Podcasts about Insertion

The tongue is the most common airway obstruction in an unconscious patient.For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).Examples of when a NPA should be considered.Contraindications and considerations for nasal airway insertion.Measuring a nasal airway for appropriate length and diameter.Insertion of a nasopharyngeal airway into the right vs left nostril.Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed. Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you are receiving testosterone or estradiol hormone pellet therapy, BioBalance Health wants to know if you have any of the following medical conditions that may require you to take antibiotics before any medical or dental procedure that breaks the skin, including pellet insertions and dental cleanings. BioBalance Health is dedicated to providing safe and effective hormone replacement with pellets for both men and women, and we want to ensure your health and safety throughout the process. We use sterile procedure guidelines, but certain conditions still require antibiotics to prevent local infections.   Conditions That May Require Pre-Procedure Antibiotics: If You Have Had a Joint Replacement.Some orthopedic surgeons recommend that patients take antibiotics before dental procedures to prevent infection in the joint that was replaced, while others may not. It is important that you follow the advice of YOUR orthopedic surgeon regarding antibiotics before any procedure. If your orthopedic surgeon has advised you to take antibiotics, please let us know. We can provide you with an antibiotic injection or a prescription to take the day of your pellet insertion that will prevent infection. If You Have Uncontrolled Type 1 or Type 2 Diabetes. If your blood sugar is not well-controlled, you may need antibiotics before your pellet insertion to prevent infection of the pellet insertion area. If you are treated and keep your sugars in good control you may not need antibiotics, however if your diabetes is in poor control, you are more likely to get an infection. It is important that you take antibiotics before your pellet insertion. The following blood sugar levels are considered indicators of poor diabetes control: HbA1c > 9.0 Fasting blood sugar > 150 mg/dL If your blood sugar exceeds these levels, or if your primary care doctor has recommended that you take antibiotics before dental cleanings or procedures, you should also take antibiotics before your pellet insertion to reduce the risk of infection.  If You Have an Autoimmune Disease and are on Immunosuppressive Treatment. If you are receiving treatment for an autoimmune condition that suppresses your immune system, you may be at higher risk for infection at the insertion site. In this case, you will need to take antibiotics before each pellet insertion. If your Rheumatologist does not believe antibiotics are necessary for you, you may proceed without them.  If You Are Receiving Cancer Treatment. Certain cancer treatments, especially those that suppress white blood cell production, can compromise your immune system. If you are undergoing such treatment, you should take antibiotics before or with your pellet insertion to prevent infection.   In Summary: If a doctor has advised you to take antibiotics for procedures, such as dental cleanings, you should also take antibiotics before your pellet insertion. Please inform us of any conditions or treatments that may require this precaution, and we will ensure you are properly prepared for your procedure.

Justin Coleman speaks with Kate Ziser, a pharmacist at the Princess Alexandra Hospital in Brisbane, about her paper on the role of triple antithrombotic therapy in patients with atrial fibrillation following coronary stent insertion. Kate explains when triple therapy is indicated, the duration of therapy, and the step-down approach to antithrombotic therapy. Read the full article by Kate and her co-authors in Australian Prescriber.

durée : 00:57:42 - Cultures Monde - par : Julie Gacon, Mélanie Chalandon - En 2016, un accord de paix a mis fin à plus de 60 ans de conflit entre le gouvernement colombien et les Forces armées révolutionnaires (FARC). Un an après, les programmes de démobilisation et de réinsertion pour les anciens combattants ont été lancés, mais le retour à la vie civile reste difficile. - réalisation : Vivian Lecuivre - invités : Camille Boutron Sociologue, chercheuse associée à l'Institut pour la paix; Julie Massal Chercheuse indépendante, associée à l'IFEA, spécialiste des mouvements sociaux notamment sur la Colombie; Valérie Robin Azevedo Professeure d'anthropologie à l'Université de Paris Cité et chercheure à l'Unité de recherche migrations et société (URMIS)

Dans cet épisode d'Insulaires Podcast, nous recevons Shana, jeune infirmière en hôpital public en région parisienne. Née et élevée à Miragôane, en Haïti, elle revient avec sincérité sur son arrivée en France à 12 ans, seule, sans même avoir pu dire au revoir à ses amis, et sur son parcours scolaire marqué par la solitude, les défis linguistiques, un redoublement, mais surtout une force intérieure et une vocation indiscutable : devenir infirmière.Elle nous parle de ses premiers stages, de la réalité du métier, du manque de reconnaissance, du racisme vécu sur le terrain, mais aussi de sa passion pour les personnes âgées, de son attachement à l'humain et de ce qui la pousse à continuer malgré les difficultés. Un témoignage touchant, sincère, et profondément inspirant.Tout au long de cette fin de saison, nous mettons en lumière l'association Les Anges Écoliers, qui agit en République Démocratique du Congo pour offrir un avenir meilleur aux enfants vulnérables :• Hébergement• Accès à l'éducation• Insertion sociale et professionnelleSoutenez leur mission :Site web : lesangesécoliers.orgAdhérez à leur action via le formulaire : Questionnaire d'adhésionInstagram : @lesangesécoliersHébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

À travers l'exemple concret du parcours de Albert, voici une présentation de la plate-forme Emploi Accompagné est un concept novateur d'accompagnement vers et dans l'emploi des personnes en situation de handicap. L'objectif est de permettre un soutien des personnes handicapées et de leurs employeurs qui soit souple, adapté à leurs besoins et mobilisable à tout moment du parcours. C'est un accompagnement médico-social et à visée d'insertion professionnelle qui permet l'accès, le maintien et l'évolution dans l'emploi en milieu ordinaire de travail.Le petit mot d'Eugénie, référente Emploi Accompagné :Je tiens à remercier Mme la maire, l'ATSEM, l'enseignante, l'ouvrier communal, la secrétaire de mairie ainsi que les parents d'Albert. Ces personnes font preuve de beaucoup de bienveillance et de pédagogie à l'égard d'Albert et lui permettent d'acquérir des compétences tout en favorisant son épanouissement au sein de son poste de travail. Je terminerai par cette citation : « Seuls, nous ne pouvons pas faire grand-chose. Ensemble, nous pouvons faire tellement de choses. – Hélène Keller »Pour en savoir plus : emploiaccompagne57.frHébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient's tongue from falling to the back of the pharynx, causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway. Indications for using an oral airway. Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex. Measuring an OPA and possible complications from inserting one that's too small or too large.Two techniques to properly insert an OPA. The use of an oral airway during CPR. The use of an OPA as a bite block after a patient has an advanced airway placed.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInOther Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506*Commissions may be earned from the above links.Good luck with your ACLS class!

durée : 00:24:09 - CRIC de Jurançon: portes ouvertes et forum insertion/orientation pour les personnes en situation de handicap. - Jeudi 20 mars de 9h à 13h au CRIC Pyrénées de Jurançon, venez assister à la journée portes ouvertes et au forum insertion/orientation pour les personnes en situation de handicap. Vous irez à la rencontre d'entreprises, centres de formation et associations et vous y trouverez des offres d'emploi.

durée : 00:03:39 - Le journal de 7h30 FB Occitanie - À l'occasion de la signature du renouvellement de la convention entre France Travail et le centre de détention de Muret, ici Occitanie a visité les ateliers où les détenus travaillent. L'objectif est de faciliter la transition vers l'extérieur, en assurant leur insertion professionnelle.

In this episode of Conversations in Lung Cancer Research, A/Prof Mel Moore, along with thoracic oncologists Dr. Malinda Itchins and A/Prof Surein Arulananda, delve into the characteristics, detection, and treatment of EGFR exon 20 insertion mutant non-small cell lung cancer. The podcast discusses recent advances, the efficacy of various treatments including small molecule tyrosine kinase inhibitors and monoclonal antibodies, and the potential future of targeted therapies. Special focus is given to the Phase 3 Papillon study and the drug Amivantamab, highlighting the need for next generation sequencing in clinical settings. Key challenges and questions in the field are also addressed, including the impact of co-mutations and optimal therapy sequencing.This episode is sponsored by: Johnson & Johnson(00:00) Introduction and Acknowledgements(00:48) Introducing the Experts(01:29) Understanding EGFR Exon 20 Insertion Mutations(05:04) Challenges with Current Treatments(06:30) Emerging Therapies and Clinical Trials(11:03) Papillon Study Insights(21:27) Future Directions and Unanswered Questions(29:34) Conclusion and Final Thoughts

durée : 00:08:44 - La Question du jour - par : Marguerite Catton - Suite à une controverse concernant des soins du visage offerts à des détenus à la maison d'arrêt de Toulouse-Seysses, Gérald Darmanin, le garde des Sceaux, a déclaré avoir donné l'ordre de suspendre toutes les "activités ludiques" en prison. - réalisation : Félicie Faugère - invités : Matthieu Quinquis Avocat

Lara a quatre enfants, et son petit dernier 3 ans et demi, le jour où elle est arrêtée et incarcérée en Californie. Deux ans plus tôt, elle a rechuté et est tombée dans l'héroïne. Elle a menti, volé des cartes bleues et usurpé des identités pour trouver de quoi payer sa drogue. Elle a tout perdu.Dix ans plus tard, devenue écrivain, Lara Love Hardin raconte son histoire dans « La vie comme un grand huit » (éditions L'Arbre qui marche) : son enfance sans amour, sa jeunesse trouble, ses addictions, la famille qu'elle a construite et la bonne mère qu'elle a cherché à devenir. L'amour inconditionnel pour ses enfants, l'écriture et un livre de méditation offert par une codétenue, lui ont permis de sortir de l'enfer où elle s'était enfermée.C'est une histoire de rédemption et de deuxième chance, un livre qu'on ne peut pas lâcher, sélectionné par Oprah Winfrey parmi ses titres favoris de 2024. On l'a rencontrée à l'occasion de son passage en France pour un entretien sans tabou, traduit en direct par Hélène Joguet.Vous aimez le podcast Mères ?Partagez avec nous votre commentaire avec 5 étoiles sur votre appli podcast : votre avis aide le podcast à remonter dans le classement, à vivre et à s'enrichir de nouveaux épisodes.Pour proposer un sujet ou un témoignage, écrivez à Marine sur contact@leslouves.com.

La réinsertion professionnelle est un gigantesque projet et je suis toujours impressionné par ces personnes qui s'impliquent dans des associations pour aider d'autres à retrouver une place dans le monde professionnel.Et, là, j'ai rencontré quelqu'un qui est la Directrice Générale d'une association incroyable : Acta Vista.Paquerette Demottes-Mainard, sa directrice générale m'a expliqué comment grâce à la restauration du patrimoine français, depuis plus de 20 ans, cette association a réinséré professionnellement des milliers de personnes. Elle nous en parle avec passion et, croyez-moi, les 20 minutes que dure cette interview sont passées comme 5 !!!Soutenez ce podcast http://supporter.acast.com/happy-work. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).Examples of when a NPA should be considered. Contraindications and considerations for nasal airway insertion. Measuring a nasal airway for appropriate length and diameter. Insertion of a nasopharyngeal airway into the right vs left nostril.Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Au cœur de la nuit, les auditeurs se livrent en toute liberté aux oreilles attentives et bienveillantes de Valérie Darmon. Pas de jugements ni de tabous, une conversation franche, mais aussi des réponses aux questions que les auditeurs se posent. Un moment d'échange et de partage propice à la confidence pour repartir le cœur plus léger.

Check out Dr Beth Allison Barr and buy her books! Hang out with the Matrons of Spice at I Read Something Bad. Chapters 00:00 Introduction and Overview 06:36 The Making of Biblical Womanhood: Unapologetic and Radical 09:07 Separating Patriarchy from Faith: The Importance of Historical Context 15:04 Dealing with Pushback and Criticism: Setting Boundaries and Focusing on Evidence 19:07 Finding Liberation in Christianity: Women's Voices Throughout History 24:11 The Reformation's Impact on Women: Solidifying Patriarchal Structures 32:42 The Undermining of Reformation Theology 33:09 The Insertion of Male Spiritual Leadership 34:07 Addressing Residual Patriarchy in Egalitarian Spaces 44:38 Teaching as a Tool for Change 49:57 Taylor Swift: Resilience and Advocacy We're picking back up with our walk through Paul, Women & Wives next week, but I couldn't wait to share this pertinent discussion with Dr. Beth Allison Barr about the historicity of egalitarian theology that I recorded MONTHS ago. Not only did I think this detour would give folks a chance to purchase the book and read it without rushing (if they wanted to deep dive with me), I also feel like this conversation adds some super helpful historical context to the soul care/formation aspect of our discussion. Plus… this episode was burning a hole in my pocket and I couldn't sit on it any longer. Dr. Barr is the author of The Making of Biblical Womanhood, which you should absolutely read too. She's a professor at Baylor and a bit of a celebrity in the evangelical world because of her research and communication around women's historical role in the Church1. That's also why Dr. Barr has been a target for those committed to preserving a patriarchal hierarchy and even folks who want to continue this deeply harmful trench warfare approach to gender roles in Jesus' movement. The subtitle of her book is “how the subjugation of women became gospel truth,” and that's so powerful because it speaks to a critical reality of women's roles in the church: it wasn't always like this. As a historian, she presents compelling evidence that this concept of “biblical womanhood” we see expressed in the vast majority of evangelical church cultures is not what Jesus intended. Nor was it the way the early church operated. If we listen to Dr. Barr, women were never intended to be subordinate to men or limited in their calling to fulfill the Great Commission. Our conversation explored some of The Making of Biblical Womanhood but also its reception… specifically how the aftermath affected Dr. Barr herself. And it wasn't great. The way people talked and continue to talk to her is appalling. Just taking a peek at her mentions is to stare into the void. Hundreds of men (and women) spouting some of the ugliest, un-Christlike nonsense. Which underscores the need for a better way to have the conversations around women in ministry. I truly believe listening to Dr. Barr won't only shift your perspective, it also equip and empower you to follow Jesus and read Scripture in a different way.

The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient's tongue from falling to the back of the pharynx, causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway. Indications for using an oral airway. Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex. Measuring an OPA and possible complications from inserting one that's too small or too large.Two techniques to properly insert an OPA. The use of an oral airway during CPR. The use of an OPA as a bite block after a patient has an advanced airway placed.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

"PREVIEW: MERCURY: Colleague Bob Zimmerman details BepiColombo, the ESA-JAXA Mercury mission, now preparing for orbital insertion and data collection. More later." 1954

durée : 00:06:18 - La Revue de presse internationale - par : Catherine Duthu - Près de 800 détenus servent de pompiers volontaires et aident à lutter contre les incendies qui ravagent Los Angeles. Ces prisonniers gagnent entre 5 et 10 dollars par jour, plus 1 dollar de l'heure pour les urgences.

This podcast discusses the halachic intricacies of *Havdalah*, within the motsei Shabbat Amidah, marking the end of Shabbat. Key topics include the proper placement of *Havdalah* within the *Shemonah Esrei* prayer, the later obligation to recite it over a cup of wine, and the sequence of recitations. The podcast also addresses situations where one may forget to include *Havdalah* in the prayer or when mistakes occur, including whether or not one should repeat the prayer or rely on the wine at the end of Shabbat. The discussion touches on various scenarios, such as if one has eaten before *Havdalah*, and explains the rationale for inserting the *Havdalah* blessing within the prayer that asks for wisdom and understanding. The importance of not making personal requests before performing *Havdalah* is also emphasized.

Initial Insertion Short Take Jessica's question is common for new Givers. She's concerned about getting the toy in so the fun can begin! Initial insertion doesn't need to be unpleasant for the receiver. For the giver, when you take the right steps to open up the ass, initial insertion goes more smoothly. This can give […] The post Short Take on the Initial Insertion appeared first on Ruby Ryder - Pegging Paradise.

Dans cet épisode, nous explorons les défis auxquels sont confrontés les individus qui se réintègrent dans la société après avoir quitté les groupes armés. Notre invitée partage les obstacles émotionnels et sociétaux, notamment la stigmatisation et les réactions mitigées de la communauté. Nous approfondissons l'importance du soutien communautaire pour assurer le succès du processus de désarmement, de démobilisation et de réintégration (DDR), aidant ainsi les anciens combattants à faire la transition vers une vie civile pacifique.

The Alan Cox Show

The Alan Cox Show

The boys are back in the Shed with guest and friend of the pod Aaron to discuss the mystique of the Mecca of golf Pinehurst, the Cowboys are as bad as you think they are, Indiana is a WAGON, the SEC reigns supreme and much more! 

Holmberg's Morning Sickness - Thursday November 14, 2024 Learn more about your ad choices. Visit podcastchoices.com/adchoices

Holmberg's Morning Sickness - Thursday November 14, 2024 Learn more about your ad choices. Visit podcastchoices.com/adchoices

The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).Examples of when a NPA should be considered. Contraindications and considerations for nasal airway insertion. Measuring a nasal airway for appropriate length and diameter. Insertion of a nasopharyngeal airway into the right vs left nostril.Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Assurances, conso, nouvelles technologies… "On en parle" vous oriente dans tout ce qui fait votre quotidien. Au programme aujourd'hui: 1. Comment repérer les premiers symptômes du diabète? 2. Immersion dans une classe d'insertion professionnelle 3. Guichet: l'intégration et l'inclusion dans les écoles ou les formations professionnelles

Your host Dr. Rita Agarwal is joined today by two outstanding guests who have an interest in preventing and treating women's pain. Drs. Anita Gupta and Stephanie Cizek. At the California Society of Anesthesiologists' Annual Meeting in Anaheim, in April 2024, there were several posters authored by Dr. Anita Gupta looking at the literature surrounding IUD insertion pain and potential treatments for that pain. Several months later the new CDC recommendations were released recommending improved pain management techniques in patients undergoing IUD placement. Around the same time there was increased media attention to IUD related pain and the fact that women's pain has historically often been dismissed, minimized or ignored. In this episode, we discuss all of this and more! 

Tous les jours, du lundi au jeudi, la France Bouge prend des nouvelles d'entrepreneurs qui sont déjà passés dans l'émission.

Colleen's first pregnancy ended in a miscarriage at 6 weeks. At 12 weeks along with her second pregnancy, Colleen and her husband found out that their daughter would be born with a genetic condition called Trisomy 18. Colleen shares her experiences with Trisomy 18 and how she found the right support to help her navigate through it all. Due to IUGR and other medical concerns, Colleen had her daughter via Cesarean with an 85-day NICU stay afterward. To her surprise, Colleen had a third pregnancy just 6 months after her daughter's delivery which ended in a heartbreaking second-trimester miscarriage. After discussing her pregnancy and birth histories at an appointment, Colleen's doctor referred her to be screened for a MTHFR gene mutation for which she came back positive. MTHFR (methylenetetrahydrofolate reductase) is a gene that impacts your ability to process and absorb folate. It can be responsible for complications during pregnancy and is detected through a simple blood test. Colleen and Meagan talk more about what MTHFR means, and what Colleen was able to do to have a fourth uncomplicated pregnancy and a beautiful, smooth VBAC delivery! Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Welcome to the show, everybody. We have our friend, Colleen, on with us today sharing her stories and navigating through this amazing journey that we call birth. Birth is such a journey, wouldn't you agree, Colleen?Colleen: Absolutely. Meagan: One of the most unique things about it is obviously through the stories we all hear. They are all unique and individual to us and even one birth that you've given doesn't mean the next birth is the same. So we're going to be talking today about navigating through birth and we know that a lot of the times through these journeys whether it be because of a Cesarean or because of how we were treated or because of how our body responded or whatever it may be, sometimes and a lot of the times, we experience trauma. Trauma is viewed differently from everybody and processed differently. We are going to be talking about navigating through trauma. Then Colleen is actually going to share some of her fertility journey as well. I think that's also a really important thing because we have so many mamas out there– we know. We know. We see it. They have to navigate through fertility challenges. We're going to be talking about that along with a VBAC. Let's get into that here in just a minute. We do have a Review of the Week then like I said, I'm going to introduce Colleen and turn the show over to her so she can share her beautiful stories. This review is from lexieemmarie. It says, “So thankful. I just wanted to say thank you for creating this podcast. I had my baby girl via emergency Cesarean at 30 weeks due to several medical complications with my baby. We spent 95 days in the NICU and while in there waiting for my sweet girl to grow, I started to research VBACs to see if it was right for me. Once I found this podcast, it sealed the deal. I absolutely can't wait to VBAC with my next pregnancy. You all are incredible to listen to because you provide the wealth of knowledge and positivity but are also fun and entertaining to listen to. Amazing job, ladies.” Aww, that just made my heart so happy. Oh my goodness. Thank you so much, Lexi, for your review. As always, we love these reviews. They make our hearts and our minds so happy. You guys, this is what we want. We want you to have that wealth of knowledge. We want to have you feel inspired and guided and uplifted and educated along the way through all of these stories. As usual, leave a review if you haven't yet. We would be so grateful. Meagan: Okay. We have Ms. Colleen. She lived in Michigan. Did you have your VBAC baby in Michigan? Colleen: I did, yes. Meagan: You did. Colleen: My husband and I live in a suburb of Detroit in Gross Point so that's where I gave birth in August of 2024. Meagan: Awesome. Awesome. Okay. Wait, 2024? Just right now?Colleen: Yeah, I'm 2 weeks postpartum. Meagan: Yes, I love it! So really, really fresh. Colleen: Fresh. Meagan: I love sharing stories that are so fresh like that. It is right there in your brain. Colleen: Exactly. Meagan: Oh my gosh. Okay. She has two beautiful children now and one two-week-old baby. Your two-year-old daughter is Gianna? Colleen: Gianna, yes. Meagan: She was born via Cesarean due to chromosomal abnormality. Do you want to share what that means?Colleen: Yeah, I would love to. Gianna has a chromosomal condition called Trisomy 18 that we did find out about through the genetic screening early on in pregnancy that she was considered high risk for coming down with Trisomy 18. As the pregnancy progressed, it became pretty evident that it would be the reality. For those of you who don't know, Trisomy 18 on its surface means that the baby will have an extra 18th chromosome in some or all of their cells. How that manifests itself is through some pretty serious medical complexities that require quite a bit of care. I will get into that a little bit more with my story but that is the quick version of Trisomy 18. She is also now 2 years old and a bubby, sometimes sassy, little girl. Meagan: Is there another name for it with an E?Colleen: Edwards Syndrome, yes.Meagan: I have another friend who has that and I seriously adore him. He is thriving and doing amazing in life. Colleen: Yes. She is a warrior. She is so strong. She is so beautiful and has brought nothing but love and joy to everyone who knows her or who don't know her. There are so many people from near and far who love her. It's great. Meagan: Yes. Awesome and then we've got Sonny who was born via VBAC just two weeks ago you guys. She says, “As a mama of a medically complex child, she is passionate about awareness and education for those within her daughter's condition. She also enjoys running, reading, cooking, and volunteering.” Colleen: Yes, that's a little bit about me. Meagan: I love it. Welcome to the show and thank you so much for being here with us. I would love to turn the time over to you to start sharing Gianna's story. Colleen: Amazing. Thank you so much for having me on. The VBAC Link was a staple on so many of my walks when I was getting ready to give birth. I just found it to be so uplifting and empowering and I'm so glad that I found you as a resource. A little bit of background before getting to my VBAC– it really does begin in about 2022. It starts out with some of those fertility issues that you had mentioned at the start of the podcast. My husband and I decided to start trying after about two years of marriage and we got pregnant pretty quickly. That ended early in a miscarriage at about 6 weeks. But we said, “Okay, let's try again.” We had processed and accepted that miscarriages do happen so we quickly said, “Let's give it another go.” But we had those reservations and that in the back of our mind of moving forward cautiously. We did get pregnant quickly again. Throughout the first trimester, we just kept it tight-lipped. We just told immediate family and then decided we wanted to do the genetic testing of course to find out the gender. We didn't really give too much thought to what else you learn from that bloodwork. As my pregnancy progressed throughout the first trimester, I was feeling confident then at about 12 weeks, we received a call from my midwife. She told us that it was a girl and that she came back high-risk with Trisomy 18. We weren't expecting that. It was scary and a shock and the more we learned and the more we read in those early days was devastating to us. We were just coming off the heels of a miscarriage so then to have this thrown at us was just a real curveball. In order to move forward and navigate that, my husband and I were always planning on keeping the pregnancy so it just meant, what does that mean going forward? After talking with more specialists and maternal-fetal medicine at the health system that I was at at the time, it became very apparent that they weren't really willing to help. We needed to find another health system. We are so fortunate because we were living out of state for quite some time then moved home before we started to try. We were living in Chicago and then moved back to Michigan. University of Michigan, so CS Mott Children's Hospital is for sure the best in the state and one of the best in the country for caring for kids with my daughter's condition. We switched all of my prenatal care there and they provided us with hope and were willing to monitor me and have a very wonderful NICU. They were willing to provide interventions and things after she was born. But as it related to my pregnancy, it completely deterred any sort of plans and any sort of “normalcy” that one might have. It was shrouded in sadness and anxiety and fear and unknown. Each ultrasound and each week was closer and closer to meeting her but also closer and closer to what does this mean for her? What does this mean for our family? I completely abandoned any apps or what size fruit she was going to be at a certain week because she had intrauterine growth restriction. That rulebook and those guidelines went out the window. I was really afraid to connect with her when I was pregnant. A lot of the time I would say, “Okay, be in tune with her. Read to her and rock her and listen to music with her,” and I would just end up in the nursery that we decorated in tears because I just had so much fear and sadness around what was to come. With that being said, because my plans had been derailed, I really threw myself into learning about her condition and learning about what would come afterward. That gave me hope as a very Type A person. I needed to be doing something to prepare and connected with other families from around the country to give me and my husband hope and learn about what life with children with Trisomy 18 looks like and what they are capable of really was our main driver throughout pregnancy. With that said, I did not prepare for birth at all. I didn't learn about how it could possibly go. I really just, like I said, focused on what care for her would look like. Just as a very small example of what that even looked like was when I came to write my birth plan, I probably wrote a couple of things like, “Oh, open to epidural. Do you have a birthing ball?” I honestly had a line in there that said, “If she is born not breathing, resuscitate her.” That is where my head was throughout pregnancy and it just came to however she was going to arrive, that was second to her being here and us starting to care for her. Meagan: Yeah. Colleen: That said, my care team, obviously I was being seen by the MFM department at CS Mott. They were very supportive. I never felt like they weren't looking out for both me and her. I think they wanted me to deliver vaginally and with the understanding that if it came to a Cesarean that would be what it was. My husband and I made it very clear that we wanted to be treated however they would handle a typical pregnancy. Meagan: Anybody else, yeah. Colleen: Yes. Yes. If it meant a C-section, that's what it was going to be kind of thing. She was showing that she wasn't tolerating labor. We got to the end of pregnancy and we were discussing what birth would look like. We all agreed that an induction at 37 weeks was going to be the plan for a couple of different reasons. From our perspective, we wanted to just start caring for her knowing that she was going to have complexities. We were in the best place possible to start that process. There is some research that would show that the longer that babies with Trisomy 18 are in utero, you could run into a stillbirth situation. Now again, it's a little bit more on the anecdotal side because many, many kids with Trisomy 18 are born vaginally at 40-41 weeks and it's how you want to play it. Meagan: You have to weigh it out for what's best for everybody. Was IUGR becoming a problem at all or was she still small but staying within her own growth chart?Colleen: Toward the end there, we were seeing some stagnated growth so yeah, they were very much of the mindset, “Let's just get here here,” kind of thing. She was born at 3 pounds, 12 ounces. She was just a peanut. Meagan: Little tiny, yeah. Colleen: I was induced at 37 weeks without having much knowledge of what the induction process was going to look like for me and I went in at a centimeter. They started with a cervix softener so that they could then insert the Foley balloon. I was in bed a lot. I utilized the tank of nitrous oxide. I labored that way for a while just to mitigate that pain. I was walking around a little bit but honestly, the Foley balloon for me in the whole induction process was probably the worst part. I was in quite a bit of pain after that. Meagan: Were you dilated at all before when they tried to insert that or was it a closed, posterior cervix? I'm assuming at 37 weeks, it's not doing much. Colleen: I was a centimeter when I came in and I was maybe a 2 when they inserted it I believe. Yeah. It was very apparent that my body was probably not ready for that process. Meagan: Yeah. Colleen: Yeah. That also became apparent once the Foley balloon came out but then pretty much I got to 5 centimeters and just parked it there for quite a bit. The pain was pretty intense so I received an epidural after laboring I would say probably 14-16 hours or something like that. The attending OB wanted to take additional steps by breaking my water and my husband and I were talking. We said, “If they break my water and then I don't progress, then what situation are we in?” We also knew beforehand that my daughter did have a confirmed heart defect. We wanted a more gentle approach to induction especially when it came to Pitocin. We really wanted to take it slow and monitor her to make sure she was tolerating it and things like that. We opted for Pitocin before breaking my water and took it slow. I would say probably another 6-8 hours went by. We were taking it very slow. I wasn't progressing and then we started to see some sporadic, not super consistent but enough to keep make us aware of her, decels that she was having. Again, the attending OB really wanted to continue on. She wanted to break my water. She wanted to optimize my chances for a vaginal birth, but again, I think my husband and I were so zeroed in on having her here safely that even the attending OB after observing some of the decels into the night was like, “Okay, I think–”Meagan: That was enough. Colleen: Exactly. She arrived via C-section on October 28, 2022 at 3:18 in the morning which we find incredibly special because 318 is a universal number around Trisomy 18. We just feel that she was meant to be here just as she is. That was enough for us to say, “Okay. We did what we think we needed to do to get her here safely.”Meagan: And happy birthday to her today. She will be 3?Colleen: She's actually turning 2. She's turning 2. Yep, yes. So that was my obviously first birth experience and it was– I can't even say different than what I expected because again, I really went into that not having much of a reference or much preparation at all. I say, “Okay. That was my experience. It was a C-section.” We weren't thinking at the time. We always knew we wanted future children but with the timeline, we had an 85-day NICU stay with her. There were other things that we were focusing on. Meagan: You and the reviewer. You NICU mamas are amazing. Colleen: Perfect review for today. After 85 days, we came home in January of 2023. We were getting settled into home life and then fast forward to about 6 months postpartum. We had just been home for a couple of months and much to my husband and I's surprise, we were pregnant again. From the first miscarriage to my daughter, we had that hope and that mentality of, “We have no reason to think that anything is going to go wrong so let's just operate from the stance that everything is going to be okay.” We took a similar approach this time around. We said, “Okay. We're going to roll with the punches. Gianna's going to get a sibling a little bit sooner than we initially had thought. Let's just play it like everything is going to be okay.” We had met with a geneticist and knew our risk for having another child with Trisomy 18. We were just slightly above the general population when it comes to the statistics there. We weren't super concerned. It was a very, very low risk. We decided to do the genetic testing anyway. I didn't consider myself to be high risk so I moved my care to a little bit closer to home. The University of Michigan is a little over an hour for us. I had a great experience but wanted to move just a little bit closer to home to a practice that is very utilized on this side of town by many women. I did the genetic testing and everything was good. We were having a boy and then the very next day, I woke up to a very large gush of blood. I went to the emergency room. This was on a Saturday. They did an ultrasound and said, “Baby is looking good.” I was again, about 12 weeks at this point. They said, “Sometimes just bleeding in the first trimester happens.” I took that at face value. I came home Now mind you, with my daughter's condition, she has a lot of medical equipment and lower muscle tone so it's a lot of carrying her around and at that point, she was still pretty small but again, I'm pregnant and I'm hauling her medical equipment plus her some days. I'm a stay-at-home mom so I'm trying to navigate all of that. I'm going about my daily life not really thinking much of it just saying, “Okay, that's what it is. The first trimester bleeding.” I went back to the OB that week and they also confirmed, “Oh yeah, it could just be bleeding.” I said, “Okay.” Then about 2 weeks later I'd say, again on a Saturday, it happened again. The bleeding had tapered off then it happened again. I went back to the emergency room to make sure everything was okay and it was a different emergency department. The nurse practitioner came back in after the ultrasound and said, “You have a really large subchorionic hematoma.”Meagan: I was going to ask if that's what it was. Colleen: Yes. We had done research obviously between the two ultrasounds and people said, “If you do, it likely will heal on its own.” Meagan: It takes time, but if you do activity and things like that. Colleen: Yes. I would say probably about 2.5-3 weeks went by with me not knowing I had it. I hemorrhaged again. This time, I really tried taking it easy leveraging my husband, my mom, and my mother-in-law to really help care for my daughter so I would be able to rest and recover. When I had gone to the OB that Monday just because I had been in the emergency room over the weekend, they painted it like there was not much you can do. If you can take it easy, great. If not, I actually went in that Monday and I had brought up the subchorionic hematoma and the provider that I met with said, “Oh, yeah. You have it but actually, I want to talk to you about something else.” It was a potential marginal cord insertion or a velamentous cord. Meagan: Okay. Colleen: She said, “I actually want you to be more aware of this than the subchorionic hematoma.” Again, it was pushed to the side. At that point, in partnership with some other pretty inappropriate and I would say frankly bad bedside manner from the practice, I was looking to move again. They were very insensitive around my daughter's condition. They made me to be othered because of her. I just didn't appreciate that. I was like, “This is a different birth.” I didn't appreciate that treatment. They asked very inappropriate questions about her and her life expectancy and things that were very triggering for a) someone who was fresh out of birth and a very traumatic pregnancy. I just felt that was very inappropriate to ask those things especially when we are also not talking about my daughter. We are talking about this pregnancy at hand that was having some issues. I was looking to switching providers. I have my best friend in the area. I loved her. She was pregnant at the time as well. She loved her OB so I was looking to switch. I couldn't get in for a couple of weeks so I just said, “Okay.” At the next month's appointment, I would switch practices away from where I currently was. In the meantime, I would say about a week and a half later, I was bleeding again. It was on a Monday so I got in that day and I personally had a little bit of peace around it because I just said, “Okay, this has happened before. Baby has always been okay, but let's get in.” So I got in that Monday and I was given an ultrasound and the ultrasound tech put the wand over my belly and then very quickly went out of the room. My heart sank. I just knew what that meant. She came back and I asked, “Was there a heartbeat?” She just shook her head no. I was by myself because my husband was home with my daughter and it was just completely unexpected and devastating. It crushed us because we again had just come off of something so difficult and had so much hope and for that to be the result was quite crushing. I had reached out to the OB that I had planned to switch to and I just explained the situation. She said, “I'd like to still see you.” I went in about 2 weeks after my miscarriage and just laid everything out for her. She shook her head after me telling her about my first miscarriage and then my daughter and this most recent miscarriage. She took it all in and she goes, “I think there is something going on. I don't think these are just flukes so I want to run some tests.”She ordered some pretty extensive bloodwork mostly in the autoimmune space but she also ran for MTHFR. After many vials of blood and a few weeks of waiting, I came back negative for anything autoimmune but I did in fact come back for MTHFR and she is a provider who believes that it does make a difference. She said at the time that she provided us with this glimmer of hope. She said, “If I know that a patient has that, I start them ideally on a pretty ‘easier' regiment or something to get them started to see if that makes any difference in their pregnancies. If not, we can build with Lovenox injections and things like that.” Basically she said, “I want you on additional folic acid.” I took methylfolate and a baby aspirin. But she posed it to my husband and I. “Do you just want to go the Lovenox route? Once you go on Lovenox, I won't be able to walk you back on additional pregnancies. If you have a successful pregnancy–”. Again, knowing this wasn't going to be the answer and that we could potentially have another loss or more issues with pregnancies but we wanted to start on that first step before jumping forward.She said, “Pick up those supplements when you feel like you are ready.” We needed time. We needed months of healing and of focusing on my daughter's care to just really level-set for our family. But in December of last year, we felt strongly that we wanted Gianna to have a sibling so we decided to try again. I got pregnant and began those supplements. From that perspective, my pregnancy was very difficult. Now, it also gave me that time both prior to getting pregnant and then throughout my pregnancy to really– I really wanted to level-set my approach and my outlook on pregnancy. I had felt like I had been always in this cycle of seeking out information or researching based on issues and I think my and as well as my husband, the trauma aspect always played into it of, okay. Here's a symptom. It could be something very normal or it could be these very unique, rare things that we got used to feeling comfortable in that space. Meagan: Yeah. Colleen: I sort of recognized that as something that I needed to work through. I needed to work through some things that were either emotions I pushed aside. I pushed aside the thoughts and feelings around especially that second miscarriage because I said, “Okay, I have a daughter with medical complexities.” I needed to jump back in and I think that distraction helped me push those thoughts away but then I will say they came back. They reared their head and I said, “Okay. It's time for me to deal with them.” So going back to talk therapy has been really helpful for me for working through some of those emotions as well as unprocessed things with my daughter's pregnancy and birth and care and things like that, the realities around her life and how it's impacted myself, my family, and things like that. I went back to talk therapy and then also got pregnant. I thought that was the perfect time to really sort of level-set my outlook on pregnancy. We forewent the genetic testing around. We just said, “What will be will be.” For now, the fourth time, we are choosing to believe that all will be well. We will have these feelings. My first trimester almost felt like the closer I got to the end of my first trimester, the more anxiety I had because I had that second-trimester miscarriage that I just had the opinion that it could happen at any time and why wouldn't it just happen to me again?There were some friends who didn't know that I was pregnant until my anatomy scan just because I felt like I needed to hold it close to my chest. Meagan: Just keeping your space safe. Colleen: Exactly. Exactly. And protecting my own emotions. So the first trimester for my son did have some of those thoughts and feelings. The OB who I had switched my care to was very accommodating. She had a little portable ultrasound machine in her office if I felt like I needed that reassurance that she would provide the ultrasound for me. She asked me how often I wanted to come see her. She was just very understanding and accommodating based on my previous circumstances. It also allowed me the space, especially as I moved through pregnancy, to really think about birth and think about how that process could be healing as well. In my second trimester, I remember going on a walk because I needed to clear my head and just feeling so overwhelmed by not knowing where to start and then I was being hard on myself because I was like, I should have done this with my daughter. I should know these things already. This is my second birth. I was being very self-critical as if I didn't have other things to focus on with her. That's when I came across The VBAC Link. I actually came across it because my husband and I had taken some on-demand birthing classes through Mommy Labor Nurse and we very much so said that we needed a refresher and probably to take some more diligent notes this time around. It was a resource that she has promoted so I checked it out and I just immediately felt like it was going to be so helpful as it was throughout pregnancy just listening to the podcast episodes, referencing the blog, getting your emails, and just really feeling like I had a resource that was going to support me. I can't express how grateful I am for that because– and I'm about to get emotional– of how along pregnancy and that journey has felt. I've constantly felt like I've been up against walls that it's been exhausting to have to overcome and to break down. Meagan: Yeah. It's a terrible feeling to feel so alone in this really big moment in your life and not feel like you know the direction all the time and then also making decisions and then having the world pretty much question why you are making that decision. It's so heavy and that's why I love this community so much because they make you feel connected to people that are not even within reach. They are hundreds and thousands of miles away. Colleen: Absolutely. Absolutely. Just to have that support because it very quickly became my goal to VBAC because I flipped the script after finding The VBAC Link. I said, “There is nothing pointing to my body not being able to do this. I'm going to go for it.” I'm a competitive person and sometimes I'm competitive with myself and I said, “This is going to be a competition and I'm going to do this.” I will say getting into the true VBAC part of it, my OB was very supportive. She said, “I think you are the perfect candidate to VBAC.” She did want to see what my body did closer to which made me a little bit nervous. She was like, “I'm not for induction but I would do augmentation.” I was like, “Okay. Let's see.” Again, it was a motivator to me to do all of the things that I could do to edge myself along kind of thing. The biggest thing I leveraged was walking. I walked a ton and I just found a routine in the business of life that worked for me that I could rely on each and every day and say, “Okay, these are the three things that I'm going to do throughout the rest of pregnancy to a) give myself peace mentally and physically, but also just to say life is busy, but this is what I'm going to do to move myself forward.” It was a lot of walking. It was a prenatal that I just really adored and I just committed to a pretty nutritious diet to make sure that I was nourishing my body in all the ways that I could. Around 36 weeks, I received a cervical check and was starting to dilate and efface. I was about 2 centimeters. Meagan: Wow. Colleen: Yes, with about 70% effacement at that time. My OB said, “Things are looking good. You are on the right track here.” I just kept doing what I was doing. I did opt for a membrane sweep at 38 weeks and I will say having never labored before, between that 36 and 38-week mark, I was having a ton of prodromal labor which was very frustrating because I never knew what was real. We went to labor and delivery once. I got turned away and sent home. I thought it was the real deal. Yes. Prodromal labor is a tease. But after the membrane sweep, it became very apparent that I was actually in labor. That afternoon, my husband and I and my daughter lay on the couch. I was having closer and stronger contractions and we joke that it was absolutely the real deal because all the times leading up with prodromal labor, everything was squared away. My meals were prepped. Everything was squared away with my daughter. My in-laws and my parents were ready to go and jump in. The day that I started to be in labor, our basement flooded with our sewage backed up. Meagan: Oh no. Colleen: I'm actively in labor and my husband comes up and says, “This is absolutely the real deal because this wouldn't have happened if you weren't.” I'm in labor and my father-in-law are bleaching the floor and scrubbing. It was a whole thing and I was like, This isn't funny right now but it will be funny one day. And it's funny. I was able to labor at home for a few hours. I got to the hospital. I had the membrane sweep at noon that day. I got to the hospital around 9:30 PM and was at a 5. I was feeling pretty good about that. I was feeling those contractions of needing to pause. I wasn't really able to talk through but still at that point now knowing what later labor felt like that it was just the beginning of things. I had a wonderful labor and delivery nurse who was super supportive. I never felt being there like I had to convince anybody. They knew that my plan was a VBAC. The attending OB was cool with it. My OB lived just a few minutes away from the hospital and said that she would be there within a moment's notice when I did deliver so I would have her for the moment of. I got to a 5. They did put me on the monitors and had me hooked up so my movement was pretty limited which kind of limited what I was able to do. I wanted to walk a little bit more. I was only able to sit on the birthing ball in a certain area of the room. That was a little bit tricky. The shower was really nice and I did appreciate laboring in the shower but it was the attending OB who had checked me when I first got there and determined I was a 5. A few hours later, the labor and delivery nurse checked me and said, “Oh, I think you are a 7.” My goal was to get to active labor before I decided if I wanted an epidural but ideally, I wanted to go unmedicated. So when they said I was a 7, I was like, “Oh, okay. All right. That's the motivation I needed to keep pushing on. I can do this.” My contractions were becoming more frequent but they weren't getting stronger. It almost felt like at a moment's notice when they had to put the IV in or if the pain was too intense that I would start to space out again which I found to be interesting. But when a few hours went by, the pain was intensifying. They wanted to check me again and it was the OB this time who had checked me earlier and she said, “Oh, you're a 6.” My husband and I said, “Well, they said I was a 7 when they checked me last time.” She said, “Yeah, but I've got the frame of reference and you're more of a 6.” That messed with my head. Meagan: I'm sure. Colleen: My breathing was no longer effective. The pain was getting to me. The next step they wanted to take was breaking my water. I just didn't feel like I was in the headspace to continue on without the epidural. Meagan: You were mentally derailed. That can happen. Colleen: Yeah. When it came to my birth plan this time around, I was a little bit more descriptive because I had done more research. I wanted to go the unmedicated route if I absolutely could. If not, at least active labor. I really didn't want any augmentations or interventions when it came to breaking my water or Pitocin. I really wanted to be able to do it on my own but I will say and I think this is one of my bigger takeaways from this birth is that even when things don't go according to plan, you really have to trust your gut. I will say in those moments, my gut was telling me I think what needed to happen to service the overall goal which was my VBAC. I said, “Okay. I think in order for my body to relax, I want the epidural.” I get the epidural. My body did just that. I was able to relax. My contractions were getting closer together again. They did break my water and now we were into the morning hours here. I get a call from my OB and she said, “Hey, I'm aware of your situation. I see that your contractions are getting closer together but they are still not at that strength that we are really wanting to see.” She said that, “If you are okay with it, they want to start me on very low doses of Pitocin.” She said, “I think you will need a whiff of it in order to get to where you need to be.” My husband and I looked at each other and I think because of our experience with Pitocin previously and not wanting to stall out or anything go wrong, we really struggled with that piece but I think ultimately, we said, “Okay, we're already here. If this is what my OB thinks this is what I need–” and again, I personally felt okay with moving forward in those directions, “then, let's give it a try.” She was absolutely right. They started at a 1 and bumped it up 45 minutes later. I was feeling some pressure and I wanted to switch positions. I had the nurse come in to help me. She lifted up the blanket to move me and she said, “Oh, his head is right here.” He had been crowing for we don't know how long.Meagan: Oh my gosh. Colleen: My husband looks down and he goes, “Yeah, his head is poking up.” My OB gets there. It was super relaxed. She just walked in. She had her sunglasses on. She was just like, “Okay, let's do this.” She was getting set up. He had a bunch of dark hair and she was giving him a faux-hawk while she waits for things to get set up. For the moments that led up to that with anxiety around the interventions, the moment of his birth was very relaxed, very calm– Meagan: Lighthearted. Colleen: It had this great energy around it. I pushed for about 15 minutes and he was born. Meagan: Oh my gosh. That is amazing. What a way to end such a lead-up to get to this moment in your life. Colleen: Yes. His birth, the moment of his birth and the half-hour leading up was so joyous and healing like I had always hoped it would be and exactly what I think my heart needed. Just not necessarily VBAC-related, but I think I also struggled with all of the needs of my daughter and having now split time, I think going from one to two for some mamas can conjure up those feelings and that guilt around what your firstborn is not getting especially with all of her extra needs and things. I was really feeling that guilt. Now he's here and he is exactly what my family needed. He is just this puzzle piece that was missing. We didn't know it. We didn't know it until he was here and now we feel that way on so many levels. Meagan: Isn't that crazy sometimes? This is one of the coolest things I think about being a doula is that we see these couples and they think that their life is so amazing and it is. Don't get me wrong. It is amazing. They think that they love each other more than they ever could love each other. I can see the love in their eyes. I can see the support as the labor goes and then this human being enters their family and like you said, it's just this puzzle piece that fit that you didn't know you were missing. It's this extra joy and this deeper love that they didn't even know existed and it's one of the coolest things to see families transform. Yeah. It's absolutely amazing. Even from no kids to one kid and from one kid to four kids, it doesn't matter. Like you said, it's the puzzle piece that they didn't know they were missing. Colleen: Absolutely. I just can't wait to watch my daughter learn from him and him learn from her. That relationship– I even had the thought where I was like, “I'm the most important thing to my daughter,” then I'm like, “Okay, but she's going to have a sibling and that is such a gift in and of itself that I just am happy to be able to provide that,” but to your point, it is. It's a love unlike any other love. You will always obviously hold your partnership with your partner. It's so important and so instrumental to providing that love for your children as well but that love that you get from birthing a child is unparalleled. Meagan: Oh my gosh. It's so amazing. It is so amazing. I feel so grateful as a doula and as someone who is done having kids– my youngest is 8 years old now but I get to keep living through all of these couples. It's just so amazing. Oh, well congratulations. Colleen: Yes. It's so beautiful. Again, it didn't go on the micro-level according to plan, but on the macro-level and in my big-picture goal of having a VBAC, it was all I could ask for. Rolling with the punches and I will say again, going back to the beginning of the podcast and sharing that I'm a very Type A person, I think had my past not happened, any of these little interventions that were needed throughout this birth could have also derailed me or discouraged me and I just think all of these experiences I had up until this point taught me that rolling with the punches and just understanding that things might not always go according to plan but healthy me, healthy baby– Meagan: And a good experience. Colleen: Exactly. Meagan: Rolling with the punches while trusting your intuition because some of those punches might look like punches but it's actually what you need. Colleen: 100%. Trusting your gut, advocating for yourself, also important to keep in mind. Meagan: Super important. Well, before we go, I wanted to quickly give some more depth into some of the things that you had brought up along the way. We talked about your daughter's condition and then there was something that you said that is a really big tip that I give to my clients when it comes to breaking the waters versus starting Pitocin. It's okay if you don't agree with me, everybody out there. A lot of people would rather break water over starting Pitocin because it's the “more natural way to get things going”. But I'm such a person of, let's try a whiff of Pitocin that we can turn off, but if we are artificially meaning we are breaking the bag of waters by ourselves against mother nature's choice, we can't patch that back up and we don't know what's going on so we don't know if baby's in a weird position. We don't know if baby is too high. We don't know what's going on so sometimes I think just starting that 1-4 mL drip of Pit and then you can always turn it off and it's gone. I was going to say that's weirdly one of my suggestions that over all of my years of doing this, I would weirdly suggest that sometimes over breaking your water. That really depends on where we are at too. If we are 9 centimeters and baby is +2 station, we're really engaged, I dont know. It might change. But if we are at the point where you were at, I actually would suggest that. I wanted to really quickly talk about VCI and marginal. So velamentous cord insertion. You mentioned that the OB was like, “Yes, subchorionic and we're here but then we've also got this.” With VCI, that is where the cord is inserted abnormally into the placenta. It can cause things like IUGR which we talked about earlier so intrauterine growth restriction. I don't know if they gave you any stats on this but it's a 1% chance of that happening with a singleton baby, a 6% chance with twins and then if they do share the same placenta, it can go up. I want to say it's upward of 15%, so much higher. But a lot of the time, even VCI babies carry to term and everything is okay. I do want to throw it out there that a lot of providers do suggest a Cesarean with VCI. I don't know if you've ever heard of that. People can have vaginal births but a lot of providers will suggest Cesareans. If you have VCI or are being told that you have VCI, just know that might be a conversation and you want to discuss that with your provider earlier on. She also mentioned a marginal cord insertion which is where that attaches to the side I believe so also an abnormal insertion. I don't know. Did your provider tell you anything about that? Colleen: Not the statistics around it but they also said that I was 6 months postpartum, post-C-section when I did get pregnant again so their recommendation I think regardless was going to be a repeat C-section. Meagan: Yeah, so it can happen. Then last but not least, I just want to throw out anything that you have about MTHFR to the listeners who may have gone or are going through experiences like you. MTHFR really depends on a provider. Some people still roll their eyes at it but it's definitely a thing. Do you have any suggestions toward anybody who may have it or maybe finding out that process?Colleen: Yeah. Meagan: Or going through the process?Colleen: For sure. Just through my own research, again, my OB was like, “Just additional folic acid.” Meagan: I love that you mentioned that by the way. Colleen: So I obviously am no expert or dietician or nutritionist but when you do have MTHFR, you can either have homozygous or heterozygous mutations. There are also two different variations. There's the A variant and the C variant. I think there is research around the severity or the impact of each of the variants on fertility and things like that but sort of the biggest takeaway when it comes to MTHFR is that it can make you more prone to clotting issues as well as malabsorption or the inability to use folic acid effectively. That is why a lot of research will indicate that you should be on the purest form of folate which is methylfolate because it's so easy for your body to absorb when you do have the MTHFR mutation and then when it comes to having additional methylfolate, essentially I found a prenatal that had methylfolate and was just chock-full of a bunch of good stuff. I was also taking additional micrograms of methyl folate on the side just as a pure supplement. Personally, I found that to be helpful and again, that is something that I baked into that consistent routine of mine making sure I was on a really optimal prenatal as well as taking the methylfolate every day. In addition to the baby aspirin, that was to mitigate some clotting issues. The other thing I will plug is a resource and a follow on Instagram if you don't already follow is Lily Nichols. Meagan: Yes. We love her. She has been on the podcast. We have her books. Colleen: Yes, exactly. In addition to when you know you have MTHFR, just really ensuring that you are getting proper nutrition and that is top of the line in pregnancy when you are trying every day of your life basically. I definitely broke and cheated with my little guilty pleasures here and there of course. But I really largely throughout pregnancy tried to stick to a really vitamin and nutrient-dense diet. Meagan: Yes. I don't know what prenatal you took and I don't judge you for any other prenatal of course. We love Needed but you said the optimal amount. That's what we are finding. So many of these prenatals don't have the optimal amount and they don't have the purest forms. We love Needed and truly 100% suggest it. But yeah, exactly what you said. It's so important. It's so important.Colleen: Exactly. That would be my advice to anyone who wonders. I would also advocate and press to be tested if you are having issues. I just think it would be so beneficial just to have that piece of information in your toolbox so that if you do want to ask either on your own or you do want to press your provider to take it seriously, then I would definitely recommend just saying, “Hey, can I get the bloodwork to find out?” Then you can go from there. Meagan: Yeah. Yeah. Bloodwork. You can start there and know. Colleen: Exactly. Meagan: Oh my gosh. Thank you so much for this amazing information along the way, your beautiful stories, and thank you for taking the time to share with us. Colleen: Thank you so, so much for having me. It was such a pleasure. Meagan: Absolutely. 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

Head to https://squarespace.com/jonsolo to save 10% off your first purchase of a website or domain using code JONSOLO! Thanks to Squarespace for sponsoring this episode!

The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient's tongue from falling to the back of the pharynx, causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway.Indications for using an oral airway. Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex. Measuring an OPA and possible complications from inserting one that's too small or too large. Two techniques to properly insert an OPA. The use of an oral airway during CPR. The use of an OPA as a bite block after a patient has an advanced airway placed.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Elon's Mechazilla catches his rocket and dudes everywhere got turned on, Bridget puts aside old grudges and declares him no longer her nemesis, Christopher Columbus might have been a Jew, your robot vacuum might be spying on you, racist holiday candles, God has a sense ironic justice, and Russell Brand is the biggest grifter of them all.0:00 - Everything Is Racist 2:44 - Siri, Please Take My Life 3:38 - Cool Science Sh*t 7:03 - Weather 7:35 - Sheath & Quest 9:39 - Dumpster Diving 12:27 - Breaking Bridget 17:03 - The Internet Is Glorious- Check out Sheath's ingenious dual pouch system - order yours and save 30% with the code DECADE- Revitalize your skin with BON CHARGE's Red Light Face Mask and get 15% offRussell Brand Thread https://x.com/BacklogReviewer/status/1846217255052357782 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.phetasy.com/subscribe

Earlier this year, the CDC updated its recommendations on pain management for IUD insertion (intrauterine devices used for birth control), which prompted Carine Carmy to share her story of how an IUD insertion sent her to the emergency room with severe pain, nausea, chills and a fever. She talks about what happened, and why we should have more in-depth conversations about pain management with our healthcare providers. She's now the co-founder and CEO of Origin, a women's health company focused on pelvic floor physical therapy, and she explains why the pelvic floor is an overlooked and crucial part of our bodies and overall health.SHOW NOTES:CDC updates guidelines on pain relief for IUD insertion https://www.cbsnews.com/news/what-to-know-about-pain-relief-iud-insertion-options-insurance/Pelvic health 101 https://www.theoriginway.com/pelvic-floor-101The 2024 Origin pelvic health study https://www.theoriginway.com/2024-pelvic-health-studySUBSCRIBE to the newsletter to get backstories and updates on the podcast - sign up at the banner on the website: www.overlookedpod.com. EMAIL US - get in touch with the show: hello@overlookedpod.comDISCLAIMER What you hear and read on ‘Overlooked' is for general information purposes only and represents the opinions of the host and guests. The content on the podcast and website should not be taken as medical advice. Every person's body is unique, so please consult your healthcare professional for any medical questions that may arise.

Sometimes we hear so much about birth - all kinds of births - that we can forget it is a normal, biological process. In today's episode, Emily's experience reiterates the ease of physiological birth - both at home with a single baby, and in hospital with twins. She is honest from the get-go when she admits that she wasn't even sure she wanted to be a parent but we follow her journey of acceptance, the grief of misscarriage, the trust in her body and the preparation she did to lean into her intuition and birth all three babies with a profound sense of faith in her breath and body. If you're currently in a period of doubt and fear (both very normal experiences in pregnancy), you'll find so much comfort in this episode. ______ What makes The Birth Class so unique? Instead of learning from one person with one perspective, we've gathered nine perinatal health specialists to take you through everything you need to know about labour and birth. Evidence based information is key to thorough preparation. In The Birth Class you'll learn from:5 midwives and an obstetrician, a women's health physiotherapist, yoga teacher and birth doula.Listen in your own time and as many times as you like so you understand: the process of labour and the hormones involved the benefits and risks of interventions your pain-relief options what happens in an emergency caesarean what to expect in the hours after birth active preparation for a VBAC Plus, you'll be taught practical birth skills that will help you navigate the twists and turns of labour. The Birth Class is accessible birth education that's both conversational and wise. Best of all, it will start a conversation with you and your support person so you can both feel prepared and confident to make informed choices; the foundation of a positive birth experience.See omnystudio.com/listener for privacy information.

Cyber as precursor to kinetic warfare?  What about cyber AS warfare?  And social media infiltration and propaganda?  Join Allan and Drew as they invite Dave Schroeder, a renowned expert in this field, to discuss the active use of cybersecurity and social media as warfare between the Western World and China, Iraq, Russia and North Korea.  They cover: Insertion of fake IT employees into key companies Political influence operations (divide and conquer) Precursors to kinetic war being the smallest tip of the iceberg Philosophical differences between nations and governments serving themselves Cultures of trust in the West, and how those are not so self-serving This one is very sobering and perhaps the most important show of the year... Y'all be good now!    

Josh and Rex review S06E09 of Buffy the Vampire Slayer: "Smashed"

The tongue is the most common airway obstruction in an unconscious patient. For patients with a decreased level of consciousness that can't control their airway, yet have an intact gag reflex, the nasopharyngeal airway (NPA) should be used as an alternative to the oropharyngeal airway (OPA).Examples of when a NPA should be considered. Contraindications and considerations for nasal airway insertion. Measuring a nasal airway for appropriate length and diameter. Insertion of a nasopharyngeal airway into the right vs left nostril.Patients with a NPA in place can receive supplemental O2, be ventilated with a BVM, have ETCO2 monitored, and have their upper airway suctioned as needed. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

CDC Advisory Committee issue vaccine guidelines for flu season; Smallpox vaccine gains expanded indication; Updated Novavax COVID-19 vaccine; Over-the-counter gel for erectile dysfunction; New inserter system for placement of contraceptive intrauterine system.

In this very first SASSYSODE I bring back previous guest Denice Bracken, MScN to chat about the new guideline from the CDC, where someone finally agreed that IUD insertion hurts & the free bleeding movement! This unstructured conversation is different for Sassy Speculum, and I'm excited to bring it to you once monthly (on off weeks from our normal episode!) Take a listen, laugh along side us, and as always... Stay Sassy!

The T-shaped device is inserted into the uterus to prevent pregnancy, and normally a patient is told to take paracetamol or ibuprofen beforehand but that's only to manage potential pain afterwards. In the US, videos circulating on social media of women sharing their experiences going through IUD insertion has triggered new guidelines around advice and use of anaesthetic and there are calls here to do the same, Louise Ternouth reports.

A new study measuring microplastics in organs of the recently deceased found that about two dozen brain samples were 0.5% plastic by weight. Also, having an IUD inserted in the uterus is extremely painful for some people. The CDC now recommends that doctors use local anesthetics.Study Finds A Staggering Amount Of Plastic In Human BrainsIt only takes a quick look at our streets and waterways to be reminded that plastic pollution is a big problem. But that's just the plastic that we can see. An increasing amount of scientific literature points to microplastics accumulating inside our bodies, particularly in organs.A recent preprint published by the National Institutes of Health found a staggering amount of microplastics in livers, kidneys, and brains of recently deceased cadavers. The brains, however, were the biggest shock: They had 10 to 20 times more microplastics than the other organs studied. Twenty-four of the brain samples measured were found to be about 0.5% plastic by weight.Joining guest host Maggie Koerth is Tim Revell, executive editor of New Scientist based in London. The two discuss this and other top stories of the week, including a possible explanation for an “alien” radio signal, a look into how orb spiders use fireflies to lure other insects, and a study that says playing video games is good for you, actually.CDC Updates Guidelines For Managing Pain From IUD InsertionThe Centers for Disease Control and Prevention recently announced updated guidelines for managing pain from inserting a popular form of birth control called an intrauterine device, or IUD. The recommendations now advise doctors to consider using local anesthetics like lidocaine to help manage patients' pain.An IUD is a small T-shaped device that is passed through the vagina and cervix and placed in the uterus, where it can remain for several years. Figures vary, but this insertion process can be very painful for roughly 10%-20% of patients. In recent years there's been an outpouring of patients speaking out on social media about just how painful their IUD insertions were. Many people have recounted how their doctors did not provide anything to help mitigate their pain or, in some cases, dismissed their experiences altogether.Guest host Maggie Koerth talks with Dr. Beverly Gray, associate professor of obstetrics and gynecology at Duke University to discuss the significance of these new guidelines.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

The tongue is the most common airway obstruction in an unconscious patient. Insertion an oropharyngeal airway helps keep the patient's tongue from falling to the back of the pharynx, causing an airway obstruction. The oropharyngeal airway is sometimes called an OPA or simply an oral airway. Indications for using an oral airway. Contraindication for an oral airway and an alternative airway that can be used for patients with an intact gag reflex. Measuring an OPA and possible complications from inserting one that's too small or too large.Two techniques to properly insert an OPA. The use of an oral airway during CPR. The use of an OPA as a bite block after a patient has an advanced airway placed.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Today's guest is Max Rempel, Molecular Biologist and PHD.  Open Loops has a PhD on the show?!?! It wouldn't be the first time a true academic and practitioner came on the show....it's more that after 280 episodes of shamelessly fringe madness, Greg's just shocked he can get one back!  Max must've never listened to it.That said, don't let the title fool you. Dr. Rempel sees through the matrix, he's explored the depths of consciousness, had experiences that contradict empirical material understanding of reality, and most importantly...he thinks he might be able to prove that aliens interfered with your DNA.  That Junk (DNA) in your Trunk (you) is untapped knowledge that may explain the very fabric of our universe, our untapped abilities, and reveal hidden knowledge about our place in the universe.  Are you carrying extraterrestrial signatures in your genes? Want to learn how you can find out?Max tells all in this mind-bendingly explosive conversation that'll Schumann resonate for skeptics and believers alike!  Max's Links: xg1.orgdnaresonance.orgmaxrempel.comhumancolony.org Let Greg know how you like the show. Write your review, soliloquy, Haiku or whatever twisted thoughts you want to share at https://ratethispodcast.com/openloops

Hannah is a VBAC mom and doula with Ebb and Flow Birth Co. located in Indiana. Hannah's first labor began very intensely. Her platelet levels were high enough for her to be able to get an epidural which she requested right away. She dilated to complete quickly, but after about 4 hours of pushing, baby just kept coming down and going back up with no progress. Hannah was exhausted and consented to a Cesarean. Unfortunately, her very effective epidural was not as effective during her surgery. It was painful. She required higher doses of medicine, hemorrhaged, and was so out of it that she remembers very little about her baby's actual birth.After the birth of her son, Hannah researched birth options and did all she could do ensure she'd never have another Cesarean. Her VBAC pregnancy included thrombocytopenia again, partial placenta previa (which completely resolved!), marginal cord insertion, and she was GBS+. With a great team and supportive provider, Hannah was able to stay focused on her VBAC goal even with the curveballs thrown at her. She went into labor spontaneously, progressed quickly, and though her pushing stage mimicked the same patterns, with the help of her doula's tips and freedom to move without an epidural, baby was able to descend and come right out!Hannah's Doula WebsiteWhat is Thrombocytopenia? ACH PublicationsPlatelet Transfusions ArticleNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Welcome, welcome. I hope you guys are having an incredible day. We have a guest today who has a VBAC story with a whole bunch of different things added to her journey. She has thrombocytopenia. Thrombocytopenia, I always say that wrong, which means low platelet count. That is definitely something that is more unique. It's a little bit more rare, but if you've ever been told that you have low platelet counts or thrombocytopenia, this is definitely going to be an episode for you to listen to. She also had partial placenta previa and even marginal cord insertion. I am so excited for her to be sharing her story today. We do have a Review of the Week so I'm going to dive right into that and then we are going to get into her beautiful story. This review was just left on Apple Podcasts recently and it said, “I recently discovered this amazing VBAC podcast and I'm absolutely hooked. The host is incredibly knowledgeable and passionate about all things related to pregnancy, childbirth, and postpartum care. Each episode is packed with insightful information, personal stories, and practical tips for expectant mothers and families. I love how they bring on guests and experts to cover a wide range of topics making each episode engaging and informative. Whether you're a first-time mom or a seasoned parent, this podcast is a valuable resource and empowers and educates. I highly recommend tuning in and soaking up all the wisdom shared on The VBAC Link Podcast.” I love this review and as always, I love them all. I love every single review, you guys. It is so amazing to get a notification in our inbox that a review has been left, so if you haven't had a chance yet, please do so. Please leave us a review. Tell us what you think about The VBAC Link Podcast. You can do it on Apple Podcasts. You can rate us on Spotify or really wherever you listen to your podcasts. Or even Google– you can Google “The VBAC Link” and leave us a review there. As I always say, these reviews truly warm my heart but they actually really help your community and these other Women of Strength find this podcast and these stories. I encourage you to leave a review and tell us what you think so someone else can find this episode as well. Meagan: Well, welcome Hannah. Thank you so much for joining us. Seriously, you guys, I can't tell you guys enough. Every time I have someone recording, I'm like, “Thank you for being here with me” because it takes a village and without all of your guys' stories, this podcast wouldn't be a thing. So thank you for being here, Hannah, and yeah. Feel free to share your stories. Tell the world what you feel like they need to know. Hannah: Yeah. Thank you so much for having me. I really appreciate the opportunity to share my story because both stories, I could talk about all day but also, I listened to your podcast consistently, constantly throughout the postpartum after I had my C-section and also during my VBAC pregnancy. With our first, I didn't really have a different plan other than what my friends and family had done. I had planned to go to the highly recommended hospital in my area with a random OB that I just chose. The only real decision I knew I wanted specifically was that I knew I wanted to go unmedicated for my birth but I didn't do anything other than general childbirth classes to actually prepare to birth unmedicated. I just assumed, “I'm going to go in and have a baby unmedicated and everything will be fine.” I didn't do anything to prepare for that and my pregnancy was pretty uneventful. I was sick the entire time. I had borderline hyperemesis– not officially diagnosed, but I was very, very sick. The only other weird thing I guess that I wasn't aware of before pregnancy was I had gestational thrombocytopenia where your blood platelet count gets lower. Meagan: Yes. We just heard about this on a recent story and I had never even heard of that before. Hannah: Yeah, I've had it with both of my pregnancies so I think my body just does that when I'm pregnant. The only thing that they had mentioned about that was there was a potential that you won't be able to get an epidural if your platelets fall too low. I had wanted to go without an epidural anyway so I wasn't really concerned about that, but again, I didn't do much to prepare. At the end of my third trimester, around that 36-week mark, they had brought up, “Well, your baby is measuring potentially big.” They estimated him weighing 11 pounds. They were like, “If you want to schedule an induction at 39 weeks, you can. If not, that's fine. It's up to you.” My OB was really great about just presenting options and not forcing things to happen. She did say, “You can schedule one of you want to but you don't have to.” I did schedule an induction for 39+5 or something like that. At 38 weeks and 39 weeks, I decided to get membrane sweeps. I got one at 38 weeks exactly and 39 weeks exactly. The day after I got my membrane sweep at 39 weeks, at 39+1, I went into labor. This was before my induction. I didn't have to end up being induced, but my contractions that morning had started so fast and so hard that I was really thrown off. I was shocked because when I had talked to people, they said, “They'll gradually build and they'll gradually get closer together and stronger in intensity over a few days or whatever it may be.”Mine started. It just hit me like a train. It was really bad so I called my husband. He was already at work that morning and I said, “We need to go to the hospital now. I need to get an epidural right away.” Because they were so intense, I just thought, I'm really far into labor, clearly. We got to the hospital and we got into triage. They checked me and they were like, “Well, you're about 3 centimeters.” I was just so annoyed. I was like, Okay. I'm only 3 centimeters. Whatever. We can stay because I'm obviously not coping well. I got an epidural right away as soon as we got back to be admitted. Thankfully my platelets were within range to get the epidural. Meagan: That's awesome. Did you get platelet transfusions at all during pregnancy? Hannah: Nope. They just monitored them. They continued to decrease, but they didn't drop below that epidural safety level but they were continually decreasing throughout my whole pregnancy. Meagan: Got it. I was curious. I'm always wondering what people with low platelets do if they do transfusions or not. Do you remember what the low number was, like the safety number?Hannah: Yeah, it kind of depends on the anesthesiologist, but for epidural specifically, they said anything below 100. I don't remember the units. It's like 100 something per milliliter or something like that. Anything below 100 would be considered not okay to have an epidural. Anything below 70 or 80 would risk people out of home birth which is another thing to consider. But yeah. Mine didn't drop below that level. It was 105 when I checked into the hospital. Meagan: Awesome. What's crazy is that less than 1% of people even have this condition. Hannah: Yeah, it's very rare. Meagan: Yeah. Yeah. Well, good. So you're 105. You're getting good. You're clear to get an epidural. Hannah: Yep. I get my epidural right away when we get back there and essentially, I just nap. My husband was really confused. He was like, “Well, I thought I was going to be doing more. I'm just sitting here,” because I just napped with a peanut ball between my legs. I progressed very, very quickly especially for a first-time mom and around 9 centimeters, I had been stuck at 9 centimeters basically not really long, but longer than I was for how fast I was progressing. When my OB came in, she said, “If you want, we can break your water just to get you to that complete state so we can start pushing.” I was like, “Yeah, fine.” I didn't really know a difference so she broke my water and then I got to 10 really, really quickly but I labored down for quite a while just because my OB was back and forth between seeing patients in clinic and then coming to see me because she comes to your birth whether she's on call or not which is nice. I labored down for a while and then started doing practice pushes or whatever with the nurse. My epidural was so strong. I felt absolutely nothing. I didn't feel a sensation to push, an urge to push. I didn't feel pressure– absolutely nothing. Me trying to push was not effective whatsoever. I pushed for about 4 hours before we ended up opting for a C-section because my son was just coming down and then going back up, coming down and going back up and of course, I was in that semi-reclined, pretty much on my back position so gravity wasn't really helping me at all. He just was not coming out. The nurse and my doctor had mentioned, “We think he's asynclitic,” where his head was tilted to the side and he just wasn't coming out. I was just exhausted and annoyed so we opted to have the C-section. That was really shocking to me. I was a little thrown off because C-section was never on my radar. It's not something I really prepared for or thought about. I just thought, C-sections happen in emergencies. I was fine. My baby was fine. We were both stable and had no problems. It was just that I had been pushing for a long time so I felt really confused on why it was happening. But the hard part for me was once the C-section started is when things really took a bad turn for me emotionally and physically. My epidural like I mentioned was super, super strong, but when the C-section started, I could feel a lot. I felt a lot of pain, not just the pressure they had mentioned. I was really, really in pain. I had told my husband, “There's something wrong. I can feel way more than I believe I should be feeling.” He told the anesthesiologist and they gave me some additional medication. I don't know exactly what it was, but whatever they gave me, I fell asleep for a little bit. I wasn't under general but I dozed off. Meagan: Yeah, it made you sleepy. Hannah: Yeah. I don't remember when my son was born or meeting him or hearing him cry because I was just so out of it. When I woke up however long that was, time was just not in my mind at that moment, but I remember my husband saying, “Babe, it's a boy,” because we didn't know if we were having a boy or a girl. That's all I really remember from the OR itself. Then in recovery, in the recovery room, my blood pressure dropped. I was going hypotensive. I apparently had hemorrhaged more than they would have liked for a C-section which is understandable with low platelet counts so they were trying to get me stable because I was essentially on the verge of passing out. Everything was blurry and my main concern while all of this was happening was having my son breastfeed. I told my husband, “They're going to work on me. Just get him to nurse,” so he was holding my son to my chest so he could nurse while they were trying to stabilize me. It took them quite a while to get my blood pressure back up and to get everything fine, but thankfully, I didn't need any transfusions or anything like that. The whole postpartum experience, everything from C-section on was just really difficult to deal with and process at that point but that's kind of how everything ended up with that one. Then I knew from then on if I had any other kids, this can't happen again. I have to do something different. Meagan: Did they talk to you about anything like, “Okay, for your next birth, if you choose to have one, you can have a VBAC”? Did they counsel you at all after that? I'm always curious if providers do. Hannah: Yeah, so my OB specifically– I told her, I was like, “If I have more kids–”, because I had never heard the term VBAC. I didn't know that was a thing. I just thought, Oh, you can have a C-section but you can go on to have kids vaginally later. I didn't realize it was such a big deal until I started looking into it and asking around about it. At my postpartum appointment, I talked to my OB about it and she was like, “Well, yeah. That's fine. There are no issues with that. You would be a great candidate for it.” It was like, okay. That's what's going to happen if I have more kids. From postpartum on, I started researching. Meagan: Awesome. So what did you find in your research? Hannah: The first thing I did was look up obviously what VBAC was. I didn't really know then I started listening to podcasts and reading and reading book and listening to stories. I came across your guys' podcast which I honestly don't know how I found it. It was 5 weeks postpartum and I had never really listened to podcasts before. I found it and I found several others and started listening. Then one of the big things I looked at was, okay. What happened in my birth that potentially contributed to this? How can I avoid this in the future or make it a better experience? One of the big things was that I got my hospital notes and my op report and everything from when we were in the hospital just to understand fully what happened because they don't explain every single detail of what's happening to you unfortunately in most circumstances. So I wanted to see all of the notes and everything that happened down to the minute that was in my chart which really helped me understand what happened, process it, and heal that. Then for me, when I was looking at why I had my C-section and all of that, when I was looking at things about VBAC, it was like if these things happen to you like a failure to progress or the baby wouldn't come out like CPD, the cephalic pelvis disproportion, then the chance of you having a VBAC are not great. I was like, Well, that's discouraging. Then the more I got to the research, the more I realized that my birth specifically was likely a cascade of interventions starting with my epidural for me. That's how I personally feel. Some people would say that's not the case but that's how I personally feel. I knew going into my next pregnancy that I would do things drastically differently to set myself up for the best possible chances of having that VBAC. Meagan: Yeah. I love that. It sounds like you were starting in all of the right places. Hannah: Yep. Meagan: So baby number two– Hannah: Yeah. We decided. 8 months postpartum, I was like, “Let's have another baby.” I feel like with both my pregnancies and both my postpartum, around that time, I just get baby fever and then I am thankful that I don't get pregnant at that time. We got pregnant with my daughter about 20ish months after I had my son. That wasn't specifically chosen for VBAC intervals or anything like that. We just weren't ready to have another kid yet. So I got pregnant with her and I had interviewed doulas before we even conceived because in my area, they book up really, really fast, especially the more experienced ones. I specifically looked for a doula who had a lot of experience supporting VBAC. Then I also looked into different birth location options. I had first looked into a birth center and out-of-hospital birth center, but where I am in Indiana, it's illegal and against the law to have a VBAC in a free-standing birth center. I was upset about that at first, but then I looked into some home birth midwives as well as hospital providers. Home birth midwives– the only one I could find in my general close area was about two hours away and the ones who were closer to me wouldn't support a primary VBAC so if you had never had a vaginal birth either before your C-section or had a VBAC before, they wouldn't support you which was really discouraging. With how fast my labor progressed the first time around, I just didn't want to travel that far for appointments or having my midwife have to travel that far for the birth because you just never know how fast it's going to be. The thing about my first birth, my OB was amazing. She was not the type of OB who would try to coerce you to do anything. She was always very supportive of whatever I decided to do. She was very supportive of VBAC but I did also interview some hospital providers, some midwives, some other OBs and ultimately, I decided to stay with my OB because I felt really comfortable with her. I felt confident in her. She had no stipulations surrounding VBAC at all. The only other OB I did interview was an OB who would do vaginal breech birth because that's one thing my OB would not do and I was like, If I have a breech baby, I'm not having a C-section so I'll go to this other OB if that ends up being the case. Meagan: Okay, you're in Indiana.Hannah: The Indianapolis area. Meagan: Did you find it hard to find that provider? Hannah: Yes and no. Yes because he's the only one in our area who supports vaginal breech and no because my doula and a network of doulas who I converse with now all recommended him because they know that he's the only one in the area who would do it. Meagan: Do you care to share his name just in case we have someone breech listening? Hannah: Yes, so his name is Dr. James Webb and he's on the verge of retiring. Meagan: No! That's the problem. Hannah: Yeah. He is very particular about what hospitals he'll deliver at and all of that, but he is the only one currently in our area who will do it so if he doesn't happen to be retired at the time of this episode coming out, you can look into him as an option. Meagan: Yeah, awesome. That is the hardest part is we are seeing so many people who do supportive breech VBAC or just breech in general are retiring. They are closing doors and that's the hardest part. Okay, sorry. So you did an interview with him. Hannah: Yes. I had him as a backup just in case baby did end up being breech. Then my pregnancy again in general was fine. I had gestational thrombocytopenia again. I was not as sick the second time around which I was very, very thankful for. The only other weird things that came up were I was GBS+. I was negative for my first pregnancy and then I had a partial placenta previa at one point which at first concerned me but then once I realized that they usually resolve as your uterus grows, then I wasn't too concerned about ending up with another C-section because of that. I also, my baby was breech at one point. Meagan: Oh my goodness. Hannah: I know. I was like, All of the things that could happen did happen. But I didn't let it discourage me. I just kept going on and doing what I needed to do. The big difference in my preparation that I did the second time around because I knew for my VBAC I wanted to be as low intervention as possible. I knew I wanted to go unmedicated. I had my doula so I took a program called HypnoBabies which is a type of hypnobirth for those who may not know. It's a medical-grade hypnosis so I consistently practiced with that throughout my whole pregnancy. I did some breathwork and progressive relaxation videos and stuff like that to make sure I was really mentally prepared to go unmedicated because I feel like that aspect of birth is so much more mental than it is physical. That's where I really wanted to be prepared for that part. Meagan: Mhmm, nice job. Hypnobirthing is really common here in Utah. I wouldn't even say common but a favorite education course and we actually have a blog about it because so many people love it. It really can put you in such a great head space. Hannah: Yeah. I know it doesn't work for everyone, but what was more beneficial for me was that I didn't just go through the course in the last 6 weeks of pregnancy or something like that. I consistently practiced throughout my entire pregnancy to make sure it became a habit or something that I was normally used to doing. I did that primarily to prepare for birthing unmedicated and then I also did pelvic floor therapy to help with my C-section scar and my ability to push because pushing was such a difficult time for me the first time around. I really wanted to know what muscles to use and how to actively engage and push if I needed to. Meagan: Awesome. Hannah: I did a lot of different things to prepare the second time around. But then at the end of pregnancy, I did not get any cervical checks. I didn't get any sweeps because I knew it would just mess with my head space. It would discourage me if I was dilated or wasn't dilated and I knew that my dilation wouldn't determine when I was going into labor. I didn't schedule an induction either. I was just going to wait for my baby to come when they wanted to come and my OB was fine with that which was great. The only thing I did do was– I didn't have to end up doing this, but if I went past 41 weeks, I was going to get non-stress tests. But we were find waiting for things to happen. I went into labor spontaneously at 40+2 and– oh, I forgot to mention. Sorry, I'll back up. I did have a marginal cord insertion with this baby too so all of the things where the cord was on the side of the placenta instead of the center. The issue there could potentially be a lack of blood and nutrient flow to the baby which could cause growth issues. Meagan: IUGR, yeah. Hannah: We did monitor that a little bit more, but there were no issues with her growth or her percentile or anything like that so that was never a concern of her being too small or too big or anything like that. But I went into labor the morning of 40+2 and it didn't start how I expected or anything like my first labor. I had excessive bleeding and no contractions. I was really confused. I was like, Why am I bleeding so much? It was more blood than I felt comfortable with. A lot of times you have a bloody show or something like that with your mucus plug, but this was filling pads. I called my doula. I called my doctor and they were both like, “Yes, just go in.” My plan was to labor at home as long as possible, but because it started that way, I was like, Okay, I'm going to the hospital. Meagan: Mhmm, and the previa had completely resolved? Hannah: Yes. Yes. It was still low-lying, but it wasn't covering the cervix at all. With the amount of blood, I was like, Well, this is a little concerning. I did go into the hospital right away and went to triage because their main concern was a placental abruption with how much I was bleeding. Meagan: That's one of the things I was thinking too. Could it be a placenta thing? Hannah: They put the monitors on us. They checked everything and we were both fine. There were no issues. The bleeding ended up resolving and they couldn't exactly tell where it was coming from. At the time, I was about 4 centimeters dilated when we got to triage and I had planned because we were both fine, I was like, Well, I'm going to go back home then, but we had to stay to be monitored for about an hour just to make sure nothing else came up or things didn't take a turn or something like that. Within that hour, I had already began to dilate more. I was already 5 centimeters and at that time, I started feeling contractions so I decided, Okay, we'll just stay. We're already here. With the bleeding, I felt a little bit more concerned so we just stayed. I told my doula I would just text her and keep her updated. We got back to be admitted and because I was GBS+, I did choose to get the antibiotics. I got that round of antibiotics and then had them unhook the IV because I wanted to be as mobile and as free as possible. Thankfully, my hospital had wireless monitors so I was able to move around. I didn't have to tote around a monitor or be stuck to the bed or anything like that. After the antibiotics went through, I was going to lay down and listen to my Hypnobabies tracks and just rest because my contractions weren't intense or anything like that. I was super, super uncomfortable laying down. I needed to be up and moving. I tried and I was just annoyed with my headphones and annoyed with the tracks and everything. I was like, I need to be up and moving. At that point, I was getting ready to get up and my water broke on its own which was different for me because it did not break on its own with my previous birth. My water broke and again, I was around 5 or 6 centimeters at this time. It was definitely my water and they made sure. It was gushing out so it was definitely my water. After that point, I just felt like I needed to be on the toilet. I went to the bathroom and sat on the toilet and my husband got me cool washcloths and was wrapping my shoulders. I was just swaying back and forth on the toilet. Quickly, within 30 minutes, I was getting hot and sweaty. I was shaking. I was doing the horse-lip breathing and my doula wasn't there yet. I had texted her right before I went to the bathroom to tell her, “Things are getting more intense. You should probably head this way.” I hadn't been there more than 2 hours so she was like, “Okay, yes. Okay, things are picking up. I'll be on my way.” When I was on the toilet and I was starting to sweat and shake, I was clearly in transition. I knew that in my mind. My nurse knew that. My husband realized that. At that time, I was like, “I need an epidural.” I told my husband that and he was like, “But you're doing so well. Let's wait for Julie (my doula) to get there and see what she suggests.” I just felt like I couldn't do it. Then my nurse was really great about just leaving us alone and letting us do our thing. She came into the bathroom to check on us like I said about 30 minutes later. I told her, “I think I need an epidural.” At this time, I did not have an IV hooked up. She had mentioned, “Well, it's at least going to take 20 minutes to get the fluids in you to even be able to do an epidural.” She knew and she was clearly trying to stall me. Meagan: Yeah, I was going to say, I think that nurse knew something you didn't know. Hannah: Yes. Looking back in my mind, I knew but I was just in denial. I didn't really want the epidural but at that moment when you are in transition, you're just like, I can't do this. Two minutes later, my doula walks in and I told her the same thing, “I think I need the epidural.” She was like, “How long have you been on the toilet? Have you switched positions lately?” I said, “Well, now I've been here about 30-45 minutes.” She said, “Let's try getting in the shower and see if that just helps things ease up or change or whatever.” I was so reluctant to get off the toilet because I was so comfortable and in my zone but I did. I got in the shower and as soon as I stood up and got in the shower, I was bearing down and pushing. I was hanging onto my husband's neck and my doula was putting water on my back and the nurse heard me grunting and bearing down and she came in and was like, “Are you complete? We need to make sure you're complete just to make sure you're not pushing against a not complete cervix.” That was one of my concerns too. I was unmedicated so I felt the urge to push obviously, but I didn't want to be in that case where my cervix would swell or something like that. But I was complete and I had just a slight lip or whatever. My doula just suggested maybe we get on hands and knees to help relieve that lip or get in a different position to even everything out. I got on the bed and got on hands and knees. At this point, I'm just pushing. My body is pushing. I have no control over it. It's happening regardless of whether my cervix is complete or not. I was on hands and knees sitting on the back of the bed. My husband was cooling me down with washcloths and rubbing my back. My doula was doing the same and taking pictures and watching me push to see how baby's movement was. I pushed on hands and knees for about 10 minutes and again, my baby was coming down and coming back up and coming down and coming back up which was discouraging because that's what happened the last time. Then my doula said, “How about we try a squat to see if that helps with gravity working in getting your baby out?” I was so tired at this time. I was like, “There's no way I can hold myself up in a squat. This is not going to happen.” But we got the squat bar. I got in the squat. My doula and my husband were both supporting me. Within 5 minutes, probably two or three pushes, my baby was out. We didn't know again if it was a girl or a boy. She came out so fast and my doula was trying to get me to do the blow breathing to control and slow the pushing but I was not. I was like, “Get this baby out,” because I knew pushing was going to be the hard part for me to get past because it was four hours with my C-section baby. My doula knew that as well so she was trying to give me that extra support to make pushing a good experience. I let it fly and I was like, “Nope. This baby is coming out now. I don't care how fast she comes out. I don't care if I tear or whatever. I just need to get her out.” So she did. She came out and it was so funny because I had the squat bar and I was trying to pull her to my chest. My doula had even mentioned this in our prenatal prep. If you use the squat bar, the umbilical cord is still going to be attached so go under the bar and not over the bar. I tried to go over the bar of course. They were trying to get me all untangled and stuff but I was so happy she had come out that I didn't even look to see if she was a boy or a girl. I just forgot to check. She was a girl and we were so, so happy and so excited. I was just in disbelief that I had done it. It happened so fast that I didn't really have time to process what was happening. It was 4.5 hours total. Meagan: Oh my gosh. Hannah: Yeah. From the first contraction I felt– so not when the bleeding started, but from the first contractions I felt to when she was born was 4.5 hours. Meagan: Holy smokes. Hannah: Yeah, that's almost a precipitous birth and I don't know what just happened. It was just a rollercoaster and intense with no breaks whatsoever. But we were so excited. So excited. Meagan: I bet. Oh my gosh. When you said almost precipitous labor, to me, that is still very precipitous. 4 hours really from the start to the end, that is so fast. I have had a couple of clients like that. Sometimes I'm just like, “How does your cervix just do that?” Because from a mom who had a 42-hour long labor, it's like, what? We envy a lot of you precipitous birthers, however, I will point out that when precipitous birth happens, it's typically super intense. Hannah: Yes and you don't have a break. It's just constant intensity. Meagan: Yes. It's so hard because people have said, “Oh, I'd rather have a fast labor than a long labor.” It goes both ways. They want a fast labor, but I'm like, you have to know that it is very, very, very intense. It usually starts right out of the gate. When I say right out of the gate, I can picture a rodeo with a cowboy on a bull and the second the gate opens, the bull is just bucking, right? Hannah: Yes, because as soon as–Meagan: That is what reminds me of precipitous labor. Hannah: As soon as I felt contractions, I went from feeling nothing that morning to feeling like my whole body was contracting. It was just very intense so I don't know. I think both have their pros and cons, long labors and short labors. Meagan: Absolutely. Absolutely. Yeah. I'm glad. Precipitous labor for a first baby is common from what I have seen in the doula world of supporting hundreds of babies and lots of moms with precipitous labor. It is common to happen the next time. So even if you didn't have bleeding, you probably would have gone in sooner rather than later too. Hannah: Or I would have ended up with a car baby because if I hadn't been bleeding, I would not have gone to the hospital. I would have been fine. My plan was to labor at home as long as possible. Meagan: So you could have had a car baby or a front door baby. Hannah: Yeah, or just somewhere that is not in the hospital baby because it was too fast. Meagan: Yes. Oh my gosh. You are amazing and it is interesting. I'm so curious. Did the doctors say why they think that you developed low platelets? Do you have that normally? Hannah: No, I don't. Meagan: You said gestational so I'm like, She must be meaning just during pregnancy. Hannah: Yes. Some people have it in general without being pregnant. Other people develop it just when they are pregnant. They don't really know exactly why. I think there are things you can do to help that and help increase those platelet levels other than getting transfusions or whatever, but they didn't really know why. I mean, I'll be interested to see if I have a third to see if I have it again, but I think it's just what my body chooses to do. Meagan: Yeah. Interesting. Well, I'm so happy for you. Huge congratulations. Hannah: Thank you. Meagan: I don't know if you're going to have a third, but I assume you'll probably have a wild ride as well and you'll have to let us know how it goes if you decide in the future to have one. Hannah: Yeah. It will probably be the wildcard. Meagan: I know. You know, that does happen. I swear baby number three– in fact actually, it was my very first doula client that I attended. I was shadowing a birth doula because I was brand new and this mom had precipitous labors and baby number three took 15 hours. She was like, “No. No. No. Why is this happening? What is going on here? No.” The whole labor, she was like, “I don't like this. This keeps going.” So you never know. Baby number three also could be a labor wildcard. You never know. Well, thank you so much for sharing your story today. Hannah: Yes. Thank you so much for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

The New York Times had a recent article discussing the United States' absence of effective pain management for IUD insertion procedures, but it doesn't have to be that way. Dr. Jenny Wu joins the show to tell us about how her research influenced her practice and the approach she now takes with patients seeking pain relief, and what she believes we can look forward to with the next generation of providers. Also, Lydia regales us with her personal IUD trauma.  Are you an expert in something and want to be on the show? Apply here!  

What You Will Learn: An Introduction and overview of kidney functions (1 min) Dr. Jenna Henderson's Bio (2 min) Dr. Henderson's journey relating to her own diagnose of chronic kidney disease (5 min) What is dialysis? (11.30 min) The kidneys' capacities to heal (16.30 min) The number one reason that people go into kidney failure that is not a “kidney disease” (17 min) The second leading cause of kidney failure that is not a “kidney disease” (18 min) Why we have to consider heart health when we think about the kidneys (21.30 min) Some common kidney disorders Dr. Henderson works with (21.45 min) The staging of kidney disease (23.30 min) The reason chronic kidney disease is a “silent killer” (26 min) Where to start if your numbers on labs indicate a kidney issue (29.30 min) At what age our kidney cells begin to break down (31 min) Some common symptoms that could indicate kidney compromise (33 min) The difference between iron-deficiency anemia and renal anemia (35 min) How to support the kidneys for someone who has diabetes using diet, herbs, supplements, and essential oils (37 min) Why you should be mindful of diuretics for kidney disease (40 min) The use of diet modifications, herbs, supplements, and essential oils to support the kidneys of someone with high blood pressure (41.30 min)  The healing power of laughter, a sense of humor, and music for the kidneys (44.30 min) The different types of kidney stones and natural support for them, including essential oils (47 min) Why dairy should not be demonized for kidney disease (50 min) How urinary tract infections impact the kidney, how often you should urinate, and what essential oils may be supportive (55 min) Can myrrh oil be helpful for kidneys? (1 hr. 1 min)  Can you use essential oils in late-stage kidney disease? (1 hr. 2 min) Closing questions and Dr. Henderson's favorite essential oils (1 hr. 4 min) Links to Learn More About Dr. Jenna Henderson, ND and Her Offerings: Website: Holistic Kidney FB: Holistic Kidney LinkedIn: Jenna Henderson References on Essential Oils for Kidney Health: Top 5 Essential Oils to Reduce Kidney Stones (NAHA Certified Aromatherapists Blog, Lemon, Lavender, Helichrysum, Peppermint, and Orange) Essential Oils for Kidney Failure: Do They Really Work? (Animal and Mechanistic Studies: Fennel, Cypress, and Juniper are Diuretics, Some May Enhance Urine Output) 16 Best Essential Oils for Kidney Health (Overview on General Health) Harness the Power of Nature: Essential Oils for Optimal Kidney Function (Rose for Renal Colic Study, Supportive Care of Essential Oils for Mood, Fatigue, and Other Symptoms) Myrrh Essential Oil Mitigates Renal Ischemia/Reperfusion-Induced Injury Deep Insights Into Urinary Tract Infections and Effective Natural Remedies  Antimicrobial Activity of Five Essential Oils against Bacteria and Fungi Responsible for Urinary Tract Infections (In Vitro) Prophylactic and Curative Potential of Peppermint Oil Against Calcium Oxalate Kidney Stones (In Vivo) The Effect of Topical Application of Lavender Essential Oil on Intensity of Pain Caused By the Insertion of Dialysis Needles in Hemodialysis Patients: A Randomized Clinical Trial  Effect of Aromatherapy on Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis  Additional Resources from the Show: The Epigenetics of Mind-Body Medicine: Smile and Relax…You Can Change Your Gene Expression and Alter Your Health by Being Mindful! Discover More in Part III Ep. 394: Essential Oils and the Microbiome, Do They Harm or Hurt our Gut Bugs? Learn more about your ad choices. Visit megaphone.fm/adchoices

Links: Today's episode is sponsored by Motif Medical. See how you can get Motif's Luna or Aura breast pumps covered through insurance at motifmedical.com/birthhour.  Know Your Options Online Childbirth Course (100OFF for $100 off) Beyond the First Latch Course (comes free with KYO course) Support The Birth Hour via Patreon!