Podcasts about GBS

Get ready for a Progress Report season finale packed with good news as Emma shares some life-changing breakthroughs! The Gates Foundation is funding a game-changing GBS vaccine, while a cutting-edge AI stroke diagnosis system in England is significantly improving recovery rates. Plus, China steps up with a bold pledge to slash greenhouse gas emissions while NASA's James Webb Telescope just uncovered an astonishing 6,000 new planets. Learn more about your ad choices. Visit megaphone.fm/adchoices

Traci Freeman holds a number of roles, including as the managing member of Believe Consulting, but in this conversation we focused on her role as a partner of the Africa Federation of GBS Associations. This federation is aimed at unlocking Africa's potential in the BPO, CX and ITO sectors. Enhancing Africa's standing as a hub for innovation, knowledge exchange, and technological advancement, promoting partnerships, youth employment, and digital enablement while driving best practices and standards. Mark Hillary called Traci at her base in Johnannesburg, South Africa to talk about the work of the federation and the opportunities for CX and BPO across all of Africa. https://www.linkedin.com/in/tracifreeman/ https://www.linkedin.com/company/africa-gbs-federation/ https://africagbsfederation.org/ SUMMARY Mark Hillary and Peter Ryan discuss the Africa Federation of GBS Associations, an initiative led by  a team including Traci Freeman to promote Global Business Services (GBS), Business Process Outsourcing (BPO), and IT services across Africa. The federation aims to manage perceptions of Africa as a high-value destination, foster knowledge sharing, and support regional development. Key countries like Egypt and South Africa are leveraging their experience to help emerging markets like Kenya, Rwanda, and Ghana. The federation, launched in February 2024, includes members from various African countries and aims to host global community engagement events by 2026-2027.

This past week has been heavy, filled with highs and lows. Our brother Joe, a missionary in Zambia, faced life-threatening illness—malaria, typhoid, and paralysis from GBS. Despite the fear, anxiety, and uncertainty, our community united in prayer and fasting, standing on God's Word.When we showed up in faith, Joe activated his belief in God's power. In a miraculous moment, after prayer and communion, he regained movement and walked—defying medical expectations. This is a reminder: faith isn't about how we feel; it's about stepping out, showing up, and trusting God even when the circumstances seem impossible.In a world full of tragedy, fear, and division, the call is clear: unite in love, mercy, and prayer. God moves when His people stand together, believing for the impossible.The miraculous isn't just for Joe—it's a sign that God is still at work, and His power is available to us today.

In this episode of HFS Unfiltered Stories, Saurabh Gupta, President of Research and Advisory Services at HFS Research, sits down with Jay Desai, Head of IT Infrastructure Operations at JTI, for an eye-opening conversation on bridging the often-disconnected worlds of business, IT, and cybersecurity. Jay shares hard-earned lessons from leading Global Business Services (GBS) through geopolitical shocks, shifting into IT and cyber leadership, and navigating the GenAI hype with realism and grit. This is a rare look into what it really takes to drive enterprise transformation, from aligning C-suite incentives to overcoming organizational resistance. Whether you're scaling GenAI or building connected enterprise models, this conversation is full of truth bombs, leadership insights, and the kind of wisdom that only comes from being on both sides of the transformation divide. Key discussion points:Breaking Functional Silos: Why IT, GBS, and cybersecurity leaders must adopt a shared vision to enable true enterprise-wide transformation.The Moral Hazard in Transformation: How misaligned ownership of costs vs. benefits creates friction between business and IT, and how to solve it.Why the 'OneOffice' Vision Still Eludes Us: The challenge of aligning incentives and OKRs across finance, IT, and HR departments.GenAI: From Hype to Reality: Why GenAI is stuck in POC purgatory, and what leaders must fix to unlock real value.Enterprise ‘Debts' Beyond Technology: Cultural, process, and people debt are just as critical as technical debt in holding back transformation.Leadership Lessons in the AI Era: Jay's real-world advice to aspiring leaders, embrace failure, earn trust, and be unapologetically authentic.Tune in now to hear what it really takes to lead across silos—and why the future belongs to those who can connect dots others can't.

Dziś zapraszam Was na kolejny odcinek podcastu BSS bez tajemnic. Tym razem moimi gośćmi są Sebastian Sala oraz Krzysztof Herdzik, współtwórcy inicjatywy NALUexperts – nowej marki na rynku doradztwa i wsparcia biznesowego, która powstała, aby pomóc liderom centrów usług wspólnych oraz dużych organizacji odnaleźć się w świecie ciągłych zmian.Rozmawiamy o tym, skąd wzięła się potrzeba stworzenia NALUexperts i czym różni się ta inicjatywa od klasycznego konsultingu. Moi rozmówcy opowiadają, jak rosnące i transformujące się organizacje często zostawiają swoich liderów samych z ogromnymi wyzwaniami, a sparing z praktykiem – osobą, która sama przez lata zmagała się z podobnymi problemami – może być kluczem do sukcesu.Usłyszycie też historie zrealizowanych projektów, które pokazują, jak przy pomocy doświadczonych ekspertów można w zaledwie 30 dni przygotować trzyletnią strategię, zwiększyć zaangażowanie zespołów dwukrotnie czy ograniczyć rotację pracowników z 32% do zaledwie 3%. Sebastian i Krzysztof tłumaczą, dlaczego pracują w modelu „expert as a service”, jak wygląda elastyczne dopasowanie współpracy do potrzeb klienta i dlaczego ich celem jest jak najszybsze uniezależnienie organizacji od doradców.W naszej rozmowie pada też pytanie o nazwę NALU. Okazuje się, że hawajskie słowo „fala” symbolizuje zarówno wartości zespołu – ciepło, współpracę i wyzwania – jak i metaforę zmian, na których biznesy muszą umieć się utrzymać. Moi goście opowiadają, jak łączą swoje doświadczenia zawodowe, pasję do rozwoju ludzi oraz… kitesurfingu, by budować inicjatywę, która nie tylko doradza, ale realnie pomaga płynąć z falą zmian.  Kluczowe punkty rozmowy:·         NALUexperts wspiera organizacje w szybszym osiąganiu celów poprzez elastyczne i praktyczne podejście ekspertów z długoletnim doświadczeniem.·         Projekty transformacyjne mogą trwać od 30 dni do kilku lat, a ich elastyczność pozwala na dostosowanie wsparcia do bieżących potrzeb klienta.·         Współpraca z NALUexperts opiera się na transparentności i etyce, a także na zaangażowaniu pracowników klienta w realizację i wdrażanie projektów.  Linki:Sebastian Sala na Linkedin – https://www.linkedin.com/in/sebastian-sala-68b57b3/Krzysztof Herdzik na Linkedin – https://www.linkedin.com/in/krzysztofherdzik/NALUexperts – https://naluexperts.com/Porozmawiaj o tym odcinku ze sztuczną inteligencją – https://bbs-bez-tajemnic.onpodcastai.com/episodes/6jNfE9ezLtq/chat  ****************************  Nazywam się Wiktor Doktór i na co dzień prowadzę Klub Pro Progressio https://proprogressio.com/pl/dzialalnosc/klub-pro-progressio/1 – to społeczność wielu firm prywatnych i organizacji sektora publicznego, którym zależy na rozwoju relacji biznesowych w modelu B2B. W podcaście BSS bez tajemnic poza odcinkami solowymi, zamieszczam rozmowy z ekspertami i specjalistami z różnych dziedzin przedsiębiorczości.Zapraszam do odwiedzin moich kanałów na:YouTube - https://www.youtube.com/@wiktordoktorFacebook - https://www.facebook.com/wiktor.doktorLinkedIn - https://www.linkedin.com/in/wiktordoktor/Moja strona internetowa - https://wiktordoktor.pl/Możesz też do mnie napisać. Mój adres email to - kontakt(@)wiktordoktor.pl  ****************************  Patronami Podcastu “BSS bez tajemnic” są:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/ Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński - https://www.linkedin.com/in/damian-rucinski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/Damian Wróblewski - https://www.linkedin.com/in/damianwroblewski/Paweł Łopatka - https://www.linkedin.com/in/pawellopatka/  Wspaniali ludzie, dzięki którym pojawiają się kolejne odcinki tego podcastu.Ty też możesz wesprzeć rozwój podcastu na: Patronite - https://patronite.pl/wiktordoktorPatreon - https://www.patreon.com/wiktordoktorBuy me a coffee - https://www.buymeacoffee.com/wiktordoktorBuycoffee.to - https://buycoffee.to/wiktordoktorBecome a supporter of this podcast: https://www.spreaker.com/podcast/bss-bez-tajemnic--4069078/support.

W tym odcinku podcastu BSS bez tajemnic zabieram Was na Pomorze, region, który w ostatnich latach wyrósł na jeden z najważniejszych ośrodków nowoczesnych usług dla biznesu w Polsce. Moim gościem jest Marcin Grzegory, zastępca dyrektora w Invest in Pomerania, który od ponad dekady współtworzy rozwój sektora GBS w Trójmieście i całym regionie.Rozmawiamy o historii powstawania ekosystemu nowoczesnych usług biznesowych na Pomorzu – od czasów, gdy region postrzegany był jako peryferyjny i nieatrakcyjny dla inwestorów, po dzisiejszy obraz dynamicznego centrum przyciągającego globalnych graczy. Marcin opowiada, jak strategiczne badania, budowa nowoczesnej powierzchni biurowej i stworzenie spójnego systemu obsługi inwestorów doprowadziły do tego, że Pomorze stało się jedną z najgorętszych lokalizacji dla sektora GBS w Europie Środkowo-Wschodniej.Dziś w Trójmieście działa ponad 220 centrów usług biznesowych, które zatrudniają ponad 42 tysiące osób. Najwięksi inwestorzy pochodzą ze Stanów Zjednoczonych, krajów nordyckich czy Europy Zachodniej, a w ostatnich latach coraz częściej dołączają do nich średniej wielkości firmy, które dostrzegają w regionie nie tylko atrakcyjne warunki, ale i strategiczne położenie.W rozmowie poruszamy także temat trendów, które kształtują sektor – od rosnącej roli nowych technologii, przez transformację energetyczną Pomorza, aż po powiązania z branżą półprzewodników i mobilności. Dyskutujemy o tym, jak międzynarodowe wydarzenia, takie jak Follow the Leaders, stają się platformą do prezentacji potencjału regionu i wymiany doświadczeń z inwestorami z całego świata.  Kluczowe punkty rozmowy:·         Pomorze, a szczególnie Trójmiasto, przekształciło się w kluczowe centrum nowoczesnych usług biznesowych w Polsce, zatrudniając ponad 40 tysięcy pracowników w ponad 220 projektach.·         Wzrost sektora BSS w regionie napędzają inwestycje zagraniczne, zwłaszcza z USA, krajów nordyckich i regionu DACH, a także dynamiczny rozwój infrastruktury biurowej i logistycznej.·         Invest in Pomerania skupia się na budowaniu synergii w regionie poprzez wspieranie innowacyjnych projektów w dziedzinach takich jak energia, mobilność i półprzewodniki, co przyciąga coraz więcej międzynarodowych inwestorów.  Linki:Marcin Grzegory na Linkedin – https://www.linkedin.com/in/marcin-grzegory-b7932298/Invest in Pomerania – https://investinpomerania.pl/Wydarzenie Follow the Leaders - https://followtheleaders.pl/Porozmawiaj o tym odcinku ze sztuczną inteligencją – https://bbs-bez-tajemnic.onpodcastai.com/episodes/IogXZIgQdLp/chat  ****************************  Nazywam się Wiktor Doktór i na co dzień prowadzę Klub Pro Progressio https://proprogressio.com/pl/dzialalnosc/klub-pro-progressio/1 – to społeczność wielu firm prywatnych i organizacji sektora publicznego, którym zależy na rozwoju relacji biznesowych w modelu B2B. W podcaście BSS bez tajemnic poza odcinkami solowymi, zamieszczam rozmowy z ekspertami i specjalistami z różnych dziedzin przedsiębiorczości.Zapraszam do odwiedzin moich kanałów na:YouTube - https://www.youtube.com/@wiktordoktorFacebook - https://www.facebook.com/wiktor.doktorLinkedIn - https://www.linkedin.com/in/wiktordoktor/Moja strona internetowa - https://wiktordoktor.pl/Możesz też do mnie napisać. Mój adres email to - kontakt(@)wiktordoktor.pl  ****************************  Patronami Podcastu “BSS bez tajemnic” są:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/ Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński - https://www.linkedin.com/in/damian-rucinski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/Damian Wróblewski - https://www.linkedin.com/in/damianwroblewski/Paweł Łopatka - https://www.linkedin.com/in/pawellopatka/  Wspaniali ludzie, dzięki którym pojawiają się kolejne odcinki tego podcastu.Ty też możesz wesprzeć rozwój podcastu na:Patronite - https://patronite.pl/wiktordoktorPatreon - https://www.patreon.com/wiktordoktorBuy me a coffee - https://www.buymeacoffee.com/wiktordoktorBuycoffee.to - https://buycoffee.to/wiktordoktorBecome a supporter of this podcast: https://www.spreaker.com/podcast/bss-bez-tajemnic--4069078/support.

Cześć! Zapraszam Was do kolejnej odsłony podcastu BSS bez tajemnic. Tym razem w studiu towarzyszył mi Paweł Płocki i – jak to zwykle z Pawłem bywa – rozmowa szybko nabrała tempa. Od najnowszych modeli open source z Chin, przez rozwiązania Microsoftu i Google'a, aż po innowacje od ElevenLabs i Suno – przyglądamy się temu, jak dynamicznie rozwija się świat sztucznej inteligencji.Rozmawiamy o narzędziach do edycji obrazów i generowania dźwięku, nowych możliwościach w text-to-speech, a także o tym, jak zmienia się komfort pracy z modelami językowymi. Sporo miejsca poświęcamy premierze GPT-5, hype'owi z nią związanym oraz pierwszym realnym doświadczeniom użytkowników – od „thinking mode” po wersję Pro. Dyskutujemy też o zastosowaniu AI w kodowaniu i o tym, jak zmieniają się narzędzia wspierające programistów.Zastanawiamy się nad tym, jak daleko posunięta personalizacja modeli będzie wpływać na naszą codzienną pracę i jakie konsekwencje może mieć wykorzystanie AI w sektorze GBS oraz w różnych branżach, w których bariera językowa powoli przestaje istnieć. Paweł dzieli się także kulisami przygotowań do wydarzenia Follow the Leaders w Trójmieście, gdzie już we wrześniu podejmiemy publiczną dyskusję o tym, czy AI to tylko automatyzacja – czy jednak coś znacznie więcej.Kluczowe punkty rozmowy: ·         Chińska inwazja technologiczna w AI przyspiesza, z Alibabą na czele, która regularnie wypuszcza nowe open-source'owe modele, takie jak Quen do edycji zdjęć.·         Microsoft wprowadził open-source'owy model text-to-speech, który generuje mowę z tekstu, umożliwiając tworzenie wielogłosowych kompozycji dźwiękowych wysokiej jakości.·         GPT-5, mimo początkowych kontrowersji, pokazuje swoją siłę, zwłaszcza w wersji Pro, co można zauważyć w rosnącej konkurencji z narzędziami do kodowania, takimi jak Cloud Code.  Linki:Paweł Płocki na Linkedin - https://www.linkedin.com/in/pawelplocki/Film Andreja Karpathy - https://www.youtube.com/watch?v=l8pRSuU81PUKsiążka “AI w rękach sprzedawcy. Jak zwiększyć efektywność sprzedaży i zdominować rynek” - https://focusonbusiness.eu/pl/ksiazki/onepress/ai-w-rekach-sprzedawcy-jak-zwiekszyc-efektywnosc-sprzedazy-i-zdominowac-rynek/297Książka „Stwórz własne AI. Jak od podstaw zbudować duży model językowy” - https://focusonbusiness.eu/pl/ksiazki/helion/stworz-wlasne-ai-jak-od-podstaw-zbudowac-duzy-model-jezykowy/293Wydarzenie Follow the Leaders - https://followtheleaders.pl/Porozmawiaj o tym odcinku ze sztuczną inteligencją – https://bbs-bez-tajemnic.onpodcastai.com/episodes/Z2KTLirpE0j/chat  ****************************  Nazywam się Wiktor Doktór i na co dzień prowadzę Klub Pro Progressio https://proprogressio.com/pl/dzialalnosc/klub-pro-progressio/1 – to społeczność wielu firm prywatnych i organizacji sektora publicznego, którym zależy na rozwoju relacji biznesowych w modelu B2B. W podcaście BSS bez tajemnic poza odcinkami solowymi, zamieszczam rozmowy z ekspertami i specjalistami z różnych dziedzin przedsiębiorczości.Zapraszam do odwiedzin moich kanałów na:YouTube - https://www.youtube.com/@wiktordoktorFacebook - https://www.facebook.com/wiktor.doktorLinkedIn - https://www.linkedin.com/in/wiktordoktor/Moja strona internetowa - https://wiktordoktor.pl/Możesz też do mnie napisać. Mój adres email to - kontakt(@)wiktordoktor.pl  ****************************  Patronami Podcastu “BSS bez tajemnic” są:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/ Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński - https://www.linkedin.com/in/damian-rucinski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/Damian Wróblewski - https://www.linkedin.com/in/damianwroblewski/Paweł Łopatka - https://www.linkedin.com/in/pawellopatka/  Wspaniali ludzie, dzięki którym pojawiają się kolejne odcinki tego podcastu.Ty też możesz wesprzeć rozwój podcastu na:Patronite - https://patronite.pl/wiktordoktorPatreon - https://www.patreon.com/wiktordoktorBuy me a coffee - https://www.buymeacoffee.com/wiktordoktorBuycoffee.to - https://buycoffee.to/wiktordoktorBecome a supporter of this podcast: https://www.spreaker.com/podcast/bss-bez-tajemnic--4069078/support.

In this episode, one of us tries malort for the first time and lives to tell the tale.  College football is back and so is the GBS pick'em.  The final round of interesting names in CFB to watch for this season and the weirdest classes being offered at every SEC school.  Fancy bottled water, a restaurant and a football team get rebrands, getting tacos delivered by drone and much more!

Gb u23 Head Coach Jonathon Cramman rejoins the podcast to talk about GBs first ever gold medal since 1938! The teams expectations, handling pressure, tactical decisions, unsung heroes, the character of this U23 squad, standout leadership moments on and off the field, what this gold medal means for British Baseball as a whole, funny and unexpected dugout moments, keeping this momentum going for future competitions, who could make the step up to the Mens Senior National Team, Keanu Reeves, Sir Terry Pratchett and much more.

We're launching a special series of episodes, each centered on one powerful theme in the home birth journey. This first set — Water Birth Stories — gathers real experiences and insights to support, inspire, and immerse you in the magic of water birth! How can you take your power back after it feels like a previous birth experience took it away? Today's story with Karine Halle features details of trauma from a hospital birth for her first child and how she was determined to have a home birth for her second.  In between her first and second birth, she felt called into doula work and became passionate about supporting families in the birth experience.  For her second pregnancy and birth, she did everything she could to put the odds on her side to have her dream birth. *Please note that this conversation contains mention of suicidal thoughts Things we talk about in this episode: Postpartum rage GBS positive Gestational Diabetes testing Body work for birth: chiropractic care, massage, yoga, exercise Links From The Episode: The Birth Hour: ⁠https://thebirthhour.com/⁠ Birthful: ⁠https://birthful.com/⁠ Evidence Based Birth Podcast: ⁠https://evidencebasedbirth.com/evidence-based-birth-podcast/⁠ Babies are Not Pizzas: ⁠https://amzn.to/3UGYtPi⁠ Ina May: ⁠https://amzn.to/3tfHuI2⁠ Hypnobirthing: ⁠https://hypnobirthing.com/⁠ The First Forty Days: ⁠https://amzn.to/3WMDtbK⁠ Birthing from Within: ⁠https://amzn.to/3tfHOqe⁠ The Fourth Trimester: ⁠https://amzn.to/3NOSUvE⁠ Business of Being Born: ⁠https://www.thebusinessof.life/⁠ Offers From Our Awesome Partners: Needed: ⁠https://bit.ly/2DuMBxP⁠ - use code DIAH to get 20% off your order or DIAH100 for $100 off a Complete Plan  More From Doing It At Home: Doing It At Home book on Amazon:⁠ https://amzn.to/3vJcPmU⁠ DIAH YouTube:⁠ https://bit.ly/3pzuzQC⁠ DIAH Merch:⁠ https://bit.ly/3qhwgAe ⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

In Episode 132 of Good Morning BSS World, I take you on a journey into the evolving BPO and GBS landscape of Georgia with a special guest, Sergo Baramia – CEO and Managing Partner at Evolvexe Group. Sergo offers a behind-the-scenes look at how Evolvexe emerged as one of Georgia's pioneering full-scope BPO providers and what makes the Georgian outsourcing market uniquely competitive.From customer service and content moderation to social media management and identity verification support, Evolvexe delivers a broad portfolio of outsourcing services tailored to global needs. Sergo unpacks why Georgia's language capabilities, international student community, and cost-efficiency make it an attractive destination for outsourcing – especially for industries like iGaming and tech support.The episode also dives into real-world operational dynamics, such as recruitment timelines, salary benchmarks, and attrition rates, offering a transparent look at what it takes to build a reliable outsourcing business in an emerging market. Learn how Evolvexe provides services in up to eight languages, attracts talent through work-from-home flexibility, and successfully serves clients across the globe — including tech giant ASUS.Whether you're exploring nearshore BPO options, interested in the Caucasus business scene, or simply love discovering new growth stories in global services, this episode will open your eyes to Georgia's untapped potential.  Key points of the podcast:The BPO sector in Georgia is growing rapidly, driven by cost efficiency and a multilingual workforce.Evolvexe Group offers a range of BPO services including customer support, back office operations, and social media management, with a focus on international clients.Georgia's strategic advantage lies in its ability to provide high-quality services at competitive prices, attracting major international brands like ASUS..  Links:Sergo Baramia on Linkedin - https://www.linkedin.com/in/sergobaramia/ Evolvexe:www - https://www.evolvexe.com/FB - https://www.facebook.com/evolvexellcLinkedin - https://www.linkedin.com/company/evolvexe-llcTalk to AI about this episode - https://gmbw.onpodcastai.com/episodes/y8cp8oXNHUY/chat  ****************************  My name is Wiktor Doktór and on daily basis I run Pro Progressio Club https://klub.proprogressio.pl - it's a community of many private companies and public sector organizations that care about the development of business relations in the B2B model. In the Good Morning BSS World podcast, apart from solo episodes, I share interviews with experts and specialists from global BPO/GBS industry.If you want to learn more about me, please visit my social media channels:YouTube - https://www.youtube.com/c/wiktordoktorHere is also link to the English podcasts Playlist - https://bit.ly/GoodMorningBSSWorldPodcastYTLinkedIn - https://www.linkedin.com/in/wiktordoktorYou can also write to me. My email address is - kontakt(@) wiktordoktor.pl  ****************************  This Podcast is supported by Patrons:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński https://www.linkedin.com/in/damian-ruci%C5%84ski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/  If you like my podcasts give a like, subscribe and join Patrons of Good Morning BSS World as well. Here are two links to do so:Patronite - https://patronite.pl/wiktordoktor  Patreon - https://www.patreon.com/wiktordoktor Or if you liked this episode and would like to buy me virtual coffee, you can use this link https://www.buymeacoffee.com/wiktordoktor - by doing so you support the growth and distribution of this podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/good-morning-bss-world--4131868/support.

In this episode of Good Morning BSS World, I connect across the Atlantic with Ahmed Refky, CEO of Planovate — an advisory firm based in Orlando, Florida, specializing in the CX and BPO sectors. With more than 25 years of global experience, Ahmed brings a wealth of insights on growth strategies, market entry, offshoring, and scaling for companies seeking to expand their customer experience operations.Drawing from his recent visit to Georgia, a rising star among emerging outsourcing destinations, Ahmed outlines the fundamentals of how markets - both new and mature - can position themselves to attract clients and investors. He stresses the importance of defining a clear value proposition, building strong people-first teams, and developing credible client references before profitability.We explore two key scenarios: how emerging destinations can become visible to global investors, and how established service providers can assess when and where to expand. From nailing down go-to-market strategies to balancing nearshore and offshore models, Ahmed provides practical frameworks based on real-world consulting experience.Crucially, Ahmed reminds us: “Relationships can't be built behind screens.” He urges stakeholders to blend physical presence with digital engagement, and avoid the trap of overselling. Whether you're a country looking to attract FDI or a BPO aiming to scale abroad, this episode is packed with actionable takeaways.Tune in for strategic insights, market dynamics, and real-world success stories that can help guide your next move in the global CX and BPO landscape.  Key points of the podcast:Identifying and focusing on a clear value proposition is crucial for both emerging destinations and service providers to attract and retain clients effectively.Building strong, face-to-face relationships and understanding cultural affinities are essential components for successful client engagement and business growth.Overselling capabilities can damage trust and reputation, making it vital to accurately represent what can be realistically delivered.  Links:Ahmed Refky on Linkedin – https://www.linkedin.com/in/ahmedrefky/Planovate - https://www.planovate.com/Talk to AI about this episode - https://gmbw.onpodcastai.com/episodes/nznooWH2LTo/chat  ****************************  My name is Wiktor Doktór and on daily basis I run Pro Progressio Club https://klub.proprogressio.pl - it's a community of many private companies and public sector organizations that care about the development of business relations in the B2B model. In the Good Morning BSS World podcast, apart from solo episodes, I share interviews with experts and specialists from global BPO/GBS industry.If you want to learn more about me, please visit my social media channels:YouTube - https://www.youtube.com/c/wiktordoktorHere is also link to the English podcasts Playlist - https://bit.ly/GoodMorningBSSWorldPodcastYTLinkedIn - https://www.linkedin.com/in/wiktordoktorYou can also write to me. My email address is - kontakt(@) wiktordoktor.pl  ****************************  This Podcast is supported by Patrons:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński https://www.linkedin.com/in/damian-ruci%C5%84ski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/  If you like my podcasts give a like, subscribe and join Patrons of Good Morning BSS World as well. Here are two links to do so:Patronite - https://patronite.pl/wiktordoktor  Patreon - https://www.patreon.com/wiktordoktor Or if you liked this episode and would like to buy me virtual coffee, you can use this link https://www.buymeacoffee.com/wiktordoktor - by doing so you support the growth and distribution of this podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/good-morning-bss-world--4131868/support.

Today on The Natural Birth Podcast we have Megan.Megan is a mama of two who's had two hospital births. She really wanted a home birth but her husband was not comfortable with that and so she wasn't either.To have a natural birth in a hospital today is almost impossible, especially without a kick ass birth advocate by your side and lots of education beforehand. You're stepping into their territory that pathologises birth with their interventions, policies and guidelines. This is just a fact.To have a natural birth today you need to get lucky with who's on shift, have a really quick birth or for the birth suits to be really busy so they have to leave you alone or have a birth support person there to advocate and protect your birth space.It's important to understand the reality you are choosing in order to make informed decisions. With this in mind, here are Megan's stories for all of you who are planning a natural hospital birth. Both Megan's births were with midwives but in different states. One in Alabama and one in South Carolina. She shares that her first was empowering as it was vaginal birth after induction. And just because you have midwives does not equate a better birth outcome. It all depends on their birth philosophy, their education and experience as well as where they work and for whom.Megan's second birth was an even better experience because she got to labor and birth in the water. She did however agree to a painful membrane sweep and to IV antibiotics for GBS+ status, which we will dive deeper into for your knowledge as many women face this decision in pregnancy.If you are, like many women, planning a natural hospital birth then please go and download my free ebook on the most common routine hospital birth procedures so that you can make a birth plan according to your wishes and that will help you optimize your chances of a natural birth.Find it at sacredbirthinternational.com under free resources or via the link in the show notes.Want to work with Anna or join The Sacred Birth Worker Mentorship?Find Anna's Website, about her Mentorship & How to Work with Her, as well as all Links & Resources she mentions in the episode here: www.sacredbirthinternational.com/links-podcast

In 130 episode of Good Morning BSS World, I reconnect with Rod Jones, patron and co-founder of the Africa Federation of GBS Associations, to explore the latest developments in Africa's rapidly expanding Global Business Services (GBS) landscape. Broadcasting from Johannesburg, Rod provides a regional update across Southern, Northern, Western, Eastern, and Central Africa. From the YES youth employment program in South Africa and government-backed strategic roadmaps in Ghana and Rwanda, to massive foreign investments flowing into Egypt, this episode paints a vivid picture of a continent on the rise in the BPO/GBS space. Highlights include:Egypt's booming CX sector with Concentrix, IGT Solutions, and VXI targeting nearly 50,000 new jobs by 2028.Cameroon's surprising BPO potential, including a multilingual workforce and 400,000 German speakers!Ghana's 5-year GBS development plan with full governmental endorsement.Ethiopia and Rwanda's structured approaches to national GBS strategy and incubation.The formation of new country-level associations and a forthcoming advisory board of global GBS leaders.Rod also touches on international interest in Johannesburg as a future BPO hub and plans for the Africa Federation's high-level gathering in Addis Abeba this September. Tune in to discover why Africa is becoming a powerhouse for global outsourcing and how collaboration, innovation, and investment are transforming its GBS landscape.    Links:Rod Jones - https://www.linkedin.com/in/rodjonessouthafrica/Africa Federation of GBS Associations - https://africagbsfederation.org/Africa Federation of GBS Associations on Linkedin - https://www.linkedin.com/company/africa-gbs-federation/posts/?feedView=allTalk to AI about this episode - https://gmbw.onpodcastai.com/episodes/uXomTVdxgZj/chatElevate Africa - https://www.weelevateafrica.org/Follow the Leaders - https://followtheleaders.pl/  ****************************  My name is Wiktor Doktór and on daily basis I run Pro Progressio Club https://klub.proprogressio.pl - it's a community of many private companies and public sector organizations that care about the development of business relations in the B2B model. In the Good Morning BSS World podcast, apart from solo episodes, I share interviews with experts and specialists from global BPO/GBS industry.If you want to learn more about me, please visit my social media channels:YouTube - https://www.youtube.com/c/wiktordoktorHere is also link to the English podcasts Playlist - https://bit.ly/GoodMorningBSSWorldPodcastYTLinkedIn - https://www.linkedin.com/in/wiktordoktorYou can also write to me. My email address is - kontakt(@) wiktordoktor.pl  ****************************  This Podcast is supported by Patrons:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński https://www.linkedin.com/in/damian-ruci%C5%84ski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/  If you like my podcasts give a like, subscribe and join Patrons of Good Morning BSS World as well. Here are two links to do so:Patronite - https://patronite.pl/wiktordoktor  Patreon - https://www.patreon.com/wiktordoktor Or if you liked this episode and would like to buy me virtual coffee, you can use this link https://www.buymeacoffee.com/wiktordoktor - by doing so you support the growth and distribution of this podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/good-morning-bss-world--4131868/support.

Christy shares her whirlwind VBAC story after two vaginal births and a Cesarean. After testing GBS positive, Christy made the intentional decision to deliver at a hospital she deeply trusted, even though it was 1.5 hours from home. But when labor kicked in fast and hard, she barely made it in time. Her birth progressed so quickly that while she ultimately had the birth she hoped for, she still needed to grieve the slower, more peaceful experience she had envisioned. During her VBAC, Christy thought she wouldn't want to be touched—yet touch grounded her. She expected to find comfort in music and calm mantras—but discovered she was more motivated by direct, no-nonsense encouragement. Her ability to adapt came from deep trust and confidence both in herself and in her carefully chosen team.Christy's story is for anyone who needs a reminder that your birth story, even when unpredictable, can still be just what you need.Needed Website: Code VBAC20 for 20% OffCoterie Diapers - Use code VBAC20 for 20% OffHow to VBAC: The Ultimate Prep Course for ParentsOnline VBAC Doula TrainingSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Join us in this solo-cast of the Birth Lounge podcast where HeHe dives into a Q&A from her instagram community!  In this episode, she is addressing some of your most pressing questions about pregnancy, labor, and postpartum. Topics covered include the differences between 'on paper' and actual pregnancy weeks, the nuances of cervical checks and how to decline them, navigating anxiety and nutrition during early pregnancy, how to handle airport security while pregnant, and the intricacies of declining certain medical procedures like membrane sweeps and scheduled C-sections. HeHe also shares essential tips on dealing with family visits to newborns and addressing the impact of GBS testing and breech births. Don't miss this episode to help ensure a healthy and autonomous pregnancy and birthing experience. 00:00 Introduction and Zero Tolerance Policy 00:56 Welcome to the Birth Lounge Podcast 01:24 How to Get Your Questions Answered 03:15 Understanding Pregnancy Weeks 05:59 Declining Cervical Checks 11:42 Coping with Pregnancy Anxiety and Weight Loss 14:14 Traveling While Pregnant 18:11 Declining a Scheduled C-Section for Breech Baby 22:44 Managing Weight Monitoring During Prenatal Visits 26:57 Group B Strep Testing Concerns 30:57 Membrane Sweeps: Risks and Benefits 32:04 Setting Boundaries for Newborn Visits 36:05 Addressing Concerns About VBAC 45:14 Conclusion and Final Thoughts INSTAGRAM: Connect with HeHe 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!   LINKS MENTIONED: Pushing Freebie: https://www.thebirthlounge.com/pushing   Secret Sauce to Pushing Course: https://www.thebirthlounge.com/secretsaucetopushing   GBS information: https://evidencebasedbirth.com/groupbstrep/   Membrane Sweep, Ep. 268: https://open.spotify.com/episode/5V41R8PDhH2Kia48mdqdub?si=kz6gtEh6SJGIGOz_pT1j6w&nd=1&dlsi=7b03c32c4cd24188   Radiation when Flying:  https://www.cdc.gov/radiation-health/data-research/facts-stats/air-travel.html https://www.tsa.gov/videos/travel-tips-pregnant-travelers https://www.epa.gov/radtown/radiation-and-airport-security-scanning https://pmc.ncbi.nlm.nih.gov/articles/PMC153688/ https://www.arpansa.gov.au/understanding-radiation/radiation-sources/more-radiation-sources/flying-and-health https://www.scientificamerican.com/article/air-travel-exposes-you-to-radiation-how-much-health-risk-comes-with-it/   Don't weigh me cards: https://more-love.org/product/dont-weigh-me-cards-postage/  

On this episode of Men of Steel, Case and Jmike are joined by nerd about town Adam Lance Garcia to dive into one of the perenial crossovers of the '70s: Superman vs. The Amazing Spider-Man! We talk tabloid-sized team-ups, Bronze Age bravado, and what happens when DC and Marvel let their icons share a skyline. Who wins? … I mean… It's Superman. It's obviously Superman. But that said, it's a blast of a conversation, so tune in, True Believers! Check out Adam's Stuff: The Green Lama: https://podcasts.apple.com/us/podcast/the-green-lama/id1593061792 From A Certain Point of View: https://a.co/d/fiY396f   Overview Adam Lance Garcia, an established Star Wars author, shares his early fandom of Superman sparked by the 1976 Christopher Reeve film and its lasting influence on his work. The 1976 Superman vs. The Amazing Spider-Man marks the first DC/Marvel superhero crossover with a creative team that includes Gerry Conway and Stan Lee, highlighting its historical significance in comic book history. The story features a 92-page length with 36 pages dedicated to prologues to set character dynamics effectively, a considerable feat for comics at that time. Character interactions are facilitated by a news convention setting, notably altering the traditional roles of Superman as he works as a TV anchor at GBS. Lex Luthor emerges as the primary villain, while Doc Ock's role remains secondary, demonstrating the power dynamics within the narrative. Unique plot devices, such as a red sun ray that allows Spider-Man to challenge Superman, illustrate creative solutions for character conflicts. The discussion reveals dated elements in the narrative, particularly an Africa sequence deemed problematic, albeit 'well-intentioned' for its time. Comparisons to superior crossovers like JLA/Avengers emphasize shortcomings in Superman vs. The Amazing Spider-Man, particularly regarding character integration and narrative depth. Iconic moments in the comic, including Spider-Man's ineffective punches and Peter Parker saving Lois Lane, highlight successful character interactions that resonate with fans. Notes ️ Podcast Introduction & Guest Background (00:00 - 03:10) Case Aiken and Jmike Folson host Men of Steel podcast discussing Superman vs. The Amazing Spider-Man Adam Lance Garcia joins as guest, established Star Wars author with extensive comic book background Superman was Garcia's first fandom, introduced through 1976 Christopher Reeve film, called it 'Super S' as child Comic Book Historical Context (04:31 - 53:25) Superman vs. The Amazing Spider-Man (1976) - first DC/Marvel superhero crossover, technically second collaboration after Wizard of Oz project Creative team: Gerry Conway (writer), Ross Andrew (artist), Dick Giordano (inker), Carmine Infantino and Stan Lee (editors) Neal Adams uncredited for redrawing Superman panels, John Romita Sr. redrew Marvel character faces for house style consistency 92-page story with 36 pages of prologues - significant length for 1976 comic Story Structure Analysis (11:49 - 24:04) Three prologues establish characters: Superman vs. giant robot, Spider-Man vs. Doc Ock, villains team up in prison Main story set at news convention in New York, allows natural meeting of characters Superman working as TV anchor at GBS (not Daily Planet reporter) creates awkward dynamic for classic Superman storytelling ️ Character Dynamics & Plot Elements (47:12 - 01:44:08) Lex Luthor dominates as alpha villain, Dr. Octopus relegated to secondary role throughout story Red sun ray device allows Spider-Man to physically fight Superman by weakening him Plot contrivances include fake Superman kidnapping Lois Lane and Mary Jane to force hero conflict ️ Problematic Elements Discussion (01:49:59 - 01:30:03) Africa sequence identified as dated and problematic, though noted as 'well-intentioned' for its era Ms./Miss distinction scene between Mary Jane and Lois Lane reflects 1970s women's liberation discourse Various plot holes and inconsistencies discussed, including gravity fight scene logic Crossover Comparisons (01:05:02 - 01:20:54) JLA/Avengers by Busiek and Perez cited as superior crossover example with lasting consequences Superman/Hulk crossover praised for using iconic character versions rather than current continuity Batman/Captain America crossover noted for better integration of characters' respective worlds Positive Aspects Highlighted (01:06:14 - 01:19:30) Iconic moments: Spider-Man punching ineffectively at Superman, two-page spread of first encounter Peter Parker saving Lois Lane scene appreciated as natural universe mixing J. Jonah Jameson and Morgan Edge drinking scene shows potential for character interactions Historical Significance (53:53 - 01:38:37) Comic serves as important archaeological artifact showing evolution of crossover storytelling Earth Dollar Sign - joking designation for shared universe setting Foundation for future DC/Marvel collaborations despite narrative shortcomings  

They said she'd never walk again. They were dead wrong.Holly's battle with Guillain-Barré Syndrome left her paralyzed and fighting for her life. Now she's fighting to tell her story—raw, unfiltered, and without permission. This isn't your typical medical recovery podcast. It's a brutal awakening to what happens when your body betrays you and the healthcare system fails you simultaneously.Each week, Holly exposes the harsh realities of GBS recovery that doctors don't warn you about, shares battle-tested strategies that actually work, and interviews survivors who refused to become statistics.Your body may have limitations, but your spirit shouldn't be one of them.Follow Holly's journey: Instagram: @hollyaftergbs Facebook: facebook.com/hollyaftergbs YouTube: youtube.com/hollyaftergbsWelcome to the No BS Wealth Podcast with Stoy Hall, your candid guide to financial clarity. In our third year, we're spicing things up by enhancing community ties and bringing you straight, no-fluff financial insights. Connect with us on NoBSWealthPodcast.com, and follow Stoy on social media for the latest episodes and expert discussions. Tune in, join the conversation, and transform your financial journey with us—no BS!As always we ask you to comment, DM, whatever it takes to have a conversation to help you take the next step in your journey, reach out on any platform!Twitter, FaceBook, Instagram, Tiktok, LinkedinDISCLOSURE: Awards and rankings by third parties are not indicative of future performance or client investment success. Past performance does not guarantee future results. All investment strategies carry profit/loss potential and cannot eliminate investment risks. Information discussed may not reflect current positions/recommendations. While believed accurate, Black Mammoth does not guarantee information accuracy. This broadcast is not a solicitation for securities transactions or personalized investment advice. Tax/estate planning information is general - consult professionals for specific situations. Full disclosures at www.blackmammoth.com.

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In this 125th episode of the Good Morning BSS World podcast, I welcome back Rod Jones -renowned CX strategist and advisor to the African BPO & GBS Federation - for our sixth engaging conversation. This month's talk spans the continent, from Egypt to Ghana, and introduces new countries like Benin into the outsourcing dialogue. Rod shares valuable updates, including:Egypt's presence at GITEX Africa and Berlin's GIZ roadshowNigeria's government-backed “Outsource to Nigeria” initiativeAI's evolving impact on African BPO/GBS - balancing automation with employmentThe Federation's new handbook to guide emerging BPO associationsBenin's rise as a new player on the outsourcing mapInsights into the upcoming Elevate Africa conference in EthiopiaPlus, we discuss how Africa is positioning itself globally, with support from global players like Teleperformance and Concentrix, and future plans for a structured federation advisory board. If you're in the outsourcing industry, this episode is a must-listen for insights into Africa's rapidly evolving BPO/GBS scene!  Key points of the podcast:The African BPO and GBS landscape is expanding with new members like Ghana, Benin, and Morocco joining the federation.The federation's new association handbook aims to guide countries in establishing and formalizing their own BPO and GBS associations.AI's impact on the BPO and GBS industry is a hot topic, with discussions focused on balancing technological advancement with job creation.  Links:Rod Jones - https://www.linkedin.com/in/rodjonessouthafrica/Africa Federation of GBS Associations - https://africagbsfederation.org/Africa Federation of GBS Associations on Linkedin - https://www.linkedin.com/company/africa-gbs-federation/posts/?feedView=allTalk to AI about this episode - https://gmbw.onpodcastai.com/episodes/ET9JzjsuvRm/chatElevate Africa - https://www.weelevateafrica.org/  ****************************  My name is Wiktor Doktór and on daily basis I run Pro Progressio Club https://klub.proprogressio.pl - it's a community of many private companies and public sector organizations that care about the development of business relations in the B2B model. In the Good Morning BSS World podcast, apart from solo episodes, I share interviews with experts and specialists from global BPO/GBS industry.If you want to learn more about me, please visit my social media channels:YouTube - https://www.youtube.com/c/wiktordoktorHere is also link to the English podcasts Playlist - https://bit.ly/GoodMorningBSSWorldPodcastYTLinkedIn - https://www.linkedin.com/in/wiktordoktorYou can also write to me. My email address is - kontakt(@) wiktordoktor.pl  ****************************  This Podcast is supported by Patrons:Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński https://www.linkedin.com/in/damian-ruci%C5%84ski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/Anna Czyż - https://www.linkedin.com/in/anna-czyz-%F0%9F%94%B5%F0%9F%94%B4%F0%9F%9F%A2-68597813/Igor Tkach - https://www.linkedin.com/in/igortkach/  If you like my podcasts give a like, subscribe and join Patrons of Good Morning BSS World as well. Here are two links to do so:Patronite - https://patronite.pl/wiktordoktor  Patreon - https://www.patreon.com/wiktordoktor Or if you liked this episode and would like to buy me virtual coffee, you can use this link https://www.buymeacoffee.com/wiktordoktor - by doing so you support the growth and distribution of this podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/good-morning-bss-world--4131868/support.

Morgan re-joins the boyz and talks GBS joins the Circle of Honor, Nordecke sneaky time, and Vancouver (both poison and game). Check links below: Pursuit: @pursuityourselfHanif Abdurraqib: @NifMuhammadBird: @cgmaciel.bsky.socialCapyBrava: @capybrava.bsky.socialhttps://ahernandezart.comBecome part of the Discord family: discordecke.soccerSupporter Supply: https://www.supportersupply.co/  Code for free delivery:  upper90boyz (that's boys with a Z)Minnows: https://linktr.ee/minnowshttps://sirkbook.com/https://nordecke.com/Podcasts are available on Spotify, Apple Podcast, and all podcast apps. Now on YouTube, with video, and the faces!  Not seeing us somewhere? Email us Check us out on our Social Media Platforms and feel free to email us! We're totally literate and will 100% read anything you send, promise.Songs by Nick Tolford and Company https://ntac.bandcamp.com/track/boys-night-outSIGN UP TO BE PART OF THE NORDECKE!  Here - https://nordecke.com/Subscribe to our channel for more soccer content:-Email us:  podcast@upper90club.com-Follow us on Twitter: https://twitter.com/Upper90ClubPod-Like us on Facebook: https://www.facebook.com/groups/upper90clubpod-Follow us on Instagram: https://www.instagram.com/upper90clubpod/-Apple Music: https://podcasts.apple.com/us/podcast/upper-90-club/id1647214221-Spotify: https://open.spotify.com/show/1xnYAtnQ8tThdn5JWX6c24-Linktree: https://linktr.ee/upper90clubpod#VamosColumbus | #Crew96 | #Upper90Club | #R96TS#SoccerPodcast #Podcast #ColumbusCrewPodcast

Welcome to the 123rd episode of "Good Morning BSS World" podcast! Today we're heading straight to the heart of Africa's rapidly evolving BPO and GBS landscape. My special guest is Rod Jones, Owner of Rod Jones Contact Centre Consulting and a leading voice in Africa's outsourcing sector. Connecting with us from Johannesburg, Rod brings exclusive updates from the Africa Federation of GBS Associations and shares firsthand insights following his recent participation at the CxOutsourcers event in Munich.In this episode, Rod provides a comprehensive regional update on Africa's BPO and ITO sectors. We discuss the Federation's impressive growth-now boasting nine full member countries and seven candidates, with a vision to reach 20 members by the end of 2025. Rod highlights the collaborative spirit and knowledge sharing that are driving professionalization and best practices across the continent.We delve into the latest developments in Southern Africa, including South Africa's refreshed value proposition and ongoing government incentives, as well as emerging associations in Namibia and Zimbabwe. Rod also shares news from East Africa, where Kenya and Ethiopia are launching new initiatives and associations, and Central Africa, with Rwanda and Uganda making significant policy strides. West Africa's dynamic progress in Nigeria and North Africa's exciting developments in Morocco, Tunisia, and Egypt round out a truly pan-African perspective.A major theme is the rise of ethical impact sourcing, empowering underprivileged communities and women, with strong support from the CxOutsourcers community. Rod also touches on the critical need for digital skills development to keep Africa competitive in the global outsourcing arena.Tune in for a unique, in-depth look at Africa's BPO future-its challenges, achievements, and the collaborative energy shaping the next chapter of global business services!  Key points of the podcast:Africa's BPO sector is rapidly expanding, with significant growth in digital skills development and international investment across various regions.The Africa Federation now includes nine full member countries and seven candidate countries, aiming to have 20 member countries by the end of 2025.Ethical impact sourcing is becoming a fundamental pillar in the BPO industry, focusing on integrating underprivileged communities, women, and refugees into the workforce.  Links:Rod Jones - https://www.linkedin.com/in/rodjonessouthafrica/Africa Federation of GBS Associations - https://africagbsfederation.org/Africa Federation of GBS Associations on Linkedin - https://www.linkedin.com/company/africa-gbs-federation/posts/?feedView=allTalk to AI about this episode - https://gmbw.onpodcastai.com/episodes/Dq05MYOX3bM/chatWebinar (May 29th, 2025): https://us02web.zoom.us/webinar/register/WN_hedlE0itSsq-j9gOetomTQ#/registration  ****************************  My name is Wiktor Doktór and on daily basis I run Pro Progressio Club https://klub.proprogressio.pl - it's a community of many private companies and public sector organizations that care about the development of business relations in the B2B model. In the Good Morning BSS World podcast, apart from solo episodes, I share interviews with experts and specialists from global BPO/GBS industry.If you want to learn more about me, please visit my social media channels:YouTube - https://www.youtube.com/c/wiktordoktorHere is also link to the English podcasts Playlist - https://bit.ly/GoodMorningBSSWorldPodcastYTLinkedIn - https://www.linkedin.com/in/wiktordoktorYou can also write to me. My email address is - kontakt(@) wiktordoktor.pl  ****************************  This Podcast is supported byPatrons: Marzena Sawicka https://www.linkedin.com/in/marzena-sawicka-a9644a23/Przemysław Sławiński https://www.linkedin.com/in/przemys%C5%82aw-s%C5%82awi%C5%84ski-155a4426/Damian Ruciński https://www.linkedin.com/in/damian-ruci%C5%84ski/Szymon Kryczka https://www.linkedin.com/in/szymonkryczka/Grzegorz Ludwin https://www.linkedin.com/in/gludwin/Adam Furmańczuk https://www.linkedin.com/in/adam-agilino/  If you like my podcasts you can join Patrons of Good Morning BSS World as well. Here are two links to do so:Patronite - https://patronite.pl/wiktordoktor  Patreon - https://www.patreon.com/wiktordoktor Or if you liked this episode and would like to buy me virtual coffee, you can use this link https://www.buymeacoffee.com/wiktordoktor - by doing so you support the growth and distribution of this podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/good-morning-bss-world--4131868/support.

In part three of his series on the unifications of Germany and Italy, Dan talks about the turbulent 1850s and early 60s. In Germany, this is a time of mass industrialization. With the regional economy growing at a record pace, Prussia and Austria engage in saber-rattling diplomacy over the future of the German Confederation.   Meanwhile, the new King of Piedmont-Sardinia, Victor Emmanuel II, aims to do what his father could not: conquer all of Italy. Taking advantage of Austrian weakness – and a burgeoning alliance with France – he and three other men will engineer a revolution that unites the Apennine Peninsula for the first time since the Roman Empire.   TABLE OF CONTENTS: Chapter One: The German Question – 00:04:22 Chapter Two: The Erfurt Union – 00:30:15 Chapter Three: The (Austrian) Empire Strikes Back – 00:42:24 Chapter Four: Enter Bismarck – 01:03:59 Chapter Five: Goodbye, Friedrich Wilhelm – 01:32:59 Chapter Six: Repression in Lombardy – 01:41:19 Chapter Seven: Enter Camillo Cavour – 01:51:20 Chapter Eight: Enter Victor Emmanuel – 02:04:32 Chapter Nine: The Crimean War – 02:17:48 Chapter Ten: Engineering a Revolution – 02:39:34 Chapter Eleven: The War for Northern Italy – 03:05:02 Chapter Twelve: The Expedition of the Thousand – 03:34:34 Chapter Thirteen: The Dictator of Sicily – 04:14:24 Chapter Fourteen: The Conquest of Southern Italy – 04:28:49 Chapter Fifteen: The Proclamation of the Kingdom of Italy – 04:51:04 Chapter Sixteen: Rome and the Risorgimento – 05:13:43   SUBSCRIBE TO RELEVANT HISTORY, AND NEVER MISS AN EPISODE! Relevant History Patreon: https://bit.ly/3vLeSpF Subscribe on Spotify: https://spoti.fi/38bzOvo Subscribe on Apple Music (iTunes): https://apple.co/2SQnw4q Subscribe on Any Platform: https://bit.ly/RelHistSub Relevant History on Twitter/X: https://bit.ly/3eRhdtk Relevant History on Facebook: https://bit.ly/2Qk05mm Official website: https://bit.ly/3btvha4 Episode transcript (90% accurate): https://docs.google.com/document/d/e/2PACX-1vTILtf6-xAur_LTmOc_UJ7iH-H3L0l_O_jUjd2CwhN9q3CWJV6zM2UCbss4HP1saanj2jSurstKqKX0/pub/ Music credit: Sergey Cheremisinov - Black Swan   SOURCES: Derek Beales and Eugenio F. Biagini, The Risorgimento and the Unification of Italy David Blackbourn, The Long Nineteenth Century: A History of Germany 1780-1918 – https://www.scribd.com/document/261666797/Long-Nineteenth-Century-History-of-Germany-1780-1918-the-David-Blackbourn Carlo Bossoli, The War in Italy Tim Chapman, The Risorgimento: Italy 1815-71 – https://read.amazon.com/?asin=B003SNK19G&ref_=dbs_t_r_kcr Gordon A. Craig, Germany 1866-1945 Erich Eyck, Bismarck and the German Empire Charles Stuart Forbes, The Campaign of Garibaldi in the Two Sicilies: A Personal Narrative Giuseppe Garibaldi, Autobiography of Giuseppe Garibaldi – -Volume 1: https://archive.org/details/autobiographyofg0001gari/page/n3/mode/2up -Volume 2: https://archive.org/details/autobiographyofg0002gari/page/n3/mode/2up  -Supplement by Jesse White Mario: https://archive.org/details/autobiographyofg0003gari/page/4/mode/2up E.E.Y. Hales, Pio Nono: A Masterful Study of Pius IX and His Role in Nineteenth-Century European Politics and Religion Denis Mack Smith, Cavour, a Biography Denis Mack Smith, Cavour and Garibaldi, 1860: A Study in Political Conflict Denis Mack Smith, The Making of Italy, 1796-1870 – https://archive.org/details/makingofitaly1790000mack/page/n3/mode/2up Denis Mack Smith, Mazzini Denis Mack Smith, Modern Italy, A Political History Denis Mack Smith, Victor Emanuel, Cavour, and the Risorgimento Giuseppe Mazzini, Address to Pope Pius IX, On His Encyclical Letter – https://play.google.com/books/reader?id=YURTAAAAcAAJ&pg=GBS.PP4&hl=en Damian McElrath, The Syllabus of Pius IX: Some Reactions in England The New York Times, The Attempted Assassination of the Emperor of the French - https://timesmachine.nytimes.com/timesmachine/1858/02/09/78528596.pdf Robin Okey, The Habsburg Monarchy: From Enlightenment to Eclipse – https://archive.org/details/habsburgmonarchy0000okey/page/n5/mode/2up Jürgen Osterhammel, The Transformation of the World, A Global History of the Nineteenth Century – https://www.everand.com/read/261688401/The-Transformation-of-the-World-A-Global-History-of-the-Nineteenth-Century Alan Palmer, Twilight of the Habsburgs: The Life and Times of Emperor Francis Joseph – https://archive.org/details/twilightofhabsbu0000palm Pope Pius IX, The Syllabus of Errors: https://www.papalencyclicals.net/pius09/p9syll.htm Trevor Royle, Crimea, The Great Crimean War 1854-1856 Frederick C. Schneid, The Second War of Italian Unification 1859-61 James J. Sheehan, German History, 1770-1866 (Oxford History of Modern Europe) Jonathan Steinberg, Bismarck: A Life

 On this episode of the "Gen AI Breakthrough Podcast", host Penny Weller speaks with Opella's Karan R Bhatia about the critical role of branding for Global Business Services (GBS) hubs in a world increasingly influenced by Gen AI. Tune in to get answers to strategic questions like – Why having a reputation as a GBS hub can be beneficial to a company? How can Gen AI be an enabler for companies in this quest? What is a good way to measure success or return on investment 

After an unexpected and terrifying health crisis, I'm finally back behind the mic with a raw and real update!! In this episode, I walk you through my recent journey with a rare autoimmune condition called Guillain Barré Syndrome —how it started, what I've learned, and how I'm healing physically, emotionally, and spiritually. From medical gaslighting to deep nervous system healing and the beauty of reconciliation, this story is full of hard-won wisdom, vulnerability, and hope. If you've ever felt ignored by the medical system or frozen by anxiety, this one's for you.Key Points:•What happened to me: A rare condition (GBS) that flipped my world upside down•Lessons in self-advocacy, intuition, and emotional recovery•How nervous system regulation and belief work have become key in my healing•A beautiful surprise reunion that reminded me love can heal anythingKeywords:GBS recovery, health crisis, nervous system healing, somatic coaching, medical advocacy, belief work, autoimmune healing, reconciliation, emotional trauma, somatic nervous system, financial resilience⭐️Check out my 1:1 Money Magic Mentorship Program here. ________________________________________________ Thank you for being here ❤️ If this podcast is a helpful resource for you, please share it with your friends, on social media. It will be extremely helpful if you could also leave a 5-star rating and review on Apple Podcasts and Spotify!Connect with me on Instagram for free tips, inspo: https://www.instagram.com/nadinezumot/ ~Podcast theme song by The Jilted Irony

In this solo episode, HeHe dives into the questions flooding her DMs—covering some of the most common (and confusing) topics in pregnancy and birth! We're unpacking 39-week inductions, what to do when you're told your baby is “too big,” navigating a GBS+ diagnosis, using upright positions during labor, the truth about hydrotherapy, and what your options really are when your water breaks at term. This episode is packed with evidence-based insight and empowering guidance to help you feel informed, confident, and in control of your birth choices.   SOCIAL MEDIA: Connect with HeHe on IG  Connect with HeHe on YouTube   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 MENTIONED: Big Baby:  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/macrosomia https://www.uptodate.com/contents/fetal-macrosomia https://evidencebasedbirth.com/wp-content/uploads/2023/02/Big-Babies-Handout.pdf     Vaccines:  https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html https://www.healthychildren.org/English/Pages/default.aspx https://evidencebasedbirth.com/ https://justtheinserts.com/     Vaccine Books: The Vaccine Book, Dr. Robert Sears The Vaccine Friendly Plan, Dr. Paul Thomas and Dr. Jennifer Margulis What Your Doctor Won't Tell You About Vaccines, Dr. Stephanie cave  Calling The ShotL Why Parents Reject Vaccines, Jennifer A. Reich  Vaccines, Autoimmunity, and the Changing Nature of Childhood Illness, Dr. Thomas Cowan    Dr. Green Mom   Hydrotherapy (Tub Use in Labor)   Infection After Water Breaks at Term   GBS: https://evidencebasedbirth.com/groupbstrep/ https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html https://neonatalsepsiscalculator.kaiserpermanente.org https://www.uptodate.com/contents/approach-to-risk-assessment-and-initial-management-of-newborns-with-risk-factors-for-early-onset-sepsis

I am joined in this podcast by Holly Frances to discuss her experience of Guillain Barre syndrome as she narrated in her illness memoir titled Life Support: Surviving Guillain-Barre Syndrome. Holly is a mother in a blended family of five, and the face behind Holly After GBS on social media, where her recovery videos have inspired millions of people around the world. Our conversation traced Holly's illness from onset with mild sensory symptoms through to complete paralysis within a short time. Importantly, she highlighted less appreciated symptoms of the disease that she experienced, particularly neck pain, a major early symptom that initially indicated a different diagnosis, and which exacerbated and spread as her illness progressed.Holly chronicled how her weakness progressed rather rapidly to complete paralysis and requirement for ventilation on the intensive care unit. We also discussed the spinal fluid analysis and electromyogram tests she had to confirm the clinical diagnosis of GBS, and the various treatments she received. Our conversation also detailed her long rehabilitation course, interspersed by relapses, and her long and slow journey to complete recovery. Significantly, Holly also explored the emotional and psychological burden that the illness placed on her, ranging from fear and anxiety to resentment and depression, and the uncertainty that plagued her mind regarding outcome. We also covered how her life and relationships changed on account of her experience of GBS, what the illness has taught her, and the advocacy work that is now the focus of her work.

 In this episode of the “Gen AI Breakthrough Podcast,” Siobhan Riggott, Vin Kumar and Martijn Geerling discuss the findings of The Hackett Group's 2025 GBS Key Issues Study. Key topics include the top challenges facing global business services (GBS) leaders – cybersecurity threats, labor costs and employee turnover—along with strategies for cost leadership, value creation, service expansion, and the growing adoption of generative artificial intelligence and digital transformation to drive future resilience. 

The wait is over. After two years and a number of interviews on For the People, the Greater Bridgeport Symphony has selected its new Music Director - so stick with us as we pick up the conversation with Eduardo Leandro, to let you know what he has in store for the upcoming GBS season.

Your gut does much more than digest food, it is a key player in your immune system, mood regulation, and overall health, especially during pregnancy. Your gut microbiome consists of trillions of bacteria, both good and bad. Maintaining a healthy balance between them is key to keeping everything functioning properly. Hear about the research on how your gut microbiome can affect common pregnancy symptoms like constipation and risks for complications like GBS and preeclampsia. Learn about the evidence on how to support a healthy gut microbiome during pregnancy and beyond, from including probiotic-rich foods in your diet to selecting a high-quality probiotic supplement.     Thank you to our sponsors   Breastfeeding doesn't always come easily or naturally, and the right education can make a big difference. The Practical Guide to Nursing Your Baby Course, created by Abby Egan, a registered labor and delivery nurse, Certified Lactation Educator, and experienced mother, walks you through everything you need to know to get breastfeeding off to a great start. The course includes lifetime access to over 4 hours of video lessons, a growing bonus content library, helpful PDFs and over 60 real-world pro tips to support you throughout your breastfeeding journey. For a limited time, Pregnancy Podcast listeners can save 20% by using the promo code PREGNANCYPODCAST at checkout at nursingyourbaby.com.   20% off Mommy Steps or Form insoles with the promo code FEET. Studies show pregnancy can make your feet grow. In one study, 61% of participants had a measurable increase in foot length, and 22% reported going up a shoe size. The thought of going up a shoe size and having to replace every pair of shoes you own might freak you out. The good news is that wearing insoles can protect your feet from going up in size.   AG1 is offering new subscribers a FREE $76 gift when you sign up. You'll get a Welcome Kit, a bottle of D3K2 AND 5 free travel packs in your first box. Even with the best diet, some nutrients can be hard to get. AG1 delivers optimal amounts of nutrients in forms that help your body thrive. Just one scoop contains essential vitamins and nutrients, supports gut health, helps you feel sharp and focused, and supports a healthy immune system. Check out DrinkAG1.com/pregnancypodcast to get a free welcome Kit, a bottle of D3K2, and 5 free travel packs in your first box.  (As a friendly reminder, pregnant or nursing women should seek professional medical advice before taking this or any other dietary supplement.)     Read the full article and resources that accompany this episode.     Join Pregnancy Podcast Premium to access the entire back catalog, listen to all episodes ad-free, get a copy of the Your Birth Plan Book, and more.     Check out the 40 Weeks podcast to learn how your baby grows each week and what is happening in your body. Plus, get a heads up on what to expect at your prenatal appointments and a tip for dads and partners.     For more evidence-based information, visit the Pregnancy Podcast website.

The wait is over. After two years and a number of interviews on For the People, the Greater Bridgeport Symphony has selected its new Music Director - so stick with us as we pick up the conversation with Eduardo Leandro, to let you know what he has in store for the upcoming GBS season. Then we'll steer ourselves toward a CT Dept. of Transportation staffer engaged in an outreach effort to help educate state residents about the agency's Active Transportation Plan. If you thought you could never have a say about how Connecticut handles transportation matters, listen in and learn how to lend your voice to improving things on our roadways. And as we try to do each April, we'll bring back an expert to discuss 8-1-1 and the state's Call Before You Dig program that could not only save residents from utility interruptions, but also helps train and educate construction professionals on the safest ways to operate when excavating.

In this episode, I delve into Guillain Barre syndrome, a relatively common neurological disorder. I discuss the clinical manifestations of the disease which range from fairly rapid weakness and sensory impairment to pain and breathing difficulty. I also detail the long road to recovery from the disease. The podcast also discusses the almost limitless triggers for GBS, from infections and vaccinations to trauma and childbirth. I also review the pathology of the disease, explaining how a wide range of antibodies target the fatty myelin covering of the nerves to reduce the efficiency of electrical nerve transmission. The podcast also highlights the investigations of GBS, particularly spinal fluid analysis and nerve conduction studies, and the treatment of the disease, which canter around immune modulating agents. I also chronicle the history of the terminology of GBS, following the work of the three French physicians, Georges Guillain, Jean Alexandre Barré, and André Strohl. I refer in this theme to the book 'Guillain-Barre Syndrome: From Diagnosis to Recovery', by Gareth Parry and Joel Steinberg.I illustrate the clinical aspects of GBS with such graphic patient memoirs as those of Carole Williams, titled 'Chaos in Body and Mind', of Meg Lumsden, titled 'Unknown', of Wenesday Ketron titled 'Geeyahn What?', of Scott Earle titled 'The Wave of Guillain Barre Syndrome', and of Robin Sheppard titled 'A Solitary Confinement'.

Bacteria called group B Streptococcus (group B strep, GBS) commonly live in people's gastrointestinal and genital tracts. The gastrointestinal tract is the part of the body that digests food and includes the stomach and intestines. The genital tract is the part of the body involved in reproduction and includes the vagina in women. Most of the time the bacteria are not harmful and do not make people feel sick or have any symptoms. Sometimes the bacteria invade the body and cause certain infections, which are known as GBS disease. ​ GBS bacteria can cause many types of infections: Bacteremia (bloodstream infection) and sepsis (the body's extreme response to an infection) Bone and joint infections Meningitis (infection of the tissue covering the brain and spinal cord) Pneumonia (lung infection) Skin and soft-tissue infections GBS most commonly causes bacteremia, sepsis, pneumonia, and meningitis in newborns. It is very uncommon for GBS to cause meningitis in adults. (CDC)

In this episode we have a GBS outing with some interesting people.  Cobra Kai has officially ended and Carrie gives her spoiler free review.  March Madness is here and so is our special GBS bracket that has nothing to do with basketball.  A trip to Mars or cash and prizes for a perfect bracket, when is charcuterie not charcuterie, a new way to consume ketchup, get the juice without getting the pickle and more!

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

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

Podcast Listener Special Sale: code SOFPREP25 for 25% offSFAS PrepSOF Selection Recovery & Nutrition GuideEnds 7 March at 11:59PMToday's question topics-Sleep in SUT-Ruck standards for SFAS-18X vs. big Army then SF-TTM BJJ Program in future?-1 year Plan Pre Airforce PJ Pipeline-Speed work on leg day?-My all time Squat, Bench, DL, 1mi, 2mi, 5mi PRs-Oldest person to get selected-Important biomarkers on labs-tips for optimizing selection prep program-How to navigate sh*tbag teammates at BUD/S & SFAS-Programming for CAG selection-Best program for pre-OSUT (18X)-Combining programs (good idea?)-Life experience and selection chances-Timing selection prep programs-How old school GBs prepped for SFAS-Cadence on slower vs. faster runs-How to become more durable-ODAs I served on-My recommended ruck/run standards pre SFASNew Program:Jacked Gazelle 2.0EBook: SOF Selection Recovery & Nutrition GuidePrograms, articlesNew Training Team on TrainHeroic: T-850 Rebuilt (try a week for free!)terminatortraining.com2 & 5 Mile Run Program - run improvement program w/ strength workKickstart- beginner/garage gym friendlyTime Crunch- Workouts for those short on timeHypertrophy- intermediate/advancedJacked Gazelle- Hybrid athleteSFAS Prep- Special forces train-upTrainHeroic- App based bodybuilding programFollow me:SubstackNewsletter Sign UpIG: terminator_trainingTwitter: @ksterminatortmyoutube: Terminator Training MethodFacebook: Terminator Training

In this episode we deliver a GBS health PSA.  College basketball is still borderline unwatchable and possible getting worse.  What tv show cast would we like to play a sport against, why you should never leave your wallet in your car, a very different type of fast food promotion, Subway is getting desperate, the mustache is the only acceptable facial hair in baseball and more!

We start off talking about BBQ python videos from Florida, then we discuss the Delta plane crash in Canada and listen to some audio from one of the passengers.  We then talk about Lily Philips and Bonnie Blue hinting that they're pregnant after each one had record setting GBs.  Then we get serious for a second and talk about the growing scandal with USAID, discuss tremors, and who is making the cows squirt.  But first, Birthdays!The Treehouse is a daily DFW based comedy podcast and radio show. Leave your worries outside and join Dan O'Malley, Trey Trenholm, Raj Sharma, and their guests for laughs about current events, stupid news, and the comedy that is their lives. If it's stupid, it's in here.The Treehouse WebsiteDefender OutdoorsCLICK HERE TO DONATE:The RMS Treehouse Listeners Foundation

Guillain-Barre Syndrome (GBS) is rare, but awareness is crucial—especially as cases rise in Pune. In this episode of the Personality Development Podcast, we bring you the inspiring story of Dr. Bitu Mani Borah, who battled GBS at just 13, turned her recovery into an empowering book, and was even felicitated by the Governor of Assam.Join us as we explore her journey of resilience, the challenges she overcame, and the lessons she learned along the way. Let's raise awareness and support those facing this condition! Don't forget to Like, Comment, and Subscribe to spread awareness! Get connected with us to join the community:Instagram: https://www.instagram.com/personalitydevelopmentpodcast/LinkedIn: https://www.linkedin.com/in/aaditya-mehta-342b7515a/Get connected with Dr. Bitumani Borah:Instagram: https://www.instagram.com/dr.bitu.mani.borah/LinkedIn: https://www.linkedin.com/in/bitumaniborah/

Group B strep (GBS), short for group B streptococcus, is a type of bacterium that naturally resides in the gastrointestinal tract, vagina, and rectum of many pregnant women. GBS is typically harmless and causes no symptoms. During pregnancy, it can pose serious risks if passed to a newborn during birth, potentially leading to life-threatening infections. Due to these risks, routine GBS testing is recommended for all pregnant women. If you test positive, there are established guidelines to protect your baby. Learn what to expect during GBS testing, how a positive result will impact your labor and birth, and explore the latest research on a simple supplement that could potentially reduce the chances of having GBS.     Thank you to our sponsors   The VTech V-Hush Pro Baby Sleep Soother has every feature you could possibly want to transform any room into a sleep sanctuary. Create ideal sleep patterns and environments for your baby so your whole family gets better and longer sleep. The V-Hush Pro has built-in sleep programs and sleep tips from WeeSleep experts, over 200 pre-programmed stories, classical music, lullabies, and natural sounds. You can even record and upload your own voice, songs, or stories using the subscription-free app. The VTech V-Hush Pro Baby Sleep Soother is available at Walmart and Amazon.   AG1 is offering new subscribers a FREE $76 gift when you sign up. You'll get a Welcome Kit, a bottle of D3K2 AND 5 free travel packs in your first box. Even with the best diet, some nutrients can be hard to get. AG1 delivers optimal amounts of nutrients in forms that help your body thrive. Just one scoop contains essential vitamins and nutrients, supports gut health, helps you feel sharp and focused, and supports a healthy immune system. Check out DrinkAG1.com/pregnancypodcast to get a free welcome Kit, a bottle of D3K2, and 5 free travel packs in your first box.  (As a friendly reminder, pregnant or nursing women should seek professional medical advice before taking this or any other dietary supplement.)     Read the full article and resources that accompany this episode.     Join Pregnancy Podcast Premium to access the entire back catalog, listen to all episodes ad-free, get a copy of the Your Birth Plan Book, and more.     Check out the 40 Weeks podcast to learn how your baby grows each week and what is happening in your body. Plus, get a heads up on what to expect at your prenatal appointments and a tip for dads and partners.     For more evidence-based information, visit the Pregnancy Podcast website.

In this episode we discuss which groundhog has the best weather prognosticating percentage and answer the question to boo or not to boo a returning coach.  Find out who won the GBS college football pick'em, news of the weird, a foot long Oreo, a bean-based card game, little debbie delivers a mash-up and more!

All "homestretch" segments from 01/20-01/24 with guest hosts Joe Concha, Harry Hurley, Tyrus, Jason Rantz, and Todd Piro plus the GBS team. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

Humans have been writing in abbreviated ways as long as writing has existed. In the 19th century, Isaac Pitman developed – and marketed – a system of shorthand that became widely adopted. Research: Baker, Alfred. “The Life of Sir Isaac Pitman.” London. Pitman. 1919. Accessed online: https://archive.org/details/centenlifeofsiri00bakeuoft/page/34/mode/2up Britannica, The Editors of Encyclopaedia. "Sir Isaac Pitman". Encyclopedia Britannica, 8 Jan. 2025, https://www.britannica.com/biography/Isaac-Pitman Britannica, The Editors of Encyclopaedia. "Pitman shorthand". Encyclopedia Britannica, 18 Apr. 2016, https://www.britannica.com/topic/Pitman-shorthand Miller, Genesie. “A Brief on Shorthand.” Utah Division of Archives and Records. April 11, 2023. https://archives.utah.gov/2023/04/11/a-brief-on-shorthand/ “Sir Isaac Pitman.” The Vegetarian. 1895. https://archive.org/details/vegetarianmonthl00unse_0/page/122/mode/2up?q=sir+isaac Pitman, Benn. “Sir Isaac Pitman, His Life and Labors.” Cincinnati. C.J. Krehbiel. 1902. https://archive.org/details/sirisaacpitmanhi00pitmuoft/page/48/mode/2up Pitman, Isaac. “Phonotypic Journal, for the Year 1845.” Vol. 4. Phonographic Institution. 1845. https://play.google.com/books/reader?id=K-gOAQAAIAAJ&pg=GBS.PP7&hl=en Russon, Allien R.. "shorthand". Encyclopedia Britannica, 10 Nov. 2023, https://www.britannica.com/topic/shorthand Triggs, T. (2009, October 08). Pitman, Sir Isaac (1813–1897), deviser of a system of shorthand writing. Oxford Dictionary of National Biography.https://www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-22322 See omnystudio.com/listener for privacy information.

TWiV explains Guillain-Barré Syndrome associated with RSV vaccines, outbreaks of metapneumovirus in China and India, editors resign to protest Elsevier's use of AI in publishing, global distribution and diversity of wild bird associated pathogens, and broadly inhibitory anti-neuraminidase antibody from human memory B cells. Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Brianne Barker Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support science education at MicrobeTV ASV 2025 GBS with RSV vaccine (FDA) Increase in respiratory infections in China (ECDC) Elsevier journal editors resign (Retract Watch) Wild bird associated pathogens (Med) Broad anti-neuraminidase antibody (Cell Host Micr)   Letters read on TWiV 1185 Timestamps by Jolene. Thanks! Weekly Picks Brianne – Dear Reviewer 2 Rich – National Data Buoy Center Alan – BBC audio program on the World Morse Code Championships Vincent – These are the 20 most-studied bacteria — the majority have been ignored Listener Picks Peter – Local graffiti in Sydney Vivian – The Peoples' Hospital by Dr. Ricardo Nuila Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.

Guillain-Barré syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis. It's caused by the body's immune system damaging nerves. While most cases are triggered by respiratory or gastrointestinal infections, vaccinations have also been linked to GBS pathogenesis. GBS can last from weeks to years, but most people start to recover within a few weeks. The earlier symptoms improve, the better the outlook. Physical therapy is important to prevent muscle contractures and deformities. Some people may experience long-term weakness, numbness, fatigue, or pain. A small percentage of people with GBS may have a relapse, which can cause muscle weakness years after symptoms end. On Jan 7, 2025, the FDA required and approved UPDATED safety labeling changes to the Prescribing Information for Abrysvo (Respiratory Syncytial Virus Vaccine) manufactured by Pfizer Inc. and Arexvy (Respiratory Syncytial Virus Vaccine, Adjuvanted) manufactured by GlaxoSmithKline Biologicals. Specifically, FDA has required each manufacturer to include a new warning about the risk for Guillain-Barré syndrome (GBS) following administration of their Respiratory Syncytial Virus (RSV) vaccine. Who is most at risk for GBS? Where pregnant women affected? This is important information….listen in for details.

What are the typical differences between hospital OB care and home birth midwifery care? Throughout her VBAC prep, Gesa was able to directly compare the two side by side. She was planning a home birth with a midwife but continued to see her OB at the hospital for the insurance benefits. Some differences she noted: Her OB used ultrasound to determine baby's position. Her midwife palpated her belly.Her midwife ran a blood test to check iron levels, and then suggested an iron supplement. Her OB did not track iron.OB visits were typically a few minutes long. Visits with her midwife were an hour or longer in her home. The hospital required cervical checks, laboring in a mask, continuous monitoring, and only allowed one support person. The way Gesa navigated her care is so inspiring. Her midwife was hands-on during pregnancy in all of the best ways and just as hands-off during birth to let the physiological process take over. Gesa's story is exactly why we love HBAC so much!Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Julie:  Good morning, Women of Strength. I am really excited to be back here with you. This is Julie, and it is my first official episode back doing regular episodes. Just like we talked about a couple of weeks ago, I'm going to be doing– or was it last week? I can't remember what week it is. But we are going to be doing every other episode alternating between me and Meagan for the most part. I'm really excited to be back here. We have a really special guest with us today. But before we get into that, I want to say that I just got back from South Korea two weeks ago. No, two days ago. If you haven't listened to Paige's episode for her maternal assisted C-section, go listen to the episode that launched on December 2nd. I do believe it was maybe episode 357. Me and Paige are talking and sharing her story. I am literally so jet-lagged right now. It is going to be a morning for me for sure. If I'm a little clunkier than usual or my brain doesn't work just right, just be a little patient with me, please, because the jet lag is absolutely real. Before we do get started though and introduce our guest, I want to read a review. Meagan sent me a review this morning, and I think it's really interesting because she sent me this review this morning. It's a 1-star review, and you might be curious as to why I'm choosing to read a 1-star review, but I'll tell you a little bit more afterward why I picked that. This one is on Apple Podcasts. This person said, “Listened to 10 episodes, and found that the stories they choose to share are usually always the same with a twist. Didn't find any episodes that said ‘A C-section saved me and my baby's life' so lots of bias and fear-mongering from people who are selling female empowerment. Maybe I'm missing the episode where the hosts say that sometimes it's okay to have a C-section. With all of these birth stories, you would think I could relate with one, but I find that the anecdotes shared in this podcast are a really easy way to avoid talking about women who are actually statistical outliers.” I think that episode is really interesting. First of all, I appreciate everybody's views and perspectives. But also, I think that review is a little bit interesting because she said she has listened to 10 episodes. I'm just assuming it's a she. Maybe that's not the right way to do that. She said she has only listened to 10 episodes. It's interesting because I wonder what 10 she picked. I feel like, isn't it maybe a sign that all of the stories are similar because our healthcare system needs a lot of work? Clearly, if so many women are having trauma and unnecessary C-sections, isn't that a sign that something needs to change? I know that a lot of us have struggled with unnecessary C-sections and really traumatic treatment in the hospital systems, so I don't know. I wanted to bring that up because first of all, we do have many, many episodes where C-sections were necessary. We've talked a lot about that how C-sections are lifesaving procedures when they are necessary. I feel like we do a pretty good job leaving space for all of the stories, but let me know what you think. Go to the Instagram post today about this episode, and let me know. What do you think? Do you think we do a pretty good job? Do you think we need to have a little bit more talking about C-sections that are actually necessary and lifesaving? Do you think it's unequally represented? Let me know. I want to start a discussion about this. Go ahead and leave a comment. Let's talk about it. But I do know that me and Meagan have been very intentional with sharing a wide variety of stories and outcomes and necessary and unnecessary C-sections. Hopefully, you feel well represented no matter what side of the view you are on. Anyway, we are going to go ahead and get started now. Today, I have a really awesome guest. Her name is Gesa, and she lives in Charleston, South Carolina. She is a mom of two boys. She had a C-section with her first baby. The C-section was because of a breech presentation after she tried everything to turn him. Knowing that she absolutely did not want to have a C-section for her second baby, she navigated the difficult search for a truly supportive provider and ended up having a successful HBAC, or home birth after Cesarean, after having some challenges to get labor started. We are super excited to hear her story. We are going to talk more at the end about how to find the right provider for your birth and your birth after a Cesarean after she goes ahead and shares her story with us. All right, Gesa. Are you there?Gesa: I'm here. Julie:  Yay. I'm so excited to have you with me today. Thank you so much for joining me, and again, for being patient with all of my technical issues this morning. Gesa: Of course. Julie:  But I will go ahead and would like to turn it over to you. You can share your story with us, and yeah. I'm excited to hear it. Gesa: Thank you so much. I'm so excited to be here and share my story. Okay, let's start with my first birth which was my C-section. Everything was going well at the beginning of the pregnancy. I was feeling a little bit nauseous, but overall, feeling well. Then at the anatomy scan, I found out that my baby was breech. I was like, “Wait, what does that mean? What does that mean for birth? What's going on with that?” We had so much time left. The provider was not worried at all. It was around 20 weeks so we thought we had plenty of time at that point. Babies are little. They flip-flop around. I was not concerned at all. As time progressed, he continued to stay breech, so he did not flip on his own. During one of my OB appointments, I was basically told, “Well, if your baby does not turn head down, we're just going to have to have a C-section.” There were really no other options given. At that point, I was actually planning a natural birth at a hospital, so that was not really what I had in mind. We had also taken a Hypnobirthing class which was awesome. We learned so much about birth and pregnancy that I had no idea about. Hearing that I was going to need a C-section if he wasn't going to turn head down was really not what I wanted. I started looking into things I could do to help him turn. I started doing Spinning Babies exercises. I started seeing a chiropractor. I did acupuncture. I even did moxibustion at some point which is really fun. It was a Chinese herb that you burn by your toe, and that's supposed to create fetal movement and help the baby flip which unfortunately did not help. I was out in the pool doing handstands and backflips about every day. I was lying on my ironing board at some point with a bag of frozen peas on my belly. I really tried everything possible to get this baby to flip. Nothing worked. I ended up trying to have the ECV at about 37 weeks. That's the version where they try to manually flip the baby from the outside. She gave it a good try to attempt, and he would not move. It was that his head felt stuck under my ribs. It was very uncomfortable. He was very comfortable where he was at. They had me schedule the C-section which I was really unhappy about, but at that point, I didn't really see any other option. It was about my 37-38 week appointment, and the OB wanted to talk a little bit more about the details of the C-section which made me really emotional because that was not what I wanted. I started crying during the appointment, then the nurse comes in and says, “Hey, we actually forgot to check your blood pressure. Let's do that really quick.” I was like, “I'm sure that's going to be great now that I'm all emotional and crying here.” Of course, the blood pressure was higher than it was supposed to be. The OB started joking, “Oh, maybe we'll have a baby today. Maybe we're just going to do an emergency C-section,” which was not what I wanted to hear at all. It made me even more emotional. I remember sitting in the office crying. Now, I had this high blood pressure. My husband handed me this magazine of puppies or kittens. He said, “Sit here. Chill out and just relax. Look at the kittens. They'll retake your blood pressure, and I'm sure it's going to be fine.” I was like, “Oh my god. Nothing is fine right now.” It ended up coming down a little bit. They still sent me to the hospital for some additional monitoring. It was all good, and we ended up being sent home. But I just felt so unsupported and so unheard in that moment. When I was thinking about the C-section, I was even considering at some point what happens if I just don't show up for my C-section appointment and just waited to see if I'd go into labor? But then I thought, “Maybe an emergency C-section would not be any better than a planned.” I had a friend who had an emergency C-section, and she said that the recovery was really difficult so that's also not really what I wanted. I went ahead and showed up to the hospital for my scheduled C-section at 39 weeks and 1 day. But I was so emotional. I was crying on the way to the hospital. I was crying at the hospital. Everybody was really nice at the hospital, but it was just not what I wanted. The idea of them cutting my body open and removing the baby was just so far away from what I had envisioned. The C-section went well. I really did not have any major issues. But recovery was pretty rough. He was pretty big. He was 9.5 pounds and 21 inches long. Recovery was a little rough. He had also a really difficult time with breastfeeding. He had a really weak suck. I just kept thinking, “What if he was not done cooking? What if they got him too early? He wasn't ready to be born yet.” We found out later that he had a tongue and a lip tie that the hospital failed to diagnose which just made things even more difficult. I, overall, hated my stay at the hospital. I felt like I was not getting any rest at all the whole time I was there. My son didn't like sleeping in the bassinet because why would he? I felt like there were people coming in all of the time and interrupting the little bit of rest that I was trying to get. They were checking on me, checking on the baby, taking temperatures, the photographer, the cleaning people. It was just like people were coming and going. The only person who did not show up who I hoped would show up was the lactation consultant. She did not show up for almost two days which was really, really disappointing. The first few months were pretty hard. I would say they were pretty rough emotionally and physically. When people ask me about my birth, a lot of times, I got comments like, “Well, at least he's healthy” or “Oh, your baby's really big, so it was probably good that you had that C-section.” That really upset me because I understand that it's important for my baby to be healthy. Yes, that is the most important thing. But at the same time, my feelings are valid about it, and my emotions. I felt really robbed of that experience to birth my own child. The fact that I had never felt even a single contraction really was upsetting to me. I felt that my body had really failed me. Yeah. I knew that if I ever were to get pregnant again, I would not want to have another C-section. So let's fast forward to my second pregnancy.I got pregnant again when my son was a little over a year and a half. Like I said, I knew exactly what I didn't want, and that was to have another C-section. When I found out I was pregnant, I pretty much immediately jumped on Facebook group and mom groups trying to do my research and find a truly supportive provider. I did call a birth center here in Charleston, and they told me right away, “We don't do VBACs. Sorry. You can't come here,” which was pretty upsetting because they basically see a VBAC or having had a C-section before is a high-risk pregnancy for your next which really does not make a lot of sense because every pregnancy is different. Just because you had a C-section, there can be so many different reasons. You should not be considered high-risk for your next pregnancy. I found a provider who I thought was VBAC-supportive. It seemed like that was my only option, so I started seeing her. As I was seeing my OB further into my pregnancy, I started asking some questions about birth. I really didn't like some of the answers she had for me. I asked about intermittent monitoring. She said, “No, we can't do that. Hospital policy is that you have to have continuous monitoring.” I didn't love the idea of being strapped to the bed. I wanted to move around freely. That was not going to be an option. I asked about eating. I got the answer, “No, we don't really allow eating while you are in labor. You can have clear fluids.” I was just thinking, “I don't want to eat ice chips while I'm in labor. If I'm hungry, I want to be able to eat.” I asked if I could labor in the bathtub because they did have tubs at the hospital. She said, “No, because of the continuous monitoring, you're not going to be able to get in the tub.” Hearing all of that made me really uncomfortable. Whenever I did ask questions, it almost felt like she didn't really want to talk about it. She didn't really want to talk about my birth plan which was really important to me. Now, at the same time, it was also COVID. I got pregnant with my second literally the week before people started quarantining for COVID. On top of all of these things that I didn't like about the hospital, there were also the COVID restrictions. I had to show up to my appointments in a mask which was totally fine, but the idea of having to labor in a mask made me a little uncomfortable. I was thinking about hiring a doula, and because they were only allowing one support person at the time, that was also not going to be an option. I knew my son wasn't going to be able to see me at the hospital which was something I was really looking forward to. I kept thinking, “Maybe there has to be another option. This can't be my only option here.” I started looking at places farther away. I was like, “Maybe I can travel to another place further away.” I was looking into birth centers around the area and all over South Carolina, really. At some point, I did come across a website that said they were offering VBAC support. I didn't really know what that meant, but I filled out a form. I said, “Hey, I need some help with a provider. I'm seeing an OB, but I'm not feeling super comfortable.” I submitted that form. I want to say that maybe a couple of days or a couple of weeks later, a midwife called me. She was like, “Hey, I'm not in your area, but I actually know a lot of people all over the state. Let me send an email to my network, and we'll see if we can find somebody who can help you.” One day, I got a call from a home birth midwife here in Charleston. She was like, “Hey, I got your message. Tell me how I can help you.” We talked a little bit about home birth. At that point, I was like, “Do I really want a home birth?” It was not something I had really considered.” During that HypnoBirthing class when I was pregnant with my first son, we watched a lot of videos of water births and home births. I always thought it was really cool, and I would love to have that experience, but at that moment, when she asked me, “Hey, would you consider a home birth?” I was like, “I need to think about that for a second.” I talked about it with my husband. I did a lot of research on home birth. I ended up sending her all of my medical records from my first pregnancy. We continued talking and checking. I continued to see my OB, and that was really for a variety of reasons. First of all, I had really good health insurance. All of my visits were covered, so all of the DNA tests, and things like the anatomy scan were covered by my health insurance, and it was just easy to coordinate those things with my OB. I also wanted to continue my care just in case there was something that would pop up that would prevent me from having a home birth and those plans would fall through. I'm a big planner, so I like having not just the plan, but also a plan B and a plan C. Yeah. I also like that established relationship just in case I needed a home birth transfer to the hospital. I've heard stories where moms were treated very differently when they arrived at a hospital with a home birth transfer, and in the case that I would have needed that, I could have just shown up to the hospital and said, “Hey, I'm a patient. I'm here. I'm in labor,” without them knowing that it was really a home birth transfer. I did not tell my OB that I was actually planning a home birth. I think she would have been pretty upset. Maybe she would have fired me. I don't know. But the difference in care that I received from the OB and from the midwife was really, really interesting. It seemed like at my OB appointments, there was a lot of focus on different tests and procedures like my weight. Further down, they wanted to do lots of cervical checks which I all declined. At the same time, when I talked to my midwife, the focus was a lot more on nutrition and on exercise. She was asking, “What do you do to prepare for your VBAC?” Lots of education on birth. There were lots of books that she suggested for me to read. I also started seeing a chiropractor pretty early in the pregnancy. I was doing my homework. I was doing my Spinning Babies exercises. I was so focused on doing everything I could to have the birth that I had envisioned. At some point, my midwife had me do some extra blood draws. She wanted to make sure that my iron levels were okay for the home birth, and they were actually slightly lower than they were supposed to be, so she put me on an iron supplement for a couple of weeks. That was an example of something that the OB never asked about or really cared about. At some point, I was a little bit nervous about the position of my baby. It almost felt like he was lying sideways, and I couldn't really tell. I brought it up to the OB. She was like, “Yeah. Let's get in the ultrasound machine. Let's take a look.” She was trying to feel, but she couldn't really tell. Everything was good. He was head down. Well, I didn't know he was a he because we did not find out the gender. Baby was head down. Everything was okay. I brought up the same thing to the midwife, and it was so funny because she did not need an ultrasound. She just felt. She felt really good. She was like, “Yeah. I know. I feel all of the different body parts. You're head down. You're good.” Of course, she was right. It was just so interesting to see how different things were approached by the two providers. I also hired a doula, and I made sure she was VBAC Link certified. It was really exciting. She was familiar with the podcast that I was, of course, listening to at the time to prepare for my VBAC. At some point, I had a situation with my OB that made me pretty uncomfortable. It was time for the GBS testing, and I had done my research. I made an informed decision. I let her know that I was declining the test. She was not happy to hear it. She kept saying, “Well, if your baby dies–”, and she kept saying that multiple times. It was like, “If your baby dies–”, and I was like, “This is so unprofessional to say it like that.” I totally understand that they need to–Julie:  Oh my gosh. I can't even believe that. Gesa: Yeah. Isn't that horrible?Julie:  That's horrible. Gesa: I understand she needs to educate me on the risks that come with declining certain tests, but that was just not a proper way to communicate that. Julie:  Yeah. Find another way. Find another way. Gesa: Yeah. Right. That situation really confirmed for me home birth was the way to go. I did not want anything to do with this hospital or this OB anymore at that point. I was fully committed to the home birth. I was planning on it. I continued my OB visits more just to check a box. At 37 weeks, my midwife brought over the birthing pool and some supplies. I gathered everything that I needed. She had sent me a list of all of the different supplies that we needed to buy and gather, so I started getting all of that. I created a beautiful birthing space for myself in our bedroom. I had my affirmations up. They were taped to my mirror in the bathroom as daily reminders. I had them hung up in the bedroom with some twinkle lights. I had the picture of the opening flower, and everything was ready. I had my Spotify playlist ready, and I was so excited for baby to come here. Then, at 39 weeks and 1 day, it was early in the morning, like maybe at 6:30 AM. I was lying in bed, and our toddler had climbed into bed with me. I felt a little pop, and I was like, “Hmm, that was weird,” but I didn't really think much of it because pregnancy is weird, and our bodies do all kinds of weird things that we can't explain when we are pregnant. I didn't think much of it. I went back to sleep. An hour later, I got up to go to the bathroom. I sit down on the toilet, and water is gushing out. I was like, “Shoot. What is going on? I'm not peeing. What's happening?” I just realized, “No, my water broke.” I wasn't expecting it at that point because you hear about a lot of women going into 40-41 weeks, 42 weeks, especially with their first pregnancy that they are going into natural labor, so I was so surprised that it happened at 39 weeks and a day. I was feeling a tiny bit of cramping, but definitely did not have any contractions. I texted my husband, “Oh my gosh. My water broke.” He was out for a workout, so he rushed home. I also texted my doula and my midwife just to let them know what was going on, but then the whole day was really uneventful. I was ready and waiting for labor to start. It just didn't. I went on a lot of walks. I tried some curb walking. I bounced on the yoga ball. I ended up getting a last-minute appointment with my chiropractor for a quick adjustment. I really spent all day just trying to get labor started. I took some naps. I also tried using the breast pump for some stimulation to get things going. I got some tiny little contractions. At that time, I thought they were contractions, but now that I know what contractions actually feel like, I realize that was not actually the case. I got some tiny contractions going, but then they fizzled out again. My midwife stopped by a few times to check on me and baby. She had me take my temperature every 4 hours and text it to her just to make sure I wasn't running a fever. Baby was moving normally. She wasn't overly concerned. She assured me that my body was probably just waiting until nighttime when my toddler was in bed and I was relaxed for things to start then. It was weird because I was leaking amniotic fluid all day, so I tried to stay super hydrated and replenish all of that water I was losing. I went to bed and thought, “Okay. This is it. We're going to have a baby maybe early in the morning. Labor is going to start.” Nothing happened. I woke up really early and really disappointed that nothing had happened. My midwife had sent me some information on PROM, so premature rupture of membranes, just to make sure I was making an informed decision. She always gave me the option to go to the hospital. She said that I could go in the evening of when my water broke. She said I could wait until the next day and do whatever I felt comfortable with, but she wanted me to be aware of the dangers with having a long time of broken waters. She also had sent me a recipe to the midwives' brew. That was something we talked about to get labor started. She said, “Something to consider for the next day if you don't have your baby overnight.” My husband went out. He bought the ingredients just in case. It was castor oil, almond butter, apricot nectar, and champagne. It was absolutely disgusting. It actually ruined almond butter for me for at least 2-3 years. I could not have it anymore. It was so gross. Julie:  Oh my gosh. That is so funny. That is funny. Gesa: I took it around 10:00 AM in the morning. At that point, my water had been broken for over 24 hours. I layed down for a nap, and maybe 2 hours later, I started feeling some contractions. They were coming in. I was just laying in bed breathing through them and listening to my HypnoBirthing affirmations and some relaxing music. My husband was actually taking a nap at that time with our son. At some point, things were getting pretty intense. I texted my doula and my midwife. I was trying to time contractions but it was also difficult. They both came over around 2:00 PM and realized pretty quickly that labor was going. They needed to fill that pool because that actually takes a while which was not something I was even thinking about.They quickly got the birthing pool filled. Once I got in the water, it was such a difference. At that point, I had some really, really heavy contractions and I think I got in there around 3:00 PM. It was such a night and day difference. My doula was awesome. She was rubbing my back. She was giving me cold washcloths on my neck. Yeah. She was super helpful. I was laboring in the tub. At some point, I needed to get out to go to the bathroom. As soon as I got out, I instantly regretted that decision because it was so horrible and the contractions were feelings so much stronger when I was not in the water. My husband was still sleeping at that point. I was like, “Okay, is somebody going to wake him up before baby comes?” But I also lost track of time of how long I even was in the pool. They did wake him up at some point. It was really funny because when he lay down for a nap, it was just me laboring in bed by myself. They woke up from the nap, and I was in full, active labor in the birthing pool with the doula and the midwife there, full action going on. He was just like, “Whoa, what's happening?” Yeah. He jumped right into action and helping me out and massaging and all of that good stuff. It was really sweet because my son kept bringing toys. He was a little over 2. He was 2 years and 3 months at that point. He kept bringing over toys. He was playing right next to the pool. He was checking on me. It was just really sweet and really special to have him there. Our dog was also walking around the pool and was really interesting in what was going on. I really lost track of time and of how long I really was in the pool. At some point, I felt some really, really intense pressure. It was almost like my body was pushing on its own without me really actively doing anything. I had heard of the fetal ejection reflex, but I didn't realize that that was what was going on. I didn't realize that baby was already coming. My midwife just looked at me. She was like, “Feeling a little pushy, huh?” I was like, “Yeah, I guess that's what's going on.” It all happened really quickly. My husband got our son situated downstairs because we wanted him to be there, but we didn't want him to be there right as baby was born. We thought that may have been a little bit too much for him, so we got him situated downstairs. Yeah, things happened really quickly. All of a sudden, his head was out. It was really fun because we got to feel his hair, and I did not have another contraction for a minute which was weird because his head was out. It was underwater, and it felt like a really, really long time between contractions. But then he was out with the next one, and my midwife caught him. He came right to my chest. My husband got to announce that he was a boy which I knew all along. We didn't find out his gender, but I just knew he was going to be a boy. My pregnancy was just so similar that I was like, “There's no way he's not a boy.” But yeah. He was born a little after 4:00 PM, so really just 6 hours from when I had the midwives' brew, so that really worked for me. Of course, I cried tears of joy. The amount of emotions I was feeling was just absolutely incredible. The rush of endorphins, I felt so empowered and so strong in that moment, like literally the strongest person in the world. It was awesome. We brought my son up and he got to meet his baby brother within minutes of his birth which was so special and such an amazing experience. Once we got settled a bit, I got to take a shower. I got to eat pasta in my bed, and then also safely cosleep with my baby in my own bed and in my own home which was just the complete opposite of that hospital C-section experience. Yeah, the home birth experience was really healing for me in a way. It gave me closure from my C-section experience. I think because I had the C-section, I just knew what I absolutely did not want, and I think that really helped me fight and prepare for my home birth experience. I still had to call my OB and cancel my 40-week appointment which was probably one of the weirdest phone calls I've ever had to made because I was like, “Yeah, I need to cancel my appointment because my baby is actually here.” They were like, “Wait, where was your baby born? We have no records of this.” I was like, “Yeah, he was born at home.” They were like, “You need to get him checked out immediately.”Julie:  You're like, “Yeah, accident.” Gesa: I was like, “No, we had a professional there. It's all good. Don't worry about it. Let's not talk about it anymore.”Julie:  I love that so much. Okay, I want to talk about a couple of things or maybe just comment. When you were talking about your C-section and how you felt guilty about how maybe he was having trouble nursing or whatever and you were feeling guilty that maybe he had been taken too early or he wasn't ready to be born yet and stuff, I felt that so hard with my C-section baby. I just wanted to validate that because I feel like that is not an uncommon thing. I feel like a lot of us have that concern when we have either a scheduled C-section or an induction that results in a C-section or maybe even an induction that results in a vaginal birth. You can look back at it and feel like, “Oh, maybe I made the wrong choice,” or “Maybe he was taken too early,” or things like that. I just wanted to validate that. Know that I see you, and I hear you, and I feel you. And everybody, not just you, but everybody. Try not to be too hard on yourself. I'm not speaking just to you, but everybody. Try not to be too hard on yourself because you were making the best decisions that you could with the information that you had available to you at the time. So give yourself some grace. Give yourself some love. I think that's really important is that we navigate our pregnancies and birth after having an unwanted C-section or an unwanted birth experience. Giving ourselves that grace is a really, really important part of it. I did want to talk about the difference in care. You highlighted a few things in your episode about the difference in care between a hospital OB and having a midwife or especially a home birth midwife. In the hospital, you're still going to see a little bit of similarities between midwifery and OBs, although midwifery care in a hospital is a lot more hands-on and a lot more personal and a lot more trusting, generally speaking, of the birth process. I just was thinking this morning about a post. There was a post in not even a VBAC group. It was just a local mom's group in my community. This woman was talking about how it was her first baby. She hasn't had an ultrasound or seen the baby since 10 weeks. She had a 10-week scan, and she hadn't seen the baby since then. She wasn't 20 weeks pregnant yet, but she was almost. She was just like, “I'm just wondering if this is normal. Every time I have an appointment with my OB, I only see him for 2 minutes. I don't feel like this is normal. I have some concerns, but I'm not being able to ask questions,” and things like that. It made me sad. It made me sad for this parent not being cared for in the way that she needs to be. It also made me sad because her experience is not that uncommon. I wanted to say that unfortunately, this is normal. You're not going to usually see your OB for more than a couple of minutes per visit. You're not going to have time to ask a lot of questions and get a lot of answers because hospitals are busy and OBs are busy. Most of them don't have the time or intentionally make the time to give you that kind of attention. It's just how it is. Now, I say most of the time because there are some OBs. I saw briefly an OB for my third pregnancy, and I love her. She was always 45 minutes late. Our appointments were always 45 minutes late. My appointment would be at 1:45, and I wouldn't get in there until 2:00 because she was giving everybody the attention that they needed. A lot of people get frustrated because she was an hour late for the visits, but I wasn't frustrated because I knew that she was giving other people the same attention that she gave to me. That is so, so rare in a hospital setting. I love that you highlighted that. I love that you talked about how your midwife took time to address your concerns, how she monitored your iron levels and gave your iron supplements and your OB didn't. It wasn't even on his or her radar. I don't know if your OB was a boy or girl. I can't remember. Their radar, right? And how your OB needed an ultrasound to confirm baby's position, but your midwife just palpated your belly because midwives are more hands-on. They are more intimately connected to the female body, to the baby, and to the physiologic birth process. Gesa: Yeah. She was more hands-on during the pregnancy, but then during the actual birth, she was very hands-off. She let me do my own thing. Julie:  Yeah! Yeah. Gesa: She wasn't constantly in my space and interrupting my labor. Julie:  Right. Gesa: She would come in very quietly and very softly. She would check on the baby and check on me, and if everything was good, she was back out the door. She let me labor in my own space and at my own pace which was awesome. Julie:  Right. I was going to talk about that next actually. I've been keeping notes while you have been talking because during your labor, you said you felt that fetal ejection reflex, and your midwife was like, “Oh, feeling pushy are we?” I know exactly what that looks like. I'm not a midwife, but I'm a doula. I've been a doula and a birth photographer, and I know what it looks like when a woman's body is progressing. But in a hospital setting, what do we do? We connect you to monitors. We put an IV in you. We sit at a nurse's station and watch the monitor. That's how we know how you are doing. We use ultrasounds to determine baby's position. We use data and numbers. We look at data to decide how the parent and the baby are doing. But in midwifery care, especially out-of-hospital midwifery care, you use a completely set of tools. We use observation. We are watching. We are listening. We are seeing. We are noticing the movements that are shifting and the sounds as they evolve and change. We are seeing the belly moved. We are seeing all of the different things, and it's a completely different approach. I know exactly what an unmedicated parent looks like as they are getting close to transition. I know the noises that change, what sounds are made, what different subtleties there are. You just learn these things when you actually just watch a laboring person, and notice what is happening. But they don't do that in a hospital. An OB and nurses– probably nurses because they are in the room a little bit more, but your OB won't show up until you start pushing. They don't know what the signs are. All they have is the data on the machine to see if you are doing. I know what approach I approve. Let's just say that. It's no secret that I'm a big fan of home births, especially for VBAC, when the parent feels comfortable there. I just really loved that. My appointments when I had my three VBACs at home, every time I saw my midwife, we would chat for an hour. She did talk about nutrition. I had preeclampsia for my first. My blood pressure was high. I was like, “I don't want high blood pressure,” so she gave me all of these nutritional things to do to help take care of my heart and help make sure that my blood pressure wasn't high. But then what would happen in the hospital? They wait until your blood pressure is high, then they treat it. They don't work on preventing it or making you healthier or things like that. I just feel like there is such a big difference in care. It's not for everybody. That's not where everybody feels safe, but I wanted people to know that home-birth midwives are very skilled. They are very hands-on throughout the pregnancy and oftentimes hands-off during the delivery because we trust these bodies to do what they need to do. Sometimes they do need help, but also observing and watching can help us know when a little bit of extra help is needed. It's such a fun little dance that can be done throughout pregnancy and labor. It's kind of like an art form as much as it is a medical side of things. Midwives are not chicken-dancing hippies that run around your room with incense and pray for a safe delivery. They are skilled medical professionals that have high levels of training and care and can practice in very similar ways that you see in a hospital setting just without all of the extra crap and interventions that are there. Obviously, they can't do surgery, and depending on your state and where you live, there are different restrictions about what out-of-hospital midwives can and cannot do. But a lot of people are surprised to find out how much training and knowledge and skills and procedures that out-of-hospital midwives have access to, so I wanted to talk about that. Yeah. Anyway, Gesa, do you want to give one piece of advice to anybody preparing for a VBAC right now? What would you tell anybody?Gesa: I think a lot of people, when they go to the doctor, they see their OB and they heavily rely on what they are telling them. They almost glorify the OB's advice in a way. We have got to remember that these doctors work for us. We don't work for them, so if we don't feel comfortable with what they are saying, we have the option to go somewhere else, and to take our business somewhere else. The doctors work for us. We don't work for them. It is never too late to switch your provider. I was going back and forth whenever I was pregnant with my first, and I was very late into my pregnancy. I kept thinking, “What if I just find a provider who does breech births?” In a way, I wish I had, but then you never know what actually would have happened, so it's hard to say how that would have changed my experience. I could have still ended up with a C-section, but I could have. I could have changed my provider at 38 weeks if I had contacted somebody, but I was just so overwhelmed by the whole situation that I didn't. But I was so glad that when I wasn't feeling comfortable with my OB during my second pregnancy and with what she was saying, that I took the step to find somebody who was truly supportive and who was able to help me with the birth that I had envisioned. Julie:  Yes. I absolutely love that. I think that's great advice. You make a very good point. It's never too late to switch providers. I think that the single most important thing that you can do to affect your birth outcome is to choose a provider who operates in the way that you want to birth just naturally. It's just what they do anyway. I feel like if you do that, then that's half the battle. Gesa: Yeah. 100%. I know some people feel very comfortable at the hospital, and a lot of people are not good candidates for a home birth. Julie:  Yeah, and that's where they should be. Gesa: When I told people that I was planning a home birth, I got a lot of people saying, “Are you sure? That's so scary.” If that's scary to you, then you shouldn't do it. If you feel safer in a hospital, go ahead. There's nothing wrong with that. Go to the hospital. Have your baby there if that's where you feel comfortable. For me, just the thought of having to fight for certain things while I'm in labor and very vulnerable wasn't something I wanted to do. I wanted to focus on laboring and birthing and just having that experience. I did not want to get into fights with OBs and nurses over whatever I could or could not do while at the hospital. That just did not sound like a good idea to me. Julie:  Yep. Absolutely. I agree, 100%. All right, well thank you so much for joining me today. Thanks for sharing your story with us. I'm super proud of you. You said that after your baby was born, you felt like the strongest woman ever. I agree. You are the strongest woman ever along with all of the women listening right now. We are truly Women of Strength, and no matter how your birth outcome ends, you are strong. You are powerful. I'm very grateful to each of you.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 New Year! Join Dr. Rebecca Dekker and EBB research fellows Morgan Richardson Cayama and Sara Ailshire as they celebrate the evidence from 2024. From updating key research on waterbirth, doulas, and elective inductions to launching new handouts, webinars, and pocket guides, it was a busy and rewarding year for Team EBB. Plus, get a sneak peek at what's ahead in 2025, including an updated virtual conference, fresh podcast episodes, and exciting new research. Let's celebrate the wins, reflect on the research, and dream big for what's next!   (00:04:06) Benefits of Water Birth in Hospitals (00:05:13) Positive Outcomes of Water Birth Research (00:10:58) Water Birth Safety: Preventing Infections and Complications (00:14:16) Water Birth Cord Avulsion Risk Factors (00:23:23) Cultural Relevance in Doula Support Services (00:25:23) Integral Role of Doulas in Childbirth (00:30:40) Elective Inductions at 39 Weeks Impact (00:44:11) Vitamin K Update: Black Box Warning Insights (00:52:20) "Top 10 Evidence-Based Cesarean Risk Reduction Strategies"   The Evidence on: Waterbirth EBB 300: The Evidence on Waterbirth EBB 318: Advocating for Waterbirth in Hospitals EBB 287: Positive Hospital Waterbirth Story EBB 268: Debunking Myths about PROM, GBS, and Waterbirth EBB 258: Waterbirth Story with Cord Avulsion EBB 230: Inspirational Home Waterbirth Story The Evidence on: Doulas EBB 309: The Evidence on Doulas The Evidence on: The ARRIVE Trial and Elective Induction at 39 Weeks ARRIVE Trial Signature Article Pain Management Series EBB 312: Injectable Opioids EBB 317: Epidurals for Pain Management EBB 320: Epidurals and the Pushing Phase of Labor Rh Incompatibility EBB 329: Blood Types, Rh Incompatibility, and RhoGAM Shot For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram, YouTube, and TikTok! 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.  

This is a video on the T-Rex lab channel, but due to the number of requests, we're also posting it here for easier listening. The actions of the Bureau of Alcohol, Tobacco, Firearms, and Explosives don't get as much attention as they should, but most people are generally aware of their recent history. However, to get a better understanding of how they developed as an enforcement agency, we have to go back to their first assignment. This will be a multi-part examination of where the ATF came from, and where they should go. Sources: https://www.amazon.com/Last-Call-Rise-Fall-Prohibition/dp/074327704X https://www.amazon.com/History-American-People-Paul-Johnson/dp/0060930349/ https://www.amazon.com/Modern-Times-Revised-Twenties-Perennial/dp/0060935502 https://play.google.com/books/reader?id=DFwWAAAAIAAJ&pg=GBS.PP6&hl=en https://www.thecornellreview.org/well-regulated-the-nfa-hearings-1-6-an-unforgivable-betrayal/