Podcasts about GBS

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 

Jak co roku zasiadam przed klawiaturą, otaczam się mnóstwem danych i informacji oraz notatek po wielu spotkaniach i piszę część merytoryczną do raportu Pro Progressio. Raport ten od wielu lat z jednej strony podsumowuje zakończony rok, z drugiej wskazuje trendy w sektorze BSS jakie z dużym prawdopodobieństwem wydarzą się w roku kolejnym.Poza powyższymi sekcjami, w raporcie znajdziecie także listę polskich i międzynarodowych Tygrysów Biznesu – wyjątkowych osób, które swoją pracą (i nie tylko) mają wpływ na rozwój sektora nowoczesnych usług dla biznesu. Dodatkowo raport zawiera także aktualną listę członków Klubu Pro Progressio.Zapraszam do wysłuchania krótkiego podsumowania Raportu Pro Progressio – edycja 2024. Kluczowe punkty nagrania: ·         W roku 2025 przewiduje się wzrost wdrażania sztucznej inteligencji w procesach biznesowych, choć obecnie większość firm nadal koncentruje się na automatyzacji.·         Migracja części procesów biznesowych do Azji i Afryki będzie się nasilać, jako odpowiedź na poszukiwanie tańszych destynacji operacyjnych.·         Model pracy hybrydowej będzie się utrzymywał, ale z coraz większym naciskiem na powrót pracowników do biur.  Linki:Raport dostępny na ARENA Pro Progressio - https://arena.proprogressio.pl/Porozmawiaj o tym odcinku ze sztuczną inteligencją - https://bbs-bez-tajemnic.onpodcastai.com/episodes/1vqPhVfKIfN/chat  ****************************  Nazywam się Wiktor Doktór i na co dzień prowadzę Klub Pro Progressio https://klub.proprogressio.pl/pl – 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/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/wiktordoktorZrzutka.pl - https://zrzutka.pl/j8kvarBecome a supporter of this podcast: https://www.spreaker.com/podcast/bss-bez-tajemnic--4069078/support.

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

Episode 66 shared by Tegan in Queensland. This episode unfortunately, is a roller coaster & I'm so grateful to Tegan for sharing her story. It's difficult to summarise Tegan's story into a quick intro, but how's this - after being accepted and excluded from the local publicly funded program MULTIPLE times in her pregnancy with her second baby, Tegan made the decision to birth at home, unassisted. We talk about so much in this episode too, like GBS diagnoses, antibiotics, gut health, breastfeeding, Cervical ectropion and more. Resources: Short cervix info Gentle Birth, Gentle Mothering by Dr Sarah Buckley Cervical EctropionFirst 1000 Days of Life: Consequences of Antibiotics on Gut MicrobiotaThere is SO much info out there on this topic - this is just one article Born at Home: The Documentary Pacific Mother (See the Trailer) Thrush in PregnancyGBS (Group B) Testing About Group B Strep (GBS) Support the showConnect with me, Elsie, the host :) www.birthingathome.com.au @birthingathome_apodcast@homebirth.doula_birthingathome birthingathome.apodcast@gmail.com

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

Welcome to episode 121 of Good Morning BSS World! I'm your host, Wiktor Doktór, and today, we're heading back to Africa for an in-depth update on one of the most dynamic and rapidly evolving regions in the global BPO and GBS landscape.My guest is the ever-insightful Rod Jones — a BPO veteran and passionate advocate for Africa's role in the global services industry. In our fourth conversation on this topic, Rod delivers a comprehensive overview of developments happening across Southern, Western, Eastern, and Northern Africa.Highlights include:The rapid expansion of the Africa Federation of BPO GBS Associations (12 countries strong and growing).South Africa's bold new government incentives and focus on tier 2 and 3 cities.Zimbabwe and

¿Está tu organización preparada para los riesgos financieros que podrían venir con una nueva era de aranceles y volatilidad global? En este episodio de Auditando y Controlando, nos acompaña Pablo Girón, experto en derivados y cofundador de GV Services, junto a Jorge Herrera, socio de GBS. Hablamos sobre cómo las empresas pueden protegerse mediante derivados financieros como forwards, futuros, swaps y opciones, desmitificando su uso y explicando por qué no son solo para grandes corporativos.Analizamos el impacto de los aranceles potenciales en caso de una segunda presidencia de Trump y las mejores prácticas para usar derivados como herramientas de cobertura y no como instrumentos especulativos.¡Dale play y aprende a blindar tu operación financiera con estrategia y disciplina!

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!

In 120th episode of Good Morning BSS World, my guest is Rod Jones - one of the most recognized experts in the global BPO and GBS industry - for an exclusive update on Africa's fast-evolving outsourcing landscape.Rod has been a guest on the show three times, and this time, he brings fresh insights into how Africa is emerging as a global outsourcing powerhouse. The continent is witnessing incredible momentum, with governments, investors, and major industry players actively investing in job creation, impact sourcing, and digital transformation. Some key takeaways from this episode include:✅ The rise of Africa as a competitive BPO & GBS destination✅ Major developments in Ghana, Nigeria, Uganda, and Ethiopia✅ New government-backed incentives and investment programs✅ How AI and digital transformation are shaping the industry✅ Upcoming events, including the Africa Federation launchFrom new BPO hubs in Botswana to trade missions bringing African outsourcing to Europe, this episode is packed with valuable updates for industry professionals, investors, and anyone interested in the future of outsourcing in Africa.Don't miss this discussion! Watch, like, and subscribe for more global BPO and GBS insights.  Key points of the podcast:Africa is increasingly recognized as a significant BPO and GBS destination, with substantial interest from consultants, analysts, and brokers driving job creation and social change.Countries like Ghana, Uganda, Nigeria, and Ethiopia are making significant strides in the outsourcing industry through government incentives, partnerships, and hosting key industry events.The Africa Federation is expanding rapidly, with nine countries already subscribed and several more in discussions, aiming to unify and promote the continent's BPO and GBS sectors.  Links:Rod Jones on LInkedin – https://www.linkedin.com/in/rodjonessouthafrica/Launch webinar Website page with YouTube and download - https://africagbsfederation.org/unlock-the-future-of-africas-gbs-bpo-industry/Talk about this episode with AI - https://gmbw.onpodcastai.com/episodes/lK2UMDsGNLD/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/  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.

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/

Welcome to 118th episode of Good Morning BSS World! In this episode, we explore how Egypt has become a strategic business hub connecting Europe, Africa, and the Middle East.My guests are Hans Henrik Groth, CEO of CrossWorkers, and Jan-Hendri Tromp, Executive at SoluGrowth. Together, they discuss why Egypt is a top destination for business process outsourcing (BPO), global business services (GBS), and IT services.Hans and Jan-Hendri share firsthand experiences of expanding their businesses into Cairo, highlighting Egypt's vast talent pool, strong linguistic capabilities, and cultural readiness for international business. With over 500,000 university graduates annually—including 50,000 in IT alone—Egypt offers a powerful solution to Europe's growing skills shortage. The discussion also covers the country's supportive infrastructure, government incentives, and nearshore advantages that make it an attractive destination for companies across industries.From customer experience and IT services to finance and telecommunications, Egypt is rapidly emerging as a key global player. Tune in to learn how businesses can leverage this dynamic market, the evolving work culture post-pandemic, and the strong strategic partnerships forming between companies like CrossWorkers and SoluGrowth.  Key points of the podcast:Egypt's strategic geographical location makes it an ideal hub for servicing European, Middle Eastern, and African markets, offering a blend of time zone compatibility and cultural readiness.The Egyptian workforce boasts significant linguistic capabilities and a large talent pool, including 50,000 IT graduates annually, making it an attractive destination for IT and customer care services.The Egyptian BPO sector is experiencing substantial growth, driven by the entry of major international corporations and supported by government initiatives, further positioning Egypt as a key player in the global outsourcing industry.  Links:Hans Henrik Groth on Linkedin - https://www.linkedin.com/in/hanshenrikgroth/CrossWorkers - https://crossworkers.com/CrossWorkers on Linkedin - https://www.linkedin.com/company/crossworkers/Jan-Hendri Tromp on Linkedin - https://www.linkedin.com/in/jan-hendri-tromp-a87b5945/SoluGrowth – https://www.solugrowth.com/SoluGrowth on Linkedin - https://www.linkedin.com/company/company-page-called-solugrowth/Talk to AI about this episode – https://gmbw.onpodcastai.com/episodes/hhbyD06Yk0a/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.Come and 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/  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.

India is dealing with an outbreak of Guillain-Barre syndrome. It's a rare condition where your immune system attacks nerve cells, causing muscle weakness and paralysis. There have been 160 reported cases since early January in Pune, hitting kids as young as six years old. Seven people are thought to have died.Iqra shares her experience of having GBS as a child and she speaks with BBC health reporter Michelle Roberts to get the details on the disease. Plus, our reporter Vandhna Bhan takes us through what's happening in India.Instagram: @bbcwhatintheworld Email: whatintheworld@bbc.co.uk WhatsApp: +44 0330 12 33 22 6 Presenter: Iqra Farooq Producers: Emily Horler, Benita Barden and Adam Chowdhury Editor: Verity Wilde

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.

दिल्ली विधानसभा चुनाव में काउंटिंग जारी, कालकाजी सीट से आतिशी 2800 वोटों से बीजेपी के रमेश बिधूड़ी से पीछे, मुस्लिम मेजोरिटी ओखला सीट से आप प्रत्याशी अमानतुल्ला खान AIMIM प्रत्याशी से करीब 9500 वोट से आगे, अयोध्या की मिल्कीपुर विधानसभा सीट पर बड़ा उलटफेर, दिल्ली के गांधीनगर,लक्ष्मीनगर, सीमापुरी, शाहदरा और विश्वासनगर में बीजेपी की बढ़त और महाराष्ट्र के पुणे जिले में गुइलेन-बैरे सिंड्रोम (GBS) के आज 7 नए मामले सामने आए. सुनिए दोपहर 12 बजे तक की बड़ी खबरें सिर्फ 5 मिनट में

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!

As of February 1, 140 cases and four deaths due to Guillain- Barré Syndrome have been reported in Pune, Maharashtra.The outbreak has shocked the public – most people have never heard of this rare, autoimmune neurological disorder before. Guillain- Barré Syndrome or GBS leads to the immune system attacking the peripheral nervous system, causing weakness in the muscles, and in some cases, paralysis. At present, doctors have said the outbreak could be linked to a bacterial infection that many of the patients contracted prior to showing symptoms. The Pune health authorities are testing water samples in all the areas where the outbreak has been reported. But how did a rare condition show up in so many people at the same time? What could be behind the large number of cases? How is it treated? What could be done to prevent future outbreaks? Guest: Dr S.V. Khadilkar, dean, professor and head of the department of Neurology, Bombay Hospital, past president, Indian Academy of Neurology Host: Zubeda Hamid Edited by Jude Francis Weston

Welcome back to Good Morning BSS World! In this episode, we reconnect with Rod Jones, Senior Partner at Rod Jones Strategic Solutions, for an insightful update on the BPO and GBS industry in Africa. This marks our second conversation, continuing our commitment to bringing you the latest developments from this rapidly growing region.Africa is emerging as a global powerhouse in the BPO industry, with millions of job opportunities on the horizon. Rod shares major updates, including the launch of the Africa Federation of GBS Associations, which aims to unite the continent's outsourcing sector. On February 5th, 2025, the first webinar will set the stage for a new era of collaboration among African GBS leaders, regional representatives, and international investors.We explore how different African regions are positioning themselves in the global outsourcing space:North Africa – Egypt, Morocco, and Algeria leading with massive expansions by major players like Concentrix.East Africa – Ethiopia and Kenya experiencing unprecedented growth, with 25,000 new jobs on the horizon.Central Africa – Rwanda setting an example in bilingual service excellence with new investments from TTEC.West Africa – Nigeria and Ghana pushing forward with strong government support.Southern Africa – South Africa expanding into Tier 2 and Tier 3 cities, with new hubs in Zimbabwe, Botswana, and Namibia.We also discuss impact sourcing, the social and economic benefits of outsourcing, and how Africa's youthful, tech-savvy workforce is shaping the industry's future. With an estimated 1 million new jobs in the next five years, Africa is on the rise as a global outsourcing hub!Don't miss this episode—stay ahead of the trends shaping the BPO world! And be sure to join Rod's webinar on February 5th to dive even deeper into Africa's GBS potential.  Key points of the podcast:Africa's GBS industry is set for significant growth, with initiatives like the Africa Federation of GBS Associations aiming to create a unified, democratic platform for collaboration and development.The upcoming webinar on February 5th will feature regional representatives discussing the objectives and value of the new federation, as well as opportunities for participants to engage and share their needs.Africa's potential to create up to a million jobs in the next five years, driven by youthful, tech-savvy labor, highlights the continent's growing importance in the global BPO and GBS markets.  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/wIYbE7ZquQF/chatWebinar (Feb 5th, 2025): https://us02web.zoom.us/webinar/register/5917375454234/WN_x5IP55g3T2-mQauTLZMFVw#/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 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/  Join the great Team of 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.

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.

In 115th episode of Good Morning BSS World podcast, I sit down with Christian Soto, Process Manager at Clariant GBS, to explore the unique dynamics of working across cultures in the Global Business Services (GBS) industry. Christian, a seasoned professional originally from Guadalajara, Mexico, shares his journey of transitioning from a leadership role in Latin America to managing multicultural teams in Poland, marking his fifth year in Europe.This episode dives deep into the nuances of cultural differences between the LATAM and European regions, exploring how these variations shape communication styles, management approaches, and organizational structures. From initial cultural shocks—like Poland's dark winter days—to adapting leadership styles for diverse teams, Christian's experiences highlight the challenges and rewards of working in a global environment.Discover insights into recruitment and onboarding practices, differences in employee loyalty, and the significance of situational leadership when managing teams with diverse cultural backgrounds. Christian also offers a comparative perspective on employee benefits and workplace dynamics, emphasizing Poland's advantages in healthcare and safety.Whether you're an expat, a GBS professional, or simply intrigued by cultural diversity in the workplace, this episode offers valuable takeaways about fostering collaboration, adaptability, and innovation in a multicultural setting. Tune in to hear Christian's reflections, challenges, and advice on thriving in the ever-evolving GBS world.  Key points of the talk:Cultural differences significantly impact management styles, with Latin America favoring a more directive approach and Europe leaning towards a democratic style.Recruitment processes in Poland are more challenging due to the specific skill sets and languages required, compared to the larger pool of candidates available in Mexico.Polish employees typically prefer a clear separation between work and personal life, whereas in Mexico, after-hours gatherings with colleagues are more common and help foster professional relationships.  Links:Christian Soto on Linkedin - https://www.linkedin.com/in/christian-soto-/Talk to AI about this episode - https://gmbw.onpodcastai.com/episodes/2Q27MSjfvTH/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/  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.

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.

In this episode of the MamasteFit Podcast, Roxanne talks with Cheryl Sew Hoy, the founder and CEO of Tiny Health, about the importance of the microbiome during pregnancy and its impact on babies. Cheryl delves into the science behind the gut and vaginal microbiomes, how they transfer to the baby during birth and breastfeeding, and their critical role in training the infant's immune system. The discussion includes practical tips on maintaining a healthy microbiome, the significance of probiotics, and the effect of antibiotics. Cheryl shares her personal journey and explains the importance of testing and understanding the microbiome for lifelong health, as well as sheds some light on increasingly more common symptoms of gut health issues that may be getting overlooked!  Check out Tiny Health here, and don't forget to use our code, MAMASTE20 for $20 off!  http://tinyhealth.com/ http://poweredbytiny.com/ 00:00 Introduction to the MamasteFit Podcast 01:06 Meet Cheryl Sew Hoy: Founder of Tiny Health 03:25 Understanding the Microbiome 04:31 The Gut and Vaginal Microbiome 06:43 Impact of Birth Methods on Microbiome 07:56 Breastfeeding and Microbiome Development 10:31 Antibiotics and Microbiome Disruption 12:36 The Role of Bifidobacterium 25:02 Family Microbiome Dynamics 28:15 GBS and Pregnancy 36:48 Making Informed Decisions About GBS 37:11 Early Testing and Prevention Strategies 38:00 Dietary Interventions for GBS 40:47 Understanding the Vaginal Microbiome 42:35 Probiotics and Their Impact 47:46 Infant Microbiome and Early Testing 50:15 Breastfeeding, Formula, and HMOs 57:27 Signs of Microbiome Imbalance in Infants 59:34 Testing Frequency and Membership Options 01:05:51 Conclusion and Final Thoughts  === Get Your Copy of Training for Two on Amazon: https://amzn.to/3VOTdwH —— This podcast is sponsored by Needed, a nutrition company focused on optimal nourishment for your perinatal journey. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Use code MAMASTEPOD for 20% off your first order or three months of subscription.⁠ ⁠⁠⁠⁠⁠⁠⁠⁠  ****Freebies***** Early postpartum recovery course:  https://mamastefit.com/freebies/early-postpartum-recovery-guide/  Pp sample  https://mamastefit.com/freebies/postpartum-fitness-guide/ Prenatal Sample:  https://mamastefit.com/freebies/prenatal-fitness-program-guide/ Pelvic Floor  https://mamastefit.com/freebies/prepare-your-pelvic-floor-for-labor/ Birth Prep for Labor Guide  https://mamastefit.com/freebies/prepare-for-labor-guide/ Birth Partner Guide  https://mamastefit.com/freebies/birth-partner-guide/ Birth Plan  https://mamastefit.com/freebies/birth-plan-guide/

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover the management of Guillain-Barré syndrome. For the presentation and ED evaluation of GBS, please see Part 1. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

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.

As we head into 2025, the business world is transforming at lightning speed—we're seeing new evolutions in the world of AI almost weekly, there is a huge and much needed focus on sustainability, a push for automation, and naturally, there is an incredibly dynamic political and economic environment, all which have an impact on GBS. They say forewarned is forearmed so in today's episode, we'll break down the Top Global Business Services Trends you need to watch to stay ahead of the curve. In order to help me explore the innovations, challenges, and opportunities shaping 2025, we invited Chazey Partners to be part of the episode. Joining me from Chazey are Phil Searle, CEO and Co-Founder, Lee Coulter, Chief Transformation Officer, Esteban Carrill, Executive Director, LATAM and Tim O'Donnell, SVP and CRO.  Throughout the episode we reference Chazey's report Transformation in the Age of AI, which you can download here.

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/

Challenge preconceived notions in obstetrics and gynecology with our latest episode, where we dismantle myths that have long influenced medical practices, even in the absence of scientific backing. From unraveling the misunderstood reaction between alcohol and metronidazole to examining the overlooked risks of clindamycin cream, we'll look at how these misconceptions take root in medical culture. We continue with a critical analysis of intrapartum GBS prophylaxis, correcting widespread misunderstandings around its purpose and timing during labor and how it affects labor management.We address the rise of dubious hormone tests, like the DUTCH Test, marketed to consumers, painting a cautionary picture of how social media amplifies these unvalidated products. We highlight the importance of consulting healthcare professionals while discussing the potential paradigm shift that self-collected HPV testing could bring to cervical screening, as recommended in the coming cervical cancer screening guiudelines. This new approach might revolutionize screening rates and quality of care, especially for underserved populations, all while realigning healthcare providers' focus on more pressing medical needs.Prepare for an engaging conclusion as we scrutinize the comparative effectiveness of postpartum hemorrhage devices Jada and Bakri, emphasizing the ethical implications of cost versus efficacy. We'll take you on a historical journey through the concept of "quickening" in pregnancy, reflecting on its cultural significance and evolution with modern science. Plus, changes for next season!00:00:02 Metronidazole and Alcohol00:13:03 Intrapartum GBS Prophylaxis Guidelines Clarified00:24:54 Hormone Testing and Cervical Screening 00:31:07HPV Self-Collect Screening Implications00:42:54 Comparative Efficacy of Postpartum Hemorrhage Devices00:51:29 Historical Perspectives on Fetal DevelopmentFollow us on Instagram @thinkingaboutobgyn.

Today's story is one that's equal parts confronting and inspiring. Meet Bret - a bloke who's been through something so rare and extreme that most of us can't even begin to wrap our heads around it. Bret was hit with Guillain-Barre Syndrome (GBS), a condition where your immune system turns on you, attacking your peripheral nerves. It's as scary as it sounds. For someone as active and healthy as Bret, the sudden loss of control over his own body was beyond terrifying. Imagine going from your everyday life to being hospitalised multiple times while doctors try to solve the mystery of what's happening inside you. His symptoms hit hard. He lost the use of his arms and legs, and felt as if he was burning from the inside out, something I'd sure never raise my hand to endure. When the GBS diagnosis finally came, it was the start of a long, grueling road to recovery. Bret had to literally retrain his brain to use his body again. Think about that for a moment... learning to hold a cup, to move your limbs, to function in ways we all take for granted. It's a level of resilience and determination that's hard to fathom. And here's where the story gets beautifully human. With the unwavering support of his wife Lisa and his loved ones. Today, Bret is back at work full-time, continuing his recovery journey, and proving just how much grit the human spirit can muster when faced with the unthinkable. This one's a powerful reminder of how tough we can be, even when life throws us the hardest punches.   SPONSORED BY TESTART FAMILY LAWYERS Website: testartfamilylawyers.com.au TIFFANEE COOK Linktree: linktr.ee/rollwiththepunches/ Website: tiffcook.com LinkedIn: linkedin.com/in/tiffaneecook/ Facebook: facebook.com/rollwiththepunchespodcast/ Instagram: instagram.com/rollwiththepunches_podcast/ Instagram: instagram.com/tiffaneeandco    See omnystudio.com/listener for privacy information.

In today's episode we hear about the rest of Atara's experience. She talks about managing GBS and its consequences with her newborns, and the importance of nutrition before pregnancy.We pick up today where we left off last week. Atara is pregnant with her second child and is experiencing a numbness on the left side of her body. She has figured out that she should be in the emergency room and what follows is what she encountered there...

One of our team members, Paige, joins us today to share our first maternal assisted Cesarean story on the podcast! Our favorite Julie joins too sharing her perspective as Paige's birth photographer. Paige tried three times to have the vaginal birth of her dreams. Each time ended in emergency Cesareans due to nonreassuring fetal heart tones. Each time, she missed the golden hour that she so desperately craved. Each time, she learned more and more about birth.With her fourth baby, she exchanged her VBAC dream for a new one. After hearing about maternal assisted Cesareans, she decided to do all she could to pursue one fully knowing it may not happen. But when it did, it was everything she hoped it would be and more. Paige's Full Birth VideoHoum ClinicDayana Harrison Birth ServicesJulie Francom Birth PhotographyYouTube Video: Maternal Assisted Caesarean Section - The Birth of Betty MaeThe VBAC Link Podcast Episode 220: Dr. Natalie Elphinstone & MACsThe Birth Hour Episode 875: Nicole's Maternal Assisted Cesarean in MichiganBaby Baking & Kid Raising Podcast Episode 6: MACs with Lauren BrentonAustralian Birth Stories Podcast: All Maternal Assisted Cesarean EpisodesYouTube Video: Nottingham University Hospitals Maternity Gentle C-sectionCBAC Support Facebook Community How to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Oh my gosh, you guys. Today is a very special day. It's a very, very special day. We have our own team member, Paige. If you guys haven't already seen the video floating around, go to Instagram today and watch what we've got posted. We have Paige, and we have Julie, and they are actually in Korea. Now, Paige lives in Korea. Julie flew to Korea to be the photographer for Paige. I was over here in Utah having FOMO as they were Marco Poloing me when she was in labor. You guys, I am so excited. I can't explain to you the love that I have for Paige. She has been on our team for so many years. I'm getting emotional. I have seen this woman transform into the most amazing, strong individual. She has created something so special for her family, and I think, for Korea. This is our first official Maternal Assisted Cesarean story on the podcast. Seriously, my eyes are all watery. I just cannot wait to hear this story. Julie was just saying how she's been dying wanting to call me this week while she has been in Korea, but she didn't want to share her story because it is Paige's story, but I love that I get to have both of them on the show. So hello, you guys. I'm sorry. I just am rambling. Paige: Hi. Meagan: Oh my gosh. Okay. We have Paige. We have Julie. You guys know who they are. Julie, obviously, has been with The VBAC Link for a long time, and so has Paige.Julie: Been with The VBAC Link for a long time? Yeah.Meagan: Yeah, sorry. You created it. Julie: We created it. Meagan: Yeah, sorry. I'm thinking of Paige. Paige has been with The VBAC Link for a long time. If you didn't know, she actually heads the CBAC group, the CBAC Link Community on Facebook, and she transcribes all of these incredible episodes. So thank you, Paige, and welcome everybody.Paige: Thank you. So yeah, I'm just sitting here in my little corner of The VBAC Link team doing my transcribing which I feel like maybe is just a little drop in the birth world bucket until something more happens for me. I've been with The VBAC Link for the last 4 years, and I feel like it's my way of preserving these stories. Spending time with the women on the podcast is such an honor, and it's just one of my favorite things to do. I've learned so much, and truly, we'll get into it, but I wouldn't have had this birth experience in the same way if it were not for The VBAC Link and for being on the team. So truly, thank you to both of you. You've changed my life. All right, what's that?Meagan: I was going to say that you've made our life better. Paige: Aw, thank you.Julie: Yes, absolutely. It is so cool to see this. Me and Paige were just talking last night about this and how it's kind of a full-circle moment. We were going over her other births and how we got here and how she got here. It's just so cool. I am so thrilled about how everything played out. There were so many little miracles. I think miracles is not the right word. There were so many special blessings and things that led her to this point. I cannot wait to hear all of it from her perspective. It's so fun to be here and share on the podcast and really, this story is going to change lives. It's going to change lives. It's going to change birth. It is going to be something that people talk about and use as inspiration and hope as they prepare for their own births, no matter how they birth because there's a lot of advocacy involved. I think that's the biggest thing. There's a lot of advocacy. Paige did a lot of advocating for herself and what she wanted. It doesn't have to be literally the same way that she birthed for anybody to take inspiration from it, so I would just encourage everybody to listen because she is such a good example of fighting for what she wants, and shifting and rolling with the punches. I am just so inspired by Paige. You mentioned it too, Meagan. I am just so inspired by how she has approached all of this. Yeah, there are lots of life lessons. Lots of life lessons in this birth. Meagan: Yes.Julie: Stay tuned, everybody. It's a good one.Meagan: All right, Ms. Paige. We're turning the time over to you. Let's hear it because I cannot wait. Paige: Okay, so I'm going to start with a brief overview of my first three births. I'm a mom to four boys. I never thought that would be my story, with four C-sections. I never thought that would be my story, but it is, and it's beautiful. For my first birth, I got pregnant in September 2015. We were living in Hawaii at the time, but moved to Lawton, Oklahoma. I received prenatal care there at the Army hospital. It was pretty straightforward, just the What to Expect When You're Expecting type prep. They have this program called the New Parent Support Program which is really great for new families.  A nurse comes to your home, educates you, and gives you resources. I did that. That was really nice. I had a friend who was a doula. We took a hospital childbirth class and watched things like The Business of Being Born, but other than that, I was mostly just really afraid of childbirth in general. I was afraid of dying. I just wanted to survive. I didn't really have any specific birth preferences. I have struggled with anxiety and panic attacks throughout my life, so I thought that if I could just survive, that would be a big win. My OB was a family friend, and I felt very safe with him. He had a great bedside manner. I didn't really push any questions. I just trusted him fully and completely. At 34 and 6, I noticed that I started leaking fluids. My New Parent Support Program nurse had advised me that if I had noticed any kind of new discharge or anything like that– colorless, odorless fluid to go and get it checked out immediately. So I did. My husband drove me. I remember I had not eaten lunch, but it was lunchtime. I was like, “Oh, just drop me off. This will be fast, then we will go get lunch.” The midwife there tested the fluids and confirmed it was amniotic fluid. I remember my OB walked in. He said, “You are leaking amniotic fluid. We need to have this baby today. The baby will be fine at 35 weeks, and it's better for the baby to come than for you to stay pregnant basically and risk an infection.” So I was like, “Oh, okay. Yeah. I trust you.” I got a steroid shot for lung development at 35 weeks. Then they started me on an IV with antibiotics because I didn't have my GBS test back yet. Then he also told me that the Army hospital there did not have a NICU to support a 35-weeker and that I would need to be transferred to the civilian hospital in town. So I would have to be transferred. Since I was already on an IV, they were just going to do it via ambulance. It was my first time ever riding in an ambulance. He also said that he legally wouldn't be able to deliver me, but he would go with me and help me make decisions. That was really nice of him to go, but still just the sheer fact that I was going to be riding in an amublance for the first time, I was going to be having the baby that day, and then I was going to have a completely new doctor, was just sheer overload going into a birth that I was already afraid of. Yeah, it was not the best circumstances for a successful induction. I arrived at the hospital. I met the doctor very briefly. I called my doula friend. She came and helped me. We did what we could, but ultimately, my body was just not showing any signs of being ready. I had no contractions at all. I was completely closed and not even soft. No dilation. My cervix was just not showing any signs of progress. After about 14 hours on Pit, they came in. I remember I had the dull cramping from the Pit, but nothing really intense. I also just remember being so painfully hungry, and they wouldn't let me each. But since I hadn't had lunch, I was just so hungry where you get the body chills and stuff. Anyway, the doctor came in, said he was having decels. He recommended having a C-section because my water had been broken for over 12 hours. I consented. I was so afraid. I remember when they were putting in the spinal, I was just heaving sobs into this poor nurse. You go in and prep. The C-section itself was fine. My arms were strapped down. I didn't feel pain, but I remember it was like an elephant was sitting on my chest. It was like, “Oh, it just feels like somebody's sitting on my chest.” It wasn't horrible, and I was pleasantly surprised by that. But then, he was whisked away to the NICU. I briefly saw him swaddled with a hat on, then he was whisked away. No skin-to-skin for my husband or me, obviously. He was 4 pounds, 14 ounces at birth. They wouldn't let me go see him until I felt ready to go. I was just so swollen from all of the fluids. I was so nauseous anytime I would sit up. I just was not ready in any state to try to go walk or be wheeled to the NICU. Finally, 36 hours after delivery, I was able to meet him. We named him before that over FaceTime, but he was in the NICU for 7 days. I wasn't traumatized because I survived and that was my goal. I met my goal, and I was really proud of myself for facing the fear, but hoped for something different the next time. With the second birth, I got pregnant in July of 2017. I had a subchorionic hemorrhage early on that resolved. We were in Texas at the time. It was Fort Hood back then, but I met with many different OB providers at the Army hospital on base there. I felt okay with it because I had a neighbor who was going for a VBAC after two C-sections. She was really supported, and then she had a successful experience there. Because of my 35-week PPROM, they suggested that I go on the Makena progesterone shots once a week from 16 to 36 weeks. I did that. They worked very, very well. I switched to the midwife track because everything was going fine. The midwives were really great. They were really holistic. They supported inducing a VBAC if needed, but they also supported me going into spontaneous labor past 41 weeks. I made it to 41 and 5. The VBAC Link was not a thing back then yet, so I did not have that resource, but I did read Ina May's Guide to Childbirth and the Natural Childbirth the Bradley Way. I read The Birth Partner. I kind of started dipping my toes into real birth education. I was learning about the physiological process of birth, learning how to do it without being afraid, and learning to trust my body. It was really empowering. It was the prep that I needed at that time. I didn't know about bodywork. I ended up having prodromal labor for about a week. It was pretty intense, but I didn't know anything about positioning, posterior, or Spinning Babies. I did find that out right at the end as I was going through it, but I didn't do chiro or any of that. I finally went in for an induction at 41+5 in April 2018. I ended up having to go with an OB on call because the midwife didn't feel comfortable with the NSTs that she saw, so she didn't want to take me on. I was like, “Oh, dangit.” The OB who was there was one who I wasn't really super comfortable with. But he was like, “Oh, well I know you really want a VBAC. We'll try to get that for you.” I was like, “Okay.”I got a Foley. I was barely a 1, but they got a Foley in and I progressed very quickly. I got to a 5 within a couple of hours. Things were going really great. They were very normal labor patterns. I felt like I was managing the contractions really well. I did consent to artificial rupture of membranes, then labored a little while longer. I got an epidural at 7 centimeters. I was told, “Oh, we just had a mom who got an epidural. She relaxed, and the baby came right away.” You hear that and you're like, “Oh, I want that. Yes.” So I did that. I got the epidural at about 6:30ish, and then between that half hour, his heart just wasn't doing well. They were flipping me. I got an amnioinfusion. I got a fetal scalp electrode. I got an IUPC, all the things. Then they gave me oxygen. It was probably about 7:00. He had a prolonged decel. I was lying flat and there were people all around me. The nurse was just like, “We need him now. Do you consent to a C-section?” I was like, “Yes.” Then I surrendered and let it go. I was like, “There goes the VBAC. This is just what needs to happen.” He was born at 7:09, and I was born under general anesthesia for that one. His APGARS were 8/9. My husband was left alone during that surgery. We do have pictures of him holding my son and doing skin-to-skin at 7:27, so about 20 minutes after he was born. I woke up and got to hold him at about 8:45, so about an hour and a half after he was born. I remember it was just really hard to talk after being intubated, but they let me breastfeed right away. I was disappointed, but I don't feel like I had a lot of trauma from that just because I was so empowered. I ended up ultimately making it to an 8. It was so fun for me to see what my body could do. I was like, “Oh, this just means that I was meant for a VBAC after two C-sections. That's what it meant.” Right then in the OR, or I guess it was the recovery room. I committed that that was going to be my story. I was like, “Oh yeah. That's just what it's meant to be. That's why it didn't work out.” I was so empowered. Then when I got pregnant for the third time in September 2019, we were in Germany. We had just moved there. I hit the ground running. I hired a doula right away and a backup doula. The prenatal care was at this small, tiny clinic in a town called Parsberg. I chose not to get progesterone shots. I was like, “I was 41+5. I think I'll be okay without them.” Yep, that's when I discovered The VBAC Link and all of the birth podcasts. I just became obsessed listening all the time, taking notes. I did the bodywork. I watched tons of birth videos. I did cranioscral therapy, chiropractic, and Spinning Babies. I took The VBAC Link Parents Course. I read lots of books. I switched my insurance. I took vitamins. I consumed it all, and I loved it. Every time I did something, I felt like my intuition was confirming that I was on the right path. I specifically would manifest, visualize, and pray, and I just was on this high every time. I feel like that's your intuition confirming to you that you're on the right path. If you feel those things, that's a good sign. You do want to follow that. Meagan: 100%. Paige: I did. Then, COVID. It was September 2019 when I got pregnant. Things were fine, fine, fine, and then COVID started happening. In March, I flew home to Denver to stay with my in-laws. We were supposed to move to Colorado in the spring anyway. My husband was not allowed to come with me. There was a travel ban for 90 days. I just did not want to get stuck in that, so I flew out very quickly with my boys– my two boys. I was 27 weeks pregnant and was living in my in-laws basement. That's a whole thing. COVID was a whole thing for everybody. But it was a scary time and stressful. I didn't know if my husband would be able to make it to the birth, but he was granted an exception to policy leave where he was able to come home. He would have to go back. That was the contingency. But I had rebuilt my team. I had found new bodyworkers. I found a new doula and a new backup doula. I found a team of midwives who were really VBA2C supportive. They were saying things like, “When you get your VBAC,” not if. They really supported all the things, so I felt really comfortable with them. I lost my mucus plug and had bloody show on June 8th. I was 40 weeks. That was my due date. My water broke that night at 11:00 PM. I had a small pop, so it was just a litte bit. I was laboring at home. Nothing really was picking up, but on June 9th, at 40+1, I went into the hospital around 3:00 PM. Labor started picking up pretty quickly after that. About an hour and a half later, my waters gushed everywhere which was really thrilling for me to experience the big gush. I was not very far along, though. My progress is just very slow, but they were not rushing me at all. They were like, “We'll stay patient. We will stay very patient. There is no rush. As long as baby is doing well, we'll just let you do your thing.” My doula was there. After my waters broke, my contractions started coupling on top of each other and getting very intense. They were quite long. I started feeling really lightheaded and dizzy. I tried to sit on the toilet and just felt like I was going to pass out. I threw up a few times. I knew it was time to get some pain relief. They offered the walking epidural option which I took at about 8:00 PM. Baby was doing great. I was really worried about getting the epidural again because I felt like that's what had caused the craziness before, but he was doing great. At 2:00 AM, he started not doing great. He wasn't tolerating the contractions well. I was like, “Oh, not again. What?” I was only 4 centimeters. I just knew that we needed to go in again. I didn't know why, but I was so sad. I didn't want another crash, so I did want to prevent another crash. I knew that if it was going to be a heart thing, I didn't want to mess with that. Especially knowing the signs of pain and coupling contractions and things like that, it just seemed like he was telling me that he needed to come. I consented to the OR and to the C-section. I was wheeled to the OR. I remember as I was being wheeled in, I was just thinking, “This is not what I want. This is not what I want. This is not what I want.” I was so sad. He was born about an hour later. I was so drowsy. I was so tired. I was not present at all. I did not feel strong enough to hold him. My husband held him. I briefly brushed his face. He was wearing his little hat and was swaddled, then they took him to the recovery room. The doula was not allowed in the OR. It was actually a miracle she was allowed at all because they had just lifted the doula ban the week before for COVID. I was like, “Okay, the baby will be in there with her.” I'm not sure why they wouldn't let the baby just stay with Sam, but it's okay. I needed his support. I was really happy that he was there. Closure took longer than usual. They said I had pretty thick adhesions, so I was just laying there trying everything to stay awake. I was fighting so hard. I remember reading words on the light and looking at the letters and just going over the letters in my mind and trying to stay awake. I was fighting so hard to stay awake. I finally got to hold him at 4:00 AM in the recovery room. It was still about an hour after he was born. I missed the golden hour again. I was so sad. I was so sad for a third time to miss it. That recovery was really hard. In the hospital, I was so heartbroken. The trauma this time really hit me emotionally and spiritually. It was physically a lot more traumatic on my body for whatever reason. I mean, just the sheer labor was so intense. My incision was black and blue and puffy. I couldn't walk normally and I didn't feel normal for 5 or 6 weeks, but I also feel like it's because I was so sad. I think how sad you are really does affect how you feel physically. Meagan: Yeah. Yeah, for sure. Paige: I do remember specifically too, my first shower there. My husband had to really help me walk over. I was so sticky from all of the sensors and monitors. He was so tenderly trying to help me wash them off. I was just sobbing. I was so sad. I felt so broken and so vulnerable. It was a beautiful time for my husband to be there and carry me because he knew how badly I wanted the VBAC that time and for him to just carry me through that. But going home, I went home to my in-laws' basement. It was dark. I didn't have a support village because it was COVID. COVID moms know what that was like. Anyway, ultimately, I did reach out to Meagan and Julie. That's when the CBAC group was started. I was like, “Is there any way we could start a CBAC support group where CBAC moms can connect?” You guys were so warm and welcoming. Immediately you were like, “Yes! Why hadn't we thought of that?” Julie, you were so gung-ho about that. I was able to connect to other moms through there which was so healing. Anyway, that was the third story. Then the time between three and four was really, really pivotal for me. The healing that I felt I needed before even thinking about trying to get pregnant was where I feel like this all really starts. When you don't get the birth that you hoped for or when you don't get a VBAC, you just feel embarrassed. You feel ashamed. You feel broken. You feel like your intuition doubted you. You feel dumb. I've seen many women comment how family members would be like, “Oh, I knew it wasn't going to happen for you.” It's hard. It's really hard. You feel very, very broken.I knew that I had to show up for myself and still give myself grace. For this birth, it was good for me because I was able to face not failure, but being wrong. I was able to face being wrong and show myself that I could still be there. Anyway, I started physically diving into healing through pelvic PT and doing a lot of scar adhesion work. The dolphin neurostimulation tools if you haven't heard about those are fantastic. I feel like they worked much better for me than scar massage. I wish I had a provider here now who would do it. I think maybe that would have helped this pregnancy and birth, but it helped my recovery so much.I started having really bad panic attacks and postpartum anxiety, so I went to talk therapy. I got on medication. I went to a chiropractor again. The thing that really, really helped my healing was joining a gym and falling in love with exercise again. I got into all of the things, the yoga, running, learning how to lift, and started really pushing my body again and trusting my body again. I didn't expect exercise to heal that relationship with my body, but I feel like it really did. I learned again that I am physically strong which was really, really nice. I started signing up for some races. I ran my first half marathon. I had a lot of emotional releases during yoga. There was one song that came on one time during a yoga practice. It said, “You can't rush your healing. Darkness has its teaching.” I loved that so much. I just started crying. I was just like, “Let it out.”Part of healing is welcoming the grief when it comes, processing it, and taking it a little bit of a time. It's such a process. You get little glimmers of understanding, but as you keep committing yourself to looking for that and looking for the understanding, it does come. I truly believe that. Anyway, life went on. There is a four-year gap in between my third and my fourth which I really needed. We moved to Korea in that time. We moved to Korea last June, and it's just been lovely. We knew that we wanted one more. I knew I was so happy with the prep and how vigorously I did it. I was proud of myself for that and I knew that I wanted to do it the same way.I knew that after everything I learned, even if it was going to be a C-section, I couldn't just show up to the hospital and have them take my baby. I knew too much. I was like, “I know that there are better ways. I know that providers practice differently from place to place. I know it's not all equal. I know every provider does things differently, even with C-sections.” I started watching videos, and I saw that even the way they performed their C-sections was not the same. I wanted to be really actively involved in how they practiced, and how I was going to be a part of it. My goals for this time were not necessarily VBAC or C-section. I never closed the door completely. I was like, “You never know. Maybe VBA3C, maybe that's my story. Who knows?” However, I did find the episode by Dr. Natalie Elphinstone. As I was transcribing that one, my fire for birth that I held felt for VBAC was coming to life again. That intuition was speaking to me, and I had not felt that fire in a long time. That was the first whisperings of, “You should try this. You should go for this.” The goals that I had for this baby were to be very intentional. I wanted the golden hour. I had to have the golden hour. I had to hold my baby first or within an hour. Please, oh my gosh. I carried so much guilt for not having that three times over. I also wanted to be treated like I mattered. I did not want to be part of a rotation. I wanted continuity of care. I did not want to feel like I was just being shuffled through a system. Whether it was a hospital or not, I knew that I wanted to feel special. Lo and behold, did I know how special I would feel at my sweet birth center. Okay, so with the intention thing, just the pieces of this birth story with number four started falling into place so specifically. I can't deny that spirituality was a big part of this because with number three, my prayers had been very, very specific. I knew that God knew what I wanted. I knew it. I knew that because I didn't get it, there was a specific reason why. That's the only thing I could cling to. As things specifically started falling into place, it started to confirm to me that this was my path and these were the reasons why the other things happened the way they did. But anyway, I got pregnant very quickly with this baby. It was the first time that it wasn't a total surprise which was really fun. I had been taking tests since I knew the day that I ovulated, and then I was just taking tests watching, watching, and watching. I was able to see the first faint line which was so fun. I had always wanted that. I had wanted that moment of, “Oh my gosh, I'm pregnant,” where before it was like, “What? I'm not quite ready,” but I was still excited. That was really fun for that. The Korea birth culture here is very intense. The C-section rate is 50-60%. There are constantly stories being shared on these local pregnancy pages of women just having the most traumatic experiences and my heart aches for them. It's very routine for doctors to suggest first-time moms to, “Go have a C-section. Your baby is big,” and not even trying to labor. Most of it is because there is a doctor's strike going on here. There is a limited number of providers. They are stressed. They don't allow husbands typically in the OR, and very routinely, they are under anesthesia. Then after birth, babies are typically taken away to nurseries, and then postpartum recovery is in an open bay type thing. Meagan: Like, combined? Paige: Exactly, yeah. Your C-section stays are typically about 8 days. I wanted to explore options. We have an Army hospital here that is pretty big and does provide labor and delivery services, but they're often maxed out so you're referred off post. I did not feel comfortable going to any of the places that they typically referred to just from stories I had heard. That's all it takes for me now. I just hear one story and I'm like, “Nope, no thank you.” I know my red flags very quickly now. I went to a tour at this birth center called Houm. It's spelled H-O-U-M. At 8 weeks, I went to go tour it. I noticed a lot of green flags, not red ones where I was just like, “Oh, I'm just going to take a note of that.” Some of the green flags from my tour as I walked in were how I felt right when you stepped off the elevator. It's this calm energy. The lighting is so beautiful. It's such a lovely set up right when you walk in. You take off your shoes because you are in Korea. You take off your shoes, then multiple staff members greeted me with a hug. That's when I met Dayana Harrison who I later ended up hiring as my doula, but she also served as my midwife. She is a student midwife working there right now. She took me on the tour. They have queen-sized beds in their labor rooms. The whole floor was dim and so quiet. It did not have a hospital vibe at all, but they do have an OR on site. I was like, “Oh, this is lovely.” They offer epidural. They have huge birthing tubs with the rope attached from the ceiling. They are so beautiful. Yeah, it's in each room. Then the OR on site does not feel like a hospital OR. It's smaller. They keep it warmer. It feels like– I don't know. It just had such a homey feeling. That's the best way I can describe it. Then some of the things I asked about, in their routine gentle Cesareans, moms routinely get skin-to-skin immediately. They have a little cut open in the curtain where baby is slid through right on your chest. They routinely would keep the placenta attached to the baby in the OR which is–Meagan: Almost not heard of. Paige: Since posting that video, I can't believe how many messages of, “How did you do that?” That's revolutionary in itself. That was a huge green flag where I was like, “Oh my gosh, what?” Typically, what is it? Why do they say you can't do that? Is it because the incision is open too long?Meagan: Yeah. They don't even allow delayed cord clamping most of the time. They just milk it because it's a major surgery. The more time the mom is exposed and open, the higher chance they have of things like infection. Once baby is out, they really want to wrap it up and finish it to be complete. Yeah. To actually leave a placenta attached to a baby is unheard of. It really is unheard of in a Cesarean. Paige: Yeah. So that was super awesome. Then they let you keep the baby. He encourages C-sections past 39 weeks. That's not a routine hard and stop final date. He encourages going into labor before saying that it's good for the baby. He encourages breastfeeding in the OR. The head OB, his name is Dr. Chung. He is also an IBCLC which I thought was so awesome. So he supports breastfeeding.Julie: Wait, wait, wait. Time out. The more I learn about this man, the more I love him. Paige: Did you not know that?!Julie: Oh my gosh. Meagan: I want to meet him. Julie: I want to put him in my pocket and take him with me to deliver every birth I ever go to ever. I love him. Paige: I've literally said the exact same thing, Julie. I wish I could just keep him with me forever. That's the thing. Throughout this whole process, I kept taking note of these green flags. I'm thankful for my other experiences because I don't think a lot of people recognize how green these flags really are. I was like, “Okay, the shoe's going to drop. The shoe's going to drop. There's something.” I'll keep going.Meagan: Can I mention too? You had Marco Polo'd me, “I'm on my way,” then you would leave, and you were like, “This is amazing.” You were just like, “This is right,” every single time. The more you went, the more it verified that you were in the right place. Paige: Yep, yeah. You just know. When you know, you know. During that appointment, he came specifically and talked to me three times. Three times. He shook my hand. I'm like, “Are you not busy? What? Three times, you have time to see someone who is just touring?” He only sees 15 patients. He is very VBAMC supportive and experienced with it. He supports vaginal breech birth. They do ECVs on-site. I didn't even bring up VBAC after three. I just mentioned that I had three C-sections, and he said something like, “Oh, do you want a VBAC? Do you want to try again?” I was like, “Oh, I mean, I don't know. I'm thinking about it.” Then, he made me cry. This was at the tour. He made me cry because he said, “I'm a different doctor because I listen to moms. I listen. They tell me how they want to birth. If you want a VBAC after three C-sections, I will support you. You can do it. You choose how you want your birth to go and I will worry about the bad.” He was like, “You don't need to worry.” I was like, “Oh my gosh,” and I started crying. I was like, “Okay, I'm going to go now.” I was not composed, and then he hugged me. I was like, “What? Who is this guy?” I didn't just jump over there. I did give the Army hospital a chance. I went to a couple of appointments there, and that was kind of all I needed to know for what I wanted. I'm so thankful they are a resource there. I'm thankful that they are here. But I did ask about their routine Cesarean practices and their VBAC practices. It was important to me to find a doctor who supported VBAC even if that wasn't what I was planning to go for. I still love VBAC so much. I think it's so beautiful and such an important option for women to have. I'm so passionate about it. I always will be. They didn't even humor the idea at all of VBAC after three. They were like, “Oh, no. You're going to have a C-section. Of course.” The idea was laughable. The C-sections only allowed one support person, no breastfeeding in the OR, no photographers. Arms are strapped down. I just was like, “Okay.” I was very gently asking questions, but then was like, “Uh-uh. Red, red, red flags.” My biggest piece of advice, and we say this over and over again, is to find a provider whose natural practices align with the things that you want. Julie: That is it. That is it so much. Sorry, I don't want to interrupt again, but let's put bold, italics, emphasis, and exclamation points on what you just said. Say it again. Say it again for the people in the back. Paige: Find that provider whose routine practices align as closely as possible with what you want. Julie: Preach, girl. Preach, girl. I love it. Paige: Because we're not meant to fight. You do not want your birth experience to be a place of fighting or stress. Julie is learning that I am a people pleaser. I'm not anything special. I did not stand my ground. I'm going to do this. I did not come blazing in. I found a provider who I felt very, very safe with, who I felt safe asking for this from, and he said yes. I knew that because his practices were so close to the MAC, he would be the most receptive. But there's a chance that he wouldn't have been, and he was. That's why ultimately it worked out because he was receptive. I couldn't have forced him to do it, but because he practices closely to it already, it wasn't as much of a push. If I tried to go to that Army hospital and introduce this idea, they'd just shut it down. Meagan: You know, that's what is so heartbreaking to me. Providers all over the world really just shut that down if it doesn't match their normal routine and their everyday thing. It's like, well, hold on. Let's listen. Why are people requesting this? Just like Dr. Natalie, she saw this and was like, “This is something that means something to people. Why don't we change the norm and create something different?” Providers, if you are listening, please try and make change in your area because it matters, and it doesn't have to be exactly how it's been. Paige is living proof of this. It just doesn't have to be that. But we can't make change if no one puts forth the effort or allows it. Paige: Dr. Natalie said that exactly. She said, “Let's make every birth the best possible version of that birth that it can be.” Meagan: Yes. Yes. Paige: She said, “If there's a way to make it better, why not? Why not?”Meagan: Why not? Because like it or not, birth impacts us. It sticks with us. You're now explaining four different stories. It's not something we just forget. We don't just walk away from these experiences. They stay with us. Now, we might process and are able to move forward in a different direction, but it's not like we forget, so why can't we make this change? It actually baffles me. Julie: Well, and the mode of delivery is the same. I really want to emphasize that. She has had four C-sections, and they were all very different. But the only one where she left walking out of it really feeling empowered is the last one where she chose a provider who aligned with what she desired for her birth, she had a say in her care, and she felt loved and supported the whole way. She felt like the staff cared about her needs.But also, time out. She didn't just feel like the staff cared about her needs. They did. They did actually, genuinely care about her needs and her experience. I feel like that's such a big difference. Meagan: Mhmm. Mhmm. Yeah. Sorry, Paige. You can continue. We got on a little soapbox. Paige: You're good.Julie: I feel like we're starting to tell the story before the story is told. Paige: No, it's great. We're getting close. I switched to them officially at 20 weeks. My first appointment was the anatomy scan. That's when I also proposed the idea of the MAC officially. After every ultrasound, he comes in, talks to you, looks at it, then you go into his office area where you just chat and ask any questions. That's just the routine setup of the appointments. I had this video prepared, and I was really nervous. It's scary. It is scary to ask your provider for something new and different. I had this video. It's on YouTube. It's by Olive Juice Photography. Everybody should go look at it. It's the birth of Betty Mae. It's the video that I watched over and over and over again because it's the only video I could find of the process from the beginning to the end including all of the prep and including how it was done. I was like, “I saw this online. I was wondering if you could watch it and tell me what you think.” That's how I presented it. It's a long video. It was like, 5 minutes. He just sat there patiently and watched. Then after, actually one thing he did say was, “I don't like how he's using forceps.” I was like, “Oh, green flag.” Then, he asked, “Is this what you want?” I said, “Yeah. I think it would be really special if it could happen.” Then, he said, “Then, we can do that.” Then, he thanked me for giving him the opportunity to grow and try something different. He said, “Will you email that video to me and any other resources?” I emailed Dr. Natalie, and she sent over a MAC PowerPoint that she had prepared of the procedures because from the episode, she was like, “Anybody interested doing this, reach out to me.” She is true to her word. She will do that. If you are interested and you want to contact her, she is very responsive. She sent me also her MAC hospital policy which I forwarded to him. I have to share what he said. He's so cute. In the email response, he said, “I watched the video you sent again. If necessary, we will contact Dr. Natalie to prepare for your perfect Cesarean delivery. Thank you so much for this great opportunity to serve you. I am excited to help your birth and confident it will be a great opportunity for further growth for us.” I was like, oh my gosh. Meagan: That literally just gave me the chills. Paige: I could not believe it. Dayana, who is also a student midwife there at home, told me that she had been planting seeds for maternal assist for a while. They had just been waiting for a mom to ask for it. That was also the time that I hired Julie. I was like, “Julie, that would be so fun if you could come out.” Then Julie was like, “Okay, let's do it.” Then I'm like, “Okay.” Then it happened, and Julie was just so brave to have the gumption to come out. Fun fact, she was previously stationed out here with the Army. It does seem like it all kind of worked out that Korea wasn't so out of touch for her, maybe. Julie: Yeah, no. It was really cool. You had mentioned it briefly, then I was like, “Oh, I wish I could make that work.” Then, I remember I was in the CBAC group. I was like, “Oh, I'm so excited for you,” or something, then you said something like, “I really wish you could come and document it. We would cover your travel out here and everything.” Then I was like, “Oh my gosh, really?” So then I talked to my husband about it. I was going to be gone for a while. He would have to hold down the fort and everything. I talked to him and he was like, “Yeah, I think that would be okay.” I was like, “Oh my gosh, Paige. My husband is fine with it. Let's do this.” I remember the day that you booked my flights and officially signed my contract and locked in and everything, then I told my husband and he was like, “Oh, this is really happening then?” I was like, “Nick, I gave you the change. I gave you the chance to eject. It's too late now.” He's been doing really great. He's a really great dad. The on-call life means he has to just take over the house at random moments. We are set up to where we can do that. It was just really funny. I'm so excited that we could make it work. Paige: This is my public thanks to Nick and all of Julie's children for allowing her to be here because it did require sacrifice on their part, truly. I'm just so thankful. I also found out, Dayana told me that she had been asked to prepare a whole presentation for the staff on MAC which she did. She prepared it for nurses, midwives, and anesthesia walking them through. The fact that she had that connection to Houm and that experience, she served as my doula but so much more. She was so much more as my advocate having that inside access to the staff. We scheduled a surgical rehearsal for 35 weeks. At 35 weeks, this was one of my favorite things. He personally was there to walk me through every step of what it would look like for my security, but I don't feel like I really needed it because I was very, very familiar, but for the comfort of the staff and everybody else too. I got to the appointment. My husband was able to be there with me on that one. The way it's set up– we'll post our video then you can visualize more of what the layout looks like. There's the prep room, then literally 10 steps across is the OR right there. In the prep room, they had a gown ready for me. They had the washing bins ready. So the way that it works, you go in. You put the gown on. You have the IV. They showed me where they would place the IV. Then you scrub up your hands. You wash with the sterile solution, and then they put gloves on top. This was the way that they did it. Then they walked me into the OR. They showed me how I would go sit up on the table, how I would receive my spinal through anesthesia, then they practiced laying me back down. They did everything step by step. It wasn't new to me. I've had C-sections before, so I knew, but it was just so sweet that they were so thorough. They showed me how they would insert the catheter. He showed me exactly how he would lay the drapes over my body. He showed me when the curtain would go up. The way they do it, you're not just watching the whole thing the whole time. You could, I guess, opt for that if you wanted to. You have the drape up, they do the initial incision, get the baby out up to his head, and then they drop the curtain. That's when they pull your arms down. The other thing too, the reason why they do strap your arms down is in case you impulsively reach down and touch your incision and breach the sterile field. That's the reason why arms being strapped down is even a thing. But for MAC, your arms are not strapped down obviously. They have somebody holding their hand on your hands which I don't think I even had. Looking back, I don't remember anybody touching my hands or my arms. But that wasn't an issue. It wasn't something that I impulsively wanted to do, to reach down there. Anyway, then the drape goes down. They guide your hands up and over to put your hands under his armpits. Come up. Bring your baby to your chest. The curtain goes back up during closure, and then they talked about how I'd be transferred back to the recovery room– not the recovery room. No recovery room. You go to the postpartum room immediately. I felt on such a high after that. It was just so beautiful how he did that. At 38 weeks, I had an ultrasound. They do ultrasounds at every appointment. I don't know that there is a perfect practice out there that aligns with absolutely everything you want. But they do routine ultrasounds. I wasn't really concerned about that, but they did flag something called kidney hydronephrosis. It's basically the swelling of the kidney. They had been monitoring that. It had presented late in the third trimester, but it was severe enough that they were starting to get really concerned about it. Basically, it can mean that there is an obstruction, and if it's really severe, it can mean that the baby needs to be evaluated within 48 hours of birth by a pediatric urologist which clearly they don't have on site. It was a whole thing. If it really is severe and there is an obstruction, then they need to do surgery really promptly to prevent kidney damage early on. That was the thing. He did suggest that I could deliver somewhere else, and then the baby would be able to be there and we would be together in the same facility. That's when I felt like the shoe dropped. I was like, “Why would he suggest that? He knows that I would not want to deliver anywhere else. Why would he even bring that up?” I was all a mess. I was alone at that appointment. I felt a little bombarded and ambushed. I was like, “This isn't going to happen. I'm not going to get it.” That night, Dayana called me. I was getting ready to reach out to her, but she called me. She was like, “I just wanted to check in.” I had emailed Dr. Chung a clarification email. I think that's really important too. If something doesn't sit well with you in your appointment, it's okay to follow up in an email just to clarify what happened. Can you lay out these options? Can you lay out what we went through? Can I have a record of the ultrasound and what you saw? Because then you're not just swirling these things in your mind. You're actually looking, then you can do your own research. I dove into research. I dove into studies. I compared the numbers that he gave me versus what I saw, and it all did align. She called me and she was like, “No, don't worry. He is comfortable moving forward. He thought that you would be concerned, so he wanted to present you with more options to deliver somewhere else, but he is very happy to deliver you here still and sticking with our plan. He does want to see you at a follow-up ultrasound at 39 weeks,” which I was comfortable with. I was like, “Sam, you've got to come with me. I can't go alone.” She promised that she would be there. That's another thing. When you have a team that you trust, make sure that you are supported, and it's not just you and your doctor. If there's something that doesn't sit well, it really helps to field it with other people not just in labor, even in your prenatal appointments or anything like that. If you feel like you need some extra support, it does really help to bring some people with you who you trust. So at 39 weeks, we all met as a team and asked lots of questions. We felt comfortable with a care plan moving forward. We ultimately decided that we would move forward with the C-section at 39+5 which would be Monday. I'm trying to think what day that was. Meagan: The 7th. Paige: Monday, the 7th. Meagan: That's what I had in my calendar. Paige: Monday, the 7th was the day. We talked about moving it up. All his colleagues were like, “No, you should deliver this baby now. What are you doing? You're crazy keeping her pregnant.” I was like, “I am comfortable waiting, and I have to wait for Julie, so it can't be until Friday. It can't be until Friday.” She gets in on Thursday. That was Wednesday, at 39 weeks. Thursday was 39 and 1.Julie was on the plane, and then that morning on Thursday, I lost my mucus plug at about 8:00 AM. I was like, “Oh, no.” I wasn't really having contractions or anything, so I was like, “Okay. We'll still make it until Monday. It's fine.” Then, Julie got in at about 7:00 PM. I started having some baby contractions. We were sitting around my kitchen table, and Julie was like, “Are you contracting right now?” I was like, “A little.” She was like, “Go take a bath.” Then, we went to bed. I took a bath, and then I went to bed. I was for sure just contracting. I was like, “But what about these logistics? What is going to happen?” Anyway, my childcare plan was going to be turned upside down and all of the things. I was stressed about the logistics. But then, I was woken up at about 10:00 PM by contractions. They were about 6-7 minutes apart, but they were definitely real. I thought they were prodromal, so I was just waiting for them to just go away. They started getting closer. They were close enough to about 4 minutes and sometimes 3. I was having more bloody show, so I was like, “These are kind of doing something.” The intensity increased. It got to the point where I couldn't lie down. I was on my hands and knees. I was standing up, bracing myself against the wall. I was trying to do different positions. Maybe it was just a positional thing. “Let me try to do flying cowgirl. Let me try to do Walcher's”. I was trying to do different positions to try to stop them. I tried to take a bath at 3:00 AM, and they weren't going away. I was like, “Okay, I can't do this. I can't risk it. We've got to go.” I woke up my husband. I was like, “Today's the day. He's just telling me that it's the day. It's time. I don't know why, but it's Friday. It's supposed to be.” At 4:00 AM, he packed his bags. At 5:00 AM, I felt so bad because Julie had just gotten in from this huge international flight. It was a 12-hour flight plus some because you had a connection. I was like, “Julie, we're going to go,” she was like, “Okay!” She was so excited. “Okay, let's go!”Julie: I wake up to a knock on the door, and they're all dressed and ready to go. I'm like, “Why did she not wake me up sooner? I could have supported you.” Paige: I felt so bad. Julie: Yeah. It was wild. It was so wild. I was ready. It was awesome. Paige: So at 5:00 AM, we left for the birth center. At 6:00 AM, we got there. I messaged my team. Dayana said she was on her way. They led me to my room which is just a beautiful suite. It's right next to the OR. They led me to my room. They said that the anesthesiologist would be ready at about 10:00 AM, so between then, I would be laboring. Dr. Chung came in, and he said, “You need to be prepared for a VBAC to happen. You might have this baby just right here.” It was so funny that he was supportive of that idea even. It was so cute. I labored. It was getting intense, but they weren't super close together. Dayana came. She jumped in, and she immediately just respected the space which was so beautiful. She started doing all of her– she's a Body Ready Method practitioner. She's done some training with Lynn Schulte and the Institute for Birth Healing, so she's very familiar with the specific way to give you comfort measures. She was so great. I felt so safe. We labored, and my husband gave me a beautiful blessing. She said the more beautiful prayer that really invited heaven into the space and made it so spiritual and special. We were playing music, then at 9:00 AM, the head midwife, her name is Joy, came in. She started the IV.Dr. Chung came in and walked me to the prep room. In our rehearsal, I was going to be scrubbing myself, but he just picked up my hands, and he started washing my hands and scrubbing my hands for me. It felt like such a selfless act getting ready to go into this procedure. It felt like he was so respectful, and then I even had a contraction during the washing. He stopped what he was doing and was so respectful of the space. It just felt so Christlike having him wash my hands going into it. Then we walked into the OR, and they got me ready for anesthesia. They put in the spinal, and then they laid me down. They did the pinprick test. They gave me a new gown that was sterile. I'm trying to think of what else. They inserted the catheter. I could kind of feel a little bit with the pinprick test, but the catheter insertion was just pressure, so I felt comfortable moving forward. They got started. We played music. They had ice ready for me on my face because I told them when I get nauseous or anxious, I tend to get a little lightheaded. They had ice ready for me. That was something I had requested, and that was so nice. They started the surgery, and it was very, very intense. I do want to be candid that it was probably my most painful surgery. I had to work through it with labor-coping stuff. I was vocal. I did mention that I was feeling pain. It got pretty intense. I don't know if in Korea in general– I know that they are a little bit more stingy about anesthesia, but it was okay. I don't feel like I was traumatized from that. The baby came out at about 10:24. That's when they say he was born. We were listening to music. I was vocalizing, then Dr. Chung says– what did he say? “Let's meet your baby,” or “Come grab your baby”, or something like that. They lowered the drape, and it was so fast. I bring the baby up onto my chest, and everything just melted away, and this instinctual, primal– all of these emotions I didn't know I had just poured out of me. I lost any sense of composure that I had. I was shrieking. In any other situation, I would have been so mortified, but that moment of not having it three times over, it was this release and this justification or this validation of finally having it. I just got to hold my baby. I was a little nervous about seeing a new baby for the first time without being swaddled and how they would be wet and slippery, and if that would freak me out a little bit, but I wasn't worried about that at all. I was just so happy that I had him and so relieved. During closure, that was also intense too. They put the curtain up. They pulled out the placenta. They put it in a bowl, and then they put it in a bag, and they rest it right there next to you. The cord was so lovely and so beautiful. There is something about a fresh, new cord. It is so awesome to see. I thought it was the coolest. I had my husband. I was squeezing his hand. Honestly, I felt like having my baby in my arms and holding my husband's hand was the best pain relief. In that moment, it was keeping me calm, keeping me steady, and getting me through the closure and the rest of the surgery.Then they transferred me to my postpartum room, and they just let us be there. They didn't push cutting the cord. Dayana gave me a placenta tour. I was like, “When do we cut the cord?” She was like, “Whenever you want.” It ended up being about 2 hours of us just enjoying it and talking about how cool it was. Yeah. She gave us a tour. I was able to wear gloves and touch it and go through it, then Sam was able to cut the cord for the first time which was so awesome. That's the gist of it. Meagan: Oh my goodness. I started crying. I've gotten chills. I have so many emotions for you just watching your video. I've literally watched it 10, maybe 15 times, and I can't wait to see Julie's entire thing that she caught. But I am just so– there are no words. I'm so happy for you. I'm so proud of you, and I've talked to you about this. I've Marco Polo'd you crying before where I can't explain it. I am so insanely proud of you and happy for you that you got this experience. Thinking about, “I've never seen a gooey baby. I've never had that opportunity. My husband has never been able to cut the cord,” and you were able to have this beautiful experience where you got to have all of those things. It took four babies to get there, but you got there. You got there because you put forth the work. You learned. You grew, and you were determined. I think as listeners, as you're listening, sometimes that's what it takes. It's really diving in, putting forth that effort, and finding what's true for you. I know it's hard, and I know not every provider out there is like Dr. Chung. He is a diamond in the rough from what it sounds like on so many levels. But they do exist. Again, going back to what you were saying, sometimes it just talks about Paige going in and saying, “Try to have an open mind. Look at this video. I would like for you to view this. Just take a look at it,” and left it in his hands. Sometimes, it just takes something so simple. But, oh my gosh. I can't believe it. We were Marco Poloing about episodes, you guys, before she was in labor. We were also Marco Poloing about social media posts. She was like, “I just don't want to say anything until it happens.” I think sometimes even then, I wonder if that's where that ultrasound had come in and maybe there was doubt. I don't know. It seems like maybe that aligns pretty well with the time that we were messaging and that. Maybe we were Marco Poloing or texting. I don't know. It's like, could this happen? Is it really going to happen? You want it to happen so bad, and then to see it unfold and to have it unfold in such raw beauty, oh my goodness. I cannot believe it.So in the OR, they let Julie in there, right?Paige: Oh, yeah. Dr. Chung is a photographer himself. Julie had asked me to ask him if she could move around or if she had to be stationary. He was so open to her walking anywhere and having free range of movement and having multiple sources of video and photo. Julie: Yeah, it was really cool. I want to speak a little bit to that side of things if that's okay for a minute. Being a birth photographer is kind of complicated and sometimes logistically crazy especially as the baby is being born because everybody has a job to do. Not every provider and nurse is supportive– maybe not supportive. Not every provider and nurse is respectful of the fact that I also have a job to do and that these parents are paying me not a small amount of money to come in and do this job. That is very important to them to have this birth documented in a special way.It can be tricky navigating that especially times ten when it comes to being in the operating room. I have about a 50% success rate of getting in the OR back home. Some hospitals are easier than others. It's always an honor and a privilege, I feel, when providers create a way for me to go in the OR because Cesarean birth is just as important, maybe even more important to have documented because it comes as a healing tool and a way to process the birth especially when most Cesareans are not planned. It was really cool to hear ahead of time about how supportive Dr. Chung was and how amazing he was going to be to let this happen. When we were in there, I don't think I've ever moved around an OR as much as I have in that OR. Providers will tell you, “Oh, you're not allowed in because the operating room is so small. Oh, the sterile field, we want to make sure you don't pass out when you're in there.” I think all of these excuses that people give are just regurgitating things. They don't want another person in the OR. It's just kind of dumb because that was the smallest OR that I have ever been in. I still was able to document it beautifully. I respected the sterile field. I wasn't in anybody's way. People were in my way which is fine because they had a way more important job to do to make sure Paige didn't bleed out and that the baby was born and that Paige's needs were met and things like that. I'm okay. I'm used to navigating around people in the space. I'm perfectly comfortable with that. It was so beautiful. I was down at her feet. Paige, I've actually been going through your images and choosing ones to include in your final gallery while you've been talking. I cannot wait to show you this. I have images of Dr. Chung pulling his head out, still images, of the head being born through the incision. It's like crowning shots. It is this beautiful image of this baby's head being born. Obviously, you've seen the one of his head all the way out. I just think it's so beautiful. I consider it such a privilege and such and honor to have as much freedom in that room. I was literally at her feet, Meagan, documenting while he was cutting her open the adhesions and all of those things. There is video. There were images. I have chills right now. And then as baby was born, I was able to move up by her shoulders and document that and her reaching down for baby. I have all of that. I think that is such one more reason why Dr. Chung is amazing. It is such a rare gem, a diamond in the rough, because Paige now has the documentation for this beautiful story, and it's just one more thing where we have work to do. We have lots of work to do, lots of work to do, and lots of advocacy with people asking for this. I just think it's so important and so cool. It's such a rare thing. I don't even think I would have been able to do all of this back in the States. Meagan: No. Julie: I just think it was so cool. I'm determined to get these images to you before I leave so we can look at them together. I cannot wait for you to see them. I can't. I'm just so excited. Paige: Well, it just makes me think of how often you've said, “If you don't know your options, you don't have any.” The purpose behind this, and why I felt I really did want to go for this option, and what was pulling me to it, is because I want to create options for women and to show them what's possible. That's why I wanted Julie to come. I wanted her. I told her specifically, “Document every step of the process so that women have more resources to see the ways we do it.” I didn't do it exactly like the Olive Juice photography video. There are little variances between it, and that's okay. But it was still so beautiful, so wonderful, and then also, I asked her to document the surgery itself because so much of it is going back and trying to process it in your mind while you're going through it. I'm so glad she did. We walked through it last night, just the moment when I was in the most pain. It was actually really wonderful to see what he was doing which I wasn't in the space to see at that time, but to go back and see, “Okay, that makes sense because he was maneuvering so much,” and to connect it. The connection piece was so valuable. For every Cesarean, I'm so passionate now that you need a doula. You need a midwife in there. You need a birth photographer. You need everybody in there. I knew it, but now, I'm so passionate that we need to advocate for ourselves just as much for planned Cesareans. Meagan: Absolutely. I still can't believe it. I'm so happy. I love this story so much. I believe everyone should hear it because like you said, we need to be educated so we can apply what we need. We don't know what we don't know. This is what we've heard for so many years, but we can know. We can know our options, and it does take us doing it most of the time. The medical world out there is trying sometimes. Sometimes, they are not trying as well. But they are trying. They are also capped in a lot of ways with resources and with time. There's just a lot that goes into it. So, dive in, you guys. Learn. Follow what you need. Follow what your heart is saying. If your heart is saying, “I want a different experience, it's okay to push for that different experience.” Paige: Yeah, definitely. I'll attach a lot of the resources that I used to help me in my prep. But I did just want to cap off by saying that I don't feel like I'm anything special. I am not a birth worker. I am not a nurse. I don't have a history of medical stuff. Dr. Chung was so cute. He was joking that I was a surgeon and getting ready to go do the surgery, but I've always been squeamish at blood and things like that. Don't feel like you don't want to go for it because you're afraid that it will be a scary thing. It is such a natural, beautiful thing. It doesn't feel as medical as it might seem. And even if you are scared, I was scared. It's okay to do it scared if you think that it might be something beautiful and if your heart is, like Meagan said, calling you to it. We're just moms, and moms are powerful, and that's enough. Meagan: I love that. Julie: I love that. I think it's really important. Paige, first of all, you are special, and this is why. Not everybo

We have an absolute legend for you on the podcast tomorrow!!! Please welcome SubGirl to The Adventures of a Hotwife!  How someone so amazing and epic and well known came on our podcast I will never know, but we had an amazing time getting to know her!  Cum listen to Realhotwife ask her allll the slutty questions.  We discuss her body count (it's more than you think) , GBs (guess how many in one night?), getting anal from the biggest in the game, picking up randoms at bars, how she became who she is, and everything else you are dying to know!I was amazed she agreed to talk to us but after learning how sweet and fun she is, I'm glad she did! You won't want to miss this one!! Follow SubGirl here for much more: https://beacons.ai/subgirl0831Support the showVisit https://linktr.ee/sexxxysoccermom to see a whole lot more of Sexxxy Soccer Mom!

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover Guillain-Barré syndrome focusing on the history, examination, and ED evaluation. Part 2 will cover management. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Did you know there are well over 100 strains of strep? This often-misunderstood bacteria reaches far beyond strep throat, with complex impacts on our health - and even deeper connections to conditions like PANS/ PANDAS and GBS in pregnancy. In this episode, we are diving deep into all things strep: how it affects the body, why traditional treatments often fall short, and how rebalancing the gut provides a powerful, holistic alternative that empowers true healing. You'll learn actionable steps for strep throat, Group B strep in pregnancy, and healing PANS/PANDAS, two conditions where strep can drive sudden, life-altering neurological changes. Packed with insights on the gut-brain connection and immune support, this episode offers an effective approach to healing that works with your body. If you're ready to gain the knowledge to feel prepared and empowered, you won't want to miss this one. Links from the episode:Explore The Children's Gut Rebalance KitExplore The Women's Gut Rebalance KitThanks for listening! I would love to connect with you ♡ Subscribe to the Nourished Newsletter Send me a DM on Instagram Take the free Gut Health Quiz Email me at customercare@onleorganics.com Sending love and wellness from my family yours,xx - Juniper BennettFounder of ōNLē ORGANICS

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