpartum hemorrhage meds that we use can be given without an IV. There is only one that truly has to be given through an IV and that's TXA but the rest can all be given other routes. A lot of times, those work better than IV Pitocin. Sometimes the ion Pitocin works better. Sometimes the ion Methergine works better. It's not this, oh we have to have a little just in case kind of thing because if there was a just in case moment, yes. We can be working on the IV and doing other things. I have to be kind of secretive about it. I have tinctures and stuff with shepherd's purse and yarrow. Those things actually have great evidence. They are really helpful for postpartum blood loss. I have a lot of moms who are more interested in doing something more holistic and natural before they try medication. Cypress essential oil, you can rub that in. I'll have doulas use my cypress roller and give them a massage while I'm trying to manage the hemorrhage and that cypress oil can help a lot too. Sometimes going back to our instinctual, old medicine that we have been using well before medicine was used for birth. Meagan: Yeah. This is a random question for both of you. Lil, I really wonder if you have seen it or heard about this too because you are so heavily in our DMs. This is going to be weird. People are going to be like, what? But I did this. We did this because we weren't sure. We cut the umbilical cord and put it in our mouth. It's really weird. Paige is like, what? You put it down in the gum area like in between your teeth and your cheek. It sits there. Okay, you guys. I've seen it just a couple of times, myself included. Yes, I put my umbilical cord in my mouth. Yes, it's weird. Paige: That's okay. Meagan: It felt like a little gummy. It was fine. I wasn't chewing on it. It was just sitting there. But anyway, it's weird but with my other client too we did it and all of her hemorrhaging symptoms just went away. Paige: That's cool. Meagan: I know this is really random but we just cut a little piece of our umbilical cord and put it in their mouth. Paige: That's so interesting. So a piece of the umbilical cord or the entire thing once it's clamped and cut and still attached? Meagan: They clamped and cut it, cut a piece, and put it in my mouth. Paige: I would be so willing to try that. I mean, what is there in that nun? Meagan: I don't know. I don't know, but it did diminish the hemorrhaging symptoms. Paige: Cool. Meagan: So very interesting, right? Okay, so are midwives restricted when it comes to VBAC on what they can accept? Lily, you are a VBAC. I was a VBAC after two C-sections. You can obviously take Lily. Could you accept me?Paige: Yes. Luckily in midwifery care, at least in Colorado, there is a lot of gray for certified nurse midwives. It's not always black and white. VBACs are okay but there is no direct, “Oh, if you have this many C-sections, we can't do it.” I think that's because ACOG also strangely doesn't have an opinion on that. They actually agree. There is limited evidence beyond one C-section. My practice has done several VBACs after two Cesareans. I don't think we've ever done one for a third or greater than two probably because I think those people a lot of times don't even consider VBAC and they just already have been seeing their doctor for their repeat C-section with each pregnancy. But I'd love to see more people going for a VBAC after multiple Cesareans because I think VBACs after two Cesareans have a whole different level of feeling empowered after that. I thin that's really cool and even special scars and stuff, there is really limited evidence on all of these things and I'd like to see more people pushing the limits a little bit. Especially since I am in a hospital, I do have an OB hospitalist on call 24/7 at the disposal of my fingertips if I need them. We are close to an OR so I think if for somebody the fear is there and they are like, “I just don't know if it's more risky because of this,” I think it's worth it to try because the more people who go for it and are successful, the better evidence we're going to get from it. Meagan: Yeah. That is exactly what I am thinking. There's not a lot of evidence after two Cesareans because it's just not happening. It hasn't really been studied and a lot of that is because people aren't even given the option. Paige: Yeah. I'll have people where it is their third or fourth C-section and they were never even given that option. They were told, “Oh, I was told I have CPD.” I'm like, “The chances of you actually having CPD are low.” Then you look at their records and it was fetal distress or something like that. Yeah. CPD is so rare. I've heard it so many times. “Baby is never going to come out of that pelvis ever.” That breaks my heart every time I hear it because there are times when I'm like, I don't know and then an 8-pound baby comes out. We can't go off of those things because the body does what it's supposed to in those moments. Don't get me wrong. Things do go wrong and C-sections do happen sometimes but yeah. To hear everybody has CPD just because they've had three C-sections, I'm like, I don't know. That would be quite a few people. Way more than we know are true. Meagan: Yeah. We're all walking around with tiny pelvises. That's just what everyone thinks anyway.Lily, being in our DMs, hearing the podcast, understanding and seeing so many of these people and what they say, do you have any advice for them when they are looking for their provider or just any advice in general? Do you have any advice from a VBAC-prepping mom? Lily: Yeah, I think for me, it is to go into it open-handed. I think we hear so many horror stories about providers often and I think that's why I went into looking for a provider with both fists up ready to fight and what has surprised me the most is just I think I said earlier that I didn't know hospital care could look like this. I remember we even posted something and I had posted on The VBAC Link that a hospital birth can be equally as beautiful as an out-of-hospital birth and there were people arguing and people saying, “No, absolutely that's not possible. That's not a thing.” Gosh, how discouraging if we go into things thinking that we can't have beautiful outcomes in different settings. Certainly, there are areas around our country that need improvement. There's not a low-intervention floor at every hospital and there are not midwives who are doing what Paige is doing everywhere but I think the more that we seek out that care and look for that care and advocate for that care, the more we will see it. As much as it sucks that we have to be our advocates, it's also a really cool opportunity that we pave the way for VBAC moms and the moms who have never had a C-section that we are paving the way for care that doesn't end up in a Cesarean. I would just say to be open-handed and yes. You can be prepared to fight and you can be prepared with your statistics. Be prepared to ask the why behind questions, but ultimately, I think that care can be so much more than we expected if we go into it thinking, Gosh, well what can I get out of this and how can I make these things happen? Like Paige said, we've had lots of conversations around, Well, this is the policy, but the policy is not the law. I'm here to support you in that. At our last appointment, she was like, “Hey, make sure you bring your doula to your appointment where we are going to talk about your birth plan because I want to make sure that she is there, that we all hear each other, that we are on the same page.” I think that's helpful too. And then having a doula. My doula was my doula with my C-section. She was with us. She was whoever was on call at the birth center actually and again, I think it was so serendipitous because she is a VBAC mom. I think I needed her then and I'm so stoked to have her now that she is just a really special human who I know is also always in my corner and constantly texting her like, “Oh my gosh, look at the new birth rooms. Oh my gosh, I had this great conversation. Oh my gosh, I'm so excited.” I think having your doula there to be your partner in advocacy is really helpful too. Meagan: Yes. Okay, that's a good question too when it comes to doulas and midwives. Sometimes I think people think that if I'm hiring a midwife, I don't need a doula and then we of course know that a lot of people just mistake doulas and midwives together. But Paige, how do you feel about doula care and working with doula care? Is it necessary? How do you work together as doula and midwife?Paige: Yes. I love doulas. I wish everybody had access to a doula truly because doulas, just like midwives, have been studied and they have better birth outcomes, more empowered births, and all of the things. Doulas are so important and doulas and midwives work really closely. I think a doula is there with that constant presence, that constant helping with anything and a really good advocate which I think is important especially if you don't have a good relationship with your provider maybe or you don't know who you're going to get. Maybe you see 7 different providers and you get who you're going to get when you're in labor. So to have that doula there to constantly be advocating for you is such an important piece. Yeah, I really wish everybody could have access to a doula because it just makes a world of difference. I can't think of any bad outcomes I've ever had when a doula was present. It's just a different level of care. Usually, people who have sought out a doula have also taken the time to seek out and do all of the things that are going to make a healthier pregnancy and a better birthing outcome. It's why I think everybody deserves doula care. It's because it does lead to better outcomes. Midwives are always known to work closely with doulas and really support them. It's a team effort. Meagan: Yeah. Yeah. We love our relationships with our midwives here. It's really great to just know how we work and know how we need to support the client and it is sometimes hard when we go to a hospital and we don't know who we are getting. And sometimes that OB or that midwife we have worked with before and sometimes it's a whole new face so it does bring us comfort to know that the client and the family know us and we know them and we can all work together. I love that. Okay, do either of you guys have anything else that you would like to say to our beautiful VBAC community before we go? Paige: I don't think so. Yeah, thank you so much for having me. This was wonderful and I just hope that everybody who is thinking about a VBAC really does their research and looks for the best provider and really finds that perfect fit because there are so many good providers out there– OBs, midwives, professional midwives, all the things. Meagan: I agree. It's okay to interview multiple people. It's also okay that if mid-pregnancy, the end of pregnancy, during, and even in labor that if something is not feeling right, you can request a different provider. You can go out and start interviewing again and find that provider that is right for you. Paige: Yes. Meagan: Well, thank you Paige and Lily for joining us today, and thank you so much for doing so much in your community. I really love your setup and hope that we can see that type of setup happening in the US because it just feels perfect in a lot of ways. Yeah. Yes. I'm loving it. Okay, ladies. Well, thank you so much. Paige: Thank you. Lily: Yeah, thanks, Meagan. Meagan: Bye. Lily: 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

Happy National Midwifery Week!We are so thankful for and in awe of all midwives do. Great midwives can literally make all the difference. Statistical evidence shows that they can help you have both better birth experiences and outcomes.Meagan and Julie break down the different types of midwives including CNMs, CPM, DEMs, and LPM as well as the settings in which you can find them. They talk about the pros and cons of choosing midwifery care within a hospital or outside of a hospital either at home or in a birth center. We encourage you to interview all types of providers in all types of settings. You may be surprised where your intuition leads you and where you feel is the safest place for you to rock your birth!Midwifery-led Care in Low- and Middle-Income CountriesEvidence-Based Birth Article: The Evidence on MidwivesArticle: Planning a VBAC with Midwifery Care in AustraliaThe VBAC Link Supportive Provider ListNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hey, hey, hey. You guys, we're talking about midwives today, and when I say we, I mean me and Julie. I have Julie on with us today. Hello, my darling. Julie: Hello! You know, sometimes you've just got to unmute yourself. Meagan: Her headphones were muted, you guys. Julie: Yeah. That's amazing. Meagan: I'm like, “I can't hear you.” You guys, guess what? This is our first month at The VBAC Link where I'm bringing a special subject. Every month we are going to have a week and it's usually going to be the second week of the month where we are going to have a specific topic for those episodes of the week and this is the very first one. It is National Midwives' Week so I thought it would be really fun this week to talk about midwives. We love midwives. We love them. We love them and we are so grateful for them. We want to talk more about the impact that they leave when it comes to our overall experience. Julie: Yes. Meagan: The overall outcomes and honestly, just how flipping amazing they are. We want to talk more and then we'll share of course a story with a midwifery birth. Okay, Julie. You have a review. I'm sticking it to her today to read the review because sometimes I feel like it's nice to switch it up. Julie: Yeah. Let's switch it up. All right, this review– I'm assuming “VBAC Encouragement” is the title of the review.” Meagan: Yes. Julie: “VBAC Encouragement”. It says, “My first birth ended in an emergency Cesarean at 29 weeks and I knew as I was being rolled into the OR that I would go for a VBAC with my next baby. Not long after, The VBAC Link started and I was instantly obsessed.” I love to hear that. “I love the wide range of VBAC and CBAC stories. Listening to the women share honestly and openly was motivating and encouraging. As a doula, this podcast is something that I recommend to my VBAC clients. I'm so thankful for the brave women sharing the good, bad, and ugly of their stories and I'm thankful for Meagan and Julie for holding space for us all.” Aww, I love that. Meagan: I do too. I love the title, “VBAC Encouragement.” That is what this podcast is here for– to encourage you along the way no matter what you choose but to bring that encouragement, that empowerment, and the information from women all over the world literally. All over the world because you guys, we are not alone. I know that sometimes we can feel alone. I feel like sometimes VBAC journeys can feel isolating and it sucks. We don't want you to feel that way so that's why we started the podcast. That's why I'm here. That's why Julie comes on because she misses you and loves you all so much too and we want you to feel that encouragement. Meagan: Okay, you guys. We are talking about midwives. If you have never been cared for by a midwife, I think this is a really great episode to learn more about that and see if midwifery care is something that may apply to you or be something that is desired by you. I know that when I was going along with my VBAC journey, I didn't interview a midwife actually at first. I interviewed OB after OB after OB. Julie did interview a midwife and it didn't go over very well. Julie: No, it was fine. It just didn't feel right at that time. Meagan: What she said didn't make it feel right. What I want to talk about too and the reason why I point that out is because go check out the midwives in your area. Check them out. Go check them out. Really, interview them. Meet with them but guess what? It's okay if it doesn't feel right. It's okay if everyone is like, “Go, go, go. You have to have a midwife. OB no. OB no.” That's not how we are in this podcast. We are like, “Find the right provider for you.” But I do think that midwives are amazing and I do think they bring a different feel and different experience to a birth but even then sometimes you can go and interview a midwife and they're not the right fit. We're going to talk about the types of midwives. This isn't really a type. We're going to be talking about CPM, DEM, and LPM. Julie: In-hospital and out-of-hospital midwives, yeah. Meagan: Yeah, but I also want to talk about the word “medwives”. We have said this in the past where we say, “Oh, that midwife is a ‘medwife'” and what we mean by that is just that they may be more medically-minded. Every midwife is different and every view is different. Like Julie was saying, in-hospital, out-of-hospital, you may have more of a ‘medwife' out of the hospital, but guess what? I've also seen some out-of-hospital midwives who act more like, ‘medwives', really truly. Again, it goes back to finding the right person for you. But can we talk about that? The CPM or DEM? CPM is a certified professional midwife or direct entry midwife, right? Am I correct?Julie: Right. It's really interesting because all over the world, the requirements for midwifery are different. You're going to find different requirements in each country than in the United States, every state has its different requirements and laws surrounding midwifery care. In some states, out-of-hospital midwives cannot attend VBAC at all or they can as long as it's in a birth center. Or sometimes CNM– is a certified nurse midwife which is the credential that you have to have if you are going to work in a hospital but there are some CNMs who do out-of-hospital births as well. There is CPM which is a certified professional midwife which a lot of the midwives are out-of-hospital. That means they have taken the NARM exam which is the national association of registered midwives so they are registered with a national association.Meagan: Northern American Registry of Midwives. Julie: Oh yes. They have completed hundreds of births, lots and lots of hours, gone through the entire certification process and that's a certified midwife. Now, a licensed midwife which is a LDEM, a licensed direct-entry midwife just simply means that they hold licensure with the state. Licencsed midwife and certified midwife is different. Certified means they are certified with the board. Licensed means they are licensed with the state and usually licensed midwives can carry things like Pitocin, Methergine, antibiotics for GBS and things like that which is what the difference is. Licensed means they can have access to these different drugs for care. Meagan: Like Pitocin, and certain things through the IV, medications for hemorrhage, antibiotics, yes. Julie: Right, then CPMs who are certified, yeah. There are arguments for both. And DEM, direct entry midwife means that they are not certified or licensed. That doesn't mean that they are less than, it just means that they are not bound by the rules of NARM or the state. Now, there are again arguments for and against all of these different types. I mean, there are pros and cons to holding certification, holding licensure, and not holding certification and not holding licensure. Each midwife has to decide which route is best for them. Certified nurse-midwife obviously has access to all of the drugs and all of the things. They are certified and licensed. You could call it that but they have to have hospital privileges if they want to deliver in the hospital. You can't just be a CNM and show up to any hospital to deliver with them. They have to have privileges at that hospital. They have to work and be associated with a hospital just like an OB. An OB has to have privileges at any hospital. They can't just walk into any old hospital and deliver a baby. Meagan: Right. I think it's important to know the differences between the providers who you are looking at. Like she was saying, with a CNM, you are more likely to have that type of midwife in a hospital setting than you would be outside of the hospital but sometimes there are still CNMs who have privileges and choose to do birth outside of the hospital. I think it's an important thing to one, know the different types of midwives and two, know what's important to you. There are a lot of people who are like, “I will not birth with anyone else but a CNM.” That's okay. That's okay but you have to find what works best for you. Julie: Sorry, can I add in? Meagan: You're fine. Yeah. Julie: It's also important that you are familiar with the laws in your state if you are going out of the hospital. I don't want this episode to turn into a home birth episode. It should be about all of the midwives in all of the locations, but also, know what the laws are in your state and in your specific area about midwives. In Utah, we are really lucky because we have access to all the types of midwives in all the different locations, but not everywhere is like that. Yeah. Just a little plug-in for that. Meagan: Yes. I agree. I agree. I did mention that I didn't really go for midwifery care when I was looking for my VBAC– Lyla, my second. I don't even know why other than in my mind, this is going to sound so bad but in my mind, I was told that midwives are undereducated. Julie: Less qualified? Meagan: Less qualified to support VBAC. I was told this by many people out in the world and I just believed it. Again, I have grown a lot over the years. It's been so great and I'm glad that I have. That's just where I was.Julie: A lot of people think that though. People don't know. They just don't know. Meagan: No, they don't know so I wanted to boom. Did you hear it? I'm smashing it. Julie: Snipping it. Meagan: That is a myth that is going to be smashed. Midwives are fully capable of supporting you during your VBAC journey. We are going to start going over some stats and things about how midwives really actually do impact VBAC in a positive way but you may even run into and at least I know there are some places here in Utah where providers kind of oversee the midwifery groups in these hospitals and a lot of them will say that midwives are unable to support VBAC. That's another thing that you need to make sure you are asking if you are going in the hospital when you are birthing with midwives because a lot of times you are being seen with your midwife, you're treated by your midwife and everything is great. You've got this relationship with these midwives and then you go into labor and all of a sudden you have an OB overseeing your care because that midwife can oversee your pregnancy but not your birth. Know that that is a thing so make sure that if you are birthing in a hospital with a midwife that you ask, “Will I be birthing with the midwives or am I going to be seen by an OB?” But also know, like I said, you can be seen in a hospital by a midwife. Okay, let's talk about some evidence and what midwives bring to the table and maybe some differences that midwives bring to the table because I do think that in a lot of ways, it is scary to think, Okay. If I have to have a C-section, if I do not have this VBAC and I have to go to a C-section and I have to be treated by an OB– because midwives do not perform Cesareans. They do assist. Let me just say, a lot of midwives come in and they assist a Cesarean, but they do not perform the main Cesarean, that can be intimidating because you want your same provider but I don't know if that's necessarily needed all of the time. Maybe to someone that is. But just know that yes, they cannot perform a Cesarean but they often can assist. That's another good question to ask your midwife, especially in the hospital. If I go to a Cesarean, who will perform it and will you be there no matter what?Okay, let's talk about it. Let's talk about the evidence. Let's talk about experiences and how they can differ. Julie: Do you know what is so funny? I want to go back and touch on the beginning where you said you didn't know and you thought that midwives were less qualified and honestly especially in-hospital, in-hospital midwives– I want everyone to turn their ears on right now– have the exact same training and skills to deliver a baby vaginally as an OB does. The difference between a midwife and an OB in a hospital is a midwife cannot do surgery. I just want to say that very concisely. They are just as qualified. They can even do forceps deliveries. They can do an episiotomy if an episiotomy is necessary. They can do vacuum assist. Well, some hospitals have policies where they will or will not allow a midwife to do forceps or a vacuum but they can administer all different types of medications. They can literally do everything. They can do everything except for the surgery in the hospital.Out of the hospital, I would argue that they still have similar training depending on if they are licensed or not. They may or may not be carrying medications like Pitocin, Methergine, antibiotics, IV fluids, and things like that. But out-of-hospital midwives, many of them, at least the licensed ones, carry those things and can provide the same level of care. The only difference between– not the only difference, a big difference between out-of-hospital midwives and in-hospital midwives is they don't have immediate access to the OR and an OB. But guess what? In states like Utah and many, many states operate similarly, there are very strict and efficient transfer protocols in place so that when a midwife decides you need to transfer, say you are birthing at home, first of all, a midwife is going to be with you a big chunk of the time. They are going to be with you. They're going to be noticing things. They're going to be seeing things. They're not going to be there for just the last 10 minutes of deliveries like these OBs are. They are going to be in your house. I feel like out-of-hospital midwives are more present with you than in-hospital midwives even. They're going to notice things. They're going to see things. They're going to notice trends a lot of the time before a situation becomes emergent if you need to be transferred. There are those random last-second emergencies and there are protocols for how to handle those too, but the majority of the time when there is a transfer needed, you are going to be received at the hospital. The hospital is already going to have your records. They're already going to know what you're coming in for and they're going to be able to seamlessly take over your care, no matter what that looks like there. Now there are rare emergencies when you might need care within seconds. However, those are incredibly rare and that is one of the risks. Those are some of the risks that you need to consider when you think about out-of-hospital versus in-hospital care. But often, I have seen many instances where things have safely gotten transferred to a hospital before they reach the level of needing that severe emergent care. I think that is the biggest thing people don't understand. I don't know how many people I've talked to as a doula and as a birth photographer where they don't want to birth at home because they don't understand the level of care that is provided by out-of-hospital midwives. I'm thinking of a birth I just went to last summer and she was thinking about home birth but the husband was like– this was 36 weeks so they weren't comfortable transferring or anything like that, but I was like, “These home birth midwives are trained in emergencies. They know how to handle all of the same obstetric emergencies in the exact same ways that they do in the hospital. They know how to handle them and address them. If a transfer is necessary, they are going to transfer you. They carry medication. They have stethoscopes and fetal monitors and everything that they do in the hospital to care for you.” The dad was like, “Oh, I didn't know that.” It's not your mom coming to help you deliver your baby. It's a trained, qualified medical professional. I don't know. I saw this quote. Never mind. I'm not circling back. I'm going in a completely different direction. I saw this quote or a little meme thing on Facebook the other day. I was going to send it to you but I didn't. It said something like, “Once your provider and birth location is chosen and locked in place, choice is mostly an illusion.” Meagan: Wow. Mostly an illusion. Julie: Yes. Like the fact that you have a choice in your care is mostly an illusion. I was thinking about that and I was like, Is it really? I've seen some clients really advocate hard, and stuff like that. But I have also seen the majority of clients where providers, nurses, and birth locations have a heavy sway and you can be convinced that things are absolutely necessary and needed by the way that you are approached and if you are approached a different way, then you might make a different choice, right? The power of the provider and the birth location is so big and massive that choice, the fact that you have a choice involved, is mostly an illusion. I was sitting with that because I see it. I've said it before and I'll say it a million more times before I die probably that birth photographers and doulas have the most well-rounded view of birth. Period. Because we see birth in home, in birth centers, in hospitals, in all of the hospitals, in all of the homes, in all the birth centers, with all of the different providers. We can tell you what hospital– I mean, there are nurses at one hospital that will swear up, down, and sideways that this is the way to do things and the next hospital 3 miles down the road is going to do things completely different and their nurses are going to swear by a different way to do things because of the environment that they are in. Meagan: Yeah. 100%.Julie: So if you want to know in your area what hospitals are the best for the type of birth that you want, talk to a birth photographer. Talk to a doula because they are going to be the ones with the most well-rounded view. Period. Meagan: Yeah. We definitely see a lot, you guys. We really do. Remember, if you are looking for a doula, check out thevbaclink.com/findadoula. Search for a doula in your area. You guys, these doulas are amazing and they are VBAC-certified. Julie: What were we going to circle back to? You were saying something. Meagan: Well, there's an article titled, “Effectiveness of Midwifery-led Care on Pregnancy Outcomes in Low and Middle-Income Countries” which is interesting because a lot of the time, when we are in low and middle-income countries, the support is not good. Anyway, they went through and it said that “10 studies were eligible for inclusion in the systemic review of which 5 studies were eligible for inclusion in the meta-analysis. Women receiving–”Julie: I love meta-analyses. They are my favorite. Yeah. Sorry, go ahead. Go on. Meagan: I know you do. It says, “Women receiving midwifery-led care had a significantly lower rate of postpartum hemorrhage and reduced rate of birth–” How do you say this, Julie? It's like asphyxia? Julie: Asphyxia? Meagan: Uh-huh. I've just never known how to say that. It says, “The meta-analysis further showed a significantly reduced risk in emergency Cesarean section. Within the conclusion, it did show that midwifery-led care had a significantly positive impact on improving various maternal and neonatal outcomes in low and middle-income countries. We therefore advise widespread implementation of midwifery-led care in low and middle-income countries.” Let's beef this up in low and middle-income countries. But what does it mean if you are not in a low and middle-income country? Julie: Well, I see the same and similar studies showing that in the United States and all of these other bigger countries that are larger and more educated. It's interesting because– sorry. I have a thought. I'm just trying to put it together. Meagan: That is okay. Julie: Midwifery-led care is probably more accessible and maybe accessible isn't the right word. It's more common probably in lower-income countries. I'm thinking third-world countries and second-world countries because it's expensive to go to a hospital. It's expensive to have an OB. In some countries like Brazil, the C-section rate is very, very high and it's a sign of wealth and status because you can go to this private hospital with these luxury birth suites and stay like a VIP, get your C-section, save your vagina– I use air quotes– “save your vagina” by going to this affluent hospital. Right? Meagan: Yes. Julie: I think in lower-income countries, it's going to be not only an easier thing to do but kind of the only thing to do, maybe the only choice. And here, it's funny because here, out-of-hospital births– first of all, insurance is stupid. In the United States, insurances are so stupid. It's a huge money-making organization, the medical system is. Insurance does cover a big chunk of hospital births and they don't cover out-of-hospital births so a lot of the time, an out-of-hospital birth is kind of the opposite. You have to have a little bit of money in order to pay for an out-of-hospital midwife because your insurance isn't likely going to cover it. More insurances are coming on board with that but it will be a little bit of time before we see that shift. But there are similar outcomes in the United States and in wealthier countries that midwifery-led care, not just out of the hospital, but in-hospital midwifery-led care has lower rates of Cesarean, lower rates of complication, lower rates of induction, lower rates of mortality and morbidity than obstetric-led care. You are going to a surgeon. You are going to a trained surgeon to have a natural, non-complicated delivery. Meagan: It's interesting because going back to the low income, in our minds, we think that the care is not that great. But then we look at it and it's like, the care is doing pretty good over there in these lower-income, third-world countries. Yeah. This is actually in Evidence-Based Birth. It says, “In the United States, there are typically 4 million births each year.” 4 million. You guys, that's a lot. The majority of these births are attended by physicians which are only 9% attended by certified nurse midwives and less than 1% are attended by CPMs, so certified professional midwives or traditional midwives. You guys, that is insane. That is so low. She says in this podcast of hers which we are going to make sure to link because I think it's a really great one, “If you only look at vaginal births, midwives do attend a higher portion of vaginal births in the United States, but still it's only about 14%.”Julie: Yeah. If you have a normal– I use normal very loosely– uncomplicated pregnancy, there is absolutely no reason that you cannot see a midwife either out of the hospital or in the hospital. Now, I would encourage you to go and interview some midwives in your local hospitals. I would encourage you to look into the local birth community and see what people recommend because even if you are going in a hospital and have a midwife, you have the same access to the OR and an OB that can take care of you in case of an emergency. A lot of people are like, “Well, I'd just rather see an OB just in case of an emergency so that way I know who is doing my C-section,” I promise you that the OB doing your C-section, you are only going to see for an hour. They probably are not going to talk to you. It doesn't matter how personable they are or what their bedside manner is or if you know anything because I promise you, when you are on the operating room table, you're not going to be worried about who's doing your surgery. You're just not. I'm sorry. That's maybe a harsh thing to say, but it's going to be the farthest thing from your mind. Plus, in the hospital, your midwife is more than likely going to be assisting with the surgery too so you are going to have a familiar face in the operating room if that happens. I also think everybody knows by now that I am not on board with doing something just in case when it comes to medical care. Just in case things can cause a lot more problems that they are trying to prevent. So yeah. Anyway, that's my two cents. Meagan: Yeah. You know, I really think that when it comes to midwives, there is even more than just reducing things like interventions and Cesareans and inductions which of course, lead to interventions and things like that. I feel like overall, people leave their birth experience having that better view on the birth because of things like that where midwives are with you more and they seem to be allowed more time even with insurance. You guys, insurance, like she said, sucks. It just sucks. It limits our providers. I want to just point that out that a lot of these OBs, I think that they would spend more time with us. I think they want to spend more time with us in a lot of ways, but they can't because insurance pulls them down and makes it so they can't. But these midwives are able to spend so much more time with us in many ways. Okay. Let's see. What else do we want to talk about here? We talked about interventions. Midwives will typically allow parents to go past that 40-week mark. We talked about the ARRIVE trial here in the past where they started inducing first-time moms at 39 weeks and unfortunately, it's stuck in a lot of ways so providers are inducing at 39 weeks and that means we are starting to do things like stripping membranes at 37 and 38 weeks. It seems like providers really, really– and when I say providers, like OB/GYNs, they are really wanting babies to be born for sure by 40 weeks but by 40 weeks, they are really pushing it. Midwives to tend to allow the parents to go past that 40-week mark. That's just something else I've noticed with clients who choose VBAC and then end up choosing midwives. They'll often end up choosing midwives because of that reason and they will feel so much better when they reach that point in pregnancy because they don't feel that crazy pressure to strip their membranes and go into labor or they are going to be facing a Cesarean and things like that. I feel like that's another really big way to change the feeling of your care with midwives is understanding when it comes down to the end of things, they are going to be a little bit more lenient and understanding and not press as hard. Like we said in the beginning, there are a lot of people who do press it– those “medwives” where they are like, “No, you need to have a baby.” We just recorded a story where the midwife was like, “Well, you need to see the OB and you need to do a membrane sweep,” and they were suggesting these things. But really, typically with midwives, you are going to see less pressure in the end of pregnancy. Midwives spend more time in prenatal visits. We were just talking about that. Insurance can limit OBs, but a lot of the time, they will really spend more time with you. They are going to spend 20+ minutes and if you are out of the hospital, sometimes they will spend a whole hour with you going over things. Where are you mentally? Where are you physically? What are you wanting? Going over desires and the plan for the birth. Past experiences may be creeping in because we know that past experiences can creep in along the way. So yeah. Okay, Julie is in her car, you guys. She's rocking it with her cute sunglasses. She is on her way. She is so nice to have the last half hour of her free time spent with us. So Julie, do you have any insight or any extra words on what I was just saying? Julie: You know, I do. Hopefully, you can hear me okay. I'm going to hit a dead spot in two seconds. Meagan: I can hear you great. Julie: Okay, perfect. I have this little– there's a spot on my road where I always cut out so stop me if I need to repeat what I said. I wanted to go back to the beginning and just talk for half a second because we know my first ended in a C-section. For my first birth, I actually started out by looking at birth centers because I wanted an out-of-hospital birth. I knew that from the beginning. I interviewed a couple of midwives and there was one group that I was going to go with at a birth center and I was ready to go but something didn't quite feel right. It wasn't anything the midwives did. It wasn't anything that the birth center was. It wasn't that I didn't feel safe there. It was just that something didn't feel right. So I just stayed with my OB/GYN. I had to get on Clomid to get pregnant. I just stayed with that guy who is the same guy that Meagan had and the same guy who did my C-section because something didn't feel right. I mean, we know now and I can look back in hindsight. This was, gosh, 11.5 years ago. I know that I ended up having preeclampsia and I ended up having to get induced because of it. Had I started out-of-hospital, I would have had to transfer. There was nothing– I would have had to transfer care before I even got to 37 weeks. I had a 36-week induction. That's the thing though. Out-of-hospital midwives have protocols. Each state has different guidelines, but there are requirements for when they have to transfer care– if your blood pressure is high, if you have preeclampsia signs, if you deliver before a certain due date, or after a certain gestational age. You're going to be safe. If you have complications in pregnancy, you're going to be safe. You're going to be transferred. You're going to be cared for. But also, I just want to put emphasis on this which is what I'm tying into the last thing I want to say which is going to be forever long, is that you can trust your intuition. My intuition was telling me that the birth center was not the right place for me even though it checked all of the boxes. Your intuition is not going to tell the future every time, but what I wanted to lead into is that– oh and do you know what is so funny also? I had three out-of-hospital births after that, but with my fourth birth, I started out with the same midwife I had for the other two home births, and for some reason, I felt like I needed to transfer care back to the hospital so I went back to the hospital for two months and all of a sudden, my insurance change and the biggest network of hospitals in my state wasn't covered by my insurance anymore so it felt right to go back to out-of-hospital birth. I don't know why I had to do that whole loop-dee-loop of transferring to a hospital just to transfer back to the same out-of-hospital midwife that I had in the first place but I believe there was a purpose to that. I believe there was a purpose to that. I want to tell you guys that if seeking midwifery care whether in the hospital or out of the hospital feels uncomfortable to you or feels like, I don't know. These midwives still sound like chicken-dancing hippies to me, I would encourage you to go talk to some local midwives whether in a hospital or out of the hospital. Just sit down and talk to them and say, “Hey.” It's easier to talk to an out-of-hospital midwife. Out-of-hospital midwives do free consultations for you. In-hospital midwives, you might have to make an appointment and it might be harder but you should still try and see and get a vibe or just transfer care to them and go to a few appointments and see. You can always switch care back to a different provider or an OB because your intuition is smart but it does not know, it cannot guide you about things that you do not know anything about. I would encourage you to go and chat with these different providers, even different OBs if you want because your provider choice is so, so, so important. It is one of the most important decisions you're going to make in your care for your birth. It should be a good one. Your intuition can't tell you to go see x, y, z provider if you don't even know who x, y, z provider is. Gather as much information as you can. Talk to as many providers as you can. Go see the midwife. Interview the doula. Check out the birth photographer's website. See what I did there? See how it feels because even as a birth photographer, whenever I'm doing interviews with people, I'm not a fly-on-the-wall birth photographer. A lot of birth photographers brag about being a fly on the wall. You won't even know I'm there. No. I don't buy that because who is in your birth space is important. I am a member of your birth team just like every other person in that space, just like your nurses, your OB, your midwife, your doula– everybody there is a member of your birth team. I am a member of your birth team too and I will hold space for you. I will support you and I will love you. I am not a fly on the wall. Now, your provider is a member of your birth team. They probably arguably are one of the biggest influencers about how your birth is going to go and you deserve to be well-informed about who they are. You deserve to have multiple options that you know about and have thoroughly vetted and you deserve to stick up for yourself and do the provider who is more in line with the type of birth you want. How do you do that? You do that by finding out more about the providers who are available to you in all of the different birth locations and settings. Meagan: Yes. So I want to talk more about that too because there are studies and papers out there showing that the attitude or the view on VBAC in that area, in that hospital, in that birth center, both midwives and OBs, but we are talking about midwives here, really impacts the way that a birth can go. So if you don't interview and you don't research and you don't find those connections and even try, you will not know and in the end, it may not be the way you want. Even then, even if we find those perfect midwives, even if Julie went to the hospital midwife, she probably would have had a great experience, but who knows?Julie: Also, arguable too though, you could be seeing the most highly recommended VBAC provider in your area in the most VBAC-supportive hospital in your area that everybody goes to and everybody raves about, and if you don't feel comfortable there for whatever reason, you don't have to see the best, most VBAC-supportive provider if it doesn't feel right and if it doesn't sit right with you. Meagan: Yes. Julie: It goes both ways. Meagan: Yes. Julie: Sorry, I'm really passionate about this clearly. Meagan: No, because it does. It goes both ways. I mean, that's what this podcast is about is conversation and story sharing and finding what's best for you because even with VBAC, VBAC might not be the right option for you, but you don't know unless you learn. You don't know unless you learn more about midwives. Really though, people usually come out of midwifery care having a better experience and a more positive experience. I think that goes along with the lines of they do give a little bit more care. They do seem to be able to dive deeper to them as an individual and what they are wanting and their desires. They are a little less medically minded and a little bit more open-minded. You are less likely to have interventions. You are less likely to have those things that cause trauma and that causes the cascade that leads to the Cesarean. I'm going to have all of the links but I'm just going to read this highlighted. It's a study from Europe actually. It says, “A recent qualitative study in Europe explored the maternity culture in high and low VBAC countries and found that–” I'm talking a lot about high and low countries. Sorry guys, I'm realizing I'm talking a lot about it but a lot of these studies differ. It says, “Clinicians in the high VBAC countries had a positive and pro-VBAC attitude which encouraged women to choose VBAC whereas the countries with low VBAC rate, clinicians held both pro and anti-VBAC views which negatively affected women who were seeking VBAC. Both of these studies have shown that having midwifery care can have a positive influence on VBAC rates with an increase in maternal and neonatal morbidity.”Right there, not only doing the research on your provider, but doing the research within your location, what their thoughts are, what their views are, what their high-VBAC attitude or low-VBAC attitude is. If they are coming at you, even these midwives you guys, and they have all of these stipulations, it might be a red flag. It might not be the right midwifery group for you. Julie: Absolutely. That's where the intuition comes in. I like what you said about the VBAC culture. You can tell at different hospitals. We have been to many, many hospitals in our area. Sorry, can you hear my blinkers? It's distracting. Let's see. I absolutely guarantee you that every hospital has a culture around VBAC. Some of them are positive and supportive and uplifting and some of them are fearful and fear-based and operate on a fact where they are going to be more likely to pull you toward a repeat C-section or other interventions. I encourage you to look into the culture of your hospital but not only hospitals too. I realize it's not just hospital-specific. It's also out-of-hospital midwives. They all have their culture around VBAC. Your out-of-hospital midwives and your in-hospital midwives, all of the midwives, your group whether you see a solo practice or a group OB practice or you see a group midwifery practice or whatever, there is a culture surrounding VBAC. You need to do yourself a favor and figure out what that culture is. I got to my appointment and I need to head in so I'm going to say goodbye really fast. I'm going to leave Meagan alone to wrap up the episode, but yes. My parting words are honoring your intuition, talk as much to your VBAC provider as you can and find out what the culture is surrounding that no matter who you choose to go with and also, do not automatically write off midwives. You are doing yourself a huge disservice if you are not considering a midwife for your care. It doesn't mean you have to go with one, but I feel like everybody should at least look into them. I love you guys! Bye!Meagan: Okay. And wrapping up you guys, I am just going to echo her. I think that completely discrediting midwives without even interviewing them at all is something that is a disservice to ourselves. I'm going to tell you that I did that. I did that. I didn't even consider it. I interviewed 12 providers, 12 providers which is crazy and I didn't interview one midwife. Not one. I was interviewing OBs and MFMs and I realize I don't remember interviewing a single midwife. The only thing I can think of is that I let the outside world lead me to believe that midwives were less qualified. Yale has an article and they say, “First-time mothers giving birth at medical centers where midwives were on their care team were 75% less likely to have their labor induced.” 74% less likely to have their labor induced, 74% less likely to receive Pitocin augmentation, and 12% less likely to deliver by Cesarean which is a big deal. I know most of us listening here are not first-time moms. We've had a Cesarean. Maybe we've had one, two, three, or maybe four, but the stats on midwives are there. It is there and it's something to not ignore so if you have not yet checked out midwives in your area, I highly encourage you to do so. Like Julie said, you don't even have to go with anybody, but at least interviewing them to know and feel the difference of care that you may be able to have is a big deal. I highly encourage you. I love you all. I'm so grateful for midwives. I'm so grateful for my midwife. My VBAC baby was with a midwife and I did have an OB. I was one of those who had an OB backup who could care for me and see me if I needed to. That for me made me feel more comfortable but it's also something that can get confusing. I think we've talked about where sometimes you will do dual care and you will have one person telling you one thing and the other provider telling you the other thing. That can get stressful and confusing so maybe stick with your provider. But do what's best for you. Again, another message. Don't just completely wipe out the idea of a midwife if you have midwives in your area as an option. It may be something that will just blow your mind. Thank you all so much for listening and hey, if you have a midwife who you suggest or you've gone through a VBAC with, we have our VBAC-supportive provider list and we would love for you to add to it. Go check out in the show notes or you can go over to our Instagram and click in our Linktree and we have got our provider list there for you. Or if you are looking for that midwife to interview, go check them out. We definitely love adding to this list and love referring it for everybody looking for a VBAC-supportive provider. 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