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Send us a textIn honor of Black Maternal Health Week, we're joined by Stephanie Etienne and Kanika Harris, creators of the documentary Listen to Me. The film follows the pregnancy and birth journeys of several black women. It reveals a devastating reality: Black mothers in the U.S. and U.K. are dying in childbirth at far higher rates than white women regardless of education, income, or resources.Kanika shares the heartbreaking story of losing her twin babies after a sudden onset of preeclampsia and HELLP syndrome. Though she arrived at the hospital by ambulance, bleeding and in critical condition, she was still stopped at the front desk and asked for insurance information before being evaluated. The tragedy was compounded when her husband, Jua, was advised not to tell Kanika the whole story about the fate of her babies, out of concern that Kanika might not survive if she received the devastating news while her own health was so tenuous.We talk with Stephanie and Kanika about why they made the film, what they want every pregnant woman to know, and how Black families are often treated with suspicion or disregard in medical spaces. They also speak of the grief carried by partners, families, and entire communities when a mother is lost.Listen to MeListen to Me on InstagramWatch the full videos of all our episodes on YouTube!**********Our sponsors:Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort.Needed -- Our favorite nutritional products for before, during, and after pregnancy. Use this link to save 20%DrinkLMNT -- Purchase LMNT with this unique link and get a FREE sample packENERGYbits--the superfood every mother needs for pregnancy, postpartum, and breastfeedingUse promo code: DOWNTOBIRTH for all sponsors. Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Watch the full videos of all our episodes on YouTube! Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

On this episode, I sat down with Dr. Mandy Patterson, a multifaceted Functional Medicine Practitioner and mother of six, to discuss the impact of nutrigenomics on fertility. Dr. Mandy shares her personal journey with severe preeclampsia and HELLP syndrome and how it led her to explore the role of genetic variations in health. The conversation covers key genetic SNPs related to fertility issues such as PCOS, endometriosis, and irregular cycles, and offers insights into how tailored nutrition and lifestyle adjustments can optimize fertility outcomes. Along with practical tips, Dr. Mandy also discusses the importance of a holistic approach in functional medicine. Listeners are encouraged to access Dr. Mandy's fertility blueprint and check out her 'Gutsy Fertility' podcast for more comprehensive insights.Want to learn more & dive deeper in my holistic approaches for a natural conception? ⁠

Birth Story 71: Melanie's Severe Preeclampsia, Two C-Sections, & Breech Home Birth with NICU Transfer In this episode of the MamasteFit Podcast's Birth Story Friday, host Gina (perinatal fitness trainer and birth doula) and Roxanne (labor and delivery nurse and student midwife) welcome Gina's friend Melanie, who shares her three unique birth stories. Melanie discusses her experiences with two C-sections, one under general anesthesia due to HELLP syndrome and another planned, but stressful and disempowering. Melanie goes on to achieve a successful VBAC home birth after two C-sections- with the unexpected twist of a breech birth and a transfer to the NICU. This episode underscores the importance of advocacy, the right support, and informed decision-making in pregnancy and childbirth. 00:00 Introduction to Melanie's Birth Stories01:29 Melanie's First Pregnancy: HELLP Syndrome and C-Section03:58 Melanie's Second Pregnancy: Struggles and Another C-Section07:42 Challenges with Medical Support During Second Pregnancy24:52 Melanie's Third Pregnancy: Aiming for a VBAC37:34 Navigating Prenatal Care Challenges39:11 Support from a Doula40:32 Exploring Home Birth Options43:08 Preparing for a Home Birth46:41 Labor and Delivery at Home56:46 Unexpected Complications01:02:44 Reflecting on the Birth Experience01:08:12 Final Thoughts and AdviceFind Melanie on Instagram @SAHMauthor here: https://www.instagram.com/sahmauthor?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==Find her OB, Dr. Nathan Riley, here: https://www.instagram.com/nathanrileyobgyn/?hl=en——————————Get Your Copy of Training for Two on Amazon: https://amzn.to/3VOTdwH

In dieser Folge erzählt Sabrina von ihren drei Geburten. Nach zwei Kaiserschnitten entschied sich Sabrina beim dritten Kind für eine Hausgeburt und da sie dafür keine österreichische Hebamme finden konnte, hatte sie bei der Geburt eine reisende Hebamme dabei. *** Die Wiener Hausgeburtshebamme Margarete Wana braucht unsere Unterstützung, um die Anwalts- und Gerichtskosten im Strafprozess gegen sie zu stemmen. Jede Spende hilft! Hier geht's zum Crowdfunding. Mehr Infos zu dem Fall gibt es hier. Die Shownotes findest du hier. Hier geht es zum Geburtsgeschichten Newsletter. Unterstütze den Podcast auf buymeacoffee.com/geburt Folge direkt herunterladen

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

On this week's Listener Series, we welcome Julia. Julia was induced at 38 weeks due to gestational hypertension. A routine delivery turned terrifying, when Julia suddenly became unresponsive. What followed was a litany of complications landing Julia and her baby in the ICU and NICU, and still to this day with an uncertain diagnosis. She shares with us the process of bringing home a NICU baby after a significant trauma and what her healing journey has been like.On this episode, you will hear:- labor complications and emergency response- NICU experience and family dynamics- second opinions and diagnosis- navigating an ICU experience- bonding journey after ICU and NICU experience- the stress of bringing home a NICU baby- finding healing and community supportYou can find and follow Julia on Instagram: @julia.omickFor more birth trauma content and a community full of love and support, head to my Instagram at @thebirthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Sera que existe um momento certo para ser mãe? Até os 40 anos, Paola não tinha certeza se queria ser mãe. Editora de beleza, primeira mulher negra a ocupar o cargo em revistas de grande circulação no Brasil, Paola mergulhava no trabalho.  Mas quando engravidou aos 42 anos, ela estava pronta para acolher essa nova vida e viver o ritmo da maternidade.  Ela conta aqui a sua relação ao tempo, a síndrome de Hellp que a pegou de surpresa, a cesárea e o nascimento prematuro da Maya. Paola lembra desse encontrou com a sua bebe de apenas um kilo e meio, das semanas na UTI e do puerpério coletivo que as mães vivem nessa unidade neonatal.  Ouvindo Paola, lembrei que na mitologia grega tem Chronos, o Deus do tempo cronológico, e Kairos, o Deus do tempo certo, do momento oportuno - um é relativo à quantidade, o outro à qualidade. Não há tempo objetivo para ser mãe, e sim um momento oportuno, diferente para cada mulher. Obrigada Paola pela sua confiança. 

We hear SO many of our listeners say things like, “I wish every first-time mom listened to these stories” or “I wish as a first-time mom I heard these stories because I truly believe it could have helped me avoid my Cesarean.” First-time moms, we want to educate you to make informed decisions during your birth. We want your first birth to be an empowering experience, no matter the outcome. And if possible, we want to help you avoid an unnecessary Cesarean.  Meagan shares some of her best tips for first-time moms regarding induction, big babies, ultrasounds, and more. We also asked members of our VBAC Link Community to send in their best tips for first-time moms. We hope this episode becomes a great starting point for you to then go on and listen to the powerful stories shared in our other episodes!VBAC Link Supportive Provider ListEvidence-Based Birth: Evidence on Inducing LaborThe VBAC Link Blog: The ARRIVE TrialNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. This is Meagan and you are listening to The VBAC Link Podcast. I am so happy that you are here. Normally, we have episodes that are filled with VBAC stories, CBAC stories, and guests sharing educational pieces on VBAC. However, today, I'm going to a quick episode for our first-time mamas out there. For years, we have had people write in a review saying things like, “Oh my gosh, I wish every first-time mom listened to these stories. This is not only for VBAC moms or VBAC-hopeful parents. This is for anyone who is giving birth,” or again, going back to the first-time mom, people saying, “I wish as a first-time mom I heard these stories and learned this education because I truly believe it could have helped me avoid my Cesarean.” Women of Strength, if you know someone who is expecting or if you are a first-time mama, listening on how to avoid unnecessary and undesired C-sections, listen up. This is going to be an episode specifically for you. As always, I have a Review of the Week so I'd like to dive into that but then get back into what first-time mamas and what our community wants first-time mamas to know. Today's review is from Emmalyn. I don't even know how to pronounce the last name, but Emmalyn. It says, “Uplifted and educated. I have been binging this podcast since I found it a couple of weeks ago and I'm addicted. As I prepare for my HBA2C” so for the listeners who are new, HBA2C means home birth after two Cesareans, “I have experienced so much healing and inspiration through hearing these stories after two attempts for vaginal deliveries with my first two kids. One preeclampsia hospital birth and HBAC (home birth after Cesarean) transfer to the hospital. The content they provide is diverse, thoughtful, and inclusive. There is so much stigma around home birth and VBAC and this is the first and only community plus the Facebook group I have found to truly be welcoming and nonjudgmental. I feel like this is going to be an instrumental tool to my birth prep for my baby coming this Christmas Eve.” You guys, I could not agree with her more. This is a place where we want you to know that you are safe, that you are heard, that you are understood. We in no way, shape, or form believe that there is only one way to birth. There just simply isn't. We just want you to know your options and feel empowered to make the best decisions for you along the way. So if you are one of these first-time mamas listening today, I am so excited that you are here and I do encourage you to continue going on through all of the other episodes. Women who are sharing their stories likely have had a Cesarean before and I think this is such a great opportunity for you to learn how to avoid a Cesarean by listening through others who have come before you and have given birth and have also learned along the way. I'll tell you right now that with my first baby, I was not ready to give birth. Although I felt ready, all I knew was that I was pregnant and I was going to have a baby and I could not wait. But there was so much more that I didn't know that I wish I knew. I have learned throughout the way and I'm going to be sharing some more experiences with you along with, like I said, really tips from our own community members. You guys, I reached out on Instagram and asked for tips for first-time moms and I'm going to go over some of those tips along with learning how to avoid a Cesarean and unnecessary interventions. Here we go. Okay, everybody. Welcome to the show. Thank you for joining me. If you are new to the podcast, my name is Meagan Heaton and I am a VBAC after two C-section mom and a doula who wants to help educate and empower anyone who wants to learn more about their options for birth after Cesarean as well as learning how to avoid a Cesarean from the get-go. I had a Cesarean when I was pregnant with my first. I went into labor at 39 weeks and 5 days spontaneously with PROM which is called premature rupture of membranes. What that means is my body went into labor as far as my water broke, but then nothing really followed for quite some time. Contractions didn't really get going and labor itself did not start. I, along with many first-time moms, was told that if your water breaks you go straight to the hospital. I went to the hospital and from then on out, it was induction. They wanted to induce my labor and they wanted to intervene instead of just letting my body do its thing. I started getting Pitocin and that led to an epidural. It unfortunately led to a Cesarean. Now, I want to tell you that Pitocin and an epidural do not always lead to a Cesarean but these are going to be common things that you're hearing in women's stories along this podcast that do seem to impact the end result of a Cesarean. With my second, I really wanted a VBAC, a vaginal birth after a Cesarean, and I went looking more into what it was and what my options were and what I should do. I ended up staying with my same provider who was a great guy. Do not get me wrong, but he wasn't the provider for me and I didn't learn that until after my second Cesarean. I stayed with him and I went into spontaneous labor again with premature rupture of membranes. This one took a lot longer for my body to kick in and unfortunately, I really never was allowed the time. I ended up walking down for a second repeat Cesarean with that one because I was told that my body just did not know how to do it. This is also another very common, common thing that so many Women of Strength are being told. Their body doesn't know how to do it. Their body can't progress. Their pelvis is too small. Women of Strength, if there is any pet peeve that I have, it is someone telling another person that their body is not capable of giving birth vaginally. I might sound grumpy about it. Let's be honest, I am. You are capable of giving birth vaginally. What are some of the things that I would suggest you do as you are going along as a first-time parent?Number one, I really believe that provider is key. If you have a provider who is on board with your birthing desires, that is going to help you so much during your labor and your pregnancy journey. If you have a provider who is very induction-happy, intervention-happy, and pushing you to even schedule an induction before you even reach 39 weeks or 40 weeks or 41 weeks, that's a problem. That is a red flag. Take a moment if you can. Go to thevbaclink.com/blog or just click the link in the show notes and check out how to find a supportive provider. Now, this blog that we have is how to find a provider who is supportive in VBAC, but I think all around it goes in line with any provider whether you are a VBAC or not. You want to find someone who doesn't put stipulations on when you have your baby and what happens during pregnancy meaning that if they are requesting or demanding that you do multiple growth scans in your third trimester and there is really no medical reason to indicate the reason to do that, that's a problem. If they are talking about the size of your baby early on or the size of you and how you look and, “You must be carrying a big baby. You are so petite,” there is already doubt that is being placed. As I mentioned, if they are encouraging an induction at 39 weeks or just getting it on the schedule, let me tell you right now that being pregnant at 39 weeks is not always fun. Being pregnant at 40 and 41 weeks is not fun. There is a lot that goes into it. Your hips hurt. You're tired. Your pelvis hurts. You're peeing all of the time. You can't sleep. Okay, it doesn't sound that great, right? But it really is such a great time and it's a time that we need to cherish and really just embrace but it's hard to do that. That's the fact. It's sometimes really hard to do that so when we have providers giving us an “out” to give birth sooner, it's very enticing. I don't shame anyone for taking that opportunity of being induced and picking your baby's birthday, but there are a lot of things that go into that. Now, as a first-time mom back in 2019 I want to say, a study came out and they called it the ARRIVE trial. The ARRIVE trial is where they had a whole bunch of people, and really actually not that many people, but a whole bunch of people in two groups. They had one group where they induced at 39 weeks and they didn't always have a “favorable” cervix. Favorable versus unfavorable meaning the cervix was showing signs of readiness to give birth. They had these moms in one group who were induced at 39 weeks then they had another group who chose not to be induced or to wait for spontaneous labor but would not let them go past 42 weeks. There were a lot of things that their goals were to point out and study in this trial which you can find out more about on our blog. It's in the show notes. We'll make sure that we have the ARRIVE trial link in there. But they really wanted to also see what it did for Cesarean. In the induction group, 79 out of 82 people were induced at 39 weeks. The people in the expectant management group, meaning they were waiting for spontaneous labor or didn't elect to induce at 39 weeks, 79 out of 80 waited. 44% of them gave birth spontaneously and 56% of them gave birth after induction for medical reasons. Now, medical reasons. There are a lot of things people can talk about or providers can talk about why you should be induced. So let's talk about some of the main reasons for an induction or some common reasons for an induction that you'll see but then always, I want you to know that you can question. If someone is saying there is a medical reason for you to be induced, question them. It's okay for you to question them. It is always okay to say no and question, always. No matter what it is in any medical scene, birth or not birth, you are always able to question and say no or no, thank you. What are some medical reasons? Medical reasons may be preeclampsia. Maybe you're having blood pressure issues or HELLP syndrome where now your liver is being affected. We've got high blood pressure or elevated liver enzymes and it really is best for you and baby to be born and to give birth. So preeclampsia may be one. Maybe you've got a unique health condition that is now impacting your personal health to stay pregnant. That may be a reason for induction. IUGR, intra-uterine growth restriction. Maybe your baby is no longer thriving inside the uterus and inside the womb and needs to come out so they can thrive on the outside. If IUGR is happening, that is a medical reason to consider induction. Those are just a few that you may encounter. Some other things may be low fluid– that one can be debatable for sure. It can be serious, or high fluids. There are so many situations. Just know that if you have a situation or if someone is suggesting an induction at 39 weeks or at any point due to medical reasons, discuss that with your provider. Definitely discuss and question and make sure that you are all on the same page and you are really understanding what the medical reason is for your induction. Don't fear to question the evidence saying that induction is the best route. Okay, so the people in the expectant management group like I said– 79 out of 80 waited. 44% gave birth spontaneously 56% gave birth after induction. So what did this study really show, really, really show about C-section? Well, let me tell you. They really tried to show that it lowered Cesarean rates from 19% to 22% but if you really dig into it deeper, it really doesn't say if Cesarean really is lowered or not. Between the two groups, there really were no significant difference in birth outcomes for the baby so again they showed that maybe 19% versus 22% were likely to end up in a Cesarean and then they also showed that they were less likely to develop high blood pressure– 9% versus 14%. That is a thing. We do know that blood pressure can elevate in the end, but overall, as of 2024, there really are a few studies that have been able to look at the effects of the ARRIVE trial and have concluded that the elective rate has significantly increased or decreased the Cesarean delivery. This is the problem though. It's being so heavily– and maybe heavily isn't the word– done. It's being so heavily performed all over the world now after this trial came out. For some reason, we looked at that and we're like, “Yep. See? It impacts the Cesarean rate. It lowers it.” But we are still having a really high Cesarean rate and first-time moms are still, still, still, still having Cesareans after induction is happening. Induction. Women of Strength, that is what we call the women who listen to our podcast, if you are being proposed for an induction or being offered an induction, maybe take some steps back. Do some research. Read our blog. Talk about induction methods. There are also a lot of different types of induction methods. I want to also say that coming back to your provider, if you have a supportive provider who is willing to induce very gently and understands the process of induction especially for a first-time mom whose cervix might not be favorable or ready, you may have a higher chance of giving birth vaginally. But if you are at a place where they like to push inductions really fast on you and all of the things, increase all of the interventions, you are going to likely have an increased chance of Cesarean. In 2023, the rate of C-sections in the United States was 32.4%. 32.4% which is really the highest it's been since 2013 and just astronomically gross in my opinion. Years and years and years ago, it was 10-15%. Even before that, it was 5%. We are seeing a peak. We are seeing a serious peak and what's happening is we are seeing a lot of the times first-time moms will have a C-section for whatever reason and then people are being told that they cannot have a vaginal birth after Cesarean, that the option is now gone or they won't even approach VBAC as a topic. It's just, “For the future, you will have to schedule a C-section.” Okay, now this is another one. If you are a first-time mom who has a friend who had a C-section and doesn't know their option, please share this podcast with them. This is such a great place for them to come and learn and know their options. Okay, so let's dive in. I asked our community. I mentioned that before. What do our community members want a first-time mom to know? What do they wish they would have known before as a first-time mom?One of our followers, Elizabeth, mentions, “Wait as long as it takes for baby to come and to change positions frequently.” Oh my gosh, I cannot agree more. This is what we are talking about, right? Waiting for our baby to come and not inducing unless it really is medically necessary and letting our bodies do what they are made to do and are totally capable of doing.Changing positions frequently is something I highly encourage and as a first-time mom or any mom giving birth, I highly suggest a doula. Doulas are amazing. I know they are not always affordable and I don't know if you have ever heard of this, but you can go to behervillage.com and you can actually register for a doula so instead of getting all of the million onesies and wipe warmers or a million sized-newborn diapers, you can register for a doula and people can help pay for a doula. It is absolutely amazing. I highly encourage it. Check out behervillage.com. We also have doulas at thevbaclink.com/findadoula. They are VBAC-certified doulas but these are doulas who are trained and educated and certified in helping you avoid a Cesarean so I highly suggest a doula because they can help know what positions to change to and they can help guide you. If you don't have a doula, that is okay. Change positions frequently. I mean, every 5-10 contractions, if you went from hands and knees and you want to stay on hands and knees, go hands and knees but put a pillow under and elevate that left leg or that right knee. Change things up because changing the dynamics of your pelvis is going to help bringing baby down. One of the main reasons for a Cesarean is that babies are in a wonky position or failure to progress or failure to dilate. That, a lot of the time, is because baby is not in a really great position and movement will help baby get in a better position and help your labor speed along. Okay, our friend, Emily, says, “Wait to go to the hospital.” I mentioned this earlier that I was told when my water broke to go straight to the hospital. Do your research to wait. Learn how long to wait, how long is too long, and again, that's when a doula comes into play. They are really great on helping to guide you on knowing when to go. Emily also– she has a couple of tips here. She says, “Trust your own intuition and what your body is feeling in the moment.” I could not agree more. Your intuition is huge and if you continue listening to this podcast, let me tell you that you are going to hear about intuition a million times. Intuition is huge. You have it and it's amazing. It's super important to follow. Sometimes we question our intuition and that is hard. Try not to question your intuition and again, do what your body is feeling in the moment. Emily says, “I didn't have a doula and it's my biggest regret.” Okay, so we were just talking about that. Doulas are amazing, you guys. I didn't have a doula for my first two. That was also a big regret. My husband was not on board with my second. After I learned about a doula and after having a doula, he said that there is no way we would have another baby again without a doula. They are just incredible you guys and there are actual statistics on doulas. They lower the chance of Cesarean. They lower the time of birth by 45 minutes. 45 minutes might not sound like a lot, but 45 minutes in labor is impactful. They also lower the chances of induction and interventions and they overall help you walk away with having a better experience. Okay, another follower says, “Trust your body. Don't accept interventions. Plans can change and breathe.” Love that so much. We have Sarah who says, “Ask for help even if you feel fine.” I love that. It's okay. Use your voice in labor. Use your voice during pregnancy. Use your voice during that postpartum experience. Even if you think you are feeling okay, it's okay to ask for help or if you have a question that is bobbling around in your brain, ask it. Don't be scared to ask it. Another follower says, “Be patient with yourself and your baby. Enjoy your pregnancy and push with an open lotus.” I love that so much. Oh my gosh, that just made me smile. We have a follower named Ash. She says, “Be informed so you can make decisions you are happy with under time and pressure.” Okay, this is something, Women of Strength, that we have found through many of these stories. These first-time mamas are going through labor who have not had a lot of education, me being one of them, going into birth. You guys, birth is a very big event. It is a very important day and impactful day. Sometimes things can change just like what one of our followers was saying. Plans can change and that means sometimes things can be offered to you that you don't really know about. You don't really know what is being offered to you so you feel like you have to say yes or no. You don't really know what you're making the yes statement to so being informed is so important.We have a blog at thevbaclink.com/blog that shares so much information along with this podcast and then we actually have a course for parents to learn how to avoid Cesarean and how to navigate through labor and avoid a Cesarean so if you are interested in learning how to avoid a Cesarean and learning more about what this VBAC stuff is even like, check us out at thevbaclink.com. Gracie says, “Don't let your doctor pressure you into unnecessary induction.” It goes along with the theme in the first part of the podcast. If you can tell, induction and pressure is something that a lot of first-time, even second and third, oh my gosh, many-time moms have. Ash says, “Have a clear but detailed birth plan.” I love that so much. Birth preferences are so important. As you get informed and get educated, you are going to learn what is important to you, what you want, what you don't want. We had a story not too long ago how as a first-time mom, she didn't realize how much her birth experience meant to her until she didn't have that birth experience. You guys, this is such an important day. Oh my gosh, it's just incredible and if you can be informed and you can have that clear birth plan– now, let me tell you that some of these birth plans don't go exactly as you've written them down. Go in with an open mind but know your desires and know the evidence and the information behind those desires and why they are important to you. Okay, M says, “Be open to birth preferences changing.” This is just going right along here. Okay, like we were just saying, sometimes they change and it can be really hard. I have a sweet and sour view on birth plans because birth plans are incredible. It helps our team and reminds them what we need and what's important and what we want, but sometimes if we write them down on paper and they don't go as planned, we can view them or view ourselves as having failed or like we did everything and it didn't work so it failed so what's the use in trying that again or wanting that again? I also want you to know that if you can go into it having an open mind, it can help you. It can help you a lot and knowing again that birth preferences change is so important. Okay, so we have a photographer here. Lilabqz_photography. She said, “It's not pain. It's power. Breathe and it will be all over soon.” I love that. These contractions are powerful. They are amazing. Oh my gosh. Okay, hypnobirthingnorthyorkshire says, “You are amazing. First-time mamas, you are. You are amazing.” Everybody listening to this podcast, let me tell you that you are incredible. You are such a Woman of Strength and you are capable of more than you have ever known. Okay, we have another follower who says, “Give yourself all the grace. You did a big thing. You are your baby's best mama.” Birth is amazing, you guys. It is a big thing and you are incredible for doing it. Another follower says, “Educate yourself and get a doula.” The next one also says, “Hire a doula.” You guys, hiring a doula is a common theme. Like I said, if you are not in a financial means or don't have the financial means, check out Be Her Village. It is absolutely incredible and can make it possible for you to have the support that you deserve. Rachel says a couple of things here. She says, “Just because you feel good to do all the things so soon doesn't mean you should. Find someone who will listen to your birth story without interrupting or opinions.” This is more for postpartum. I agree. Take it easy. Even for pregnancy, take it easy. Just because you feel like you can run a marathon doesn't mean you should. Rest up. Rest easy. Give back to your body. Hydrate. Fuel with good nutrition and find someone who will listen to your birth story without interrupting or opinions. You guys, opinions will come in all around even before you have your baby. I mean, here I am. I'm sharing some opinions. Just find someone who will listen and validate you. You deserve it. Okay, Lauren says, “If you don't want a C-section, listen to The VBAC Link. You'll learn so much.” Oh my gosh, Lauren, thank you so dang much for that. That is what this episode is all about, to help you learn how to avoid a Cesarean. Our friend, Jess, says, “Eat to replenish yourself from birth and pregnancy. Meal trains are great.” Oh my gosh, I can't say that enough. If you haven't set yourself up for a meal train before and you haven't had your baby yet or even if you had, they are incredible and they will help your birthing partners so much. Julie says, “Surrender. Surrender it all. Birth is incredible. You're going to feel so many sensations.” Even if you don't want to go unmedicated, you guys, you're still going to feel so many sensations that are new and somewhat shocking but also incredible. You're birthing a baby. It's just absolutely amazing.Then Rachel says, “Do your research. Be mentally prepared for either type of birth and recovery and have a postpartum plan or a birth photographer and take pics.” Okay, you guys. Such incredible information. I echo all of them. Obviously, we've also been talking about some of those topics. You are strong. You are capable. Don't let anyone doubt you. Okay? Don't let anyone doubt your ability. Keep listening to these stories. These stories are meant for you as well. They are meant to help you learn, to help empower, to help grow, and honestly, one mama at a time, we're going to see the Cesarean rate drop, you guys. We're going to see it drop. Thank you so much for joining me today. I'm absolutely honored that you are here listening to the podcast and like I said, if you want to learn more about The VBAC Link and what we have to offer along with so many free resources, you can join us at thevbaclink.com. We've got the podcast, the blog, the course, resources, and so much more.Oh, and for kicks and giggles, I want to throw out the fact that we have a supportive provider list so if you are looking for a supportive provider whether it's a VBAC or not, don't forget to check out our provider list. You can find us at thevbaclink on Instagram, click on linktree, and you'll find the supportive list there. Thank you so much and take care. 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

Sabina is one of our VBAC-certified doulas from Canada and is sharing her peaceful FBA2C today. While free birth comes with its own risks and benefits, we know that many women feel drawn to this option when they have no support or do not feel safe birthing any other way as Sabina did. We want to share all types of births after Cesarean and honor all stories! The way Sabina trusted in her body and in the physiological birth process after a traumatic experience with HELLP syndrome is truly inspiring. Among the many important messages from this episode, Meagan says: “If you are a provider listening and you perform C-sections, please, please hear what we are saying today. What you say to us while we are on the table in the most vulnerable position… impacts us. Every word that comes out of your mouth, please think about it. Please think about it because it impacts us…I'm getting emotional because I remember my provider talking crap like that and saying things like that. It impacts us longer than you will ever, ever know and it will impact us for every future birth. Please, providers. Please, please, please from the bottom of my heart, I beg of you. Watch what you say to people.” The VBAC Link Blog: VBAC with PreeclampsiaNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello Women of Strength. It is Meagan and I'm so excited to be recording wtih you today. You've probably been listening all summer but I've actually not been in the recording studio all summer. I record up until May until my kids get out of school then I take June and July off so I can be with my kids and save you guys from the screaming and the dog barking and all of that in the background. It's August and we are back in the studio and we have our friend, Sabina. Hello. Sabina: Hello. Meagan: I'm so excited to have her on today. You guys, she is one of our VBAC-certified doulas which is so exciting. She is also a mama of three. She is a FBA2C. Okay, you guys. F is a new one. We haven't been sharing a lot of F. We've had H and V and breech B so what does F stand for?Sabina: F stands for free birth which means I did not have any kind of provider with me during my pregnancy or during my birth. I just did it all by myself. Meagan: Yep, you did. Sometimes I feel like it's a mother-led pregnancy. Sabina: Yes. Yes. Meagan: This is something. We've talked about this a little bit before we got recording. The world, when we look at free birth, frowns deeply upon it. It's not for everyone. Sabina: No. Meagan: That's why a good majority doesn't. However, I think it's important to share these free birth stories. They are still beautiful stories and it doesn't mean because you didn't have a provider that your story doesn't deserve to be heard, right?Sabina: Right. Meagan: I think that it's also important to talk a little bit about the fact that so many people are not getting the support. You're going to tell us a little bit more about why you chose free birth, but the world as we know it is not VBAC-supportive in many ways, in most ways. Sabina: Still. Meagan: Yeah, as we know. You are in Canada, right?Sabina: Yep. Meagan: We know that there are some hurdles there too. Even here in Utah, over the last 10 years of me being a doula and having babies of my own, I've watched the VBAC support wane and actually wane in the less-ideal way which is really unfortunate. We have a lot of people who try. They try and find the support. They try and get what they deserve. You deserve support. Women of Strength, no matter who you are or where you are, you deserve support. Most people who choose to free birth ran out of those options and decide that they are still going to do what's best for them. That is what Sabina did and I'm excited for her to share her stories. In addition to free birth, we have some other little things in there. HELLP syndrome, if you've ever heard of HELLP syndrome you guys, or if you haven't ever heard of HELLP syndrome, we're going to talk more about that and what that looks like, the symptoms and things like that, and what it could mean. Then larger babies and then yeah, I want to talk a little bit more about VBAC doulas too because we love our VBAC doulas. I don't know. Are you serving right now? Sabina: I am, yeah. Meagan: You have a new babe, but you are. Okay, if you are in Canada– and where are you again?Sabina: I'm in Ottawa. Meagan: Ottawa. Okay, you guys, give her a call. You can find her on our website at thevbaclink.com/findadoula. Sabina: I don't have a website but my Instagram is @letsdoulathisvbac. Meagan: Let's doula this. We will make sure to tag her so just go to today's Instagram or Facebook and find her. We do have a Review of the Week so we will jump into that and then get into your beautiful stories. This review is by mitaya. I don't know. I think it's probably an abbreviation. I don't know. Maybe it's a name but it says, “I vote this place on over the speaker in every OB/GYN office.” I love that. It says, “I cannot even begin to describe what an encouragement these podcasts have been for me. I have completely binged on these in the past few weeks and they have grown my confidence for my up and coming baby. I cannot stop sharing everything I am learning and even helping to encourage first-time moms on how to educate themselves to avoid a Cesarean in the first place.” Ding, ding, ding. We're actually going to have an episode about that, y'all. So if you're ready to share an episode with a first-time mom, it's coming up. “Thank you so much for this no-B.S., truth-declaring, and empowering platform that I know has encouraged so many more than just myself. Keep being amazing. I can't wait to share our story in just a few short months. All of my love.”Thank you so much for your review and I hope that you had your VBAC and had a beautiful birth. If you are still listening with us, let us know. Give us a shoutout on my email or on Facebook or Instagram. Meagan: Okay, Ms. Sabina. Are you ready to dive in to these beautiful stories? Sabina: I am. Meagan: Let's do it. Sabina: This is surreal because I've been picturing this whole pregnancy how I would talk about things if I was on the podcast. Every time I had a symptom, I thought about how I would say it on a podcast so it's very cool to actually get to do it. Meagan: Tell us all of the things. Here you are. Sabina: Okay. I'll start with my first birth. I was pregnant in 2019 and I had one appointment with an OB then realized it wasn't for me. I switched to midwives and had a perfectly uncomplicated pregnancy. I'm very athletic so I was in shape working out the whole time. No symptoms of anything other than heartburn and some rib pain. We had midwives who were great and then around 41 weeks, actually on 41 weeks to the day, we had our ultrasound just to make sure everything was going well. When we got there, I started getting a lot of pain in my right side. Again, I had rib pain so I just brushed it off. It's nothing. I had seen my midwives the day before and everything looked good. Blood pressure was fine. We were sitting in the waiting room and it just kept getting more and more uncomfortable. I started sweating and I asked my husband if we could just step outside for a bit then I remembered one of my friends saying that when she was in labor, she would put her arms around her husband and just dangle to open everything. I tried that hoping it would relieve some pressure and I just started panicking. My husband who was very naive at the time was like, “Oh, this is it. You're in labor.” I was like, “No. This is not right. It's not going away.” Meagan: Something's off. Sabina: Something's off. We went back in and I asked the receptionist if I could just go lie down. They brought me into a room and at this point, I couldn't sit still. We called my midwife and she asked if I was prone to panic attacks and I said, “No, I've never had one.” They checked the baby and he was totally fine. But my midwife was like, “Okay, I'll meet you at the hospital.” We called the ambulance and this is where it starts to get fuzzy. I was in shock. I couldn't remember everything but we took an ambulance and the only reason we took an ambulance was because I thought they would help but they didn't do anything. They just waited and took me to the hospital. I spent the ride on my hands and knees and when we got to the hospital, my blood pressure was 275/174. Again, we had just checked it the day before and it was totally normal, 121/80. My midwife was there and they asked if they could check my cervix just to see if it was a bizarre labor and I was barely a centimeter. I was still very posterior so nothing was really happening. I do remember my mom quickly poking her head in. My husband must have called her but then they were like, “Okay, let's do a C-section.” I don't remember a lot. I remember as soon as they gave me the epidural, I could relax. Everything just went away. I briefly remember seeing my husband and being like, “Oh my god. We're going to have a baby.”I remember hearing him cry. They showed him to me the first time. I also had a cyst on one of my ovaries so they showed me that. It was kind of cool. Then in the recovery room, I very briefly remember trying to feed my son and then I told them that my vision was jumping around and I couldn't focus so they handed him over to my husband and then I don't remember anything else. Basically, they never treated my blood pressure. They just–Meagan: Wait, they didn't do anything? They were just like, “We've got to get the baby out” type thing then they ignored the astronomically high blood pressure?Sabina: Yes. Meagan: Okay. Sabina: Even though the baby was fine because we had just had the ultrasound and checked everything, they completely neglected the blood pressure. Obviously, it dropped when I got the epidural because it gets rid of the pain so it goes down a bit. Later, I found out that they had the medication ready, they just never gave it to me. So as soon as the epidural wore off, my blood pressure shot right back up and I ended up having a seizure. My husband, I mean I don't remember any of it, but my husband was kicked out into the hall shirtless holding our newborn not knowing what was going on. My parents were down the hall and heard the code blue and just knew it was for me. Then I was just talking to my mom about it yesterday. She said that they were at the nurse's station demanding to know what was going on. They were telling her to calm down and they just sent them to see my husband. He was in a dark room by himself with a newborn who was crying because he probably wanted to eat or whatever. He just looked like he was a ghost. He didn't know what was going on. It was horrible. Even to this day, it hurts knowing that that was his entrance into parenthood. Meagan: And both of your experiences too. His entrance and both of your experiences. It didn't start off very positively. Sabina: No. Definitely not. I remember seeing my dad briefly and then I don't remember anything until the next day. I woke up and my dad was there and I just said, “What happened?” He told me I had a seizure and then the first couple days, I don't remember much. My son was in the NICU just because I couldn't take care of him and they would bring him to me once in a while so I could feed him. My mom said she noticed that every time he was with me, my blood pressure would drop obviously. It makes sense. She advocated for him to get to stay with me. I started breastfeeding even though I was honestly half-dead. They told my family the day it happened that the next 24 hours would determine which direction I went so it was pretty scary. Meagan: Oh my gosh. Sabina: Yeah. Pretty scary. We ended up getting a private room in the ICU and my son was allowed to stay with me as long as somebody else was there. My mom and husband just kept switching off. The nurses were phenomenal. Every nurse we had was great. They brought us a full cart of baby supplies because we had nothing. We didn't even have a hospital bag but I saw every other person in the hospital. It was incredibly frustrating. We saw residents. We saw random specialists who had nothing to do with me. We saw interns. I never saw the same doctor twice and I was there for a week.Meagan: Whoa. Sabina: Yeah. We kept being told by one doctor that, “Okay, if your blood pressure stays below this level for the next 24 hours, you get to go home.” Then the next day, a doctor would come on and I'd say, “Okay, it stayed below. Can we go home?” They were like, “Oh no, no, no. You're probably here for the next several days.” It was back and forth like that and it was incredibly frustrating. Eventually, I left against medical advice because I knew I couldn't heal in the hospital. I knew I needed to go home. We went home with two blood pressure medications and by day two, I had to stop taking them because my blood pressure was so low. Meagan: Whoa. Sabina: Obviously, I made the right choice. It got to the point where I could hardly get out of bed and I was so lethargic because of the blood pressure being so low. Meagan: Your body truly was responding. It was in that flight/fight mode where you're probably so tense the whole time you were there. Your body was not able to even try to recover. Sabina: Yeah. I mean, that was our first week as parents. It was in the hospital. Eventually, we got moved to the labor and delivery ward but still, we were not home. We weren't comfortable. We were bored because we were just there and then we're seeing everybody and their uncle at the hospital coming in because I was a unique case. It was super frustrating. I do want to mention with the HELLP syndrome that my kidneys were failing. I had swelling in my brain. I had to get one MRI or two CTs or the other way around. I only remember one of them. Meagan: Your liver obviously. Sabina: Yes, yeah. My liver was definitely not ideal. Meagan: That was the start of the pain. Sabina: Yeah, again, I thought that was the rib pain. Meagan: Kind of up there. Sabina: I was perfectly healthy. Yeah. I was perfectly healthy. I had worked out that morning. Meagan: Wow. Sabina: I felt totally fine. It was very sudden. Meagan: Did you have any other symptoms like headache, blurred vision, swelling, nausea? Sabina: Not until after that pain. After the C-section, my vision was jumping. Meagan: Yeah, you said. Sabina: Yeah. I couldn't focus and then the next two days, right here on my head on the right side had severe pain. Nothing would help. They were giving me pain meds and stuff and nothing was helping so eventually, I just stopped taking them. But beforehand, there was absolutely nothing. They didn't test my blood or urine because it wasn't routine to check it at that time and they had no reason to check it but it was very, very sudden and very severe. Because they didn't deal with the blood pressure, I still wonder to this day if they had dealt with it or tried. Meagan: Given you magnesium or something. Sabina: If it wouldn't have been as severe of a reaction or a problem. Meagan: Yeah. Sabina: It's very frustrating to look back. Of course, after that I had PTSD but I didn't know that I had PTSD and the support wasn't really there. My midwife was like, “Well, of course, you're going to have some hard times,” but that was kind of it. That was the only support I got. My sister actually was pregnant at the same time and was due a month later. She got induced because she just went past her due date and I was so upset when she was in labor because I was so jealous. It's a horrible feeling because you're happy for them but I was just so jealous. My midwife came over that day. Again, there wasn't really much support surrounding that. It was just like, “Yeah, that's normal. Move on.” My sister ended up getting a C-section just because she got the cascade of interventions. It was a typical story. For the next year, it was extremely difficult mentally. Any time I tried to talk to somebody about it, it was always like, “Well, you have a healthy baby,” so trying to justify that everything was worth it because the baby is healthy. Again, I didn't tell my family how much I was struggling but anytime like for example, I would talk to my mom about it and be like, “I missed all of those moments with him like the first night. I wasn't with him at all.” She would always say something like, “Well, he was taken care of,” because she was there. I'm super grateful that they were there, but it would crush me inside because–Meagan: But not by me. Sabina: It should have been me. All of those moments should have been me. Then toward my son's first birthday, we were talking about his birthday party and again, my sister did not mean anything by this because she just didn't know what I was going through but she was like, “Well, you didn't really give birth so we'll call it his removal day.” I just played it off like it was fine, but my insides just crumbled. Meagan: That would impact me. That just made me have a little bit of an ick. I'm sure she didn't mean any harm by that, right? But that just gave me the ick. Sabina: Yeah, she didn't mean harm at all. So I just would play these things off and smile and nod sort of thing, but inside it just crushed me. Meagan: I'm sorry. Sabina: I never thought that I would have a C-section. You just don't think that's going to happen to you. His first birthday was really hard and then after that, I just started looking forward to the next one which was good but also not good because I didn't really do any healing or recovering. I just was like, “Okay, it's done. Let's move on.” So my second birth was in 2021 and it was more of a classic unsupportive provider scenario. I went with the same midwife because she was amazing during our first birth and I had a lot of trust with her. She was amazing but she told me I needed to see high-risk as well. I went to see the high-risk doctor and he did not want to see me. He just was l​​ike, “You are a pretty low high-risk because it happened so late in your pregnancy. Take baby aspirin. Get some extra ultrasounds. We don't need to see you.” I said, “Great. That's perfect. I don't care.” But my midwife was like, “Nope. You need to see him every month if you want to continue with us.” Meagan: Was that the protocol of their staff or was that just her opinion giving her comfort of you seeing an OB?Sabina: Yep. I think it was her comfort because she said that then if something did happen, we had him on hand sort of thing. Meagan: Okay. Sabina: I still wanted a home birth. I wanted a home birth with my first. Obviously, it didn't happen so I still was totally comfortable. I knew it wasn't going to happen again. We were going to take every precaution but my midwife was like, “Nope. It's too risky because you are a VBAC and you've had that happen, we can't support you in a home birth.” Again, I didn't know all of the red flags at this time and I just trusted her too much to think otherwise. I pretty much left every midwife appointment crying because any time I had tried to be positive and be like, “Okay, well if I can't deliver at home, I'll deliver at the hospital,” they'd be like, “No. You can't deliver at this hospital. You have to go to a higher-level hospital.” Those were the ones where I stayed in the ICU for a week so I didn't want to go there. Meagan: Triggering. Sabina: Yeah, and that's where I had to go for the high-risk too. I was going there once a month and then 2-3 times a month toward the end of this hospital where we had been through all of this trauma. Eventually, I asked if I could do the appointments over the phone because you'd get the ultrasound then you'd have to wait 2-3 hours to see the doctor because they were always so behind. I checked my blood pressure. I was just like, “Can you just call me?” That was fine so it made it that much easier. Yeah. Eventually, my midwife said that if everything was fine by a certain point, she would talk to the OB at the hospital that I wanted to deliver at and see what they thought. Ultimately, they said I had to transfer to OB care if I wanted to deliver there. It was stupid. Again, another red flag. I had to be induced and yada, yada, yada. There were all of these stipulations and everything needed to be what they needed. We saw the OB once and I did not– we were in and out in 5 minutes. I did not like it. She could not have cared less about me. It was very obvious. My midwife said that starting at 38 weeks, we should try and do stretch and sweeps every few days to get things going before my due date. Meagan: She really wanted you to have a baby before that 41-week mark. Sabina: Yes, exactly. She was more scared than we were. Even my husband wasn't as scared and he is a very anxious person. Yeah. We started doing the stretch and sweeps and again, I should have refused but you don't know what you don't know at that point. I found The VBAC Link when I was 37 weeks so I wish I had found it earlier so that I could have done the course and saw all of these red flags and had taken things into my own hands. Eventually, we kept going in to get induced but we got sent home because there were no beds. Again, I was like, “Why are we doing this then? I'm obviously not high on their priority list.” Eventually, we went in. They broke my water. We waited to see if anything would happen and nothing did. They started Pitocin. For the first 6 hours on Pitocin, I was able to handle it but my husband and I were so uncomfortable in the hospital room mentally, physically, and emotionally. We didn't want to be there. We were never in the room alone so we couldn't be ourselves because there were strangers there. I eventually asked for the epidural. I told my midwife that if I asked for the epidural, try everything else first, then do the epidural. As soon as I asked for the epidural, she was just like, “Okay, let's do it.” No pushback, so that was super frustrating as well. We got the epidural then 2 hours later, a different OB came in, checked me, and was like, “No. You are not dilating. It's not working. You need a C-section.” Again, I didn't know this at the time, but she said there was no progress but I had dilated a centimeter. I had fully effaced and– yes, fully. Not just a little bit. Fully effaced. Meagan: If everybody could see my face right now, I'm like, what? That's not change or progress?Sabina: Then my cervix had come forward too. Meagan: Big changes all around. Sabina: Big changes. Big changes, just not fast enough for this doctor. I knew it wasn't necessary. I waited for my midwife to come in and fight for me and she just went along with it. I was like, “What? No.” I didn't know I had the right to just say, “No, I'm not doing that.” Neither did my husband. Meagan: Even though you had the right, it's still very hard. Sabina: It's very hard. Meagan: It's a very difficult thing to be like, “Actually, no. I've got two medical professionals here telling me what I should do but I think no and how do I say that?” Sabina: Yeah, and you're already in such a vulnerable state then there is all that negative energy too which really affects me. I'm a highly sensitive person so energies really affect me. Meagan: You were proof in your first birth too. As soon as that doctor walked in, I could feel that negative energy. I knew she didn't care about me. She wasn't in this job for the right reasons. I bawled and my husband tried to comfort me. He was like, “It's going to be different. We're going to remember everything. We know what's happening this time.” I just kept saying, “Yeah, but we don't need it. The baby is fine. I'm fine. It's just not necessary.”Anyway, eventually, we had the C-section and I just laid there on the table sobbing. I did obviously remember everything but I was just miserable. I was pumped full of every drug so I was exhausted. I think it really affected the bonding experience between me and my baby. That first night with my son, I wanted him constantly. I wanted him on me. I didn't want anyone to take him with her. I wanted her to sleep separately so I could sleep which is very unlike me. I really think all of the Pitocin and everything blocked my natural hormone releases. While I was lying on the table, my husband and the baby got taken away to the recovery room and I was just trying to rest. The OB was like, “So do you want more kids?” I was like, “Yeah.” She was like, “Well, they'll all have to be C-sections,” while I was laying on the table after sobbing that whole time. It was just horrible. Meagan: I don't want to interrupt you but I do because I want to point out to everyone that especially if you are a provider listening and you perform C-sections, please, please hear what we are saying today. What you say to us while we are on the table in the most vulnerable position– some of us are strapped down to a table– what you say to us impacts us. Every word that comes out of your mouth, please think about it. Please think about it because it impacts us and it impacts us longer– I'm getting emotional because I remember my provider talking crap like that and saying things like that. It impacts us longer than you will ever, ever know and it will impact us for every future birth. Please, providers. Please, please, please from the bottom of my heart, I beg of you. Watch what you say to people. Okay, sorry. Keep going. Sabina: That's okay. I totally agree with you. The lack of bedside manner, especially for VBACs because when you've gone through a C-section, even if it was planned or whatever, it still can be traumatic and they just don't get it. She even told me, “I had 3 C-sections. Once your baby is out, you won't care how it happened.” It's like, good for you but not everybody is the same as you. Maybe you don't care about birth experiences but lots of women do. It was super frustrating. We stayed one night in the hospital and then left. Of course, the PTSD came back. The midwives all tried to tell me that the C-section was necessary because her hands were up over her face so she wouldn't have come out anyway but their stories weren't the same so I realized that they were lying and were just trying to justify that it was necessary. Meagan: Yeah. That's unfortunate.Sabina: Yeah. The PTSD came back and I it got to a point– I can't remember how many months my daughter was but I was visiting with a neighbor and I was talking about my experiences and I was like, “Next time, I'm going to have a VBAC. I'm going to do whatever it takes to have a VBAC.” She was like, “Why would you even try that?” I was like, “What do you mean?” She was like, “Well, there's the risk of rupture so why would you even do that when you could just have a C-section?” It broke me. I came home. I bawled to my husband and a few days later, I was still really upset about it. He didn't know how to help which is fair and he was just like, “Maybe you need to see a therapist.” I'm sure there are some out there, but I couldn't find any that fit here and therapy is not something that I thought would help me. I know it helps lots of people so I started looking up my symptoms and things. I found out that it was PTSD. It got to a point where I was like, okay. I need to fix this for myself. I took The VBAC Link Course which already was super helpful just because I felt empowered going forward. I knew that my potentially both C-sections weren't necessary but definitely the second one. I knew the risks and benefits of having a vaginal birth after two C-sections. I had all of the proof in front of me. Then it also pushed me to become a doula. I've always wanted to be in the birth world. I became a nurse to work in obstetrics but then left nursing after 4 years because it just wasn't for me. I was like, “This is what I'm meant to do.”I wish I had known about doulas for my other two births. I took a doula course and then I took The VBAC Link Doula Course and within a month of starting my doula page, I already had a VBAC client who reached out which was super exciting. She got in with the midwives that I had, with the particular midwife that I had. I was like, “Okay. Maybe this is a good thing. Maybe I can teach her about VBACs.” The first appointment, she was great apparently then after that, it was constantly, “Well, you have this so maybe we should do a hospital birth or you have this.” Every time she saw them, they were trying to push her to a hospital birth. She ended up having a free birth with me which was really cool. Meagan: She did? Really? Sabina: I told her from the get-go, “If that's something you want, I'm here for you. I'm totally comfortable with that.” Her original plan was just to maybe not call the midwives unless she felt something was wrong but then after some of those appointments, she was like, “No. They're not coming. We're not calling them. If we need help, we'll just go to the hospital.” Yeah. She had a free birth and it was awesome. It was great to be there. I was 14 weeks pregnant at the time so it was great for me. I actually met my doula a year before we even tried to conceive because I wanted to be prepared. She wasn't a VBAC doula, but she was newer and very open to the idea of having a home birth after C-sections. We became friends to the point where I actually attended her birth 3 months before she attended mine. Meagan: Oh my gosh, so cool. Sabina: Yeah, when I got pregnant with this one, I pretty much knew right away that I wasn't going to have a provider. It wasn't for me. I did apply to the midwife groups but every one of them either refused or said I was on the waitlist but I wasn't. As soon as they saw I wanted a home birth after two C-sections, that was thrown out. I mentioned it to my husband once and then the second time I mentioned it, he was fully on board which was mentioned. Meagan: Really? Because you said he was anxious about things yeah. Sabina: Anxious, yeah. But I had been educating him along the way too with everything that I learned. Any time I told him stories of other women who had difficult births or my client who was having these horrible appointments, he would get angry too so yeah. He really had become pretty educated on the topic which was amazing. He was very comfortable with our doula as well. He was like, “She's really knowledgeable.” We had a plan in place for if there was an actual emergency and if I wanted to transfer for whatever other reason. We had it set up and most other things I felt like I could handle myself unless it was one of the few very serious emergencies. My mindset going into this birth was amazing. I read daily affirmations to myself before bed and then I would listen to her heartbeat. I could hear it with a stethoscope around 15 weeks so every night I would listen to her heartbeat and I just felt so connected and so in tune with my body and my intuition which was something that kept getting shut down with my other births I found. It was the most stress-free pregnancy. We didn't do any tests. We got a couple of ultrasounds just because I like seeing the baby and I'm a very visual person but that was it. Both me and my husband were like, “This is amazing. We're just living our lives normally and not these stipulations and all of these worries being pushed on us.” I was checking my blood pressure but I just eventually was like, I don't really feel like I need to do this. It was very low. It was 90/50 for most of the pregnancy so I was like, I'm fine. I was still taking the aspirin just as a precaution but that was it. I wasn't in a rush. I wasn't like, baby has to be out at a certain time. I was just like, let's let things happen because we didn't get that opportunity with the last two. I had my mucus plug start to come out around 39 weeks and 4 or 5 days which was very exciting but I told my husband that it doesn't really mean much. Things are happening as they should. A couple of days later, the bloody show came out as well. Again, I was like, “We are fine. This could be going on for weeks. Whatever.”Then that night, so it was actually the morning of my due date, I had prodromal labor. I started feeling contractions and of course, I got excited but it started I think at 4:00 in the morning. I just sat there and breathed through them. They weren't intense. They were very easy to get through then me and my husband got everything ready when he got up then it stopped. I was like, “Okay, whatever. My body is just practicing.” For the next week or so, the mucus plug kept coming out throughout the week just in little bits. I didn't have any other contractions until– I have it written down here– the night of July 3rd into the morning of July 4th so probably 10 hours. I had prodromal labor overnight then it stopped as soon as I got up in the morning. I tried doing the Miles Circuit and both times it stopped the contractions so I was like, okay. Whatever. At least I know how to stop them. Meagan: Sometimes Miles Circuit does stop them because a lot of the times prodromal is a positional thing. Baby is trying to figure it out so the Miles Circuit helps with position and if it moves baby, it can stop them. Sabina: Yep. I was a little bit frustrated that day because I was like, I'm losing sleep now. I don't know if I should rest during the day because I still could be weeks away from giving birth. I was like, “We need to stay busy. We need to have plans for every day just so I don't feel like I'm rushing.”Meagan: Take your mind off of it. Sabina: Yeah. We kept busy that day then we were sitting after dinner. Around 8:00 PM I started feeling them again and I was like, “Great. Another night of no sleep. Okay, whatever.” The second night I had them, they were stronger than that first time but I could still breathe through them and stay lying down. That night they were even stronger which is odd because usually prodromal labor is the same. Meagan: It's monotone, yeah. Sabina: But these ones, I couldn't lay down which was really frustrating because I was so tired. I had to keep getting up. I tried doing the Miles Circuit and it didn't help so I was like, “Okay, I guess I'm going to stay awake all night.” In the morning, I got up and I was waiting for them to stop. I tried to have a hot shower and they were still going. It was 10:00 in the morning at this point and the other ones had always stopped at 8:00. I was like, “Okay. Maybe this is something.” My husband was like, “Get Jess here.” I was like, “Well, I'm fine though. I don't need the help.” But I texted her to let her know what was going on and then for my husband's sake, told her to come because I knew he needed that comfort. We called her and we called our friend who was going to come watch the kids. For the whole day, I was contracting and dealing with it beautifully. I was breathing through it no problem. I was excited every time I got a contraction. I wasn't timing them because I felt like that was stressing me out. I felt like they needed to be a certain length and a certain time apart. I stopped timing them and it was just really nice. Our friend was taking the kids swimming. Me and my doula were mulling around the house and she would play with the kids too. It was like we were all just hanging out. It was so peaceful. Then around 4:00, she does reflexology, my doula, so she got me to lay down and did some acupressure stuff on my feet. While she was doing that, I had a really big contraction and after that they pretty much stayed. I think that was the shift into active labor. My husband made everybody dinner which was nice and I was just in the kitchen picking up the food while going through contractions. Eventually, the kids went to bed and our friend left. At this point, it was 8:00 at night. I had the TENS machine on. I had been going back and forth from the toilet because the toilet is the dilaton station. Any time I had to go to the bathroom, I would stay there for 4-5 contractions. Again, I was still fully in control and mentally fully aware. I was happy in between contractions so around 9:30, I decided to get in the tub because they were still increasing. My husband and doula were both there. My husband and I really got to connect during this labor and he was so present. I had asked him after my previous births if he was proud of me. He was like, “I don't know if I would say proud.” He didn't mean it negatively, but it just hurt that he wasn't. So throughout this labor, anytime I looked at him, he'd tell me how proud he was of what I was doing or he would tell me how amazing I was and it was just so nice. He could hold me and we could just be ourselves without feeling the pressure of people watching. So then around 10:30, transition hit. I struggled. I was so mentally tired because I hadn't slept in three nights of no sleep and my mental strength had been what was keeping me going the rest of the time. I was struggling. It lasted 3.5 hours so it was a long transition. Of course, I had the moments of “I can't do this. I'm not strong enough” or whatever and my doula just went, “Okay, if that's how you feel then we need to talk about the alternative.” I was like, “No.” I shut it down. I can do this. We're not going anywhere so that was great. All she needed to say was that one thing. I felt my water break at 12:30 which was amazing because I'd never felt that before and it gave me that push then a couple of contractions later, my body started pushing on its own which again, was amazing. It was very intense and I just couldn't stop it. Every time I got a contraction, I couldn't stop myself from pushing so I just went with it. I could feel her. I reached up inside me and I could feel her head around 1:40ish which was so incredible. How cool is that? So a couple of contractions later, I could feel her crowning, and my husband– I sat up and my husband was like, “Oh my god. I can see the hair.” He was so excited. It was adorable. It took me another 20 minutes to get her head out. I had a lot of pressure in my back and on my right side so I was like, “Maybe she's posterior,” but I didn't know. Once her head came out, she wasn't posterior. Meagan: Was she looking sideways a little?Sabina: I think she was asynclitic because all the pain was on the right and I ended up tearing only on the right side so I'm pretty sure she was crooked. Her head wasn't really coned either so that's what I'm assuming. That's my guess anyway. Meagan: Yep. Coming down a little wonky. Sabina: Her head was out. I got to feel her. We didn't know the gender of this one either which was very exciting. We were 99% sure it was a boy so I kept referring to her as “it”. “Oh, I can feel its ear. It's turning.” I felt her turn too which was cool. My doula took videos. In the video, right before she came out, I said, “She's all gooey,” which is crazy to me because I thought it was a boy but in the moment I said “she”. It was very cool. I'm pretty sure that was all intuition. Meagan: That is crazy. Sabina: I had a 3.5-minute break between when her head came out and the next contraction then on the next contraction, I pushed 3 or 4 times. I felt her come out. I sat back and got to pull her up to my chest. I just looked at my husband and I was like, “We did it. We did it. She's here.” His reaction was everything. I don't think he realized she was out because I had been moving around so when I sat back I think he thought I was just readjusting then all of a sudden, I pull her out. He had a huge smile on his face. He put his hands on his face because he couldn't believe it. He started bawling and it was just, oh my god, incredible. She cried. The second I took her out of the water, she squawked and was moving around and everything. It was the best moment of my life. It was everything and even though it felt like a dream because I was so tired and of course, you're in shock that this actually happened, but it was incredible. She was totally healthy. I got to feel her cord pulsing. I didn't even get to see the placentas with the other two even though I wanted to so then we just stayed in the tub for a bit. I was extremely sore. Once that initial high wore off, I was like, “Holy crap. My crotch.” Meagan: I just had a baby. Sabina: I was like, “My crotch hurts.” My husband ran the other tub for us and we got to see the gender too which was super fun and a big shock to both of us. I got up to switch over to our shower tub and I was like, “Oh, there's a little bit of pressure.” I grunted and the placenta came out which was very cool because I didn't get to experience that the other two times. We went to the other tub and I got to do the placenta tour by myself. I got to let her latch by herself. I love those videos of babies finding the nipple themselves so I let her do that. She was coated thickly in vernix. For a 41-week baby, it was super thick. I think it was intentional for me because I always wanted that gooey baby and she was extremely gooey. I have photos of it all over my face, all over my nose. It was just everywhere. Yeah. Then we transferred to the bed. We got to cut the cord. I made a little cord tie because I hate those plastic chip clip things. I made her a cord tie and I got to put that on. When the kids woke up in the morning, they just got to come in the bedroom and she was there so it was the best. My doula was great. She did counterpressure and she helped my husband any time he was having moments of panic. At one point, I said, “What's taking so long? Is she stuck?” That's his trigger. For some reason, he's terrified of the babies getting stuck. You can see in the video that he looks over to my doula all panicked. I didn't know because she just calmed him down without me knowing which was great. Sabina: I did tear. When I was in the tub, I looked down and I saw something floating. I was like, oh is it gunk? But it was a piece of my inner labia that had ripped off. Meagan: So what did you do about that? Did you let it heal naturally? Did you do the super glue thing?Sabina: I've never heard of the super glue thing but I wouldn't have tried that. Meagan: Yes, super glue. There are some midwives here in Utah, birth center and home birth midwives who when there's a little bit more tear that would maybe make them say, “We need to do some stitches but not too bad,” they would superglue it. It's pretty minor, but they would superglue it. They just say that it causes more trauma to put a needle in, a needle in, a needle in, yeah. Sabina: I originally told myself that if I tore, I would just let it heal, but I couldn't actually figure out where it attached to. We even got a mirror and we were trying to figure out where it had actually ripped off of so I was like, “You know what? We're going to have to go in.” There's a really small hospital about 20 minutes from us. We went to the emergency room and told them, “I just gave birth. I don't have midwives. I need to be stitched up.” They sent us to the OB unit. The doctor really took his time and he stitched up every little tear that he saw which I didn't really want but I didn't know any different. At one point, I asked, “How many stitches are you putting in?” He was like, “You've kind of got a zig-zag tear up.” That was part of it and then beside my urethra. “I'm trying to fix it but I'm also trying to make it look aesthetically pleasing.” I was like, “Okay, I appreciate that. I want it to look decent afterward.” We did have some issues with her. They wouldn't leave her alone even though we didn't want her looked at. There was one doctor in particular who just really caused a lot of problems and threatened to call child services and stupid stuff like that. In hindsight, I would have just let them call child services because she was perfectly healthy and they would have come here. They did end up coming here even after we did what they wanted and she was like, “Why am I here? This is so unnecessary and such a waste of my time.” In hindsight, that's what we would have done. Anyway, the stitching was fine then we came home. I healed. The stitches were the most uncomfortable and sore part. With everything else, I healed relatively quickly. I was back to working out just after two weeks which I know is very quick. Meagan: Whoa, that's really quick. Sabina: That's just me. I did that with my C-sections too. Meagan: You felt really good. Sabina: After the C-sections too, I was back after two weeks with light stuff. I worked my way up. I didn't just go back to the intense stuff. My husband even said that it was the best experience of his life and he would gladly do that again over what we had been through. It was amazing. It was amazing. Meagan: I'm so happy for you. I can see the joy. I can see this cute little one right here. Oh my goodness. I am so happy for you. Sabina: Thank you. Meagan: I'm happy you had that support. You had that team. You even had support for your kids. You had everything planned out and I'm so, so, so happy for you. Sabina: Thank you. I should point out too that she was our biggest baby. Meagan: Was she?Sabina: Our other two were 6 pounds, 14 ounces and she was 8 pounds, 5 ounces. Of course. Meagan: Okay, that's definitely a lot bigger of a baby. I wanted to talk about that too. It's actually going to be in another episode where we are talking about big babies. Did people ever comment on your pregnancy like, “Oh,” and did that ever impact you like, “Oh my gosh, maybe I'd have too big of a baby?” Sabina: I honestly instinctively knew it was going to be our biggest baby because I knew that I was going to deliver vaginally. With the other two, their heads were in the 5th percentile and they would have slipped out. I knew it was going to be challenging and I knew that I was meant to have the biggest challenge that I could basically. She was very fluid-filled so she lost over a pound after birth. She dropped down to the low 7s so I don't know if the vernix had anything to do with that, but I looked the exact same as the other two pregnancies, maybe even smaller. It just looked like I had a soccer ball stuffed up my shirt. I was not big at all. Meagan: Okay, okay. That's good. Sabina: Yeah, we never really got comments about a big baby or anything. 8,5 is big but not crazy big. Meagan: It's not but it's bigger than 6 pounds. So many people are being told, “Oh my gosh. You're so big.” All of these things. Don't let people get to you, Women of Strength. Believe and understand that your body is going to make the right-sized baby.Sabina: Yep, exactly. Just because you're big doesn't mean your baby is big. You could have lots of fluid. It could be how you're carrying. It's all so silly. The ultrasounds are silly. Meagan: Torsos. Sabina: Yeah, exactly. If you have a shorter torso, you're going to stick out further which makes sense. I weighed myself before and after birth just out of curiosity. I had gained 18 pounds during pregnancy and I lost 16 of it with her coming out. So 16 pounds of baby, fluid, and placenta is a lot. Meagan: That is a lot and that's amazing. People have a hard time bouncing back like that. You just bounced back right after the baby was born. I also wanted to talk about HELLP syndrome a little bit because there are people who worry about it happening with future pregnancies. You had mentioned that your provider was like, “Well, you are a low risk because it happened so late in pregnancy.” According to the Preeclampsia Foundation, HELLP syndrome, there are two L's in this and is it hemolysis?Sabina: Hemolysis? Meagan: I'm like, I never know how to say that. Elevated liver enzyme levels so that pain that she was describing in the beginning was her liver. It was her liver. Anyway, we've got symptoms of blurry vision, pain or sharpness in that upper-right middle part of the belly, headache– and she mentioned it was on her right side but these are things that are common with preeclampsia. A headache, blurry vision, overall not feeling well, fatigue, sweats– I only had one client who had HELLP but she had night sweats. She would wake up and was just Iike, “I just was so wet then I would feel yucky.” Sabina: I had a lot of that in the recovery of HELLP syndrome. I was very sweaty at night. Meagan: Very, very sweaty at night, yeah. Super nauseated that continues to get worse. Nose bleeds are kind of a weird thing but that can be a symptom and they can have a hard time stopping. You keep getting nosebleeds. And seizures. They are the last and most serious and weight gain and swelling. Sabina: Yeah, the major one. Meagan: But according to the Preeclampsia Foundation, women who have had HELLP syndrome in previous pregnancies have a 2-19% chance of getting it again. 2-19% is pretty low.Sabina: That's the range. Meagan: Women who experience HELLP before 29 weeks of gestation in their first pregnancy may have an even higher risk though. So where your provider was like, “It was 41 weeks,” you had a lot of a lower risk. Just know if you have had HELLP syndrome, could you get it again? Yes. Will you get it again? Maybe, but your chances are lower than if you got it earlier on. Sabina: Yeah, and there are a lot of precautionary things you can do to prevent it. Meagan: That's what I was just going to say so we can talk about that. If you've had HELLP syndrome, and even just preeclampsia, what are some things? You mentioned aspirin. What are some other things you did to try and avoid it in future pregnancies?Sabina: As I mentioned, I'm a very active person so obviously a healthy lifestyle in general is going to help but then we did a lot of extra urinary tests and blood work. Even if you have no symptoms, it can still show up in those tests so maybe if we had done blood work for me or a urine sample, we would have known ahead of time. Those are really the only ones I did to help prevent it. Then I checked my blood pressure twice a day at home which was excessive but with all of the pressure from my providers, I just felt like I should. Meagan: I think it's warranted for sure. Sabina: Yeah. It was a good way to monitor. Sometimes it would go up slightly so you'd be cautious and then if it went back down, you're like, okay it's fine. It was just a one-off thing. Like I said, with this pregnancy too, I did all of those things other than the tests. I took the aspirin. I stayed healthy. I made sure I was well-hydrated the whole pregnancy. Meagan: Yes. I was going to say hydration. Sabina: Yes, that's a hard one. It's something I struggle with on a daily basis. Meagan: I know. I struggle and I'm not even pregnant. That's why I love our Needed hydration packets from our Needed partner and it helps me because hydration is so hard. Sabina: It is. Meagan: Hydrate. Make sure you are watching out for those symptoms. If you've had it, don't hesitate to call your provider or take charge of your care. Thank you so much again for sharing your beautiful stories. I really appreciate you so much. I'm trying to think if we've had a free birth, an intentional free birth. Sabina: You've had one and I've listened to it. Meagan: Have we had one?Sabina: You've had one and it was Ashley Winning. Meagan: Oh, duh. Of course. Yes. Sabina: She was the first one who I had ever had of a free birth then I found Free Birth Society after that so she started me down this path. Meagan: Yes. Oh, she's so great and she's in Australia. Definitely someone to listen to for sure. Okay. Well thank you so much and congrats and we'll talk to you later. Sabina: Thank you. Thank you so much for having me. This was a dream come true in so many ways. Meagan: Oh, it makes me so happy that you're here. And remember if you're looking for a doula, go find her. Her link will be on today's episode. 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

"I'd love to be as fat as I was in high school!" Welcome back, Camille! Keri and Camille dive right into an update on the girls! Camille's girls spent time in the NICCU after Camille developed HELLP! We jump into a book review of The Gift of Fear by Gavin de Becker and how to encourage our kids to listen to their intuition. From listening to our mommy feelers in the grocery store to boo-ing the bullies in our kids' lives, generational motherhood comes into play as we navigate this wild ride called motherhood! Join us for a conversation about NICCU, HELLP, education, Europe, violence, domestic violence, The Gift of Fear, MAMA TRAUMA, mama bear, lioness, use your voice, MOMMY INSTINCTS, intuition, bear vs. man, bullying, bullies, birth order, sisters, and generational motherhood.  **********************************************************************************************************  If you like this episode and want to connect other Mama Trauma Survivors to the Momsday Bunker, please like and share! Follow the Keri Momsday Prepper on Facebook and Keri_Henson_aka_Momsdayprepper for tips and tricks on preparedness. You can reach Keri at MomsdayPrepper.  

Following an emergency c-section due to HELLP syndrome in her first pregnancy, Jolene Brink was determined to have a different birthing experience with her second child. Through the support of a knowledgeable medical team and insights gained from her EBB Childbirth Class, she successfully achieved her goal of an unmedicated VBAC with the birth of her son, Guthrie, in 2022. Jolene's journey towards a VBAC was a transformative process of healing, empowerment, and reclaiming her birthing experience, showcasing the importance of advocacy and informed decision-making in maternal healthcare. Resources: Check out Doulas of Duluth to learn from her instructors Cooper Orth and Dana Morrison, and follow them on Instagram! Learn about Jolene's work here! Read The Preeclampsia Foundation's article on HELLP Syndrome Follow the Preeclampsia Foundation on Instagram van Oostwaard, M. F. et al. (2015). "Recurrence of hypertensive disorders of pregnancy: An individual patient data meta-analysis." Am J Obstet Gynecol 212(5): 624.e1-17. https://pubmed.ncbi.nlm.nih.gov/25582098/ Duley, L., et al. (2019). "Antiplatelet agents for preventing pre-eclampsia and its complications." Cochrane Database Syst Rev. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820858/ Listen to the Evidence on VBAC - EBB 113 EBB Childbirth Class now includes a module all about planning a VBAC! Learn more about the EBB Childbirth class here. 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.

We are honored to be joined on the podcast today by Emily, Maliyah's Mom, to talk about her TFMR (termination for medical reasons) last year. In our previous interviews about TFMR, the parents have had to make the decision to terminate due to their baby's own serious condition(s). In this case, Emily had to choose a termination to save her own life and lost her daughter in the process. This is a crystal clear example of how abortion is healthcare. Emily's pregnancy was killing her, and there was no way to save both her baby and herself. This conversation feels more important than ever with the continued attacks on reproductive healthcare in many states here in the US. Thank you for listening with an open heart to Emily's story, and thank you Emily for your vulnerability. Note: This episode contains the majority of the medical details of Emily's TFMR, and if you find pregnancy complications triggering, we recommend you skip straight to the next episode in which we speak with Emily more broadly. ::: Things we talk about in this episode: - HELLP syndrome - Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome - ALAIL | TFMR is Baby Loss, an interview with Hadley's Mom Jill - ALAIL | When "Choice" Doesn't Feel Like a Choice, an interview about TFMR with Adelyn's Mom Alyssa - ALAIL | The Stillbirth Specialist, an interview with OBGYN Dr. Heather Florescue (Part 1) - ALAIL | From the Other Side of the Stirrups, another interview with OBGYN Dr. Heather Florescue (Part 2) ::: Support As Long As I'm Living podcast at ⁠buymeacoffee.com/alailpodcast⁠ OR buy buying our MERCH at ⁠bonfire.com/store/alailpodcast⁠! ::: Follow As Long As I'm Living on Instagram at ⁠⁠⁠⁠⁠⁠⁠⁠⁠@aslongasimlivingpodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠, send us an email at ⁠⁠⁠⁠⁠⁠⁠⁠⁠aslongasimlivingpodcast@gmail.com⁠⁠⁠⁠⁠⁠⁠⁠⁠, or visit us at ⁠⁠⁠⁠⁠⁠⁠⁠⁠anchor.fm/aslongasimliving⁠⁠⁠⁠⁠⁠⁠⁠⁠! We would love to hear from you! ::: As Long As I'm Living is a podcast about life, love, and laughter after infant loss. Judith and Alina are rebuilding Happier Ever After one day at a time despite excruciating grief and trauma and offering support to grievers of all flavors, but especially those who have lost a baby to SIDS, infant death, birth accidents, stillbirth, TFMR, ectopic pregnancy, or miscarriage. --- Support this podcast: https://podcasters.spotify.com/pod/show/aslongasimliving/support

We are honored to be joined on the podcast today by Emily, Maliyah's Mom, to talk about her TFMR (termination for medical reasons) last year. In our previous interviews about TFMR, the parents have had to make the decision to terminate due to their baby's own serious condition(s). In this case, Emily had to choose a termination to save her own life and lost her daughter in the process. This is a crystal clear example of how abortion is healthcare. Emily's pregnancy was killing her, and there was no way to save both her baby and herself. This conversation feels more important than ever with the continued attacks on reproductive healthcare in many states here in the US. Thank you for listening with an open heart to Emily's story, and thank you Emily for your vulnerability. Note: We separated out the majority of the medical details of Maliyah's birth into a separate episode for those of you who find pregnancy complications triggering. To listen to that episode for all of the context, go back one in your podcast feed! ::: Things we talk about in this episode: - ⁠HELLP syndrome⁠ - Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome - ALAIL | ⁠TFMR is Baby Loss, an interview with Hadley's Mom Jill⁠ - ALAIL | ⁠When "Choice" Doesn't Feel Like a Choice, an interview about TFMR with Adelyn's Mom Alyssa⁠ - ALAIL | ⁠The Stillbirth Specialist, an interview with OBGYN Dr. Heather Florescue (Part 1)⁠ - ALAIL | ⁠From the Other Side of the Stirrups, another interview with OBGYN Dr. Heather Florescue (Part 2)⁠ ::: Support As Long As I'm Living podcast at buymeacoffee.com/alailpodcast OR buy buying our MERCH at bonfire.com/store/alailpodcast! ::: Follow As Long As I'm Living on Instagram at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@aslongasimlivingpodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, send us an email at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠aslongasimlivingpodcast@gmail.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, or visit us at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠anchor.fm/aslongasimliving⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠! We would love to hear from you! ::: As Long As I'm Living is a podcast about life, love, and laughter after infant loss. Judith and Alina are rebuilding Happier Ever After one day at a time despite excruciating grief and trauma and offering support to grievers of all flavors, but especially those who have lost a baby to SIDS, infant death, birth accidents, stillbirth, TFMR, ectopic pregnancy, or miscarriage. --- Support this podcast: https://podcasters.spotify.com/pod/show/aslongasimliving/support

Send Kiona a Text Message!In this episode, Angela talks about her struggles with conception through IVF due to her late diagnosis of stage 4 endometriosis. She also talks about her micro preemie birth experience with her son Bennet at just 25 weeks gestation in addition to some of the details of how having a tiny sick baby in the NICU was impacted by the COVID-19 Pandemic.  Disclaimer: This podcast is intended for educational purposes only with no intention of giving or replacing any medical advice. I, Kiona Nessenbaum, am not a licensed medical professional. All advice that is given on the podcast is from the personal experience of the storytellers. All medical or health-related questions should be directed to your licensed provider. Resources:Project NICU: https://www.projectnicu.com/ Hand to Hold: https://handtohold.org/ Preeclampsia Foundation: https://preeclampsia.org/ Perinatal Support of Washington: https://perinatalsupport.org/ Postpartum Support International:https://www.postpartum.netChances of Miscarriage Data: https://datayze.com/miscarriage-chart#google_vignette Definitions:In Vitro Fertilization (IVF)PreeclampsiaEndometriosisHELLP Syndrome APGAR ScoreNecrotizing Enterocolitis (NEC)Acute Respiratory Distress Syndrome (ARDS)Support the Show.Thank you so much for tuning in to this episode! If you like this podcast, don't hesitate to share it and leave a review so it can bring the podcast to the attention of others. If you want to share your own birth story or experience on the Birth As We Know It™️ Podcast, head over to https://birthasweknowitpodcast.com/ or fill out this Guest Request Form. Support the podcast and become a part of the BAWKI™️ Community by becoming a Patron on the Birth As We Know It Patreon Page! And don't forget to join in on the fun in the Private Facebook Group!

Många har hört talas om havadeskapsförgiftning, men få vet vad det faktiskt innebär. I veckans avsnitt gästas vi av Karolina från Preeklampsiföreningen. Vi snackar om föreningen och vad de bidrar med. Vad är preeklampsi och HELLP och hur vanligt är det? Vad är havandeskapsförgiftning vs preeklampsi? Vilka symtom är det bra att ha lite koll på? Det och mycket mer (bl.a. en personlig erfarenhet) får vi lära oss om i veckans avsnitt. Enjoy! Hosted on Acast. See acast.com/privacy for more information.

On this week's Listener Series, we welcome Stephanie to the podcast. Stephanie required an induction due to sudden hypertension at 40 weeks and 1 day. Her daughter required a NICU stay and Stephanie put her own health on the back burner until 6 days postpartum when her health took a turn for the worst and she experienced multiple organ failure due to HELLP syndrome.On this episode, you will hear:- Medically-indicated induction and pregnancy complications- Cholestasis - Subchorionic hematoma- HELLP and multiple organ failure- Postpartum preeclampsia- Healing and community support- NICU stayFor more birth trauma content and a community full of love and support, head to my Instagram at @thebirthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Dr. Christina Pinnock is a Maternal Fetal Medicine Specialist/Perinatologist based in California and creator of the ZerotoFour Podcast. She is here to help us tackle topics like what constitutes a high-risk pregnancy, lupus, preeclampsia, HELLP syndrome, gestational diabetes, fibroids, and bicornuate uteruses and how they relate to VBAC. The overarching theme of this episode is that all pregnancies are individual experiences. If you are hoping to achieve a VBAC and you have pregnancy complications, find a provider whose goals align with yours. By ensuring that your comfort levels are a good match, you are on your way to a safe and empowering birth experience!Dr. Pinnock's Website and PodcastNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 00:58 Review of the Week03:13 Dr. Christina Pinnock03:56 Importance of a VBAC-supportive provider06:36 High-risk pregnancies11:02 Lupus and TOLAC14:31 Preeclampsia 17:19 Varying ranges of preeclampsia20:46 HELLP Syndrome 26:36 Other High-risk situations 27:54 Gestational Diabetes35:00 Inductions with gestational diabetes42:25 Fibroids 46:33 Do fibroids tend to grow during pregnancy? 51:20 Bicornuate UterusMeagan: Have you ever been told that you were high risk, so you'll be unable to TOLAC? Or maybe you can totally TOLAC assuming nothing high-risk comes into play? What does high risk mean? We often get questions in our inbox asking if having your previous cesarean makes them high risk. Or questions about topics like preeclampsiaclampsia, gestational diabetes, bicornuate uterus, fibroids, and more. I am so excited to have board-certified OB/GYN Dr. Christina Pinnock on the show today. She is a high-risk pregnancy doctor passionate about educating women along their pregnancy journeys so they can be more informed and comfortable during their pregnancy. She is located in California and has a podcast of her own called “ZerotoFour” where she talks about topics that will help first-time moms prepare for, thrive, and recover from pregnancy as well as shares evidence-based information and answers everyday questions like we are going to discuss today. 00:58 Review of the WeekMeagan: We do have a Review of the Week, so I'm going to jump into that and then we can dive in to get into these fantastic questions from Dr. Christina Pinnock. Today's reviewer's name is Obsessed!!!! It says, “The best VBAC and birth podcast. I am grateful to have discovered Meagan and this podcast. I definitely believe listening to stories of these amazing women and their parent's course helped me achieve my two VBACs. Thank you for all you do The VBAC Link.”Oh, thank you so much Obsessed!!!!!  And as always if you wouldn't mind, drop us a review leave us a comment and you never know, it may be read on the next podcast. 03:13 Dr. Christina PinnockMeagan: Okay, Women of Strength. I am seriously so, so excited to have our guest here with us today! Dr. Christina, is it Pinnock? How do you say it? Dr. Pinnock: Yes that's perfect.Meagan: Ok, just wanted to make sure I was saying it correctly. Welcome to the show! You guys, she is amazing and has been so gracious to accept our invitation here to today to talk about high-risk pregnancy and what it means. Hopefully, we'll talk a little bit about gestational diabetes because that's a big one when it comes to VBAC. And if we have time, so much more. So welcome to the show and thank you again for being here.Dr. Pinnock: Thank you so much for having me, I'm excited to be here and chat with you and your audience about these great topics, so thank you.03:56 Importance of a VBAC-supportive providerMeagan: Yes! Okay well, this isn't a question we had talked about, but I'm curious. Being in California, do you find it hard to find support for VBAC or do you find it easy? I mean, California is so big and you're in Mountain View. So I don't know exactly where that is. You said the Bay Area, right? So how is it in your area? How is VBAC viewed in the provider world in your area?Dr. Pinnock: Yeah, that's a good question. I actually did most of my training on the East Coast, so it's been a good experience seeing the differences in coastal practices. I think where I did my training we were pretty open to VBACs and supported them. In California, I've had a similar experience and I think it really depends on where you are.  I'm in the San Francisco Bay Area and I work at an institution where we support TOLACs and want our moms to VBAC as long as it's safe and it's what they desire. But I really think the opportunity to TOLAC depends on your individual OB provider that you have and their comfort in offering that. And importantly, the hospital resources that you have available in your area. California's huge and depending on where you live it can be a very, very different infrastructure both geographically and specifically within the hospital. And so I really think that differences in that offering is based around those resources rather than maybe patient desire or even sometimes provider desire. So it really just depends on those things. Meagan: That's so good to know. I mean, we tell our community all the time that provider is a really, really big key when it comes to being supported. But also I love that you were talking about the actual hospital because for me with my second– I had a VBAC after 2 C-sections and with my second, my provider was 100% gung-ho and super supportive. But in the end, I ended up switching because the hospital was going to end up restricting my provider in supporting me in the way he wanted to support me, right? So it's also really important to vet your location and your hospital.Dr. Pinnock: Yes, absolutely. Sometimes, someone may live in a location where they don't have that choice, unfortunately. If you do have that choice and you can choose hospitals and providers that can support it, by all means if you have that ability. 06:36 High-risk pregnanciesMeagan: Absolutely. Ok well, let's dive in more to high-risk. So a lot of the time, I'd love to see what you think about this. A lot of the time, providers will tell moms because they've had a previous Cesarean, not even a special scar or anything like that, that they are automatically grouped into the high-risk category. So I don't know what your thoughts are on that in general, but let's talk more about high-risk pregnancy. What does it mean? What does it look like for TOLAC? How is it usually treated? And are there often restrictions given for those moms? Dr. Pinnock: Yeah, no. That's a really good question. One thing about pregnancy, there's some level of risk in all pregnancies. No matter if you're completely healthy, no medical problems, or you're trying to TOLAC, or you have other medical conditions that exist before pregnancy, all pregnancies carry some level of risk but not all the risks are equal. There are some conditions that the mother can have before pregnancy that can put her pregnancy at a higher risk of developing some complications. There are some conditions that can actually develop during pregnancy that can cause the pregnancy to be at a higher risk of developing complications. Lastly, there are some conditions specific to the placenta, the baby, how the baby developed, or even the genetic makeup of the baby that can contribute to a high risk of having complications. All of these three categories can impact the status of your pregnancy being considered high-risk. So typically, if you have a condition that falls in one of those three boats, then your pregnancy could be considered a higher risk. Usually having a previous C-section or even two previous C-sections by itself is not really something that I would use to classify someone as having a high-risk pregnancy. I do think that definitely talking with your provider about your desire for delivery earlier on can help both people to be on the same page, but if you otherwise have nothing else going on in the pregnancy and you have one previous C-section or even two previous C-sections, I think the pregnancy itself, I wouldn't consider it a high-risk pregnancy. Meagan: That's good to know. Dr. Pinnock: Yeah no, absolutely. And when you think about the delivery, I think about it a little bit differently than the pregnancy. I think for the delivery if you are interested in having a TOLAC and you have a previous C-Section or two, then the management of your delivery and the risk of your delivery isn't the same as someone who hasn't had a C-section. I think about them as like two different boats. But overall, conditions that are related to maternal health can be high blood pressure, diabetes, and autoimmune conditions like lupus. Those things can cause your pregnancy to be considered high-risk. A good example of a few things that can develop in pregnancy that can make your pregnancy high-risk include things like preeclampsia which is high blood pressures of pregnancy. Having twins or having triplets can make your pregnancy a higher risk. In some instances, even gestational diabetes depending on what's going on and where you are can be considered a pregnancy with some high-risk features. And then genetic conditions for baby whether that's a difference in how one of your babies' organs developed, or a genetic condition that's discovered from testing; any of those things can really impact that high-risk status and how your pregnancy will be monitored and managed after that. Meagan: Ah these are all such great topics and actually things that we get in our inbox. Like, “Hey, I have lupus,” or we'll have one of our VBAC doulas say, “Hey, I have a client who has lupus. She really wants to TOLAC and have a VBAC. What does that mean for her?” Obviously, all of these conditions are going to be treated differently throughout the pregnancy and probably even during the labor and delivery portion. 11:02 Lupus and TOLAC Meagan: I don't know if we can touch on a couple of those like lupus. What does that look like for someone? If I have lupus coming in, I'm doing okay right now. I have it. What does that look like for someone wanting to TOLAC and to have a VBAC?Dr Pinnock: Yeah. I think it's similar to your first question about whether a C-section would make your pregnancy considered high-risk. So the lupus diagnosis would increase the risk of certain medical conditions happening in pregnancy relating to both mom and baby. Your doctor may get some extra blood work to monitor how your lupus is progressing in pregnancy. Your doctor may get some extra ultrasounds to make sure that baby isn't too small and add some extra monitoring to make sure that baby is staying safe and that if there is a risk for baby to be in distress that that is picked up. And so the actual monitoring and management of the pregnancy is usually done with the help of a high-risk pregnancy doctor like myself with an OB provider. That is really specific to what is going on with that person. If everything goes smoothly and lupus stays under control and we get to the moment where we're thinking about how we're going to deliver baby, that's sort of a separate boat. In an ideal world, everything goes well in terms of the lupus and pregnancy and if you're interested in having a TOLAC, having a diagnosis of lupus should not restrict you from that option. You can still have that as an option but it really just depends on the specifics of how your pregnancy has unfolded. Have you developed any other conditions like high blood pressures in pregnancy or preeclampsiaclampsia where your doctor is maybe thinking you may need to deliver earlier? Are there things going on with your baby where we think baby is under more stress where we would really need to be very intentional about how we deliver baby? It's a really nuanced thing and it's based on the specifics on that person's condition. I think an overarching theme is whatever is going on with the pregnancy that impacts the delivery if things are not going as smoothly. But if things are going smoothly and you want to try for a TOLAC, that's not necessarily a reason to say, “No, you absolutely can't do this,” unless there are specific conditions that came up in your pregnancy that make it less safe for either you or baby as the mom. Meagan: Yeah. Something that I'm just hearing you say so much that's standing out is that really is individual, depending on that individual and depending on that individual's case. I think that's something important for listeners to hear because someone who may have lupus that's going really, really fine, TOLACs going to be a really great option for them. But someone who may have active symptoms and it's going and it's really hard, that may be a different suggestion in the end. But I like that you're like, We're in this boat and then we travel over to this boat into this time, and then it's a matter of how we float that boat and how we get to our destination.Dr. Pinnock: Exactly.14:31 Preeclampsia Meagan: Would you say that the same thing goes for preeclampsia? Preeclampsia can develop at any stage of pregnancy. I mean, we've had clients in weeks 18-20 develop it and then have to be really closely watched and all of these things. Is that someone also where you would say the same thing? Where it's like, We're in this boat doing these things and these tests and monitoring, and then again we get into this next boat and we have to decide what the best route is?Dr. Pinnock: Yeah, no. That's a good question. I think it's similar but a little different with preeclampsia. It depends on the type of preeclampsia that's going on. Preeclampsia is a spectrum and with the part of the spectrum that's more on the severe side, we still try for a vaginal birth. It really depends on, as you've mentioned, how far along you are in the pregnancy.Maybe you are 28 weeks and you have such a severe form of preeclampsia that your doctor is like, “I don't think we can get any more time with the pregnancy,” that's a very different situation than someone who has a very non-severe form of preeclampsia at 39 weeks who wants to TOLAC and have all of those options available. It really does depend but the overall theme with preeclampsia if you do want to try for a vaginal birth and your health and baby's health are stable in the moment, then usually we do try as much as possible to have a vaginal birth. But things like very early gestational age and really severe complications of preeclampsia make the possibility of having a vaginal birth less likely. It makes the possibility of someone who wants to TOLAC in that setting less likely. It really depends on the severity of that spectrum of preeclampsia, but we always try for a vaginal birth if we can. Meagan: Yeah. This may be too hard of a question to answer, but can we talk about that range and the severity? What does a low to moderate to severe case of preeclampsia look like in a person? What would be considered that severe, “Hey, we might need to reconsider our birth desire here,” to “Hey, you have it. It's really low right now,” or to “We're in choppy waters right now.”17:19 Varying ranges of preeclampsiaDr. Pinnock: That's a good question. Pre-e is defined as elevated blood pressure in pregnancy after 20 weeks. So once you hit 20 weeks, if your blood pressures are elevated, 140/90 times multiple times and we see any evidence of preeclampsia's impact in some organs in your body.One of the most common things that we used to use to diagnose is the presence of protein in the urine. Once we see that, we're like, “Oh, man. I think you may have preeclampsia,” then we do an evaluation of the rest of the body to understand how severe it is. Preeclampsia is a disease that's thought to develop from the placenta when it implanted. It can cause dysfunction or impact on the organs. It can cause severe headaches. It can cause changes in your vision and problems with your blood cells, your liver, your lungs, and your kidneys. We go from head to toe and take a look at how those organs are being impacted by preeclampsia and then we ask you how you're doing. If you're having a headache, if you're having changes in your vision, pain in the belly, and all of that, it helps us to understand the severity. So depending on your symptoms, your blood work, and your blood pressures, those things together help us say, “Is this a severe form of preeclampsia?” and if it is, then we usually have some specific things that we have to do. Generally, you likely are monitored in the hospital. We keep a close eye on your blood pressure and your organs. That pregnancy is considered to be very high risk. Very high risk for a harm for mom, so risk of seizures, impact on the organs that can sometimes be lifelong and risk to baby. The highest risk to baby is that risk of being born early, so pre-term delivery. And usually if you have severe preeclampsia, we usually recommend delivery no later than 34 weeks. So once we do develop that severe form, we keep a close eye on things. If you have the non-severe form, so if your organs look oay and your blood pressures are stable but you have some protein in your urine and we do think you have preeclampsia but it's not severe, then we give you some more time. We still monitor you and baby very closely, but we can maybe try to get the pregnancy up until 37 weeks and after that, the risk of continuing the pregnancy and harm to maybe the mom and baby are a bit higher than some of the risks of being born at 37 weeks. So at that time is when we would say, “Let's have a birthday.” It really depends on those things. Meagan: Okay, that's so good to know. I think sometimes that also can vary like, I've got high blood pressure, but I don't have protein. Or I've got a trace of protein but I'm doing okay, I don't have any symptoms. But we also know with preeclampsia it is important to watch really closely no matter whether severe or not because it can turn quickly. Where you have zero signs and the next morning and you wake up with a headache and crazy swelling and you have that blurred vision with really high numbers. So it's just really important to watch.Dr. Pinnock: Exactly.20:46 HELLP SyndromeMeagan: I really do like to ask that question because a lot of people ask, do I have to have a C-section? Do I have to be induced? What does that mean? Am I severe or not severe? And we also note, we weren't even talking about this, but HELLP syndrome. So we can develop more, right? Preeclampsia affects more the mom, but then alsothe  baby timewise. HELLP syndrome is another really high-risk complication. What would you suggest for that when it comes to TOLAC because we have platelets being affected there? That one is a tricky, tricky one. Dr. Pinnock: I think HELLP syndrome is on that same spectrum of hypertensive disorders in pregnancy. But HELLP syndrome can be pretty life-threatening and dangerous for mom and by extension baby. So HELLP syndrome is when we find that your body's sort of hemolyzing so there are some things in your blood that's causing your blood vessels to sort of open red blood cells. We find also that you have elevated liver enzymes so your liver's being impacted pretty severely and then the platelets or the blood cells that help with clotting get really, really low. And so the combination of that with or without elevated blood pressures make us very concerned about HELLP. So the worry is if we don't deliver the baby pretty expeditiously and deliver the placenta which is thought to be really the source of the diagnosis, mom can get really ill and we really try to deliver as soon as possible. The exact way we deliver is really dependent on the specifics of what is going on. So maybe if your liver enzymes are very, very elevated and there's a high concern for mom's health and safety, your doctor may say, “I don't think we have time to try for a TOLAC, especially if you're not in labor. I think it would be too unsafe. I think I would recommend a C-section at this time because of that,” then that would be that recommendation. Sometimes we do try for a vaginal birth with HELLP, but it would be a case where we would want to limit how long we try but overall we try to deliver as fast as possible either vaginally or with a C-section. And if you do want to try for a TOLAC in that setting, I think my recommendation is to really, really be open to whatever is best for your health and your babys health. That's my advice for all women who are in labor. It's such an unpredictable experience and you can come in with your desires and your doctor can come in with their desires for you, and your baby or your health just dictates something else. And so with HELLP, that's an even more significant moment where if your body's telling us one thing, we have to listen. You may not be eligible for a TOLAC at that point. I think in more cases than not, many providers may not have that bandwidth or think it's safe to try for TOLAC in that setting. Meagan: Yeah. I've had very few clients as a doula who have had HELLP, but one of the clients– they actually both ended up having a Cesarean, but one of the clients' providers was even uncomfortable with even having an epidural and actually suggested general anesthesia. Is that a common thing if HELLP is super severe that could possibly be what's suggested or best?Dr. Pinnock: Yeah, no as I mentioned with that kind of diagnosis, you can have pretty low platelets. And so when we think about a procedure like an epidural or even a spinal, so any sort of neuraxial anesthesia where we're not putting mom to sleep, we're just numbing mom from the waist down, that requires insertion of a needle or a catheter in the back. That's near a lot of important structures so once you have that puncture, you're going to have some bleeding. And if those platelets aren't enough to sort of prevent that bleeding from extending, then our anesthesia team may not be comfortable doing that procedure safely because it's not safe. They may offer to give some platelets etc but often with HELLP, it may not be as fast acting and sometimes you may just hemolyze again. Those platelets may go back to being very low and if we are thinking about having a delivery urgently, delaying for that reason may not be safe for mom and baby. Oftentimes, if the platelets are too low, then our anesthesia colleagues, who are a very important part of the team, may recommend against trying for an epidural or even a spinal and recommend general anestheia.In my experience, I don't do C-sections under general anesthesia often, but when I do, it's usually recommended for a very, very significant reason and it's always with the safety of mom and baby in mind. It's never something that we want to do. It's only something that we do if we have to do for mom's safety or for baby's safety. Meagan: Yeah. So good to know. And they actually ended up doing a platelet transfusion as well specifically for the Cesarean. Obviously, we know blood loss is a thing that's a big surgery so they were trying to help her there. 26:36 Other High-risk situationsMeagan: Okay, well are there any other high-risk scenarios where you feel like truly impact the ability to have a TOLAC offered?Dr. Pinnock: Yeah. I think the highest risk conditions that could prevent mom from having a TOLAC are probably conditions related to the heart or lungs where the physiology or the changes that happen in labor can make it so that a vaginal birth is not safe or recommended for mom or baby. A TOLAC in those high-risk settings is often not recommended. There are a lot of cardiac and lung conditions that we take care of. There are not that many that we would say you can't have a vaginal birth, but sometimes there are blood vessels in the heart that can be dilated or blood vessels near the heart that can be dilated that we may say, “No, you definitely need a C-section,” so if you wanted to TOLAC we wouldn't recommend that. Those are probably the highest-risk conditions that I take care of and where a TOLAC is not recommended or even offered because it's just not considered to be safe. 27:54 Gestational DiabetesMeagan: Okay that's so good to know. Okay, let's jump in a little bit to gestational diabetes. We can have both managed and not managed. Do you have any advice for listeners who may have gestational diabetes or maybe had gestational diabetes last time and they're preparing to become pregnant or wanting to learn more about how to avoid it if possible or anything like that? Do you have any suggestions to the listeners?Dr. Pinnock: Yeah, that is one of my favorite things. I really believe that just paying close attention to your health and taking steps before pregnancy can make a world of a difference in your risk of developing certain conditions. Gestational diabetes is one of those conditions that can be definitely most susceptible to things that we can do before pregnancy. And so I know that this is going to maybe sound like a broken record to those who had gestational diabetes before, but just look at your lifestyle factors. I think that the most undervalued or underestimated intervention is really exercise. It doesn't have to be your training for an Iron Man or a marathon. It could just be like a 20-minute walk every day or a ten-minute job every day and work your way up. We definitely found that aerobic exercise more days of the week than not, and resistance training, it could be with resistant bands, if you have any sort of light weights or even body weight. Any resistance training to help build up that muscle mass can help to reduce your risk of getting gestational diabetes. If you couple that with adjusting your diet, and diet is such a big topic but essentially no matter what your background is, focusing on the whole foods of your cultural background is best. So low processed foods, more homecooked meals with whole grains, fruits, vegetables, fish, and limitations of red meat and processed foods. All of those things can go a long way with preventing gestational diabetes and also reducing the recurrence of gestational diabetes. I'm really passionate about that. Meagan: Yeah, us too. I didn't have gestational diabetes, I had kidney stones weirdly enough because my body metabolizes nutrients differently during pregnancy and anyway, it's totally not gestational diabetes but I had to look at my pregnancies and before as something like that. Really dialing in on nutrition. Really dialing in on my exercise. And I couldn't agree more with you that it doesn't have to be this big overwhelming Iron Man training or running a marathon. It really can be a casual 20, 30-minute stroll around the neighborhood walking the dog or whatever and dialing in on those whole foods. We love the book Real Food for Gestational Diabetes by Lily Nichols. If you haven't ever heard of that, it's amazing. It's a really great one. You might love it. And I definitely suggest that to all of my clients. She even has one for Real Food During Pregnancy. Just eating good food and then we love Needed because we know that getting our protein and getting the nutrients that wer eally need can really help like you said recurring and current and just avoiding hopefully. So we really love that topic, too. But gestational diabetes doesn't just nix the opportunity to TOLAC, correct?Dr. Pinnock: No, it doesn't. Gestational diabetes can be a really tough diagnosis for a lot of women to get in pregnancy. It can be really disappointing especially if you may be a relatively healthy, active person and you don't have a lot of risk factors for developing gestational diabetes. It can kind of feel like a gut punch almost. Meagan: Yeah! And it's very overwhelming because you're like, What? No! Dr. Pinnock: It is! And it happens fast. You're diagnosed and then you have a flurry of things that you have to now do and change and think about. It can be very stressful. But I always tell my patients that there are things that put some people at risk of developing gestational diabetes more than others, but all women because of those placenta hormones can have insulin resistance or your body's just not responding as well to the insulin that you're making. Depending on those risk factors, some women develop it. Some women don't. And once you do develop gestational diabetes, it's something that we really pay attention to because it can increase the risk of things for moms so particularly it can increase the risk of mom developing preeclampsia and it can increase the risk of things for baby. Babies can be on the bigger side or have macrosomia if the blood sugars are too high. They can actually have a higher risk of having a birth injury if we're having a vaginal birth or mom may actually have a higher risk of needing a C-section if you're trying to TOLAC and baby's on the bigger side. Rarely, and this is sort of the thing we worry about the most, is that if those blood sugars are too high for too long, baby can be in distress on the inside and it can increase the risk of having a stillbirth or having baby pass away. So because of those things, once we diagnose it, we do pay attention to it and we try our best to sort of make those changes hopefully with diet and exercise to sort of manage the blood sugars. If we're having perfect blood sugars with those changes, then wonderful. If we're not, and it happens and you need some additional support then your doctor provider may recommend some other management options like medications to help to bring the blood sugars down. But I think, when we think about TOLAC, we want to think about separately managing the pregnancy, keeping mom and baby safe, and then thinking about the safety of delivery. So as long as the baby's size isn't too big, as long as mom and baby are healthy and safe, you can definitely try for TOLAC with gestational diabetes. But those two things are big “buts”. You really want to try your best to manage your blood sugars so baby's size doesn't work against your efforts of trying to have a TOLAC.35:00 Inductions with gestational diabetesMeagan: Yeah, we know that the size can definitely impact providers' suggestions or comfortablity to offer TOLAC. And we know big babies come out all of the time, but we know sometimes there's some more risk like you were saying. So can we talk to the point of inductions?So a lot of providers will, and you kind of touched on it. There can be an increased risk of stillbirth. But a lot of providers seem to be suggesting that induction happens at 39 weeks. Some of the evidence shows that in a controlled situation, meaning all of the sugars are controlled, but what do you see and what do you suggest when someone is wanting a TOLAC, has gestational diabetes, may have a baby measuring larger or may have a provider who is uncomfortable with induction which we see all the time? Any suggestion there and what do you guys do over in your place of work?Dr. Pinnock: Yeah, that's a great question and it's something that I individualize to every patient. So let's think about it in two different buckets or three different buckets. Say you have gestational diabetes that's pretty well controlled with just diet. So with diet and exercise, your numbers are pristine. Baby is a good size, we're not over that 4500-gram mark where we start to say, “Is it really safe to try for a vaginal birth?” and that's okay. If we are in that boat, then I think it's reasonable to allow for mom to go into labor and try for TOLAC if that's their desire. The exact gestational age at which someone goes into labor varies. We don't have a crystal ball. We don't know. Meagan: Nope.Dr. Pinnock: We do have to balance waiting for that labor process with the inherent risk of babies being less happy and distressed and the risk for a stillbirth as the pregnancy progresses. Now, if you have gestational diabetes that's well controlled with diet, we think from the studies that we have that our risk of stillbirth is similar to someone who does not have gestational diabetes which is good. And so for those pregnancies, depending on your specific location and provider, we may do some monitoring with non-stress tests or something like that later in the pregnancy until you deliver. Usually, we start at around 36 weeks or so if you're well-controlled with just the diet and allow you time for your body to go into labor and have a vaginal birth. Now, if we get to your due date and nothing, baby is still comfortable inside. They're like, Oh no. I'm just hanging out, we start to think, How long are we going to allow this to go on? At that length of time, we start thinking about, Okay. We're at 40 weeks. What are the risks to mom and baby? And so at 40 weeks, we're about a week past 39, and we know that the risk of– if things are perfect for anyone, the risk of having babies be in distress, maybe the placenta's just been working for a long time and isn't just working as well and the risk of stillbirth goes up, we don't want to go to 42 weeks. So I think at that moment, it's a good time to think of an exit strategy. If your baby is just so comfy on the inside, think about, when I would say is an upper limit of reasonablility to wait for labor? That varies depending on the person and provider. But I think reasonably, up until 41 weeks. I wouldn't go past that. If we're allowing our body to go into labor up until 41 weeks, then we have to think about, How does that impact my risk of having a successful TOLAC? After 40 weeks, some of our studies suggest that you may be at a higher risk of having a failed TOLAC or needing a C-section and that's regardless of whether you're induced or whether you go into labor. TOLAC-ing does carry that inherent risk so it's really just dependent on your doctor, you,  your provider, and balancing all of those things. I think going until 41 weeks is probably the maximum limit for a well-controlled gestational diabetes with perfect sugars, no medications, and we're still doing monitoring to make sure that baby is doing well.Now, if you're in the camp where you're either gestational diabetes, or even controlled with diet, or if your gestational diabetes is controlled with medication or if you're diet-controlled, but those sugars aren't great, any scenario where the sugars aren't perfect and we need either medications or your sugars aren't perfect, I don't generally go past 39 weeks.The reason being at 39 weeks, baby is fully developed and after that, the risk of having a  pregnancy loss goes up because of that uncontrolled or not optimally controlled gestational diabetes. I think at that gestational age you would want to think about maybe an induction or maybe a repeat C-section depending on how you're feeling if your body isn't going into labor. And that's a personal decision. Now, if you have gestational diabetes managed with medication and your baby is big and maybe let's say over 4500 grams which is sort of that range where we worry about the safety of a vaginal birth. And you're now going into labor, then that becomes a little bit more of a shared decision-making where you want to think of, My baby's big. I would need to be induced. Is this going to be something I want to commit to or is it something I don't want to commit to? That's a personal choice but I think at that gestational age I would say I wouldn't want anymore. ACOG though does recommend or does allow for moms who do have gestational diabetes well controlled with medication, like if your blood sugars are perfect with the medication to go until 39 weeks and 6 days. So technically you can use those extra few days, according to our governing board or the American College of OBGYN. But it's going to really come down to you and the relationship you have with your doctor and what you both are comfortable with. Maybe you have a provider that is open to that recommendation or a provider whose more open or comfortable to a 39-week delivery regardless of how well your blood sugars are controlled once you're on medication. But ACOG does give us that wiggle room to say we can go further. 42:25 FibroidsMeagan: So good to know. Okay, let's see. Is there anything else we would like to talk about high-risk-wise? I know I had mentioned one time about fibroids and heart-shaped uterus. Do you have anything to share on those two topics, because those are also common questions? Can I TOLAC with fibroids? Can I TOLAC if I have a heart-shaped uterus? Where does that land as VBAC-hopeful moms?Dr. Pinnock: Yeah, no. I think those are some great things to consider. So I think we can open with the fibroids. I think if you've have had fibroids and you've had that fibroid removed, so you've had a myomectomy, there are a handful of things where we usually say, “No, we don't want you to TOLAC.” One of them is if you've had a previous uterine rupture or that previous Cesarean scar opened in a previous delivery, that's an absolute no. The risk is too high. We don't think it's safe. The other is if you've had a previous surgery where that surgery included the fundus or the top of the uterus where those contractile muscles are. Usually, with a myomectomy or fibroid removal, that involves that area. If you've had a fibroid removed in that area or you've had a myomectomy, a TOLAC is not recommended. So those are sort of one of the few things or few times where we say, “Absolutely, no.” If you have a fibroid and maybe you just discovered you had it during pregnancy, most of the time fibroids don't cause any problems. They're benign growths of the muscle of the uterus that can vary in size. So generally if they're small to medium size and depending on their location they may not cause any problems. If they do cause a problem, the most common thing women experience is pain. But usually if they're not too big and they're not in a location where we're concerned about, it should not really your ability to TOLAC. Now if the fibroid is like 10 centimeters and located near the lower uterine segment or the part of the uterus where the baby transports through to come out through the vagina, then we're going to take a pause and say, “Is this going to be a successful TOLAC?” Is the fibroid going to compete too much with the baby's head for baby to come down safely and should we just think about doing a C-section? And a C-section in that event is also not straightforward or a walk in the park because either way, the fibroid is present near where we would use to deliver the baby. So short answer is that yes, you can TOLAC with a fibroid. But the long answer is that it really depends on how big the fibroid is, where it's located and whether we think it's going to obstruct that area where baby's going to come from. If it's not, then it's reasonable to try and many women have TOLAC'd with fibroids all the time. So it's definitely not a reason to say, “No, you definitely can't.” If you've had the fibroid removed though, then it's a no. That's just one thing to talk about if you're considering that procedure and you have an opportunity to talk with the provider who is offering that procedure, just knowing that after that for most surgeries that remove the fibroids you won't be able to try for a vaginal birth. 46:33 Do fibroids tend to grow during pregnancy? Meagan: Good to know. Good to know. And is it common for fibroids to grow during pregnancy? Does pregnancy stem them to grow? Or does that impede them because you've got a baby growing in there and the focus is on growing a human and not growing a fibroid?Dr. Pinnock: No, that's a good question. Interestingly enough, we see about a split group so about a third of them stay the same. They don't change in size. A third of them shrink and a third of them grow. Meagan: Oh wow.Dr. Pinnock: We don't know which third it will be. Two-thirds of them either get smaller or stay the same size. But there are women who experience growth of the fibroid and it's actually due to those hormones estrogen, progesterone, and all of those hormones being released by the placenta. It stimulates the fibroid to grow and that's actually when some women experience pain. The fibroid grows. It outgrows its blood supply and then it degenerates or dies off a little bit and it causes this pretty significant pain for some women, but interestingly it's not 100%. A lot of people don't have many symptoms and don't have any pain. When I monitor fibroids, a lot of them don't change in size. Some of them get smaller and sometimes I'm not able to see them later on because they're so small. But there is that percentage who experience the growth of their fibroid and that's usually when pain is experienced from them. Meagan: Okay. And you mentioned that they could. I mean, 10 centimeters is a pretty large fibroid but it can happen, right?Dr. Pinnock: I've seen it. Meagan: Yeah, so it can happen. You said it can compete with baby coming down. Can fibroids also inhibit dilation at all? Can it impact dilation at all?Dr. Pinnock: Absolutely. Some of the things that we see or that we worry about if there's a large fibroid present is other than impacting the area where baby can come through, it can cause dysfunctional labors. So those muscles that are contracting in a uniform way aren't going to be able to contract as uniformly as they would have if the fibroid wasn't there. So sometimes the labor can stall. The cervix isn't dilated as much. Even sometimes we see that fibroid causing babies to actually present head down and so that's also something that we can see with very large fibroids. It can actually increase the risk of baby being breech or transverse or malpresenting in general. Meagan: interesting. And you said that sometimes there aren't even any symptoms at all, so how would one find out if they do? Is that just usually found at 20-week ultrasound? Or is it possible that at 20 weeks you had it but it's so minute and it's so small, that you can't even see it? And then in labor we have some of these symptoms or whatever and it's there but we don't know?Dr. Pinnock: Not usually. Most women, if they didn't know they had a fibroid before pregnancy, get diagnosed in pregnancy at an ultrasound. Either a first trimester or 20-week ultrasound, we look at the uterus in detail and we can pick up fibroids. We are hopefully not going to have a 10-centimeter fibroid present at 10 weeks that's missed that's just going to magically present at 39 weeks and be a surprise. Usually the fibroid, if it's there, is picked up on an ultrasound. That's the most common way it's picked up. Depending on the size, it may be a reason why your doctor or provider recommends for you to have ultrasounds in the pregnancy. Sometimes we monitor the fibroids. We monitor their locations, the size of them, and we make sure that they're not too big to be causing a problem. Rarely if they grow, they don't usually grow from like 3 centimeters to 10 centimeters. They may grow a centimeter or two. It's very unusual to have that big change. And so for the most part, it's picked up on ultrasound. We know the size of it. If it grows, it grows a small amount. It's not going to grow from 5 to 10, and we're going to know the location of it from that first time we evaluate it. It's not going to be a surprise moment at delivery where we're like, Oh my goodness, this wasn't picked up.51:20 Bicornuate UterusMeagan: Okay, good to know. Good to know. Okay and last but not least, I know we're running short on time and I want to make sure we respect that. Any information you have on a heart-shaped uterus? Is TOLAC possible with heart shaped uterus? Have you seen it? Have you done it?Dr. Pinnock: I have not seen it or done it to be honest. I do think a heart-shaped uterus just so we're using the same language that's considered a bicornuate uterus, is that–?Meagan: Yes, a bicornuate uterus.Dr. Pinnock: So for a bicornuate uterus or any kind of situations where the uterus developed differently, interestingly the uterus develops from two different stuctures. It develops from something called the Mullerian Duct and early in development when you are a tiny, tiny baby, those two structures fuse and when they fuse, they come side by side first, and then they fuse. When they fuse there, is a little wall in the middle that gets removed and so when all of that is done you have uterus that is shaped as we know it and we have that cavity on the inside where the baby would come in and grow. Now with a heart-shaped uterus, or a bicornuate uterus, there is an error when those structures come together side-by-side. So sometimes they just stay side-by-side and they don't fuse as well or sometimes they fuse but only fuse partially. So you have the uterus that as we know it, but sometimes you can have two separate structures. So two separate cavities where the prgenancy can grow, or you can have one cavity where there is still some tissue right in the middle there. It can vary depending on the suffix of how that fusion happened. Essentially, if there's less space in the cavity either from that tissue or having two separate but smaller cavities, there's presumably less space there for baby to grow. There's less contractile strength on that one side and so it can theoretically increase the risk of certain things happening in labor. I think the things that we see most commonly with bicornuate uteruses, it can have a higher risk of having a pregnancy loss, so a miscarriage. High risk of baby being born early because that area is just smaller so it's not as strong in holding the pregnancy. And similarly, baby can also be malpresented more commonly because the are is much smaller than a full uterine cavity.Meagan: That's what we see a lot is breech. Dr. Pinnock: Exactly. I haven't seen too many cases. It's a rare thing to see. I haven't seen too many cases where baby's head-down and we're at full-term and wanting a TOLAC. A lot of cases I've had, baby is breech or malpresenting so we end up doing a C-section. The shape of the uterus is not going to change for the next pregnancy so chances are the baby's usually malpresenting. I don't think we have any big databases or big data to say is it safe? Is it not safe to TOLAC? I think the main thing you'd be concerned about it that spontaneous uterine rupture if there is labor going on even if you haven't had a C-section and also if you've had a C-section before. So I think a TOLAC would be a little bit of an unknown for this situation. I would think on it pretty heavily and talk with your doctor about the specifics of your situation. If your previous C-section because baby was breech, chances are baby's not going to be presenting head down because of the shape of the uterus. It tends to have things that recur as to reasons for having a C-section. So we don't have any large databases where we have women who have TOLAC'd with this condition, so hard to say. So maybe give it a try, but maybe thing long on this one. Meagan: Case by case, it all comes down to case by case.Dr. Pinnock: Yes. That's pretty much what I do. Anything in pregnancy that's a little bit more nuanced and any high-risk condition, it's very individualized. And we have to really have that approach with high-risk pregnancies or anything that comes up that makes your pregnancy higher risk of having anything happen to mom and baby for sure. Meagan: Right. Oh my goodness. Well, I love this episode so much and cannot wait to hear what people think about it. I'm sure they're going to love it just like I do. I know I mentioned at the beginning of your podcast and things like that, but can you tell us more? Tell us more about the ZerotoFour podcast and where people can find you. I know you have YouTube and all the things, so tell us where listeners can follow you.Dr. Pinnock: Yeah. You can find me on Instagram @drchristinapinnock, the ZerotoFour Podcast so the zerotofourpodcast.com where I share the episodes with new moms about pregnancy. I really started the podcast with the goal of helping moms to be more informed and comfortable about everything along their pregnancy journey. I share topics from the whole spectrum of that journey to help you feel more prepared and informed and empowered about your pregnancy experience. You can find episodes there, on Apple Podcasts, Spotify, or anywhere that you listen to podcasts.Meagan: Awesome. So important. This is a VBAC-specific topic, but I mean those first-time moms, we have to learn. We have to learn all the things because there is really so much. We just talked about a little nugget of a couple of high-risk situations and there's just so much out there that can happen. It's so good to know as much as you can. Get informed. Learn all the things. Follow your podcast. I definitely suggest it. We'll have all the links in the show notes and thank you for joining us today. Dr. Pinnock: Thank you so much for having me. It's been a pleasure. 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.Our Sponsors:* Check out Dr. Mom Butt Balm: drmombuttbalm.comSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

In dieser Folge erzählt Evelyn von den zwei Geburten ihrer drei Kinder. *** Die Shownotes findest du hier. Hier geht es zum Geburtsgeschichten Newsletter. Unterstütze den Podcast auf buymeacoffee.com/geburt Folge direkt herunterladen

It can be difficult to find VBAC support with gestational diabetes and most who are supportive of VBAC highly recommend a 39-week induction. Heidi's first pregnancy/birth included gestational diabetes with daily insulin injections, a 39-week induction, Penicillin during labor for GBS, pushing for five hours, and a C-section for arrest of descent due to OP presentation. Heidi wasn't sure if she wanted to go through another birth after her first traumatic experience, but she found a very supportive practice that made her feel safe to go for it again. Though many practices would have risked her out of going for a VBAC due to her age and subsequent gestational diabetes diagnosis, her new practice was so reassuring, calm, and supportive of how Heidi wanted to birth. Heidi knew she wanted to go into spontaneous labor and try for an unmedicated VBAC. With the safety and support of her team, she was able to do just that. At just over 40 weeks, Heidi went into labor spontaneously and labored beautifully. Instead of pushing for over five hours, Heidi only pushed for 30 minutes! It was exactly the dreamy birth she hoped it would be. ThrombocytopeniaReal Food for Gestational Diabetes by Lily NicholsInformed Pregnancy Plus Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 05:50 Review of the Week08:04 Heidi's first pregnancy with gestational diabetes12:05 Taking insulin18:08 39-week induction 20:59 Pushing 24:29 Arrest of descent and opting for a C-section27:06 Researching providers before second pregnancy38:04 Discussions around induction41:45 NSTs twice a week47:10 Testing for preeclampsia54:53 Spontaneous labor57:43 Going to the hospital1:02:03 Laboring in the tub1:06:22 Pushing for 30 minutesMeagan: Hello, Women of Strength. It is Meagan and we have a friend from New Hampshire. Her name is Heidi. Hello, how are you? Heidi: I'm doing great. How are you?Meagan: I am so great. I'm excited to record this story today because there are so many times in The VBAC Link Community on Facebook where we see people commenting about gestational diabetes and for a really long time on the podcast, we didn't have any stories about gestational diabetes. Just recently, this year really, we've had some gestational diabetes stories. I just love it because I think a lot of the time in the system, there is doubt placed with the ability to give birth with gestational diabetes or there is the whole will induce or won't induce type thing, and with gestational diabetes, you have to have a baby by 39 weeks if they won't induce you and it just goes. So I love hearing these stories and Heidi's story today– she actually had gestational diabetes with both so with her C-section and with her VBAC. It was controlled. It was amazing. That's another thing that I love hearing is that it is possible to control. We love Lily Nichols and the book about gestational diabetes and pregnancy. We will make sure to have it in the link, but it is so good to know that it doesn't have to be a big, overwhelming thing. It can be controlled and it doesn't have to be too crazy. Right? Did you find that along the way? Heidi: Yes. Yes, definitely. The first one was pretty scary, but then the second one, you know what you are doing and you can control it and you can keep advocating for yourself. Meagan: Absolutely. And then in addition to gestational diabetes, she had advanced maternal age barely with her second, but that is something that also gets thrown out. A lot of the time, we have providers saying, “We shouldn't have a vaginal birth. We should have a C-section by this time,” so that's another thing. If you are an advanced-maternal-age mama, listen up because here is another story for you as well. We don't have a lot of those on the podcast. We are so excited to welcome Heidi to the show. 05:50 Review of the WeekMeagan: Of course, we are going to do a Review of the Week and then we will dive right in. This was from stephaniet and it says, “Inspiring and Educational.” It says, “As a mother currently in her third trimester preparing for a VBAC, I was so happy to find this podcast. The stories shared are so encouraging and it is so comforting to know that I am not alone in feeling that once a Cesarean, always a Cesarean.” 100%. That is 100% true. You are not alone here. And once a Cesarean is not always a Cesarean. It says, “This does not have to be my story. Thanks, Meagan and Julie, for providing the support and education to women who are fighting for a chance to have a natural childbirth. I would love to encourage anyone wanting to learn more about VBAC to listen to this podcast.” Thank you, stephaniet. This was quite a few years ago, actually. This was in 2019. We still have some reviews in 2019 that weren't read. It's 2024, so that's really awesome and as usual, if you have a moment, we would love your reviews. Your reviews truly are what help more Women of Strength find these stories. We want these stories to be heard so leave us a review if you can on Apple Podcasts and Google. You can email us a review or whatever, but definitely if you listen to the podcast on a platform, leave a review and that would help. 08:04 Heidi's first pregnancy with gestational diabetesMeagan: All right, Ms. Heidi. Welcome to the show and thank you for being with us. Heidi: Thanks for having me. This is awesome. Meagan: Well, let's talk about it. Share your story with us with your C-section. Heidi: Yeah. We were planning for a child and we just decided. We were like, “Okay. Let's shoot for an April birthdate.” We just thought that we could just have a child, but we got lucky and we did on the first try. Meagan: Amazing. Heidi: We went to our local hospital that was about five minutes away for care and it just seemed good enough. At the time, I thought you just go to the hospital. You get care. You can trust the provider and you don't really need to do anything other than a hospital birth class for prepping. We just went along that journey. They assured me, “This will be a normal pregnancy. Everything is great.” The pregnancy was uneventful until about 20 weeks when I found out my baby was missing a kidney during a routine ultrasound. That sent us down Google rabbit holes and all kinds of fun things. Meagan: I'm sure, yeah. Heidi: Yeah. So at that point, we were assigned a Maternal-fetal medicine OB. I was offered an amniocentesis if we wanted to check and see what else was wrong and things like that. That was a major curveball. Meagan: Did you end up participating in the amnio? Heidi: No, we didn't. We had a couple of detailed ultrasounds after that. At first, they didn't actually tell me what they were looking for. I had three ultrasounds in a row that were not the more detailed ones. Meagan: Oh, okay. Heidi: I was like, “Why am I having all of these ultrasounds? Nobody is saying anything.” I finally got a phone call telling me that my daughter was missing a kidney so that's what they were looking for. I was like, “Okay. Good to know.” Meagan: Yeah. You would have thought some communication before then would have happened though. Heidi: Yeah. It was pretty scary. So what seemed pretty uneventful–Meagan: Got eventful. Heidi: Yeah, it did. So right around 28-30 weeks when they do the gestational diabetes check, I went in for my check and found that I would need to start tracking my blood sugar and diabetes does tend to kind of run in my family even though everybody is very healthy. I was wondering if it would come up and also being older, sometimes they say there is a link but it still took me by surprise because I'm a very active person and I eat really healthy. I felt like a failure basically. Meagan: I'm so sorry Heidi: Yeah. All of a sudden, I'm meeting with a nutritionist. They give me this whole package of a finger pricker. Yeah, exactly. All of a sudden, I'm submitting logs four times a day checking blood sugar, and the fasting numbers for me just weren't coming down so it was about one week of that, and then all of a sudden, they were saying, “Okay. You probably need insulin.” 12:05 Taking insulinHeidi: It came on so fast, so strong. Meagan: Wow. Heidi: It was really scary so then I found myself going to the pharmacy. I am a very healthy person so it was just all really weird going to the pharmacy buying insulin and learning all about insulin and learning almost how little the medical field understands about gestational diabetes. That was something bouncing in my head bouncing off the wall trying to understand the plan there. Meagan: Yeah. Heidi: Yeah, so after that, then I got phone calls from the nurses. They said, “You know, now you are on insulin. Now, you are going to have twice weekly NSTs required at 35 weeks.” I'm thinking, “Well, I'm working full time. How am I going to do all of this?” There is just so much sick time and it was really, really difficult to hear all of that. Meagan: Yeah. How do I have time for all of that? Plus just being pregnant. Heidi: Yeah. Yeah. Insulin and just for anyone that doesn't know, basically you inject yourself. I was injecting myself every night with an insulin pen and it was all just very weird because you're also thinking, “Well, I'm pregnant. I've never been on this medication. What is it going to do to me? What is it doing to my baby?” Very nervewracking. It's all normal to feel that way. Meagan: Yeah. I think sometimes when we get these diagnoses, we want to either recluse because it's so overwhelming, and sometimes then, our numbers can get a little wonky, or we dive in so much that it consumes us and we forget that we are still human and we don't have to do that. Heidi: Yeah. Now that you say that, I definitely did a little bit of both. Meagan: Did you? Heidi: I did a little bit of denial and then I did a little bit of obsessive researching. Meagan: Yeah, because you want to know. You want to be informed and that's super good, but sometimes it can control us. Heidi: Yes. Absolutely. You're watching every single thing that goes into your body. I probably didn't look at food normally until my second pregnancy to be honest with you. Meagan: Really? Heidi: Yeah. Meagan: Yeah. Yeah. So it was working. Things were being managed. Heidi: Yes. I was honestly very grateful for the insulin. Obviously, it took a little while to feel that way, but it was very well-managed. My numbers were right in range. My blood sugars were always normal throughout the day. I never had to do anything during the day. I just checked my blood sugars. Then the other thing that came as an alarm, they told me about the NSTs which are non-stress tests. They also mentioned that I would need an induction in the 39th week because–Meagan: 39 to be suggested, I should say. Heidi: Yeah. It wasn't explained to me that with that provider, it was a choice. It wasn't a suggestion. It was like, “You have to do this or you might have a stillbirth.” It was really scary. Meagan: Oh. Heidi: I didn't know I had a choice. Being a first-time mom and not knowing about evidence-based birth, this podcast, or all of it. I had no idea. So I was told I could schedule it anytime after my 36th week and for every appointment that I had as I started getting closer, I felt a lot of pressure from the providers to schedule the induction. They cited the ARRIVE trial. Meagan: Yes. Another thing I roll my eyes at. I don't hate all things. I just don't like when people call people old and when they tell people they have to do something because of a trial that really wasn't that great. But, okay. Heidi: Yep. Yeah. I mean, they didn't explain the details of it either. They just said, “Oh, it's the ARRIVE trial,” so I go and Google and try to make sense of it. They just say, “Stillbirth risk increases.” They say, “If you are induced at the 39th week, there is no increase and chance of a C-section,” so I thought, “Oh, okay. Sure.” Meagan: Right. Right, yeah. Heidi: I finally gave in near the end and I scheduled my induction for the 39th week and 6th day. Meagan: Okay, so almost 41. Heidi: Yep. So then I worked right up to the night before my induction. I was admitted to the hospital at 7:00 AM. I was planning for an unmedicated, uncomplicated delivery and an induction using a Cook balloon because my provider had checked me in the office the day before and they found that I was 1 centimeter dilated so they said they could probably get the balloon. I'm thinking, “Oh, it's going to be a mechanical induction. There's going to be no IV. It's going to be really as natural as possible.” 18:08 39-week induction Heidi: I get into triage and immediately, they start putting an IV in my right arm. I am right-handed. Meagan: Why do they do that? If you are listening and you are getting an IV, don't hesitate to say, “Hey, that's my dominant hand. Can we put it in the other one?” Also, don't hesitate to say, “Don't put it in my wrist where I'm going to try and be bending and breastfeeding a baby in the end. Put it in the hand or put it up in the arm.” Heidi: That's really good advice. I didn't know that the first time. Meagan: I didn't either. Heidi: I knew enough to say, “Whoa, whoa, whoa. Put it in my left hand.” They ended up putting it in my forearm. So here I am. I was hooked up to Penicillin. I was GBS positive. I feel like I had all of the things. Meagan: Yes. We've got gestational diabetes, GBS, maternal age, and now we've got an induction. Heidi: Yeah. Oh yeah. So yeah. They put in Penicillin, Pitocin, and saline, and then they showed me how to move around while wheeling an IV pole. Meagan: Mmm, yeah. Fun.Heidi: Yeah. We felt a little gutted at that point. We are in the hospital and sorry, when I say we, it's my husband and I. Yeah. The midwife had trouble getting the Cook balloon in. We just sat around on Pitocin that first day. The OB finally got it in around 10:00 PM that night. It was her first visit to see us actually. She probably could have gotten it in earlier had she come earlier. It sped up the labor overnight as soon as the Cook balloon went in. It was a bit painful. They stopped the Pitocin the next morning. My water broke on its own. They were talking about coming in to break my water and I think my body probably heard them, so it broke on its own. Yeah. I was just laying in the bed and it happened. Then labor began to pick up, but the contractions were still not regular. Pitocin was increased and then the contractions got really intense, but still irregular until around 4:00 PM that day at which point, I just couldn't take it. I asked for the epidural. Meagan: That's a lot. That's a lot. Heidi: Yeah. It was intense. 20:59 Pushing Heidi: The shift changed and a new nurse had a student with her. So I consented to the student being there thinking, “Oh yeah. Come on. Come observe my awesome labor. This is going to be amazing. It's going to be a vaginal delivery and everything,” so I'm like, “Yeah, sure. Let them learn.” I achieved 10 centimeters dilation and full effacement around 9:00 PM that night so it was really exciting. Meagan: That's actually pretty fast. 10:00 is when the Cook was planned the night before. 9:00 PM, so hey, that's pretty good. Heidi: Yeah. I was happy about that. I was so excited to push. I couldn't feel a lot because I was on the epidural, but it really took the pain away and it helped a lot in the moment. So let's see, I was mostly on my back. I was tired. I was just really tired at this point. There was, the nurse that I had was pretty new. She had been there for I think 6 months and then she was also trying to juggle the student nurse. She didn't have a lot of knowledge of positioning. I thought going into it that all nurses were trained in Spinning Babies and all nurses had the knowledge of baby positioning and things like that, but I was wrong. Meagan: Yeah, unfortunately, they are not all. I don't think a lot of them have it actually. Most of them don't. Heidi: Yeah. I pushed mostly on my back and when the OB came in around 11:00, she noticed my pushing was not effective at 11:00 PM. Meagan: So two hours in. Heidi: Yes. My position needed to be changed. She got me up on the squat bar and then she left again, but she showed me how to push and everything in the meantime. When she came back in, she explained to me that I would probably need a C-section soon. I don't exactly remember that sequence of events because it is so intense. I felt really defeated. I was like, “I just started. What do you mean I will probably need a C-section?” Meagan: So you were still wanting to keep going?Heidi: Oh yeah. Oh yeah. She also explained that meconium started to show in the amniotic fluid. The OB explained to me that the baby was probably in distress because of that. That was all that was said. Heidi: I spiked a fever. They gave me Tylenol and then the baby's heart rate began to slow a little bit, just for a little bit. The OB inserted a monitor on the top of her head. At this point, I felt like I was pushing for my life. I was like, “Oh my gosh. I need to get this baby out. How do I do this?” But I still felt like, “I can do this. I can do this. I know I can do this.” Meagan: Yeah. Heidi: But there were definitely questions at this point. 24:29 Arrest of descent and opting for a C-sectionHeidi: Yeah, so then around 2:30 in the morning, I was told by the OB to get on all fours and try one last position and I could opt for a C-section at that point or I could push until the OB came back in. I was like, “You know what? I'm going to give it all I have. I'm going to work so hard and the baby is going to come out in the next 45 minutes. She's got to.” So I did. Honestly, I was so grateful that I had that last 45 minutes. I feel like if I didn't, it would have been stolen from me. I feel I was defeated when she came back in because she was still not out and I was exhausted, but I was ready. The baby was not going to come out any other way at this point for whatever reason. That was going to be dissected months later, years later by me, but in the moment, yeah. She was at station 0. I was told she wasn't far enough down to do an assisted delivery, so they wheeled me into the OR for the C-section. I requested that the baby have skin-to-skin as well as delayed cord clamping. Unfortunately, none of this happened and I guess I should also note that once they put the monitor on her head, she did great. She still was not in distress. I was doing great too. The C-section was just really for arrest of descent. They just thought it was taking too long because I had been pushing for a little over 5 hours at that point. Meagan: Yeah. Heidi: Yeah. She was born via C-section at 3:20 in the morning. She weighed 7 pounds, 1 ounce and she was in the OP position. Meagan: I was just going to say, was there a positional issue here? I always wonder when there's patterns like yours where I'm like, “That sounds like a positional thing.” Okay, so OP. Occiput posterior for anyone who is listening or sunny-side up. Baby just needed rotation. Heidi: Yeah. Yeah. Yeah. That was that. Meagan: Yeah. So then did you end up when you got pregnant, did you end up staying with this provider? How did that journey begin? 27:06 Researching providers before second pregnancyHeidi: I went back– let's see. I'm trying to think. I went back for routine care almost a year later. I had care in between, but I had wanted to see that provider just to have closure. I asked her. At the time, I wasn't really sure that I wanted another child. My husband and I were just really thinking, “Is that what recovery is always like?” After the C-section, it was really hard. I asked her, “If I were to have another child, what would be my odds of delivering vaginally? Could I have another child that way instead of the C-section?” She said, “You probably would end up with another C-section if you even tried so you probably have about a 40% chance.” It was not based on anything. Meagan: Hmm. So she didn't even do the calculator, just gave you a percentage. Heidi: No. Just gave me a percentage. Meagan: Oh dear, okay. Heidi: So at the end of that appointment, again, I still had not really educated myself and knew that there were amazing resources out there, so I just said, “Okay. If I have another child, I'll have to have another C-section.” I went home and told my husband. I said, “If we have another child, we're going to have to have a C-section.” We were both like, “Okay, maybe we won't have another child.” Yeah, so then another year passed. We were beginning to get ready and slowly started to research other providers just for routine gynecological care. We ended up finding a hospital that was just about 25 minutes away just thinking, “Well, what if?” I had heard this hospital was well-known for VBACs and I had also started seeing a pelvic floor therapist prior to going to this hospital for care who was working at this hospital. It was kind of on my radar. Heidi: From there, I met the OB. I met the OB and then I was just really shocked at how supportive she was. In the past, you just go into the OB or gynecologist and they will put you in a gown and they do whatever they need to do, a pap smear or whatever. But this one, the nurse had said, “Don't get undressed. They want to meet you. They want to talk to you first.” Meagan: I love that so much. I love that. That's awesome. Heidi: It was so different. It was in a hospital, but it didn't feel like a medical office. The rooms were painted blues and greens. You could tell there was a lot of effort being made to make it feel like home. I began my journey. I had just met with her. This OB had talked to me about birth story processing. I had no idea what any of this was. I had no idea that I even had trauma from my last pregnancy at this point until I had just met with her and was talking with her. She said, “There is no pressure if you don't want to have another child.” I was just there to meet with her and have a check-up. I think I want to say a couple of months passed and actually, that night, I went home to see my husband. I was like, “You know if we do have another child, it's going to be here.” Yeah, so a couple of months went by and we did decide to have another child. Again, the baby was conceived right away. No complications. This time, we started working with a doula. I began birth story medicine at the same time. I did that for a couple of months in addition to my therapist to process the birth trauma and just everything. I was tested for gestational diabetes early during this pregnancy. I started insulin at 11 weeks and I was just kind of ready this time. It wasn't as scary honestly the second time. It's a lot of work. I would say that it was annoying, but it wasn't scary. Meagan: Well, and you're like, “I've done this before. I did a really good job last time. I learned a lot,” because you did go pretty deep into it, so you're like, “I can do this. I've got this.” Duh, this kind of sucks, but you know. You got it. No problem. Heidi: Right. My first baby was born at a really great weight and there were no complications at all. Meagan: Good. Did they already start talking about induction and things like that from the get-go? Did they talk about extra testing? Because at this point, you for sure have it. Earlier or later, did they talk about that stuff? Heidi: With this provider, I went in and they told me I was old last time, the other provider. I'm really old. They looked at me and were like, “No, you're not.” Meagan: No, you're not. Heidi: Yeah. They're like, “You're 37. That's not old.” Meagan: Yeah. Heidi: I'm like, “What?” Meagan: The other clinic, would they have wanted to do NSTs because of age and gestational diabetes? Heidi: I don't know. Meagan: Okay. But these guys were like, “No, we're good. We don't need to do any extra testing because of an early diagnosis of gestational diabetes and now you're 37.” Heidi: Yeah. They said what they do consider older but it's still not impossible was, I believe, over 40. Meagan: So you didn't even have that pressure from the get-go? Heidi: No, no. Meagan: What an amazing way to start. Heidi: Yeah. It was amazing. They also weren't concerned with the fact that I was on insulin. We did talk about NSTs because I asked because I knew it would come up and they had said, “You can have once a week as long as your sugars are in control, we are comfortable with that.” I felt so relieved. Yeah. It was such a holistic, relaxed approach. They trusted me to manage my body and to know what I needed and that was so empowering, the whole journey whereas before, I felt like I had a really short leash and they were basically managing everything for me as if they knew what was right for me and my body. Meagan: I was just looking. I'm just looking because I'm sure people are like where is this person? Where is this provider? Was it at the CMC? Is that where it was? Heidi: Yes. Yeah, Catholic Medical Center in Manchester. Meagan: Awesome. This is good. These are good vibes here with this provider. Heidi: Totally, yeah. Oh my gosh, yeah. 38:04 Discussions around inductionHeidi: So let's see. Once I'm diagnosed with gestational diabetes, I have maternal-fetal medicine ultrasounds, but that also was true because my first daughter was born missing a kidney. Again, she's totally healthy and totally great, but they wanted to make sure that nothing weird was going on, yeah. That was at about 32 weeks. They were also checking the baby's growth and baby's size at that point. Baby was measuring very average. She had two kidneys. Little things that we take for granted, we were so grateful for. Yeah. That went really well. The pregnancy was just progressing really well. In my third trimester, I was struggling with all of the extra appointments and the trauma that I was processing though from my last birth because I knew and my gut told me, “You need to work through this because if you don't, you have to be really strong to have a VBAC. You have to really work through a lot of mental blocks and things that come your way.” So I just started getting really stressed between work and the appointments will all the different therapies so I decided to take a couple of months away from work prior to the delivery in order to process everything and prepare myself. That was a really hard decision but it was probably one of the best decisions that I could make. Meagan: Good for you. Heidi: Yeah. At around 36 weeks, it was suggested to me by my provider that I could consider a 39-week induction, but it was delivered so differently. Meagan: Good. Heidi: Reasoning basically says that ACOG has a suggestion for insulin-controlled gestational diabetes. They basically told me the data. They told me why they are suggesting this, but ultimately it is my choice. It was a discussion that I just found to be so incredible and weird in a really good way. Meagan: Which in my opinion is so sad that these things happen that are good conversations have to feel weird to us because that should just be normal, but it's not a lot of the time, right? Heidi: Yeah. I was working with my doula at the time and she was a really big proponent of expectant management and letting everything happen naturally and honestly, that's all I ever wanted. I think that's what most people want. So I just explained, “I am not interested in induction. I want to do expectant management as long as everything progresses the way that it's going and it goes well. That's what I want to do.” They said, “Okay. We can do that.” Meagan: I love that. That's great. Heidi: It was amazing. It was really empowering. 41:45 NSTs twice a weekHeidi: So let's see. They suggested that I have a 36-week ultrasound to check my baby's size again. Actually, no sorry. They suggested it. I was actually able to negotiate my way out of it. I said, “You know, I just had one at 32 weeks. Is it really necessary to have another in 4 weeks?” I talked to the OB and she was like, “You know what? No. You don't have to do that.” Yeah. Meagan: Things are just getting better and better. Heidi: Oh, so good. Yeah. So right around then, the NSTs began. I'll just say also, I walk into– so NSTs were really awkward during my first pregnancy. I sat on the hospital bed so uncomfortable and sitting up with all of these things attached to me. At this provider, I go in. There is an NST room and it's painted blue and it's really common. There is a reclining chair and for me, it just really felt like they were normalizing the fact that NSTs do happen and it's okay and it's normal. Here's a special space for it. Meagan: Well, and almost like they are setting you up for success in those NSTs because in NSTs, when we are really uncomfortable and tense, overall, that's not going to be good for us or our babies. That's going to potentially give us readings that we don't want but when we are comfortable and we are feeling welcomed and we are like, “Yeah, we're not happy that we are here taking this test,” or sometimes we are, but when we are comfortable and we are feeling the beautiful colors and the nice, soft recliner, it's a very different situation to set you up for very different results. Heidi: Yes. Absolutely. Yeah, so then my journey just kept going. My NSTs were beautiful every week. It was really interesting how they set them up because they had the NSTs after the doctor's appointments because they weren't expecting. If they can get a good reading, I think the minimum is 20 minutes whereas I had the NSTs before so it was like they were looking for a problem then I had the doctor's appointment so I ended up being there for 2 hours during my first pregnancy. But these ones, I never sat more than 20 minutes.The nurses usually saw what they needed within 5 minutes and they said, “Your baby is doing great. You're out of here as soon as the time is up.” Meagan: That is amazing. Oh my gosh, 2 hours. That is a long time. Heidi: Yes. Yes. This pregnancy was really odd, but I'll take it. I stopped needing insulin during the last two weeks. Usually, there is a peak near the end of pregnancy, and then the need for insulin goes down in the last two weeks I want to say. For me, it actually just kept going down, down, down, and then all of a sudden, it was gone. That didn't happen last time. They were a little nervous about that because it didn't really happen. I explained to them, “I think it's honestly probably lack of stress,” because I wasn't working at my job at the time and I was moving a lot more too, so who knows? Meagan: Really interesting. Heidi: It did make them a little nervous because they said there is very limited data, but sometimes it can indicate an issue with the baby. Meagan: Oh, the placenta. Heidi: Sorry, I'm nervous so I'm forgetting. Meagan: There are times when it can be the placenta being affected. Is that what they were saying?Heidi: Yes, thank you. They said, “We could offer an induction at this point,” because I was at 39 weeks when they brought that up. I said, “I don't think so. I really want to stay the course. I want to do expectant management.” They said, “Okay, would you be open to twice-weekly NSTs?” I said, “Yes. If that lets me keep doing what I'm doing, we can do that and it's probably not a bad idea, because you never know.” 47:10 Testing for preeclampsiaHeidi: I woke up one morning at week 40 and thought my water was trickling out. I texted my doula and she was getting home from another birth and was going to rest, so I worked with my backup doula for that day which was a little scary. I didn't know what was going to happen from there. Around 6:00 PM that night, my husband and I arranged for my mom to watch our daughter because we needed to get to the hospital to get the amniotic fluid checked. We probably should have gone a little earlier, but the backup doula had suggested it might not be amniotic fluid. It might just be discharge. Meagan: Is there much going on labor-wise? Heidi: Not really. It was pretty quiet. Then I actually had an NST the day before that and there really wasn't much going on. I felt little Braxton Hicks-type things, but nothing much. We packed our bags, got ready, and got my mom. We arrived in triage. I had slightly elevated blood pressure which was just a routine check, but that basically led to them testing me for preeclampsia and then a urine test. Meagan: Hmm, a slight increase? Oh, man. Heidi: Yeah. It was slightly increased. You know, like a lot of people, hospitals make me nervous. Meagan: Yep. Yeah. They jumped right in and started going the moment you got there. Heidi: Yes. Yeah. It's different. It's still in the hospital, but it's separate. Labor and delivery is separate. They just had a very different mindset at the moment. I was sure that I didn't have preeclampsia. They asked me all of the questions and I'm like, “I really don't think that's what this is.” They were saying, “You're also post-date with gestational diabetes.” Meagan: Post-date by one? Heidi: Yes. Meagan: Or by 40 weeks. Heidi: Yeah. Yeah, so I would need an induction if I get preeclampsia and all of this. Who let this girl go this long? What the heck kind of thing? Meagan: Not helping your blood pressure, that's for sure. Heidi: I definitely started feeling PTSD. I was just like, “This again? Oh no. I feel like I'm in prison.” That's the way it felt last time. I knew I needed to get out of there fast. It wasn't good. The OB came in and lectured me. This was a different OB. She lectured me about preeclampsia and how I should really stay in the hospital. They were going to send for bloodwork even if it came back okay, I should stay the night. They drew the blood and I'm just beside myself at this point. I was like, “Well, when are they going to get the results back?” They said, “Probably about an hour or so.” You know how backed up the lab is. They were like, “Are you really going to drive home and come back?” I was like, “If I have to come back, which I really don't think I will, then yes, I will.” The blood was taken. The nurse ran back within– I want to say it was 10 minutes. It was really fast. She said, “You guys should really consider staying. Your platelets are low.” I said, “Okay.” Meagan: The labs came back that fast? Heidi: They came back really fast. Meagan: Because you were saying that you were maybe going to go back home? That's interesting. Heidi: Yeah. I said, “Okay. That's thrombocytopenia.” My provider had said I had that. We talked about it and I also had it during my last pregnancy. Meagan: Wait, what did you just call that? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia. I've heard low platelets. I've never heard it called that. Heidi: Thrombocytopenia. I actually listened to a podcast oddly enough with Nr. Nathan Fox. Meagan: We love him. Heidi: Yeah, he's awesome. He was basically saying that it's common and it's generally not a big deal. Meagan: I just Googled it. Yeah, it says it's a condition where the platelets are low. It can result in bleeding problems. Yeah. Okay, all right. Keep going. Heidi: Yeah. It was interesting because he had said, “Within range,” and I was within that range, but I also talked to my provider about it months before and she said, “Oh yeah. This is common. We are not concerned with your levels.” Luckily, I was like, “Oh my gosh. I know enough.” I was like, “Nope. I know what that is. We are okay and we are going home. They can call us with the results.” So we went home. Meagan: That is amazing. Did they make you sign an AMA or anything like that? Were they just like, “Fine. We were going to have you stay, but you are good to go.” Heidi: Yeah. There was no paperwork. Meagan: Okay. Good. Heidi: I was free. Yeah. I was actually amazed at how– I mean, I was very firm with them. I was just like, “We are going home now.”Meagan: That is hard. That is really, really hard to do, like really, really hard so good for you for following your gut. Heidi: Yeah. It felt really good. Yeah. We got home. I started to feel some mild, irregular contractions and the same thing I had been feeling. We sent my mom home because she was still at my house. Like, “Go ahead. We've probably got another day.” I was like, “I know something is going to be happening soon. I feel it.” So around 10:30 that night, I got the call from the OB– Meagan: Yours? Heidi: Sorry, the one in the hospital that was treating me. She had said, “All right. You don't have preeclampsia. You don't have to come back.” I said, “Okay. We did it.” Meagan: Yep. Yep. Yep. Can you imagine having to be there that whole time? Heidi: No. Yeah. I'm sure they would have found something else. Who knows? Meagan: You never know. 54:53 Spontaneous laborHeidi: Yeah, so when we were home, we unpacked our bags, ate some food and sent my mom home. I bounced on my birth ball. I was pumped. I was so excited. We were like, “Okay. Back on the normal track.” Then around midnight, some contractions started that I figured would stop once I laid down for bed. I didn't really know. I never really had normal, non-Pitocin-induced contractions before, so I didn't really know what they would feel like. I was in denial, to be honest. I was like, “There's no way. I'm not going into labor right now. What are these? These are nothing. It's just cause I'm nervous or something.” I laid down. My husband was already asleep at this point and they didn't stop. They just kept getting stronger. I was lying there thinking, “No. I can't go into labor right now. I don't want to see that OB. I can't. I can't. This is not happening.” I was just willing my body, wishing and willing my body to wait until 6:00 AM or 7:00 AM until the shift change. So then I was like, “Okay. I should probably start timing these because this is no joke.” I found a timer and started timing them. They were spaced at 5 minutes apart lasting a minute each. I was like, “This is early labor. This is it.” I finally woke my husband up and I was like, “Hey. I think we're going.” Meagan: This is going to happen. Heidi: Yeah. I called my doula. I had been texting her meanwhile the whole time and she was super supportive throughout, then I finally was like, “I need to call her.” She talked me through what I was experiencing because I had no idea. She was like, “You guys should probably leave soon because this is your second baby and it could happen really fast.” I noticed there was pink discharge. Meagan: And you had made it to 10 before. Heidi: Yes, exactly. She was like, “This could happen really fast.” I noticed some discharge and it was pink. Contractions started to be really regular and really painful. She was like, “That's probably your cervix dilating.” I was like, “Why am I dragging my feet? We need to go. We need to go now.” 57:43 Going to the hospitalHeidi: We called my mom to have her come back to our house. I think it was 1:00 in the morning at this point. She didn't answer immediately probably because she was exhausted. Meagan: Probably asleep, yeah. Heidi: When she did, it was finally 2:00 AM and there was a bit of an ice storm outside, just a little one but just enough to make the roads slippery because she had texted me when she was going back home and she was like, “It's kind of icy. I just want to let you know.” So then I was like, “Oh no. My mom's on her way, but it's going to take her a while to get back to the house.” Then it's going to take us a while to get to the hospital. It was really getting pretty scary, but we were just like, “Okay. Let's just pack our bags again,” because we had started unpacking them. My provider had actually said that they were comfortable with me going until at least 41 weeks so I was like, “I could go until 41 weeks and then who knows?” Meagan: Right. Heidi: Anyway, so we put everything back. It was a really good distraction and then every single contraction, we would stop and brace ourselves. My mom got to our house at 3:15. We got to the hospital around 4:00 AM. It was the longest car ride of my life. My doula was like, “The contractions might slow down in the car.” I was secretly praying that they didn't because so many people that I knew had prodromal labor and I was like, “I want this to come like a freight train. I don't want it to stop.” It is so painful, then a lot of people say you get nervous when you get in the hospital. Things will slow down. I was just so nervous about all of that. I got to the hospital. My doula arrived soon after. We spent almost two hours in triage even though we were already there filling out paperwork. The contractions didn't stop or slow down during this. I was beside myself. I was like, “Oh my gosh. My body is ready. We are doing this.” The nurse in triage, at the time, was a different nurse. I think she worked a half shift or something, but she was really skeptical of VBAC. I was not comfortable with her. She said I couldn't eat. She had obviously outdated info. I asked her, “Why can't I eat?” She said, “Well, the odds of you needing another C-section are higher.” I'm like, “Well, how do you know that?” It was just really frustrating. I requested a midwife to deliver my midwife because the same OBs were on staff. I was going to a midwife for my care, a midwife, and an OB team. I actually ended up seeing the midwife even more than the OB so I really was comfortable with requesting a midwife to deliver, but the nurse really pushed back. She said, “You're a VBAC. I don't think you can have a midwife.” Yeah. She went into the hall, made a phone call with the midwife and the midwife on staff actually said no supposedly because I was a VBAC. Meagan: What? They had never said anything like this in your prenatals. Heidi: No. No. I think again, it's a little different. They also use other hospital staff at this hospital so you never know who you're going to get, but my doula is there and that's what matters. That's why I had a doula because you don't know. Meagan: You don't always know, yeah. 1:02:03 Laboring in the tubHeidi: They asked to do a cervical check. I was hesitant, but they said, “We have to do this to admit you.” I was like, “I'm not leaving at this point. I'm clearly in labor.” I consented to it and they found I was 4 centimeters dilated so I stayed. I got to my room around 6:30 and actually, I think I was about 80% effaced at this point. I got to my room around 6:30 and I just began setting it up to distract myself. My doula started setting up the bath for me. I was like, “I want to go to the bath.” I got to the tub around 7:00 AM to deal with the contractions because I really wanted a natural birth this time. My water broke 5 minutes after that. Shift changed at 7:00 AM. I feel like my body was like, “Okay, hey. Shift change at 7:00,” and then my water broke. Meagan: You said we were in triage for two hours and I was like, “Your body was waiting for shift change intuitively.” There you go. Heidi: I got in the tub. My water broke. A new nurse came in around 7:15. She had a trainee, but this was a nurse who had a lot of experience and she was just training to be in labor and delivery so it was basically like an extra set of experienced hands. She was also a nurse who had run a training for us a couple of months before and I was like, “I hope I get this nurse. I really, really hope I get this nurse.” In she walked, and I couldn't believe it. She came down to me at the tub. She started asking me questions right away about my birth plan. It's like she studied it. It was the most amazing thing. I can't exactly remember what she was asking, but just clarification and she was like, “Yes. We can do this. We can do this and we will do that.” I was like, “Wow.” The first time, I had a birth plan, but I'm pretty sure they burned it. Meagan: Aww. Heidi: Then she just started talking about how the birth process would go and how I would be feeling mentally more than likely and she also said that she is well-versed in Spinning Babies. Meagan: What you wanted! Heidi: Yeah. Yeah. I was like, “This is heaven.” I also took a short course in it to prep for this labor and I really was trying to do all of the things. I couldn't do all of the things, but I think there is a lot of science to Spinning Babies, especially having an OP baby the first time. Initially, I was experiencing back labor. She asked me, “Where do you feel your pain?” I said, “In my back.” She said, “Get on all fours. The baby could be OP.” I was just like, “Oh my gosh. I will do anything to not have another OP baby.” She said, “We're going to spin her.” I stayed on all fours. I just did this. I started using the nitrous. This hospital provided nitrous. Meagan: Nitrous oxide?Heidi: Yeah. The other hospital did not have that, but I was so excited for that. It helped me just breathe through my contractions, really get in tune with my body, and gave me a focus. I was able to move around really freely. When I was in the tub, I started to feel the urge to push so we moved out into the bed. I still stayed on all fours. But I was also just, I don't remember this, but my doula was saying that I really was kind of dancing. I was moving in the ways that my body told me to do. It felt so incredible and obviously painful. 1:06:22 Pushing for 30 minutesHeidi: Then it was about 9:15 and I was really, really wanting to push at this point. I was told to wait for a cervical check though and I was like, “Why do I need a cervical check? I'm ready.” Meagan: My body is saying I'm ready, yeah. Heidi: Yeah. A midwife came in. She introduced herself and she was like, “I'm going to be delivering your baby.” I was like, “Okay.” I couldn't believe it. It was a different midwife and she was like, “I want to check you because you could have a lip if you're not fully effaced. Your pushing will be ineffective.” She found that I was 10 centimeters dilated, fully effaced so then we went on and pushed. My daughter came out at 9:46 AM so we pushed for a half hour. Meagan: Oh my gosh! So you got baby in a good position and isn't there such a difference between pushing? Heidi: Yes. Not having the epidural, I could feel everything. It was so real. She was 7 pounds, 3 ounces. She did have a compound presentation. She was head down, but yeah. She came out with her hand pressed against her head. Meagan: Yes, come out thinking. Heidi: Yeah. I had really no tearing, very, very minimal. I achieved the delayed cord clamping. My husband got to cut the cord. We didn't have to remind them of our wishes. They just knew. We had a golden hour which I never had before, but I was told I could take as long as I wanted, and yeah. It was just the most beautiful thing I have ever experienced in my life and I just couldn't believe I did it. Meagan: Yeah, what a journey. I am so happy for you. Heidi: Thank you. Meagan: Congratulations. And now, at this time of recording, how old is your baby? Heidi: She is 8 weeks.Meagan: 8 weeks. Brand new! How has the postpartum been? Heidi: Oh my gosh. It's been amazing. I mean, as amazing as it can be. Let's be real, but compared to what it was. Meagan: Good. I'm so happy for you. You know, when you finished your first, you were like, “My husband and I didn't even know if we would ever want another kid.” I can just see this joy on your face right now. Where are you at in that stage now? Are you two and done or are you like, “I could do this again”? Heidi: We are two and done. Meagan: Hey. Heidi: Yeah, I mean it's funny because the nurse and my OB were like, “You really should have another one.” Meagan: This is what I did. I went out with a bang. You went out with a bang. Heidi: You can't top this. Meagan: You got the birth you wanted and all the things. You know, you advocated for yourself in the birth room. You left and then still advocated for yourself in the birth room. I mean, how amazing. How amazing. Heidi: Yeah. I ended up with the most supportive team. You do never know what you're going to get, but the team that came in at 7:00 AM, oh my goodness. They treated me like I was just a normal, vaginal birth. There was no VBAC. There was no jargon. It was beautiful. Meagan: I love hearing that. That is truly how it is supposed to be and it's so often not. Then yeah, then we learned more about the correct diagnosis or term of low platelets. I totally Googled it really quickly and it just said that gestational thrombocytopenia, how do you say it? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia is a diagnosis of exclusion. The condition is asymptomatic. It usually occurs in the second half of pregnancy in the absence of a history of thrombocytopenia. Heidi: You got it. Meagan: It said, “The pregnancy and the platelet counts spontaneously return to normal within the first two months of postpartum.” We will make sure to have a little bit more reading. It will go back into some things, but one of the things it does say is that it is not necessarily an indication for a Cesarean delivery which is also important to know because I mean, there can be low platelet levels that are more intense like HELLP syndrome and things like that, but this is a really good things to know because that would have easily been something if it hadn't been for Dr. Nathan Fox and if it hadn't been for them talking to you about this. It could have scared you like, “Oh, okay. Okay. Let's stay.” But you were fully educated in the situation and were able to make a good choice for you and advocate for yourself and say, “I feel good about this. You can call me when the preeclampsia levels come back, but I feel good about this decision. We're moving on.” Then the amazing, miraculous, no insulin need, that's another really cool thing about your story, but I also wanted to share Lily Nichols. I don't know if you've ever heard of her. Heidi: Yes. For my first pregnancy, I read both of her books. She's amazing. Meagan: She's amazing. We'll be sure to link her books and stuff in the show notes as well so you can make sure to check it out. If you were given a diagnosis of gestational diabetes or even actually just in general, her books are amazing. You can read and be really, really well educated. Okay, well thank you so much for sharing your beautiful stories. Heidi: Yeah. Thank you 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

Though Karen did research and took birthing classes before her first baby, she didn't realize how much advocating for herself could change the course of her birth. She wanted to be the “good” patient and told herself she could do without the things her body told her she needed during labor. Karen ended up pushing for over four hours and consenting to what she was told was an emergency C-section, even though the actual surgery didn't happen until hours later.Karen had some serious postpartum symptoms of swelling and difficulty breathing that were dismissed and even laughed at until things came to a point where she knew something was very wrong. She was diagnosed with postpartum cardiomyopathy, admitted to the ICU, and transferred to cardiac care. Doctors told Karen very different things about her condition. She went from being told not to have any more children to hearing that VBAC was absolutely safe. Karen discusses how her gestational hypertension came into play with the different advice as well. Karen found her voice. She advocated for herself. She knew what her body was saying and what it was capable of. Her labor was so smooth and she WAS able to birth vaginally!Informed Pregnancy PlusNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 3:46 Review of the Week06:27 Karen's stories08:50 First labor10:47 Pushing for four hours15:11 Karen's C-section17:43 Postpartum swelling and difficulty breathing21:03 Fluid in her lungs23:52 Moving to Florida and getting answers25:13 Getting pregnant again29:53 Advocating for a VBAC32:14 A spiritual dream34:34 Gestational hypertension39:36 Signing an AMA41:31 Going to the hospital45:20 Pushing for 20 minutes47:30 White coat syndrome51:59 Symptoms of hypertension and preeclampsia54:52 Tips for hypertension and preeclampsia 56:55 Karen's final tipsMeagan: Hello, hello. We are getting into almost our 300th episode, you guys. Every single time I'm recording and I'm looking at these numbers, I am blown away. I cannot believe that we have almost put out 300 episodes. Oh my goodness. I am so glad that you are here. I have this energy this year. I don't know what it is. You'll have to let me know if you notice it, but I have this energy every time I'm recording this podcast. 2024 is vibing. I'm vibing with it. I'm really liking it. We have our friend Karen and are you from Florida, Karen? Karen: Yep. I'm in Orlando, Florida. Meagan: Florida. That's what I was thinking. So if we have Florida mamas looking for providers, this is definitely an episode. I feel like probably weekly we would get 10 messages asking about providers and Florida is huge so Florida is actually one that is really common where we are getting messages for supportive providers. So Karen, along the way, if you feel to name-drop some providers that are supportive, feel free to do so but we are going to get into sharing her story in just one moment because we do have a Review of the Week. 3:46 Review of the Week Meagan: This is from louuuhuuuu. So louuuhuuuu, thank you for your review. They say that this is “very inspirational.” It says, “I knew I wanted a VBAC with my third pregnancy, but I wasn't sure if it was possible. However, I knew I didn't feel like being flat-out told, ‘No' at the first appointment. Listening to the podcast was definitely the start of me really researching birth and looking into my options. I ended up with a successful HBA2C and I definitely don't think I would have had the courage or believed it was possible without this podcast. Thank you, Meagan, for all of the work that you do to provide this information.” I love that review so much. I think that through time in my own research, I was told no. I wasn't told, “No, no.” I was told, “Sure, probably yeah. You could VBAC,” but I never really got that positive vibe. I feel like this community that we have created with all of the people on the podcast and all of the people in the community on Facebook truly is something that I lacked when I was preparing for my VBAC. I'm so grateful that we have this community for you today. Thank you, louuuuhuuuu, and huge congrats on your HBAC, your home birth after two Cesareans. If you didn't what HBA2C meant, that's home birth after two Cesareans. Just like louuuhuuuu, you can too. Make sure to follow us in our Facebook community. You can find it at The VBAC Link Community on Facebook. Answer all of the questions and we will let you in. You can find out as well that it is possible. VBAC is possible. 06:27 Karen's storiesMeagan: Okay, Karen. Welcome to the show and thank you so much for taking the time to share your story today, well your stories today. Karen: Yeah. Thank you for having me. It's a little wild actually being on your show. I've been thinking about what I was going to say even before you invited me like, “What would I say if I finally get my VBAC? It's crazy to actually be sharing my story now so I'm really excited to be talking to you today.” Meagan: Well I'm so excited that you are here and sharing your inspirational message. You know, going through your submission, it sounds so similar to so many of us. You went in for a totally planned unmedicated birth that switched to the complete opposite where you had a C-section. There are so many of us. When I was reading that, I was like, “I bet I could probably find hundreds of stories not even just in our own community that start out like that.” Karen: Yes. That's why I love listening to your podcast so much because for the first time, I didn't feel alone. But yeah. I can get into my story now if you'd like. Meagan: Yes. I would love it. Karen: Okay. So back in August– or, I'm sorry. My son was due in August 2023. This was our first baby and he was a little bit of a surprise baby, but he was very much welcome and we were excited for him. At the time, we were living in Virginia. My husband had just gotten out of the Navy and he was about to start law school. I did prepare for the birth but I don't think I prepared enough. I took a Hypnobirthing class and the doula who was leading the class was super supportive. She was just like, “You're just going to birth beautifully. I can just tell.” The midwives, the nurses at the practice were like, “Oh, you're going to birth beautifully. I can just tell.” I just kept hearing that over and over again. My ego was a little over-inflated and I was like, “I don't need to do much. I've got this.” I don't think I was prepared enough. I didn't know what I was really getting into. 08:50 First laborKaren: So when I actually started going into labor, I got there way too early. I got to the hospital too early. Like you mentioned, I wanted an unmedicated birth. I got there, I think my contractions were about every seven minutes. Now I know that I definitely should have waited at home longer. But everything seemed to be going well. I arrived. They admitted me. They seemed a little bit hesitant, but they were like, “Oh, well she's in labor. Let's just bring her in.” My water broke on its own that afternoon. Things seemed to be going well until the pain really started kicking in. I had a really hard time working through the pain even with everything I learned in HypnoBirthing. I still hadn't quite found my voice yet, my mama voice. I couldn't tell people, “Hey, you're distracting me. I'm trying to do HypnoBirthing.” I felt embarrassed about putting up the sign outside my door saying, “Hey, HypnoBirthing in progress. Please keep quiet.” I just didn't speak up. I was just trying to be a good girl and just listen to what everyone says. I heard so many times in different episodes being a good girl and just doing what I've been told. Meagan: Right. We are people pleasers. I think a lot of us are people pleasers. We don't want to ruffle feathers. We want to stay in line. We want to follow this path that we are being told we have to stay on. Karen: Yes. I mean, I just didn't realize it was something I needed to form as a mama to be able to stand up for myself because pretty soon there was going to be a baby that needed me to stand up for them. Like I said, during the birth, there were just so many distractions, people coming in and out, nurses, and visitors. It was too much. I did end up getting an epidural because I just couldn't hold out any longer. 10:47 Pushing for four hoursKaren: Around 2:00 AM, the labor and delivery nurse told me, “Oh, you need to start pushing.” I was on my back. I pushed for about two hours. I had some breaks but the baby was just stuck. For part of it, we could see that he was crowning but he just would not come out. During this entire time, no one really looked at me. I just had this one labor and delivery nurse. She was so sweet, but the midwife didn't come by. The OB didn't come by. No one really came by and I wanted to move into different positions. I felt my body telling me, “Hey, try this. Try this,” and they would tell me, “You can't move. You have to stay like that.” I pushed for four hours. Baby was in distress. I felt fine but the midwife came in and told me, “You're going to need a C-section.” This was the first time I had seen her. She told me. Meagan: Wow. Karen: Yeah. So she says, “You need a C-section. He's not going to come out vaginally.” I didn't know. I didn't know what to do. I mean, I felt that was my only option. I got really upset. I started crying. I felt like a failure. I know now that I'm not a failure. That wasn't it. But that's how I felt at the moment and my husband was devastated. He was such an amazing birth partner and he felt like he failed me. I was like, “No. You didn't fail either,” but at that moment, we just felt so let down that one, I had to ask for an epidural, and two that I was going to need a C-section. Karen: They told me. I don't remember if the word “emergency” was used or not, but they made me feel like it was an emergency and it needed to happen immediately. When I look at the paperwork and all of that stuff, I'm like, “Where was the urgency?” Because the C-section didn't happen until 10:00 AM. Meagan: Yeah. That's not an emergency. This is another thing that I'm going to be honest– it irks me because there are so many of us who are told it is an emergency. When we hear “emergency”, what do we think? Panic. Scary. Right? We divert into asking– divert. I don't know if that's the right word. We stop asking questions and we say, “Okay. Okay. Okay,” because it's an emergency and we are told that. Karen: Exactly. Meagan: I think a lot of times, truly that we are told it is an emergency and that offers some sort of– it's weird, but some sort of validation where it's like, “But it's an emergency, so okay.” We just agree and then we are grateful. We look at them in a way because it's an emergency so they are saving. Does this make sense? I don't know. Karen: No, it does. To me, when I think about it now, it feels like manipulation. Meagan: Okay, yeah. Yeah. Yeah. It can be. Truly, there are real emergent Cesareans. Karen: Agreed. Meagan: We are so grateful for Cesareans that can help us and those are real, true emergent situations, but so many of us are told it's an emergency and then like you said, it's 10:00 AM or they come in and they're like, “We need to shave you,” and it's like, “Okay, that's not an emergency.” If they have time to shave you, talk with you, and leave you for four hours, no. It's not an emergency. Karen: Exactly. So if I had known what I know now, I would have asked for my options, asked to push and change positions. There are so many things I would have done but like you said, I thought it was an emergency. I was treating my baby in danger. I need to do this now even though there was nothing wrong with the baby. There wasn't. Meagan: Or you. Karen: Mhmm, exactly. His heart was fine. Everything was fine as far as I could see as far as I remember, as far as the paperwork says, so it doesn't make sense anymore to me. But yeah. 15:11 Karen's C-sectionKaren: My husband was told to dress in scrubs while they prepped me and then I asked the nurse to make sure that no one was in the room when I got back. When we came back to surgery, they wheeled me over to the OR and they were just checking to see that the epidural was still good. I could feel them touching my belly. I told them and that's the last thing I remember. The next thing I know, I just hear a baby crying in the distance. I was waking up in a different room and there were just these two nurses chatting about their day. To me, it was traumatizing. I couldn't even process what was going on and what happened. That was just so, so scary. Meagan: I'm so sorry. Karen: Yeah. Sorry. So then they wheeled me out and that's where my husband and our whole family were waiting. I was so frustrated because I told the nurse I didn't want anyone here. I knew I would be upset after the C-section and there was everyone in the room waiting. I also found out that my baby got passed around so I didn't even get to be the first to hold him. That was so extremely upsetting. I told my husband, “I want everyone out.” Everyone left and it was just me and my husband and our baby, Luke. We were there for about 15 minutes before they started to prep me to move the recovery room and I was like, “Wait a minute. I thought I got a golden hour where I would get to be alone with the baby for an hour.” They were like, “Oh yeah, you can do that in the recovery room,” and they just wheeled me over. I get so sad when I look at pictures of that time because my baby is so beautiful. I love him so much, but I felt so drugged up that I couldn't connect with him. You can see it in the pictures. I just look like I don't know where I am. I'm in pain. It's just not what I imagined that experience to be. Meagan: Right. Karen: I definitely felt robbed of an experience. I felt extremely traumatized. That was hard in and of itself, but I was trying to come to terms with what happened. It was just a very rough time in the hospital. We had some family drama as well so that didn't help. Meagan: No. Karen: I was discharged less than 48 hours later which now I know is way too early considering the symptoms I was feeling. 17:43 Postpartum swelling and difficulty breathingKaren: My legs were extremely swollen. My whole body was extremely swollen. It didn't even look like I had given birth because I was just swollen all over. One nurse even made fun of my legs and she was like, “They look like baseball bats.” She was just tapping them.Meagan: That's a warning sign. That's something to think about. Karen: Well, I didn't know that. Meagan: Well, of course, you didn't, but as a professional, she shouldn't be tapping on your legs. She should be like, “Hmm, was this like this?” Karen: I've told other medical professionals that story and they are horrified. They are like, “That was a big warning sign something was wrong,” but they discharged me regardless. I felt so completely unprepared. It was just a very bad experience all around. They didn't have a lactation consultant working over the weekend so my baby was crying and crying and crying. He wasn't getting enough to eat when he was breastfeeding. They were just laughing and saying, “Oh, all moms feel like that. He's getting enough to eat.” Sure enough, my son was jaundiced and his pediatrician was like, “No, he needs formula. He's not getting enough to eat.” He had a significant tongue tie so he was not getting enough to eat. When I got home, like I said, baby was starving. I'm not getting any sleep. When he does fall asleep, I can't sleep. I remember explaining to different people like, “I'm having trouble breathing every time I lay down.” Everyone was just like, “Oh yeah. New mom, new baby. Totally normal.” Meagan: What? It is not normal to not feel like you can't breathe. Karen: You're going to love this then. At one point, I called the nurse hotline at the hospital because they gave it to me when I was discharged. I told the nurse, “When I lay down, I can't breathe. It feels like I can't breathe.” Her response was, “Oh, sometimes new moms don't know how pain feels like.” I was just like, “Okay, I guess this is just me.” She was like, “Technically, we're supposed to tell you to come to the hospital if you are having trouble breathing.” Meagan: Technically. Karen: Technically. So I was trying to be the good girl and trying not to ruffle any feathers and I was just like, “Okay. I'll keep pushing through,” but the moment I realized things were not good, I was extremely depressed. I thought that I was going to die and leave my child alone. I was having horrible thoughts like that. Then I realized, “I'm starting to hallucinate.” So after three days of not sleeping, there was one incident where I heard my baby crying and screaming. I went over to the bassinet to look at him and he's sleeping peacefully, but I can still hear him crying and screaming clearly. I'm like, “That's not normal.” 21:03 Fluid in her lungsKaren: Once he woke up because I was trying to be a good new mom, so once he woke up, I packed myself up and my mom and I went to the ER. I explained to them, “I'm not getting sleep. I can't sleep. Every time I lay down, I can't breathe.” They were like, “Okay. Maybe you have a blood clot.” They took me back. They did an MRI scan and when I was lying down for the scan, I started taking these small quick breaths and the nurse was like, “Are you having a panic attack? What's going on?” I go, “I can't breathe.” She finally was the one that was just like, “There is something deeply wrong here. This is not normal at all.” I loved her. She really pushed to make sure that I got seen quickly. They determined that I was experiencing congestive heart failure. The way they explained it is my heart was not pumping strong enough I guess. It wasn't pumping right so that's why I was having trouble breathing because my lungs were filling up with fluid. They were able to give me medication. It was Lasix to help push out all of the fluid. I was kept at the ICU for two nights then they transferred me to the cardiac wing of the hospital. I was there four nights total because they just wanted to keep an eye on my blood pressure and this obviously wasn't normal what was happening. My blood pressure was through the roof. That was a really, really difficult time because one, I was away from my new baby and then I had three different doctors tell me, “There is something wrong with your heart. You won't be able to have more children. Your heart can't handle it.” That was distressing because my husband and I dreamed of having a big family and we were thinking, “This might be our last child.” But weirdly enough, my OB– the one who performed the C-section– disagreed. I don't like how he said this, but he was like, “Oh, don't be dramatic. It was just a little extra fluid. You're fine.” I was like, “Okay.” He said, “You can have a VBAC. You can have as many children as you want. You're going to be fine.” I wasn't a fan of him but that was interesting that he had told me, “You're going to be a great VBAC candidate.” He kind of put that idea in my head. He said that the only reason my son got stuck was because he was 9 pounds, 15 ounces so basically a 10-pounder. I was like, “Okay.” I didn't know what I know now, but that's the reason they gave me. 23:52 Moving to Florida and getting answersKaren: Eventually, we moved to Florida because I'm from Florida so I felt more comfortable with the medical care there. I just kept finding out different ways that I was failed by the medical system back in Virginia. My primary doctor determined that I had postpartum depression. My son was already two years old when she discovered that. It was just like, “Oh, okay.” Here's some medication. Now I feel like myself again. It made me realize, “Okay, what else do I need to look into?” I got a cardiologist. She was saying, “There is nothing wrong with your heart.” She can't definitively say because she wasn't there, but she was like, “They put too many fluids in your body. You are fine. There is nothing wrong with your heart.” She was just like, “You're good to go. You can have a VBAC. You can have another C-section. You can do whatever you want. You're fine. We can keep an eye on you, but you're okay.” I started seeing an OB and I told her everything that happened and I was just like, “I want a VBAC.” I told her everything the cardiologist said, gave her all of the paperwork and she was like, “Yeah. You can totally have a VBAC.” So with both of their blessings, I was like, “Okay. Let's try for baby number two. I'm okay. I'm healthy. I'm fine.” 25:13 Getting pregnant againKaren: So I got pregnant with baby number two and that was very exciting. I thought everything was going well then at 20 weeks, my OB said, “Unfortunately, I can't be your doctor anymore. This practice cannot deliver you. You are too high of a risk for this office.” Meagan: For the office. Karen: Yes. Yes. They only delivered at these smaller boutique hospitals so they said that I needed to deliver at a high-risk hospital or a hospital that accepts high-risk patients. Meagan: Okay, got you. I got you. Karen: I got a little tongue-tied. They told me I needed to deliver at a different hospital that I didn't want to deliver at. I was like, “If I'm going to deliver at a big hospital, it's going to be Winnie Palmer in Orlando.” I'm a huge fan of theirs. So I was just like, “Okay. I can't deliver with this office even though they've been aware of all my situations for a while. I'll find a different office.” But I was already 20 weeks so it's really hard to find a provider at 20 weeks. Meagan: It can be, yeah. Karen: The other disappointing thing they told me is, “Oh, by the way, you can't have any more children. You really shouldn't because, with everything that is going on with you, your body can't handle it.” It was just like, I don't understand where this is coming from. You've been telling me I've been okay. My cardiologist says I've been okay. I didn't really get what was going on. Karen: I called around and only one clinic would take me when I was that far along with this high-risk label on me. Meagan: I was going to say the label. That's exactly the word I was going to say. Karen: Yeah. I didn't feel like it really fit, but that's what they said I was. I found a big practice that had lots of doctors. It is a very prominent practice here in Orlando and I felt like I just had to settle. The first doctor I met with I was already frustrated because I asked for a female doctor and they gave me a male doctor. I don't have anything against male doctors, I just feel more comfortable with a female doctor but he was just like, “Oh. You can't VBAC at all. You had a vertical incision so you have to have a repeat C-section.” I was like, “I don't– I've never heard anyone say that. Where does it say that in my medical records?” He was just like, “I don't see it in your records, but this other doctor said that you had a vertical incision.” I'm like, “Well, how does she know that?” So I had to go and start pulling all of these records and got the surgical notes for my C-section and everything and finally, I found something that said I did not have a vertical incision so once I showed it to him, he was just like, “Oh, okay. Well, you still can't VBAC. Your hips are too tiny. You can't deliver a baby.” Meagan: Oh my goodness, just pulling them all out. Let me just shift this jar around and pull out the next reason. Karen: Yes. I was just like, “Are you serious? Okay.” Meagan: Goodness. 29:53 Advocating for a VBACKaren: So me and my husband were like, “No. I want to try. We want to try.” I'm so glad my husband was there because he is always so good at being an advocate for me. He was just like, “No. She wants a VBAC. What can we do to make it happen?” So he said, “Well, your weight is one thing because your baby was so big the first time because you gained a lot of weight. We can help you try but if after two hours of pushing you can't get that baby out, we're going to give you a C-section.” It was very frustrating, but I felt like I really had no choice. Meagan: Yeah. Karen: I hadn't discovered you yet so I was just like, “Okay. I guess it is what it is. I will try my best to have a VBAC, but this guy's going to stop me.” So I was very blessed that due to a scheduling issue, I had an appointment with a totally different doctor. She was this young female doctor. She was around my age and I felt like I could relate to her. I just really enjoyed talking to her. I don't know if this has something to do with it, but my background is I am Japanese and Colombian and she was Asian, so it was just like, “Okay. I have someone else who is a person of color who understands at least the cultural differences.” So I don't know if that really had anything to do with anything, but it did make me feel more comfortable with her.Meagan: Which is important. Karen: Yes. After years of different doctors telling me there was something wrong with me, it was so nice to have her say to me, “Oh. You want a VBAC? Yeah. You are super healthy. You are going to be fine.” It was just like, “Oh my gosh. You think I'm healthy? Every doctor had been telling me that I'm overweight. There's something wrong with my heart. There's something wrong,” and she was telling me that I was healthy. That just made me so inspired and I just became a lot more proactive with my health. I didn't feel like things had to happen to me. I felt like I had a lot more control over my situation. 32:14 A spiritual dreamKaren: There was also one other event that happened and this was around Christmas. I'm a Christian, so we've been going to God a lot with prayers and I have been asking for a successful VBAC. So Christmas morning, I woke up to a dream but it didn't feel like a dream. It felt more like a vision and I was giving birth vaginally to a little girl. In the dream, I had the knowledge that this was going to be my third child. I was like, “Wait a second. But I'm pregnant right now with my second child. How did that birth go?” I just was told by God, “Oh, that birth went well too. You're going to be fine. You're going to be happy. You're going to have many children.” So I woke up so happy that Christmas morning. I told my husband with everything I've been battling and all of these negative thoughts, there is no way that this could have been something I produced myself or just dreamed of myself because it was such a positive, happy dream when before that, I had just been having constant nightmares about C-sections.It was just this moment of, “Okay. God really is with us and he's going to make sure everything is okay.” So yeah, between having this great doctor and then having that dream, I just was more motivated to really take control of the situation like, “Okay. I don't have to let things happen to me. What can I do?” Which actually led me to The VBAC Link. I was already 33 weeks pregnant when I found you guys so it was kind of late in the game, but I'm so glad I did. I listened to The VBAC Link obsessively in the car, when I was walking my dog, all the time and I would just hear these different stories and notate, “Okay. This is what she did. This is how she got results. This is what happened to her.” I started taking all of these notes about how I should respond in different situations and I'm so glad I did because I did use some of that later on. 34:34 Gestational hypertensionKaren: Unfortunately, I did develop gestational hypertension but I'm still not completely convinced that I actually had it. They diagnosed me the week I had to put down my dog and I had her since I was 15 so it was just devastating. I was under a lot of stress and I tried to explain that to them. They were like, “No. This is gestational hypertension.” I'm like, “Okay. Here is another label.” But I kept on top of my blood pressure readings. I never had high readings. I ate well. I tried to do exercise as much as you can when you are in your third trimester. Unfortunately, this practice had a policy that patients with gestational hypertension must deliver by 37 weeks. Meagan: Whoa. Karen: Yes. They said that if you are a VBAC patient, they won't induce you. So there's another timeline. I had to deliver by 37 weeks. But yeah, things seemed to be going really well. Once I reached around 36 weeks, I actually started having prodromal labor. I'm like, “Okay, yes. Things are going really well.” Because I had gestational hypertension, I was going 3-4 times a week to the doctor at that point. Meagan: For non-stress tests and stuff? Karen: Yes, exactly. They could see that I was already 3 centimeters dilated so I was like, “Great. Everything is going great.” At the 37-week appointment, there was a scheduling issue and instead of being able to see my regular doctor, they assigned me to a different doctor and that just made me really, really nervous. I was just like, “I don't want to go. I don't feel right. Something is going to go wrong. It's not my doctor. I don't want to go.” My husband was like, “No. It's going to be okay. It's going to be okay. Let's go.” He canceled work so he could go with me. He was like, “Everything is going to be okay.” The other thing that happened that morning was my sister who was going to be in the room with us woke up with strep throat. I was like, “This is not a good week. This is not a good day. I don't want to go in.” So when I went in, my blood pressure was 160/113 which was extremely high. This doctor told me, “You need to get a C-section today.” So I was just like, “Okay. I don't want to hurt my baby. That's fine.” I was really, really upset. I was crying and I told her I was scared and she was like, “Why are you scared?” My husband was pretty blunt and was like, “Because the doctors almost killed her last time.”She was like, “How did they almost kill her?” He was like, “They put too much fluid in her body and they caused heart failure.” She laughed and she said, “That's not a thing.” I was like, “Well, my cardiologist said it was a thing. How could you say it's not a thing?” I went to the hospital. I was really upset but the nurse there was amazing. She was like, “What happened?” I basically told her everything like my life story basically up until that point. She was like, “I checked your blood pressure when you came in. You are fine.” She was like, “This is ridiculous. It just sounds like you are stressed out.” At that point, my blood pressure was–Meagan: Reasonably so.Karen: She checked my blood pressure and it was 117/83 so it was great. It was so funny because she kept the blood pressure cuff on me and the doctor who was working that day was the same doctor who told me I'd never be able to VBAC and kept coming up with excuses. My nurse was just like, “Look, her blood pressure is fine.” Then she took my blood pressure again in front of him and it went back up. She was like, “Can you step out?” She took it again and then it was fine. She started advocating on my behalf. She was like, “You guys are causing her heart pressure to go up. You guys are stressing her out. She does not have high blood pressure because of herself. It's you guys.” The doctor was just like, “Oh, well I guess it's fine, but wouldn't you rather just have a birthday today?” I'm like, “No. I would not like to just have a C-section for no reason.” He's like, “I really don't want to send you home though,” but you really should consider this C-section just in case your blood pressure goes back up. I was like, “Look. I can check it repeatedly and if it goes up, I will come back. I'm not going to be stupid and put my son's life in danger. I will come back.” He just kept trying to convince me and finally, we were like, “No. We're leaving.” I told them, “If I'm going to have a C-section, it's going to be with my regular doctor. I trust her. I'm going to have control over this situation somehow. Even if I have to have a C-section, it's going to be by someone I trust. It's not going to be by you.” 39:36 Signing an AMAKaren: He was not thrilled about hearing that but he said, “Okay fine. You have to fill out this paperwork saying you're leaving against medical advice, but it will be fine.” I was like, “Okay, fine.” I filled out this paperwork. I was scared like, “They're probably going to kick me out afterward, but whatever.” I filled it out and I went home. They did make me schedule a C-section for two days later when my regular doctor was on call. I was like, “You know what? If it has to happen that day, it's fine. I did everything I could. I took control of whatever I could. It's my doctor.” She made me feel seen and heard and she had my best interest at heart, so we are going to pray and just do what we can. The next two days, I walked 10 miles. I drank raspberry leaf tea. We had sex. We did basically everything you can do to get labor going. I was still having prodromal labor so we would get our hopes up and then it would stop and then get our hopes up and then it would stop. Around midnight the night before I was supposed to get my C-section, I was so upset. I was just like, “It's not going to happen. I'm just going to have to get a C-section.” I just gave up completely. My husband was just like, “No. God told you this was going to be fine. You're going to be fine. Let's just get some rest because it's already midnight and we have to leave at 3:00 AM so let's just get a little bit of rest and it will be fine. We will talk to the doctor in the morning.” I was like, “Okay.” So we went to sleep at 1:00. The alarm rang at 3:00 and I was in labor. Meagan: Yay! Karen: I was so excited. 41:31 Going to the hospitalKaren: We went to the hospital. They still prepped me for a C-section. They were like, “Just in case,” but I was having regular contractions. It wasn't going away. My doctor came in. She checked me and she was like, “Okay. If you want to TOLAC, I'll send you over.” I was just like, “Oh my gosh, yes. This is my dream!” We were so happy. They wheeled us over and it just felt so surreal. We just kept waiting for the rug to be pulled out from under us and someone came in and was like, “No, you need a C-section now. You're not allowed to be over here,” or something. We were just waiting. I wanted this to be another unmedicated birth, but our midwife came in and she told me her plan. She said she wanted to try a small bit of Pitocin to see if I could make the contractions a little bit stronger and then she saw my hesitation and told me, “It's only a small amount to help move things along, but you are not on a time limit. You can take however long you need to labor. It's just to help move things along. The max is 10. We won't ever get to that point.” I was just like, “Okay. I'm going to put my trust in you because my doctor trusts you.” She also asked if she could break my water to help move things along and I felt at ease so I was just like, “Okay. That's fine.” My husband was really surprised I was consenting to the Pitocin and to the water breaking. I told him, “I don't know. All this time, I'm always fighting against my gut and my gut is telling me I can trust them fine and this is going to be okay.” I listened to her plan and I said, “Yeah, let's do it.” They also kept a really close eye on my fluid levels– the thing that the other doctor said was not a thing. It felt good to know that they were actually paying attention to me and listening to me. Karen: The other thing that happened was at 10:00 AM, my sister completed 48 hours of antibiotics so she was able to join us and I was like, “Okay. Everything is going to be okay.” My husband and I were finally able to relax. Meagan: Good. Karen: Yeah. Again, I wanted to go unmedicated but I noticed something about my body which was that I could not relax my pelvic floor. I was so tired. I was so exhausted from the last 48 hours, from the walking, from not sleeping, and from everything. I was just like, “I'm trying, but I cannot relax it.” I was just like, “I think I want an epidural. I think that will relax my pelvic floor and just relax in general.” They gave me the epidural so I was finally able to get some rest. Without even having to ask them, the midwife would come in, put me in different positions, and just do different things to help me get the baby down on its own instead of last time where they just left me lying in there with no instructions. Then around 4:00 PM, they told me I was fully dilated and they were like, “Let's do some practice pushes. Let's just make sure you know what you're doing with your body. We can troubleshoot and then when you're ready, you know what to do already.” I was like, “Yeah. That's fine.” They get everything ready, start doing some practice pushes, and the midwife goes, “Oh, these aren't practice pushes.” 45:20 Pushing for 20 minutesKaren: She starts getting suited up and the room starts filling up with people and 20 minutes later, my baby was out. Meagan: 20 minutes! Karen: Yeah, 20 minutes of pushing. He was 9 pounds so he was still a big baby and perfectly healthy and beautiful. It was wonderful. One thing that my husband noticed was that the whole room was all women. It was such a cool girl power moment. They were all cheering and so happy for me getting my VBAC and it was just a total girl power that we were all like, “Yes. We did it. Girl power! The doctor is a woman. The pediatrician is a woman. We did this.” It was such a cool, surreal moment and then they had other nurses coming in and they were like, “We heard your story. That is so cool you got your VBAC.” It was so, so amazing. It was just such a huge difference having this supportive environment. I don't know. In that moment, it was like an instant feeling of relief because I felt like all of this trauma that I had been carrying with me for so long was just lifted. I felt like I was finally healed and I was able to forgive myself for the C-section and realize, “Okay. You didn't fail at anything. Things happen. You didn't know. It's okay.” Finally, I didn't have this label that I was defining myself with for so long which was traumatic birth. I finally just got to have the birth I wanted for it to be pretty smooth after the drama of the earlier morning. Everything just went perfectly and it was so, so beautiful. I was crying. We were all crying. The doctor was just like, “Okay, is this pain crying or is this happiness?” I'm like, “This is happiness!” Meagan: Pure joy.Karen: That's my story. 47:30 White coat syndromeMeagan: That is awesome. I love that you truly got to end that way surrounded with women and somebody that you really like and just having everyone rejoicing and happy and crying together and having that space be such a drastic change in your first birth. That is amazing. Thank you so much. Did you have any blood pressure issues during your labor at all? Karen: No. My blood pressure was fine. They were keeping an eye on it the entire time and I was getting nervous because I thought, maybe if it should up they would wheel me over to a C-section, but no. It was fine the entire time. Meagan: I love that. It's kind of interesting because there have been times where I've had clients where they don't have any signs of hypertension or preeclampsia or anything like that, but then they go to their visit and then they are like, “Oh my gosh. My blood pressure was just through the roof.” They go home and they are checking it at home and they are like, “It's fine.” But then they go and it's through the roof every time they go. We just had a client just the other day. She's 34 weeks and she went and her blood pressure was pretty high. It really was. It was high. The reading was high and they did a couple of readings. They said things like, “Well, we might have to go to an emergency C-section.” This and that. Anyway, she was like, “Whoa, whoa, whoa, whoa. Hold on.” She was like, “I want to go home.” She went home and relaxed and had food. Her blood pressure was fine. White coat syndrome is a real thing and it's something to take into consideration like, “I never have blood pressure issues. I don't have any signs. I don't have protein. I don't have these things. What may be going on?” I love how your nurse was like, “Hey, can you step out? Go out.” She was very able to relate to that. Then sometimes, we have it and we don't know why. With your first pregnancy, did you have any high blood pressure at all? Karen: No. It was just a very uneventful pregnancy. Everything was perfect. It was very strange for these blood pressure problems to happen afterward.Meagan: Yeah. I think it's called peripartum so it could happen before or postpartum cardiomyopathy. Karen: Yes. Yes. Meagan: That's what I was thinking it was going where the heart muscles weaken and can lead to heart failure progressively. The symptoms include fatigue, hard to breathe, and feeling your heart rush. Those are common. Karen: Yeah, so that's actually what is on my medical records is that I had peripartum cardiomyopathy but my cardiologist was just like, “I don't believe that for a second. Your heart is fine.” She kept an eye on my heart the entire pregnancy and after the pregnancy. Nothing else happened. Meagan: I almost wonder if your heart was under stress. You talked about fluids. We get an astronomical amount of fluids during a C-section too. I'm just wondering if your body just went under a lot with a Cesarean. There was a lot of shifting and a lot of things happening and then of course a Cesarean. It just made me curious because sometimes if you have hypertension before, it can be a risk factor in that. Interesting. Karen: Yeah. That's something that the cardiologist said is that sometimes it gets confused with fluid overload. She thinks that's what happened. Part of the labeling that was happening is throughout my second pregnancy, I kept having to tell people that I did not have blood pressure issues with the first because they kept going, “Oh yeah, well you had blood pressure issues with your first pregnancy,” and I'd be like, “No, I didn't. Stop assuming that.” Meagan: I mean, I am no medical professional by any means, but it makes me wonder if it could have been related to the birth itself. 51:59 Symptoms of hypertension and preeclampsiaMeagan: I'd love to talk about hypertension and preeclampsia and things like that because hypertension is something that happens during pregnancy and it can be associated with lots of different reasons, but sometimes hypertension during pregnancy can lead to preeclampsia or HELLP or things like that. I want to give a little educational tidbit here. Talking about just hypertension. High blood pressure or hypertension does not necessarily make us feel unwell all the time. You can have that and not know. So you walking into your visit and them being like, “You have hypertension.” You're like, “Oh.” It's not completely abnormal to just walk in, but sometimes we might have headaches or not feel super great. If you are feeling crummy or especially if you are feeling like you can't breathe when you lay down or have shortness of breath, do not think that those are all just normal pregnancy symptoms that people who told you, “Oh, yeah. It's a new mom.” You're like, “No.” So follow your body. Trust your body. Preeclampsia is a condition that does affect pregnant women and can sometimes come on after that 20-week mark where we are having some of that swelling. We are having the high blood pressure. We have protein in our urine. That's when it turns into that preeclampsia stage. It's really hard. It's still unknown exactly why preeclampsia or hypertension come, but it's believe to be placenta-related so sometimes our placenta doesn't attach in the full-on correct manner and our blood vessels are pumping differently so we can get high blood pressure. I want to note that if you are told that you have high blood pressure or if you have preeclampsia, that doesn't always mean you have to schedule a C-section. It just doesn't. It doesn't mean it's always the best decision to not schedule a C-section if that makes sense, but that doesn't mean you have to have a C-section because you have hypertension or blood pressure. I feel like time and time again, I do. I see these comments in our community where it's like, “I really wanted my VBAC, but I just got preeclampsia. The doctor says I have to have a C-section.” That just isn't necessarily true. They can be induced. I know you mentioned your one hospital was like, “No, we can't induce because you are a VBAC,” which also isn't necessarily true. 54:52 Tips for hypertension and preeclampsia Meagan: Sometimes we also want to be aware of hypertension or preeclampsia getting worse because labor can be stressful on our body and all of the things. I wanted to just give a couple of little tips. If you have high blood pressure, increase your hydration. Go for walks. Cut out a lot of salts so really eating healthy and then you can get good supplements to help. If you are in labor and you are getting induced or something like that, sometimes you may want to shift gears. Maybe an epidural can be a good thing to reduce stress or a provider may suggest that it's not abnormal. But know that if you were told you have hypertension or you have preeclampsia, it doesn't always mean it's a for sure absolutely have to have a C-section. Even your provider was like, “Oh yeah. We've got this high blood pressure stuff. I really wanted to keep you.” You were like, “No.” Then your other doctor was like, “We'll kick you over here to 38 weeks,” because everything really was looking okay. Yay for that doctor for not making you stay and have a C-section that day. Know that you do have options. Time and time we talk about this. Don't hesitate to ask questions. Ask questions. Can I get a second opinion? Can I go home and relax and take a reading there? Is there something I can take to help with my blood pressure? Those types of things and then following your heart. What does your heart say? That's just my little tidbit. Do you have anything to add? I know you didn't have high blood pressure in the first pregnancy and then you kind of did sort of maybe have white coat syndrome or blood pressure with the second but do you have any tips on this situation? You were exactly in that space of they are telling you you have blood pressure. He is telling you he doesn't want you to go home and that type of thing.Do you have any messages to the audience?56:55 Karen's final tipsKaren: One thing I started doing during this pregnancy was meditation and that helped a lot. Whenever I felt like, “Okay. I'm going to go into a stressful situation,” which was most doctor visits, I would meditate before the doctor came in and that would really help a lot. Meagan: Yes. Exercising, eating, hydrating, meditation, and doing something to bring yourself back down can help. It doesn't always help. Sometimes we have high blood pressure and we do not understand it. We cannot control it as much as we are trying to. It just doesn't want to listen to what we are trying to do or receive the things we are trying to do, but all of these things can help. I am just so happy for you that you found good support, that you found the true bubble of love in your hospital room at the very end, and that you were able to have your VBAC. Karen: Thank you. Yeah. I do want to make sure. I'm not trying to send a message of, “Ignore high blood pressure! Do what you want!” It absolutely can be a very scary thing. If you need to have a C-section because of it, totally understandable. It's just that my big message that I tell new moms is to listen to your body and you are allowed to say no. You are allowed to say no to people and ask for options. But the big one is to listen to your body. Listen to your gut. You know what is really, truly going on with your body. Meagan: Of course, right. And typically, birth is actually the full cure for things like preeclampsia. Getting baby earthside is typically the end of that preeclampsia and the stop. That doesn't mean you shouldn't say, “No, I'm not going to do anything,” but just know that you have options. Induction is still okay typically. Ask those providers about your individual needs. Talk about your individual case but yeah, I would agree. I'm not trying to say, “Don't listen to your provider.” I'm just saying that you have options and you often will have options if they say one thing or another. Don't hesitate to ask questions. Karen: Exactly. Exactly. 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

On this week's episode,  we are joined by Amanda E. White. She is an author and licensed therapist as well as the founder and director of Therapy for Women.  Amanda sits down with us to share her story of pregnancy, birth, and postpartum as she navigated multiple challenges including suicidal ideation, breastfeeding, and HELLP syndrome. On this episode, you will hear:- Suicidal ideation while pregnant and postpartum - Hyperemesis Gravidarum, IUGR Diagnosis, and HELLP Syndrome- Pressure to breastfeed and lack of education on feeding options- Guilt and bonding challenges- Expectations vs. reality of birth experiences- Supportive measures for mental recovery- Advice and wisdom for those in the healing processGuest Bio:Amanda E. White is a licensed therapist and the creator of the popular instagram account @therapyforwomen. She is the author of the book “Not Drinking Tonight: A Guide to Creating A Sober Life You Love.” She is the founder and owner of the group therapy practice, Therapy for Women Center, based in Philadelphia serving clients across the country. In her clinical work, she specializes in working with individuals with substance use disorders and eating disorders. People are drawn to Amanda's unique expertise, accessible approach to healing and mental health. She has been featured in notable publications such as Forbes, Washington Post, Shape, Women's Health Magazine, and more. For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

The porch light is always burning! Camille and Keri have a conversation about listening to our bodies, our “mommy feelers” and our knowing. Motherhood has always been on the horizon for Camille. As she walks the bunk mates through what HELLP is and how she navigated through it, we get a story as inspiring as a West Texas sunset! HELLP, also known as Hemolysis, Elevated Liver enzymes and Low Platelets, can be a life threatening syndrome developed during pregnancy. This results in premature births and many nights in a NICU. Join us now in the Momsday Bunker!   

Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP >140/90 plus end organ dysfunction Treatment

As long as a country mile! Keri talks about the two most important days in her life. Intertwined in motherhood, finding your purpose and keeping it at the forefront of your being, will keep you grounded during times of crisis. In this episode you will learn about HELLP and a little about what our next guest's momsday moment was all about!  

The first time I spoke with Michael, I felt like I was reconnecting with a friend. Like a mental health counselor should be, he is warm, genuine, content and a particularly good listener. Michael is also funny and extremely well read. (Reminds me of another Pitt grad I know — my husband, Patrick Huey: maybe there's somethin' to studying in Pitt's iconic Cathedral of Learning.) And like a good, long-time friend he is unapologetic about his awesome quirks like raising Nigerian dwarf goats and jumping on couches. (Watch the Youtube version to see his agility, y'all!).In today's episode #54, Michael shares his secrets for surviving in a sea of estrogen, which include farm work alongside his super skilled and visionary wife, Caroline, and their daughters. He shares his backstories about being held in the grips of sugar and video games, as well as how he came into his calling of counseling. I really enjoyed learning about how he connects with his patients and uses therapeutic modalities - including humor(!) that match with their interests and personalities to get in a state of flow with them. We of course get into a discussion of how nutrition impacts mental health among all ages; from ADHD to dementia, we see a link between food choices and metabolic outcomes. Bottom line, y'all: ultra-processed foods with their addictive, cheap, inflammatory inputs including toxic seed oils, sugar and all of its forms and cheap “Glyphosated” grains leads to an incredible array of mental and physical health problems. Michael and I end with a discussion of the importance of having a relationship with yourself, and he wisely passes down the advice to “make friends with your mind.” In practice, he has patients describe the characteristics of a good friend, and then asks them to treat themselves in a similar manner. I love this idea and will certainly use it in my practice, where I hear things like “I'm my own worst critic” or “I hate myself when…” or “I'm so bad” all too frequently. This is one of the many reasons why I'm a huge proponent of morning and evening routines; both are an opportunity to practice grounding and gratitude, which go a long way in developing positive self regard. Give us a listen, and let me know what you think as well as send ideas for future shows and guests! If you would like to support his favorite local NC beef farmer, check out Oak Cattle Farms.Remember how I said connecting with Michael is like talking to an old friend? In our conversation, I felt comfortable enough to bring up art piece I did while in the care of a counselor after I experienced postpartum anxiety given my near death experience with pre-eclampsia and HELLP syndrome. Thanks to all y'all who have supported The Nourishment Mindset through your listenership, viewership, reviews and questions and show ideas! If you haven't yet bought the book, what are ya waitin' for?!! You can do so on Amazon or my website for a signed copy shipped for free.LINKS: https://amzn.to/3kDN85z https://www.favorfat.com/nourishmentmindset.html https://headway.co/providers/michael-sisley https://www.therapyportal.com/p/acounselor/ https://www.oakcattlefarms.com/shophttps://youtu.be/GSKXdmDONd4 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit favorfat.substack.com

Episode 156: Obesity, Fertility, and PregnancyFuture Dr. Hamilton defines obesity and explains the pathophysiology of obesity and its effects on fertility and pregnancy. Dr. Arreaza adds some input about the impact of epigenetics on newborn babies.  Written by Shelby Hamilton, MS3, American University of the Caribbean School of Medicine. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition of obesityObesity is a multifactorial chronic disease that is increasing in prevalence across the globe. It can be defined as a body mass index (or BMI) greater than 30 kg/m2. According to the CDC from 2017-March 2020, the prevalence of obesity in United States adults was 41.9%.Classification of obesity by BMI.Obesity can further be divided into three classes: class I which is a BMI between 30-34.9; class II which is a BMI between 35-39.5; and class III which is a BMI greater than 40. We recommend avoiding the term “morbid obesity” because of the negative connotation of the word “morbid.” Class III or severe are better terms in those cases. This classification is based on the individual risk of cardiovascular disease. One of the greatest health consequences affecting individuals with obesity is the cardiovascular effects including hypertension, dyslipidemia, and coronary artery disease. Other effects include insulin resistance and diabetes, cholelithiasis, non-alcoholic fatty liver disease, osteoarthritis, and even depression.How Does Obesity Affect Fertility?Obesity can have an extensive effect on the overall health of an individual. In addition to these commonly discussed effects, obesity can also influence a person's fertility. This is especially observed in women with polycystic Ovary Syndrome (PCOS) who have a greater BMI and also have symptoms of anovulation. Excess adipose tissue plays a role in the effects that obesity has on fertility. White adipose tissue can secrete a specific group of cytokines known as ‘adipokines'. These adipokines include leptin, ghrelin, resistin, visfatin, chemerin, omentin, and adiponectin. With a greater percentage of adipose tissue, there are higher rates of hypothalamic gonadotropin hormonal dysregulation, which can be combined with insulin-related disorders, low sex hormone binding proteins, and high levels of androgens. The combination of these factors can result in decreased ovarian follicle development and decreased progesterone levels.Hormonal changesObesity is an endocrine disorder. One specific adipokine that affects the hypothalamic-gonadotropin axis is chemerin. Chemerin impairs the release of follicle-stimulating hormone (FSH) from the pituitary gland. This reduction in FSH release consequently leads to anovulation, meaning that no egg will be released from an ovarian follicle, contributing to infertility. Shelby: Another adipokine affecting fertility is adiponectin. The receptors of adiponectin are predominantly expressed in reproductive tissues, including the ovaries and endometrium. In individuals with a greater BMI, a decrease in adiponectin secretion has been observed, resulting in decreased stimulation of its receptors, especially in the endometrium, which has been linked to recurrent implantation failure. Adiponectin has also been shown to affect glucose uptake in the liver. With reduced adiponectin levels, there is reduced hepatic glucose uptake, leading to insulin resistance. As tissues become less sensitive to insulin, the body compensates by secreting higher amounts of insulin, leading to hyperinsulinemia. Higher levels of circulating insulin have also been proven to cause hyperandrogenemia in women by blocking the hepatic production of sex hormone-binding globulin. Insulin can also act on the IGF-1 receptors in the theca cells, increasing steroidogenesis, and thus, increasing androgens. With hyperandrogenemia, there is also increased granulosa cell apoptosis as well as increased peripheral conversion of androgens into estrogen. This creates negative feedback to the hypothalamic-pituitary axis to decrease the release of gonadotropins such as FSH which are critical in ovulation.Leptin is another adipokine that is shown to be increased in obesity. Studies on mice have shown that leptin impairs the development of ovarian follicles, resulting in a decrease in ovulation. In these studies, it was also observed that leptin reduces the production of estriol by the granulosa cells in the ovarian follicles as well as increases the rate of apoptosis in granulosa cells, both of which affect ovulation. Leptin decreases hunger, but persons with obesity may be resistant to its effects and that's why they have higher levels than a person with normal weight. They have high levels of leptin but are still hungry because they have leptin resistance.Studies have also shown that the fatty acid composition of follicular fluid found in ovarian follicles also plays a role in fertility. In individuals with a high BMI, this fluid contains high levels of oleic acid, which can cause embryo fragmentation after fertilization occurs. Stearic acid is another fatty acid found in elevated levels in the follicular fluid of women with a greater BMI, which can also affect the quality of the embryo while in the blastomere stage.The bottom line is obesity decreases fertility. It does not mean that patients with obesity will not get pregnant, but it can make it harder to get pregnant. Female patients who are losing weight must be warned about their improved fertility once they start to lose weight.What effect does obesity have on pregnancy?While obesity may make it more difficult for a woman to get pregnant, it is not impossible. However, there are potential risks both to the mother's health as well as the baby's health. Therefore, it is very important to monitor these patients even more carefully.Women who have a greater BMI pre-pregnancy are at a greater risk of developing gestational hypertension. Gestational hypertension is defined as blood pressure greater than 140/90 on more than one reading in the second half of pregnancy. Hypertension during pregnancy can also have serious complications such as kidney failure, stroke, myocardial infarction, or even heart failure. Gestational hypertension can also result in preterm birth or low birth weight.Treatment of mild hypertension in pregnancyRecent studies published in the AFP Journal support the treatment of mild hypertension in pregnancy. It states that “evidence and expert opinion support treating mild chronic hypertension in pregnancy with approved antihypertensives, with a strength of recommendation: B”. There was a randomized control trial with about 2,000 women who were randomized to receive antihypertensive treatment vs no treatment. The treatment group had a lower incidence of preeclampsia with severe features, preterm birth, placental abruption, and neonatal or fetal death. There was not an increase in fetal growth restriction or maternal or neonatal complications. So, it is advisable to treat chronic, mild hypertension in pregnancy, according to the AFP Journal.PreeclampsiaPreeclampsia is another condition that is at a higher risk in women with obesity, which is a more serious manifestation of hypertension in the second half of pregnancy. Along with high blood pressure, there are also effects on the kidneys and liver. Hypertension accompanied by proteinuria is indicative of preeclampsia and should be taken seriously. Preeclampsia can become eclampsia, where the patient also experiences seizures. There is also the risk for stroke, HELLP syndrome, placenta abruption, preterm birth, and fetal growth restriction.Gestational diabetesAnother risk is gestational diabetes. Elevated blood glucose during pregnancy can result in a larger baby and delivery by cesarean. There may also be a greater risk of the mother and child developing diabetes mellitus later on in life.OSAWomen with a greater BMI may also be at risk of developing obstructive sleep apnea during pregnancy. Not only can this result in fatigue but can also contribute to the development of gestational hypertension and preeclampsia.Effect of obesity on the fetusAs mentioned, there are some risks to the fetus in women with a greater pre-pregnancy BMI. There is a greater risk for these babies to be born with birth defects such as congenital heart defects and neural tube defects. Another risk previously discussed is macrosomia, or large for gestational age. Larger babies are also at increased risk for shoulder dystocia during delivery as well as resulting clavicle fractures, brachial plexus injuries, and nerve palsies. Preterm birth is another risk, which also increases the risk of short-term and long-term health complications. Lastly, a higher BMI is directly correlated with the risk of spontaneous abortion or stillbirth.SummaryAs the prevalence of obesity increases, it is important to discuss the health risks that are associated with this disease. In our patients of childbearing age and who may be hoping to conceive, it is even more important to discuss how a higher BMI may affect fertility and pregnancy. While discussing these topics with patients, it is important to try our best to build rapport with the patient so that the discussion is seen more as one of concern and support rather than one of criticism regarding their weight. We may want to help by not only telling patients to “lose weight” or “diet”, but we can also provide them with resources regarding dietary adjustments and ways they can incorporate physical activity into their lives without just telling them to eat less and move more. Stay tuned for our episode on the management of obesity in pregnancy.ConclusionNow we conclude episode number 156, “Obesity, fertility, and pregnancy.” Future Dr. Hamilton explained how obesity affects the hormonal regulation of fertility. She also explained the obstetrical risks associated with obesity. Primary care professionals need to educate our patients about the benefits of preconception weight control. Dr. Arreaza explained that hypertension is a common condition in pregnant patients with obesity and mentioned the benefits of treating mild hypertension in pregnancy. We hope to bring you an episode on the management of obesity in pregnancy soon, so stay tuned! This week we thank Hector Arreaza and Shelby Hamilton. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Gautam, D., Purandare, N., Maxwell, C., Rosser, M., O'Brien, P., Mocanu, E., McKeown, C., Malhotra, J., & McAuliffe, F. (2023) The challenges of obesity for fertility: A FIGO literature review. International Journal of Gynecology & Obstetrics, 160(S1), 50-55. https://doi.org/10.1002/ijgo.14538Pandey, S., Pandey, S., Maheshwari, A., & Bhattacharya, S. (2010). The impact of female obesity on the outcome of fertility treatment. Journal of Human Reproductive Science, 3(2), 62-67. https://doi.org/10.4103/0974-1208.69332.Perreault L. Obesity in adults: Prevalence, screening, and evaluation. In: UpToDate, Pi Sunyer FX (Ed) Wolters Kluwer. https://www.uptodate.com (Accessed on October 6, 2023).Obesity and Pregnancy FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/obesity-and-pregnancy, Accessed on October 10, 2023.Adult Obesity Facts, Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/obesity/data/adult.html, Accessed on October 7, 2023. Dresang L, Vellardita L. Should Medication Be Prescribed for Mild Chronic Hypertension in Pregnancy?. Am Fam Physician. 2023;108(4):411-412. Royalty-free music used for this episode: "I Think We Have a Chance."  downloaded on November 11, 2023,  from https://www.videvo.net/.

Este síndrome se presenta en aproximadamente 1 a 2 de cada 1,000 embarazos

In this episode, we're joined by Josi (she/her). Josi is living with her husband and her four kids aged 9, 8, 8 and 4 in Brisbane. Josi was only 23 when her first daughter was born via planned C-section due to breech presentation. Shortly after she fell pregnant again, this time with twins ! Another planned C-section was her chosen mode of birth, which turned into an emergency c-section at 36 weeks due to suddenly developing preeclampsia and HELLP syndrome.  Thinking that their family was complete, they were very surprised when baby number 4 came along and this time Josi was on a mission to avoid having to have another C-section. Her local hospital was somewhat unsupportive and she changed her antenatal care to a private midwife at 30 weeks and booked into a hospital that is over one hour drive away but is known to be more VBAC friendly.  Josi had her VBA2C, that she describes as a homebirth like hospital birth, at 41+1. They arrived at the hospital with 45 min to spare before their son was born.  Follow our instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@definitelybabypodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠for photos of weekly guests and episode updates and releases. The Definitely Baby theme music was written by Hagan Mathews and produced at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@sleeplessfootscray⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. The photo in the podcast logo was taken by ⁠⁠⁠⁠⁠⁠@maki.levine⁠⁠⁠⁠⁠⁠. This episode was recorded on the land of the Turrbal people and the lands of the Wurundjeri Wilam and Boon Wurrung/Bunurong peoples of the Kulin Nation. Australia always was and always will be the land of the First Peoples. Every month, I Pay The Rent and so can you - click⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠to learn more.

Nicole Purnell from Momma's Voices joins us on the podcast this week. Nicole shares her birth story from 18 years ago, which served as her motivation for getting involved in maternal health advocacy. Nicole experienced Preeclampsia & HELLP syndrome which led to a placenta abruption and the stillbirth of her son at 34 weeks. Five years ago, after many years of volunteering with the Preeclampsia Foundation, Nicole left her corporate job to work for Momma's Voices. Things you will hear in this episode:-Momma's Voices, giving survivors a voice in their experience-Connecting with others who have experienced the impact of  birth trauma-Providing support work through an altruistic lens-How to get involved with Momma's Voices-Tips on how to share your storyYou can learn more about Momma's Voices and how to get involved and support them by following their instagram: @mommasvoicesGuest BioNicole Purnell is the Program Director at Momma's Voices, the first ever maternal health patient advocacy coalition. Nicole shares her story of preeclampsia and HELLP syndrome which resulted in a placental abruption and the stillbirth of her son at 34 weeks. This led Nicole to become a maternal health advocate and has been doing incredible work in this space for the last 15 years.For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

In honor of NICU Awareness Month, I have my friend Brandi Storey on the podcast to tell her story.Brandi lives outside of Fort Worth with her husband, Jamie and two little girls.Brandi's second pregnancy was a little different than her first. She was admitted to the hospital at 26 weeks pregnant for bed rest with pre-eclampsia and started induction 6 days later because of HELLP syndrome. Penny was born at 27 weeks and spent 112 days in the NICU.Brandi suffered from a lot of guilt right after birth and feeling disconnected from her baby. They also struggled with juggling a high risk baby in the hospital all while having a 2 year old at home.She shares the hard & unknowing times, how Jamie & her stayed strong through it all & how celebrating the small victories, lead to the big victory. As well as, advice for couples and families who have a baby in the NICU today.CONNECT WITH HOST:Website: www.mamayouredoinggreat.comIG: @kendahlyanezWant to get connected with other mamas like you?Join the CommunityText the word WELCOME to (833) 264-0911 or sign-up HERE to get a weekly encouragement text delivered straight to your phone!

On this episode, Ebony Ford joins us and shares her journey through infertility, loss, and birth trauma. While pregnant, Ebony was diagnosed with severe preeclampsia and HELLP syndrome which put her in acute liver and kidney failure. Her traumatic, near death birth story and her daughter's NICU journey birthed a passion for advocacy and mentoring. Kayleigh and Ebony discuss the importance of advocacy and support plans especially when considering a subsequent pregnancy and delivery after birth trauma, like Ebony experienced with her son.  You can find Ebony Ford on Instagram: @andweshallreignEbony Ford is a 32 year old Washington DC native. She is the proud wife of  Ryan Ford, gospel artist and mother to her pride and joy, her daughter Reign Victoria. Ebony received her Bachelors Degree in Psychology and Certificate in Pastoral Counseling from Liberty University and is currently pursuing her Masters degree in Forensic Psychology. She hopes that her education and personal experience will allow her to open her own practice and specialize in near death experiences, more specifically birth trauma.For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Brook had a normal pregnancy up until about 19 weeks when she was admitted to the hospital. Her team discovered that she was severely preeclamptic and developed HELLP syndrome. HELLP Syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. It stands for Hemolysis, Elevated Liver enzymes and Low Platelets. Connect with Brook: @the.gonzales.homeSupport the showConnect with Lina on @linaforrestal on InstagramFollow the @newmamaspodcast on InstagramRead Lina's Blog: www.linaforrestal.comSupport the Show: Buy Me a Coffee (https://www.buymeacoffee.com/newmamaspodcast)

We are joined today by Dr. Barry Brock, aka “The King of VBAC” along with one of his VBAC-hopeful patients, Kara. Kara and Meagan ask Dr. Brock VBAC-related questions similarly to how we hope you interview your providers during your VBAC preparation. Dr. Brock touches on topics such as gestational diabetes, big babies, preparing for your VBAC, induction, placenta previa, preeclampsia, HELLP syndrome, VBAC after multiple Cesareans, and vaginal breech delivery. Additional LinksNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsThe VBAC Link Facebook CommunityFull Transcript under Episode DetailsMeagan: Hello, everybody. Welcome, welcome. We have a really cool episode for you today, an episode that we have been really anxiously waiting for and so honored to be having. We love having birth professionals on the podcast and today we are so honored to have Dr. Barry Brock chatting with us today about birth and VBAC and all of the things. And then we have an extra special cohost today, Kara Sutton, who is actually one of Dr. Brock's patients. Hello! Kara: Hi guys. I'm so excited to be here. Meagan: So excited to have you guys. I just wanted to share a little bit about the amazing Barry Brock before we get going into all of these amazing questions that this community has asked. Dr. Barry Brock has been a doctor for over 30 years and has experience in obstetrics and gynecology. He has been attending as a doctor at Cedars and I believe Dr. Barry Brock, you had your residency there, right? Dr. Brock: I did. Meagan: That's really cool so you've been there for a while. Dr. Brock is amazing and takes pride in giving quality care to all of his patients. Seriously, one of the coolest things—I mean there are a lot of cool things—but especially with me in the VBAC world, one of the coolest things to me is that you have an outstanding Cesarean rate. It's very low. I think that's one of the things that you are very well known for along with helping people have vaginal breech deliveries which we know is kind of trickling out in the world and vaginal twin deliveries and of course, VBACs. So welcome, Dr. Brock, and thank you so much for being here with us. Dr. Brock: It's my pleasure. Meagan: Oh my gosh. Yes, and as I mentioned, we've got Kara who is a patient of Dr. Brock. Kara, tell us how it is to be a patient. Kara: I am a mom of two. I had an emergency and I had a planned C-section due to PTSD from that first emergency C-section. Now I am four months pregnant with my third baby girl and Dr. Brock is my doctor. I'm excited to try and achieve a vaginal delivery with this one. Dr. Brock has the LA rep as the go-to VBAC doctor if you're trying to achieve VBAC so that is why I am seeing him. I switched doctors specifically for this pregnancy which I think is super important to find the right doctor. I feel really excited and comfortable with Dr. Brock for this particular delivery, especially after the trauma from the first two. For those of you guys who don't know, Cedar Sinai is a really famous hospital in LA. We're in Beverly Hills here today. Everyone from Kylie Jenner allegedly and Jay-Z and Beyonce and all of the people have delivered there so he's kind of a rockstar. So I'm excited. Meagan: Yes. Oh my gosh. It is such an honor. Such an honor so thank you both for being here.Kara: Yeah, so I kind of wanted to jump in right away and wanted to ask Dr. Brock, why do you think the national average C-section rate is so high and why do so many doctors just schedule a C-section? Dr. Brock: Well, the docs are very concerned about a healthy baby and a healthy mother. It takes the stress off of the doctor if there are any problems getting the baby out, but there's no evidence that we've improved the Cesarean section. We have massively increased the Cesarean section rate and we have not improved the fetal outcome. So obviously the system that we're going with here needs to be tweaked a little bit. But they also need experience. To do a vaginal breech delivery, you have to have the skill and expertise to be able to do that and if you're not doing that, you don't have the skills so for a lot of doctors, for them, it's safer to do the Cesarean section than to do a vaginal breech delivery. I understand that. You're not skilled. Among the criteria that the American College of OBGYN recommends is that if you're doing a vaginal breech delivery, you have to know how to do it. Of course, if you don't do it, you don't get it done. Another thing is that doctors are very concerned with fetal monitor tracing and they are concerned about the baby's health and well-being. So when the baby comes out, the other side of the coin is that we do lots of Cesarean sections for fetal distress but most of those babies come out screaming. Well, you can say that we saved this baby from getting in trouble or we did an unnecessary Cesarean section. Remember there is also the mother's health and the baby's health. There's a higher risk to the mother's health– ten times greater having a C-section than a vaginal delivery– but extremely rare. So that's not a major factor. You say ten times greater but the incidence is so low. It's much greater that you walk outside when it's raining and get hit by lightning. But still, in LA, it's a very rare thing so I'm not concerned about that. Doctors want the best for the baby. It seems like this. A lot of the time they can get away with a Cesarean section. Some insurance companies pay for more Cesarean sections. You don't have to go ahead and spend hours and hours in labor. My philosophy is a little different. But you need the skill and expertise. That's when obstetricians can deliver a healthy baby vaginally. Meagan: Yeah. Wow, I love that. I feel like we could do a whole podcast just on this question alone because it is such a big question. Like you said, I love that you touched on what if we've got a Cesarean but the baby comes out screaming? We've had people say, “I've had this emergency C-section but then my baby had an 8/9 APGAR so was my baby in distress?” So thank you so much for touching on that. Another big question that we have that a lot of people ask is the big baby question. What if I'm being told that my baby really is too big to give birth vaginally? Is that really a thing? What's the accuracy on that and how would I know if choosing a Cesarean is the right choice versus going for a vaginal birth after a Cesarean? What's the safety there for the baby?Dr. Brock: Well, a major concern is– the American College addressed that. It is with mothers that are diabetic and have gestational diabetes. If the baby's over 4500 grams, which is a very big baby, then consideration should be for Cesarean section for the risk of shoulder dystocia. But that's it. At 5000 grams, if you do not have gestational diabetes, that's a huge baby. Kara: What is that in pounds? Meagan: It's like 9 pounds. Is it 9?Dr. Brock: 12 pounds or something like that? It's a huge baby. Meagan: Yeah, anything over 11 is an extra large baby, and then at 9 pounds, 15 ounces is where they start paying attention, right? Dr. Brock: Yeah, but the biggest problem with shoulder dystocia is if you have a very large baby and you do a mid-vacuum or forceps, then the incidence of having shoulder dystocia is very high, like 25%. But most of the time, mother nature goes ahead and plants the hat and wants a vaginal delivery. It'll tell you. Maybe it's stuck or something like that. But to me, it's always worth a try because basically, you're saying that mothers who are diabetic would have died in labor. Mother Nature knows what to do. When you give it a chance to prove it, I've seen it all. I've had a mother who had two Cesarean sections for a 6-pound baby so she really wanted a vaginal delivery. I waited and waited and waited and she delivered her 9-pound baby.  Mother Nature knows what to do. Meagan: Right. So for gestational diabetes, maybe if they are controlled and everything is looking good and the baby doesn't look like it's 12-13 pounds or a really large baby, you still feel that it's reasonable to go for a vaginal birth? Dr. Brock: I practically always think it's better for a vaginal birth. I mean, there are exceptions. I do VBACs after two Cesareans. I don't do it after three. The incidence for you to rupture after one Cesarean is 0.5-1% which is very small. For two Cesarean sections, it's 5% but then it climbs dramatically after that so I don't do that. Obviously, you have to look at if the placenta is implanted properly. If the patient is of an abnormal presentation of the placenta with placenta previa or accreta. Accreta is when the surface of the placenta digs itself into the wall of the uterus and that presents a major problem. That's a good idea to get a good center who knows how to handle it. Meagan: Absolutely. Dr. Brock: But Mother Nature– give it a chance. Meagan: Give it a chance. Kara: I'm interested. So why won't all doctors induce VBACs? What's the best method for induction and what should I do if my doctor refuses? Dr. Brock: I induce for medical reasons. When someone has a previous Cesarean section, we don't give prostaglandins because that has shown an increased chance of rupture. I much prefer all my patients to go into labor spontaneously. I sign for a lot more testing after 40 weeks. It depends if we find medical problems but they'll test twice a week to make sure the fluid's normal, the Doppler flows are normal, and the NST are non-stress tests where we see baby's heartbeat. I consider 42 weeks as normal. If someone's, like I said, diabetic, I'll do 40 weeks unless there are other problems. But I prefer them to go into labor naturally because I think it's easier on the mother and it's a higher success for a vaginal delivery. But saying that, this week, I've had a mother who had a baby who was abnormal and it was going to be fine. He needed heart surgery. She had two previous Cesarean sections. We induced her and she had a vaginal delivery. The baby, thank God, is doing fine. We will do heart surgery probably in 3 or 4 months. Each person's different and we have to take everything into consideration. Right now, I like to wait for Mother Nature to do its thing. Keep an eye on Mother Nature, but let mother nature do its thing. Meagan: I love that. Keep an eye on mother nature, but let Mother Nature do its thing. Because we do, we have so many people writing in saying, “My doctor says I have to have a baby by 39 weeks spontaneously or my chances of VBAC are completely out the window and I have to schedule a Cesarean.” It puts people in a fight or flight mode where they are out there trying to do all of the things to try to be induced but it's not working because their body is not ready when really what we need to do is step back and let Mother Nature do its thing. Dr. Brock: Well, there are exceptions. Obviously, someone who is sitting in my office and is 3-4 centimeters dilated and she's 39 weeks then she's an easy induction. If you're closed and high, then don't rush to an induction. Meagan: Right. Right. Dr. Brock: For each person's safety, individually you have to do that.  Meagan: And that is one of the most important things I think any provider out there should view is that everyone is an individual. I'm not the same as Cara and Cara's not the same as this mom that just had her VBAC after two Cesareans. We're all individuals and have different situations. So one of the big questions is breech. If we have someone that is having a breech baby or their baby is breech and not turning, a lot of people just have these repeat Cesareans and we know that you are really big in supporting that. Obviously, there are again, things that have to pan out. But why do you think breech is really going away? If someone is having a breech baby, what can they do to help avoid that C-section if they don't have a provider like you that's maybe more supportive of having a breech delivery?Dr. Brock: Well obviously, because in today's society of birth, people don't have the skills to do a breech delivery. You can't have a breech delivery unless your provider knows how to do it. The first thing I want to do is try to turn the baby. At 37 weeks, we will schedule you. We do it at 37 weeks because statistically if the baby hasn't turned at 37 weeks, there is less chance that he will do that. Also, the fact that if something happens in a version– I've done hundreds of them and I've never had a problem but theoretically if something happens and we do a Cesarean section, baby is at term at 37 weeks. That's the first thing I would do. With the breech delivery, I treat a breech delivery– I don't care if it's a first-time mother or a second. I do the same thing. Just like Kara, when she gets around 6-7 centimeters dilated, which means the active phase of labor– she can labor at home or wherever, but once she gets to 6 or 7 centimeters, I want everything to go quickly. What I mean is that I want her to dilate quickly. I want the butt to settle down quickly and I want to push her out quickly. You're not going to push for 3 or 4 hours. I'll do that for first-time mothers or with any mother head-down but not with a breech. I want it to go quickly. A lot of babies don't do that, but that's where I stay safe because if it flies out, it flies out. The biggest problem with breech delivery is that the head is coming last. The cord is beside the head so you've got to get the baby out quickly. Using those criteria, I've had very good success and no problems, but I've done many Cesarean sections because obviously, I remember one patient who came in. She was 9 centimeters. It was fantastic. She was doing great. She started pushing and all that came down was the testicles. So I sectioned for a 10-pound baby. So mother nature is telling you, “Just because you're committed to a vaginal delivery, you don't drag the kid out.” The idea is to let the baby do its thing. The reason we want butt down, especially in first-time mothers, is that if it's not his feet coming out, the cervix may dilate to 6-7 centimeters and the feet come out and the body comes out and the cervix is not fully dilated when it gets to the head and it gets trapped. The cervix never clamps down. It just never fully dilates. That's why we usually don't do footling breech. We don't do vaginal delivery. There are exceptions, but rare exceptions. If a multiparous patient comes in and the feet are there and the cervix is completely dilated, the baby just falls out. That's really an exception to the rule. The other concern with a footling breech is especially if the mother is dilated, that patient is concerning because if the water breaks and she's dilated and just the feet are there, the cord may fall out. It's called a cord prolapse. That's a contraindication to try to do something at home. If someone is dilated and footling breech, that's the kind of patient I would bring to the hospital and do a C-section for cord prolapse. Meagan: Yeah, which makes sense. There are not a lot of you out there that will support or is trained and educated in vaginal breech delivery and from what we're gathering is that it's not really being taught a ton in medical school anymore. Is that correct? Dr. Brock: Well, not in my residency. I mean, I may offer to do that but it's easier. I mean, you schedule a C-section. You walk in. It's an hour. You're done versus spending 8, 10, or 12 hours laboring this patient. So the incentive isn't there to do that. So the skills are disappearing. I mean, I've offered to come in and assist anyone who wants to do a breech delivery and I've done that but not that often. The residents are always invited. They can do that but just because they do it in residency, it's a big staff to get through. They may do one or two breech deliveries but they don't feel comfortable to keep on going out in the private practice. It is dying out. Meagan: Yeah. It makes me sad. It makes me sad. Kara: I have a question because I have had two C-sections. How long should somebody wait to conceive after a C-section? I've heard mixed things about this. I've been told mixed information about this and I just would love to hear your point of view on that. Dr. Brock: Well, there's some data to show that ideally it is two years apart but everybody's facts come into play. For someone who is much older and has trouble getting pregnant, if someone had a baby at 40 and wants another child if she is waiting until 42, she may never get pregnant. I've not found it to be a big factor but statistically, it does seem to be safe. I would do psychologically what's better for you how far apart you want to have your kids. Besides, mother nature does help. It takes some time to get pregnant as you get older. Kara: Great. Is the thought that the longer you wait, the more healed your C-section scars are and your uterus is stronger or is that not real? Meagan: Like is there less chance of rupture that way? Dr. Brock: Literature is in my mind, not that clear. Statistically, it's probably true but it's like saying you're at a greater chance of dying if you're driving at 58 miles an hour instead of 55. It's true, but statistically, is it really a factor? Meagan: It's not substantial. It's not anything that's a concrete yes or no. Okay, and talking about VBAC after two Cesareans or more, what are the complications surrounding a C-section or even a repeat C-section? We talk here a lot about the risks of VBAC– rupture and things like that– but we don't talk a lot about complications, especially even years later. Are there complications for people who have had Cesareans even years later? Dr. Brock: Years later, I don't know much about that. I do know the higher the Cesarean section rate, you're going to have an increase of abnormal implantation of the placenta from accreta or things like that. It goes up. Instances of rupture with more Cesarean sections go up. I've done Cesarean sections, 5, 6, and 7 Cesarean sections. It depends. The doctor who goes in there with all of the scarring, while it's very, very difficult and dangerous, it may pass on to the next time, but most of the time, it's not a problem at all. I have no limitations per se on how many Cesarean sections someone can have. I have a patient right now. She had a Cesarean section then I did a VBAC. Now she's pregnant again but she wants a repeat Cesarean section because she had anal problems and she had surgery so her surgeon recommended that she doesn't try for a vaginal delivery. I'm not 100% in agreement but I have no problem respecting her wishes and we set her up for a Cesarean section. Each case has to be individual. There are no absolute rules for anything. As far as consequences, most of the time for later on, there is but it's more related to how many times you get pregnant, not how you deliver. Bladder dropping and things like this, each pregnancy puts a toll on that. I think mother nature plans for you to have your first kid when you get through puberty. I think it's a very bad idea for 13-year-old kids to have kids. But mother nature, that's the whole plan. That's the animal kingdom. That's what we do. Of course, for millions of years, you were dead at 20 but that's a different story. Meagan: So kind of piggy-backing off of that question too, we had someone write in talking about how she had a Cesarean and then they went in for a second Cesarean but they didn't use the same incision so she's got two incisions which I had never actually heard of, in her uterus. In the uterus, they cut a different spot is what she said. She's asking– okay, so now she's got two incisions in her uterus. Is that something that would be suggested for her to VBAC because she'd really like a vaginal birth? Dr. Brock: No, that's fine. First of all, the patient doesn't know about the scar on the uterus. It's the doctor. When I go in there unless someone had a vertical incision and there's no such thing as a classical. They call it a classical incision, but that was done 100 years ago and they went up and down incision on the belly and they went up and down incision on the uterus. The top of the uterus is the fundus is what we never do. That's at a much higher instance of uterine rupture. We used to do that. Somebody added, “Once a section, always a section.” That's where that falls. I would say 95% of Cesarean sections are low-transverse. They are very low on the uterus. But when I go down and do that, I see the bladder there. I don't know where the last Cesarean section was. I can't see. I just tape down the bladder and make an incision so I have no idea in the uterus. But we do know that, like I said, during Cesarean sections and repeat, it's not a problem. We do know that.I've given it to patients that had previous fibroid surgery. The American College recommends, what is the indication for the surgeon? Does he recommend you for vaginal? He should tell you that. My philosophy is when I do that, it depends on if I enter the cavity of the uterus and whether I would recommend a Cesarean section. Sometimes the fibers outside of the cavity, I have no problem recommending a vaginal delivery. I've done vaginal deliveries after another doctor did multiple fibroids laparoscopically. They sewed it up and I asked him. He said, “Well, it should be fine. We did multiple scars and she did great.” Yeah, individuals.Meagan: Exactly, yeah. Thank you. Kara: I have a question. I did not have supportive providers in regard to my first two deliveries. I had an emergency C-section and then a planned C-section and nobody brought up that I could deliver vaginally or any of that. I just felt like I had a C-section so I had to have one the second time around. So I wanted to know what are the ways to really help someone find a provider who actually tries for that? I think a lot of women can't find the right doctor who can do that. Meagan: Yeah. Dr. Brock: It's hard to say. Some hospitals publish the C-section rates of their doctors. That's one way to look into it. But blogs and things like this, you have to talk to your doctor and see what's comfortable. You can't force your doctor to do something he's not comfortable with. Many years ago, one of the doctors, an old-time doctor, refused someone to do a VBAC because he had a bad outcome with a baby. Your personal experience comes in. Everyone's trying to do the best thing. They're trying to do what's safe for you and your baby. You just have to find a match that works for you. Kara: When you're interviewing your doctor, what are the types of questions you can ask to get a sense of his or her skill level with it or comfort level with VBAC? Dr. Brock: Well, I've had a patient come in. She had three previous Cesareans sections. She wanted me to do a vaginal birth. I said, “Don't. My limit is two.” They have it out to think that it's the same but it's not. It's about talking to your doctor and asking them personally. “I'm thinking about having a VBAC. What do you think about it?” You want to be comfortable with your doctor and listen to his advice, but there are different opinions out there. If you're comfy with your doctor and you trust your doctor, I have no problem if he feels that he did a section and recommends another section, I understand that. We do know that certain things that change behaviors. They talk about measuring the thickness of the scar, of the uterus, and things like this. A study just came out that found no correlation whatsoever. Meagan: I was going to ask that. That is a huge question too. “My doctor said I can't because my thickness isn't thick enough.”Dr. Brock: Well, there was no correlation. It made me nervous. I had one who had a scar. They said she had a window in the ultrasound. She had two previous Cesarean sections. I delivered her baby vaginally no problem. After that article came out saying there was no correlation, and my experience showed there was no correlation but each case is individualized. I may have a previous rupture and that's a different story. There is no good literature on that and it's probably not worth the risk. Meagan: Right. What about single and double sutures?Dr. Brock: The data shows that I will always use the double closure. The only thing I would make an exception for is that sometimes when they get their tubes tied and it will save some time while having a C-section or vaginal delivery. But no, literature says that double closure has lower chances of rupture. Meagan: Would you support someone wanting to VBAC if they had in their op reports a single-layer suture? Dr. Brock: Yes, I would. A higher instance doesn't mean it's going to happen. As all patients, with this one especially, when you have a previous Cesarean section, I don't want you to deliver at home. *Inaudible* Usually, it's not unreasonable to place an epidural catheter in. Not actively, but if something happens, we can just give you some medication so you don't have to put them under general anesthesia. Just to be prepared.Meagan: Right, right. Be prepared. Kara: You prefer that they labor at the hospital and not at home? *Inaudible*Dr. Brock: Yes, yes. Right, because that's a concern we have. The baby will tell us something. I did a VBAC last night and she's not that tall. She's only about 5 feet. This baby seemed huge but it was way out of bounds. The reasons are that the pelvic, mother nature doesn't know about these Cesarean sections. So first-time babies go down low in the pelvis. The cervix is firm and holds the babies in there prematurely but after the first delivery, the cervix can get soft so mother nature keeps an eye until you go into labor otherwise you'll deliver prematurely. But that's when the head is high. The higher the head is, that's going to put pressure on the scar. I feel much more comfortable as the head drops in the pelvis, it's getting below the scar, and the chance, I think, of rupturing drops dramatically when the head drops. But mothers may not drop until they go into labor. Meagan: Right. Talking about preterm, if someone had a preterm Cesarean birth, are they a candidate in your eyes for a vaginal birth after a Cesarean? Dr. Brock: It depends on how premature. Babies vary with premature. We talk about if she didn't go into labor, and they had to have it done. It depends on the thickness of her lower uterine segment. The doctor goes in. He may feel like there's not enough safe room to make a transverse incision so he has to do a low vertical. The low vertical is associated with a lower instance of rupture. Mind you, before we say you have to find your records and find exactly what type of scar on the uterus it is. But now, American College says, “No. If you had a previous Cesarean section, unless you know that it's a low vertical, then you can try for a vaginal.” If it's a high vertical, definitely. Low vertical, it is a little different but we have to wait and see. I'm not against going for a repeat Cesarean section if someone had a 25-week Cesarean section. If the lower uterine segment was not developed, the doctor did it appropriately. There is no harm to the baby coming out low vertically extended up. Meagan: Right. That makes sense. Cara, did you have another question? I know that we were talking about it before. Kara: I was just wondering if I'm preparing for a VBAC, which I am in four months. Is there anything you recommend that patients should do to prepare for a VBAC? That's something I think about all of the time. Is there anything that patients should do to prepare for that? Dr. Brock: There's nothing. There's really nothing that you can do.Kara: No running?Dr. Brock: You don't want to gain too much weight during pregnancy. The more weight you gain, the bigger the baby so that's a major factor. If you start gaining 40, 50, or 60 pounds, then the baby may be bigger and things like that. Most things to prepare are like with any pregnancy. Get yourself into shape before you're pregnant. Get your weight down before you get pregnant. Those are major things that you can do. Once you get pregnant, we tell you not to gain too much weight, but we don't want you to lose weight. Exercise can always be done during pregnancy, but I always prefer getting into shape before you get pregnant. Kara: No one ever tells you that. I swear. Or at least no one's ever told me that. I think that's a good thing to know. Dr. Brock: Yeah, because you're slim. Meagan: Yeah, well just being healthy overall and overall healthy. That's not even just for VBAC. It's just if you're going to have a baby, try overall to be healthy in general every day. Even if you're not having a baby. Good nutrition and all of that. Preeclampsia is something that is sometimes developed. Is that something that someone could TOLAC and have a VBAC with? Dr. Brock: Yes. It really depends but nowadays, with previous history, we give baby Aspirin and try to lower the incidence of recurring. We keep track of the blood pressure throughout the pregnancy. But yes. If I knew the cause of preeclampsia, I'd win the Nobel Prize. It's the mystery of mankind. We know it's associated with first-time mothers, elderly mothers, and twins, but we don't know exactly the cause. All we can do is keep an eye on it and make sure it doesn't occur. Now if it does occur, unfortunately, the delivery for that and the treatment for that is delivery. Meagan: Right. This is a spinoff but HELLP syndrome. If someone develops HELLP syndrome and their platelets are good and everything, are they still candidates for VBAC or is a Cesarean delivery really safer? Kara: Can I ask, what is that? Dr. Brock: First of all, it's a subset of preeclampsia hypertension *inaudible* where the mother can get elevated liver enzymes and low platelets. That is an absolute indication that we have to deliver the baby. Okay? Now, people go ahead and say, “Oh, well you were *inaudible* delivery. We should do a Cesarean section.” I have nothing against doing that but if a patient is, it may take a long process because she's not ready, but I think that she has to be managed in a hospital, her blood pressure is under control, and she has to go for delivery. Now, it may take a day or two and maybe she's not willing to wait that long or her doctor isn't or things like that, but I have no problem as an independent event to have a vaginal delivery if you have HELLP but it's definitely an indication. Meagan: Yeah, isn't that really the only way to help is to get the baby out? Dr. Brock: Correct. The only way to help HELLP syndrome is to get that baby out. Meagan: The only way to help HELLP syndrome is to get that baby out. Yeah. Okay, that is so good to know. It's not as common in our community, but we have definitely seen people ask and then they worry about the platelets and surgery. They never know what's safe or not. Dr. Brock: The other thing is that if the platelets are low or under 100,000 the anesthesiologist is very leery of putting in an epidural. The reason that over a spinal is because platelets are used to clog your veins and if he hits a blood vessel in your spine putting it in, then it can cause damage and cause paralysis so they really don't do spinals. They do general anesthesia, not regional anesthesia if someone has low blood platelets. I had a patient who had very low platelets not from HELLP, *inaudible* and she couldn't get an epidural. We definitely didn't want to do a Cesarean section because she had low platelets so we did it the old-fashioned way. She didn't have an epidural. She had a vaginal delivery and it hurt. Meagan: Yeah, well that's good to know though. That's really good to know. So as someone who's had a vaginal birth after two Cesareans myself and obviously Kara is preparing, we talked a little bit about how to prepare. But is there anything that we need to know? We talked a little bit about the risk earlier but is there anything that we need to know about vaginal birth after two Cesareans that we may not hear about with just VBAC after one?Dr. Brock: I mean, like you said. The risk is higher. The doctor who might be a little nervous or leery obviously, stress shows that doing a Cesarean section may be higher which I understand. If there are concerns, he may cross-match for blood and have it available in case you need that. That's how the doctor is not the issue. Like I said, labor in the hospital and not at home because if something happens, “Oh, I'm five minutes away from the hospital,” but that's not true. You may be five minutes but you're at least 45 minutes before you can get the baby out. You try to hold your breath for 45 minutes, so that's why in the hospital. But like I said, everything is done before you get pregnant. Try to get in the best shape you can and not gain too much weight and make sure the baby isn't huge. If someone had a macrosomic infant and is diabetic, the doctor may take that into consideration. Meagan: Right. We have a lot of people in our community that don't have the support in their area and do find themselves having to travel long distances to their provider that is supportive. I think a big worry is uterine rupture. We talk about uterine rupture and it sounds really scary. We talked about getting to that hospital as soon as you can. But for those who are driving or are further away, are there any signs or symptoms that you would say, “Okay, you need to seriously deviate your plan and go to the nearest hospital at this point?”Dr. Brock: Well, certainly massive bleeding. If you go ahead and have searing pain, that would be from the uterus. There are no absolute signs of anything, but stars up early, that's why you go in early so these things don't happen. Thank god the instance of rupture is very small. In a hospital setting, even with a rupture, there's no guarantee that the baby is going to get in trouble but it's considered a greater risk. If you're not in the hospital, it's a risk to the mother's health and the baby's health. But the instance is small. But common sense is. If you've had four Cesarean sections and now you decide you want a vaginal delivery, you're putting yourself at greater risk. It's not worth the risk. Babies don't do well if mommies aren't around so you want to make sure you're doing fine. Meagan: Make sure everyone's good. Yes. Awesome. Kara, do you have any other questions, especially as a patient? I'm sure you guys have this time in the office to ask as well. Kara: We have an appointment right after this. No, I just feel really grateful to have found Dr. Brock and I really feel that I wish more doctors were as skilled and as knowledgeable as you are. I am really, really impressed with your experience level and your support of mothers trying to do things the way they want and the way were made to do. I'm just very grateful and thank you for being with us today. I know how busy you are with eight deliveries this week. Meagan: Literally, I know. You just had births last night. I'm sure you'll have births today. It's always such an honor to have birth professionals on the podcast because these people who are listening to the podcast really are in a very vulnerable state and want to get all of the information. So it's so fun to have a skilled OBGYN here answering these questions from the community. It really does. It helps people guide and feel better. Honestly, just hearing the support you have, no wonder you're the VBAC king in LA. Dr. Brock: There are a lot of other people who do VBACs. Kara: You're being humble. He's being humble. Meagan: There are. There are a lot of people out there that do VBACs but it does seem to be harder to find people that do VBACs in the manner that you do like, “Let's monitor mother nature, but let's let mother nature do its thing.” It doesn't seem like you have a lot of restrictions. We have a lot of providers out there that do have a lot of restrictions so it's humbling to hear that you're like, “Hey, let's do this. Let's trust the process. I'm going to be here. I'm going to guide you along the way and I'm going to monitor but I want what's best for you and I want to listen to what you want to do and I want to support you.” Thank you so much for being that person for this community. Dr. Brock: Well, the other thing that I was saying is that for someone who is in labor, I do monitor the baby. It's not intermittent monitoring because that's how I keep track of the baby. The other thing I do when I do the tracing is that a good baby can look bad on the tracing, but a bad baby cannot look good. So you have to understand that. If a baby is a healthy baby and has some variation but it comes back and it's back to normal, that's a healthy baby. But even with the worst tracings, statistics say that 50% of the time, the baby gets in trouble. But just a terrible tracing, follow your doctor's advice and do what he says. But still, hopefully, results will come back good. Meagan: Right. Standard practice all over the world really is continuous monitoring with VBAC because we know that fetal heart dropping and distress are one of the main signs that something, some separation may be happening. If you're listening, know that it's pretty standard. That's pretty standard care all over the world. Dr. Brock: It keeps your doctor's *inaudible*. If you're not monitored, we don't know what's going on. Meagan: Right, yes. Okay, well thank you so much for taking the time out of your day and being with us. We really do appreciate it. Dr. Brock: All right, have a good day then. Kara: Thanks, Meagan. Meagan: You too. Bye, you guys. 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

After being faced with some unusual circumstances and having to ask for help recently, I found myself struggling unexpectedly. What I found was surprising to me, and opened an awareness to whole set of beliefs that I didn't know I had. Today, I am going to reflect on how these beliefs were showing up for me every day and affecting my home life, work life and relationships.

On today's podcast, we discuss how Britany went from mild preeclampsia to emergency c-section at 32 weeks in under 24 hours. No this episode isn't here to scare you about pregnancy- it's here to give you a personal, realistic insight into what preterm birth can look like - both the good and the bad - everything from successful emergency c-section reactions to postpartum bowel movements to milking your tits like a cow because that's what you become if you chose postpartum: a milk factory. Please note Britany is not a doctor. If you have any questions regarding your pregnancy, preeclampsia or HELLP a discussed in this podcast, please talk to a medical professional.CONNECT WITH BRITANYhttp://www.instagram.com/britanywilliamshttp://www.tiktok.com/@britanywilliams

​​Having a premature baby or a newborn who spends time in the NICU can be a traumatic and emotional experience for parents.In this week's episode, Tara speaks with Jodi Klaristenfeld, founder of FLRRiSH, a platform that offers support and resources for parents of premature babies. Jodi shares her personal story of having a premature baby due to a rare and life-threatening form of preeclampsia and HELLP syndrome, and how she created FLRRiSH to help other NICU parents. Tara shares her own experience of being a NICU mom as well. The conversation highlights the need for more awareness and resources for parents of preemies, and the crucial role that support plays in their journey. Over 80% of NICU parents have some type of mental health issue within the first five years after their child's NICU stay, yet there is not enough support for parents in this situation. Jodi emphasizes that being a NICU parent is a beautiful experience because it allows for a unique bonding experience with your child, but it also comes with its challenges and emotional toll. She encourages parents to seek help for themselves and their children without shame and not to compare their child's progress to others.If this story resonates with you or if you want to learn more on how to support NICU parents, listen to this episode. Links:https://www.flrrish.com/https://instagram.com/flrrishhttps://facebook.com/flrrishhttps://linkedin.com/company/flrrish-inc/ Follow & DM me @modernmomprobs Pick up my book Check out modernmomprobs Shout out to Citizens of Sound Leave a review

It's preeclampsia awareness month, so of course I had to talk about it on this week's podcast episode.  One of the complications of preeclampsia is HELLP Syndrome, which stands for "Hemolysis Elevated Liver enzymes Low Platelet" syndrome. HELLP syndrome can be very dangerous in pregnancy because it is associated with bleeding complications, stroke, and even death! Check out this episode to learn all about this serious complications of preeclampsia, how it's diagnosed, and how it's treated.  Download and listen now... and don't forget to share with your friends!See omnystudio.com/listener for privacy information.

It's preeclampsia awareness month, so of course I had to talk about it on this week's podcast episode.  One of the complications of preeclampsia is HELLP Syndrome, which stands for ""Hemolysis Elevated Liver enzymes Low Platelet"" syndrome. HELLP syndrome can be very dangerous in pregnancy because it is associated with bleeding complications, stroke, and even death! Check out this episode to learn all about this serious complications of preeclampsia, how it's diagnosed, and how it's treated.  Download and listen now... and don't forget to share with your friends!See omnystudio.com/listener for privacy information.

Pre-eclampsia affects more than 200,000 pregnancies every year, just in the US alone. Dr. David Berry, a maternal fetal medicine doctor, helps us kick off the first of a four-part series where we dive into the intricacies of this disease by sharing symptoms, signs and treatment options.   In this episode, we chat about: What is pre-eclampsia and how is it diagnosed? As a Maternal Fetal Medicine doctor, what percentage of your patients are affected by pre-eclampsia? How does that compare nationally? Why do we see more women of color, particularly black women, affected at a higher rate than others? In 2022 The New Yorker published a story about the rise of pre-eclampsia cases during and post-COVID. How much of that is due to better testing/diagnostics and how much is it really rising? And what does that mean for moms-to-be? What is HELLP syndrome? How difficult is it to accurately diagnose? What should women and their doctors be on the lookout for in the third trimester and after birth? What are the treatment options for pre-eclampsia? If a woman suspects she has pre-eclampsia or is diagnosed with it, what should she be asking her doctor? What's your best advice to a woman diagnosed with pre-eclampsia?   Dr. Berry is a specialist in maternal-fetal medicine, a branch of obstetrics that manages and treats complicated and high-risk pregnancies. He is a native Texan and moved to Austin in 1978. He graduated from the University of Texas followed by his medical training in Galveston, Ft. Worth and Houston. He was the founder of Austin Perinatal Associates in 1997 and has served the women of central Texas with complex pregnancies since that time. He is an expert in pre-eclampsia, critical care obstetrics, cancer in pregnancy and cervical cerclage, and currently is employed under Texas Children's Hospital as they expand their footprint into central Texas.   New Yorker article: https://www.newyorker.com/science/annals-of-medicine/why-a-life-threatening-pregnancy-complication-is-on-the-rise   Connect with Dr. Berry: Website: https://women.texaschildrens.org/program/maternal-fetal-medicine/locations   The NICU is hard. We're here to help.   Hand to Hold is a national nonprofit dedicated to providing neonatal intensive care unit (NICU) parents with personalized emotional support, educational resources and community before, during and after their baby's NICU stay. NICU support is available at no cost to NICU parents in English and Spanish.   Connect with Hand to Hold: Learn more or get support at handtohold.org   Follow Hand to Hold on social media: Facebook: https://www.facebook.com/handtohold Instagram: https://www.instagram.com/handtohold/   Twitter: https://www.twitter.com/NICUHandtoHold YouTube: https://www.youtube.com/HandtoHold   The following music was used for this media project: Music: Thriving Together [Full version] by MusicLFiles Free download: https://filmmusic.io/song/10332-thriving-together-full-version License (CC BY 4.0): https://filmmusic.io/standard-license   Music: Bright Colors Of Life by MusicLFiles Free download: https://filmmusic.io/song/7855-bright-colors-of-life License (CC BY 4.0): https://filmmusic.io/standard-license  

Hello everyone! We are back with our April Q&A episode, and it is loaded with your excellent questions! Don't forget you can subscribe on Apple podcasts Patreon to hear the extended, ad-free versions.  Here's what we are talking about today:Is it safe to plan a birth center birth if someone has a history of pre-eclampsia, HELLP syndrome and a postpartum hemorrhage?Is it appropriate and/or expected to tip your doula?Other than placenta accreta, what other reasons are there for retained placenta?Can I take beef liver supplements in pregnancy? And do I need to worry about getting too much Vitamin A?  What is safe and what is not?In the case of surrogate and adoptive mothers, who should hold the baby first after the birth?I am experiencing postpartum rage and resentment toward my partner. How long does this last?And in our extended version (available on Apple subscriptions & Patreon):What can I take for after birth pains?If I have an elevated fasting blood sugar and a diagnosis of Gestational Diabetes, is my baby really at risk? If so, what can I do without going on medication?Is being over age 35 really a risk factor in birth?Is there anything you can do to prevent Cholestasis in pregnancy?And of course, everyone's favorite: Quickies!Thanks for joining us, and remember you can call our phone line with your questions 24/7 at 802-GET-DOWN. (That's 802-438-3696)**********DrinkLMNTLove Majka Products Silverette Nursing Cups Postpartum Soothe Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Many changes during pregnancy affect your cardiovascular system, which includes your heart and blood vessels. While some changes in blood pressure are normal during pregnancy, hypertensive disorders are among the leading causes of maternal and perinatal mortality worldwide.   Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia, HELLP, and eclampsia. High blood pressure during pregnancy can stress your heart and kidneys, leading to heart disease, kidney disease, and stroke. As well as increase your risk for preterm birth, placental abruption, and cesarean birth. High blood pressure can also reduce blood flow to the placenta, affecting the flow of oxygen and nutrients to your baby. You can see why your care provider closely monitors your blood pressure throughout your pregnancy.   The majority of pregnancy-related conditions disappear after you have your baby. Mothers remain at risk for hypertensive disorders after they have their baby, even if they have no symptoms during pregnancy. Your ability to recognize warning signs and promptly seek medical attention can potentially be life-saving.   Thank you to our sponsors   Did you know that your health insurance will cover the cost of a breast pump? It's true! In fact, many health insurance plans also cover milk storage bags, breastfeeding prep courses, and more. At Aeroflow Breastpumps, you can shop top-rated breast pumps from brands like Medela, Spectra, and Motif without ever opening your wallet. Fill out their quick and easy insurance eligibility form, and they'll take care of the rest! It might just be the easiest thing you do this pregnancy.   Zahler goes above and beyond to use high-quality bioavailable ingredients like the active form of folate, bioavailable iron, and omega 3s. Save 20% off the Zahler Prenatal +DHA on Amazon with the code PREPOD20. Email your order number and mailing address to vanessa@pregnancypodcast.com to get a free Core Greens powder. Core Greens contains a blend of powerful superfoods, 29 fruits and vegetables, antioxidants, and prebiotics, all in bioactive forms. You can always see the current promo code for the Zahler prenatal vitamin by clicking here.   10% off Epic Will with the code PREGNANCYPODCAST. Epic Will is an inexpensive and easy way to ensure your family is protected. Get the building blocks of an early estate plan, including a last will and testament, healthcare power of attorney, an advance directive, and a financial power of attorney. I know we don't want to think about not being there for our kids. Secure your future in as little as five minutes and have peace of mind that your family's future is safe with legally binding documents built by an attorney.   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.

We are back with the March Q&A, and it is packed with your awesome questions! How do I go about choosing a midwife? Are there red flags?I had pre-eclampsia and HELLP syndrome. Can I still have a home birth?Is it safe to take Valtrex in pregnancy for cold sores or is there an alternative?Is it necessary to rub and dry the baby after birth or can baby just be handed to me?Can we talk about the Lindsay Clancy situation and how do we know if we are suffering postpartum psychosis?Does Covid cause decreased blood flow and does Aspirin help?And for those who subscribe on Apple podcasts or Patreon, in the extended version we answer:How do you know when IUGR is a legitimate diagnosis?Is there a way to pump enough to delay the return of your period when breastfeeding?Can you prevent the loss or decrease in milk supply when pregnant but still nursing?When should you introduce a bottle or transition a breastfeeding baby to the bottle and how do you do both?Do you have resources that you recommend for continuing education for parents?In a home-to-hospital transfer for the mother, does the baby go too and if so, does the baby get evaluated? Can the baby stay home?And in our quickies segment we touch on:Surrogates and co-sleeping, young midwives, periods and breastfeeding, induction for gestational diabetes, favorite items for new moms, keepsakes, hiccups in pregnancy, retinol in breastfeeding, Vitamin K alternatives and our shoe collection. Thank you as always for calling in your awesome questions!  Don't forget to join us on Patreon for the extended version and twice monthly live Q&As on all kinds of topics!Thanks for joining us, and remember you can call our phone line with your questions 24/7 at 802-GET-DOWN. (That's 802-438-3696)**********DrinkLMNTLove Majka Products Silverette Nursing Cups Postpartum Soothe Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Katie has a co-host, Serheen Noor Ali from Hello Sleuth on today's episode where we hear Jodi's story of developing HELLP Syndrome and having a premature birth. Jodi walks us through her birth story along with those first moments meeting her daughter. She speaks to the joy we find in the unexpected and will leave you inspired to embrace where you are today. You will get to know Jodi's heart behind the creation of Fllrish. [5:40] Full circle of relationships [6:07] The crash course of becoming a medical parent [7:14] Special needs mother's quitting the workforce [9:30] Thinking ahead about Kindergarten [10:27] Jodi's husband went on his last business trip [11:21] HELLP Syndrome diagnosis [12:45] The calm reassurance from her provider [13:42] The birth plan [14:50] The onset of symptoms of HELLP [17:11] Not seeing her daughter for 2 days as she needed to recover [18:16] The meaning behind Jenna's middle name [20:44] Telling her doctor their was a problem [24:00] How life and death is transformative [26:32] Husbands and fathers getting more credit [28:29] Beginning to process what happened allowed Jodi to have maternal feelings [31:03] Their own growth trajectory [34:12] Deeper joy to be found in the journey [36:29] Putting one front of the other and checking your feelings [39:20] Not coming home with your child is difficult [40:37] The creation of Fllrish [42:25] De-stigmatizing learning differences 44:32 Resources for parents Connect with Jodi Website Instagram Whether you are a parent or professional, we want you to join our community. Sign up for our newsletter here. Parents, download our free parent starter kit. When you download our starter kit, you'll learn how to: Give medicine to your child without it becoming a wrestling match Prepare your child (and yourself) for a shot so they can feel less anxious Create and use a coping plan for any medical appointment or procedure The first sign of sniffles, or worse, shouldn't send you into a tailspin. Feel confident in your role as a parent and advocate, no matter what medical situation you're facing. Child life specialists, get affordable PDUs on-demand here. Shop for your CLOC gear here.        

Melissa lost her son due to having severe pre-eclampsia and HELLP syndrome. She underwent gastric bypass surgery and lost a lot of weight. She was then able to get pregnant and have her rainbow baby. She talks about dealing with hating your body and dealing with jealousy towards others who are easily able to get pregnant. --- Support this podcast: https://podcasters.spotify.com/pod/show/findinghopeafterloss/support

The traditional explanation and assumed pathophysiology of HELLP syndrome stated that it was a late manifestation/further progress of preeclampsia with severe features. But can HELLP present clinically without hypertension? What about without proteinuria? If a patient has lab criteria of HELLP alone, without hypertension, does she still require magnesium sulfate? In this episode, we will summarize data from 3 sources (ACOG practice bulletin on thrombocytopenia, ACOG practice bulletin on gestational hypertension and preeeclampsia, CMQCC hypertension bundle), and answer these questions and more.

In this episode, Alison Rieke shares her birth stories. Alison is the mother of 2, and she works from home as ambassador for a health and wellness company. Alison experienced HELLP syndrome during one of her pregnancies, and she shares her symptoms and her experience, as well as her wisdom and insight. The acronym HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome is one of the Hypertensive Disorders of Pregnancy, which are discussed in episode 18. After the birth of her second child, Alison made the career pívot that allowed her to work from home. To learn more about what Alison has to offer; either the product or the business, you can follow her on Instagram @denverali Coaching offerBuzzsprout - Get your podcast launched! Start for FREEDisclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showConnect with Kelly Hof at kellyhof.comMedical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

Tiare is a boy mom, a realtor in Indiana, and an amateur bodybuilder. Tiare experienced HELLP syndrome during one of her pregnancies, which is a rare medical condition of pregnancy. The acronym help stands for hemolysis, elevated liver enzymes, and low platelet count. In this episode Tiare shares her symptoms and her experience as well as her wisdom and insight from all of her deliveries. Follow Tiare on Instagram! @tiare_smith_realtor Coaching offerSupport the showConnect with Kelly Hof at kellyhof.comMedical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

Jade Kearney is the Co-Founder and CEO of She Matters, a digital health platform designed to improve postpartum comorbidities for Black women through community, culturally competent healthcare providers, and culturally relevant resources. Victoria and Will talk to Jade about why postpartum depression is so dangerous for women, her experience as a mother and why she founded She Matters, and what culturally competent care looks like for Black women. SHEMATTERS (https://www.shematters.health/) Follow SHEMATTERS on Instagram (https://www.instagram.com/shematters.io/), Facebook (https://www.facebook.com/shematters.io/), or LinkedIn (https://www.linkedin.com/company/she-matters-inc/about/), or YouTube (https://www.youtube.com/channel/UC3_drWpk9DaXakn5d1jHjIg). Follow Jade on LinkedIn (https-//www.linkedin.com/in/jadekearney/). Follow thoughtbot on Twitter (https://twitter.com/thoughtbot) or LinkedIn (https://www.linkedin.com/company/150727/). Become a Sponsor (https://thoughtbot.com/sponsorship) of Giant Robots! Transcript: WILL: This is the Giant Robot Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Will Larry. VICTORIA: And I'm your other host, Victoria Guido. And with us today is Jade Kearney, the Co-Founder, and CEO of She Matters, a digital health platform designed to improve postpartum comorbidities for Black women through community, culturally competent healthcare providers, and culturally relevant resources. WILL: Jade, thank you for joining us. JADE: Thank you for having me. WILL: So I want to start off the podcast and really talk about the issues that you're working to solve because, to be honest, before I was a dad, I had no idea about any of the things that you're trying to solve, but now that I am a dad, I am very well aware of it. So, can you explain to our audience exactly what you're working to solve? JADE: No problem. What we're working to solve is we're trying to decrease the incidence of Black maternal morbidity and what that means is how Black women are treated in the delivery room and postpartum. I'm not sure if anybody is aware, so I always try to give the statistics upfront: Black women are four times more likely to die during pregnancy and after pregnancy than White counterparts. And here in the state of New York, we're 12 times more likely to die. So what we're doing as a company is we're looking to decrease postpartum comorbidities through culturally relevant resources, community, and culturally competent healthcare providers that we supply through our She Matters app. WILL: Those stats are so devastating to hear. You hear the stats and postpartum and things like that. Why is postpartum so dangerous? JADE: Postpartum is dangerous because postpartum starts the moment you have a child. And when you first have a child as any type of woman, Black, White, Asian, your focus is on the child, and you're not paying attention to the signs of your body. Also, postpartum is not talked about that much. After you have a baby, the focus is on the baby, and a lot of women don't understand what they're experiencing when they're experiencing it. So there may be some very, very alarming signs that are happening that are going off in your body or mind because we're talking about mental health and physical health that a woman doesn't resonate with because no one's talked to her about it. So there's no information. So a woman is experiencing...has an out-of-body experience having postpartum anxiety and depression and doesn't know what's going on because there's been no information given about it. It can be a silent killer, really, when you think about eclampsia, and you think about HELLP syndrome, which is like high blood pressure during and postpartum. These are the top killers of all women. And if you don't know the signs of that, if you don't know what to look for, you may very well think it's a part of postpartum when you're actually in danger. VICTORIA: And that sounds so important to increase awareness in the education and community around these issues. Can you tell me more about what culturally competent care actually looks like for Black women? JADE: So culturally competent care means that you are receiving care from a health provider that understands the stuff that I'm conversing with you guys about. They understand Black maternal morbidity; they understand it is due to systemic racism. They understand that cultural competence is the first step toward communication and trust. So they're meeting Black women where they are. For instance, culturally, a Black person may say, a Black mother, in particular, may say, "God told me this wasn't normal." Some people may see that as psychosis, so the person may be having terrible mental health issues. In our culture, that's something that we may just say. So to be culturally competent, you have to be aware that, oh, that's a colloquialism used in the Black community, and so I really should be focused on how this mom is feeling instead of maybe she needs to go to the psych ward. There are little differences and nuances like that that cultural competency changes the trust barrier, and it changes the communication barrier for both the healthcare provider and the mother. VICTORIA: Right. That makes sense to me. And for myself being from Maryland, I have friends who have gone to doctors who just wouldn't believe them when they brought up that they were in pain. Or if another doctor referred them to get an MRI, the new doctor wouldn't want to provide that service. And so your app is trying to bridge that gap and that systemic racism that's built into the system as well. JADE: Absolutely. That's a common complaint of Black women or Black people, but really Black women, that when we are in distress, when we are in pain, that people just don't believe us because people aren't comfortable with us being in pain, and that goes back to systemic racism. And if you're not culturally competent, you may be unaware of your cultural biases just because you've never had the conversation. And so, 89% of procedures done to Black women are done without their full consent, so Black women are not comfortable. They didn't want to have the procedure. They were coerced into the procedure because people don't listen. Doctors don't listen to us. WILL: Jade, let's take a second because I love your passion behind it. Where does your passion come from for this situation? Tell us about your experience as a mother and why you founded She Matters. JADE: Well, my passion comes from becoming a mother, becoming a Black mother to a Black child when I had my first daughter. The first doctor I went to treated me like a statistic, and she was a Black doctor. I felt so scared all the time that I knew it wasn't the right practice for me, and I switched practices at 27 weeks. And when I got to my next practice, I was able to talk to my doctor, Dr. Garfinkel, in Morristown, New Jersey, who is a Jewish man, but was culturally competent, knew the statistics, understood the system and promised me that he would do everything in his power to make sure I had a healthy birth. I did have preeclampsia. I did have an emergency birth. But my daughter and I made it out of that situation healthy. The issue was during my postpartum period; I had nowhere to go. I didn't understand that the mental illness that I was facing around postpartum OCD, where you have terrible ruminating thoughts about your child or yourself, so harming your child or harming yourself, I didn't understand that that can happen during postpartum and really felt like I was losing my mind. I felt like I was failing as a mom, and I felt a lot of shame. I went to both my family and friends, and because of the stigma around mental health in the Black community, I didn't find any support there. What I did find was shaming. I found disbelief and really just avoidance of the problem. Like, my mom said to me, "We're Black women. We don't have time for this. You have to go back to work. You need your health insurance." When I reached out to my healthcare provider at the time, I was told, "I'm going to send you Zoloft and check in with you in six weeks." That's not what I needed to hear. Because I'm a Black woman, I wasn't comfortable with taking an antidepressant. I also was uncomfortable not speaking to my healthcare provider. And I knew that there was a disconnect right there. I couldn't go to family and friends. And I couldn't go to the healthcare system because I was being completely neglected by psychiatrists, by the emergency room, by doctors. And I created She Matters because I never wanted any other Black woman to feel the way that I felt during my first 12 months of being a mother. I thought we need culturally competent healthcare providers. We need communication with each other, community so we can validate our experiences when we're having these weird things that happen to your mind or body. And we need culturally relevant resources because when I was on the internet, I couldn't find anything where Black women were talking about our problems because of the stigma. I couldn't find a lot of information around the postpartum state of Black women because we're neglected in healthcare. So that's why I founded She Matters. VICTORIA: And you founded it over four years ago. And at the time, I believe you were in the process of one of your master's degrees. And looking at the degrees you have, it almost seemed like you planned on founding a company like this. [laughter] But yeah, can you tell me more about your education and how that feeds into your ability to perform as a founder? JADE: Sure, I did not plan this. [laughter] I was definitely being over-educated, didn't want to leave school; I love to learn. And so I have a degree in diversity and inclusion management and digital media design from NYU. And at the time, I thought I was going to create continuing education platforms or blended learning programs for K through 12. I didn't know that this would be my trajectory. And so everything I did around diversity and around digital media has helped me launch She Matters. It's really allowed me to cultivate who I am as a CEO and not look at the problem only as a Black mother who experiences these things but also as a business person, also as a tech founder, and be able to zoom out and see what adjustments need to be made that aren't personal to my story. VICTORIA: And that probably is why you've been so successful, and congratulations on your most recent round of funding. What are you most excited about to be working on with your new capacity? JADE: I am most excited about working with the thousands of healthcare providers that we're getting ready to work with. It's so important that cultural competency be something that's not a new wave or something popular, but it becomes ingrained in the healthcare system. I love when hospitals are open to making these changes, and they're aware of the problems within hospitals. I'm also really excited about our new symptom tracker that can be connected to wearables. So preeclampsia, eclampsia, and HELLP syndrome are some of the things that I talked about. And we've created a system tracker on our app that can help mothers get to the hospital faster. I'm really excited about unveiling that on our version two of the app. WILL: What causes these issues in the Black community? Why are they so overlooked? JADE: Why are they so overlooked in the Black community, by Black people, or in general? WILL: Just in general. So you said that you were overlooked and your doctor was a Black lady. But then you had a Jewish doctor that said, "I'm going to take care of you." From your understanding and your view, what do you think caused that? JADE: It's systemic racism. So the status quo...systemic racism doesn't change because you're Black. We're all part of the system. And that's why cultural competency is needed. Everyone needs that regardless of your race because when you're part of the system, sometimes you're unaware of your biases. People are doing what's been done, and what's been done is unfair. There's no health equity. People are comfortable with the level of pain Black women experience. People are comfortable with the stats being where they are. Things are just now starting to change. People are just becoming uncomfortable, and that's going to take some years for everyone to become uncomfortable. But it is because this is the system as it is, and people are comfortable with the current system, Black, White, or other. VICTORIA: Right. And you talked about what new features you're excited about for your platform. And how does the app that you've created start to increase that cultural competency? Like, how does it really work within a healthcare system? JADE: The app is for our community of moms, and our learning management system is where healthcare providers go. So that's where you get the experience of the culturally competent certification. And you get the curriculum, and you get the experts in health equity leading the classes and talking about Black maternal morbidity and making connections between systemic racism and health outcomes. Our LMS system is the most important part of our training. And our app is the most important part to communicate with our moms and offer a listserv of these doctors who are taking our certification, the resources that we talked about, and those symptom trackers that we talked about. Without technology, none of this would be happening. VICTORIA: That's great. So you have really two user groups, right? You have your Black women mothers and then also hospitals that you're designing for. JADE: Yes. VICTORIA: And I wonder if you found any interesting design challenges for either group. JADE: And this is my life. The most challenging thing for the mothers is engagement because you have to understand being a mom is full-time. It's like a full-time and a part-time job together. So how do you create programming at an engagement level that's fair for moms? How do you measure a mom's engagement? It's going to be a little bit different because if you have one child or four children, your time on an app is going to be different, not to mention if you have a full-time job. So it's just about creating engaging programming that mothers will take their downtime to utilize. And I feel like we have a little bit of secret sauce there; it's around our ability to connect to our moms and to bring experts in healthcare to our mothers. When it comes to healthcare professionals, I think healthcare professionals are more than willing to take a course. It is explaining to hospitals that Black women are worth the investment because, remember, they've been comfortable with the situation as is. Having to convince people that the demographic that you've ignored is important is a job. I also feel like once a hospital decides to come on board with us, I have this huge sigh of relief because trying to explain to people why Black women deserve to live through birth and after can be taxing. VICTORIA: I can imagine being a mom yourself and having this startup and having to do that difficult work of explaining to people how systemic racism affects their healthcare and why they should care is exhausting. So how do you recharge and find time for yourself and balance your life if it's possible? [laughs] JADE: I have a great support system; I cannot lie to you, like, between the people who helped me with my children, my team here at She Matters, our board. Like, some people talk about their boards...my board is like family in terms of the support that they give to my co-founder and I. They've been committed to helping us change maternal morbidity in the United States and to have their support and to have the support of everyone in my life is most important. And I often say to founders, "You cannot do this without support. I don't care how much money you raise. You will lose your shit no matter what your venture is." Because being a founder, being a CEO is very lonely. It doesn't look like anything that's been done before, and you don't have punch-in and punch-out hours. So support is the way that I keep my mind healthy. I'm able to have downtime for myself, and the way that I'm able to be the best person I can be so I can be the best mom. MID-ROLL AD: Are your engineers spending too much time on DevOps and maintenance issues when you need them on new features? We know maintaining your own servers can be costly and that it's easy for spending creep to sneak in when your team isn't looking. By delegating server management, maintenance, and security to thoughtbot and our network of service partners, you can get 24x7 support from our team of experts, all for less than the cost of one in-house engineer. Save time and money with our DevOps and Maintenance service. Find out more at: tbot.io/devops. WILL: You know, you're from Newark, New Jersey. What is your favorite thing about that area? JADE: I love Newark. In Newark, we say 'nurk.' I know outsiders say 'noo-urk.' But I love being from Newark because I saw kind of the best of both worlds. Newark has such a rich history. And there are so many problems currently around just systemic racism, whether it's education, healthcare, the judicial system, and you kind of see both things play out where you have great private schools, and you have great universities. Shout out to Rutgers; I went to Rutgers, Newark. And then you have all the problems that the country has. So it gave me a different lens. I own where I'm from, but I also saw the greatness of where I'm from. And I believe it's helped propel me to where I am because I have lived both lives firsthand. And I know what it's like to go to a school that's not receiving funding, to go to a hospital that's coined a Black hospital and to be treated unfairly, and then to go right into another town in Essex County and be treated differently because it's quote, unquote, "a White hospital." Newark has given me the duality that I have as a person to experience both lives. WILL: Wow, you speak of systemic racism. And in my opinion, I think there are almost two sides of it. I think you have the side that that's their beliefs and the way that they comprehend it, and that's what they're going to believe. And then you have a different side that's like; I had no idea because I've been in my bubble for so long. And correct me if I'm wrong if I'm missing a category, but in my experience, it's almost the two that I see. And especially with 2020, I think a lot of that slowly started peeling back. And so it seems like you're dealing with that head-on. How have you been received by the doctors and the hospitals in that area? JADE: It just depends on the doctors and the hospitals. Sometimes people say, "This is what we really want, oh my God, because we don't know what to do." And this is such a huge problem speaking to Black maternal morbidity. With the Black Momnibus Act that was passed in November 2021, there's been $3 trillion put into the pipeline to make these changes. So hospitals are paying attention. But paying attention and providing your healthcare professionals with the service are two different things. I've been received in both ways; wow, you guys are the second coming. And yeah, this is great, but we're not really focused on it right now. We want to pretend that we're focused on it, but we're really not. It's difficult. And I do think those two sides of the coin of systemic racism exist where there are people who are proponents of it and who know what they're doing, and there are people who have no idea. Either way, training is necessary so that you can treat people equally. WILL: Yes, I totally agree with that. Totally agree with that. If you had one message you had, you know, however long you want, what would be the one message that you would want the audience to know about She Matters and what you're solving? JADE: She Matters is solving for an American problem. This is an American healthcare problem. And people assume when you say Black maternal morbidity that it is not an American problem. Black people are Americans. And I know that sounds crazy because if you're born here, you're an American. But it's not crazy. People act like this is a separate problem from themselves. No, this is our problem, everyone's problem. When women are dying, that's everyone's problem. When there are health inequities in your hospital, it's everybody's problem. We should all care about Black women dying, period. VICTORIA: Yeah, I think there's a book out this year that calculates the cost of systemic racism, and this area, in particular, the amount of death and the hospital costs related to this is, for no other moral reason, it's very expensive. And addressing it and protecting our community keeps us all healthy, and safe, and good. I love what you're doing with the app. And I think it's so important, and I'm really glad you came on the show to tell us about it. I'm curious, if you could travel back in time to when you first started, what advice would you give yourself? JADE: Prepare for the long haul, prepare for the long journey, prepare for the long road. Pace yourself. This is a marathon, not a sprint. It is going to be harder than you think. I didn't think it was easy at all. But I did think that people would understand the severity of the problem we're solving for, and that's just not the case. [laughs] So the convincing part, like I mentioned earlier, is very taxing. I become exhausted with explaining the value of my life as a Black woman. It's exhausting. WILL: Wow. If you can sum up (This is a two-part question.) your toughest decision or time since you founded She Matters, and let's end it on your best, successful, happy moments since you founded She Matters. JADE: Okay. The toughest was raising our most recent round. There's a lot of systemic racism there as well. Black women get less than half a percentage point of the venture capital given to startups. And knowing that challenge and speaking to investors who claim that they have interest in people of color and women of color, and when you get in front of them, it becomes the same stats that you use for all startup and tech companies when this is different. This is not a chip. This is not something that people are familiar with. So people not understanding that when it comes to something like this, which has not been done before, sometimes you have to use a different metric system. We should present to you in a way that is comfortable in Silicon Valley. So I'm not saying we shouldn't do anything that everybody else does; no, we should. But when we're presenting to you, you have to understand the hurdles and the challenges that it took for us to get in front of you. If Black founders are in front of venture capitalists, we are unicorns. We're the best of the best because for us to get there, we had to go through hell and fire. So that's the one thing. And when it comes to the most positive thing, it would be the amazing feedback we get from mothers and from healthcare professionals. Some people send us donations; some people just volunteer their medical experience, which is expensive. Anytime a healthcare professional says, "I have 10 hours that I can volunteer to a Black mom," that's huge for us. A therapist saying, "I'll offer any She Matters community member 45 minutes free," do you know how much my therapy is? [laughter] I'm like, oh my God, that's so amazing. And those things matter to me. Like, it's not about revenue for me as much as it is about getting the women the help that they need. And so every time what I say lands with a healthcare system or professional, it warms my heart. Every time a mother is helped, it warms my heart. VICTORIA: Well, that's wonderful. It's been amazing to hear more on this issue. And I hope our listeners appreciate getting educated on this topic. Is there anything else you want to promote or take a second to leave our audience walking away with? JADE: Yeah, sure. Just go to shematters.health to learn more about what we're doing. And if you're a Black mother, download the app. If you're a healthcare professional, sign up for our next cohort November 7th. If you just want to learn more, send us an email. Follow us on social media, @shematters.io, on Instagram. We're around, and we love to hear people's feedback. We're here for the volunteering. We're here for it all. We're here if you just want to learn more really. WILL: Jade, thank you so much for, one, being on the podcast, but most importantly, the impact that you are having on our community, the United States, the world because I think you are going to have that impact on the world the longer you're in this, and the more you go. So just thank you. Thank you for everything. JADE: Thank you, guys, for giving us a platform to reach more people, and thank you for caring enough to have me speak for Black mothers and for She Matters. I appreciate it. VICTORIA: Well, thank you so much. I really enjoyed our conversation today. WILL: You can subscribe to this show and find notes along with a complete transcript for this episode at giantrobots.fm. VICTORIA: If you have questions or comments, email us at hosts@giantrobots.fm. WILL: You can find me on Twitter @will23larry. VICTORIA: And you can find me on Twitter @victori_ousg. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. WILL: Thanks for listening. See you next time. ANNOUNCER: This podcast was brought to you by thoughtbot. thoughtbot is your expert design and development partner. Let's make your product and team a success. Special Guest: Jade Kearney.

This week is Baby Loss Awareness Week, October 15th is Pregnancy, Infant, and Child Loss Remeberence Day, and today on Sense of Soul podcast we will be remembering Dylan Taylor. His parents, our dear friends Angelica and Billy Taylor joined us for a hard and very heartfelt conversation. In 1997 the newly married couple were preparing for their first child. They had learned through an ultrasound that they were having a boy. Billy and Angelica were so excited to begin their lives as parents. Everything was going well until Angelica begun to have concerning symptoms that lead her to the hospital, in her second trimester.  Angelica was diagnosed with “HELLP Syndrome” a rare pregnancy complication. It is a type of preeclampsia that causes elevated liver enzymes and low platelet count. Many women who have HELLP syndrome need to give birth early to prevent health complications.  Angelica and Billy were faced with having to make decisions that nobody should ever have to make. However this was an emergency and the urgency was a matter of life and death. The risks were great, inducing labor would mean that their baby would be very premature, but if they didn't, there would be a chance Billy would lose them both.  Angelica and Billy take us back to the day they had their firstborn, to the moments they lost their firstborn. Hear from a fathers prespective as Billy so genuinely shares his story, learn how they struggled in grief, yet managed to survive this traumatic loss and find their happy once again.  If you or someone you care about has lost a child to stillbirth, miscarriage, SIDS, or any other cause at any point during pregnancy or infancy. 1 in 4 women will lose a baby during pregnancy, delivery or infancy, Please join us in raising awareness this October for Pregnancy and Infant Loss Awareness Month and share this episode. YOU ARE NOT ALONE! If you'd like to contact Angelica and Billy you can email them at bapmtaylor@gmail.com https://starlegacyfoundation.org/awareness-month https://babyloss-awareness.org  Visit Sense of Soul at www.mysenseofsoul.com Do you want Ad Free episodes? Join our Sense of Soul Patreon, our community of seekers and lightworkers. Also recieve 50% off of Shanna's Soul Immersion experience as a Patreon member, monthly Sacred circles, Shanna and Mande's personal mini series, Sense of Soul merch and more. https://www.patreon.com/senseofsoul Thanks to our Sponsors! KACHAVA: www.kachava.com/senseofsoul ATHLETIC GREENS: www.athleticgreens.com/senseofsoul

This is really a great story of managing through a difficult and unexpected birth course. After a completely uneventful and easy pregnancy, around 37 weeks Christina felt like something just wasn't right so she went to the hospital. She was subsequently diagnosed with something called HELLP syndrome, one of the most severe forms of preeclampsia. After being transferred to another hospital, she ultimately delivered via c-section and you are going to hear all about her experience today. In this Episode, You'll Learn About: -How quickly and easily Christina and her husband got pregnant -What it was like for Christina to be pregnant and working in-person during the height of COVID -How staying active helped with her pregnancy symptoms -Why she took an interest in hypnobirthing and what she did to prepare -How she approached researching and getting ready for an unmedicated birth -What HELLP syndrome is and how it is managed -How Christina and her husband's differing careers facilitate coparenting --- Full website notes: drnicolerankins.com/episode176 Check out The Birth Preparation Course Register for the class How to Create a Birth Plan the Right Way Take a quick, fun labor pain quiz