Podcasts about Pacu

I am so excited to have my dear friend and colleague, Olga Geissler, back on the pod! I met Olga through The Naked Mindset Facebook group and we have been able to maintain a wonderful friendship outside of that group!Olga is a registered nurse who works in a high stress trauma PACU. She also is a coach whose passion is helping women reach their highest level of health and wellness especially those who are working to be alcohol free.Let's get into it! Some topics include:⭐️How negative self talk and the all or nothing mentality are stopping you from reaching your health and fitness goals⭐️Change can't happen if we are living in auto-pilot⭐️Surrounding yourself with a powerful peer group for positive change⭐️How a negative mindset leads to negative behaviorsAs a reminder, if you have a chance, please rate and review the podcast so more women just like you can learn more about the Rockstar way! I appreciate you for your support and love ❤️Olga's Links:RTF# 70 Alcohol and Your Health with Guest Olga Geissler https://spotifyanchor-web.app.link/e/n03syo36oEbRTF# 78 Navigating Holiday Parties & Alcohol with Family, Friends, andFestivities! https://spotifyanchor-web.app.link/e/7kRBZkbbbGbRTF# 117 Navigating Alcohol and Perimenopause with Olga Geissler https://spotifyanchor-web.app.link/e/YtHXWMdf2LbRTF# 134 Alcohol and the Holidays: What Every Woman Over 40Needs to Know! https://spotifycreators-web.app.link/e/YApD7liuZObOlga Geissler Instagram https://www.instagram.com/olgageissler/Peak Wellness Revolution Facebook Page https://www.facebook.com/profile.php?id=100092759019529Links:Join the Rockstar Fit Chicks Weekly Newsletter  https://rockthatfitness.kit.com/e10d0c66ebCheck Out Our Offer for Extensive Lab Work with Marek Health ⁠https://www.rockthatfitness.com/rock-that-fitness-marek-healthFREE 30 Day Strength Challenge (dumbbell only) https://www.rockthatfitness.com/rock-that-fitness-30-day-strength-challengeFREE 30 Day Strength Challenge Next Level (full gym equipment needed) https://www.rockthatfitness.com/rock-that-fitness-30-day-strength-challenge-next-levelApply for RTF 1:1 Coaching https://www.rockthatfitness.com/coachingHead to the Rock That Fitness Instagram Page https://www.instagram.com/rockthatfitness/ Music from Uppbeat (free for Creators!):https://uppbeat.io/t/cruen/we-got-thisLicense code: RBWENWHGXSWXAEUE

In this two-part series, we're taking a deep dive into the art and science of managing blood pressure throughout the anesthetic journey—from pre-op to PACU. In Part 1, we focus on the foundational principles of blood pressure management with a special emphasis on identifying, understanding, and treating hypotension.Stay tuned for Part 2, where we'll tackle hypertension and explore the tools at our disposal—plus when and how to use them effectively.Support the showTo access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com

Let's start your week strong with a quick tip you can incorporate right away. In this Mo's Monday Minute shortie episode, I'm sharing the tips I've learned in PACU when I've got a patient with a spinal block. ___________________ FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! 20 Secrets of Successful Nursing Students – Learn key strategies that will help you be a successful nursing student with this FREE guide! All Straight A Nursing Resources - Check out everything Straight A Nursing has to offer, including free resources and online courses to help you succeed!

Vi fortsätter vår djupdykning i Steven Seagals filmografi med Marked for Death från 1990. Seagal spelar John Hatcher, en DEA-agent som vill dra sig tillbaka efter sin partners död men blir ofrivilligt indragen i kampen mot ett Jamaicanskt gäng vars ledare verkar ha övernaturliga förmågor. Håll i hatten för det här är en film fylld med aikido, voodoo och kycklingar! Mycket nöje! Superlänk till alla plattformar: https://linktr.ee/Filmsmakarna   #stevenseagal #markedfordeath #filmsmakarna #jamaica #aikido #senseiseagal #voodoo #Fiskmås 

Oggi a Cult, in diretta dalla Biblioteca Civica "Franco Galato" di Gorgonzola: la bibliotecaria Nadia Daniela Volpi; Silvia Pinto sul progetto per ragazzi/e PACU; il fotografo Gianluca Colonnese; Pierangelo Invernizzi per il Cinema Teatro Argentia; l'assessore alla cultura Nicola Basile

Questions to Ask Yourself Before Moving to an ASC#1 Can you handle fast and efficient turnovers?Quick room turnovers and efficient instrument reprocessing ensure smooth patient flow and high standards of care in an ASC. Key to this is effective teamwork, a strong understanding of OR and PACU standards of care, and ethical practices to uphold quality and safety protocols.#2 Do you have expertise in a specialty care area?Experience in orthopedics or cardiovascular, for example, is advantageous, as it makes nurses more versatile and valuable in an ASC setting. Critical care experience is also beneficial for PACU or overnight care in an ASC because it enhances the ability to handle emergent, unanticipated patient events.#3 Are you comfortable collaborating with surgeons?Surgeons often have a vested interest in the center and are supportive and collaborative with staff, Davidson notes. “My experience as an AAAHC Surveyor allowed me to see how a collaborative and engaging ASC work environment can foster a culture of continuous improvement and patient-centered care that is exciting to be a part of.”Support the showWelcome to the Periop Talk—your go-to vlog and podcast series where we examine the world of perioperative nursing.Episode after episode, we're bringing you professional tips, clinical wisdom, and personal stories that'll make you feel like you're chatting with your work BFFs. Curious about the latest surgical techniques? We got you. Wondering how to navigate the challenges of the periop journey? We're here for that too.Our vlog and podcast series isn't just about sharing information; it's about building a community. Meet the people behind the masks, hear their journeys, and join the rotation of periop professionals making a difference. From students and new nurses to seasoned pros, we've got content for every stage of your perioperative practice.Periop Talk is your peek behind the red line to the world of perioperative nursing. It's not just about the OR – it's about the heart and soul of healthcare. Let's scrub in and share the periop love!Watch us at: (1) Periop Talk vlog - YouTube

Our destination is the remote Tsimane region of Bolivia in pursuit of the savage and powerful Golden Dorado with Marcelo Perez, founder, and CEO of Untamed Angler and the Tsimane Lodge.   The Tsimane region sits at the base of the Andes mountains, hundreds of miles from civilization, where mountain streams run clear and fast, and fly anglers can sight-cast for voracious Dorado reaching upwards of 40 lbs.    Marcelo grew up in Argentina fishing the jungles for Dorado and found his passion in building remote jungle fly fishing lodges.  Join us as Marcelo explains why Dorado should be on every fly angler's bucket list and the incredible story of how he created the Tsimane Lodge.  Also, stories of the native Tsimane people, giant Pacu, and hundred-pound Maturo on the fly.  Could this be the best Dorado fishing on the planet?  You be the judge!   With host, Steve Haigh Be the first to know about new episodes.  Become a subscriber  Destination Angler on YouTube Contact Marcelo:  https://tsimanelodge.com/  |info@tsimanelodge.com   Instagram | Facebook   Please check out our Sponsors: Angler's Coffee  Elevating the coffee experience for the fly-fishing community & anglers everywhere with small-batch coffee delivered to your doorstep.  Use code BREW20 and receive 20% off your first subscription order. Facebook & Instagram @anglerscoffeeco     Got Fishing  Crafting world-class fly-fishing adventures specially designed to your level of experience and budget.    Facebook @GotFishingAdventures Instagram @GotFishing TroutRoutes  The number one fishing app, helping trout anglers avoid the crowds and explore new public water. Download it and receive 20% off using Destination20 promo code in the app store today! Facebook @troutinsights Instagram @TroutRoutes    Adamsbuilt Fishing  THE trusted source for quality fly fishing gear, built to last at an affordable price. Waders, Nets, Outerwear.  Facebook & Instagram @Adamsbuilt Destination Angler Podcast:   Website YouTube Instagram & Facebook  @DestinationAnglerPodcast  Comments & Suggestions:  host, Steve Haigh, email shaigh@DestinationAnglerPodcast.com Available on Apple, Spotify, or wherever you get your podcasts. Recorded September 12, 2024.     

This episode is part of a PodSwap, where we swap episodes so each of our audiences can learn from one another! We are swapping episodes with Nurse Mo, MSN RN from Straight A Nursing. She currently works in the PACU, teaches in a BSN program, and manages her educational platform for nursing students. In this episode, Nurse Mo is sharing all the reasons why older nursing students can (and do!) thrive in their programs. Hit play on this episode so you can focus on the positives, recognize your strengths, and realize it's not too late to follow your dream! (affiliate)  Crucial Concepts Bootcamp - Start nursing school ahead of the game, or reset after a difficult first semester with this nursing school prep course, Crucial Concepts Bootcamp. Learn key foundation concepts, organization and time management, dosage calculations, and so much more. FREE CLASS – If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES… you can thrive in nursing school without it taking over your life! Straight A Nursing Website - Learn nursing concepts and get tips to help you thrive in school and at the bedside. Learn more about the FreshRN All-Access Pass here: https://courses.freshrn.com/p/membership To see our latest course catalog (med-surg, ICU, precepting, charge nurse, ortho, cardiac, neuro courses, and more), click here: https://courses.freshrn.com/ Get weekly tips, encouragement, stories from the bedside, and more - just for nursing students and new nurses at: https://www.freshrn.com/email-sign-up/ Connect With Me Online! Facebook: https://www.facebook.com/FreshRN Twitter: https://twitter.com/Kati_Kleber Pinterest: https://www.pinterest.com/Fresh_RN/ Instagram: https://www.instagram.com/kati_kleber/ TikTok: https://www.tiktok.com/@freshrn Music credit: Keep My Cool by Benj Heard

 This week on the Team Lally Real Estate Radio Show, we interview Leigh Loganbill of Vitaflow Wellness. We talk about the benefits of IV drips and how they connect Science with health and wellness.We also have your favorite experts providing this week's tips on property management, mortgage loans, home inspection and home insurance!Who is Leigh Loganbill?Leigh grew up in Kansas, but was living in the Bay area (San Fran) prior to moving to Hawaii. She went to school at Kansas State, and University of Kansas Medical Center. She will be starting her master's program at Hawaii Pacific University in August. She came to Hawaii in 2005 as a travel nurse with the intention of staying 6 months, but she never left. She worked in the ICU at Queens and Kapiolani, then settled at Straub working as a stat nurse, in the Emergency Room and PACU. She has been a registered nurse for 25 years.VITAFLOW WELLNESS opened in 2019. It is a unique IV lounge and lifestyle med spa located in Kailua Hawaii. They connect Science to well-being by prioritizing prevention. Their services include IV Vitamin Drips & Booster Shots (Mobile Service available), NAD+, Xeomin- Anti-wrinkle injections, Medical Grade Microneedling, PRP (Platelet-rich plasma) & Hair Restoration- coming in February, Antioxidant Testing & Supplementation and Hydrojelly Facials.To reach Leigh, you may contact her in the following ways:Phone: 808-780-7245Email: aloha@vitaflowwellness.comWebsite: www.vitaflowwellness.com/

 This week on the Team Lally Real Estate Radio Show, we interview Leigh Loganbill of Vitaflow Wellness. We talk about the benefits of IV drips and how they connect Science with health and wellness.We also have your favorite experts providing this week's tips on property management, mortgage loans, home inspection and home insurance!Who is Leigh Loganbill?Leigh grew up in Kansas, but was living in the Bay area (San Fran) prior to moving to Hawaii. She went to school at Kansas State, and University of Kansas Medical Center. She will be starting her master's program at Hawaii Pacific University in August. She came to Hawaii in 2005 as a travel nurse with the intention of staying 6 months, but she never left. She worked in the ICU at Queens and Kapiolani, then settled at Straub working as a stat nurse, in the Emergency Room and PACU. She has been a registered nurse for 25 years.VITAFLOW WELLNESS opened in 2019. It is a unique IV lounge and lifestyle med spa located in Kailua Hawaii. They connect Science to well-being by prioritizing prevention. Their services include IV Vitamin Drips & Booster Shots (Mobile Service available), NAD+, Xeomin- Anti-wrinkle injections, Medical Grade Microneedling, PRP (Platelet-rich plasma) & Hair Restoration- coming in February, Antioxidant Testing & Supplementation and Hydrojelly Facials.To reach Leigh, you may contact her in the following ways:Phone: 808-780-7245Email: aloha@vitaflowwellness.comWebsite: www.vitaflowwellness.com/

Olá, hoje é 10 de setembro de 2024, meu nome é Mauro Luiz, sou Assessor de Agronegócios em Três Lagoas/MS, e vamos falar sobre o cenário da piscicultura no Brasil, com foco nos resultados das exportações do segundo semestre de 2024.  Comparando-se o primeiro semestre de 2024 com o mesmo período de 2023, observa-se um aumento de 98% no volume de produtos exportados.  Conforme levantamento da Embrapa Pesca e Aquicultura, o volume exportado neste primeiro semestre já representa 79% do total exportado no ano de 2023 em toneladas, e 96% em valor.   No segundo trimestre do ano, foram observados aumentos significativos em todos os resultados da piscicultura.O faturamento das exportações brasileiras de produtos da piscicultura aumentou 72% no segundo trimestre de 2024, comparando-se com o trimestre anterior, atingindo US$ 15 milhões entre abril e junho.  Filés frescos ou refrigerados mantêm posição de destaque dentre as categorias de produtos exportados, atingindo o montante de US$ 15,7 milhões no primeiro semestre, representando um aumento de 145% em relação ao mesmo período de 2023.  Os peixes inteiros congelados foram a segunda categoria mais vendida, com aproximadamente US$ 5,9 milhões e aumento de 73% frente ao primeiro semestre de 2023.   Representando 93% do total exportado no primeiro semestre de 2024, a tilápia manteve a primeira posição entre as espécies exportadas, representando aproximadamente US$ 22 milhões e aumento de 98% frente ao mesmo período de 2023.  O destaque como segunda espécie mais exportada é para o curimatá, com US$ 614 mil. Os pacus foram a terceira espécie mais exportada, com US$ 530 mil.  O estado do Paraná se manteve como o maior estado exportador de tilápia, com um total de US$ 16,5 milhões, representando 70% do total exportado no período. São Paulo foi o segundo maior exportador da espécie, com US$ 4,6 milhões e participação de 20%.  Os Estados Unidos continuam como o principal destino das exportações da piscicultura brasileira, com importações no valor de US$ 20,7 milhões, representando 87% do total exportado.O Peru foi o segundo principal importador no período, com US$ 1,0 milhão, representando 7% do total.   O Banco do Brasil conta com linhas de financiamento para investir na exploração de peixes e custear as despesas da produção.Procure o seu gerente de relacionamento para maiores informações.  Conte sempre com a assessoria especializada em agronegócios e com toda a equipe do Banco do Brasil. Fica a dica de crédito consciente e sustentável. Até a próxima.

Rockstars, help me welcome back our guest today, Olga Geissler! As a reminder, Olga is a registered nurse who works in a high stress trauma PACU. She also is a coach whose passion is helping women reach their highest level of health and wellness especially those who are working to be alcohol free. In today's episode, Olga and I tackle a crucial and often overlooked topic: the intersection of alcohol and perimenopause. We talk about personal experiences, explore the science behind how alcohol affects our bodies during this stage of life, and discuss ways to navigate these changes for better health and well-being. Join Olga and me as we navigate this important conversation and empower ourselves with the knowledge and tools to make healthier choices during perimenopause. As a reminder, if you have a chance, please rate and review the podcast so more women just like you can learn more about the Rockstar way! I appreciate you for your support and love ❤️ Links: RTF# 70 Alcohol and Your Health with Guest Olga Geissler https://spotifyanchor-web.app.link/e/n03syo36oEb RTF# 78 Navigating Holiday Parties & Alcohol with Family, Friends, and Festivities! https://spotifyanchor-web.app.link/e/7kRBZkbbbGb The Naked Mind by Annie Grace https://thisnakedmind.com/ The Naked Mind Facebook Group https://www.facebook.com/groups/TNMgroup FREE 30 Day Strength Challenge (dumbbell only) https://www.rockthatfitness.com/rock-that-fitness-30-day-strength-challenge FREE 30 Day Strength Challenge Next Level (full gym equipment needed) https://www.rockthatfitness.com/rock-that-fitness-30-day-strength-challenge-next-level Head to the Rock That Fitness Instagram Page https://www.instagram.com/rockthatfitness/  Sign up for RTF 1:1 Coaching https://www.rockthatfitness.com/coaching Join Rock That Fitness' Email List for Updates and tips on Nutrition, Fitness & Mindset! https://www.rockthatfitness.com Music from Uppbeat (free for Creators!): https://uppbeat.io/t/cruen/we-got-this License code: RBWENWHGXSWXAEUE

This week is a very special episode of the Marli Williams Podcast, where my amazing girlfriend, Liz Patail joins us to celebrate our 1-year anniversary with an open-hearted conversation that touches on the foundations of how to build a healthy relationship. From our unforgettable first meeting at an amazing event called Art in the Dark in Portland, to the moments of vulnerability and strength that have shaped our connection, this episode is a treasure trove of insights. Liz, a PACU nurse at the VA and a passionate creator, shares how intentional friendships and personal growth play critical roles in her life. Tune in to hear about the importance of authenticity, maintaining autonomy in partnership, and the power of stepping out of your comfort zone at social events to find love or make connections. Don't miss out on some hot tips about being genuinely present and filling up those emotional bank accounts in all your relationships. This episode is perfect for anyone seeking inspiration and insights on building healthy relationships, self-improvement, and the art of staying authentic.

As the DA you are paged to come to PACU to review a patient with pre-eclampsia who has just had a PPH and a repair of a perineal tear after delivering in labour ward. The O&G team ordered a VBG because she was febrile and they want to assess her lactate and start her on some antibiotics. The O&G registrar is concerned however because her potassium / K has come back as 7.8 mmol/L.... Join Natalie and I as we discuss the issue of hyperkalaemia specifically in the context of women suffering from pre-eclampsia. Why are they at risk of this important electrolyte abnormality and what are the principles of management? We also review a recent paper addressing some of the myths surrounding the treatment of acute hyperkalaemia (thanks to Casey at Broomedocs.com for bringing this paper to our attention). Useful References Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030. PMID: 34890894 LITFL, ECG library, Hyperkalaemia https://litfl.com/hyperkalaemia-ecg-library A case of probable labetalol induced hyperkalaemia in pre-eclampsia. https://pubmed.ncbi.nlm.nih.gov/25370900 Hypocalcaemia and hyperkalaemia during magnesium infusion therapy in a pre-eclamptic patient https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614650 Oh's Intensive Care Manual. 7th Edition. Chapter 93 – Fluid and Electrolyte Therapy. Bersten A, Soni N et al. 2014.

DrJoseph Wells, Anesthesiology Resident at the University of Kentucky, discusses care for patients in the Pediatric PACU.

Florence Nightingale was born on May 12, 1820 and National Nurses Week coincides with her birthday. She was called The Lady with the Lamp because she often rounded at night, and her dedication to patient care has continued for over 200 years.This Saturday, in honor of National Nurses Week, The Word on Medicine will air our program “All About Nurses." We are filling the radio station's recording studio with APNPs, RNs and OR nurses: Ashley Jurceka-Kolansinski (RN, 12 CFAC), Bethany Haefke (RN, BSN, PACU), Cara Kinderman (RN, BSN, level 4 PACU), Gabriella Pyptiuk (MSN, APNP), Gina Nickel (RN, MEDSURG-BC 12 CFAC), Hannah White (RN, 12 CFAC), Jessica Lunn (RN, Charge Nurse 12 CFAC), Justin Dworak (CRNA, APNP), Lisa Johnson (CRNA, APNP), Mary Elizabeth Holden (PA), Matthew Reuter (DNP, APNP), and Tiffany Early (RN, 12 CFAC). We discuss the powerful impact of nurses on all of us. You won't want to miss this program, especially if you are thinking of nursing as a career; if you have a nurse in the family; or if you just want some good entertainment. This program is a tribute to the nurses who make health care possible!

Macy's first birth was a scheduled C-section due to breech presentation that required follow-up exploratory surgery due to an unknown cause of internal bleeding. Unfortunately, her surgeon had accidentally nicked an ab muscle. Macy's recovery was very difficult.With her second, doctors were nervous about her chances of VBAC and would only let her try if she showed up in active labor before 39 weeks. Otherwise, she would go in for a scheduled C-section. Macy agreed and her birth ended in another Cesarean. Her birth was beautiful and her recovery was smooth, but it still wasn't the empowering experience she hoped for. Macy hit the ground running during her third pregnancy. When doctors were not supportive of a VBA2C, she knew home birth was her best option. She found a midwife who was willing to take Macy on as her first VBA2C client! We know you will absolutely love listening to this birth story. Like Meagan said, “It is so beautiful. It is so peaceful. It sounds like one of those births where you close your eyes and you envision birth and how peaceful, beautiful, and calm it really can be.”The VBAC Link Blog: VBA2C Practice Bulletin - VBACInformed Pregnancy - code: vbaclink424Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 03:44 First C-section with internal bleeding and a follow-up exploratory surgery09:04 Second pregnancy11:37 Scheduled C-section and getting pregnant again shortly after18:44 Finding a supportive home birth midwife23:24 VBA2C prep during pregnancy27:46 Labor begins32:42 Breaking her own water and pushing for 17 minutes36:47 ACOG's statement on VBA2CMeagan: Hello, hello Women of Strength. We are so excited to be sharing an HBA2C story and if you don't know yet what HBAC means, that's home birth after Cesarean and then HBA2C is home birth after two Cesareans. I feel like that's kind of funny. It's never really a term I used because I wasn't at the hospital and I wasn't at home, but I also kind of feel like I sort of had an HBAC. It was at a birth center. Maybe that's a term, birth center birth after two Cesareans. I don't know. But obviously, VBAC after two Cesareans are near and dear to my own heart and today we have our friend Macy from California sharing her HBAC story and just before we started recording, we were talking about how one of her messages that she wants to give is that you can do this. Right, Macy? You're just like, you can. People can do this. Macy: For sure. Meagan: Yes. Yes. I am excited to hear your story and then I wanted to also just talk a little bit at the end about some evidence on VBAC after two C-sections. So if you're wondering more about VBA2C, make sure you stick to the very, very end even after the story because we'll talk a little bit about that. 01:24Meagan: We do have a Review of the Week and this is from Jenna. It is actually on our How to VBAC: Ultimate VBAC Prep Course. She says, “I just started but have already learned so much. After two C-sections and one where my doctor made me think it was very risky, I was terrified to try again. With this course, not only have I learned the truth about VBAC, but I am excited to attempt mine in August.” That's coming up. I am so excited for Jenna. Thank you so much for the review and the support, of course, of taking the course. I am so excited that you are getting educated and definitely keep us posted. 03:44 First C-section with internal bleeding and a follow-up exploratory surgeryMeagan: Okay, cute Macy. Welcome to the show. Macy: Thank you for having me. Meagan: Absolutely. I'd love to turn the time over to you and share whatever message you feel is important for our beautiful Women of Strength listeners. Macy: Okay, well like with all VBACs, my story begins of course with my first pregnancy. During my first pregnancy, I was pretty healthy. I didn't love being pregnant, but I was excited that we were starting our family and I got to– I can't remember– 34 weeks maybe, 35ish, and baby was still breech. They offered me the ECV procedure, but they told me I would have to do it around 37-38 weeks and I was worried about it being so early before my due date that she would turn again. I was scared. They got me scared. They don't really present the ECVs as something that should work. Meagan: I know. I know. Macy: My midwife with my third pregnancy was like, “I wish you would have done it,” but they talked me out of it so I decided not to do it. Come 40 weeks, she was still not flipped, but I wasn't in labor so another thing is I wish I would have just waited to see because maybe she would have flipped in labor. Meagan: Sometimes they do. I actually recently had a client last year in 2023 that did have that. She was scheduled for her version and then she went into spontaneous labor so she actually went in pretty early because she was like, “Oh my gosh. My baby's breech. I was scheduled the next day for a version,” and they were like, “Baby's head down.” So it definitely happens. Macy: With my third one, she was sunny-side up. She was posterior, but I could feel her turning and getting into position. But anyway, I'll get there. I'll get there. I had my C-section scheduled. My daughter, Alayna was born 10 days before Christmas in 2018. She was perfect. She was 6 pounds, 13 ounces. I was not great. After my surgery, I came out. I was in the PACU and my blood pressure was dropping crazy low and my heart rate was spiking super high. I was ghost-white and they were like, “We don't know what's going on.” Long, long, long story short, I was having crazy internal bleeding. Meagan: I was going to say, were you hemorrhaging? Because that sounds like hemorrhaging. Macy: I was hemorrhaging. I was bleeding internally, but it was from having surgery. It was not anything to do with baby or birth. It was just surgery. So what we discovered is they had accidentally nicked an ab muscle and it was bleeding. 24 hours after my daughter was born, I had to go back in for an exploratory surgery and I was put under anesthesia completely again. They had to cut back open my layers and start over. Thankfully, they didn't have to cut into my uterus again, but they did open me back up and stop the bleeding, cauterize it and I mean, my recovery was just horrible. Meagan: Not great, yeah. Macy: I mean, thankfully I only had one baby so it was just her and my husband is amazing. I could not ask for a better partner, but it was just hard. It was hard to accept that, to grieve the birth I had dreamed of my whole life, but it never occurred to me that I couldn't have a VBAC. My mom had me via C-section and my three subsequent siblings were all VBAC. So when someone said to me at 12 weeks, I recovered. I was back at the gym and someone from the gym was like, “Oh, so you have to have all your babies as C-sections now.” I was like, “Wait, that's a thing still? We're still doing that?” I was like, “No. I'm going to have a VBAC.” I never even thought about it. I immediately was like, “Oh, so this is going to be a thing.” That's when I found you guys and I started listening before I was even pregnant with my second one, but when I did get pregnant three years later with baby number two, I probably binge-listened to every single episode. I was like, “I'm doing this.” 09:04 Second pregnancyMacy: I switched providers just because I didn't have a great experience so I was like, my postpartum care, I didn't care for my pediatrician so I just switched everything. But because I was with a new provider, I had a really difficult time locating my surgical notes. My new providers wanted to know if my first C-section was done with a single or double-layer closure. Meagan: Oh, interesting. Okay. Macy: Because of course, if it's single, it's going to increase my risk for a rupture. I at this point was already like, the risk of rupture is so low. I am not worried about it. Breech baby is a great candidate for VBAC. Meagan: And the evidence on that is really not solid on which one really is best. There are some that show double may be better, but that doesn't necessarily mean that your rupture rate skyrockets because you have a single layer. So they are focusing on something that didn't have a ton of evidence. Macy: Right. I was like, “There is just not enough research to justify all of these C-sections.” But because they didn't understand what had gone wrong and why I had to have a second surgery even though I told them a million times it wasn't anything to do with my uterus. It wasn't a me problem. It was a doctor's problem. They were just like, “We just don't feel comfortable with TOLAC.” And you know, it's always TOLAC. It's never just a VBAC. Meagan: I know. Macy: But they didn't want to do anything. They didn't want to offer ultrasounds. They just were not willing to take a chance even though it was a really good chance. So basically, they were like, “The only way you are having this second baby VBAC is if you come to the hospital and you are in labor and it's time to push.” I mean, that's kind of scary to someone who doesn't know. I mean, now that I've done it I'm like, “That's what I should have done,” and that's what I tell my friends. You don't go to the doctor until your contractions are two minutes apart because they try to scare women out of their VBAC. 11:37 Scheduled C-section and getting pregnant again shortly afterMacy: So I just didn't really stand up for myself. I just agreed like, “Okay, I guess.” I told myself, “If I go into labor before my scheduled C-section at 39 weeks, then that's the way God wants it and I will have my VBAC.” Obviously, that never happened and 39 weeks is pretty early now knowing especially when due dates are just guess dates. Meagan: Very important note that you just gave there. Macy: Yeah. I had my baby at 39 weeks. She was perfect. I mean, my recovery was– she was another 6 pounds, 15 ounces so they were almost the same size. That was Reagan. Recovery was a lot better but still, I had a 3-year-old at home. Going from one to two was pretty good for me. I have a big family. That was great. But it was still not the empowering birth that I wanted. I did feel– I don't want to say I didn't feel empowered because C-section is badass. It's hard. Meagan: Yeah. Mhmm, yeah. Macy: It's not the easy way out ever. There is no easy way out of birth. I do want to preface that and say if that's what ends up happening and you only have two kids and you only have two C-sections, that's okay too. I knew we weren't done having kids. I wanted the birth I wanted. I did not plan to get pregnant with such a short turnaround time. I was almost 8 months postpartum when we found out we were pregnant again. We were a little surprised. I mean, we are grown adults. It shouldn't be that surprising. Meagan: But still, it can be a little alarming when you weren't mentally preparing for that. Macy: I had just finished breastfeeding. I was just starting to track and all of these things so I was like, “Oh no.” But that was kind of when my work really started for me because I was like, “Okay. We are doing this again and I'm going to do this the way I want. This is going to be how I want it to go. This is my story and this is going to be an essential component of who I am as a woman and as a mother going forward for the rest of my life. I need this to go the way I want it to go.” I wanted it to go the way God wanted it to go of course, but I was like, “I'm going to take more control.” Meagan: Can I add something to that? Sorry to interrupt, but there are so many times that I hear people, I read on social media that people are getting after moms and parents who are like, “I want this birth. This is what I want. This is what I feel I need,” or what you are saying. “I want it to go a certain way.” They are like, “Why do you have to focus on what you want? It's not what you want. It's what's best for the baby.” They are railing on these people. I want to stop and say that what you said is okay. I feel like maybe a little passionate about that too because so many people were naysayers to me. “It does not matter what you want. It's what's best for the baby.” It's like, well guess what? That's also maybe what's best for my baby. Macy: Right. Meagan: It's okay to say, Women of Strength, “I want this birth. This is what I want.” And you deserve that. You deserve to go after what you want. Macy: It is hard and being a mom is hard. Meagan: Yes. Macy: You can start out in a way that you feel empowered. It is life-changing. It really is. Meagan: It is. So sorry for interrupting, but I just wanted to give a little tidbit that it's okay for people to want what they want. I wanted a white vehicle. I was going to find a white vehicle. It's okay to get what you want and to put forth energy and to say that out loud, “I want this VBAC. I'm going to get this. I want it.” Macy: You spend almost 10 months thinking about this and praying about it whereas you talk to– I mean, it wasn't as important to anyone else in my life except for me. That was okay. Especially the doctors and the providers, I'm just another person to them and yes, there are some really great providers out there and they do care, but they are at their job. They are doing their job. Well, my job is to be a mother. That's my job, so doing what serves me well was birthing my baby the way– Meagan: Having a VBAC. Macy: Having a VBAC. So I really hit the ground running. There were a few girls in my town who had recently had homebirths. They weren't VBACs, but they were VBACs so I reached out to them– shoutout to my girls Megan and Emily. They were so helpful because they were real people. I reached out to you guys and I just wanted to know, “Hey, what is the research on really close pregnancies?” because I wasn't going to hit the 18 months. Meagan: The 18 months. Your babies were going to be 17 months apart, right? Macy: 17 months. So that was even annoying too because I was like, “I'm right there. Come on.” You guys were like, “Go join the Facebook Community group.” I was so glad that I did because I was just finding story after story after post after post. Not only were so many women having VBACs after two+ C-sections, but they were close together. Some were like, “Mine were 12 months apart.” I'm like, “Oh, I'm good to go then.” It was so nice having that community. I was even able to join a community within the community of everyone who was due at the same time as me so when we got close, we had a group message and everyone was like, “Is it happening today? Is it happening today?” It was so nice not to be alone in that. I also had to find a midwife because I knew my providers were not going to be supportive of VBAC after two. I actually had a hard time finding a midwife which was also annoying because I was met with some medwives who were just really going to stick to that 18 months. 18:44 Finding a supportive home birth midwifeThen I happened to just find a woman who was like, “I've never done this before. You are my first VBAC after two,” but she was a midwife who was very knowledgeable. She had done lots of home births. She had done VBACs, but not after two. She was like, “If we don't start accepting these patients, how are we ever going to change the status quo? How are we ever going to make a change?” Meagan: Boom.Macy: Right. Meagan: It's so true though. Macy: I was like, “Okay. Statistic me, please. I would love to be a statistic for the positive.” The only thing was I was like, “I can't be one for a hospital birth, but it's fine.” Meagan: That's okay. That's okay. Macy: So I found Sarah. I started my visits with her. I had to travel an hour to my visits. It wasn't the worst thing ever. Meagan: That's a commitment though. That's a commitment. Macy: Towards the end, she came to me a lot more which was so nice. So nice. Meagan: That's really nice. Macy: Then we did a couple of phone calls, but we also texted all of the time and would FaceTime. It was just so personal. I also received co-care with another third local provider. I did that because my midwife wanted to have me get ultrasounds to check my uterus. She wanted to check for previa and we wanted to check for– what's the other one? I'm blanking. Meagan: Accreta? Macy: Yes, so she just wanted to be aware. Meagan: Placental issues and make sure the placenta is out of the way and all is doing okay. You're actually clear to have a VBAC. Macy: Yeah. Meagan: Which is very responsible of her. Macy: I received my co-care. I would go in there. I don't know. I almost had a chip on my shoulder because I was like, “I don't really need you guys,” kind of. I didn't leave those appointments feeling like I wanted to cry like I did with my second pregnancy because I knew that I had something better planned. So it wasn't as upsetting, but they were pretty rough on me. I had expressed my interest in a VBAC after two and you have to see the series of providers within the office. I had only one who was a little bit younger which was interesting, but he was the only one who was like, “Yeah. I really support this and the birth you want to have. I'm going to give you a referral to UC San Francisco and when we get to the end, I want you to start care there and plan to have your birth there.” He was the only one who was like, “I support the birth you want to have.” Everyone else was pretty awful. They told me, “If you TOLAC and your uterus ruptures, you will die and your baby will die.” I was like, I will never forget getting in my car and texting my midwife and being like, “Can you believe that he just said this to me?” I was just like, “Are you God? Do you know?” How could you say that to someone? “You will die.” Because that's not the case at all. That was interesting but I knew. Like I said, I knew I had a backup plan in the back of my mind. It was just eye-opening for me more than anything. It wasn't upsetting. Meagan: Someone that doesn't necessarily know the evidence of that, it can be terrifying. Macy: Yeah. Yes, totally. And you know what? It's frustrating because a lot of people just trust their providers. I'm a very skeptical person. I'm very conspiratorial, so I'm always researching things and looking into things, but people who are not prone to that are just going to trust what the doctor says because they went to school and they are smarter than them. It's so unfortunate that it's causing a high C-section rate for no reason. 23:24 VBA2C prep during pregnancyMacy: That was a bummer but anyway, throughout my pregnancy, I did all of the things. I did my VBAC Link course. I loved it. It was great to have that. I did a Lamaze class which was really fun. It was funny because we were the only parents in there with other kids. One other lady was a VBAC, but the rest were all first-time parents. They were like, “What are you doing here?” I'm like, “This is new for me.” Again, shoutout to Modesto Birth and Beyond. They are fantastic. They have a great set of doulas. I'm now on a friendly basis with them. They were great to have and they were really supportive of my whole journey. Let's see what else. I did a Hypnobirthing class. I read Ina May's Guide to Childbirth. I mean, I walked and I stayed in shape. I kept doing CrossFit. I did CrossFit for all three of my pregnancies so I kept on. I ate healthy. I drank lots of water. I did all of the things. But I knew that when it came down to it, my mind was going to either make or break me.Fast forward to 41 weeks and I was getting very, very anxious. Meagan: Were you getting anxious because you were getting ready to have a baby type thing or were people giving you some grief that you were over 40 weeks? Macy: By the time I was 40-41 weeks, the grief and the doubt and the naysayers that I got were kind of gone. Most of the people in my life were supportive. I always got that question of, “What if this happens?” I live 5 minutes from the hospital, so I was not too worried about it. I was more anxious of, I was ready to meet this baby. I was the biggest I'd ever been. Third baby, only 17 months apart. My belly was huge. It was hot. I was swelling. I was ready to be done, but I also had never labored before. I had no clue what my body was going to do. Was I just going to go into spontaneous labor at 40 weeks? At 39? I had no idea. So every day that passes, I'm sure you remember that too, every day was a whole week where you wake up in the morning and I would just cry, “I can't believe I'm still pregnant.” Meagan: I remember going to bed and I was like, “Tonight could be the night,” and then I'd wake up and I was like, “It wasn't the night,” then that night, I'd be like, “Maybe tonight,” and it just kept happening. Macy: So annoying. I had so much prodromal labor. I had contractions. I could time them and I was like, “Oh, they are 20 minutes apart. They are for sure going to get closer,” then I'd go to sleep, wake up, and be like, “Okay. Here we go again.” Let's see. So on a Monday, I did acupuncture. Then on a Wednesday morning, I was 41 weeks and I went and got a massage. I got some acupressure. You never know if these are the things that really get things going, but sometimes they do. I got a massage and she gave me some moxibustion so I did that. You light it and do it around– my mom was like, “This is so hokey.” I'm like, “If it works, who cares?” I was trying everything. But I didn't want to be induced and I hadn't had my membranes swept yet. That was going to be the first intervention that my midwife and I agreed on because she was like, “Legally in California, you can't go past 42 weeks and have a home birth.” I was like, “Okay. I've got one week. One week and this baby will be here.” 27:46 Labor beginsMacy: That Wednesday morning, I went and got my massage and by 2:00 in the afternoon, I was like, “Okay. Things are starting to pick up.” I started having pretty intense contractions. I was having to– I could still talk. I was still taking care of my two little girls, but I was starting to feel really uncomfortable. My mom went home, then she came back. My husband gets off work at 3:30 and it was 2:30. I was feeding my youngest one a snack and he was like, “Do you want me to come home early?” I was like, “No, I can totally make it until you get home.” I had a contraction where I leaned over my kitchen counter, and then I was like, “Okay. Maybe just come home now.” He came home. I just didn't feel it. I was starting to feel irritated by my kids and I was like, “I just want to go in my room and watch a show on my laptop. I just want to be alone.” I didn't necessarily want them to leave yet, but I wanted to be alone and I wanted to know that they were taken care of. He came home and he was taking care of them. He was like, “Do you think this is it? Let's call my mom.” I was like, “Yeah. I think this is happening and I think it's going to be soon.” I just didn't know how long I was going to labor. It was a mystery. My mother-in-law came and picked up my little two daughters. That was kind of sad watching them leave knowing the next time I saw them, we were going to be a different family– a better family, but a different family. Yeah. I just labored at home. It was so nice not having to go anywhere. I took a shower. I had some snacks. I wasn't super hungry, but I definitely started drinking my electrolytes and started preparing to be hydrated. Meagan: Smart. Macy: I was like, “I'm preparing to run a marathon so I need to gear up.” I didn't nap. I've never been a great napper, but I laid around and watched some shows, then I didn't text my midwife right away because I had been bugging her so much with all of my prodromal labor that I was like, “I'm not going to text her until it's really happening.” But by 6:00 or 7:00 PM, i texted her and was like, “Just so you know, my contractions are about 10 minutes apart.” As they got closer, she was like, “Okay. I'm going to come now.” Once the sun started setting, it was getting a little bit more intense. We set up my birth space at home. I set up my pool. Well, I didn't. My husband set up the pool and we laid out all of the sheets on the couch and hung my birth affirmations. Actually, they had been hanging. My birth affirmations had been hanging for a couple of weeks so I started having them memorized, but we turned on the twinkle lights and I started listening to the Christian HypnoBirthing app which was fantastic. I just had such a peaceful labor. I don't know how else to describe it. My mom came in and then my sister-in-law came over then my other sister-in-law came over. They just talked around me. I could hear them, but I was just in my space. I labored and my water never broke for a very long time. I got in the pool at one point and then I got back out because my husband was like, “I think that being in the pool is slowing down your contractions a little bit. I want you to get out and walk.” I got out and started walking down the hall then I got really sick with a contraction. I happened to already be laboring backwards on the toilet and I was like, “Oh my gosh. I'm going to throw up.” I jumped back off the toilet so I could throw up in it then my midwife was like, “Okay. You're in transition now. You've got to be.” I hadn't had any checks at all this whole time either too so I had no clue what I was even dilated at. I was just completely trying to trust my body and just know that when it was time, it would be time. It really was. My body just did what it knew to do. 32:42 Breaking her own water and pushing for 17 minutesMacy: Like I said earlier, I felt her move into position. I got back in the water and I felt so relaxed in the water. I was drifting off in between contractions. Meagan: Oh, that's awesome. Macy: It was so calm and I just kept telling myself, “Breathe her down with every contraction,” and just all of the things I had been practicing, I was finally able to put into use. That was really cool, then I had a couple of urges where I was like, “I feel like I can start pushing soon.” I was like, “Do you want to check me now?” As soon as she stuck her finger, I was like, “Oh, no. No. Get your finger out. It's time. She's coming.” She was like, “Yeah. She's ready. She's right there, but your waters haven't broken yet.” I was like, “Can I break them myself?” She was like, “Yeah,” so I reached in. I gave it a pinch-twist and in the water, I broke it. Meagan: Oh my gosh, that's so cool. Macy: I felt the padding around her head, then I just felt her head. I felt her hair. I started pushing when it was time to push and I pushed for 17 minutes. It was perfect. Like I said, I felt her move and get into position. She came out and she was 9 pounds, 12 ounces so she was 3 pounds– Meagan: I was going to say 6lb,15oz, right, was your second and close to your first?Macy: 3 pounds heavier than my other two. She came out. She did perfectly. Her heart rate was perfect the whole time. She came out mad, screaming mad. She was so cozy in there. She did not want to come out. She came out but hearing her cry within 20 seconds was so reassuring. She was safe. I didn't need anybody. I just needed to trust my body and to trust the Lord. My midwife was like, “That was one of the most perfect births I have ever attended.” She was beaming with joy and she was so excited for me. She was just so happy because she was like, “I've never done this after two.” She was like, “You changed everything I thought I knew about home birth, about after two C-sections.” She even now has another client which is great who is a VBA2C. I cannot wait for this podcast to come out so I can share it with my midwife and she can share it with her new client. Hopefully, they have a really great birth too. All in all, it was just everything I dreamed of. I was so thankful and I just remember laying there with her on my chest. I was watching the video last night trying to get in the mindset and remind myself and get there. On the video, I can hear myself go, “I'm so freaking proud of myself.” Meagan: You should be!Macy: I was beaming with joy. I was like, “That was so hard but so worth it.” So it was great. It was a great experience. I could not be more happy with her birth. She's a great baby. She's so happy. She was a little hard at first for 10 weeks which was different for me, but after that 10-week hump, she was a really good baby. Her name is Lucille. Meagan: Cute. Macy: We call her Lucy which means “light” and she is the light of our lives. She is the best and I can't even believe we had a family without her for a minute there. But that's my story. 36:47 ACOG's statement on VBA2CMeagan: Oh my gosh. It is so beautiful. It is so peaceful. It sounds like one of those births where you really do. You close your eyes and you just envision birth and how peaceful and beautiful and calm it really can be. To me, you just described the birth that you physically did with one that I would imagine. Macy: Yes. It's how it felt. My sisters-in-law and my other girlfriend who was there taking pictures just kept saying, “You did so good.” I was just like, “I don't know what that means.” But everyone was proud of how it all went. I think that's so super revolutionary. I hope my story touches other people's lives. Meagan: It totally will. I'm so happy that you found your midwife and that your midwife was willing to take you on because a lot of the time, providers can be nervous if they have never done it before. Macy: Which I get. Meagan: Oh yeah. For sure, for sure. I'm just so glad that she was willing. That's one of the things that gets me sometimes with so many people who just are not, we have to respect them and what they are comfortable with. But really, the evidence does show that VBAC after two Cesareans is reasonable. The overall risk and rate of rupture is approximately 1.4% so it's still very low. It's still very, very low. I mean, ACOG themselves, the American College of Obstetricians and Gynecologists, they suggest it. They say it's a completely reasonable option so for so many people to be cut off after one is heartbreaking because there are so many people who could have a vaginal birth all over the world but aren't given the option. We have a high Cesarean rate. We have so many. There are so many people. Just actually weirdly enough at the gym, a man who is the darndest cutest thing ever, his name is Robin and he will always say hi to me and check in on me and how I'm doing. He knows that I cycle and one of the things he asked the other day was, “How's that doula thing coming?” I said, “It's really great.” He said, “I never asked you. What made you want to become a doula?” I just told him my story and he said, “Oh, so you had two C-sections?” His eyes were wide. He said, “But you said you have three kids.” I said, “Yeah.” He goes, “But you only had two C-sections?” I said, “Yeah.” I said, “With my first two girls.” He was like, “Wait.” He literally was stumped there for a minute. Macy: Yeah, people don't know. Meagan: He said, “You had a normal birth after two C-sections?” I said, “Yes.” I said, “Robin, I had a vaginal birth after two Cesareans.” He looked at me because I said the word vaginal. I said, “That's what it is.” He said, “I didn't even know that was a thing.” People just don't. They just don't know that and then there are still so many providers all over the world who aren't supporting it. In the ACOG Practice Bulletin, it says that VBA2C, vaginal birth after two Cesarean, is reasonable to consider for women with two previous low-transverse Cesarean deliveries to be candidates for TOLAC. We mentioned the word TOLAC earlier, a trial of labor after Cesarean. A lot of providers use that. It is a medical turn. We call it VBAC. They call it TOLAC. It's not a VBAC to them until the baby has passed through the vagina. It says that they are candidates for TOLAC and “to counsel them based on the combination of other factors that affect their probability of achieving a VBAC.” Meagan: Now, just a couple of things to share before we drop off on this episode, if you had a Cesarean before or two Cesareans, it is not necessarily a reason for you to have a third. If you have gestational diabetes, that doesn't mean that you can't VBAC either. I'm trying to talk up these other factors, right? If we have preeclampsia, that doesn't always necessarily mean that we have to schedule a Cesarean. We've shared stories in the past. We've even had things like babies with medical conditions where still even their provider said, “Just because your baby has this doesn't mean you can't have a VBAC.” That doesn't always necessarily mean you can't either. If you have a big baby, here we are. A nine-pound baby, right? A nice, squishy little baby. Big baby doesn't mean you can't either. A diagnosis of a small pelvis shouldn't be considered– these factors really are more extreme I feel like so if your provider is giving you some of these, “Oh, well you could have a VBAC after two Cesareans but because your baby didn't come down the last two times, it's just probably not going to happen.” You can't see it. Macy rolls her eyes with me. Macy: The baby is going to come out. It has to come out. Meagan: Baby is going to come out. Believe in yourself. Do the research. We do have a VBAC after two Cesarean blog. We'll make sure to link it here and kind of spin back to what you said about how you were like, “Let me be a statistic. Let me a statistic to your midwife.” VBA3C– we don't have a lot of stats on VBA3C and I think a lot of it is because we are not doing them. We are not allowing them yet we have so many VBA3C moms in our community who share or on our podcast who show that it still is possible. I feel like there needs to be more risk assessment there and studies need to be done there. So know that even if you've had three Cesareans, that still doesn't mean that you are eliminated from the chance to go for what you want, fight for what you want, and have that experience not only that you want but that you deserve. Macy: For sure. Meagan: Yes. Thank you so much for sharing your story and I cannot wait for this to be published for you to send this to your midwife so she can send it on to the next Woman of Strength. Macy: Thank you so much for having me. I have loved being here and talking with you. I hope there are so many lives touched and changed by sharing my story.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Our Sponsors:* Check out Dr. Mom Butt Balm: drmombuttbalm.comSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

 Estás escuchando #JUNTOSRadio   ¿Cuáles son las diferencias entre la anestesia del parto natural y la cesárea? , ¿Es dolorosa la aplicación de anestesia epidural?, ¿La anestesia epidural tiene alguna influencia sobre el tiempo del parto? El Dr. Bryant Staples es profesor adjunto en el Departamento de Anestesiología del Sistema de Salud de la Universidad de Kansas , nos responde a estas y otras preguntas.       Sobre nuestro invitado:   El Dr. Bryant Staples, trabaja como anestesiólogo multiespecialidad en el hospital principal y los centros quirúrgicos ambulatorios, crea/ejecuta regularmente la programación diaria de unos 150 proveedores y participa en los equipos regionales de anestesia y PACU.  Desde 2016, se ha desempeñado como médico informático para el sistema de salud (incluidos sus centros quirúrgicos ambulatorios y hospitales en Great Bend y Hays), dirigiendo optimizaciones en el registro electrónico, encabezando funcionalidades para aumentar la seguridad del paciente, mejorar la facturación/cumplimiento y simplificar los flujos de trabajo. Como enlace del banco de sangre desde 2020, ha trabajado para simplificar los pedidos de sangre y la documentación en todo el hospital y ayudar a garantizar una entrega de sangre segura y rápida. Trabajando en un equipo interdisciplinario de médicos, enfermeras y administradores, ayudó a diseñar e implementar el equipo de respuesta de vía aérea difícil del hospital en 2018 y continúa sirviendo en el comité directivo.  Los intereses de investigación del Dr. Staples están relacionados con el rendimiento y la eficiencia de las operaciones, la mejora de la calidad y la seguridad del paciente.       Recursos informativos en español:    American Pregnancy Association  https://americanpregnancy.org/es/healthy-pregnancy/labor-and-birth/what-is-an-epidural/  Medline Plus  https://medlineplus.gov/spanish/ency/article/007413.htm     Facebook: @juntosKS      Instagram: juntos_ks      YouTube: Juntos KS   Twitter: @juntosKS      Página web: http://juntosks.org      Suscríbete en cualquiera de nuestras plataformas de Podcast: Podbean, Spotify, Amazon Music y Apple Podcast - Juntos Radio      Centro JUNTOS Para Mejorar La Salud Latina      4125 Rainbow Blvd. M.S. 1076,      Kansas City, KS 66160      

Barry Fox, Head of Operations, Inland Fisheries Ireland on the South American Pacu fish found earlier this week in Lake on Cavan Leitrim border by angler Steve Clinch.

FREE! CRNA School Interview Prep Guide: https://www.cspaedu.com/uc9a5ih4In this third episode with our guest host David Warren, he explores post-extubation emergencies that would require your attention. Tune in as he discusses laryngospasm, the most common emergency you will encounter after such a procedure. David presents several ways to address it as quickly as you can. He also talks about treating post-extubation obstructions and the importance of ensuring that the patient is breathing properly before moving them to PACU.Have you gained acceptance to CRNA school? Congratulations! Prepare with the #1 pre-anesthesia curriculum, as recommended by CRNA program faculty. Start the NAR Boot Camp today: https://www.cspaedu.com/bootcamp Get access to planning tools, mock interviews, valuable CRNA Faculty guidance, and mapped-out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy: https://www.crnaschoolprepacademy.com/join Book a mock interview, personal statement, resume and more at https://www.TeachRN.com Join the CSPA email list: https://www.cspaedu.com/podcast-email

Bebel Gilberto ('Adeus América', 'Eu vim da Bahia', 'É preciso perdoar', 'Undiú', 'Ela é carioca'), Luiz Millan ('Pacuíba', 'Full moon', 'Morungaba' -con Lisa Ono-, 'Montparnasse' -con Clémentine-, 'Que os ventos limpem os tempos') y Luciana Souza & Trio Corrente ('Pra machucar meu coração'). Abre Pat Metheny con 'I fall in love too easily') y cierra Bianca Gismonti Trio con 'Piano station').Escuchar audio

Here at The VBAC Link, we want to empower you with better birth experiences AND better postpartum experiences. The Lactation Network does just that. Caitlin McNeily is Vice President of Consultant Relations at The Lactation Network, working closely with thousands of International Board Certified Lactation Consultants in all 50 states. Her background in medical device sales led to the creation of Ashland Breast Pumps. It was through this work– connecting with new parents desperate for help– that led to The Lactation Network.Chrisie Rosenthal is an International Board Certified Lactation Consultant and Director of Lactation Content and Programming at The Lactation Network.She has helped more than 7,000 families through her successful private practice, The Land of Milk and Mommy. She's worked alongside large pediatric practices in Los Angeles and as a hospital-based IBCLC. In addition, Chrisie is the author of two best-selling breastfeeding books: Lactivate!: A User's Guide to Breastfeeding published in 2019 and The First-Time Mom's Breastfeeding Handbook: A Step-by-Step Guide from First Latch to Weaning published in 2020. Caitlin and Chrisie are both moms who had breastfeeding struggles of their own. They are passionate about helping other moms have the care and advice they wish they had!Additional LinksThe Lactation NetworkHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have an amazing episode today for you with our friends, Caitlin and Chrisie. They are from our favorite, The Lactation Network, and are IBCLCs with The Lactation Network. We are going to get into the topic of how The Lactation Network came about but also, all of the questions and what it means to work with The Lactation Network and an IBCLC. We talk so much about preparing for birth and then birth. We talk a little bit about postpartum. We are starting to get more into postpartum because it is a really important topic, but this is a topic that is near and dear to my heart because I have had three babies and three pretty different experiences. I've had some challenges along the way, so we are excited to welcome our guests today talking about breastfeeding and pumping and going back to work and all of the things and what it looks like to work with an IBCLC through The Lactation Network. So, welcome ladies. Caitlin: Thank you. We are so excited to be here. Chrisie: Thanks, Meagan. Meagan: So excited to have you. I think maybe we can just start off right off the bat with what is TLN? We've been talking about it for a little while now, but what is The Lactation Network? How did it start and where are you today? Caitlin: Yeah. My name is Caitlin McNeily. I am the VP of consultant relations at TLN. TLN stands for The Lactation Network. We are the largest network nationally in the U.S. of IBCLCs, lactation consultants for short, but IBCLC stands for Internationally Board Certified Lactation Consultants. I am based in Chicago and have been with TLN since its inception and have seen it through a couple of iterations and have watched it grow as my fourth baby, as I sort of lovingly refer to it as. I do have three kiddos of my own– 13, 11, and 8. I had very different nursing experiences with all three of them. All three of them were C-sections and all of those were equally as different. So you know, when starting TLN, so much of it was very much in my wheelhouse at the time. I was pregnant with my third baby and going through that whole process. I wish I knew then what I know now about all of the amazing support that a lactation consultant can offer. The way that TLN was born, I think, is relevant to cover briefly but essentially when the Affordable Care Act mandated coverage of breastfeeding support and supplies, I was brought into a company to start a breast pump, what we call a DME which is a durable medical equipment company. I won't get in the weeds there, but essentially, we provide equipment directly to patients and we handle the insurance component. It started with the breast pump DME, getting parents the essential tools that we need, certainly in the U.S. with limited maternal leave. We certainly need breast pumps if we expect them to continue their breastfeeding journey. That was where the business really started. Roughly 12-18 months into that endeavor, a lot of these parents were calling me back postpartum saying, “Hey, you were really helpful at getting me a breast pump, but now I'm really struggling with my breastfeeding journey. Can you help me?” I myself am not clinical, so it wouldn't have been appropriate to try and troubleshoot their nursing issues. I leave that to the experts now. At the time, what happened was I reached out to an IBCLC locally here in Chicago and started sending her on some visits. Now, because the Affordable Care Act mandates that this care be covered, it was seemingly going to be a smooth transition from breast pumps into breastfeeding support. There is some lack of understanding, a lack of a pathway into insurance reimbursement for lactation care and I met that head-on by working directly with insurance providers and working through some new pathways that they could adopt to be able to cover this care for patients. As soon as there was progress made there with some insurers, we were sort of off to the races. Then what happened, was more lactation consultants were hearing about us. I was reaching out to more lactation consultants around the country as our patient base started to grow. It was very much an organic growth process, very supply and demand if you will. Now, our first visit was in 2016 so fast forward to 2023 and we've helped over 300,000 individuals with their breastfeeding journeys. Meagan: Wow. Caitlin: Yeah. It's a huge nod to the exceptional care of our IBCLC network. It's also really just standing up the reality that parents in this country deserve lactation care. I think a lot of times, we get very stuck in the conversation or drama or consideration around breastfeeding when the reality is lactation care is human health care. When you birth an infant, you are going to experience lactation on a variety of levels and in a variety of facets. However, this is a physiological and biological reality of the birth process and bodies that birth babies and lactate deserve healthcare surrounding that. Meagan: Amen. Caitlin: That is just our steadfast mission is to make this care accessible to all birthing families. Meagan: I love that so much. I love that you say lactation care in general because we are all going through different experiences. We all have these babies and then we are like, “What do we do with these things that are making milk? How do we feed these babies and how do we go back to work?” And all of the things, right? I love this network so much. I can literally scream it to the rooftops, you guys. This is amazing and it should be something that everyone gets. So you work with insurance, but are there still insurances that maybe aren't quite there yet? How does that factor in? Caitlin: Yeah, yeah. That's an excellent question. We are dogged in our pursuit of expanding lactation care within insurers that we do work with currently and expanding it into different pairs that are not currently working directly with The Lactation Network. We have no intention of stopping that mission or slowing down that mission. Our goal is to hold insurance companies accountable for this very essential care. The economic argument, the healthcare outcome argument– these things are black and white. There really is no gray area as it pertains to the benefit of taking care of lactating parents. In addition to insurance, understanding the importance of this care and the true economic value of this care, employers are starting to perk up as well meaning they want to make sure that when one of their parents goes out on maternity leave that they are set up for success in this arena because the statistics of predominantly women of childbearing age dropping out of the workforce to take care of their infant and their health and their mental health and their homes and all of those things. It can't be overstated how beneficial it is for employers to take care of their employees in this capacity. They will have easier times recruiting. They will have easier times retaining top-tier talent. This generation of women having babies and families bringing babies into this world are very contemplative when they choose what business they want to enter into agreements with. So much of that right now is based on the benefits base. They want to know that their employer is going to support their endeavors at home to keep them productive at home and happy at work.Meagan: Oh my gosh. Yeah, when I was working, I had my daughter and then I went back to work. I just remember the stress of, “How am I going to do this? How am I going to pump and keep my milk supply and feed my baby and do all of these things?” At the time, my work was like, “I guess you could go in the back storage room.” That was about all they gave me, then I was like, “Okay, well the milk has to be refrigerated.” They were like, “No. You can't. No. Bring a cooler.” So every day, I was trucking in this big pump and this cooler and all of these things. It would have been so nice to have more of that support. I probably would have stayed longer-term maybe. I don't know but it would have been nice to not feel– I mean, I still felt more support than I know some, but I still was like, “This is weird. They are not gung-ho about this.”Caitlin: Yeah. It's not ideal. Meagan: Yeah. It wasn't ideal. Caitlin: It's not ideal. Yeah. I think to paint the picture of what is available through The Lactation Network for those types of parents, it doesn't matter if you are staying at home or going back to work. It's not a one-size-fits-all-all, but the lactation care cadence that should be commonplace is that it should be preventative. That is where it falls in the Affordable Care Act. This is preventative care because as I mentioned before, your body is going to do this. Much like we go to scope out a pediatrician prior to the baby being born and then we go for our 7-day check-up and all of these things, we are really passionate about trying to shift the paradigm to match that type of preventative care as it pertains to lactation. What that can look like is a prenatal visit, a 3-day postpartum visit– so the day after you get home from the hospital, and then we can have adjustments because baby adjusts so much as your milk comes in and those first two weeks are so substantially different. You can have a troubleshooting visit. You can have a plan to go back to work and create a pumping schedule visit, storing milk. Occasionally, we'll run into a case of mastitis or clogged ducts. Oftentimes, when a parent goes back to work, their milk supply can drop a little bit. It can be just trying to engage in a new schedule with your breast pump, engage in a new schedule with waking up early, stress,  hydration, and eating at work. Those things can all play into your milk supply. Working directly with a professional to a) set your mind at ease, but also to adjust that plan accordingly. Those visits can go all the way through weaning. This is really a journey. It's a personal journey and this is where I would love to kick it to Chrisie because we are so fortunate to have her at TLN. She is just a top-notch human being and IBCLC on top of it. I think she can shed some light as to why TLN is so passionate about the IBCLC certification and why we only work with IBCLCs. Meagan: Yeah and more even on what IBCLCs truly do. We are talking about what those look like, but what more do you do, Chrisie, for parents? Chrisie: Yeah, thank you, Caitlin. I'd love to start with just what an IBCLC is because I think that there is a lot of confusion in the space of lactation caretakers to use that word, right? Lactation providers. IBCLCs are unique in that we are the highest credentialled healthcare providers specializing in lactation. We are truly the gold standard. One of the things that exists– and I always say that I love all of the supporters. I love all of the educators. There is a place for everybody, but I think it is important for families to know what differentiates an IBCLC. IBCLCs typically, it takes about 3-5 years to become an IBCLC. That includes a program that takes 90 hours of education in human lactation, coursework in 14 health science subjects, 300-1000 hours of supervised clinical experience, and then passing boards and recertifying every five years. It is definitely an in-depth program and process. Meagan: Very. Chrisie: Yes, absolutely. At TLN, we only work with IBCLCs. I think that's important to mention. We connect these families with that gold standard in lactation care. As IBCLCs, we are working with the pediatrician and with the OB. We are focusing on the parent-baby diad and what breastfeeding looks like. Consultations definitely differ from LC to LC. We all do it a little bit differently, but in a typical consultation, we're going to meet. We're going to go over your medical history. We're going to do an in-depth, deep-dive into how feeding has been going. We will probably observe a feed if that's applicable. We're going to talk about your feeding challenges, your feeding goals, where you want to go, and what's getting in the way of that. I always make lots of space for parents to ask whatever questions are on their mind and make sure I share evidence-based information, then at the end, we're going to create a plan for a follow-up and a plan for how to get from A to B and solve whatever issue it is that we are looking at. That's typically what a consult looks like. As I said, we're all a little bit different. I stay in touch with my patients in between consults. You know having been there that questions pop up all the time, just little questions. How long can I leave breastmilk out for? Just little things, especially if you're a first-time parent. I always say that even for parents who have done this before, every baby is different. Every breastfeeding experience is different so as Caitlin said, really think of LCs as being there from beginning to end, from prenatal to weaning is so important. We know that it makes an incredible impact on the breastfeeding journey for parents and for babies. Meagan: Oh my gosh. Yes. I mean, I wish because I had a baby and then I was meeting with an IBCLC days later but I was already days behind in engorgement and a really upset, hungry baby. It wasn't that I couldn't feed my baby, it was just that my boobs were really rock-hard. I remember when I met with an IBCLC, she was like, “It would be really hard for you to latch onto a rock,” with my mouth like this. She was like, “We've got to soften these up.” I was like, “I don't even know.” I was just a mess. If I had had that care before I had my baby, we would have been able to do exactly what you said– go over my plans, go over my goals, and come up with things to look for and what to know, then I would have had your help way before I was days past my breaking point of my husband being like, “I'm going to the store,” and I'm like, “I just want to feed my baby!” Chrisie: Exactly. I think that happens all the time, Meagan. I think that families are starting to take prenatal breastfeeding classes which is amazing. I always recommend my families do that. I think a piece that really needs to come to light is the value of prenatal consultation. It's exactly what you are talking about. Meet with your IBCLC one-on-one consultation before baby is here. I highly recommend doing it if it's not your first baby and if it's your second baby. Talk about what happened last time. Talk about a plan for ideally how to avoid those speed bumps the next time.Also, if this is a new IBCLC to you, you're going to get a chance to connect with them before the baby is here and find out how they work and find out if you will work well together. Is this the person you want to support you in your breastfeeding journey? But to your point, we're also going to talk about how to navigate those first few days, how to reach out for help, when to reach out for help, common speed bumps that happen including engorgement which you just mentioned, and how to navigate that. It really lays the foundation for getting off to a good start. Meagan: Absolutely. I just think it's so beneficial and what's so great about The Lactation Network is that it's really so easy to get a consult and get going. You've made it so easy. It's a matter of clicking, filling out a form, and starting your consultation. Right?Chrisie: Yeah. We have IBCLCs across the nation in every state. If you don't have an IBCLC, we will connect you with one. We will check your insurance to make sure we can get you covered, then right. It's just a matter of scheduling. The other thing that I think is really important to mention is that IBCLCs practice in different ways. We have IBCLCs who do home visits, who have offices that you can come to, and who do virtual consults. Many of my families like a combination of those. They might start off with an in-person but then maybe move to some virtuals for follow-ups. There are lots of different ways to do this. I also think that sometimes people if they don't know what to expect in a lactation consult, they might feel like– I'm just going to give you an example– they have to do a feed or maybe they have to do a feed virtually and that's not always true. I think maybe they picture a very invasive physical exam. That is not true. So I also think that another thing that comes up is home visits. Sometimes people worry about, “Oh my gosh, postpartum. My house is a mess. I don't want anybody to come in.” Oh my gosh. Don't worry for a second about that. That is the farthest thing from our minds as LCs. We will come to you in the space that is most comfortable for you, take care of you, and make sure you have all the information and support that you need. Meagan: And truly make our lives easier and take out the question even before birth. There are different types of birth. Even like Caitlin just said, she had three C-sections. I've had C-sections. There are vaginal. There is VBAC. There are unexpected C-sections and planned C-sections. There are a whole bunch of things that happen in birth. We know that medication, fluids, and all of the things that happen– trauma responses and all of these things can impact maybe how and when our milk comes in. Then also, our mental state. I remember with my first, I came out of my C-section and I just remember being in my hospital room dozing off, coming up, and then there was a new person holding my baby. Then I'd doze off and wake up and then a new person was holding my baby. All I could think was, “What's going on?” That's all I could think, not, “I need to feed my baby. Everyone needs to leave. How do I feed my baby? I'm not awake enough to feed my baby.” You know? Should I have started pumping? There are all of the things. Do you guys have any tips even before scheduling a consult that would maybe say, “Hey, look out for these or do these things? Different births can impact the way that milk comes in and things like that.” Chrisie: Yeah, I think it is important to acknowledge that especially in the first few days how the birth that you have absolutely does impact your early breastfeeding experience. In fact, I recently found a study that points out that women who deliver by VBAC are 47% more likely to initiate breastfeeding than women who deliver by a scheduled Cesarean. Meagan: Whoa. Chrisie: I know, right? I felt like that was a little shocking when I saw that. We know that women who deliver via Cesarean birth are more likely to experience early difficulties with breastfeeding. They are less likely to have their baby to breast within 24 hours. All of that to say, it's an added layer of significant complication in terms of initiating breastfeeding. I always like to tell my families, and in a prenatal consultation is definitely something that we cover, what your birth plans are, what your birth history is if you've had a baby before and how that will impact breastfeeding and what your struggles were the first time. I'm going to give you another example. If you have a long labor and you have a lot of IV fluids, that can postpone your milk transitioning. It can make it harder for your baby to latch. Your baby is more likely to lose a lot of weight quickly which means your baby is more likely to be supplemented in those early days, especially in the hospital. All of these have a real impact. Those are the things we are going to cover. With a Cesarean, there are positioning considerations. We're going to probably move that baby off of the torso and find positions that are more comfortable. Typically, these challenges are surmountable in the first few weeks so I never want to paint the picture that these are things that we can't have a plan for, but I think having a plan is key. Having the support is key. Having those conversations and having somebody that you can reach out to when you are experiencing any breastfeeding difficulty. Caitlin: I would like to piggyback on that. I think that a lot of people are like, “Well, I'm not one of those people who has a birth plan,” because the joke is always as soon as you make your plan, it changes. Meagan: It all goes out the door. Caitlin: Exactly. But I do think to Chrisie's point, in hindsight, my first C-section was emergent and I was put under for it. All was well. Everything worked out, but even for my second and third, I wish that I had spoken up about different things. If I have to go under again, this is what I want to have happen. Remembering that when you're in your labor and delivery suite, let everyone know, “Hey if this does have to go to a C-section, I want it communicated to the OR that I want the baby put on my chest immediately after delivery. I want it communicated that my intention in PACU is to immediately initiate breastfeeding and get skin-to-skin. Those are things where we can have all of the best intentions in the world, but it is worthwhile just thinking through some different scenarios. I think it is helpful to quell any of that anxiety because to Chrisie's point, these things are out of our control and that is totally the job of the medical professionals to take the best care of us and our babies, but it is definitely possible to just have some of those high-level thoughts and conversations. For my daughter, she was my second C-section. I was conscious, but even then, it was sort of not really outwardly known that you could request immediate skin-to-skin, and then in PACU, the nurse wasn't really working with me on breastfeeding very much. I lost some of that time and skin-to-skin that you only really realize later because you're so in this mentality. It's just such a whirlwind in the best possible way. They are the greatest moments ever, but really put pen to paper and think through some of those different scenarios. That's why that prenatal visit with an IBCLC is so amazing because when you are meeting with your OB, they are really just making sure that everything is going smoothly. That's not to say that they are not spectacular. Doulas are certainly helpful in getting some of these plans together, but as it pertains to breastfeeding and the potential different delivery methodologies, an IBCLC is really the best person to set you up for that type of success. Don't overlook it. We can't get all of the answers from Google. Breastfeeding is a very biological experience. We tend to like a lot of quick answers and quick fixes. Just knowing that you have time, relax into it, and reach out for help. It's definitely the way to be prepared. You've made your Pinterest-perfect nursery. Let's focus on what the actual delivery and feeding is going to look like because right after that baby arrives, that is where all attention goes. Meagan: Yeah. When we actually started talking about TLN, we had someone write in. She was like, “Can I do a review on an IBCLC and how important it is?” It impacted her. She had three C-sections. She had a history of getting mastitis with every single baby so she ended up working with an IBCLC before she had her third C-section that was planned and they worked on all of these things. She was able to avoid all of the things that she had last time. She was like, “She was literally at my hospital bed the day I had my baby.” They had scheduled it because it was a scheduled C-section so she was like, “I will come. You tell me when.” She was like, “It was so impactful. It made my experience with my newborn so much more powerful,” because she was able to take out the stress and the question and all of those things and have more of that Pinterest-perfect birth experience. It was so powerful for her. I think it's so important to talk about those things. You know, she said, “If you can, get skin-to-skin in the OR. Do these things and then I'll meet you later.” She did all of those things. She just said it was totally life-changing. Caitlin: I'm happy that you brought that up, Meagan. I think a great question for your delivering hospital is, do you have an IBCLC on staff and will I be able to see them? Because having one on staff doesn't mean that you will be able to see them necessarily. If it is an extremely busy, university-setting hospital, they may have four or five lactation consultants, but they are really, really regulated to NICU. So ask those pertinent questions because once you've had your prenatal visit with a TLN IBCLC, you have their contact information. You can even, if you're having a C-section, schedule your first postpartum visit for the day you get home or the day after you get home depending on how long you are going to stay in house. There are really ways to be so prepared in that capacity. For in-hospital care, it's really important that you know going in if you're going to have that bedside care from a hospital-based IBCLC. That would definitely be a valuable question to ask when you are preparing to deliver. Meagan: Absolutely. Chrisie: I will also piggyback on that. It's such a great point because having worked in a couple of big hospitals here in Los Angeles, and I don't know if this is true for every hospital, but even if there is a hospital IBCLC, we are often stretched pretty thin. One of the things that I tell my families when I connect with them prenatally is to request to be seen by an IBCLC when you move to the postpartum floor. I know from my experience that families requesting to be seen were at the top of the list. The next group was the patients that either the nurses or the doctors wanted to see to round on. The third group who might not get seen are the families that seem to be doing okay and haven't asked for a visit. Again, that was my experience, but I think it helps to ask. That's a great thing to have your support person do to advocate for you. Ask your nurse or the charge nurse to have the IBCLC come by every day when you're in the hospital. Meagan: Yeah. I mean, one of my experiences, and this is why I think having an official lactation consultant, an IBCLC, is because I did request and they said, “It's the weekend. They're not here.” So to your point and to Caitlin's point, asking ahead of time, “Hey, do you guys have IBCLCs? Not only do they have them, but do they work 7 days a week?” Because I was on the weekend and then I had these C-sections and then days later, I finally found an IBCLC and I was so far behind when I maybe could have connected. Maybe it could have even been a virtual like, “Hey, how does this latch look? It's hurting,” or all of these things. We could have nipped a lot of problems in the butt honestly. Chrisie: Exactly and then to compound that issue, I often hear from families that while they are in the hospital, they will hear a lot of conflicting information about breastfeeding from different care providers and it's so frustrating for them. Most families are coming from the place of, “I'll do whatever I should be doing, but please provide a consistent plan.” That is where either the IBCLC on staff or the IBCLC you've connected with prenatally can jump in and help you and be the person who clarifies that plan for you and gives you a way forward.  Meagan: Absolutely. Well, we have some questions that people from our VBAC Link community on Facebook asked if you don't mind. I would love to ask some of them. This one was from a mom. It says she is due in April. It says that she is a stay-at-home mom and has a toddler as well. Her goal is to exclusively nurse because she thinks that pumping will be too much. “How do I navigate nursing a newborn and caring for a toddler's schedules, general trips, etc.” She nursed and pumped last time. Chrisie: Such a great question. First, again, huge plug for a prenatal consult right there. Let's have a plan. Let's have a plan. Then, I'll just share a couple of tips that I give my families in these situations. The first one is babywearing. Babywearing makes such a huge change. It really helps keep that newborn close. Skin-to-skin has so many benefits. We know breastfeeding does better when babies are skin-to-skin. Babywearing is just skin-to-skin while your hands are free and now you can also take care of your toddler. I'm also going to say a huge plug for support. We know where those difficult moments tend to be. The first six weeks, growth spurts, let's plan for them. If you are alone with your baby and your toddler, let's have a plan for support. Who is offering to come help? Who can help you take care of the toddler? Can somebody come to relieve you so you can get some shifts? Is it in the budget to hire a postpartum doula to come and support you? Support, support, support especially in those early weeks. Then as we progress a little farther into the breastfeeding journey, I always like to share with my families some tips for navigating feeding times with a baby while also having a toddler because you probably know this, but it tends to happen that you put the baby to the breast or to the chest and then your toddler wants your attention. Meagan: Mom!Chrisie: It's not a coincidence, right? It's the moment when you're doing this thing. “Oh, I'm really not available.” So how do we navigate that? Again, having a plan in advance. Maybe we reserve some special toys or activities for nursing time. Make it positive. Maybe that's also snack time for your toddler. Maybe as breastfeeding gets a little bit easier, you're able to have your toddler come sit with you and read a book. But basically have a plan to make breastfeeding a positive experience for your toddler as well so it's not set up as this competition for them trying to get your attention during that time which is really difficult for parents to navigate. Meagan: Yeah. I love those tips. This other question from this mama says, “I will be tandem nursing when my next baby comes. My first daughter has a slight lip tie and has always had a little bit more shallow of a latch. Just wondering if there are any ways to get a solid latch if the next one comes with a slight lip tie. It didn't seem to affect my first daughter getting milk out while nursing, but I do think it caused my supply to never really come in fully.” Chrisie: Yeah. Yeah. So love that she is asking this question in advance for sure. There is a lot we are still finding about restrictions or ties. One thing I would look into in this situation is if the second child does have a lip tie, is there also a tongue tie happening? Often, we know when there is a lip tie, there is a tongue tie. Not always, but often. That's when working with an IBCLC, they're going to help you navigate what's happening with breastfeeding and do you need a referral to what we call a preferred provider? Typically an ENT or a dentist who specializes in ties. Let's have that baby evaluated by the specialist. Let's find out early on. Are there any lingual or bilingual restrictions that are preventing the baby from removing milk both efficiently and comfortably for the parent? Information is key there, right? Especially if we know there is a history. IBCLCs in your community will be able to give you the names and contact information for those preferred providers so that we can find out that information right away. I also love that she brings up an important point about supply. Sometimes, very strong supplies can mask tongue ties and lip ties even and really make those issues not so obvious in the beginning, but then they might show up later on. Like she said, maybe it affected her supply. I often see people who do okay even though their baby has some restrictions, but then the 3-month regulation hits, and suddenly their nipples are sore. Suddenly their supply is really feeling an impact and it's because there was an underlying restriction this whole time. Meagan: Yeah. Chrisie: So early information, let's find out. Meagan: Yeah, I was just going to ask you if IBCLCs can technically diagnose a lip or a tongue tie or if they can say, “Hey, it looks like maybe there is something going on.” I also had some restrictions. I had some issues in the beginning with my milk coming in. I talked at the beginning about how I was a little bit out of it. I had a rocky first start, but then when my daughter was five, she went to the dentist and the dentist said, “How did she eat? How did she eat as a newborn?” I was like, “We had our troubles, but we got through it.” He was like, “Good for you. She actually has a severe lip tie. We actually need to take care of it because it's going to start impacting as her teeth are coming in.” It was so thick. I was like, “Oh.” So yeah, those two questions. Can an IBCLC diagnose or can they just say, “Hey, it looks like we may have some restrictions here. I would suggest you go to this provider.” Chrisie: The latter. We are not allowed to diagnose. It is not in our scope to diagnose, but we do connect you with the appropriate medical provider who does. Meagan: Yes. Chrisie: They will do an evaluation and make a recommendation. Meagan: Obviously, we love our pediatrician and we love our docs, but my pediatrician, I asked and she was like, “No, not at all.” Sometimes, I feel like pediatricians aren't as skilled as IBCLCs at recognized, so maybe they can't diagnose, but they can recognize and get you to that next-step provider to help your feeding journey and your supply and all of these things be better in the end. Chrisie: Exactly. Exactly. I second that. I also love pediatricians so much, but IBCLCs are really the experts in navigating the lactation aspect and referring you to again, what we call a preferred provider for evaluating lip ties and tongue ties. Meagan: Yeah. I love that. Again, a whole other reason why we need an IBCLC through The Lactation Network. Okay, so this question, I think again plugs into getting that prenatal or that consultation before. This mama says, “I would like for my husband to take some of the nighttime feedings to allow me longer stretches to sleep.” We know sleep is so important. It says, “He wants to help with this too. Is there any way to do this without negatively impacting breastfeeding or getting up in any way to pump?” You know, having her to actually lose sleep and giving it to the husband in a bottle. It says, “There is conflicting information online and I've heard from most mothers that they just end up doing the nighttime feedings anyway. Maybe their spouse could help with diapers instead.” This is such a good one because sleep is a good one we know for our mental health, especially after birth and recovery, especially if we've had a long birth or a Cesarean and things like that. We just need that sleep, but how can we help our partners be involved without negatively impacting? Chrisie: Yeah, I love that question. I will also say that it taps into something I hear all the time which is about conflicting information online. There is so much conflicting information about breastfeeding online. To be honest, there is so much bad information about breastfeeding online which again, is a plug for an IBCLC. That's why you need that expert in your back pocket to be the person who says, “Okay. Here is the deal. Here is what we need to do.” In this specific example, I do have this conversation all the time because I think one thing that is important to note is that I find the first six weeks to be the hardest for so many reasons, right? But if you're a first-time parent, I know it's common, and I felt this myself, when it's your first baby and you're doing this for the first time, it can feel like, “Oh, this is what it feels like. I'm never going to sleep again. Oh my gosh. This is what breastfeeding is like.”I think it's important to know the different stages, what breastfeeding looks like, and what sleep looks like at the different stages. So just having those expectations and that information can go a long way. In the first six weeks, babies tend to be nocturnal. They tend to be more alert at night. Nights are tough for the first six weeks. Throw in growth spurts where we have all of the cluster feeding. Nights tend to be a little bit harder during those times. We know that. We know that sleep is going to be tough in the first six weeks. It's important to know that it does get better. It usually does get better after what we call the six-week growth spurt. That is one factor. But to answer the specific question, I like to talk to my families about what I call tag-teaming at night which I think is what she is asking about. Once we introduce a bottle, then you do have a little bit of play in terms of how the partner can support those nighttime feeds. Again, it's such an important topic to talk about before the baby gets here. How are we going to navigate nighttime feeds? It's so important. Sleep is so important. One possible scenario and this really depends on the specifics that are happening within the family, but once we are introducing the bottle, it might be possible for the parent to pump before they go to bed. Maybe the partner grabs the next feed with a bottle and then the parent who pumped right before bed is able to skip that feed and then grab the next feed. So we kind of pre-pump essentially. This plan works for some people. We do have to introduce a bottle. Where a lot of people go as well, the standard information is that I shouldn't introduce a bottle until 4-6 weeks so that plan is not going to help me. My take on that is that we don't always have to wait 4-6 weeks. Let's talk about the specifics that's happening with your baby and your family. But also, it is important to note that in general, we do need a one-to-one ratio,  one pump session for every bottle in order to protect your supply and preserve your breast health. If we go too long, especially in those first six weeks, if we go too long before removing milk from the breast, we can get clogged ducts. We can get mastitis. We can get other issues. Now, unfortunately, prolactin which is the hormone that is driving a lot of this, peaks in the middle of the night. So often, we have our strongest supply right in the middle of the night. So how are we navigating all of that? That's what comes down to the specifics of the IBCLC putting together a plan for you and your family. I will say that generally, we are usually able to carve out a longer stretch of sleep for the birthing parent after that six-week growth spurt. But absolutely, sometimes we can if we just take that scenario. Maybe the other parent or a support person is giving a bottle and it means you wake up, do a 15-minute pump session, and go back to sleep. That might be a lot faster than the process of feeding a baby from beginning to end. These are all things that we look at creating a plan for. Meagan: Yeah, plans are important. Caitlin: They are. They are. I'm not clinical, so mom to mom we're saying a lot of things that can be interpreted as overwhelming. I want parents so much to settle into this amazingly delicious life moment and we are very much a fast-moving and fast-paced world. This time is so precious. It's so amazing. You will just want to inhale your new baby. It's so– I just think giving yourself permission to take those 4-6 weeks to really just rest, recuperate, and establish that connection. Your brain is going to really go to Target. Find some time to go to Target. Maybe that's with a support person, so that if you get there and 15 minutes later, you need to ditch your cart and go nurse in the car, someone else can stand with your cart or they can say, “This is totally fine. I'll put back the items and we'll meet back in the car.” If you are feeling that real urge to get out and do things, make sure you get out and take a walk. I saw a really funny meme yesterday where it said, “Nap when the baby naps.” It's this new parent with a stroller outside and she lies down on the sidewalk. Obviously, that's great advice, but in practice, it's difficult so just know that you will rest. You will sleep. It is the best, most special time and we are here to help you prepare for it the best we can. It's not a Google time. It's not something that you can really search Google for all of these answers. It's important to go into it knowing you can trust yourself, trust your body, and advocate for help. This used to be done with a huge village. We lost that village a bit. Bring in an IBCLC in early and often to be that outside person who comes in and is solely focused on this feeding relationship to nourish yourself, your baby, and your family to give you, your spouse, the grandparents, the siblings– all will be impacted by this peace of mind and this support. It's very, very crucial and lovely. I wish all of you tons of snuggles. Meagan: I literally just got the chills. Such a powerful message right there. So, so powerful. Women of Strength, if you want to schedule your consult right now, all you've got to do is click in the show notes or you can go to our Instagram and look in our bio. It's really easy to schedule a consult and start your plan today. Then one last question– if we have IBCLCs maybe who are listening, because we do. We have such a large birth community who listens. They may want to join The Lactation Network. How could they do that or is that possible? Chrisie: Yeah, absolutely. Caitlin: Yeah, absolutely. I would encourage anyone listening to check out our website. It's tln.care. T as in the, L as in lactation, and N as in network dot care. Come visit us. Come ask questions. We are just so, so passionate about this space and are so grateful that we have had this time. Meagan: Well, we love you guys so much. We are so grateful for your time. We just know that you are literally changing lives all over. Thank you so much.  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

'Brazilian match' es un disco del compositor y cantante brasileño Luiz Millan con colaboraciones de músicos como Randy Brecker, David Sanborn o Mike Mainieri y las voces de Lisa Ono, Clémentine o New York Voices: 'Pacuíba', 'Full moon', 'Andar descalço', 'Morungaba' y 'Que os ventos limpem os tempos'. Del disco del percusionista brasileño Nanny Assis, 'Rovania', en el que participaron Ron Carter, Randy Brecker, Chico Pinheiro, Fred Hersch, Lakecia Benjamin... piezas como 'Manhã de carnaval', 'No agora', 'Nenhum' o 'Back to Bahia'. Del último disco de Pat Metheny 'Dream box' sus versiones de 'Never was love', 'I fall in love too easily' y 'Morning of the carnival'.Escuchar audio

Hey Girl hey! I am so excited to have Olga Geissler back on the pod. As a reminder, Olga is a registered nurse who works in a high stress trauma PACU. She also is a coach whose passion is helping women reach their highest level of health and wellness especially those who are working to be alcohol free. This episode is truly epic!! It really feels more like a conversation between old friends on my living room couch more than a podcast. Some topics discussed are: ⭐️Making a plan ⭐️Setting a limit and sticking to it if you decide to drink alcohol ⭐️Allowing others to do them and not letting their decisions impact your life ⭐️Redirecting the conversation about being alcohol free towards increasing connection with others Join me as I have a wonderful conversation full of vulnerability, curiosity, and love with my friend Olga Geissler! Click the link to learn more about Rock That Fitness Membership and join the band NOW!--> https://www.rockthatfitness.com/rockthatfitness Links: RTF# 70 Alcohol and Your Health with Guest Olga Geissler https://spotifyanchor-web.app.link/e/n03syo36oEb The Naked Mind by Annie Grace https://thisnakedmind.com/ The Naked Mind Facebook Group https://www.facebook.com/groups/TNMgroup Olga Geissler Instagram https://www.instagram.com/olgageissler/ Join Rock That Fitness Email List for Updates and tips on Nutrition, Fitness & Mindset! https://www.rockthatfitness.com Rock That Fitness on Instagram https://www.instagram.com/rockthatfitness Music from Uppbeat (free for Creators!): https://uppbeat.io/t/cruen/we-got-this License code: RBWENWHGXSWXAEUE

Dr. Hutchins makes the entire PACU laugh

Paula Pheasant - Volunteer NursePaula grew up shying away from the spotlight, with little desire to venture too far from home. But a radio ad she heard on the way to school one day gave her a one-minutelook into Mercy Ships and opened her mind to adventures that she never dreamed of.  Paula Pheasant volunteers as the PACU (post anesthesia care unit) team lead on board the Global Mercy. Caring for patients as they come out of their surgery, Paula is able to witness their first reactions as they wake up to a new life. After serving for almost 10 years, Paula shares, “I can't imagine my life without having been here.” In this episode, Paula shares about the important work she does on board caring for patients post anesthesia, the joy one patient gave her during a time of personal loss, and how God has taken her from the background into a position of leadership.  For more information about Mercy Ships, visit www.mercyships.org Follow us on Instagram at New Mercies Podcast    

We've got a mix of topics this week, started with a bit of discussion around the recent Rapid Reset denial of service attack, before diving into a few vulnerabilities. A Node "permissions" module escape due to having a fail-open condition when unexpected but supported types are passed in. Then we talk about some common AWS Cognito issues, a fun little privilege escalation in Confluence, and a log injection bug leading to RCE. Links and vulnerability summaries for this episode are available at: https://dayzerosec.com/podcast/219.html [00:00:00] Introduction [00:00:15] HTTP/2 Rapid Reset Attack [CVE-2023-44487] [00:04:35] [Node] Path traversal through path stored in Uint8Array [00:09:44] Attacking AWS Cognito with Pacu [00:14:33] Privilege Escalation Vulnerability in Confluence Data Center and Server [CVE-2023-22515] [00:21:15] Not Your Stdout Bug - RCE in Cosmos SDK The DAY[0] Podcast episodes are streamed live on Twitch twice a week: -- Mondays at 3:00pm Eastern (Boston) we focus on web and more bug bounty style vulnerabilities -- Tuesdays at 7:00pm Eastern (Boston) we focus on lower-level vulnerabilities and exploits. We are also available on the usual podcast platforms: -- Apple Podcasts: https://podcasts.apple.com/us/podcast/id1484046063 -- Spotify: https://open.spotify.com/show/4NKCxk8aPEuEFuHsEQ9Tdt -- Google Podcasts: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy9hMTIxYTI0L3BvZGNhc3QvcnNz -- Other audio platforms can be found at https://anchor.fm/dayzerosec

Anneke is a Pelvic Floor Physical Therapist from Oregon who is a long-time VBAC Link Podcast listener. During her first pregnancy, she would listen to 5+ hours of episodes commuting back and forth from work! Anneke was more than committed to having a vaginal birth with each of her pregnancies, but what she has learned from her births about advocacy, trust, and defining success are beautiful lessons that have changed her forever.At The VBAC Link, we are here to help you achieve your goals of a vaginal birth. But even more importantly, we are here to advocate for empowered decision-making in the birth space. Anneke is an inspiring example of being educated, strong, and finding healing within circumstances that were out of her control.“Since my first birth, I've asked, ‘Why? Why not me? Why does this keep happening and why can't I just be like so many others on the podcast and so many others across the country? Why can't I just will it into being?' From these questions, I'm starting to believe that my story actually might begin at the end. I've realized that maybe my story isn't about the mechanism of birth at all, but what it birthed in me which was the ability to see my own strength.”Additional LinksThe Lactation Network WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello. Wherever you are listening from, welcome to The VBAC Link. We have three beautiful stories for you today. They are all unique. They all have certain things along the way that add some unique factors. We have our friend Anneke. I keep questioning that, but it's Anneke and she has had three Cesareans. Her Cesareans really all have been a little bit different and for different reasons. We've got IVF. We've got low fluid and we have breech presentation. I'm excited to share your stories or have you share your stories today, but as always, we love starting our podcast out with a review. Review of the WeekToday's reviewer is from a girl named Megan. It says, “Great resource.” It says, “Such a great resource for VBAC mamas to come and listen to women's stories and get great evidence-based practice information. I do wish these ladies would do a little less interrupting of the storytellers.” Well, I'm so sorry, Megan. We definitely do jump in so hopefully, Anneke, you don't feel too interrupted. But we do like to be a part of your story as well because we want you to share your story, but we are listening and we are listening for the first time. We are reacting as if someone else would react the first time they are listening, right? So yeah. Thank you, Megan, for your review. We do love your reviews as always. Seriously, anywhere you listen– Apple Podcasts or Google. You can email us. Write us on Instagram. Let us know what your review is because we would love to read it on the next podcast. Anneke's StoriesMeagan: Okay, Ms. Anneke. Welcome to the show. Anneke: Thank you. Meagan: Thank you for being here and sharing these stories. I just want to turn the time over to you and have you share away and educate these listeners. Anneke: Awesome, well I am a long-time listener of your podcast actually. I think I found your podcast before I gave birth to my first child. Meagan: Oh really? Anneke: Yeah. I was doing 5-hour drives. I am a pelvic floor physical therapist. Meagan: Oh yes. I wanted to talk about that too by the way at the end. Don't let me forget. Anneke: Well, I was contracted to work where I am actually working now. It was a 5.5-hour drive. I would go down once a month and treat patients so I would listen to 5.5 hours of your podcast. Meagan: You would get through quite a few episodes. Anneke: Yeah. Lots of episodes. I always had this dream that I would be able to come on The VBAC Link with this triumphant VBAC– well, with this triumphant story. I never expected to have a Cesarean. I don't think anybody ever does. But after I had my first, I was like, “Okay. My goal is to someday be on The VBAC Link with this triumphant story.” I'm not here today with the triumphant vaginal birth that I was hoping for, but I really think that my births tell three stories. The first one is about advocacy and then the second one is about trust and then the third one is about defining success. Meagan: Oh, that just gave me the chills. That really did. So let's talk about this. Anneke: So my first pregnancy started after about three and a half years of infertility. We went all the way through to IVF. I'd been having some mental health struggles getting through all of the infertility pieces so I'd been doing counseling and that was amazingly helpful. We get into the pregnancy. Everything is going beautifully and at about 18 weeks, I had some really bad swelling. I told my provider and he was like, “Well, sorry. Sometimes people just get swelling.” I just went with that. A friend of mine who is a pelvic floor PT– I was seeing her because I was doing all of the things. I had prenatal yoga and I was seeing a pelvic floor therapist because I had some pelvic pain and pelvic tension in the past. She took my blood pressure one day and it had always been normal in the OB's office. She was like, “Wow, you're a little elevated.” That was in August at about 20 weeks probably. Baby looked fine and he was growing just fine. I'm just continuing to get more and more swelling. They were like, “Well, shucks.” I probably went into OB triage three times because I had systolic pressures above 150. Meagan: Oh!Anneke: Yeah. The third time I went in, they said, “Stop taking your blood pressure. Stop coming in. You're fine.” Meagan: Did you have protein at all? Anneke: No, so everything was always really clear. I was peeing in a cup every time I went into the OB's office. They would take my blood pressure and they'd say, “You're fine.” I went in sometime in October to get my flu shot and they said, “Oh, your diastolic (bottom number), is a little high.” I had an OB visit two days later and they said, “Just let him know.” He put me on metoprolol, a beta-blocker blood pressure medication, and had me start tracking my blood pressure which was kind of validating because I had been trying to tell them for weeks that my blood pressure was high. So I'm tracking it and the metoprolo was working okay. My blood pressure was elevated, but it wasn't scary. I went to my 32-week visit and I actually did have a little bit of protein in my urine at that visit. So we were living in Salem which is the capital of Oregon so it's a big city. The big research hospital is only an hour away. It's really close. They went and sent me for bloodwork after I had some protein in my urine. They called me later that day and said, “Hey, your numbers are borderline so we want you to come in and get these injections.”Nobody had talked to me about preeclampsia. Nobody had talked to me about, “Hey, we're concerned about this.” They were just like, “Hey, you're probably looking at an induction at 37 weeks.” They said, “You're borderline. We need you to come in for these shots.” I was heading down to Lakeview where I live now to do some contract work. I said, “Well, I'm going out of town this weekend. Can it wait until next week?” I could come tomorrow. The shots are supposed to be 24 hours apart. They said, “Oh yeah, yeah. It's fine.” Now, looking back, in a movie, that's where they would say, “Dun, dun, dun.” They sent me 5.5 hours away to rural Oregon where the only hospital there is a critical access hospital that does not have a NICU. It does not have on-call anesthesia. It has nothing. Although now, having been here, it has a lot more than what we think. So anyway, I go down. I work that day. I woke up the next morning and had all of the preeclampsia symptoms. I bet I had gained 20 pounds overnight. Meagan: Oh man. Anneke: My blood pressure was 180/25. I came down and my mom and my husband were staring at me because I was so swollen. Meagan: You didn't look good. Anneke: Yeah, and because of the attitude I got from triage– my husband had me call triage up in Salem and they said, “You need to go in right away.” But they had sent me home so many times before, so I was like, “Well, I have a hair appointment so I'm going to go to my hair appointment.” My hair looked awesome and I walked into the local ER here. This is where I grew up, so I knew everybody working and they didn't recognize me because I was so swollen. I had gone from borderline preeclamptic on Wednesday to by Saturday morning, severely preeclamptic. I ended up being life-flighted out to Salem. Meagan: Oh my gosh. Anneke: The ER doc that was here said, “If you were one week farther along, I would deliver you.” I was only 33 weeks at that point. They got me up to Salem and they were able to stabilize me. They said, “Okay. We're just going to go week by week. We're going to try to hold you off until 34 and 35 and get you as close as we can.” So Saturday went by. Everything was looking better. Sunday, our game plan was to wait, and then by Sunday evening, I had stopped peeing. I was drinking tons of fluid. That was actually the first time– I mean, I'm a medical provider and that was the first time that I was like, “Okay. Something is wrong.”Meagan: Yeah. My body is not happy right now. Anneke: Yeah. The nurse was like, “Okay, come on. Let's just go pee.” I was like, “Dude. There's nothing in there.” Lo and behold, I had kicked over to near eclampsia. They worked for a couple of hours to try to get my blood pressure down and stabilize me. It wouldn't stabilize. The OB who was at the hospital in Salem came in and said, “I think we are going to induce you tonight and you're going to have 36 hours to deliver or we're going to take you to C-section.” That was really scary for me. I had a doula. I had a doula team that I loved, but my whole birth plan was movement. I really wanted to go medication-free, but they said, “Look, no. We're going to induce you. Cytotec, Pitocin, and you're going to be in bed.” I got really scared and talked to my doula and my husband, and then the OB came back in probably an hour later and said, “Nope. Actually, we're just going to take you to C-section,” then basically turned around and walked off. The poor nurse. I remember just bursting into tears because even though I was scared of not moving, I really didn't want a C-section. That actually– my son was born the next morning at 3:00 AM and they whisked him straight to the NICU then because of all of the magnesium they had me on, I didn't hold him. That was Monday morning. I probably didn't hold him until Tuesday afternoon. I got to see him briefly, but one of the things that stands out to me the most is being in the PACU, the recovery from surgery, and the doc staying with me for about 2.5 hours. Looking back, docs don't stay with you. Meagan: No. Anneke: They are very worried about you if they are by your bedside for 2.5 hours. We were really lucky. We had a very short NICU stay. We had a wonderful NICU team. My recovery was rough, but as soon as I gave birth, the preeclampsia started to fade. I lost all of that water and I felt a lot better. But I walked out of the hospital 10 days later with my baby, looked at my husband and said, “Next time, I am doing a vaginal birth.” He was like, “Pump the brakes for a minute.” Meagan: He's like, “Maybe let's just not even talk about that.” Anneke: Yeah. But I was so committed. I had really severe postpartum anxiety that I probably should have been treated for because if anyone comes out of the NICU, you come out of this gruesome schedule of waking your baby up and pumping and feeding. So for about 6 weeks, I just didn't sleep and had really severe postpartum anxiety. I should have been treated probably, but you're not really in a headspace to think about that. But I remember, thank God for my mom and my husband, screaming at my mom about washing the bottles incorrectly. Thank goodness my mom loves me because she was like, “Okay,” and just supported me. Meagan: Yeah, but those are actually signs of postpartum anxiety where you need things to have to be just so or you're really nervous about a binky falling on the ground. Yeah. It seems super irrational to other people, but it is so real to the person going through it. Anneke: Right. Right. I think it just speaks to the lack of postpartum care that we have. They discharged me. I mean, I found out about 5 years later that I almost died that night. The Cesarean was life-saving. That was absolutely what I needed. They discharged me 5 days later with just, “All right. We'll see you in 6 weeks,” and then at 6 weeks, they're like, “Well, back in the saddle, Sally.” There's no coverage there. No coverage of care for me. Meagan: I know. It's where we're going wrong. Anneke: Right. Meagan: They're going wrong in the postpartum area in a lot of ways. Anneke: Yeah. I had trauma and nervousness. It was probably 6 or 7 months before I finally came out of that postpartum anxiety, probably a year before I felt like myself. After about a year, I mean, I think just like everybody, you're like, “Okay. I could do this again.” You know? I started to get in shape. I started to exercise again, and then I had this weird episode of bleeding. I thought, “Oh, it's just my period coming back and being stupid. It actually ended up being a miscarriage. I had never gotten pregnant before. I had never gotten pregnant on my own before so it was kind of this weird happy/sad experience. Fortunately, we were able to naturally conceive my second child, my first daughter, about two months later. Meagan: That's awesome. Anneke: Yeah, it was amazing. I was so grateful. I found immediately that I had this focus on wanting this vaginal birth. I felt very fortunate because the other podcast I listened to all throughout my pregnancy was one by Parijat Deshpande. She had a podcast– I guess she doesn't record for it anymore– called Delivering Miracles. It was all about high-risk pregnancy and doing all you can to reduce your risks of having a high-risk pregnancy and also recovering. I think I emailed her office person every week for a year because I really wanted to work with her. I finally was able to get in with her right around the time we found out we were pregnant. She does a lot of trauma relief work. It's a lot less of talking out your issues and more using movements and visualizations to help bring down your sympathetic fight and flight nervous system. I worked with her throughout my entire pregnancy. I felt like a rockstar. There was no swelling. I guess in the meantime, the other part of the story is that we had moved down to Lakeview– the really rural, critical-access hospital place. We moved down here in between my first and second child. There are no VBACs here so the closest place is about 3.5 hours away for a supportive VBAC provider. Meagan: That's a long drive. Anneke: It's a long drive. We actually made the decision that we were going to go back to Salem to do a VBAC. I love my provider down here. I actually went with the guy who admitted me to the ER the day I had preeclampsia. He was a totally different personality than I thought was going to be a good fit for me. When he admitted me that day in the ER, he explained exactly what was happening to me. He explained why he wanted me to do the things he wanted me to do. I thought being flown– and he explained, “Look. You could have a seizure. You could have a stroke. This is my very strong recommendation. This is not a prison, but this is a strong recommendation.” I just really liked that approach. I felt like I had a lot of trust there. He had saved my life. I mean, it sounds dramatic, but he had saved my life once. I went with him again and he was very supportive of figuring out how to make the VBAC work and when to go and how to transition, but he also had a backup plan for a Cesarean just in case. At about 28 weeks, they always do a little ultrasound at the visits, and she was breech but everything else looked fine. He was like, “Oh, you have plenty of time.” The weeks go on and she continues to be breech. He's in the back of his head thinking, “Okay, we need to probably start looking at the calendar and thinking about dates.” I'm just in denial at this point. I'm like, “It's going to happen.” Like all of the stories on The VBAC Link, you will it. You positively think. You do the stretches and the walking and the whatever and they're going to turn. Baby is going to turn. We get to 34 weeks and he said, “You know, let's just check you on ultrasound. I just want to make sure,” because my placenta had been anterior. He was like, “I just want to make sure that your placenta is off your scar in case we have to do a Cesarean.” We were excited because of course, it's a really small town. Lakeview is where I live and it is a town of about 2,000 people and a county of about 7,000. You literally know everybody. We're about 100 miles from the closest next hospital. We're very rural. We know the ultrasound tech of course and she was like, “Oh, we're going to do 3D,” so we walked in being very excited. She did the biophysical profile and I had a fluid level that day of– my AFI was a 4.1. Meagan: Oh. What week is this? Anneke: 34. Meagan: 34. That's low. Anneke: That's low. She was like, “You're not leaving today.” I was like, “What?” So thank God, I was working with Parjat Deshpande. We immediately kick into all of the things to help keep my anxiety low and help keep it all out of my body. We were tracking so now I was doing biophysical profiles. I think they started every other day and my fluid numbers started to come back up. Our docs here consult with maternal-fetal medicine out of a town about 3.5 hours away. They said, “Okay, as long as you are trending upward, you are fine.” But at that point, we kind of knew that a VBAC was off the table because with that low of fluid, baby is really unlikely to turn. At that point, I was like, “Okay. Let's just keep her healthy. Whatever we need, whatever we've got to do.” So we are chugging along and at about 35 weeks and a couple of days, my fluid level got all the way down to 2.1. It had come up and then it started to come way back down. The earliest that our hospital can deliver babies is 36 weeks. Meagan: You were a week out. Anneke: I'm a week out, yep. Oh my gosh. There's all of this lore about low amniotic fluid, so I was probably drinking close to 2 gallons of water a day. There is no direct correlation. There is a correlation with hydration and low fluid, but not pathologically low fluid. But there is all of this lore, so I was drinking close to 2 gallons of water a day and also drinking these buttermilk and blueberry smoothies. It was an Indian culture thing to have buttermilk to help with fluids. They are actually weirdly good but I was drinking one of those every day. Meagan: Interesting. I've never even heard of that. Anneke: Yeah. I mean, all of the Google things. We were just doing all of the Google things. We made it to– when I was 36 weeks, both my OB and I breathed a sigh of relief. We're like, “Okay, we made it. Okay, so here we go now. We're going to keep tracking her to 37 and get her to early term or late preterm.” The MFM was like, “Nope, just go for it.” We ended up delivering her at 36+1 via Cesarean. What was so wonderful about that birth is because of my work with Parijat and really trusting in a medical team that was around me, I felt like that birth was not traumatic. It was scary and we were worried, but she came out of me and just started screaming right away. I was able to breastfeed. She came right to me in the OR and we breastfed in the OR. I mean, the one nice thing about having a Cesarean is that the spinal takes a long time to wear off and you have a catheter. I think I did skin-to-skin for 6 hours. My husband did not hold her for 6 hours. That was one of the things that really left me with some trauma from my son. So I just remembered these goldeny, autumn afternoons and she was just on my chest and I just could not have been happier. Even though it wasn't the VBAC and it was preterm, it was still like I just had this incredible team around me that ultimately gave me the experience I wanted even though it wasn't the method. Meagan: Right. That is something that I feel is so important to touch on because sometimes we hear Cesarean stories and we hear trauma. Scary, traumatic. Anneke: Right. Meagan: I don't want to say that Cesareans can't be scary or traumatic or that they're not, but they don't always have to be. They actually can be very healing. Anneke: Right. Meagan: And redemptive. You might think, “Oh, you didn't get a redemption birth because you didn't have a VBAC,” but there are a lot of really amazing beautiful wins that were very redemptive in her birth, right? Anneke: Right. Meagan: That skin-to-skin and being involved and having that team be supportive of the whole team and motivating you, “Okay, we're going to get to 36 weeks.” All of these things are really awesome stuff. Anneke: Yeah. It was incredible. You know, we've had two births now that were– the first one was very scary. The second one was very scary and we almost stopped having kids. I had this dream of having four children. My husband is like, “Well, I wanted two. You wanted four so we compromised on four kids.” That's what he says now, but at the time, he was like, “No. I can't go through this again.” I was actually kind of along, especially for the first year, on the same path. I felt so grateful to have a positive experience. Everybody was healthy. Our family was wonderful. About a year out from her birth, maybe 7 or 8 months out from her birth, I really started feeling like I wanted to pursue our dream of having four kids. My husband really struggled with that so he and I both went to counseling. We went separately to counseling because we both had a lot of trauma actually left over from the first birth, my son's birth. Both of us– he did some EMDR work which was really powerful and I just did some talk therapy which was really good. Ultimately, we decided that we wanted to have a third baby and then eventually go on for a fourth. It took us a little bit longer to get pregnant. At that time, I found out that in my first birth, they were tracking my labs and one of the things they track is sodium. That fluid imbalance, sodium is a very important lab value that we need. I was digging through pages and pages and pages of notes trying to figure out, “Why did they never even give me a chance?” Because even though my daughter's birth was very redemptive, I still had this fire in me for wanting to know what a contraction felt like. In the meantime, I've developed this pelvic floor and OB program at our little local hospital here and I'm a childbirth educator and I'm just touting the virtues of vaginal birth and feeling like we have totally overmedicalized birth. So I'm digging through all of my notes and I find that my sodium had been trending over the 12 hours before even I realized that I wasn't peeding. My sodium had been trending down. By the time they made the call to go to C-section, I was three data points away from being a 50/50 survivor. My sodium had gotten so low. I didn't have 36 hours to try to labor. Meagan: Well, and when sodium gets really, really, really low, can't you actually have a stroke? Anneke: Yeah. Yeah. Meagan: And a major stroke. Anneke: Yeah. Like 50/50 coin flip on survival. It actually gave me a lot of closure to see that. I wish they had explained it to me like that at the moment, but it was like, “Okay, that was the right call.” Meagan: Validation.Anneke: Right. I hate it when you're given platitudes about, “Well, healthy mom and healthy baby.” It's like, “Well, obviously.” I wouldn't wish for something different, but there's also an experience that I'm looking for. So rolling into our third pregnancy, shoot. Being pregnant with two kids is no joke. I kind of had a harder pregnancy. We were able to conceive naturally again. Meagan: Yay!Anneke: Yeah. This time, we started with maternal-fetal medicine. They were tracking us from 16 weeks on. I had monthly visits with them all the way up to 36 weeks. Again, everything is going swimmingly. She looked lovely. My fluid is great. My blood pressure is low. We get to 28 weeks and she's breech. Along with being a pelvic floor PT and a mom of two at the time, I am a varsity volleyball coach and my husband is a wildman firefighter. If you haven't been out west for the last couple of years, it's been insane or I guess living under a rock because it's made national news. So this is during the summer rolling into volleyball season. I've got a breech baby. I've got this whole plan for a VBAC. I'm going to go into labor. We're going to drive 3.5 hours. I'm going to labor in the car with my husband driving like a grandma. We're going to do this. I was back to every day listening to a VBAC Link podcast and just willing it into being. I hit about 33 weeks and I'm doing uterine ligament mobilizations on myself. I bought a Spinning Babies class and was doing close to 2 hours of exercises a day to do inversions and side-lying and all of the rebozo sifting. At about 33 weeks, a friend of mine told me about this postural restoration physical therapist over in Grants Pass which is about 4 hours away from here and I went. I got an appointment with her and drove 4 hours one way to go see her. I got in with an acupuncturist. We did all of the things. Meagan: Literally, yeah. Anneke: Literally all of the things. A little after Labor Day, my husband was home. So firefighters work for 2-3 weeks on and then they get 2-3 days off. Usually, in busy fire burn season, they will turn and burn and go back out. He came home after Labor Day and I was a wreck because I was so stressed out with trying to get her turned. It was the middle of volleyball season. It was a busy fire season. They were supposed to leave the next day to go on another 2-week assignment and I just burst into tears. He was like, “Do you need me to stay?” I'm not very good at asking for help, but I knew that if I didn't leave everything out on the table, I would always wonder if she didn't turn, I would always wonder, “What if?” We made the decision that he was going to stay back from what would have probably been his last fire assignment before she was born anyway and we did, like I said, 2-2.5 hours of exercises daily to try to get her to turn. I drove back and forth to Grants Pass several more times and then finally, I was really nervous about doing a version, but that was something that my OB in Medford had suggested as a possible thought and my OB here was like, “Look, we can't offer you a VBAC here. I don't feel comfortable doing a version here because we just don't have the resources.” So at my 36-week appointment, I said, “Look. I don't know how comfortable I feel with a version. Is that going to be too much?” This is what I love about my OB. He leaned forward and said, “I have never known anyone as committed to wanting a VBAC as you. I think you need to do everything.” We drove over to Medford. We took all of our bags just in case it threw me into labor or something. Meagan: Right, or you had to stay. Anneke: Right. We went over and saw my OB there. He was like, “Okay. You're going to go to the hospital.” He explains the whole procedure. They couldn't give me the uterine relaxing medication because I had a little cardiac event in the pregnancy earlier that was just a one-off but he didn't feel comfortable giving that to me. For anyone who has been through a version, those are really uncomfortable. I mean, it wasn't the worst pain I've ever felt, but it's like being squished, very heavily squished by a full-grown man. You could see it in his face. He gets a hold of my daughter and he turns her 90 degrees and then she slips back. You can see that he's like, “Oh yeah. We've totally got this.” He hooks his hands on again and turns her 90 degrees and she slips back. So he's like, “Okay. Third time's the charm. Third time's the last time. We're not going to do it anymore, but we're going to get her.” He gets a good grip on her and he gets her to 90 degrees and gets her a little bit farther. I felt her jerk and her heart rate dropped to 60. We all just held up our hands and we're like, “Nope. Nope.” I didn't know this guy very well. He came very highly recommended. He was very friendly, but I'd only seen him a couple of times. He was just like, “Okay, well you can drive back to Lakeview and go schedule a C-section. We'll see you later. I have more patients to see.” I really liked him, but I'm starting to get a little sniffly and teary. He was just like, “I'm really sorry,” and left. I think I cried the entire way home and then I cried the whole next day. I told my husband, “I'm not calling my local OB. I'm not calling him.” He was like, “Yeah, but the baby's got to come out at some point.” I did finally see my OB the next week which would have been close to 38 weeks. I mean, the poor guy. I know he felt so bad, so he was like, “Okay, what can we do?” I really wanted to go into labor. I mean, this OB puts up with a lot of my shenanigans, but that was a hard no. He was like, “Absolutely not. You're not going into labor. We're not going to introduce bacteria when we don't need to.”I'd read a lot about a gentle Cesarean where mom gets to pick baby up or baby gets to go straight to her chest. Meagan: Mother-assisted Cesarean. We're seeing it happen. Anneke: I know. I'm very committed to the next one to maybe making this happen. I've got to work on this guy for a little bit, but that was a hard no on this one. One week was not enough time to prepare him, but what we were able to do is I had good friends who were OB nurses. We were able to schedule it on a day that they could be there. Our normal procedure for Cesareans here is that baby is born and then they do the cord clamping and then baby goes to the warmer, but my OB for delayed cord clamping instead of just laying her on my legs, held her out with full arms extended, probably burning to let me see her. She was a big kid. She was almost 9 pounds. That's actually the picture that I sent to go along with it. Then he took her over to the warmer and my friend, the nurse, was right behind him and swooped her up and brought her right to me. It was as close to that immediate skin-to-skin as we could have gotten. My struggle in the week between the version and her birth was that I just felt so broken. I really felt like my body had failed me and that for whatever reason, I wasn't destined to ever feel a contraction or to even try to give birth vaginally. I worked with my therapist over that week and actually did some EMDR myself because I just really felt like what I had done was valuable. I did everything I could to give her a vaginal birth and I under no circumstances wanted that feeling of brokenness to be passed to her even via osmosis. I worked really, really hard to have that open, brave feeling the day of her birth. When she got put on my chest, I didn't want any of my insecurities to get passed on to her. It was difficult after her birth too. I really struggled with feeling like I was worthy and like I had done enough. The other thing too is that I felt like I was going to have difficulty teaching childbirth education. Who am I to teach in this space? Meagan: I get that. When I became a doula, people would say, “Oh, so how was your vaginal birth? Did you go unmedicated?” I'm like, “I had two C-sections.” They're like, “Well, how do you feel qualified to support me through a vaginal birth then?” It's like, “I totally do.” Yeah. It was really something hard to overcome not having ever had a vaginal birth. Anneke: Right. Right. I had one patient. She sticks out to me. She said, “Well, okay. What do contractions feel like?” I had to be like, “Well, people describe them as–”. I wasn't able to tell her and that tore me apart. Since she was born, I've taught two series of childbirth education. I've had a bunch of pregnant patients and I've helped patients labor and helped teach them positioning and counterpressure. I realize looking back, I'm a pelvic floor PT and I threw my entire base of knowledge into my drive and journey to achieving a vaginal birth three times. When that failed, I literally went with blind faith. Anything that the internet or anyone suggested to me, I tried. I prayed and I meditated and I positive-affirmed myself every day and it still didn't happen. So in the end, I've never had that chance to be able to actively tell her or from experience tell my patients what a contraction felt like. Since my first birth, I've really asked, “Why? Why not me? Why does this keep happening and why can't I just be like so many others on the podcast and so many others across the country? Why can't I just will it into being?” So from these questions, I'm starting to believe that my story actually might begin at the end. After my belly has been cut into for the final time after the scar tissue knits back down and I can cough without pain, I've realized that maybe my story isn't about the mechanism of birth at all but what it birthed in me which was the ability to see my own strength and give that to my people who are in a world where victimhood and fragility eat away at our resilience and our grit. I thought that not being able to labor to not meet my children has broken me but I can't be broken. I can't be a broken mother to them. I want my kids to be strong, confident, and powerful. I can't teach them that if I can't model that. So I didn't get a vaginal delivery. I didn't get to experience labor pain and comfort measures and to have my partner doing counterpressure and using a comb and work together to bring my babies through my pelvis. I didn't get to look adoringly at my husband as I pulled my baby onto my chest myself, but what I did was I made the choice to put my child's needs before my own desires and I sacrificed my body in order to protect theirs. My labor was really giving my control and placing trust in my medical team and God to bring my babies into the world. I'm not broken by my births. I really feel like I'd been remade into what a mother is supposed to be. Meagan: Absolutely. I'm just crying over here. That was beautiful. That was absolutely beautiful. You know, I've talked about this before, but the way we give birth doesn't define us. It doesn't say that we are a successful mom for giving birth vaginally or by a Cesarean. It doesn't mean that our children are going to be weak or struggle because they didn't come out vaginally. Anneke: Right. Meagan: Wow. I just love everything. I'm seriously crying here. That was just beautiful. You are beautiful. Anneke: Thank you. Meagan: Every single one of these births is beautiful. You don't have to give birth vaginally to have a beautiful experience and to be a powerful mom. Like you said, “I'm not coming here today to share the vaginal birth that I wanted so badly and that I longed for,” but look at what you have done. Look at how you've grown. Look at how strong you are. I believe that our children– right now, they are little. They probably don't really understand the magnitude of what a Cesarean birth or a vaginal birth even looks like and what that means, but I promise you that no matter what, these babies are going to be grateful for you. Women of Strength, as you are listening, know that the way you give birth does not define you. You are incredible. Anneke: It actually hit me during the last childbirth education series that we taught. We go around and we talk about all of the interventions for birth– epidural, IV meds, Cesarean, or vaginal. So often, we have people who say, “Well, whatever baby needs.” It actually struck me during this last class. I said, “Look, of course, it's whatever baby needs. What you need is to cope. You need to know your strength and what will keep you strong because that is what takes you through this without trauma and takes you through feeling stronger and successful no matter the mechanism, no matter the medications, or the delivery method. It's about how you approach your birth and how you are going to continue to be strong whether you are pushing them or whether you are being brave and being cut open. No matter what it is.” Meagan: No matter what, yeah. Well, thanks for that. That was amazing. Anneke: You're so welcome. Meagan: Sorry for the sniffles, guys. That was beautiful. Congratulations. Anneke: Thank you. Meagan: Huge congratulations to all of your growth. Even through your journey with pelvic floor, you are going to help so many people. And with pelvic floor, tell us a little bit more about what you've learned even both ways with vaginal and Cesarean and how the pelvic floor actually is connected to both, and how even Cesarean mamas need guidance through pelvic floor. Anneke: Yeah, absolutely. I actually see a lot of the same issues post-vaginal and post-Cesarean birth. With vaginal birth, usually what happens is you're pushing a watermelon through a quarter-sized hole so those muscles and your joints are designed to stretch. There are lots of movements and things that can help. It would be like overstretching your hamstring. It just reactively spasms and tightens back down. That's even in the absence of tearing and things like that. Pelvic floor tension is really, really common after a vaginal birth but also after a Cesarean birth. Now you've lost stability from your abdomen. You can't even sneeze for 8 weeks without feeling like you're going to burst open. My nose actually wasn't better for a year after my first son because it was just so fast. Oftentimes, I actually see a reactive spasm of the pelvic floor in women with Cesarean deliveries as well because your pelvic floor is overcompensating through your lack of abdomen support. I actually treat those women a lot of the same and then of course, we do a lot more of scar tissue work with Cesarean. It's a lot more like abdominal training early on in women with vaginal delivery, but yeah. I mean, it's almost identical. The initial recommendations are a little bit different, but by 6 weeks, I'm treating women the same. What I actually love, I wanted to mention this about rural hospitals. People get scared to deliver in rural hospitals, but what's beautiful about our situation is that your OB will also likely be the one to come deliver and will also see you for the 3-day weight and color check, the 2-week visit, the 4-week visit, and the 8-week visit. They'll see you at the 6-week visit for you too. We have so much better follow-up for mom and baby here than I got in a big, fancy hospital in the city. I think I see people way sooner than I would see them in the city. I'm seeing people easily 4 and 6 weeks out where in the city, it might be 6 or 8 months. Meagan: Right. There are so many of us that it's 6 weeks out. That's when we are going in for our first visit and they're like, “Oh, what birth control do you want?” That's what we're asking. We've gone weeks and weeks and weeks with the pelvic pressure and that bulge or the leaking or that disconnect when we could have been doing something. Maybe 2 weeks out, we're not doing the exact same things, but there are things that we can do even through breath with our scar or mobilization for a Cesarean and all of these things that we can do. If you are like the many of us who don't get seen as you have which is the way it should be in my opinion, I think that we should be seeing people 3 days out or 2 weeks out and all of these things because that's when so many things are not caught. Know that it's okay. You can still turn to a pelvic floor specialist and therapist even while you're waiting. Anneke: Yeah. I've started a program at our hospital where I actually try to catch C-section moms in-house. I'll give them laying on your stomach and early abdominal work and how to get out of bed. Nobody teaches you how to get out of bed after a Cesarean. You can really screw up your scar tissue by straining on it too much or just be in a lot of pain for a really long time. The other really great thing about PT and insurance companies now is that you actually don't often have to wait for your doctor to refer you. If you are 2 weeks out and you are still leaking or you have a lot of peeing, you don't have to wait to see your doc. You can actually just call a pelvic floor PT and a lot of insurances will let you self-refer. It's pretty awesome. Meagan: Right. It is awesome. I just think, like you were saying, we just don't talk about pelvic floor after a Cesarean very much because we just don't think about it. We haven't pushed a baby out of our vagina so probably are okay, but the disconnect with our abs– Cesarean birth really is quite intense internally. So yeah. Don't hesitate. Go out. Can you tell everyone where to follow you?Anneke: Yeah, so where I talk most about pelvic floor and PT stuff is actually called @teamgriffith2011 on Instagram. If you are interested in finding a pelvic floor PT near you, if you go to the section on Pelvic Health, just Google that on the internet and there is actually a PT locator. That is how you will be able to find someone close to you. Meagan: Fantastic. Do you suggest people do it even before birth? I know you did with yours, but as a pelvic floor PT, do you suggest people go before?Anneke: Especially if you don't have a program in your hospital where PT tries to snag you before you leave, I would think it would be helpful. I do what I call a labor and delivery biomechanics visit. I'll have people come in. We'll talk about positioning and counterpressure and then I almost always give them vaginal delivery and Cesarean early-stage exercises. That would be something that a PT would be able to tell you what are the very first things you should start doing, when to start doing kegels, or how to get back. A lot of times, it's just teaching you how to diaphragmatically breathe because that will teach you how to coordinate your pelvic floor to the yoga breath. Meagan: Awesome. Well, thank you so much for giving me a good cry today. Anneke: You're so welcome. Meagan: And educating us on pelvic floor. Seriously, it was beautiful, and congratulations to all three of your babies. Anneke: Thank you so much. Meagan: Yep.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

Rockstars, help me welcome our guest today, Olga Geissler! I met Olga through The Naked Mindset Facebook group and we have been able to maintain a wonderful friendship outside of that group! Olga is a registered nurse who works in a high stress trauma PACU. She also is a coach whose passion is helping women reach their highest level of health and wellness especially those who are working to be alcohol free. Olga graciously talks about her experiences of using alcohol and food to help manage stress, numb her feelings, and stop her thoughts. She is candid about how she was able to justify her decisions surrounding her alcohol and food intake despite feeling lonely, gaining 30 pounds, and not being happy. Olga also shares how alcohol affects our bodies on a physiological aspect which has helped her maintain her sobriety for the past two years. Join me as I have a wonderful conversation full of vulnerability, curiosity, and love with my friend Olga Geissler! Links: The Naked Mind by Annie Grace https://thisnakedmind.com/ The Naked Mind Facebook Group https://www.facebook.com/groups/TNMgroup Olga Geissler Instagram https://www.instagram.com/olgageissler/ Join the Rock That Fitness Waitlist to Learn When Open Registration for Fall 2023 Starts! https://www.rockthatfitness.com/rockthatfitness Join Rock That Fitness Email List for Updates and tips on Nutrition, Fitness & Mindset! https://www.rockthatfitness.com Rock That Fitness on Instagram https://www.instagram.com/rockthatfitness Music from Uppbeat (free for Creators!): https://uppbeat.io/t/cruen/we-got-this License code: RBWENWHGXSWXAEUE

Pat Metheny ('I fall in love too easily'), Bebel Gilberto ('Adeus América', 'Eu vim da Bahia', 'É preciso perdoar', 'Undiú', 'Ela é carioca'), Luiz Millan ('Pacuíba', 'Full moon', 'Morungaba' -con Lisa Ono-, 'Montparnasse' -con Clémentine-, 'Que os ventos limpem os tempos'), Luciana Souza & Trio Corrente ('Pra machucar meu coração') y Bianca Gismonti Trio ('Piano station'). Escuchar audio

You don't hear VBAC stories with gestational diabetes very often, but we want to change that! Charlotte joins Meagan on the podcast today sharing her experience with gestational diabetes and a surprise preterm delivery at 32 weeks. Though she had some pretty significant curveballs thrown at her, Charlotte's commitment to controlling what she could along with an amazingly supportive team allowed her to have an empowering birth experience. Charlotte knew she wanted a VBAC for an easier recovery. What she didn't know was truly how much of a blessing in disguise it became during the intense weeks she spent as a NICU mama. Additional LinksReal Food for Gestational Diabetes by Lily NicholsReal Food for Pregnancy by Lily NicholsNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode DetailsMeagan: Hello, hello. You are listening to The VBAC Link and I am excited to be sharing a story with you today that we have gotten a lot of requests about. It's something that we don't see very often and my question is why? I don't really know why we don't see these stories popping up. Even in the community, I've had to search through our VBAC Link Community on Facebook to find these stories. There are three I think.So I'm excited to talk about this story today because I know that it's very much requested. We're going to be talking about gestational diabetes. Gestational diabetes again, is something that we don't see but it's actually pretty common. Crazy enough, we're seeing a rise in fact. Last year, in 2022, there was an article published talking about the actual rise that we're seeing. They said, “The new analysis of 3.25 million birth records follow a string of studies that suggest gestational diabetes has become increasingly prevalent over the last three decades,” which is kind of crazy. Every year anywhere from 2-10% of women will be diagnosed with gestational diabetes. We know that the Cesarean rate here in the U.S. is just above 32%. If you think about the 32% and 2-10%, you've got to think that people who are going for a VBAC are having gestational diabetes. My question is, are we not seeing VBAC with gestational diabetes because providers aren't allowing us? That's my question. Charlotte, today, welcome to the show. She is going to be sharing her story about gestational diabetes and her VBAC. Right, Charlotte? Charlotte: That's right. I'm super excited. Meagan: Yes. Yes. I'm so excited. I'm so glad that we connected. Charlotte lives in South Carolina in Greensville specifically. They have two baby boys– not baby, baby but they are young. She has a very baby and then a younger baby. She works in healthcare administration for a very large healthcare system and has truly become a birth nerd outside of work. This is something that birth just does to a lot of us. It captivates us. Right, Charlotte? Charlotte: Totally. Meagan: Do you feel that your birth is what brought you into your obsession with birth and VBAC in general? Charlotte: It's life-changing. Once you've been through it, it was such a seismic shift for me and it opens your eyes to what women are going through. Then you hear people's stories and everyone has something that has stuck with them. People who are years and years older remember exactly how their birth story was. I'm very Type A, so I just turned to research. I love it. Meagan: Yeah. Yeah. That's why I became a doula, through my own birth experiences and I know that's why a lot of other doulas become doulas or midwives or why OBs become OBs. It's really awesome and we are really excited to have your episode on the show. So thank you for being here today. Review of the Week I have a Review of the Week as usual so I'm going to get into that and then we will share Charlotte's birth stories. Today the review is from Blanely and it says, “There For Me When I Needed Support.” It says, “I got pregnant right at the start of the pandemic in 2020. It was a very lonely time isolated with my toddlers. I couldn't even hug my mom or get her support in the beginning. I had to switch providers due to insurance changes and I was scared. The VBAC Link became my companion at this time. Julie and Meagan, my friends, I would listen with one earbud while caring for my boys. It was educational and encouraging just when I needed it. I learned tons about birth and how to advocate for my VBAC. “In January 2021, I had my successful VBAC. It was a wonderfully redemptive process. Even though they aren't being produced right now, it is still the first thing that I recommend to any of my friends who are expecting. VBAC or first baby, I just love it and I hope it comes back soon.” Well, this was back in the pandemic and we did take a break and we are back. So thank you, Blanely. I hope you are still with us and I hope you just heard your wonderful review. We really do appreciate these reviews so much so if you haven't had a chance, I always ask. Stop and go check out on Apple Podcasts, Google, or wherever you're listening, and leave us a review. We absolutely love them. Charlotte's StoriesMeagan: Okay, Charlotte. Oh my gosh. I am serious– you're going to be the first episode, I believe. I don't recall any other episodes of gestational diabetes. Charlotte: I think that's right because I looked when I was diagnosed. I found a birth story that was a VBAC not on a VBAC podcast about gestational diabetes. It was one that I could listen to. Meagan: Yes. Yeah, and we've got some that had diabetes previously before pregnancy, but none with gestational diabetes. So congratulations on being our first. I hope you are not the last. If you are listening out there also, and you had gestational diabetes and you had a VBAC, we do want to share your story. We want to help people just like Charlotte when she was out there looking for these stories and only found one, we really want to add some stories because it's really not something that we are seeing or hearing. I'd like to turn the time over to you. We know that every VBAC has to start with a C-section, so if you want to talk about your firstborn's birth, we would love that. Charlotte: Absolutely. Well, thank you for having me. I, once again, was telling you that this podcast really started my journey. There was the C-section and then some conversations with providers that fueled the fire. Then after that, The VBAC Link was one of the first things that I turned to. It's super surreal being here today. I'm married to my husband, Hunter, and in 2020, my father had– before the pandemic started– two back-to-back major surgeries which put things into perspective. Then the pandemic hit and a lot of things got canceled. It's the same story for a lot of people. We were like, “Okay.” We had been putting it off. We'd been together for 11 years at that point and we were like, “Let's just go for it.” We got pregnant very quickly in the first month. We were super excited. It was an uncomplicated pregnancy other than just the general stuff from the pandemic. It's tough to be pregnant and not have the support or feeling like you can go and be out with your friends or see your family without potentially killing them or being scared of that. Meagan: I know. There was all of this fear. And even then, for a lot of my doula clients here in Utah, they were being told that if they went out and they got COVID, they were threatened. They were like, “You won't have your baby. You won't have your husband. You could kill your baby.” They were saying these very, very scary things. Charlotte: Yeah, so that wasn't great. In hindsight, with that pregnancy, I had a lot more time to myself worrying. Overall, it went very well. Right around the time that they were making sure with no questions that you had a birth support partner and all of that you were starting to see– even though he was delivered in January 2021 which was almost the worst of it. We were at a normal OB practice. As I mentioned, I worked in healthcare administration and academic medicine. I work remotely now, but back then, prior to the pandemic, I was going to the hospital. I was very comfortable with physicians. My mother was a physician. So yeah, I had no issue with that. I really had no reason to question medical care. Meagan: Right. Charlotte: There was also a new birthing center, a new birth wing of our hospital. They had always delivered babies but they had delivered at the other hospital in town for whatever reason. I was one of– within the last year, it had opened 11 months ago. They were still– I mean, it was amazing. Meagan: Getting on their feet. Charlotte: They were. I think there were just some growing pains but they had everything you could think of in this new center. So anyway, I was 30 weeks pregnant so I did deliver a little early with this guy. My son, Auggie. Augustus is his full name. Meagan: I love that. Charlotte: Yeah, I had a trickle come out in the middle of the night around 38 weeks and I was like, “What is that?” It could be pee. It could be whatever. Nothing started. We went back to bed, no big deal. I finished up some things with work the next day. We just said, “You know, why don't we just get this checked out?” We went to labor and delivery. They tested it and it was negative for amniotic fluid so we were like, “Okay, great.” We went back. We got home around 9:00 PM that night. I went to bed early. I just was tired from being in triage. It always takes longer than you expect and then woke up at 1:00 AM to pee as everybody does in the last trimester of pregnancy. There was more of a gush at that point. That's when I knew for sure that the startings of my labor started with water breaking. Now I know, that can be the start of a ton of positioning issues which is what happened with me. Yeah, so then I really quickly went into labor. I had actually done a birth class virtually with a doula. I didn't have a doula, but I felt like, “Okay, I'm going to try to go as long as I can without an epidural.” That was always my thing. “I'll go as long as I can, but I'll still probably have one.” I always had this disclaimer. I started laboring. It felt very primal and very natural. It was dark. I was on all fours, but it felt intense from the beginning. I say this now to my husband, “I never feel like I've had early labor with either of these labors. It just goes straight to intense for me personally.” So I was feeling really like, oh my gosh, grunting and moaning and doing all of the things. We did that for about 4-5 hours. Then I started to feel nervous. I wanted to go ahead to the hospital. We made our way there. When I got there, they checked me. They checked the amniotic fluid. It was the amniotic fluid. I believe it had been the time before as well. They checked me and I was 4 centimeters so I was super excited. I felt like, “Oh, this is moving super quickly and I'm going to have this baby today.”I was on the birth ball. I was prepared, or so I thought. I got to my room and felt, “This is super intense. I am nervous that this is going to move super fast that I won't be able to get an epidural, so I'd better go ahead and get anesthesiology to come. There were a bunch of people coming in and out. I'm sure it slowed things down at that point, but I had a medical student and an attending come in and ask if I wanted to be part of a cervical check study. I work in academic medicine so yeah, of course. Definitely. Let's sign up because that matters for students. You learn all of these things after the fact. You don't want to say no to things like that. Meagan: It's kind of awkward because you're like, “I know you need to learn and I want to help you.” Charlotte: Yeah, but it's like, “No. I don't need more checks. I don't need more people interrupting me.” Meagan: Especially with your water broken. Charlotte: Now I know. Right. Right. So anyway, there were things like that and they come in. I'm feeling very intense still and I'm 7 centimeters. Meagan: Wow! Charlotte: I'm feeling amazing. I'm going to keep moving this along. This is great. I'm texting all of my family and friends, “Hey, this is easy. I'm getting my epidural and in a couple of hours, this is done.” So they gave me my epidural. It worked great and I just chilled. I knew about the peanut ball and I did do the peanut ball, but I think I just laid around. I had my catheter. I was drinking all of the fluids and the popsicles, and just the normal things. You're hooked up to everything at that point. We were just chilling and then time passed and it was the whole day. They checked me again, “You know, okay. You're taking some time but it's still normal.” I actually had a midwife that was the person on call, or the 24-hour provider, so I did have a midwife caring for me. They just kept saying, “This is normal for a first birth.” I was like, “Okay.” More time passed. They decided, “Okay. Let's get some Pitocin to keep this going.” So I started Pitocin. I'm sure you're hearing the same old story, the cascade of interventions. Meagan: You know, it does. It does happen like that. Not always, but it does where it's like, “All right. We've been going. We've been going. We do need to get this labor going.” Pitocin is the next option, right? Charlotte: Yep. And so yeah, then it started with that. I knew, “Okay, let's do the peanut ball. Let's move around.” I didn't know. I thought a peanut ball was enough. It wasn't with the right positions and had I known all of the positioning issues I came to find out my son had, if I had a doula and if I had the right tools at my disposal, I would have held off on the epidural. There are so many things I would have done and that's tough for me. That's something I struggled with. What if I could have done better if I had known? Meagan: But you can't blame yourself. You can't blame yourself. Charlotte: No, you can't. So anyway, time passes. All in all, the labor was 27 hours. I don't know exactly the duration of time, but at one point we got multiple checks. “Okay, you've gotten a little farther. Great. Let's do internal monitoring. Let's do this. Let's see. Okay, the baby is not coming down as much as we would like. He's OP, asynclitic.” I come to find out that I think he had a nuchal hand because he came out like this and his hand was super bruised up. Meagan: Oh yeah, so when your water broke, he just [inaudible]. Charlotte: Yep. And asynclitic, your head is tilted to the side. He had all of those things. He was not coming down. An OB manually tried to push him up and switch him and was sweating and working hard for 30 minutes on that so you can imagine my body going through it. My epidural kept breaking through so I'd go from zero to 100 Pitocin, 9-centimeter contractions, and just pain. Meagan: And messing with things. Charlotte: Mhmm. Tons of meds. They'd try to get it all back and I'd be fine again. But it's like, in hindsight, we did throne position. They let me push on all fours. They let me push. I did end up getting to 9 centimeters or so when we started pushing. They let me push for 4 hours. So in hindsight, there is a lot that they let me do with an epidural, just things I think would be part of a positive story. All in all, 27 hours passed. I'm exhausted. Nothing is wrong with me. Nothing is wrong with the baby, but the midwife comes in and says, “Look. I think we need to call it. I don't think he's coming down. He's super high still.” Right or wrong, I don't know if more time would have helped, but he was starting to get a swollen part on his head and they just said, “I think it's time. You can definitely have a vaginal birth one day.” She said that to me and I was like, “Okay. I'm done too.”I definitely was tearful. You always have those angels in your story. I had an angel nurse that came and said, “Oh, honey. I've had 3 C-sections and it's great.” At the time, it's what I needed just the right person at the right time to comfort you. Meagan: And being able to relate. I think being able to relate and be like, “Okay, you did it. You're here.” Charlotte: Exactly. I was whisked away into the C-section. Usually, the husband doesn't follow you right away. They do all of the things and then they come in. Well, my husband never comes in. Meagan: Oh. Charlotte: My husband had not eaten and had not slept. He ended up getting lightheaded and almost passing out in which case he was being cared for by the midwife that was caring for me in the PACU. Meagan: Oh no. Charlotte: He never came in. They got his phone which was a godsend and I had this amazing CRNA that took the most amazing pictures of the C-section that ended up being a big part of my healing process, being able to see everything. Meagan: Yes. Yes. Yeah. It's weird because sometimes you don't even think or know if you want to see that, but it is so healing, or at least it was for me. Charlotte: Mhmm. It helps you piece things together. Once again, parts of that were a really positive thing. I had a clear drape. I didn't ask for that. They did the clear drape. They did skin-to-skin to some extent, or delayed cord clamping– not as much as you would want, but they did all of that. But I was so out of it by that point. I was shaking. I was passing out constantly, so I was holding my baby, but I thought he was suffocating on me, so I was just like, “Just take him to his dad.” It was uncomplicated and exactly what we thought. It was all positioning issues. No big deal, really. They take me to PACU and wheel me in. The Type A person in me goes, “Okay, forget recovering from that. Now I need to take back control of my experience. Hunter, get me a cold brew coffee.” I just shake my head like, “Why didn't you just sleep when you could have? I drank a cold brew in PACU and put that kid to my boob and they were like, “Wow, you know how to do that already?” I just was like, “Yep. I want to be the mom now. I want to get back to normal.” Well, that was the beginning of a very traumatic couple of days when I didn't sleep at all in the hospital. I got very engorged. He had latch issues. I was told to start pumping. I got an enormous oversupply, like 90 ounces in one day. Meagan: Oh my gosh. Charlotte: A couple of weeks in, yeah. It changed our experience. Obviously, he ended up getting a milk protein intolerance. It layered on. I don't blame the C-section on that, but I do blame my mindset a little bit– and probably got some bad advice from lactation. They didn't know I was going to have an oversupply and go crazy like that. But yeah, I had trauma from that too. I'm like, “Okay, I'm recovering from a C-section and I'm pumping around the clock and all of that isn't coinciding with me caring for my baby.” My husband learned to do everything in the hospital. Meagan: Or caring for yourself. Charlotte: Yep. It was all focused on my recovery. Anytime he needed to eat, it coincided with me needing to pump. It was heartbreaking, really. The second I allowed myself to stop, we started bonding luckily. After that, our relationship truly began. But yeah, it was a traumatic experience. You don't expect that you're going to have this life-changing thing and then have to have you recovering from a C-section too. Meagan: Right. Charlotte: That's kind of that story. I definitely feel good over time with therapy. I'll give a plug to EMDR therapy. It's a type of eye movement therapy. I had one session of that and it helped me get down to a rational level why I was so upset by that experience and just starting to talk about it with people and watch everything helped over time. Looking at those pictures, it no longer became such an emotional thing as time went on. But I still felt sad when I saw people having what I wanted– a good breastfeeding experience and a typical birth. But more and more, I did have a typical birth. In my close friend group, maybe four or five of us have had a C-section. Several were breech, but it started to be like, it wasn't that I was feeling alone. It was that I started to question, “What's going on? Why is this happening?” Meagan: Right. Yeah. That's how it was in my tight friend group. There are four of us from high school. Three out of the four of us have had multiple C-sections. Charlotte: Yeah. Yeah. And more and more so, I'm rooting for people to get a vaginal birth. I'm like, “Get a vaginal birth, please. Have a routine situation.” Meagan: I know. Charlotte: You don't see it very often, at least not in my close group. That's what really made me question things. Fast forward to January 2022 and I'm not quite thinking of having a baby yet, but I had a routine OB appointment. I asked about VBAC. I said I wanted to probably stop taking my birth control and that maybe sometime this year, we would start trying. They said, “Yeah, we're a VBAC-friendly practice.” I told her maybe a one-minute spiel on what happened to me. She said, “Just based on what you've told me, I would say you have a 20% success rate.” Meagan: Oh. Charlotte: I guess she can calculate it in her head without even doing the calculator. I guess they're super friendly like that. They do so many. Come to find out, they have a super high episiotomy rate and a lot of other things, and they're not friendly really at all. Meagan: You're like, “You are ‘friendly'.”Charlotte: Yeah. So I felt completely gutted by that. I hadn't even really committed that I wanted a VBAC, but feeling that I was told that just was so upsetting. It made me start listening to The VBAC Link. Through a couple of episodes, I heard about requesting your operative notes so I did that which was amazing. On that note, it said a bunch of things that I didn't know. I didn't know asynclitic. I didn't know some of the terms which made me able to speak to it in a more educated way. Then yeah. I messaged the doctor. She was like, “No, absolutely. Nothing was wrong. You could totally do it.” She still gave me a success rate of 54% but she was like, “That's just a conversation topic. You can absolutely do it.” I was like, “Okay, great.” She told me I was 10 centimeters, so they saw. I got there. I can do this again. I started interviewing doulas even before I was pregnant. I just started to hear positive things like, “If you can get through an OP, asynclitic baby, water breaking, 27-hour labor, you've got this. With a well-positioned baby, it would not be like what you experienced.” Hearing these things, I started to get hyped up like, “I can do this.” Meagan: Excited, yeah. You felt the empowerment back. You were feeling empowered. That is what is so important because on that first visit, any empowerment that you had was wiped like an erase board. It's like, “Oh, you're 20%.” Okay, great. So that's so good to hear that you were being built back up. Charlotte: Absolutely. So yeah. So then months passed and then in July-August we decided to start trying again. Luckily, again, we were pregnant again and came to find out we were having another boy, another son. We were very excited and that's when my preparation started. I did all of the things. I joined a midwife practice. It was a midwife practice that delivered at the most acute hospital. They were actually affiliated with the big health system here. So that gave me comfort that I would be able to birth in a suite that had a pool but it would be in a hospital right down the hall from an OR if I needed it. That was great. I hired a doula that had VBACs, that was the VBAC whisperer in town. I went to Webster-trained chiropractic and did prenatal yoga. I did everything I could think to do. I tried not to go overboard with eating and then yeah. I even went to a pelvic floor specialist to practice pushing. I did everything I could think of. That was how I could control it. My control thing with me– I just wanted to feel like I did everything in my control to get this. If it doesn't happen, I think I could come to peace with that. That's what I felt would be the case.  So anyways, fast forward. Routine pregnancy up until 28-29 weeks when you get the gestational diabetes screen. Did it, failed it. I was bummed by that, but also heard, “Oh, so many people fail it.” So then I did the 3-hour test. I think I failed three of the four that you needed in the time. You needed two to pass. So yeah. I failed it. I was surprised how gutted I was. I was devastated by that because I kept waiting for the other shoe to drop the whole pregnancy because I hadn't had any barriers. You know all of the barriers that people have where you have to advocate for yourself. I hadn't experienced that even having a VBAC consult with their OB group that helped them out. I supposedly went to the doctor who is all pro-C-section. He was even surprisingly very supportive. So what's going on? Meagan: What's going to give? Charlotte: Yeah. The midwife said, “Nope. You can still see us. You can still come to us even if you have to go on insulin, but you really need to try and stay diet-controlled.” That was what I heard. “Diet control is what will help you stay a normal-risk patient.” That's easier said than done I've come to realize. It's challenging too because time passes. You have to get an appointment with the dietician. You have to get your supplies through insurance so it takes a while to get in the routine of taking your blood sugar multiple times a day and then maybe weeks pass before you can figure out what's causing you to have spikes.So it's a whole new thing. I'm trying to focus on VBAC, prenatal yoga, and all of the things that help you be super zen, but now I have multiple appointments and tracking logs. It was very stressful for me. There are certain things– your fat and blood sugar, for example. There is very little you can do to control that. It's very challenging to get that control because it's all about your placenta and how it is metabolizing quicker. It's not what you ate in pregnancy. There are a lot of misconceptions about it. The best thing that I can share is Lily Nichols has Real Food for Pregnancy and then Real Food for Gestational Diabetes and maybe you can link to those, Meagan. Those two books were super helpful for me because of what I can find out– they probably work for some people, but the dietician stuff you get just from the hospital in one visit, and the handout is really high carb. Considering it's the carbohydrates and the sugars that are causing issues, it doesn't work. The plan just on paper doesn't work for everybody to control their gestational diabetes. That was too high for me. When I followed that plan, I wasn't in control of my diet. Lily Nichols, you can take bits from each, but I found that that book, and that's what my midwife suggested, was lower carb and all about real foods. It had stuff about supplements and all of that. I found that super helpful to staying diet-controlled. In hindsight, even though I probably had it the whole time, I ended up only doing diet control for two weeks before I gave birth. So lucky for me in some ways, it was one of the silver linings. I didn't do the diet for very long but I did get all of the information I needed. Eventually, they were telling me, “If you became insulin-dependent or needed insulin or were out of control,” I think it was 90% of your readings needed to be in control. You could have a one-off here and there. If they weren't then you needed to start seeing a maternal-fetal medicine doctor who could consult on your diabetes and insulin. You could still deliver with the midwives, but my perspective was if you're on insulin, you have to start having NSTs weekly. You have to start having– I can't remember what it is called– BP or some other weekly testing for the baby. I can't remember. It's some acronym just to check their heart rate and all of that. I can't remember what it's called but there are two types of weekly testing you would have to have if you were on insulin. I don't think you have to have growth scans, but I think they would probably start to offer them to see how baby was doing. That's where I feel like maybe people start to get discouraged by their providers when their growth scan is large or when they start to have NSTs obviously. There's much more surveillance and then they encourage you to get induced. If you are on insulin, it's a lesser time that they allow you to go. They make you go anywhere from– I'd have to look it up but it's like 37 if it's really out of control to 39 if it's insulin-controlled. Diet-controlled, you're treated like any other birth. That's where, I think, maybe you're seeing not as many VBACs. You have a lot of barriers that come in. Meagan: Yeah, because they're not in control or they've been transferred to MFMs and they're like, “At this point, it's just better to get this baby out earlier and control blood sugar and have a repeat Cesarean.”Charlotte: Yeah, and I might have made that decision myself. You just start to get medicalized again and it's discouraging. You worry, “What's happening to the baby? Is it okay? The NST is not looking good.” I just think it takes that from you. It's needed sometimes, I'm sure. In some ways, it was a blessing in disguise. I would have had a C-section if my son could have stayed in for two more months. It was a blessing in disguise in some ways that it happened when it did. So anyways, I guess I'll continue unless you have other things you want me to talk about. Meagan: No, I just pulled up the book and sent it to myself, so we're going to make sure that we have it in the show notes. Charlotte: Yeah, great. Meagan: Because I think that's really important to have. Charlotte: Yeah, yeah. Just more tools at your disposal. Lily Nichols is a dietician and she even says, “Some of the stuff that they are still teaching is archaic. We've found that there are better ways to do these things.” She helped develop the gestational diabetes stuff for the ADA so she has major credentials. Yeah. I think she is legit. Anyway, two weeks pass. 32 + 2 and I feel huge. I'm not, but I feel pressure low. I told my mom, “I can't do this for much longer,” the night before which is weird. I had also bought some Easter stuffies with names on them for my son and I bought one for my other son which was foreboding. He was here by Easter and wouldn't have been otherwise. Meagan: Yeah. That is interesting. Charlotte: I don't know if my body knew or if I knew in the back of my head that he was going to come early. I started to feel pressure and just weird but nothing like I would have noticed. I just started to feel like, “Oh, gosh.” I had a pedicure for later that day. That weekend, I was going to have my baby sprinkle. I didn't have an in-person shower with my son and didn't end up having one with my second son. But I had all of these things planned. I had a pedicure, of course, and all of that stuff coming up. I don't think that's what put me into labor, but it was kind of funny. I'm like, “If I ever have another kid, I probably wouldn't get a pedicure.” Meagan: Yeah. You're like, “It's a little coincidental for me.”Charlotte: Yeah, so I was just like, “I need my back massager,” because I was already feeling something in my back. I was like, “Oh my god, it feels so good.” I get home. My husband and my son are home and we have just learned about rebozo. I was taking a Hypnobirthing class. That was the other thing was my hypnosis class. So he was doing rebozo shifting for me and it felt so good. I was like, “Okay, great.” I was practicing my hypnosis and I was just like, “This is Braxton Hicks I think, but man. These are crazy.” I never remember someone saying that Braxton Hicks hurt. It's waves. It's definitely a wave each time. I lay down and I told my husband, “I'm just going to rest for a second and I'm going to get in the bath.” Well, when I get to the restroom, there's blood. That freaked me out, obviously. I still don't think I'm in labor, but I'm like, “Something might be wrong.” Meagan: Especially at 32 weeks, right? You're like, “Uhh.”Charlotte: So I go get in the car. I told my husband, “I just need to go to triage.” It's 30 minutes away. I always knew we were going to have a little bit of a drive to get to the hospital. I drive myself to the hospital in labor now that I've come to find out. I was doing my hypnosis techniques. I was just like, “Let me just get there as fast as I can.” Luckily, I got there fast. I think I got there in 25 minutes. I got there super fast. My mom had me a month early and drove herself to the hospital. That was always her claim to fame. I had to do it too. Meagan: You're like, “I'm going to do it too.” Charlotte: Yeah. I had to do it too. My parents live in town, so they came over to watch my son so my husband wasn't far behind me. I get to triage and they put me on the monitor. Baby was fine. It doesn't look like I'm having contractions which is good news. They're like, “Okay. Let's get the midwives in. I'll check you if that's okay.” She's like, “Oh, yeah. These are not really typical waves.” Then she checks me and I see her face go white. She's like, “You're 5 centimeters, so I'm going to need to call the doctor because we can no longer help because you're preterm,” which was a bummer. I'm like, “Okay, great.” Then she says, “Ope, there's a contraction.” For whatever reason, it wasn't showing contractions, I think that happens sometimes in preterm births apparently because they are so far up or small or something. Meagan: Yeah, I was going to say that they are used to tracking them lower and it's not. The uterus is smaller. Charlotte: So anyways, the doctor comes in. He's a resident. All of these things could have been bad, but it's so funny. I ended up having the most amazing providers. It was just interesting to me. All of the things I was worried about– I don't know if VBAC is becoming more of a thing now or because they work so closely with the midwife practice and they see it happen and they see it happen well with success— the midwife group in town has an 80% success rate. Meagan: That's awesome. Charlotte: Anyways, yeah. So they come in and they're just like, “We're so sorry. You're 5 centimeters. You're having this baby. We can try and just slow it down. There's not really anything we can do but you can just lay there and let's just hope you stay in labor for 24 hours.” Meagan: Did they try to stop your contractions or anything like that? Charlotte: No, I think I was right over the cusp of when they would do magnesium. I don't know exactly why they do or don't, but they said they do it with younger than that or I think cerebral palsy or something like that. Meagan: They didn't try to do any steroid injections for lungs? Charlotte: They did do steroid injections, but– it went too quickly for it to matter. I go in. We'll just see what happens. I didn't know what to do. I was like, “Should I be doing labor things or should I just be sitting here?” The nurses were like, “Don't go to the bathroom. We don't want you to start going on dilation station.” I was like, “I need to go though.” So I was feeling conflicted. We called my doula. She was in a four-day induction supporting another person, so she was not able to come and she said, “Well, do you want me to send a back-up doula?” I said, “Yeah. Bring them on. Whatever.” That doula ended up being amazing. She gets in. She gets right in. I'm starting to feel really uncomfortable. They checked me again. I'm 7 centimeters. This is moving so much faster than my last birth. This all started around 4:00 PM with not really anything except for the waves. By the time I got there at 7:00, it was starting to feel more intense and I had the baby by midnight, so 12:30. It was fast for me. I wouldn't say precipitous or whatever. Meagan: But still, 27 hours, right? Charlotte: Mhmm. She gets in there. The doctor says, “No, you can do whatever you want.” Oh, let me back up for a second. When they said, “The baby is coming this early,” I said, “Do we need to do a C-section? Whatever. If we need to get the baby out, let's just get the baby out.” They said, “No. If you want a VBAC, that's totally fine,” and that it would be beneficial for the baby at this point. Having a vaginal birth at this gestation is better for the baby's lungs than doing a C-section. Of course, they'll do a C-section, but there are some benefits to pushing out. I was so excited by that and then they were like, “You want to go unmedicated, right? Do you?” I said, “Yeah, I do. Can I move around?” He said, “Yeah. There is no stopping this baby at this point. Just do what you need to do.” So I was able to get on the birth ball. I wasn't in a birth room with a pool, but I was able to do my thing and move around at least. This time, I had really committed that I was going to do unmedicated because of the hypnosis and all of the things that I had done. So yeah, I labored very quickly. I had a very intense transition pretty much the whole time I was there. There was a lot of blood coming out which was scary. I was out of it, but I was like, “Is this okay?” There was blood dripping everywhere and they were like, “Yeah, you're probably having a placental abruption.” Meagan: Did they say anything about your placenta?Charlotte: Yeah. They said, “This is probably a placental abruption, but if you're having it and the baby is fine, it's fine. If the baby is not fine, you'd go to a C-section.”Meagan: Then it's not fine, yeah. Charlotte: That was interesting. I had never heard of placental abruption. That was probably why I was going into preterm labor because the placenta was starting to separate. So yeah. I just kept moving around and doing my thing. All fours were most comfortable for me and then I was 10 centimeters and the doctor came back in. The NICU staff came in and they never freaked me out about how preterm he was. That was the comforting thing. They said, “32-weekers do amazing. They do well.”Luckily, we were at a hospital that takes care of 22 weekers. We were at the best hospital for this so that was super comforting through the whole experience. I think I would have had a lot more fear had they not said those things to me. So yeah. They broke my water and they were like, “This might take a second for him to come down. We've got the squat bar up.” I did two practice pushes. I was feeling so much pressure. It's like pushes that were semi-productive. And then all of a sudden, I just felt this fire in me to just push him out in one push. I pushed so hard and apparently, I screamed. I don't remember screaming, but I screamed so loud and he shot out. Meagan: Oh my goodness. Charlotte: We got all of this on pictures too, so yeah. He came out. I don't know if he was screaming, but he came out. Leo is my second son. He was 5 pounds, 2 ounces so he was a big boy. Meagan: Okay, yeah. That's a good size. Charlotte: I don't know if it was gestational diabetes or whatever, but he was a good size. They did bring him over to me briefly. All of these things, I understand. Meagan: Right, right. Charlotte: They let me hold him for 10 seconds because they needed to go get him some oxygen of course. Meagan: They needed to make sure that his little lungs needed some extra care. Charlotte: Yes. He was whisked away to the NICU where once again, there's trauma and things. Of course, I wish that my baby could stay with me but in the moment, it was rational. He needed to go to the NICU so in the moment, I felt back to myself. I was a little stunned, but I was like, “Oh my god. I feel my body. I feel no drugs, no fluid.” I mean, I think I did have a little bit of fluid, but it was just so different than my last experience where I was so drugged up. Meagan: Yeah. Charlotte: I got to see my placenta which they sent off for pathology and they found nothing. There's no answer. It was just challenging like, “Why did this happen to me?” But it just happens sometimes. I did have COVID two months before. The gestational diabetes even– no symptoms from it, but I just wonder. I had it in February. I was diagnosed with gestation diabetes in early March and I had him in late March. It just feels like as time goes on, they're finding placental issues. They didn't see anything obvious.So yeah. He came. He's healthy. We spent 39 days in the NICU which was a challenge. It really was. I don't wish that experience on anybody. You're postpartum and pumping and going home without your baby, being there for my son but having to be at the NICU all day every day. It was a huge challenge for us, but he had a very routine time in the NICU. He just needed time to grow. He came back to us not this past Sunday, but the Sunday before and we were just so happy. He's eating well. He's 8 pounds. He's amazing. Meagan: Wow, good! Charlotte: So yeah. Now we're on our healing journey of now it's postpartum, the typical postpartum things. But I just can't be thankful enough that I didn't have to deal with all of these challenges with a C-section recovery on top of that. I mean, I felt physically back to myself very quickly. I had a very small two-stitch tear up, not down but I felt fine. I'm just grateful for that and I'm grateful for all of those providers who let me do my thing and trusted me and my boy to work together to get him out safely so yeah. That's the story. Meagan: Yes. Your team sounds really, really awesome. Charlotte: Yeah. Meagan: Like really awesome. We hope that those types of teams are cloned all over the world, but we know that it doesn't always happen that way, so if you're listening and you've got gestational diabetes and you don't have as supportive of a provider, know that you can always keep looking, but too, know that you can do exactly what Charlotte did. You can control what you can control. Control what you can control. You read the book. Learn how to control your diabetes. Learn all about that and then try and just take baby steps along the way even when random things are thrown at you like early term or preterm labor. That could have been where you are like, “Here's the boot. Instead of a shoe, here's a boot. It's being dropped. Now I'm going into preterm labor.” But you didn't let it. You just put those boots on and kept walking. Right? Charlotte: Mhmm, yep. Meagan: That's so awesome. So, so awesome. Did you have any symptoms of gestational diabetes before you got tested? Charlotte: I don't think so. No. I tried to think back on if I did. I think I caught it so early. I got the testing done. That's another thing too. I would recommend trying to get your screening done as early as possible because the earlier you catch it, the earlier you can control it with diet. It becomes harder to control as time goes on, but you can stop that baby potentially. You can maybe diet-control enough that the baby doesn't get too big. There's a lot of really supportive Facebook groups. Gestational diabetes, nutrition, and all of these things because it's hard to find information out there and it's helpful to hear those stories of, “Hey, my baby came out and was small or was 8 pounds,” just not these huge babies that you hear of. I'm sure a lot of people aren't diagnosed or are borderline and maybe have similar things. Meagan: Yeah, there are undiagnosed where we are like, “Whoa.” I had a client whose baby was 11 pounds. Charlotte: Yeah. Yeah. I mean, I think one way I started to feel was that this may be a blessing in disguise. Had I not just been on the borderline, maybe I would have had an 11-pound baby, and whoa, to be honest. Leo would have been big if he had gone to term. But the earlier you find out, you can diet control. You maybe can control your weight gain and have a healthier pregnancy overall. Meagan: And have fewer issues after. Charlotte: Because I felt amazing. Just the fact that I had such a high-protein diet and things in that time period, I feel like that made me even better equipped to have a vaginal birth. So yeah. I think there are positives if you can get past that initial challenge of it that, “Okay, this is just going to keep me on track to have a healthy pregnancy,” you can do it. You really can do it. I think as long as you just say, “Look. They're going to do screenings. They're going to offer things.” It may end up in an induction but I think it's still worth pursuing if it's something that you want to do. Meagan: Yeah. That is one of the things. It may end up in an induction and that is still possible. They may be telling you that your baby is big. That doesn't mean that vaginal birth is not possible. Right? Big babies come out of pelvises all the time. Inductions and VBAC– Yes, it's not as ideal as spontaneous labor but still very possible. Know that if you are listening, you're not alone out there even if you might feel alone because there are not a ton of stories out there. That makes me sad so we are going to change that here on the podcast. It's starting right here with Charlotte. Awesome, well thank you so much for sharing your story today. Charlotte: Absolutely. Thanks 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

Foreign Nurses are some of the highest human trafficked professionals in the US. Many get threatened with high fines and visa status suspension if they cancel their contracts. Labor trafficking is a REAL in the American healthcare system. On this episode of The N&H Podcast our special guest Kaye Mendoza joins us to talk about her "HERO's' journey as a foreign nurse and how she became 'The Accidental Foreign Nurse Lifeguard" helping and consulting many foreign nurses who have been victims of labor trafficking. Kaye is a bachelors prepared RN who has spent 19 years in contractual nursing with specialties in Peri-operative, PACU, Labor and Delivery nursing. She is a volunteer advocate for contract nurses locally and internationally. An admin of social media group called "Lefora Filipino Nurses to US", a 200,000+ community members promoting education on nursing migration, clinical and cultural transitions to help aspiring foreign nurses around the globe who are entering the US nursing workforce. Kaye is also a mixologist, pro photographer, contract nurse hacker, drone pilot and she's also just enjoying her freakin life! This episode is sponsored by Rogue Nurse Media Empowering Nurses and Patients to tell their stories. Nurses get 1.0 FREE CE's go to nursesandhypochondriacs@gmail.com Give us a 5 star rating on apple podcasts For The Well Written Nurse Writing and Storytelling classes go to: https://www.eventbrite.com/e/whats-your-story-part-1-detox-intro-to-writing-and-storytelling-tickets-94768506153 Join our email newsletter http://mailchi.mp/f134561374e9/rogue-nurse-media-501c3-newsletter-empowering-nurses-and-patients-to-tell-their-stories  

Abre ('I fall in love too easily') y cierra ('Never was love') Pat Metheny con su disco 'Dreambox'. Del disco de Luiz Millan 'Brazilian match', en el que participan Randy Brecker, David Sanborn, Mike Mainieri o Eddie Daniels, 'Pacuíba', 'Full moon', 'Morungaba' -canta Lisa Ono-, 'Montparnasse' -canta Clémentine- y 'Que os ventos limpem os tempos'. Y del disco de Nanny Assis 'Rovania', en el que tocan Randy Brecker, Ron Carter, Fred Hersch o Laekecia Benjamin, 'No agora', 'Nenhum', 'Manhã de carnaval', 'Back to Bahia' y 'Proponho'. Escuchar audio

The Oklahoma Department of Wildlife Conservation (ODWC) said an 11-year-old boy caught an exotic Pacu in a neighborhood pond. A Pacu is a South American fish closely related to the Piranha but with human-like teeth. Asa Ellerup, the wife of suspected Long Island serial killer Rex Heuermann, filed for divorce Wednesday, less than a week after New York police arrested her husband on a half-dozen cold case murder charges. A South Florida jury awarded $800,000 in damages to a little girl who received second-degree burns when a hot Chicken McNugget fell on her leg as her mother pulled away from the drive-thru of a McDonald's restaurant. See omnystudio.com/listener for privacy information.

Many anesthesia rotations have you work in different parts of the hospital, to get a glimpse of what perioperative medicine truly means. This includes Preop, Acute Pain Service, optimization clinic, SICU, PACU, and of course, the OR. The episode describes what you will be doing in each and how to thrive.

Astor Piazzolla, un genio musical del siglo XX, se fue un 4 de julio. Le recordamos con grabaciones de 'Michelangelo 70', 'Tanguedia', 'Milonga del ángel', 'Vuelvo al sur'- con la voz de Roberto Goyeneche-, 'Regreso al amor', 'Libertango' y 'Adiós Nonino'. Además, Pat Metheny con 'The waves are not the ocean', de su último disco 'Dream box', y Luiz Millan con 'Pacuíba', 'Full moon', 'Andar descalço' y 'Que os ventos limpem os tempos'. Escuchar audio

Critical Care Time is the podcast for everyone who cares for the critically Ill. Whether you work in an ICU, a Med-Surg unit, an ED, a PACU or the back of an ambulance - Dr. Cyrus Askin & Dr. Nick Mark provide practical insights and useful tips to enhance your skillset. They are triple board-certified intensivists who love patient care and teaching. Journey with them through deep dives into physiology and practical pearls, leaving no stone unturned in the world of critical care medicine. Through their own insights, expert interviews and targeted reviews of the literature, Nick and Cyrus provide practical, relevant critical care pearls. If you bill for critical care time, you must make time for Critical Care Time! Hosted on Acast. See acast.com/privacy for more information.

'Brazilian match' es el título de un disco que ha publicado el compositor y cantante brasileño Luiz Millan con colaboraciones de músicos como Randy Brecker, David Sanborn o Mike Mainieri y las voces de Lisa Ono, Clémentine o New York Voices: 'Pacuíba', 'Full moon', 'Andar descalço', 'Morungaba' y 'Que os ventos limpem os tempos'. Del nuevo disco de Pat Metheny 'Dream box' las tres versiones que hace de 'Never was love', 'I fall in love too easily' y 'Morning of the carnival'. Y tres canciones, 'Querença', 'Migrants' -que da título al disco- y 'Canto a Yemanjá', del caboverdiano Mário Lucio. Despide el pianista Alain Jean-Marie con 'Morena´s reverie'. Escuchar audio

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and being in a solo practice within a group practice. I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Solo Practice Within Group Practice — with Sam Jejurikar, MD". Some surgeons dream of complete autonomy. They want to do whatever they feel like doing without having to answer to executive boards or other surgeons they work under.  They want to set their own hours, hire and fire staff and buy equipment if they feel like it.  They also want to make more money and assume they will in solo practice since they keep all of the profits and not just a percentage.  However, the flip side of that autonomy means they also get to handle their own books and inventory, while also marketing to attract cosmetic patients.  The business and marketing side of plastic surgery can be fun, daunting, uncertain and confusing.  So, is Solo or Group practice better? Here's a unique business model that allows you to run your solo practice as you want, but also enjoy the perks of being under the umbrella of a much bigger practice. Very interesting! This week's Beauty and the Biz Podcast was an interview I did with Sam Jejurikar, MD, a board-certified plastic surgeon and a member of the Dallas Plastic Surgery Institute that includes 10 surgeons, 4 ORs, 40 staff in a 45,000 square foot facility. We talked about their unique business model to buy into the practice but run as a solo practitioner and how they make decisions with so many surgeons involved. Visit Dr. Jejurikar's website P.S. Want Catherine's book for free? Just leave us a review, text (415) 851-0172 and her book is on the way!

Chanel Williams is a PACU travel nurse and has been a traveler for 4 years. Join Chanel and Dylan as they discuss helpful routines and habits when prepping, recovering, and during a contract! Learn more about Chanel's Journaling practices and 30 days of Self Care for Exhausted Healthcare Workers on Instagram @travelnursenel

Katherine Leamy set out in life to become a physical therapist but instead became a fantastic nurse and we talked about all things PACU nursing: the ratios, the time spent with each patient, her autonomy, how she involves the family for support, and the importance of critical thinking skills because, after all, the PACU is a critical care unit!  We even dished on the funny things patients say when waking up from anesthesia (I can't imagine what I said!). She sold me on PACU nursing when she described what she loves about it: the close proximity of her colleagues, the teamwork, and seeing her patients progress by providing everything they need in the short time they are with her. AND, bonus, she's a travel writer with a book on the horizon! It's a memoir of traveling not only solo, but traveling light, I mean her Instagram is @the5kilotraveller. She describes writing as a “total escape from nursing” and suggests nurses could benefit from using writing as a creative outlet. In the five-minute snippet: pasta with lemon sauce in Italy? Sign me up! For Katherine's bio, visit my website (link below). PACU care certification:American Board of PeriAnesthesia Nursing CertificationProfessional Organizations for PACU:American Society of PeriAnesthesia NursesAssociation of Operating Room NursesSocial media:InstagramWebsiteBlogContact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comGive me feedback! Leave me a review! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast Email: theconversingnursepodcast@gmail.comThank you and I'll see you soon!

A report from the Joint Commission reveals that 80% of serious medical errors are related to miscommunication during the transfer of care. There is a need to standardize a safe handoff process in the Post-Anesthesia Care Unit (PACU). This episode's guest is helping our nursing tribe overcome this issue. Jenny Finnell sits down with Cathy Zuniga, the founder of PACU Nursing Minutes—your Perianesthesia nursing education resource! Cathy shares with us how she hopes to streamline the handoff process, providing us access to some of her tools and resources so we can implement them in our work and improve patient outcomes. Join this insightful conversation and get your hands on one of the most thorough PACU reports. Get access to planning tools, mock interviews, valuable CRNA Faculty guidance, and mapped-out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy here! https://www.crnaschoolprepacademy.com/join Book a mock interview, personal statement, resume and more at http://www.NursesTeachNurses.com Join the CSPA email list here! https://www.cspaedu.com/podcast-email Send Jenny an email or make a podcast request! Hello@CRNASchoolPrepAcademy.com PACU Report Sheet Free Downloadhttps://pacunursingminutes.com/safe-hand-off/ Follow Cathy on Social:https://www.youtube.com/channel/UCqkcr8XfeDQV0aeWVOFtFTQFb https://www.facebook.com/profile.php?id=100070843233039IG: https://www.instagram.com/pacunursingminutes/

Pat Hirsch, a nurse who has a depth of experience in critical care and PACU units, describes some of the common types of liability in this setting and how PACU personnel handle them. The possibility of falling always looms large in a PACU. Patients may be disoriented, have pre-existing cognitive issues, visual disturbances, language barriers, and other issues. Where Pat works, low-, medium-, and high-risk patients are pre-identified. High-risk patients are given yellow socks and wrist bands, and other precautions are set into place. Breathing issues may be common for those with COPD, lung restrictive conditions, and sleep apnea. CO2 levels must be monitored. Many simple physical techniques, like having a conscious patient cough, can resolve the issues, but sometimes more complex maneuvers are required. Being sure that pulse ox monitors are working correctly is an important part of the equation. PACU personnel need to be particularly aware of the possibility of internal bleeding by recognizing its signs. This serious condition may sometimes require a return to surgery. Be sure to listen to or read this valuable and instructive podcast. Not only will it help you in analyzing PACU cases, but the life you save may be your own. Join me in this episode of Liability and Safety in PACU: Insights from an LNC with Pat Hirsch What classifies a post-anesthesia patient as a fall risk? What measures can prevent falls in the postoperative care unit (PACU)? How do PACU personnel handle breathing issues? What particular guidelines apply for the pulse ox readings? How do PACU personnel recognize and deal with internal bleeding? Listen to our podcasts or watch them using our app, Expert.edu, available at legalnursebusiness.com/expertedu. https://youtu.be/z6a4pqNcJMY You can still order the recordings for our 7th Virtual Conference! LNC Success™ is a Virtual Conference 3-day event designed for legal nurse consultants just like you! Pat Iyer and Barbara Levin put together THE first Legal Nurse Consulting Virtual Conference in July 2020. They are back with their 7th all-new conference based on what attendees said they'd find most valuable. This new implementation and networking event is designed for LNCs at any stage in their career. Build your expertise, attract higher-paying attorney clients, and take your business to the next level. After the LNC Success™ Virtual Conference, you will leave with clarity, confidence, and an effective step-by-step action plan that you can immediately implement in your business. Your Presenter of Liability and Safety in PACU: Insights from an LNC with Pat Hirsch My name is Patricia Hirsch and I'm from Cincinnati, OH. I've been an active bedside nurse for almost 39 years. My nursing experience includes Med-Surg, Telemetry, CCU, ICU, MICU, SICU, ED, Pre op and PACU. I've been working in a PACU for the past 16 years, along with pre op in the past 10 years. My clinical experience in Critical Care and PeriOp nursing has fostered my knowledge of the nursing process and standards of care in nursing.I also worked in many different hospital settings and worked for a nursing agency for 10 years. This broadened my knowledge in how different healthcare systems operate.I am also proficient in EPIC, and know how to navigate the EMR. This comes in handy when teaching clients how to understand the EMR! Connect with Pat https://www.linkedin.com/in/patricia-hirsch-67712153

Colleen returns to the show to share her experience at a new job in PACU, where she has now been working for several months. This position is an outpatient role, avoiding the need to work nights or weekends. It is an opportunity to learn and be supported in the earliest time of practice.  Note: Colleen left her first new graduate job after just 4 months. She moved forward in search of a role that supported her transition to practice as a novice RN in a nurse residency. Listen to Careerwise Nurse podcast episodes 22, 23, and 31, to hear Colleen talk about her previous experience as a new graduate RN.     Connect with Colleen on Instagram @colleen.anya FOLLOW the show RATE & REVIEW!!  Help grow the show to reach more nurses!! Are you looking to get more out of nursing than just a job? The Careerwise Nurse podcast is meant for you if you are launching your career, growing into your role, or seeking ways to thrive as a nurse! The Careerwise Nurse podcast is from nurses for nurses.  Current and future student nurses - this is for you, too! Careerwise Nurse is an opportunity to connect with Natalie D'Itri, MSN, RN. Natalie is an experienced nurse, who coaches nurses to live their best nursing life.  Support this podcast: Buy me a coffee! Talk with Natalie about tuning into your best nursing life.  Schedule a free introductory coaching call:  https://calendly.com/natalie-ditri/careerwisenurse Join the Facebook community - Careerwise Nurse Instagram: Careerwise Nurse    Email host Natalie D'Itri, MSN, RN, AOCN   

join Casey & Alexis as they talk about their new roles as nurses and what it's like in the PACU! you won't want to miss some of the stories Alexis has to share!!

If your nursing program provides a periop clinical experience, consider yourself very lucky! I really enjoyed my periop clinicals and learned a ton about this exciting area of nursing. The three stages of periop are preoperative, operative and postoperative (PACU). Patients go through each of these stages every time they have a surgical procedure, and each stage has its own unique challenges and opportunities to learn something new. In this episode, I'm sharing what my periop clinical experience was like and some tips on what you can expect in all three settings. If you'd like to learn more about PACU nursing, check out episode 238 where I dive into what a day in the recovery unit is like. Starting nursing school soon? Then you've probably heard the horror stories. See how Crucial Concepts Bootcamp has helped students feel more confident, joyful and ready for nursing school here. __________  The information, including but not limited to, audio, video, text, and graphics contained on this podcast are for educational purposes only. No content on this podcast is intended to guide nursing practice and does not supersede any individual healthcare provider's scope of practice or any nursing school curriculum. Additionally, no content on this podcast is intended to be a substitute for professional medical advice, diagnosis or treatment. Straight a Nursing is a proud member of the Airwave Media Network. Learn more about your ad choices. Visit megaphone.fm/adchoices

CRNAs and SRNAs/RRNAs have asked us to give them the essential information needed to manage different OR cases. Episodes they can listen to while on their commute, on a run, or just relaxing at home with their headphones. Today we're going to review the Anesthesia Management for a Pheochromocytoma. This is the second episode in our endocrine surgical procedures series, so get ready for this power-packed episode full of "need to know" info you can use in the OR and stuff you might even find on exams.    Here are some of the things you'll learn on this show: The pathology of a Pheochromocytoma. (3:40) The signs and symptoms you'll find. (5:16) What if it goes undiagnosed? (6:37) How to differentiate this from other interoperative problem. (7:25) Treating known diagnosed Pheochromocytoma. (10:52) What will you be watching for as you monitor patient? (15:58) Intraoperative hemodynamic goals. (19:29) Let's work through a PACU scenario. (24:45)   About our hosts: https://kpatprogram.org/about-the-school/faculty.html    Visit us online: http://beyondthemaskpodcast.com    Get the CE certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf

Maureen has experience in the ICU, PACU, and as a nurse educator. She is also the owner of straightanursingstudent.com.

A few years ago I made the big leap from ICU to PACU and I haven't looked back since. Sure, I loved the ICU where I worked, but I made the decision to step away from that so I could step even more into this…podcasting and teaching online. And I have to say, though I first was drawn to PACU for the flexible schedule it allowed me, I've really loved working in this environment. In this week's episode, I'm taking you to work with me and talking through a typical day in the post anesthesia care unit. I'm so excited!!! So if you've ever wondered… What does Nurse Mo do when she's not working on the podcast? What's PACU nursing like? Can PACU be a career option for me? Then this episode is FOR YOU!  I had a lot of fun making this episode and I hope it inspires you to consider post anesthesia nursing. It's fast-paced, highly variable, and yes…the schedule is pretty great! Nursing School Thrive Guide: Get the book that's like having your nursing school bestie by your side every step of the way. (#ad) Going from ICU to PACU:There are so many differences in these two dynamic environments, and I share them with you here!   RATE, REVIEW AND FOLLOW! If this episode helped you, please take a moment to rate and review the show! This helps others find the podcast, which helps me help even more people :-) Click here, scroll to the bottom, then simply tap to rate with 5 stars and select, "write a review." I'd love to hear how the podcast has helped you! If you're not following yet, what are you waiting for? It takes just a quick moment and the episodes show up like magic every Thursday. And, when I release a bonus episode, those show up, too! You'll never miss a thing! In Apple Podcasts, just click on the three little dots in the upper right corner here. Know someone who would also love to study with me? Share the show or share specific episodes with your classmates...when we all work together, we all succeed! On Apple Podcasts, the SHARE link is in the same drop-down as the follow link. Spread the love! Thanks for studying with me! Nurse Mo

Be sure and check out DRAGON BALL Z: KAKAROT! We're excited to talk with paleontologist Matthew Kolmann about a fish whose legendary ferocity ranks with the shark and the barracuda - the piranha! Are they capable of turning an animal into a skeleton in minutes? No. But they're still wicked cool. And don't worry - we manage to throw in some cryptid stories too!   Content Warning: We do talk a bit about testicles being bitten off by fish. Teddy Roosevelt's book about his trip to South America, Through the Brazilian Rainforest. Then there's the weird back-story about his seeing a cow eaten by the fish, apparently part of a staged event. The legend of the Swedish pacu fish that eats testicles came from a 2013 article that was referencing a less reputable paper that was, in turn, reprinting an urban legend. Pacu don't eat people's testicles, although they do eat nuts. The Piranha film series has done little to further our cultural understanding of these fascinating fish. I slightly messed up the title of the film about Mokele Mbembe. It's Baby - Secret of the Lost Legend (1985). Boto Encantado - the magical shape-changing river dolphin Were-Jaguars are quite common in legends of South & Central America. Here's an academic paper on the topic, specifically referencing the shape changing Kanaima. Learn more about your ad choices. Visit megaphone.fm/adchoices