Podcasts about preterm

Send us a textThis week we have a couple of great Local interviews! Ochsner Children's Hospital has been one of our anchoring sponsors for years now and for our fifth season, We have created a BRAND NEW SEGMENT called         "A Mother's Giving: & the Milk Bank of Louisiana with Dr. Harley Ginsberg."Dr. Ginsberg is board certified in both pediatrics and neonatal-perinatal medicine and has been on staff at Ochsner since 1987. He served as both the Section Head of neonatal medicine at Ochsner and the Medical Director of the neonatal intensive care unit (NICU) at Ochsner Baptist Medical Center from 1989 until 2021. Dr. Ginsberg managed the team at Ochsner that took care of babies during Hurricane Katrina. Currently he is Medical Director of the NICU at Ochsner Kenner Medical Center. Dr. Ginsberg is the Founder and Medical Director of Mothers Milk Bank of Louisiana at Ochsner Baptist and is a member of the Standards Committee for the Human Milk Banking Association of North America. He has written chapters for medical textbooks on neonatology and has published scientific medical in articles in the New England Journal of Medicine, Pediatrics, Journal of Perinatology and Clinics in Perinatology. Fully accredited by the Human Milk Banking Association of North America, Mothers' Milk Bank of Louisiana at Ochsner Baptist was Louisiana's first human milk bank and the 24th nonprofit milk bank in the United States. Preterm infants are at risk for a condition called necrotizing enterocolitis, which results in inflamed intestines, bacterial infection and damage to the colon and intestines. Without proper care, the infant may die.Pasteurized donor human milk helps offset these potential dangers. Unfortunately, some mothers of preterm infants cannot produce their own milk. That's where Mothers' Milk Bank of Louisiana steps in.As of August 2020, Louisiana provides Medicaid coverage for using pasteurized donor human milk in a hospital. In 2022, Louisiana legislators approved inpatient and outpatient coverage for pasteurized donor human milk. Listen as Dr. Ginsberg and I dive into the Milk bank of Louisiana and hear the powerful impacts it has on our community and state! Go to https://www.ochsner.org/services/mothers-milk-bank-at-ochsner-baptist to learn more or to make a donation today!______________________________________________________________________________________________Then later we welcome back DIRTY DOGS! The local documentary making big waves in our city yall. Not only did the documentary chronicle the heated monopoly on New Orleans' food cart licenses for the French Quarter. What WAS a half century monopoly was essentially ended by a group of passionate film makers that felt convicted to MAKE THINGS RIGHT.  I am so excited to welcome restauranteur and host Brad Bohannan and Cinematographer, Adrian Sosebee to talk about their HOLLYWOOD AWARD they just received in  Beverly Hills! Brad also talks to us about his latest venture with his inspirational wife, Jefferson Parrish Council Person, Arita Bohannan. Together and with a village behind them, they work to bring inclusive and autistic friendly playgrounds to neighborhoods and communities tThank you to our family of amazing sponsors! Ochsner Hospital for ChildrenWww.ochsner.orgRouses MarkersWww.rousesmarkets.comSandpiper VacationsWww..sandpipervacations.comCafe Du Monde www.shop.cafedumonde.com The Law Firm of Forrest Cressy & James Www.forrestcressyjames.comComfort Cases Www.comfortcases.orgNew Orleans Ice Cream CompanyWww.neworleansicecream.comERA TOP REALTY: Pamela BreauxAudubon Institute www.auduboninstitute.orgUrban South Brewery www.urbansouthbrewery.com

Send us a textResponse to Inhaled Nitric Oxide and Mortality Among Very Preterm Neonates With Pulmonary Hypertension.Baczynski M, Weisz D, Thomas L, Fevrier S, Castaldo M, Soraisham A, Hyderi A, Agarushi R, Bhattacharya S, Lalitha R, Sidhu A, Abdul Wahab MG, Altit G, Hébert A, Louis D, Elsayed Y, Mitra S, Deshpande P, Kharrat A, Zhu F, Ting J, Yoon E, Shah PS, Jain A; Canadian Neonatal Network Investigators.JAMA Netw Open. 2025 Feb 3;8(2):e2458843. doi: 10.1001/jamanetworkopen.2024.58843.PMID: 39928335 Free PMC article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textEvaluating decision regret after extremely preterm birth.Belden L, Kaempf J, Mackley A, Kernan-Schloss F, Chen C, Sturtz W, Tomlinson MW, Guillen U.Arch Dis Child Fetal Neonatal Ed. 2025 Feb 21;110(2):191-199. doi: 10.1136/archdischild-2024-327287.PMID: 39164062As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textShort Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants.Chawla S, Wyckoff MH, Lakshminrusimha S, Rysavy MA, Patel RM, Chowdhury D, Das A, Greenberg RG, Natarajan G, Shankaran S, Bell EF, Ambalavanan N, Younge NE, Laptook AR, Pavlek LR, Backes CH, Van Meurs KP, Werner EF, Carlo WA; National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN).JAMA Netw Open. 2025 Feb 3;8(2):e2461312. doi: 10.1001/jamanetworkopen.2024.61312.PMID: 39982720 Free PMC article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textWhole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial.Faix RG, Laptook AR, Shankaran S, Eggleston B, Chowdhury D, Heyne RJ, Das A, Pedroza C, Tyson JE, Wusthoff C, Bonifacio SL, Sánchez PJ, Yoder BA, Laughon MM, Vasil DM, Van Meurs KP, Crawford MM, Higgins RD, Poindexter BB, Colaizy TT, Hamrick SEG, Chalak LF, Ohls RK, Hartley-McAndrew ME, Dysart K, D'Angio CT, Guillet R, Kicklighter SD, Carlo WA, Sokol GM, DeMauro SB, Hibbs AM, Cotten CM, Merhar SL, Bapat RV, Harmon HM, Sewell E, Winter S, Natarajan G, Mosquera R, Hintz SR, Maitre NL, Benninger KL, Peralta-Carcelen M, Hines AC, Duncan AF, Wilson-Costello DE, Trembath A, Malcolm WF, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA Pediatr. 2025 Feb 24:e246613. doi: 10.1001/jamapediatrics.2024.6613. Online ahead of print.PMID: 39992674As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

This week Bobbi Conner talks with MUSC's Dr. Christopher Goodier about reducing risk of pre-term birth.

On New York University Week:  Reducing the rising rate of preterm births is an important goal for the future. Laura Jelliffe-Pawlowski, professor of epidemiology and precision health at the Rory Meyers College of Nursing, looks into the data to find solutions. Dr. Laura Jelliffe-Pawlowski is a Professor of Epidemiology and Precision Health at NYU Rory […]

Today on the podcast, Radical Birth Keeper School graduate, Eveliina shares her three unique birth stories. At 30 weeks with her second child, Eveliina experienced bleeding and was coerced into an “emergency” c-section, leaving her with a painful vertical incision. The death of her daughter woke up Eveliina's inner mother lion. With Eveliina's third pregnancy, she had a wild pregnancy and freebirthed her beautiful healthy third daughter at home with her family in Finland.Follow Eveliina on Instagram @vapaasynnytyssuomi✨Doors to the Radical Birth Keeper School are OPEN! - The groundbreaking program for women embarking on the path of sovereign birth-work. https://www.freebirthsociety.com/radicalbirthkeeperschool✨ Matriarch Rising Festival tickets are now LIVE! Join us for our annual women's gathering -  https://www.matriarchrisingfestival.com/✨The FBS private membership community, “The Lighthouse” is the most epic space for conscious women! - Get on the waitlist for when doors open next! - https://www.freebirthsociety.com/membership✨Connect with Free Birth Society on Instagram at - https://www.instagram.com/freebirthsociety✨Check out our best-selling course, The Complete Guide to Freebirth - https://www.freebirthsocietycourses.com/cgtf✨ Join the waitlist for the MatriBirth Midwifery Institute - https://www.freebirthsociety.com/mmiwaitlist✨Get our FREE Freebirth starter kit here! - https://www.freebirthsociety.com/start-here✨Are you a sovereign birth professional? Get listed on the MatriBirth Directory here - https://Matribirthdirectory.com✨Join the MatriBirth Directory and connect with sovereign birth professionals near you! -  https://matribirthdirectory.com/✨ Get on the waitlist for REIGN ~ Emilee Saldaya's action-oriented coaching container that is guaranteed to elevate you into your next phase of life for 2025 - https://www.freebirthsociety.com/reign✨Donate to the podcast - https://www.paypal.com/donate/?hosted_button_id=2YJBSCNYXT52Y✨Subscribe to our Youtube channel - https://www.youtube.com/@FreeBirthSociety✨Learn about everything we do at  - https://www.freebirthsociety.com~~~~~This episode is brought to you by MASA Chips. MASA is part of a growing movement to bring back real food. The kind of food our grandparents ate before Big Food got involved. MASA chips are just three simple ingredients: organic corn, salt, and beef tallow. No seed oils, no fillers, no ultra-processed garbage.When you snack, snack on something real! Go to https://masachips.com/discount/FREEBIRTHSOCIETY and use code FREEBIRTHSOCIETY for 20% off your first order!~~~~~When you need guidance from someone you can truly trust, someone who aligns with your values on sovereignty and natural living, look no further than Dr. Jennifer Tice, ND - Naturopathic Pediatrician + Homeopathic Expert

Send us a textIn this episode, I had the pleasure of speaking with Dr Ilana Levene, who is now a Neonatology subspeciality trainee at Oxford, England. Ilana has done some fantastic work on exploring the important topic of human milk expression. She described her randomized control trial in using relaxing techniques to facilitate human milk expression in the NICU. She shared the challenges that she had in conducting her RCT. We also talked about RCTs with negative results and how negative results are also important in conducting research. Ilana has now created a website with printables for parents and staff in the NICU on human milk expression. This can be assessed for free here : http://www.hifn.org/printable . Ilana also shared her interest in perinatal equity and shared details on her project Spectrum which involves gathering photos of the lactating breast conditions/chest from people with a wide spectrum of skincolours. These will be provided as a free educational image library. Currently she is chairing a priority setting partnership for LGBTQIA+ perinatal care. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Dr. Phillip Bennett, a co-director of the March of Dimes Prematurity Research Center at Imperial College London, discusses a historic randomized controlled trial (RCT) that will test a vaginal probiotic's ability to reduce preterm birth risk.

There is a lot doctors and scientists still don't fully understand about what includes labour, both pre and at term. But we do know that there are treatments that can reduce your chance of having a preterm birth, especially if you have had one in the past. Preterm birth can be especially traumatic for those living in remote communities which is why in our guests on today's podcast, Drs. Kirsten Duckitt and Jennifer Kask, developed a prevention of preterm birth pathway in Northern Vancouver Island that is spreading to other remote communities. They share with us a moving story of a pregnant individual from a remote community who had her baby in their hospital, and break down the definitions and rates of preterm birth, risks to mama and baby, and how they can be decreased. Listen to our podcast on Being a NICU parent! Taking you from anxious and overwhelmed to confident during your childbirth experience: Pregnancy to Parenthood Online Prenatal Masterclass. *This episode is a re-release. Original release date: November 3, 2021.

Send us a textSimilarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry.Wehrle FM, Bartal T, Adams M, Bassler D, Hagmann CF, Kretschmar O, Natalucci G, Latal B.J Pediatr. 2022 Nov;250:29-37.e1. doi: 10.1016/j.jpeds.2022.05.047. Epub 2022 Jun 2.PMID: 35660491 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textDouble Jeopardy: A Distinct Mortality Pattern Among Preterm Infants with Congenital Heart Disease.Higgins BV, Levy PT, Ball MK, Kim M, Peyvandi S, Steurer MA.Pediatr Cardiol. 2025 Apr;46(4):939-946. doi: 10.1007/s00246-024-03519-4. Epub 2024 Jun 12.PMID: 38864860 Free PMC article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textParental and Medical Classification of Neurodevelopment in Children Born Preterm.Richter LL, Janvier A, Pearce R, Bourque CJ, Church PT, Luu TM, Synnes A.Pediatrics. 2025 Feb 1;155(2):e2024066148. doi: 10.1542/peds.2024-066148.PMID: 39786567As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this Complex Care Journal Club podcast episode, Ms. Pearce and Dr. Synnes discuss a series of patient-oriented research studies aimed at partnering with parents in reimagining meaningful outcomes for premature infants. They describe the inclusion of parents on the study team, recruitment of parent participants, lessons and challenges while conducting the study, messages for other researchers and parents, and the next steps from this work. SPEAKERS Rebecca Pearce, B. Ed, MSc Vice Principal Villa Maria High School Parent Partner CHU Sainte-Justine and Canadian Premature Babies Foundation‌ Anne Synnes, MDCM, MHSc Clinical Professor, Neonatologist University of British Columbia British Columbia's Women's Hospital and British Columbia's Children's Hospital Research Institute HOST Kilby Mann, MD Assistant Professor Pediatric Rehabilitation Medicine Children's Hospital Colorado DATE Initial publication date: February 10, 2025. ARTICLES REFERENCED Pearce R, Synnes A, Lam MM, Richter LL, Bacchini F, Jones M, Luu TM, Janvier A; PARENTS' VOICE NETWORK. Partnering With Parents to Change Measurement and Reporting of Preterm Birth Outcomes. Pediatrics. 2024 Nov 1;154(5):e2024067093. doi: 10.1542/peds.2024-067093. PMID: 39354888. Haslam MD, Lisonkova S, Creighton D, Church P, Yang J, Shah PS, Joseph KS, Synnes A; Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network. Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort. J Pediatr. 2018 Jun;197:75-81.e4. doi: 10.1016/j.jpeds.2017.12.020. Epub 2018 Feb 3. PMID: 29398054. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/p65m4p98gppf65mz3zhmm9g/February_Pearce_and_Synnes_ccjcp_final_revisions‌ Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Pearce R, Synnes A, Mann K. Focus on Abilities: Parent-Identified Outcomes of Preterm Infants. 2/2025. OPENPediatrics. Online Podcast: https://soundcloud.com/openpediatrics/focus-on-abilities-parent-identified-outcomes-of-preterm-infants

Welcome to ohmTown. The Non Sequitur News Show is held live via Twitch and Youtube every day. We, Mayor Watt and the AI that runs ohmTown, cover a selection of aggregated news articles and discuss them briefly with a perspective merging business, technology, and society. You can visit https://www.youtube.com/ohmtown for the complete history since 2022.Articles Discussed:Cats learn to associate faster than babies.https://www.ohmtown.com/groups/nonsequiturnews/f/d/cats-learn-to-associate-images-with-words-faster-than-babies/Microplastics in Preterm placenta.https://www.ohmtown.com/groups/technologytoday/f/d/the-hidden-threat-in-the-womb-microplastics-found-in-preterm-placentas/Recreating DeepSeeks OpenAI Killerhttps://www.ohmtown.com/groups/nonsequiturnews/f/d/team-says-theyve-recreated-deepseeks-openai-killer-for-literally-30/Nobody really knows AI, apparently.https://www.ohmtown.com/groups/nonsequiturnews/f/d/if-you-think-anyone-in-the-ai-industry-has-any-idea-what-theyre-doing-it-appears-that-deepseek-just-accidentally-leaked-its-users-chats/More snow in Hawaii than NYC.https://www.ohmtown.com/groups/nonsequiturnews/f/d/hawaii-could-get-more-snow-than-new-york-city-has-had-this-year/The Art of Firing People by EA.https://www.ohmtown.com/groups/mobble/f/d/ea-apparently-thinks-theres-an-art-to-firing-people/Summer Game Fest 2025https://www.ohmtown.com/groups/technologytoday/f/d/summer-game-fest-returns-to-the-youtube-theater-on-june-6/Something is Wiping out Sea Urchinshttps://www.ohmtown.com/groups/technologytoday/f/d/an-extremely-violent-global-pandemic-mysterious-disease-wipes-out-sea-urchins-worldwide/Driven to Prisonhttps://www.ohmtown.com/groups/mobble/f/d/2-jailed-for-posing-as-learner-drivers-to-sit-theory-test/Decode this Ancient Script

Breastfeeding twins can be challenging, especially when the babies are late preterm. What are some of the ways these babies behave differently? What should you know before attempting to tandem nurse? Plus, some great advice for managing triple feedings: breastfeeding, supplementation and pumping. Learn more about your ad choices. Visit megaphone.fm/adchoices

HeHe welcomes Zhenya Lindgardt, President and CEO of Sera Prognostics, to discuss the critical issue of preterm birth, its rising incidence in the U.S., and innovative solutions available today. Zhenya explains the definition and statistics of preterm birth, and introduces the Preterm test, a blood test that predicts the risk of preterm birth as early as 18 weeks of gestation. The conversation also covers the effectiveness of Sera Prognostics' intervention bundles, improvements in pregnancy care, and the importance of innovation in maternal health. Listeners will learn about the accessibility and process of the Preterm test and the overall goal of making this technology widely available to improve maternal and neonatal outcomes.   Understanding Preterm Birth Advancements in Preterm Birth Testing Interventions for High-Risk Pregnancies Clinical Trials and Results At-Home Testing and Accessibility Innovation in Maternal Health Guest Bio: Zhenya Lindgardt is an accomplished leader in healthcare innovation, currently serving as the President, CEO, and Board Director of Sera Prognostics, Inc. and CEO of The Commons Project Foundation. As the leader of Sera, Zhenya is revolutionizing the maternal and infant health space by addressing the preterm birth crisis with cutting-edge science. With a rich background including senior roles at Uber Technologies and a 19-year tenure at Boston Consulting Group, she has demonstrated expertise in driving growth and fostering innovation. Her contributions span multiple therapeutic areas and focus on leveraging data to improve patient outcomes and reduce healthcare costs. INSTAGRAM: Connect with HeHe on IG  Connect with HeHe on YouTube   https://www.facebook.com/serapregnancy https://www.instagram.com/serathepregnancycompany?igsh=NTc4MTIwNjQ2YQ== https://www.linkedin.com/company/sera-prognostics BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: Websites: Sera | The Pregnancy Company PreTRM® Premature Birth Risk Blood Test from Sera March of Dimes Report Card CDC NYU article about racial disparities in pre-term birth rates What is causing the rise in pre-term birth?   Diagnostics: AVERT Trial Press Release: Sera PreTRM® Test Prevention Strategy Demonstrates 18% Reduction in Severe Neonatal Morbidity and Mortality in Newly Published AVERT Trial | Sera   AVERT Trial Data: https://www.mdpi.com/2075-4418/14/14/1462

Understanding Amniotic Fluid: What's Normal and What's Not Amniotic fluid is the protective liquid contained within the amniotic sac that surrounds a baby during pregnancy. This vital fluid plays a critical role in fetal development, providing cushioning, regulating temperature, and enabling the baby to move and grow within the uterus. It also facilitates the development of essential systems like the lungs, digestive tract, and musculoskeletal system. What Is Amniotic Fluid Made Of? Amniotic fluid begins to form around the 12th day of pregnancy and is initially composed of water from the mother. As the pregnancy progresses, it includes fetal urine, nutrients, hormones, and antibodies, creating a nutrient-rich environment for the growing baby. What's Normal? The amount of amniotic fluid changes throughout pregnancy, peaking around 34 weeks and then gradually decreasing. Here's what's considered normal: Volume: Typically, the amount of amniotic fluid ranges from 500 to 1,000 milliliters at term. Clear or Slightly Tinted Fluid: Normal amniotic fluid is clear or slightly yellow-tinted. Healthy Fetal Movement: Adequate fluid allows the baby to move freely, which promotes muscle and bone development. Doctors assess amniotic fluid levels using ultrasound and measure the Amniotic Fluid Index (AFI) or the Deepest Vertical Pocket (DVP) to ensure levels are within a healthy range. What's Not Normal? Abnormalities in amniotic fluid levels can indicate potential complications: Low Amniotic Fluid (Oligohydramnios): This condition occurs when fluid levels are too low and can lead to: Restricted fetal growth. Increased risk of umbilical cord compression. Complications during labor, such as reduced cushioning for the baby. Excess Amniotic Fluid (Polyhydramnios): Excess fluid can result from issues such as gestational diabetes, fetal anomalies, or infections. It may cause: Preterm labor. Difficulty breathing for the mother due to uterine overdistension. Increased risk of placental abruption or cord prolapse. Discolored Fluid: Green or Brown (Meconium-Stained Fluid): This indicates that the baby has passed its first stool in utero, which could signal fetal distress. Bloody Fluid: This may suggest complications like placental abruption or injury. Monitoring Amniotic Fluid Routine prenatal care includes monitoring amniotic fluid levels. If abnormalities are detected, your healthcare provider may recommend additional tests, interventions, or close monitoring to ensure the safety of both mother and baby.   Your feedback is essential to us! We would love to hear from you. Please consider leaving us a review on your podcast platform or sending us an email at info@maternalresources.org. Your input helps us tailor our content to better serve the needs of our listeners. For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources Instagram: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB Thank you for being part of our community, and until next time, let's continue to support, uplift, and celebrate the incredible journey of working moms and parenthood. Together, we can create a more equitable and nurturing world for all

Preterm infants, especially those born at periviability, are at inherent risk of a variety of short-term neonatal complications- depending on their gestational age- including sepsis, respiratory distress, IVH, and have an overall higher mortality compared to term born infants. Well known interventions are intended to reduce these complications; these include antenatal corticosteroids, magnesium sulfate for CNS protection, and antibiotics for latency in PPROM. This is an even bigger issue for those born in the periviable interval. That group is a unique population. But does mode of delivery matter? Cesarean delivery is currently not recommended before 25 weeks' gestation unless for maternal indications, even in the setting of malpresentation. We'll cover recently stated guideline in this episode. These recommendations are based on a lack of evidence of improved neonatal outcomes and survival following cesarean delivery and the maternal risks associated with cesarean delivery at this early gestational age. Plus, for non-vertex presenting fetuses, C-section has been reported to reduce risk of neonatal mortality, but what about vertex presenting preterm/periviable babies? In this episode, we will review the mode of delivery and neonatal outcomes in preterm birth with a special focus on those born in the periviable interval, like 22- and 23-weeks gestation. There's lots to cover here…so listen in for details.

Oscar-winning Michelle Yeoh's career has spanned four decades. Starting out as a martial arts actor, she became a key figure in the Hong Kong action scene. But it was her role in James Bond film Tomorrow Never Dies that catapulted her into Hollywood. She's since starred in many hits including Crouching Tiger, Hidden Dragon and the multi-Oscar winning movie - including for her own performance - Everything Everywhere all At Once. Now, she's in the film adaptation of the musical Wicked. She joined Nuala McGovern live in the studio to discuss it.We look back at a special programme, that came live from the Radio Theatre in Broadcasting House in London, looking at the support for children with Special Educational Needs and Disabilities – or SEND as it's often known in England. Nuala heard from guest panellists including Kellie Bright, an actress in EastEnders but also a mum to a child with SEND, Katie, who is 17 and says she was completely failed by the SEND system, and the Minister for School Standards, Catherine McKinnell.On 22 September 1994, the American TV show Friends premiered on NBC and the characters Monica, Rachel, Phoebe, Joey, Chandler and Ross became household names. To celebrate its 30th anniversary, Anita spoke to one of the show's writers and producers, Betsy Borns and the journalist Emma Loffhagen about why the show still resonates today.We hear from listener Siobhan Daniels. She wrote to us on Instagram: 'I would love you to talk about van life and an alternative way of living.' Siobhan is 65 years old and after selling her home and possessions has lived in her motorhome for the last five years. Preterm birth is the leading cause of neonatal deaths in the UK. Last month the House of Lords Preterm Birth Committee published a report calling on the government to do more to reduce the risks of babies being born prematurely and to improve the lives of those families who are affected. Anita discussed the proposed changes with Nadia Leake, who gave birth to twins eleven years ago at just 22 weeks and is the author of 'Surviving Prematurity,'Corinne Bailey Rae's latest album is a complete departure from her previous work. Black Rainbows is inspired by a trip to Stony Island Arts Bank, a Chicago-based archive of black art and culture. The record spans punk, rock, experimental jazz, electronica and more. She joined Anita for a very special performance live from the Woman's Hour Glastonbury picnic table back in the summer.Presenter: Anita Rani Producer: Annette Wells Editor: Emma Pearce

Is that your water breaking or did you just pee yourself (again?) At this stage of pregnancy, it's important to learn the signs of pre-term labor in case that baby wants to make an early appearance! Sarah chats symptoms to look out for and some tell-tale signs birth is near, PLUS baby's development, tips for the week, and a to-do list to help keep us all on track Want more from Sarah? Personal Instagram: @SarahMerrill_Hall Share some Laughs: @bigkidproblems Check out the NEW IG @bottleserviceBKP Shop Sarah's Pregnancy/ Postpartum Must Haves on Amazon Shop Bottle Service MERCH!  Big Thank You to our Episode Sponsors! MANSCAPED - Get 20% off + free shipping with the code bottleservice at Manscaped.com Green Chef - The #1 Meal Kit for Clean Eating. Go to greenchef.com/bottleservice50 and use code bottleservice50 for 50% off your first box plus 20% off your next two months! Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textIn this episode, Ben and Daphna sit down with Dr. Dieter Wolke, professor of developmental psychology at the University of Warwick, to discuss life course outcomes for very preterm, very low birth weight infants. Dr. Wolke explores the concept of life tasks, emphasizing milestones like independence, social integration, and relationships. He highlights the long-term impacts of neonatal experiences, the role of overprotective parenting, and the need for individualized support across the life span. This insightful conversation challenges traditional labels and advocates for a nuanced approach to fostering well-being and resilience in preterm children.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textIn this episode, Ben and Daphna sit down with Dr. Cindy McEvoy, professor of pediatrics and director of neonatal research at Oregon Health & Science University, to discuss optimizing lung development in preterm infants. Dr. McEvoy shares insights from her research on the benefits of prolonged CPAP use in preterm infants, showing how it supports lung growth, improves alveolar volume, and enhances pulmonary function. She emphasizes the importance of education and proper CPAP application to maximize benefits while debunking myths about weaning protocols. This conversation highlights the potential of targeted respiratory strategies to improve long-term outcomes.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this heartfelt and eye-opening episode of the Empowering NICU Parents Podcast, host Nicole Nyberg dives deep into the profound and often unspoken challenges of prematurity. From the critical moments in the NICU to the lasting physical, emotional, and developmental impacts on children and their families, this episode sheds light on the full scope of the prematurity journey.Discover how preterm birth affects every organ system, why the NICU environment plays such a pivotal role, and how parents can navigate the long-term outcomes with knowledge and confidence. Nicole also shares her personal experience as a mom of a micropreemie, offering insight, support, and a reminder that no family is alone in this journey.Whether you're a NICU parent, healthcare provider, or someone wanting to better understand preterm birth and its impact, this episode is packed with essential information, actionable advice, and heartfelt encouragement. Tune in, be inspired, and join the movement to raise awareness and empower families navigating life beyond the NICU!Dr. Brown's Medical: https://www.drbrownsmedical.comOur NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/ NICU Mama Hats: https://empoweringnicuparents.com/hats/ NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/ Newborn Holiday Cards: https://empoweringnicuparents.com/shop/ Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/ Episode 64 Show Notes: https://empoweringnicuparents.com/episode64 Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/ Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents Pinterest Page: https://pin.it/36MJjmH

In this episode, Dr. Jamie Lo welcomes Dr. Sarah Osmundson to discuss SMFM Consult #71, focusing on the management of previable and periviable preterm prelabor rupture of membranes (PPROM). Together, they delve into key considerations for patient counseling, the challenges of defining viability across different institutions and regions, and the maternal and neonatal outcomes linked to various management strategies. Dr. Osmundson highlights the critical role of informed consent, the need to align care with patient values, and opportunities to address gaps in research through collaborative efforts. This episode unpacks the complexities of managing PPROM and provides valuable insights for maternal-fetal medicine providers navigating these nuanced and sensitive conversations. Click here for the full episode transcript.  Additional Resources -         SMFM Consult Series #71 -         SMFM Clinical Webinar Series: Management of Previable and Periviable Preterm Prelabor Rupture of Membranes -         Maternal morbidity after preterm premature rupture of membranes at

In the United States, more than 400,000 babies are born prematurely each year, which is about 1 in 10 babies. Over the last several decades, multiple studies have shown a link between poor oral health and increased occurrence of preterm birth. Researchers have looked at various ways to improve dental health during pregnancy, including doing a “deep-teeth cleaning” (also called ‘scaling and planing'), which involves removing plaque and tarter on the teeth and below the gum line. However, despite improving periodontitis, deep teeth cleaning approaches have not proven to be effective in the prevention of preterm birth. But now new data has discovered an easy and inexpensive way to improve oral health and potentially reduce preterm births. This data was originally presented at the annual Pregnancy meeting at SMFM, but now it is a peer reviewed publication. In this episode, we will review how chewing xylitol gum has promising results for preterm birth reduction. Nonetheless, some important limitations must be reviewed. Listen In for details.

I'm pleased to welcome you to this podcast for a crucial topic in the care of preterm babies: the use of surfactant therapy guided by tests of their lung function. Practice is evolving in this area, and we're here to discuss the latest evidence. Three guests are joining me today, Greta Sibrecht and Franek Borys, authors of the October 2023 Cochrane review, and, later, Anna Lavizzari, lead investigator for one of the ongoing studies.

I'm pleased to welcome you to this podcast for a crucial topic in the care of preterm babies: the use of surfactant therapy guided by tests of their lung function. Practice is evolving in this area, and we're here to discuss the latest evidence. Three guests are joining me today, Greta Sibrecht and Franek Borys, authors of the October 2023 Cochrane review, and, later, Anna Lavizzari, lead investigator for one of the ongoing studies.

Dr. Sam Mesiano, an investigator at the March of Dimes Ohio Collaborative Prematurity Research Center, discusses the enzyme that leads to progesterone withdrawal and labor in cases of infection-related preterm birth - and how this enzyme discovery can be used to revive progesterone therapy to delay or stop preterm birth.

A new Woman's Hour series, Forgotten Children, explores the impact on families when one or both parents are sent to prison. Reporter Jo Morris hears from Kerry Wright, who was just 17 and living in Spain with her parents when British police arrived at their door and arrested both of them, from Nan (not her real name), whose daughter received a prison sentence, leaving Nan to care for her five grandchildren and to Emily (not her real name), whose husband was sentenced to prison for domestic abuse. Nuala McGovern also spoke to Sarah Burrows, founder of Children Heard and Seen, a charity supporting children and families with parents or partners serving prison sentences, and Lucy Baldwin who is a research fellow at Durham University and a criminal justice consultant.As a new musical adaptation of The Devil Wears Prada, with lyrics contributed by the American musician Shaina Taub and music by Elton John, hits London's West End, Anita Rani was joined by the show's leading ladies, Vanessa Williams, Georgie Buckland and Amy Di Bartolomeo to discuss the enduring appeal of this story.Nuala spoke to TV presenter and author Giovanna Fletcher from the Himalayas at the start of her trek to raise money and awareness for CoppaFeel! the breast cancer charity.Preterm birth is the leading cause of neonatal death in the UK. Today the House of Lords Preterm Birth Committee have published a report calling on the government to do more to reduce the risks of babies being born prematurely and to improve the lives of those families who are affected. Anita discusses proposed changes with Nadia Leake, who gave birth to twins eleven years ago at just 22 weeks and is the author of 'Surviving Prematurity,' Evelyn Forde was the first black female president of the Association of School and College Leaders, awarded an MBE for services to education, and named Times Educational Supplement Headteacher of the Year in 2020. In her book Herstory: A Leadership Manifesto, Evelyn shares her journey through the education system, her experiences of racism in her career, alongside the testimonies of other black leaders in the sector. With just 1% of headteachers in state schools in England from a black background, she joined Nuala to discuss why she thinks urgent action is needed to address the issue in education. A new musical – Mozart: Her Story - tells the story of Wolfgang Amadeus Mozart's sister Maria-Anna, who taught him how to play the piano. Nuala is joined by the lyricist, Tegan Summer, and actor, Gabrielle Brooks who gives a performance from the new show.Presenter: Anita Rani Producer: Annette Wells Editor: Rebecca Myatt

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from November 9-15, 2024.

Preterm birth is the leading cause of neonatal death in the UK. Today the House of Lords Preterm Birth Committee have published a report calling on the government to do more to reduce the risks of babies being born prematurely and to improve the lives of those families who are affected. Anita Rani discusses proposed changes with Nadia Leake, who gave birth to twins eleven years ago at just 22 weeks and author of 'Surviving Prematurity,' Caroline Lee-Davey, CEO of the charity Bliss, which supports parents and families of premature or sick babies, and Baroness Laura Wyld, a member of the Preterm Birth Committee.A Georgian heiress and her husband are suing a property developer for over £36 million after buying a mansion and discovering a “moth infestation”… “of extreme proportions”. The couple describe killing up to 100 moths a day, watching them land on their children's toothbrushes, plates of food and cutlery. And they are now seeking damages including £50,000 for moth-shredded clothes. The property developer denies all claims. Well, it's that time of year where you may be getting your winter woollies out and we wondered what's the best way to deal with such an occurrence? Anita is joined by Harriet Walker, Fashion Editor at The Times, who has been having her own nightmare experience with moths.In the next instalment of Woman's Hour's week-long series Forgotten Children, which looks at the impact on families when one or both parents serve time in prison, reporter Jo Morris speaks to Emily (not her real name), whose husband was sentenced to prison for crimes he committed against her. Emily discovered that, not only did she have to face the stigma of her children's father being in prison, but as a single-parent she also struggled to access services to help her children cope with their father's imprisonment. As a new musical adaptation of The Devil Wears Prada, with lyrics contributed by the American musician Shaina Taub and music by Elton John, hits London's West End, Anita is joined by the show's leading ladies, Vanessa Williams, Georgie Buckland and Amy Di Bartolomeo to discuss the enduring appeal of this story. Presenter: Anita Rani Producer: Rebecca Myatt

Preterm birth is the greatest cause of neonatal mortality and morbidity, with infants born extremely preterm at highest risk. Author Brett J. Manley, PhD, the Royal Women's Hospital, Melbourne, Australia, discusses a new study of the effect of intratracheal corticosteroid administration on survival free of bronchopulmonary dysplasia in preterm infants, with JAMA Deputy Editor Tracy A. Lieu, MD, MPH. Related Content: Intratracheal Budesonide Mixed With Surfactant for Extremely Preterm Infants

I'm honored to share a replay of my guest appearance on Mary Coughlin's Care Outloud Podcast.Together, we dive deep into the personal and professional impact of my journey as a NICU parent after the premature birth of my son William at 23 weeks. We explore how that experience transformed my life, inspiring my dedication to family-centered care, trauma-informed care, and mental health support for NICU families.Throughout our heartfelt conversation, I also discuss my work as a Neonatal Nurse Practitioner and Clinical Product Specialist at AngelEye Health, as well as how I created Empowering NICU Parents to provide resources and support to families during their NICU journey.It was an incredible honor to join Mary, someone I have admired for so long. Mary's expertise in trauma-informed care, coupled with her compassion and wisdom, made this conversation truly special.Tune in to hear more about our shared passion for improving neonatal care and the importance of connection and support for NICU families.Dr. Brown's Medical: https://www.drbrownsmedical.comOur NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/ NICU Mama Hats: https://empoweringnicuparents.com/hats/ NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/ Newborn Holiday Cards: https://empoweringnicuparents.com/shop/  Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/ Episode 63 Show Notes: https://empoweringnicuparents.com/episode63Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/ Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents Pinterest Page: https://pin.it/36MJjmH

Send us a textFetal haemoglobin and oxygen requirement in preterm infants: an observational study.Ulinder T, Hellström W, Gadsbøll C, Nilsson L, Gebka M, Robertz G, Bruschettini M, Hellstrom A, Ley D.Arch Dis Child Fetal Neonatal Ed. 2024 Sep 25:fetalneonatal-2024-327411. doi: 10.1136/archdischild-2024-327411. Online ahead of print.PMID: 39322316As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textTeleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.Gentle SJ, Trulove SG, Rockwell N, Rutledge C, Gaither S, Norwood C, Wallace E, Carlo WA, Tofil NM.Pediatr Res. 2024 Sep 28. doi: 10.1038/s41390-024-03545-1. Online ahead of print.PMID: 39341942As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Want to send us a message? Fan mail? Thoughts on the episode?In this episode, Katie takes Rachel behind the scenes for an in-depth exploration of donor milk—an intriguing topic that might just challenge everything you thought you knew about this practice.                                                    I have to caveat that some of the information in this episode is possibly going to get your knickers in a twist though – do we have any episode that don't?!We'll be discussing:  The history of milk banking  Are we seeing different health outcomes when using donor milk compared to a mother's own milk?Are there differences between donor and mothers milk that we should know aboutWhat about informal, unpasteurised, milk sharing? Is this also happening in the hospital settings as well? And have you ever heard the term “milk sibling” before? I'll also dive into whether we need to rethink our approach to milk when caring for vulnerable infants. Plus, Rachel asks me about the future of milk banking—where is this practice headed?LINKS:Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants Early postpartum pumping behaviorsSupplementation of Mother's Own Milk with Preterm Donor MilkMaternal production of milkProactive Lactation Care Economic benefits and costs of human milk feedingsThe institutional cost of acquiring 100 mL of human milkWant to listen to the new podcast 'The Feeding Couch'? Find it here or on all good podcast hosting platforms! Get 10% off Katie's Breastfeeding & Lactation: the fundamentals online course today with code POD10 at checkout. Support the show Please support the show via Patreon or BuyMeACoffee MERCH here! Music Joseph McDade Like this podcast? Leave us a review here Want more from Katie and Rachel? Katie's website Rachel's website DisclaimerThe information provided on this podcast does not, and is not intended to, constitute medical or legal advice; instead, all information available on this site are for general informational purposes only. The Midwives' Cauldron podcast reserves the right to supplement, change or delete any information at any time.The information and materials on the podcast is provided "as is"; no representations are made that the content is error-free. Whilst we have tried to ensure the accuracy and completeness of the information we do not warrant or guarantee the accurateness. The podcast accepts no liability for any loss or damage howsoever arising out of the use or reliance on the content.

Send us a textPaediatric intensive care admissions of preterm children born

Send us a textDon't wait, vaccinate: evaluation of routine vaccination administration and reactogenicity in preterm infants.Abdelmessih E, Desai PV, Tracy J, Papadopoulos J, Bashqoy F.J Perinatol. 2024 Sep 10. doi: 10.1038/s41372-024-02111-1. Online ahead of print.PMID: 39256613As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

We have received so many messages and emails from you requesting more VBAMC stories and today, we are giving you just that. Susana joins us from Mexico sharing her VBAC story after five Cesareans!Each of Susana's Cesarean experiences was unique in their own way, but the dream of a vaginal birth never left her heart. When she found a supportive midwife and doctor during her VBA5C pregnancy, Susana knew this was her chance to finally achieve that goal. With her husband by her side encouraging and supporting her, Susana powerfully pushed her baby out. The hospital staff and community buzzed with shock and amazement over what she had achieved!“That moment was unlike any other moment in my life.”ACOG Article: Dr. Angelica GloverEvidence-Based Birth: The Evidence on VBACNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Women of Strength, this is the moment so many of you have been waiting for. We have a VBA5C so for anyone who doesn't know what that means, it is a VBAC after 5 Cesarean story for you today. This has been requested so much. We received emails in our personal email. We have gotten it on social media saying, “Please, can we get some stories that have VBAC after more than 3 Cesareans?” We know so many people out there don't know that this is an option or they know it's an option but they don't find the support or they can't find the support. They are few and far between but we have our friend Susana today who is going to be sharing her VBA5C story. Welcome, Susana. How are you?Susana: Hi. Thank you so much for inviting me. I'm so excited. Meagan: Oh my gosh. I am so excited. Yes. I am so excited and you are in Mexico, correct? Is that where your VBAC was? Susana: I'm sorry? Meagan: Was your VBAC in Mexico?Susana: Yeah, but it was a very, very hard way. I'm going to share what I did. First of all, I can't separate this way from my faith because I prayed so much for this and I trusted so much and also, I trusted so much in the process and in the body and those things But okay, I'm going to tell you what happened with me and why I had five C-sections. First of all, I got pregnant in 2009. My pregnancy went very healthily with no problems at all. I was 41+5 weeks and I had a doctor who was– well, he said he was for natural birth. I don't know how to say it. He was pro-birth. Meagan: Yeah, that he's pro. He's supportive. Susana: Supportive. Yeah, that's the word. But in reality, he was more C-section-supportive. While we were passing a very difficult part of our life because my father-in-law passed away exactly on my due date. We were very emotional and very sensitive. Labor wasn't starting so the doctor said, “No, baby is not engaged. You are only 3 centimeters. I can say that baby is not going to birth naturally. I say that it is better for you to go directly to the C-section.” I was disappointed because I was walking so much every day, but for the situation for my husband and all of the family, I accepted. We went to the C-section. I got pregnant again in 2010 8 months later and I was very excited to now get a VBAC. The doctor said he wasn't going to support me but in the end, I had a TOLAC, a trial. I was progressing well. I was 5 centimeters when I went to the hospital and the doctor was a little bit nervous because the C-section that I had before was one year and five months before so he was like, “You have to be fast because we have the risk of uterine rupture.” He started to make an impression on me and I was starting to be stressed. After 5 hours I think, he said, “Baby is not getting down. You are still at 5 and we are going to the C-section again.” I cried a lot and my husband said, “We tried and we can't do this anymore. It can be dangerous. Go to the C-section.” It was very traumatic because they put in the epidural and it only worked in half of my body. I started to scream, “No, please. No. I can feel everything.” They put the epidural in again. It was difficult. Then I got pregnant again in 2012 but I didn't fight anymore. I decided for a repeat C-section. The good part is that it was peaceful because I was accepting the situation. Everything went well. Then I got pregnant in 2013. Also, we were going to opt for a C-section because I didn't have any other chance but the doctor started saying, “No more babies. Four C-sections is a thing,” and things like that but my husband and I were talking about it and we thought that it wasn't an option for us to have– I don't remember the word. Tying the tubes. Meagan: Oh yeah, a tubal. Susana: Yes. The sterilization. So we went to a repeat C-section. It wasn't as smooth as the one before because my baby was 37.5 weeks so we had a little problem with maturity. Is that the word? She was very small. Meagan: She was technically preterm. Susana: Yeah. Preterm. She showed signs of preterm. She was whimpering and something like that. We had to go to the neurospecialist. Everything was going well and there was no problem at all, but we were careful for another pregnancy. We waited a lot and we got pregnant again in 2017. I spent the half of my pregnancy with the same doctor, but at half of the pregnancy when I was 20 weeks, some friend told me, “Oh, you know what? There is a mom in Brazil who had a VBAC after four C-sections.” I was like, “What?” I didn't know that existed. I started to inform myself and I found a supportive midwife but she said, “We aren't going to chance it to go to the hospital. We have to have the birth in your house.” We prepared everything for the home birth and the bad thing is that I was anxious at 39 weeks and had prodromal labor. I passed the due date. I was 41 and 42 and then 42.5 weeks so stress started to play a role here. I started labor but I passed three days in labor so that was really, really hard. I passed two days at 5 centimeters dilation. Then my midwife said, “I don't know what has happened. I think we can't wait anymore. You have to go to the hospital. Baby is good.” The heart rate was optimal but I didn't know what to do anymore. We went to the hospital. It was the only public hospital. Oh, the doctors were freaking out like, “What are you doing? Come on. You have to get the C-section 2 weeks before.” I suffered very, very much obstetric violence. It was very traumatic. Baby was very low. I was at 8 centimeters when I got to the hospital. I was begging for them to let me try and let me push but they said, “No. You are crazy. We have to go to the C-section right, right now.” When they pulled baby out, they broke the uterine artery and I lost a lot of blood. I was very weak and it was very painful. That was a disaster. We were like, “No more babies I think”, but by the grace of God, I got pregnant again in 2021. Sadly, I had a miscarriage on Christmas actually. It was very sad. But I don't know. That miscarriage let me know that my body works and that I would be able to have good contractions and my body was able to give birth. I prayed, “God, if you want, I want another baby.” In November of 2022, I got pregnant again and that time, I was totally strong to fight for another try to have a vaginal birth. My husband was totally against the trying. He was so scared. Also, I was a little bit scared, but I was trusting at that time. I was trusting so hard. I was praying so hard. I decided to not go to the doctor because I was so scared of the doctor. I was hesitant. I don't know why I didn't want to hear, “You are in danger. No. This is so dangerous. You can't try. You have to go directly at 38 weeks to the C-section and you have to have a blood transfusion and you are of advanced maternal age,” because I am 41 years old, but I don't know. I said, “I don't want that in my pregnancy.” Actually, I had a friend who had seven C-sections and then had four home births. She was telling me, “No. Trust God. You have to know when they talk from fear and when they talk from the truth.” I could tell that a lot of people were speaking to me from the fear they felt, not from the truth. I stayed with that doctor until 28 weeks. I found a doctor who wasn't judging me and who was open but he didn't have experience with VBAC after multiple C-sections so he said, “I can check you and support you but not in the birth. I can't do that. I have no experience.” Well, for me, it was like, “Oh, I'm at the beginning of the way.” Okay, so I kept praying and when I was 34 or 35 weeks in the pregnancy, I had a doula who gave me a contact of a midwife that she was supporting VBAC after three C-sections in a hospital with a doctor. I said, “Maybe there's a chance for me.” I contacted her. I talked to her and she was very optimistic. She said, “Yeah. Of course. I can support you. We can prepare a home birth. I can support you. I can be your attendant.” I don't know the word. Meagan: Maybe advocate? Susana: Not advocate. I mean, she was the one who received the baby. Meagan: Oh, like catching. Yeah, attending. Susana: Yeah, attending the birth. But my husband was like, “No, not a chance.” Because for my husband and also for me, it was very difficult and not secure. We were scared. We thought about what if something happened. That midwife told me, “I can speak with the doctor and maybe we can have a plan.” I said, “Okay.” I was 36 weeks so it could be difficult that he started to attend me in these late weeks. But I still had trust and confidence in God. I kept praying all of the time. One day, she called me and said, “Susana, good news. The doctor said yes. I told him all of the truths. I didn't hide anything and he said, ‘Okay. If you are with me, I can attend this birth. But I need to watch her in the next days.'” So we went to the doctor. The doctor was in another city 40 minutes to an hour away from here. My husband couldn't be with me so my parents went with me. My parents were so scared. Meagan: I bet. Meagan: They were very against trying. My husband wasn't completely confident about it. All of my environment was against the VBAC. When we went to the doctor, the doctor was so supportive and so humane and so good and so kind. He said, “We are going to try. We are going to make our best. We are a good team. The midwife and I work together very good and very successfully but I'm going to keep all of the team here if we need the C-section in the last moment.” We agreed on that. My parents were so relieved. We talked with my husband and he was relieved also but he also had doubts. But in the environment of a hospital and– oh, I don't know the word. The place where they make the C-section? Meagan: The operating room? Susana: Yeah, the operating room. In the side of the room, if everything was good, we trusted. He was supportive for the first time. He said, “Okay.” Two weeks passed after this visit and there was the moment when I started getting excited with things with labor. It was on the 11th of August last year in 2023 when I saw my mucus plug and the bloody show. I said, “Oh. I think things can be starting at any moment.” But in my last experience when I had the bloody show, it was two or three days before the labor really started. I patiently waited and the contractions started to be hardest but there was a half hour in between them. It was very manageable and still manageable. I passed the day with my normal activities. I had lunch with my parents and my five kids. I went to gymnastics class with my daughters and actually at night, we went to mass with friends and families that we know. A friend of ours invited us to dinner and I said, “No. I want to go home.” My husband was like, “What? You don't want to go anywhere.” My husband started to sense that something was wrong. We returned to home and contractions started to be closer and intense. I wrote to my midwife and she said, “Okay. You have to count how many contractions happen in one hour,” so I started counting and from 10:00 PM to 11:00 PM, I had nine contractions. I wrote her and she said, “Okay, you are starting. I'm going to go to your home.” By the way, she lives 2 hours from my city so she came to my place at 2:30 AM and checked me. I was only 3 centimeters and 60% effaced. She went and she said, “Oh, congratulations. You are a 3. We only have to wait 7 more.” She was so positive and so kind and so lovely. But for me, it was like, What? 3 centimeters. There's a long way to go. I was so disappointed and I started to have a crisis thinking, Okay. This is going to be three days of labor. It's starting to be unbearable. I don't know what I'm going to do. My husband told me, “You have to know that this is not going to be easy.” I was like, “Oh my god. What is going to happen?” I wrote a friend and she told me, “Maybe you were wrong. Maybe you are not in labor yet. Maybe it is prodromal labor so calm yourself and keep making your activities as normal.” I said, “Yeah, maybe that's true. Maybe I'm not in labor yet.” One of the things is that my contractions don't hurt in the uterus or in the belly. They hurt in the legs. Meagan: Oh. It radiates down. Susana: Exactly. I felt like it started in the hips and ran into the legs but I felt like– I don't know how to say– but a burning. Yeah. It was burning pain. It was very, very intense. My friend told me, “Put one leg on the chair and one leg on the floor and balance side to side while a contraction comes.” I made that and that was really, really helpful. I could have a contraction very easily that way. I was telling myself, “My pelvis can open. My baby can know how to birth. Everything is okay. God is with me,” and things like that. That affirmation worked very, very good because it calmed myself and that's how I passed the contractions all day long. Not the day, only the morning. My daughter, that morning, had a science fair so we decided it was at 8:00 AM so we went. It was the worst time for me having those contractions every seven minutes and very painful. All of the parents were like, “What is happening to her?” Meagan: That's amazing that you went. Susana: It was because I thought, I'm going to have three days in labor. My midwife had told me that when there's a labor after so many C-sections, there's a lot of times that it lasts three, four, or even five days so in my mind, that was my expectation. While I was at the science fair, I said to my husband, “Please take me home. Let's go home. I am in a lot of pain.” I called my midwife again and she came. She checked me and I was 6 centimeters so for me, I was like, “What? Whoa!” Yeah. She said, “We have to go to the hospital.” Oh, before that, we were planning to rent an AirBnB in the city which is Leon, Mexico to spend with all of the family those days that I was supposed to be in labor. So she said, “Forget about that plan. We will go directly to the hospital.” We called the doctor and the doctor said, “I need to check her with an ultrasound. You need to go to the office with me.” I thought it was useless, but we went to the office. It was the worst travel because I had contractions every 4 minutes and we were traveling in the van, but the good thing was that my midwife was making pressure on my hips and that released the pain. After 1 hour and 20 minutes, we arrived to the doctor. He checked me really fast and he said, “You are 6 centimeters.” Again, I was so disappointed because I thought, “Oh my god. One hour and I'm still a 6.” But my midwife told me, “No, I don't think so. I think you are maybe a 7 or an 8.”She is very wise. She had a lot of intuition. So we went to the hospital and it was 20 minutes away from the office. We arrived at the hospital at 12:35 PM. When we arrived at the hospital, he wanted to put me in an emergency room, but the doctor arrived immediately and told them, “No. Put her directly in a room because it was going to be a room birth.” I gave birth in a room, not in an operating room, but in a labor and delivery room. Meagan: They had you labor the rest of the way and give birth in the operating room?Susana: Yeah. In Mexico, all of the births happen in the operating room. Actually, it's not an operating room but it looks like it. It only has that stuff that they put the woman with the legs up. Yeah, I don't remember the name, sorry. Meagan: Like just the position? Susana: Yeah. Meagan: Okay, gotcha. Susana: So we went to the room. My midwife said, “Do you want to go to the shower?” I said, “Yeah, please.” I went to the shower. At that time, my water broke like a balloon because I felt something really big getting out. It was shocking and I was like, “What? Is that the placenta?” She said, “No, let me see what it is.” It was the amniotic sac almost complete. It was amazing because my midwife told me, “I've never seen something like this.” It was amazing. After that, the contractions felt very different with no pain and I started to feel to push. It was very different for me and very scary because I never felt something like that. Meagan: Right. Susana: My midwife told me, “You're going to birth now. You have to choose your position.” I stayed on my knees on the floor with the arms on the bed and started to push my baby out. I can say I didn't feel any pain in this moment. I only felt the pressure. I think I had the reflex, the fetal ejection reflex.Meagan: Yeah, mhmm. It's like where the baby just comes out. Susana: Yeah, because I wasn't pushing and my body was pushing. It was an amazing feeling but also, I was scared because I didn't know how to do that. My husband was praying with me and he was very supportive and very loving in that moment. That moment was awesome. I know God was there. I knew all my prayers were answered in this precious moment. I only let my body make its worth. I felt incapable of pushing a baby out. That was an amazing feeling. I don't know how to say it. It's like you are here but you are not. Meagan: Yeah. It's surreal. It's really– when you realize you're in that moment of pushing your baby out and I can't even imagine after five Cesareans, just that moment of, Wait, is this really happening? Susana: Exactly. It was like a dream. My husband was telling me, “Yes. You are so strong. You are telling me the truth. The miracle is done. Come on love. You can do it. You are so close.” I can't remember exactly but I think it was four or five pushes and baby was out. Baby had two wraps of the cord. Meagan: Double nuchal cord, okay. Susana: Yes. Then the body was out and it was a relieving feeling. It was magical. Everything was done. Every pain, every pressure, and every fear was gone. I felt that very warm and wet body in my arms. It was a magical moment like, I can't believe this is happening. Praise to God. I was crying. That moment was unlike any other moment in my life. Meagan: I can't even imagine. Wow. So was everyone very pleased and shocked? That's not a normal thing. For VBAC after one and two, it's like, okay. After three, providers are like, “I don't really know. Risks do go up so we are nervous about this,” so after five, how was your community around you?Susana: Yeah. They were very shocked. Actually, the hospital didn't allow VBAC after multiple C-sections, but the doctor said because in the lobby, they asked, “How many pregnancies and how many births? All those were natural births?” The doctor said, “Yeah.” Everything was happening very fast. After the baby was born, everyone was screaming, “Vaginal birth after five C-sections here!” The nurses and the doctor and the people in the lobby said, “What?! It's a miracle.” Everybody was so happy. Everybody was shocked. I don't know. It was amazing. Meagan: I'm sure they had a lot of feelings. I'm sure they were so happy for you and so shocked and even probably still questioning, “Wait, really did that just happen?” Because even we as a mom pushing in that moment, I think it's very much for the providers too, “Wait, is this happening?”Susana: Yeah, actually the doctors said the medical community was pretty– I don't know the word but they were saying, “What did you do? You didn't do another C-section? What's wrong with you?” They didn't do the episiotomy and I didn't tear at all. Meagan: Amazing. Susana: What else? He said, “It was a perfect birth.” Nothing went wrong. Nothing. So for him, for my doctor, he was very proud. He was not scared of sharing the evidence or the support and my case. Meagan: Right. He wasn't scared of sharing that he was supportive of you doing that. Susana: Exactly. He put on social media what we did. A lot of people were like, “What?” But he told me, “I only supported you because of your midwife because she is amazing. She is very wise. She has a lot of intuition. She had a good eye to know when it can happen and when not. Meagan: Yeah. Susana: She is awesome. Meagan: I wonder if they work together often now. Susana: Not too often because she usually goes to home births but when a couple wants a hospital or a VBAC, she works with him. Meagan: Oh my gosh. That's awesome that they can work together and it really truly makes it possible for those who want to. We know that not everybody will and we know that the risk is not acceptable for others. Susana: Right. Right, exactly. Meagan: Something that I love on ACOG, there is a website that is called acog.org so the American College of Obstetricians and Gynecologists so it's more here in the U.S. but there is a provider called Dr. Angelica Glover. She wrote an article on VBAC and one of the things that I enjoyed about her article was the very end. It says, “One size does not fit all. If you are pregnant and have a previous Cesarean birth, talk through all of these questions with your OB/GYN. Weigh the risks and benefits of each birth option like you would with any important healthcare decision.” I love that. Just like you would with any healthcare decision. It says, “Think of this as an ongoing conversation with your OB that starts early in pregnancy and evolves over time. Your feelings may change and your risk factors could change too. There is no one-size-fits-all answer when it comes to choosing between trying for a VBAC or a repeat Cesarean birth. What matters is that you are comfortable with your decision and you feel supported through your pregnancy and birth.” I love that because really in the end, VBAC after three, four, five, or whatever may not be comfortable for someone else but it may be for someone like you. Then the biggest factor is finding the support and we know that can be really hard so I love hearing that you had two providers who were on board with you, trusted you, and trusted the process. I do love that your midwife talked to you about how it can take time and you made it to 8 centimeters before right? Your body had done it. It just still needed time. It has gone through a lot and there was scar tissue and all of the things. It can take time, but you were allowed that time. You were allowed that time. They trusted you and they trusted themselves even. I am just so happy for you and I appreciate you sharing your story because it is one of those things that is really desired. A lot of people don't know it's an option then they find out and they are like, Wait, is this really possible?Yes, it is so it's really nice to hear a story here and there as they come along to show that yes. Women of Strength, it is possible. Are there risks? Yes. There are risks. Are they more than VBAC after one or two Cesareans? Yeah and honestly, we don't even know the exact evidence on specifically VBAC after five Cesareans because they are not studied and they are not happening. Susana: No, they are not but I can say that I read a lot. I found very good information from the Royal College of Gynecology and Obstetrics in the United Kingdom and it said that as a provider, you have to let the mom share if they want to try or do the repeat C-section, but always the vaginal birth is less risky than a repeat C-section especially after too many C-sections. Meagan: We do know that there are increased risks with repeat Cesareans as well. We know that is also very much a thing so we want to make sure that we are taking into consideration that as well because we've got issues where uterine rupture actually can also happen in a repeat Cesarean and that risk can be there. Bleeding and hysterectomy, there are risks that are sometimes actually higher for a Cesarean than a vaginal birth. It's just important to know all of the risks. I think sometimes we hyper-focus on the risk of VBAC instead of going through and looking at things. Evidence-Based Birth has such an amazing article and I think it was actually even a podcast episode on VBAC. She talked about how there are a ton of studies within here. She goes through the maternal outcomes here. Susana: That's awesome. Meagan: Yeah. It shows the maternal outcomes and the newborn outcomes. It says, “Maternal adverse events or bad outcomes were more frequent among women who had a C-section birth after Cesarean,” meaning they attempted a VBAC but it ended up in a Cesarean compared to those who had a VBAC. That's another risk. We have Cesarean risks. We have VBAC risks and then we have where we are going for a VBAC and it goes into a Cesarean. There is also risk there. We really need to just pause and stop and look at everything. I mean, literally, everything before we make a decision. There are so many times like with your first birth, there was so much going on. You had such an unfortunate event happening with the loss of your loved one and a provider was saying, “Oh, you're only at 3 centimeters and 60% effaced so this is probably not going to happen,” when in reality, that vaginal birth probably very much would have happened but we just didn't know. We didn't know. Susana: Yeah, totally. Yeah. Meagan: It's so hard because there are so many times where we hear these things from a provider. Me too. I did too. I was like, okay. We trust them and we don't want to not trust our provider but at the same time, we want to make sure that we do get informed. I'm so proud of you for along the way getting informed and learning about your options and I'm so happy for you that you were able to have your vaginal birth. Susana: Yeah, thank you. Thank you so much. I can say at least here, I think younger OB/GYNs are more open to support VBAC than the older OB/GYNs. I don't know how it is in the United States, but here, I think that is happening. Meagan: Yeah. I think it takes us all continuing to advocate for ourselves to have these providers stop and change their point of view because I believe that so many times, even if the evidence is there, there are so many times that it takes seeing it to believe it. You can look at a piece of paper and look at the evidence and you can see that, but at the same time, you're like, Okay, yeah. Sure. That probably can't happen, even though it's right there on the form, but seeing it really can change a lot of people's perspectives and just opinions. I think that is what you probably did to that entire hospital. Like you said, “Vaginal birth after five Cesareans in here!” Yeah. They were all blown away and you really did. You changed their perspective. Susana: Yeah. I am so happy to help another woman, to inspire, to read, to find information, real information. Don't let the doctors scare you. There is risk in all of pregnancy. It can be risky. Life is risky. Meagan: Life is risky. You're not wrong there. There is risk everywhere. It's just important to know the risk and then decide if that risk is acceptable to you. If that risk is acceptable to you, then great. Go for it. If not, that's okay. Susana: It is worth every moment and every pain. Everything, it was worth it. Meagan: Yeah. Well, I'm so happy for you. Congrats again and thank you for being with us today and sharing a VBAC after five Cesareans story. Susana: Oh, thank you so much. I'm so happy and I hope that a lot of women hear this podcast and are inspired themselves. 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

In this episode, Kevin C. Klatt, PhD, RD (he/him) speaks with 2 highly distinguished nutrition physician clinicians and researchers, nenatologist Steven Abrams, MD and pediatric gastroenterologist Robert Shulman, MD about their recent paper, “What would happen in the United States if there were no cow milk-based preterm infant nutritional products: Historical perspective and evaluation of nutrient-related challenges”. This episode discusses the challenges in feeding preterm infants and the roles of human milk, fortifiers and cow's milk based nutritional products in the context of recent litigation and potentially future compromised access to preterm infant nutrition products.  Relevant Links:Recent NICHD advisory panel discussing NEC mentioned by Dr Abrams Be sure to connect with us! AJCN: @AJCNutrition; Dr. Klatt: @kcklatt; Dr. Abrams, @stableisotope. Find all of the publications from the American Society for Nutrition (@nutritionorg; @jnutritionorg) at our website: https://nutrition.org/publications/.

The Unexpected Journey: Understanding and Navigating PPROM Life throws curveballs, and sometimes, those curveballs come in the form of these little letters: PPROM. For those unfamiliar, PPROM stands for Preterm Premature Rupture of Membranes, a medical term that sounds as serious as it is. In plain English, it means that the water breaks too early—before 37 weeks of pregnancy and often long before anyone is ready. What Is PPROM? Preterm Premature Rupture of Membranes, or PPROM, is a condition that affects roughly 3% of pregnancies, yet it accounts for nearly one-third of all preterm births. It occurs when the amniotic sac, which surrounds and protects the baby in the womb, breaks open before 37 weeks of pregnancy and before the onset of labor. This rupture can lead to significant complications, making it a critical condition to recognize and manage promptly. What Causes PPROM? The exact cause of PPROM is often unclear, but several factors can increase the risk. Infections of the reproductive tract, such as bacterial vaginosis, are a common cause. Other risk factors include a history of PPROM in a previous pregnancy, cervical insufficiency, multiple pregnancies (such as twins or triplets), and lifestyle factors like smoking. In some cases, the condition may occur without any identifiable risk factors, which makes it all the more important for expectant mothers to be vigilant about their health and prenatal care. Signs and Symptoms Recognizing the signs of PPROM is crucial for early intervention. The most common symptom is a sudden gush or a steady leak of fluid from the vagina, indicating that the amniotic sac has ruptured. Other symptoms may include increased vaginal discharge, a sensation of wetness in the underwear that doesn't dry, or a trickling of fluid that may come and go. Some women may also experience pelvic pressure or mild cramping. If you notice any of these signs, it's essential to contact your healthcare provider immediately. Diagnosis and Management If PPROM is suspected, your healthcare provider will likely perform a physical examination and order tests to confirm the diagnosis. This may include testing the vaginal fluid for amniotic fluid, ultrasound to assess the amount of amniotic fluid around the baby, and checking for signs of infection. Once diagnosed, the management of PPROM depends on several factors, including the gestational age of the pregnancy, the presence of infection, and the health of the mother and baby. If the pregnancy is near term (after 34 weeks), labor may be induced to reduce the risk of complications. If the pregnancy is earlier, the goal is often to prolong the pregnancy while minimizing risks. This may involve hospitalization, administration of antibiotics to prevent infection, corticosteroids to speed up the baby's lung development, and careful monitoring of both mother and baby. Potential Complications PPROM can lead to several complications, primarily due to preterm birth. Babies born prematurely may face challenges such as respiratory distress syndrome, infections, and developmental delays. Additionally, the longer the membranes remain ruptured, the higher the risk of infection for both the mother and the baby. Chorioamnionitis, an infection of the amniotic sac, is a serious complication that requires immediate medical treatment. Emotional Impact and Support The diagnosis of PPROM can be an emotionally challenging experience for expectant mothers and their families. Anxiety about the health of the baby, uncertainty about the outcome, and the potential for an extended hospital stay can all contribute to significant stress. It's important to seek emotional support, whether through counseling, support groups, or talking with other mothers who have experienced PPROM. Your healthcare team can also provide resources and guidance to help you navigate this difficult time. Outlook  While PPROM is a serious condition, advances in prenatal and neonatal care have significantly improved outcomes for both mothers and babies. Early recognition and appropriate management are key to minimizing risks and ensuring the best possible outcome. If you're pregnant and have concerns about PPROM, don't hesitate to discuss them with your healthcare provider. Being informed and proactive about your health is the best way to safeguard the well-being of both you and your baby.   Your feedback is essential to us! We would love to hear from you. Please consider leaving us a review on your podcast platform or sending us an email at info@maternalresources.org. Your input helps us tailor our content to better serve the needs of our listeners. For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources Instagram: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB Thank you for being part of our community, and until next time, let's continue to support, uplift, and celebrate the incredible journey of working moms and parenthood. Together, we can create a more equitable and nurturing world for all.

Send us a textEffects of a live versus heat-inactivated probiotic Bifidobacterium spp in preterm infants: a randomised clinical trial.Athalye-Jape G, Esvaran M, Patole S, Nathan EA, Doherty DA, Sim E, Chandrasekaran L, Kok C, Schuster S, Conway P.Arch Dis Child Fetal Neonatal Ed. 2024 Aug 17:fetalneonatal-2023-326667. doi: 10.1136/archdischild-2023-326667. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textRetrospective study of preterm infants exposed to inhaled nitric oxide in Kaiser Permanente Southern California: morbidity, mortality and follow-up.Bhatt DR, Braun D, Dizon RA, Shi JM, Weerasinghe S, Sabio A, Reddy S, Lee HC, Ramanathan R, Lakshminrusimha S.J Perinatol. 2024 Jul 18. doi: 10.1038/s41372-024-02051-w. Online ahead of print.PMID: 39025953As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a Text Message.Procedural closure of the patent ductus arteriosus in preterm infants: a clinical practice guideline.Mitra S, Bischoff AR, Sathanandam S, Lakshminrusimha S, McNamara PJ.J Perinatol. 2024 Jul 12. doi: 10.1038/s41372-024-02052-9. Online ahead of print.PMID: 38997403 Review.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Candida in women is being right? Afterall, vulvovaginal candidiasis during pregnancy is common. Candida species may be isolated from the vagina of 15 %-21% of nonpregnant women; this rate increases to 30% during pregnancy. While it is generally benign and isolated to the vagina clinically, some Candida species have the capacity to be troublemakers. C. Glabrata has the potential to be a bad player, with the possibility of invasive disease. Candida IAI is rare but can lead to neonatal infection, high mortality, preterm prelabor rupture of membranes, and childhood neurodevelopmental impairment. The most prevalent predisposing condition is preterm prelabor rupture of membranes, followed by intrauterine pregnancy with a retained intrauterine contraceptive device, cervical cerclage, diabetes in pregnancy, and pregnancy after in vitro fertilization. Preterm labor is the most common symptom with Candida IAI, and only 13% of cases involved fever. Case reports have also associated C. Glabrata with third trimester stillbirth. Although case reports have documented this since the 1980s, this is still an evolving diagnosis as awareness of the condition increases. Nonetheless, the clinical features of Candida IAI are not well understood, and best management of the condition is unclear. In June 2024, Candida Glabrata was called a “global priority pathogens”. In this episode, we will review this rare but very real clinical conundrum. One of our podcast family members actually managed a patient, s/p IVF, with periviable PPROM found to have Candida Glabrata fungemia. How is this possible? Shall we treat Candida in the urine? We will discuss this in this episode.

Caylee joins us from Canada sharing her experience with two VBACs after a twin Cesarean birth. She also shares what it was like having cholestasis in all three pregnancies. Cholestasis is a liver condition that slows or stalls the flow of bile. Meagan and Caylee discuss in greater detail what cholestasis means during pregnancy, what symptoms can look like, and how it is diagnosed. One of Caylee's most intense symptoms was incessant itching. She talks about how it affected her not only physically but mentally as well. While all three of her pregnancies were preterm births and her two VBACs were medically necessary inductions, Caylee advocated throughout her entire labors and was able to stay the course to achieve the vaginal births she knew she was capable of. Cleveland Clinic Article: Cholestasis of PregnancyAmerican Journal of Obstetrics and Gynecology Article: Risk of Stillbirth in U.S. Patients with CholestasisHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. Welcome to the show. We have our friend, Caylee, with us and her little wee, tiny little newborn. Caylee: Hi everyone. Meagan: Oh my gosh. Welcome to the show. How old is your baby? Caylee: He just turned 3 months. He was born a month early though. Meagan: Okay, 3 months and a month early. We are going to talk about why he was born a month early. You guys, today we are going to be sharing some stores and talking a little bit about cholestasis. This is something that we actually don't have a lot about on the show. When you were listening, Caylee, did you? Caylee: I don't think I've heard a single episode, yeah. Meagan: Did you hear about it in general on other platforms? Was it talked about?Caylee: Not really, no. I found it online on Facebook. I'm in the ICP Care Facebook group and that's super helpful. They are amazing in there and super knowledgeable, but yeah. It's not very common. It's quite rare. I think it's 1 in 1000 women who end up getting it. Meagan: Yeah. Caylee: So yeah. It's not very well known about and even with providers, providers don't know about it very well either. Meagan: Yeah. I think that can be part of the problem, right? Because we've got providers who don't know a lot about it and then it can cause a little bit of a panic and then a lot of the times, it can cause Cesareans or lead, I should say, to Cesarean. We're going to be talking about that today and sharing her stories. Review of the WeekMeagan: But I do have a Review of the Week so I'm going to get into that and then turn the time over to cute Caylee. This is from Cori and it doesn't say where it's from. Somewhere in the universe, it is from. It says, “The VBAC Link is gold.” It says, “Of all of the things I did to prepare in pursuing for a VBAC after two C-sections, I think is one of the most important is that I was listening to this podcast. Hearing these stories and information from Meagan and Julie made the dive into learning about VBAC and birth in general so much easier. I was blessed with my VBA2C” so VBAC after two C-sections “with my sweet Brynne Lynn and I sincerely believe I wouldn't have gotten to that point without this resource and the community. Thank you guys for all that you do.” Oh, that just makes me smile so much because this community– oh my gosh. I mean, Caylee and I were kind of just talking about this. Yes, Julie and I are here, but there is this community, this absolutely incredible community and all of the people coming forth to share their stories. And Caylee, you just said it yourself when you were like,  it's like all of these people who came and shared these stories impacted you. Caylee: Yeah, totally. Meagan: Yeah, they are the reason. You are the reason right here. Caylee, you are the reason why what Cori said in this review is possible by sharing your stories, by coming in the community on Facebook and on Instagram and having these conversations and learning and also being vulnerable. There are so many times where I see posts where it's the most vulnerable, genuine post and I can't explain to you the outpouring of love that I see come in for this person from this community. The VBAC Link Community, just the VBAC community in general, oh my gosh. You are all amazing. Thank you so much and yes, if you want to join that community, check us out on Facebook at The VBAC Link Community. It is a private group. You do have to answer the questions to get in so just keep that in mind. If you are not answering questions, you might not be allowed in. And on Instagram, and of course, if you want to have a review that I could share for the Review of the Week, please do so. We would love that.  Symptoms of Cholestasis Meagan: Okay, Caylee. Are you ready? I'm so ready. Caylee: I am ready, yes. Meagan: Awesome, I would love to turn over the time. Caylee: I don't know where to start. Should we start by talking a little bit about cholestasis so that they understand the risks? Meagan: Yeah, I think that– well yeah, the risks, the symptoms, and then also how it can be missed and then how it can sometimes– well it kind of goes with the risk, but there are other things that can come in I should say from cholestasis and I actually even had a client myself, a VBAC client after two C-sections. She had cholestasis, preeclampsia, VBAC after two Cesareans, and was induced. Caylee: Wow, good for her. Meagan: Yeah, but preeclampsia, right? Okay, let's talk about the things. So what are the symptoms that you one, may be experiencing, and two, that there may be that someone might not experience? Caylee: Yeah, so for me, it was intense itching mainly on the bottom of my feet and on the palm of my hands but I had it everywhere. I have scars on my ankles, up my arms, on my belly just from scratching. Meagan: From scratching? Caylee: Yes, incessantly. It's an itch that you can't really scratch. It's in your blood that is making you so itchy so you can scratch all you want and it's temporary relief but as soon as you stop, it's like, oh. I broke down in tears so many times and had ice packs on my feet and on my hands while I was trying to sleep. Another symptom is darker urine output and some upper right quadrant pain. Meagan: Yes. Yeah. Caylee: Those are very common and some people also experience jaundice. Meagan: I was going to say yellowing, jaundice. Decreased appetite. Caylee: Yeah. You're more likely to get preeclampsia and gestational diabetes. Yeah. Meagan: Mhmm, yeah. So nausea, feeling unwell, dark urine, lack of urine output which a lot of the time, dark urine is the beginning of that. Your kidneys are warning you and then you stop. Yeah. I had a client, not the one I was telling you about, but another client. She said that her bowels like her poop smelled really weird, like abnormal. Caylee: Yeah, I've heard that before too. Meagan: Yeah. That's the first time when she was like– that was actually one of her first symptoms that she noticed. Thinking back, she was like, “Yeah, I guess I was kind of itchy, but I wasn't itchy-itchy until later.” But that was one of the things where she was like, “I just thought I ate something weird.” Caylee: Yeah. Meagan: A decreased appetite. Pain in your belly and your quadrants, jaundice, and of course, itching. Those are the main signs. Caylee: Itching. And the severity of the itching can vary greatly between cases so the first time, it was quite mild and then it progressively got worse throughout my pregnancies. That's different for everyone who experiences that so if you have any itching, you should ask for LST's and bile acid tests from your provider. Itching can also precede the bile acids rising and the elevated bile acids is what's dangerous for the baby. It increases the risks in the baby where they might pass meconium before birth and also stillbirth risk goes up a lot if the bile acids are above 40. Meagan: Too high, yeah. So when you are pregnant, if you are having symptoms, definitely go in and get checked like she said. Get these tests. Then if you have cholestasis, if you test positive and things are looking like you have it, it is something that may increase extra testing and extra visits because you do want to keep a close eye on this. Again, like she said in the beginning, it's really rare. Even right here, it shows on this link that I'm going to put in the show notes, it's from the Cleveland Clinic, but it shows 1-2 in 1000 people during pregnancy will experience this. It's pretty low, but it can be a serious thing. Also, I was going to ask you because I know my clients have in the past. They've been given some things to try and control, to minimize, to control, to lower things to try and continue pregnancy to a good, safe term stage. Were you given anything like that? Caylee: Yeah. I was put on a medication called Ursodiol. It helps lower bile acids to make it a little bit safer for the baby so you can continue. With my last pregnancy, they were very severe levels. They were over 100 so it was kind of touch and go there whether we could get him to 36 weeks or not. They were talking about inducing me at 34 weeks. We ended up opting for non-stress tests and biophysical profile ultrasounds just to keep an eye on him. Meagan: And he did well? Caylee: He was doing well. He had already passed meconium sometime before I was induced though at 36 weeks. It was time for him to come out. He was already in distress so it was good that we did end up taking him out at 36 weeks, but he did great. Really great. Meagan: Good. Good. That's another thing I would like to drop in and note that if you do have cholestasis, it may be something that brings you to something like an induction that is earlier than expected. Obviously here, we're going to share this story in just a second about VBAC and induction. It's possible and totally doable, but that is a thing. Cause of CholestasisMeagan: She's mentioning bile. It is in the liver, right? Am I correct? It's in the liver. Caylee: Yeah. Meagan: We don't really know why. I don't know why. Do we know exactly why it happens?Caylee: They don't. They think it's something to do with pregnancy hormones and the placenta, but they don't know for sure. It's some sort of genetic factor as well, but no woman in my family who I know has had it. So I think it's just something that can happen sometimes. Meagan: Yeah. I have heard the hormones like estrogen and progesterone can be too much in the body. So just to circle back around again, if you have had any of these symptoms or if you are having any of these symptoms, it's okay. Don't hesitate and go in and get checked out. Caylee: And if you go in and get a negative result and still have symptoms, ask your provider to keep testing you. Meagan: Yes. Go back and check again. Okay, so baby number one? First pregnancy: TwinsCaylee: Twins. Meagan: Twins! Caylee: Baby one and two, my first pregnancy. Meagan: So twins. You had symptoms? Caylee: I did, yes. I got it pretty early on and they tested me and it was negative. They just put me on Ursodiol before anything came back positive. They didn't do anymore testing or anything. I didn't have any itching. The medication must have made it go away somewhat. Yeah. I was only 21 when I was pregnant with the twins so I was pretty young. I didn't know much of anything. I knew I wanted a vaginal birth. I had actually switched providers in my third trimester to somebody who was comfortable with vaginal birth with twins and they ended up being breech when they decided they needed to take them out. Preterm Cesarean at 36 weeks due to breech presentation and IUGRIt wasn't due to cholestasis, but I did have them at 36 weeks because one of the twins had stopped growing so they took them out. Meagan: IUGR? Caylee: Yeah. Yeah. He was quite significantly smaller than his brother. Meagan: Okay. That can happen with twins too, I know. Caylee: Yeah, totally. Yeah. My twin A was 6 pounds, 7 ounces, and twin B was 4 pounds, 4 so it was quite a big difference. Meagan: Mhmm. Caylee: Yeah, so it was a C-section with them. We were in the NICU for two weeks. Second pregnancyCaylee: I ended up getting pregnant again when the twins were 16 or 17 months old. I knew I did not want to do that again, having a C-section so I found supportive midwives and got on with them. Unfortunately, I don't know if it's in Canada, but they don't allow home birth for your first VBAC for some reason. Maybe it was just those midwives, I don't know, but I really wanted a home birth and they were like, “No, let's do hospital. It's safer.” I was like, “Okay, as long as I can still have my VBAC. I'll just do that.” The pregnancy went well. I thought I wasn't going to get it again. No itching, then I hit 34 weeks and the dreaded itching started again. I kind of had a feeling that I had it during my first pregnancy too from my own research. I had mentioned it to my midwives beforehand so we were looking for it seeing if it would happen. They sent me for testing right away at 34 weeks. It came back negative so they ended up testing me again weekly and then at 36 weeks, they tested me and my liver function tests were very high. My liver was basically failing and they didn't even wait for the bile acids to come back. They just brought me in for an induction. Meagan: What week again? Caylee: I was 36 weeks and 2 days when they started my induction.Meagan: Okay, so technically preterm. Caylee: Yes, yes. InductionCaylee: When I went in, they started with a Foley balloon to help dilate my cervix and that was awful. It's like a torture device, I swear. But it was effective I guess. It dilated me and then it fell out and I don't know if they didn't have a nurse for me or something, but I was waiting 8 hours for them to continue my induction. The OB came in and he wanted to break my water. I said, “No. Let's start low Pitocin.” He was like, “Well, it's not really going to do anything if you're not going to break your water too.” I said, “Okay, let's see how it goes.” Meagan: Yes. Caylee: We did that. Labor was going smoothly. I loved being in the shower. It was amazing. Then they made me get out because his heart rate was dipping really high so they wanted to get me out and be able to monitor him a little bit better. That's when things got really intense and I felt like I wasn't able to cope as well after I got out of the shower. I think in the back of my mind, I was still pretty young with him too for my first VBAC. I was only 24 and I know that uterine rupture risk is very low, but for some reason, I just couldn't get that out of my mind and every contraction I'd have, I'd just feel like I was being ripped open and was so scared that I was having a uterine rupture. I ended up– it was 32 hours into my induction and I still was at 4 centimeters just because I wasn't letting my body relax and do the work. I was tensing and fighting every contractions because I was terrified. I ended up getting an epidural at 1:00 AM and 5 hours later, I woke up and was fully dilated and pushed for 15 minutes and he came out. Meagan: 15?! 1-5? Caylee: Yeah, 1-5. Meagan: Oh my goodness. Caylee: As he was coming out, I pulled him up to my chest and it was just this amazing feeling like, Oh my god, I did it. The high that comes with that is unbelievable. Meagan: Yeah. Caylee: I just kept looking at everyone saying, “I did it. I did it.” Meagan: Absolutely. Caylee: It's an amazing feeling. Meagan: It really is. Caylee: I fought with the OB who was on call a little bit, the one who wanted to break my water. He kept saying, “Does she want to do this? Let's just go for a C-section.” I'm like, “Yeah, I can do this all night long and he can stay out of my room until I'm pushing. My midwives have got this, thanks.”Unfortunately, because I had to be induced, I had to be overseen by an OB so my midwife ran the show and was able to be with me and do everything, but he had to be there in case anything went wrong I guess. Meagan: That's kind of normal. A lot of the times, when there is a hospital midwife, there are OBs who oversee them. Caylee: Yeah. Yeah. So yeah, that was my first VBAC, first induced VBAC. Second Induced VBACCaylee: I just recently had another induced VBAC. With this one, my levels went up high. I think it was 28 weeks that I tested positive so it was sooner. Meagan: Significantly sooner. Caylee: Yeah. They went from 0 to 100 within a matter of days. They put me on Ursodiol immediately as soon as it came back positive. I was being monitored weekly with NSTs, non-stress tests, and they were sending me for biophysical profiles as well weekly which is an ultrasound to check on the baby's well-being. He was doing well so they just were keeping going with that and unfortunately, the Ursodiol did not help my itching this time around. It was so severe. I was in tears pretty much daily from the severity of the itching. Yeah. It was really bad this time. The mental health aspect of having that incessant itching I don't think is talked about a lot either. It really gets to you. It's depressing. Meagan: Oh, I would not do well with that. I would find myself getting very anxious probably and out of control. Caylee: Even now, if I get an itch, I get PTSD. It's like, Oh my god. It's not going to stop. I freak myself out and work myself up. I remember that after my second pregnancy as well. It was like I'd get a bug bite and I'd just have to itch and itch and itch until it was bleeding. Oh, it was just bad. I don't know how to leave itching alone now. His levels were very severe, or my levels I guess. My liver function tests were some of the worst that my OB had ever seen. Meagan: Interesting. Caylee: So yeah, it was just really bad. Caylee: I had actually applied for midwives. We had just moved from Alberta for BC pretty much as soon as we found out we were pregnant with Henley here. I applied pretty much as soon as I found out I was pregnant for the midwives here. I ended up hearing back from the midwives in Edmonton which is an hour and a half away that they could see me up there but once I got the itching and cholestasis, I was like, “Just transfer me to an OB where I live. It's just easier for me then all of my appointments will be out here and I don't have to drive 1.5-2 hours to appointments in the middle of winter.” Yeah, so they scheduled my induction for exactly 36 weeks because of the high levels. They didn't want me going past that because with levels over 100 bile acids, the stillbirth risk goes up very high after 37 weeks. Meagan: Did they give you a percentage or anything like that? Caylee: Yeah, I think it's upwards of 15% with very severe levels. Meagan: Oh wow. Caylee: If levels stay under 40, your risk of stillbirth is around the same as anyone else's. They go up 3% over 40 and over 100, it's even more. So it was a bit touch and go there. They were talking about inducing at 34 weeks and we were able to get to 36. Still preterm, but a higher likelihood that he wouldn't need additional support. InductionCaylee: I was induced at exactly 36 weeks. I actually had influenza B when I had to be induced. Meagan: That's miserable. Caylee: As if labor isn't hard enough alone, I had to have influenza B. It was great. Meagan: Miserable. Yes. Caylee: Yeah, one perk though was that we got a private room right away. I didn't have to labor in triage until I was far enough along to get my delivery room or whatever. They put me right in there. I was able to get set up and feel like it was my space and get more comfortable. So yeah, they started with the Foley balloon again to open the cervix. They can't do Cervadil or a few of the other cervical ripening– Meagan: Cytotec. Caylee: Yeah, because it really does increase the risk of uterine rupture with induction, but the Foley balloon is a safer option and it works. Within an hour and a half this time, my cervix was 4 centimeters. Meagan: Wow. Caylee: From barely a 1. It was kind of funny. I was standing there talking to my husband and I took a step toward the bathroom and it just flopped out and there was this line of blood up and down the floor. It was like a total bloody show. Meagan: Mucus. Caylee: In a perfect line. Meagan: Oh my gosh. Caylee: Because they attach the tube to your leg. They tape it to your leg so when it falls out, it makes a long, smooth line. My husband pulled the nurse call button and she's laughing. She ended up cleaning me up. Things picked up pretty quickly from there this time. I felt it was much more manageable though. I don't know if the nurses were nicer this time and they were doing the Pitocin a bit slower because I remember with my first VBAC, the contractions just felt back to back like I wasn't getting a break at all and it was really mentally wearing me out after 32 hours. I hadn't slept. I ended up getting the epidural but this time, it felt like more of a natural progression. I don't know. I've never had natural labor, but for me, I was able to handle it a lot better. Maybe that's because I knew what to expect this time so it wasn't as scary. Meagan: It could be. Caylee: Yeah, I don't know. Or I've heard too that with cholestasis that the bile acids or something make Pitocin more effective so maybe I didn't need as much of it this time because my levels were higher. I don't know but it was much more peaceful this time and I knew what to expect even though I was sick. I labored in the shower for a little bit with the mobile monitor because with inductions, they want to be able to monitor the baby constantly which I know is talked about a lot on here as something that is not ideal. Meagan: Yeah. Even if no induction with VBAC, it's really, really common if not 100% that your hospital is going to want that monitoring. Caylee: Yeah. And having that mobile monitor though is so helpful if your hospital has one of those. Definitely ask because oh my gosh, it's so nice to be able to get up and walk around and move and shower. Unfortunately, because of the flu, we were battling a fever. I had a fever so as soon as my Tylenol would wear off, my fever would spike and then his heart rate would go up. I had an anterior placenta so it was kind of in the way of the monitoring and it was hard to get him constantly so they ended up wanting to do the electrode. Meagan: The IUPC and the FSC? Caylee: Yeah, I think so. It's the one that they put on the scalp. Meagan: Okay, that's an FSC, fetal scalp electrode. Caylee: Yeah, that unfortunately didn't work very well. I was bed-bound but I was so sick that I didn't even really care. I was just switching sides laboring through, using the gas. I loved the gas this time.Yeah. I ended up getting to an 8, 8 centimeters and the OB unfortunately was not the OB who I had through my pregnancy. She had gone on vacation for my induction, unfortunately. I was really sad about that, but the OB on call came in and he was like, “You know, this is taking pretty long. I think it's time that we start thinking about a C-section. I'm getting worried about your scar.” I'm like, “I've done this before and it took longer last time. I am not having a C-section.” Meagan: Good for you. Caylee: I don't think he really liked that though because he was like, “Well, then you're getting an epidural because at least if you have the epidural and something happens, we can rush you in and open you up faster,” and blah, blah, blah. I'm like, “It has to be at least 24 hours and it's only been maybe 12 hours of hard, active labor here. My C-section scar is strong. It's been over 7 years since my first C-section. We are both doing well. Yes, I'm sick. Yes, his heart rate keeps going up when we have a fever but when the Tylenol kicks in, his heart is going back down and his tracing is normal. Why would I have a C-section?” Meagan: The fact that you're having a fever is more likely to the fact that you are sick versus that you have an infection.Caylee: Yeah, exactly. They tested me when I got there and they knew that I had influenza B and I tested for Group B strep so I was just having to fight with another OB again which is really frustrating, but yeah. He ended up leaving the room and my doula and my nurse were both like, “Wow, you're amazing. I'm actually so impressed with you saying no to him.” I guess a lot of people just go with what the doctor says. Meagan: Well, I guess. Caylee: That is why there are so many unneeded C-sections. Meagan: Well, we've talked about it on the show where it's like, I didn't go to years and years of medical school, so okay, I guess. Same thing with me, I was like, Okay, and went down and had a C-section when I completely did not need a C-section. Caylee: You hope that doctors are saying that when it is actually medically necessary and not when it's convenient for them. I think he was getting like, It's been 24 hours. I'm almost off-shift. I don't know, but I was not having it. It was actually funny. When he texted me, he was like, Oh, you're 8 centimeters, but he's -2 position and not coming down. He was like, It's probably time to do a C-section. I was like, “No, it's not actually.” Meagan: Oh my gosh. He really wanted to do a C-section. Caylee: Yeah, so I was like, “No, I'm not having a C-section.” He ended up leaving the room and pretty much immediately, I had a super strong contraction. I jumped off the bed trying to get away from it because apparently, that can help. I kind of grabbed my nurse's shoulders, the poor thing. She is this tiny, little 20-something nurse. I grabbed her shoulders and my body was pushing. I was farting and things were moving down there. Meagan: I bet that baby was coming down quickly too. Caylee: Yeah, that quick movement. Popping up just brought him down and she was like, “Are you pushing?” My doula was like, “Well, that's a good sign.” I was like, “I don't think so.” But my body was just doing it and then I barely made it back on the bed before his head was out. Meagan: Oh my gosh. So was the provider even in there? Caylee: No. Nope, he was just leaving the room telling me that I needed a C-section because I wasn't progressing. Meagan: I know that he had left but I didn't know if she was beeping him back in like, “Come back in!”Caylee: I guess he was down the hallway at that point and his head was out. I made it back onto the bed thankfully. My nurse was down there taking the fetal electrode out of his scalp panicking a little bit being a nurse. She was like, “You need to keep pushing.” I'm like thinking in my mind, No, I need to rest for a second. His head's out. He's fine. I knew in my soul that he was okay. I took half of a second to rest and then my body was pushing again and he was out. Meagan: Oh my gosh. Caylee: He had the umbilical cord wrapped around his neck and his armpit. I thought that maybe was why he wasn't coming down. Meagan: It could be. Caylee: Maybe he was tangled up in there a little bit and couldn't come down fully but maybe that quick movement that I did to pop out of bed was just enough to let him come down. It was so quick. I was looking around. My doula ended up riding out into the hallway to call my OB back and my nurse was frantic. She was like, “This was my first baby I caught!”Meagan: Aw, and it was a VBAC. Caylee: Yeah, yeah. I'm looking around the room like, “Whoa. What just happened?” I went from 5 minutes ago being told it was time for a C-section to my baby on my chest. Meagan: Yes. Oh, that is amazing. You know, maybe that person needed to leave to also relieve some stress so baby could come down. That's another thought I had. Caylee: Yeah, I think that was it and maybe my baby was like, Yeah, we're not going for surgery, mom. Let's show this OB what's up. Meagan: Yeah, seriously. It reminds me– is it the tiger or the lion? I can't remember the thing, but when you are being chased or when you are in a hostile environment, you either tense up or you run or whatever. We've got all of these senses and you could have been like, Nope. I am not having this baby with you in this room. I've had enough of your C-section talk. So cool. So after, with all of the babies, but especially with this one because your levels were so bad, were there any complications? Caylee: I guess I did touch on this a little bit before. I forgot though during my birth story there, when they broke my water, because I did allow it earlier this time because I felt with my first VBAC that that actually helped speed things up a little bit. I did allow them to break my water and start Pitocin at the same time this time. When they broke my water, it was full of meconium. They weren't too worried about it. Thankfully, that OB seemed pretty C-section happy and he was still like, “Oh, no big deal. We'll just monitor him. It's okay. There is a risk there for aspiration, but it's not a total risk that that will happen.” So they were just monitoring that. When he came out, he was fine for being 36 weeks. He was breathing good. They wiped his face because there was the meconium on his face, but no. He was great. It was more me that I was worried. I was like, “Is he okay?” They were like, “He's fine.” Meagan: Good. That's so good to know. I was just curious because he was early, high levels, induction, fevers, all the things so that's so good to hear that he was really great. Caylee: Mhmm, yeah. Even my twins were 36 weeks, 2 days when I had my C-section. They were in the NICU for 2 weeks and that was just for feeding and growing. They didn't know how to suck and then with my now 5-year-old, he was totally healthy when he came out too. He was 36+4 at the time he was born because my induction took so long with him, but yeah. He was healthy. He did have jaundice quite badly though so he needed the bilirubin lights and then with my baby now, he also had jaundice but he was able to stay off of the lights. He was just under that level for needing phototherapy. That's pretty common with early babies anyway. I don't know if that had anything to do with cholestasis in general or if that was just them being early that it was more likely to happen.Meagan: Yeah, that makes sense. Oh, well thank you so much for sharing your story and talking more about cholestasis with us. Like you said, there is not a lot out there. It is not very common so it makes sense that it is not talked about that often. However, uterine rupture isn't very common but it is talked about all the time. Caylee: Yeah. Meagan: So you know, but it's good. It's good to be aware. It's good to understand the symptoms and what's going on and why so I'm so grateful that you shared your stories. I'm so grateful that everyone is healthy and happy and wonderful and you are smiling and have some good birth experiences and maybe some healing birth experiences. Caylee: Yeah, totally. Meagan: You showed yourself that you could stand up to pressuring doctors. Caylee: Yes. I honestly thank my doula for being there for my last birth because I don't know if I would have had the confidence to be that firm with such a pushy, “this is what's going to happen” doctor. We had talked about it previously that she can't say anything for me but that she will be there to support and give me the power to advocate for myself. I totally felt that power from her. She was amazing. I'd like to shout her out to Little Loves Doula in Red Deer. She was amazing. Stephanie, she's great. If anyone is in Red Deer, Alberta, definitely contact Stephanie from Little Loves. Meagan: Well, you know that we love doulas here and always encourage checking out a doula. We do have VBAC Link-certified doulas. She's got her doula. Yeah. Caylee: I think she was also VBAC Link certified. Meagan: Was she or is she? Caylee: Yeah. Meagan: That's so awesome. You can check out The VBAC Link doulas at vbaclink.com/findadoula. Let me tell you, it's so fun to see all of the doulas in all of the different states. We are growing within the States. And if you have a doula in mind who is not on the VBAC list, send them the link. We would love to have them and have them support our VBAC clients and our VBAC community. Thank you so much again. Caylee: Thank you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Approximately 0.5% of all births occur before the 3rd trimester of pregnancy, and very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. Preterm prelabor rupture of membranes (PPROM) is a known risk factor for preterm birth and is responsible for 30–40% of preterm deliveries. While PROM occurs around 8% of all (term) pregnancies, PPROM occurs around 1% of the time. Periviable birth is delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. Women who experience PPROM before 27 weeks have a 10% risk of early PPROM and a 35% risk of preterm delivery in a subsequent pregnancy. Despite improvements in perinatal and neonatal care, infants born at

“The 9 lb 2 oz baby that they said I could never push out and could never have had her vaginally– I ended up going on to have a 10 lb 10 oz baby girl.”Brittany first gave birth to twins via Cesarean at 34 weeks and 1 day. She didn't get to meet her babies until 36 hours after delivery and they had to stay in the NICU for 10 days. While Brittany was so thankful it was not a longer NICU stay and the babies got to come home at the same time, she grieved the introduction into motherhood that she thought she would have. Brittany's next birth ended in a difficult CBAC under general anesthesia. Once again, she was not able to hold her baby right after birth like she so badly wanted. Her physical and mental recoveries were intense and tough. Not long after her third baby was born, Brittany felt called to understand more about her births. She wanted to learn why things happened to her the way they did and if there was a way to help prevent other women from going through the same things. She became a doula with Joyful Beginnings Doula Care and absolutely loves it!With her fourth baby, home birth was on Brittany's heart. With the education from doula work and her own births, Brittany set herself up for success by surrounding herself with a beautifully supportive birth team. Her HBA2C was quick, uncomplicated, redemptive, and empowering!Brittany's WebsiteThe VBAC Link Blog: Preterm CesareansTVL Blog: Everything You Need For Your HBACTVL Blog: Provider Red FlagsTVL Blog: VBAC/HBAC PreparationTVL Blog: VBAC MidwifeTVL Blog: Big BabiesHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have our friend, Brittany, today with us sharing her HBAC. If you have not been with us very long or are still unsure about all of the crazy terms in the VBAC world, HBAC is home birth after Cesarean but she is a home birth after two Cesareans so HBA2C so similar to what I am. I am a VBAC but I was in a birth center, not a home. I'm so excited to share– well, I'm not going to be sharing it, but she is sharing it today so welcome, Brittany. Thank you so much for being here with us. Brittany: Thank you so much for having me. I'm excited to get to share my story. Meagan: Absolutely. Me too. We will get right into that. I'm just going to do a quick review then we will do our intro and we will dive right in. This review was left by Brianna Moody and this was left in 2023 and it says, “So binge-worthy.” Okay seriously, I could not agree already with her because I feel like this is the type of podcast that when you are looking for your options for birth after Cesarean, you just want to hear every story and I get into those binges especially with podcasts so I could not agree more. I believe that this podcast is bingeworthy. It says, “I found The VBAC Link Podcast in my second trimester after my midwife suggested that I start listening to positive stories to get in a good headspace as I prepared for my VBAC.” Okay, I also love that her midwife is suggesting that. I 100% agree there as well. It says, “What I didn't expect was to hear so many different types of birth stories in one place. I was floored by the amount of information in each episode and by how much these stories impacted me. I found that I love listening to all of the different stories, even the CBAC stories. Honestly, I think those helped me process some of my fear about potentially having a CBAC.” Okay CBAC, Cesarean birth after a Cesarean, just want to make sure we know what that means. It says, “--as could be something that could still be beautiful and empowering. I tell everyone I know about the podcast, even first-time moms because there is truly something that could benefit every birthing mama on here. I am so happy to say that I had my VBAC baby in January.” Ah, so amazing. Congratulations, Brianna Moody. It says, “--in January and it was the most beautiful experience. I still cannot believe I really did it. I took so many things from the podcast that helped make it possible. Thank you so much for sharing your heart and passion for VBAC with the world.”Okay, I'm obsessed with this review. So many amazing things right here. Yes, binge the podcast. You're going to learn so many incredible things, like so many. Every story, just like she said, has its similarities but also it's very different. That's something that I love about birth then I love that she pointed out that CBAC could even be viewed as beautiful and empowering. I love that because I want you to know, Women of Strength, VBAC doesn't have to be the right answer. If it's not feeling right for you, that's okay. You can go and have a Cesarean birth and it can be absolutely beautiful. Know that it's an option to do both and you can still have a beautiful, empowering experience. Okay, all right. I'm going to let you guys go. We're going to get to the intro and then we're going to dive into Brittany's HBAC after two Cesareans. Meagan: All right, Brittany. A long intro. It's time for you to share with us your beautiful stories. Brittany: Yes, thank you. Okay. So I'm going to start at the beginning and give a little brief overview of my history and kind of what led me to pursuing an HBAC after two C-sections. In 2019, I had my first pregnancy and I was actually pregnant with twins so that was a big, exciting thing for us. It was very unexpected and overall, I had a pretty normal pregnancy. I didn't really have a whole lot of issues until the end. My blood pressure started to creep up here and there and then at 33 weeks, I went in for an appointment and I was diagnosed with preeclampsia. That was very overwhelming. I did not have a lot of knowledge about birth really in general. I was one of those who went in and just trusted everything my OB said. I just rolled with it and they looked at us and they said, “We need to admit you. Your blood pressure is too high. You have protein in your urine.” So my husband and I went over to the hospital immediately following and realized that we were going to be staying there for a little bit. They were able to manage my blood pressure for about a week and then I needed to deliver the twins at about 34 and 1. So it was actually July 5th, so it was right after the 4th of July and it was hard. It was definitely a hard, all of a sudden transition that we weren't expecting. We were thrown into the hospital. My husband had to come out of work and things just continued to get worse. At 34+1, we did another ultrasound and both were breech like they had been the entire pregnancy so we really were not given any options besides a scheduled C-section. I didn't really think twice about that. I just thought, “Okay. This is what you do. We have breech babies. We need to do it.” So at 34+1 on July 5th, I went in for my scheduled C-section. I had the twins and obviously, being born early, they were taken to the NICU so it was a very abnormal experience in the sense that I had these babies. My body knew I had just had babies, but the babies were taken from me. They were instantly taken from me and I had to go back on magnesium for my blood pressure post-C-section so I actually did not even get to see my babies, hold my babies, or touch my babies until about 36 hours later. So it was just a very abnormal experience, especially for a first-time mom. I got wheeled to recovery and they were like, “Here's a breast pump. You need to start pumping.” It was all of these things that I just wasn't prepared for and I hadn't done before. It was such a new experience. Thankfully, they were only in the NICU for 10 days, but as you can imagine, recovering from a C-section, going back and forth to the hospital, trying to figure out pumping and how often to pump. It was just a lot. It was a lot and it was very unnatural. It is just not a natural experience to be separated from your baby or babies after they are born, but we made it and we got through that trial. We were very, very, very lucky that they got to come home together 10 days after being born. Meagan: Wow, 10 days? Brittany: Yes. A miracle within itself. Meagan: That is very fast. Yeah, that's great. Brittany: It was very fast. They were doing great. They were just considered those eaters and growers. They really didn't have any major issues. My son was on CPAP for maybe 48 hours but after that, they were just learning how to eat and grow and they got to come home together which is also very rare for twins. Meagan: That's awesome. Brittany: Yes. We were very thankful for that. Following that pregnancy, we got pregnant again unexpectedly when the twins were only 9 months old. As you can imagine, that is a lot. That was in 2020 and it was right in the thick of COVID. Things were different. Things were crazy. They weren't even really, at least at the practice I was at, allowing women to come in for appointments until the second trimester. Just all of these different things. It was a lot. It was a lot to process that I was pregnant again. I was wondering if I was pregnant with twins again. There were so many questions that I had and I just was not getting any answers or any support during that beginning period.So at about 13ish weeks, they finally allowed me to come in person and be seen in person. We were pregnant with just one which we were thankful for. It would have been a lot to have twins back to back. But I didn't have a significant amount more knowledge at this time. I knew a little bit more about birth. I knew I didn't want to have another C-section. I knew that there was something called a VBAC. I was hoping to be able to do that. I didn't want to have to go the same route, but I really didn't have much education. So we kind of just went with the flow. We were at a smaller hospital closer to us this time around and looking back, I would 100% say that my provider was VBAC tolerant, not VBAC supportive. I don't think that I could identify that at the time not having the knowledge and the resources, but definitely now, I can tell that they were very just VBAC tolerant. Meagan: Sorry to interrupt you, now looking back–Brittany: No, go ahead. meagan: I was going to say that at the time you weren't able to identify which is very, very, very common but now looking back, what were some of those very first signs? Is that what you were going into? brittany: Yes. We kept having conversations about can I have a VBAC. Do I have to have another C-section? It was like, We'll see. When we get closer, we'll see. We don't want to risk anything. It was a lot of the nonchalant I'm going to beat around the bush, but really, I'm probably going to pull the rug out from underneath you at the end. There were a couple of appointments where I left really discouraged and in tears like, I feel like this isn't going to happen. I don't understand. But again, I just didn't have the knowledge to really be able to question what they were saying. I just assumed that if this isn't going to work out, it's not going to work out because it's not safe or x, y, and z reasons. My pregnancy went on and of course, in the back of my mind, there was the concern of preeclampsia again because I had it with the twins, but I had no blood pressure issues. I had no issues with that pregnancy. Obviously, carrying a singleton compared to twins is very different and so we got towards the end and at about 38 weeks, they started talking about wanting to induce me. I was like, “Why are we doing this?” But again, I just didn't have the knowledge to really question their reasoning behind it. So they had actually scheduled me for an induction at 39 weeks. My husband and I left that appointment and we knew enough to know that we didn't feel good about it. We were like, “This just doesn't feel right. Something feels off about this. Why are we brushing this?” So when the time came, we actually canceled that induction and didn't show up. We went to just another regular appointment that following week and I was getting ready to go into my 40th week. They were okay with the fact that I had not done the induction, but they were really, really pressing an induction for 40 weeks which was a couple of days after. meagan: Which is also another red flag. brittany: Yes. Yes, very much so. Again, something I couldn't identify at the time besides the fact that I felt insecure about it. So we decided to do the 40-week induction and when we got there, we were going to start with a Foley bulb but it ended up that I was already 3 centimeters dilated. My body had made some good progress. I was already effaced, so they jumped right to the Pitocin induction. Because this was in the thick of COVID, there were no doulas allowed. I did have a discussion with my husband about potentially hiring a doula. I knew of doulas. I was like, I think this would probably be going for trying for a VBAC, but that was not an option. You had one support person allowed. That was it. My mom couldn't be there. Nobody could be there. No doulas could be there. It was just a really, really hard time in the hospital system. We did the best we could to prepare for what was to come but just did not have the education and the support that we needed going into the situation that we were going into. To make a very long story short, it was intervention after intervention after intervention after intervention. It was basically the definition of the cascade of interventions from Pitocin to epidurals to just everything in between.Thankfully, by morning, the induction started at about 6:00 PM, and by 9:00 PM, they were like, “Oh, we're going to have a baby. This is going to be before lunch.” I was almost 10 centimeters dilated so we were really excited about that We got to the pushing phase and things just didn't move. I mean, I was making very little progress and knowing and having the knowledge that I have now, I look back and realize there was very much a disconnect happening with my mind and body which I've seen happen in some other women sometimes when having epidurals. We pushed. I pushed for a total of about 5 hours. meagan: Wow. brittany: We did have some breaks in between. Yes. There was actually not an OB on the floor so it was with a nurse. She left to go home and the one that I was going to have was in the office, so they basically just let me keep at it and the nurse did try. I will give her credit in that she tried to get me into some different positions, but we just could not make any progress with her and we did know when my water broke that there was some meconium in my fluid so we knew that that was there and that we needed to be aware of it.But after about 5 hours, we were exhausted. It was like, “What is going on? Do we need to make some decisions? Why can't we get an OB over here?” So finally, the OB I guess had finished her shift across the way in the office and made her way over. At that point, it was about 6:00 PM. It had been a very, very long afternoon and she came in and she did an assessment and she said, “There is a lot of meconium, so we need to make a decision. We either need to get this baby out with a vacuum or we take you back for a C-section.”I was like, “Well, what's a vacuum?” We had no knowledge of what that was or what the pros and the cons were. They literally brought in a pamphlet and were like, “Here's a pamphlet to read about it.” meagan: They didn't just tell you all of the pros and cons right there? brittany: No. meagan: They gave you a pamphlet after 5 hours of pushing and feeling exhausted? brittany: Yes. They gave one to us. meagan: I'm sorry, but that's silly. brittany: It's terrible. Yeah, it's terrible because I was in no head space. I was just beyond exhausted. She said, “I'm going to give you about 30 minutes and we are going to prep the OR. When I come back, let me know what you want to do and we can try the vacuum or we can go back for a C-section.” I was like, “Okay.” My husband and I are talking through this and really have no idea what to do. Reading a pamphlet in that time and place is just not okay and not adequate. So she came back in and she gave me another assessment and she said, “Okay, I'm really sorry but we need to go back for a C-section right now. Meconium is very thick and this is becoming very problematic.” She took the vacuum option off the table and said, “We need to go and we need to go now.” So we went back for what I consider more of just an urgent C-section, not an emergent C-section and it was an experience. About halfway through, I started to feel what I felt like was way too much. They actually did end up putting me to sleep fully after she was born. meagan: After she was born?  brittany: She came out, and she actually– after she was born. So when she was born, she didn't cry. I panicked about that and my husband was like, “It's okay. It's okay,” and we found out that she did have a lot of meconium and she did need to be resuscitated. She actually had an APGAR score of 2 which was much, much less than my twins who were born at 34 weeks so thankfully, they got that addressed very quickly and by that 5-minute mark, the APGAR score was back up to an 8, but at that point, I told them, “I am feeling way too much of what you are doing to sew me back up.” I started to really panic. My pain level was very high so I saw her briefly and then they took her to the NICU and then they actually ended up just putting me to sleep because I woke up back in recovery following. She was a 9-pound, 2-ounce baby. They very much threw the label of big baby, this is why you couldn't push her out. She was stuck, and things of that nature. She was sent to the NICU again. She was my third NICU baby. This is my third baby that I haven't held or touched post-delivery. Just a weird, weird experience. So this C-section was much, much more challenging for me than my first. Obviously, I had labored down for many hours. I had pushed for many hours and then went into a C-section which makes a huge difference but I also had an infection post-birth which one of the OBs said was probably from the numerous amount of cervical checks that they gave me after my water broke. So I just had a really, really hard time. I went into postpartum already struggling. I was struggling before I even had left the hospital. Thankfully, our little girl only had to stay in the NICU one night. She was able to be with me the second night and then was able to come home with us, but still, it was just a very abnormal situation where you wake up from the surgery. You just had a baby. Your hormones are all over the place but your baby is not there. You are in pain. It was just a very unnatural situation. I really went into postpartum already a few steps behind. I just was really struggling physically. I dealt with a lot more pain this go around and mentally, I struggled a lot emotionally. I didn't know it until later on, but I really believe that it's healthy to grieve a birth that doesn't go the way that you had maybe envisioned or planned and that's such a healthy thing to do. It felt so silly to me at the time. You're like, Okay. My baby's healthy. My baby's here. Why can't I get this together? But really, it's so much more than that. I know so many people will say, “But we have a healthy baby,” which is what you want and is so great. It is not the only thing that matters though and I think so many people, so many women don't realize that. People mean so well. Family and friends come in and say, “Oh, but thank God the baby's okay.” Yes, of course, thank God the baby is okay, but it's not the only thing that matters. You essentially have a grieving mom in the thick of postpartum who also just had a major surgery, so it was a lot. It was a lot. It was honestly a really miserable postpartum recovery for me and I also had twins who were 17 months old. It was just a lot. So at my 6-week visit, the OB who did my C-section said, “Okay. That's it. It will be C-sections from here on out. VBAC is off the table. You just need to know that.” I left that appointment and I actually remember texting my cousin just about it and I was like, “Okay, I guess that makes sense. I've had two C-sections.” Then weeks following, I just was more and more unsettled with that. I really was grieving the whole situation. I was grieving the fact that I had three babies and somehow hadn't gotten to hold one of them after delivery. It was all of these emotions that I was trying to process and through that, I became very obsessed with birth like, I need to understand. I need to know. I need to educate myself and I want to know as best I can what happened in Lyla's birth. How did we end up here? I really began to educate myself. I delved into all of the things. A few months later, I really felt the Lord calling me to pursue becoming a doula. I mean, we had three kids under two-years-old, so it was crazy to think about taking anything else on, but I remember it was that following July, I went to my husband and I was like, “Listen. I know this is crazy. I know we have so much on our plate, but I really, really feel like the Lord is calling me to pursue becoming a doula so that I can help educate and empower other women and hopefully help them avoid being in the same situation that I was.” He, being the man that he is, was like, “I think you would be great.” He was like, “I'm totally supportive. I'm totally on board.” So then that started my journey of becoming a doula and it was about a year where I went through my program. I worked with those first initial moms. I did all of those things and I really, really loved it. Then I found out I was pregnant again and that was January of 2022. I knew for sure I needed and wanted a different situation. I could not walk through the same scenario that I walked through, especially with my second daughter and I wanted things to be different. I really had home birth on my heart and where I live, I live near Charlotte, North Carolina, there was actually only one hospital that would allow you to pursue a VBAC after two C-sections. meagan: Really? brittany: All of the other hospitals will not, yes. So I started to pursue home birth but then also thought, Maybe I'll do co-care because then I will have something lined up if something does go wrong, blah blah blah. So I tried to get into that hospital with their OB/GYNs and at all three of their locations, they were not accepting new patients. Initially, I was very discouraged. I remember crying that day, texting my husband, What are we going to do? This is the only hospital that will even allow this and that will even potentially let me come in and try. He very simply said, “The Lord closed that door to co-care. Focus on home birth. That's where your heart has been.” At the time, that overwhelmed me, but looking back, it was one of the best decisions and I'm so thankful for it. I do believe there is a time and place for co-care for certain women, absolutely, who want to do home birth but want to have that co-care piece, but for me, looking back, I think co-care would have destroyed me mentally just with all of the appointments, all of the extra things being said even though I knew and had that VBAC knowledge. It's hard when you are constantly getting little bugs in your ear of, “You shouldn't do this. We need to induce,” or things like that so in the end I was very thankful for that. I simply pursued home birth. I interviewed a lot of midwives and I ended up with, I'm very biased but, who I think is just the best midwife ever. She's really, really awesome and received just such amazing care. My visits were an hour long. It was very proactive care trying to stay ahead of things that could come up just with nutrition and supplements and things like that. So I hired my team, my midwife. I hired a doula because I told my husband, I said, “I know I am a doula but I also know what happens when you are in labor.” I said, “Everything goes out the window and you go to labor land.” I said, “I want somebody there who I know can be my brain and can help me with all of the things when I can't think straight.” He was super supportive of that and I hired a really awesome doula. So once I had my team in place, I felt really, really good about it moving forward. My husband was so extremely supportive. He's one of those where anybody who is a doula, their husband is extra educated at birth. I feel like he has to listen to all of my stuff all of the time, but he was so supportive. At that point, I had a really standard pregnancy. The biggest things that I did were to continue, I used The VBAC Link a lot just whenever that doubt crept in my mind of Am I making the right choice? Is VBAC after two C-sections really safe?” I would go back to some of those resources that you guys put out. That knowledge that I had just to read through again to give myself that sense of peace that I made again. I listened to every VBAC after multiple C-section podcast that you have and really tried to focus on those positive birth stories. The biggest thing I did was that I really made the effort to protect my mental health meaning we kept the decision we made very, very private from family and friends which was hard because everybody, especially after my last experience was like, “Where are you giving birth? What is the plan?” But I knew that I didn't need the opinions of everybody. I didn't have the time or energy to educate everybody around me in the decision that I had made. My husband, myself, and our birth team were confident in the decision that I had made in moving forward so we just kept it very private. My best friend and my sister-in-law knew and they were my support throughout then once we got toward the end and I reached that full-term mark of 37 weeks, we did tell all of our parents because we wanted our parents to know. My mom was going to be there and his mom was going to come at some point. Thankfully, our family was very supportive. My mom used to be a labor and delivery nurse so she had a lot of questions, but my midwife sat down with her and let her ask all of them. So our family was on board, but I really just made the point to protect my mental health and only view and read things that were positive and only talk to people who I knew were going to be encouraging and positive about it. That was truly one of the best decisions I made throughout my pregnancy. Fast forward, we get to 39 weeks and 4 days. I thought for sure that I was going to go over 40. With that doula mindset, I always tell my clients, “Prepare to go over 40 weeks so that mentally you're not distraught when 40 weeks comes.” Oh man, I was like, “It's going to be over 40.” I was so secure in that that when it happened, I was not ready almost. I was a little overwhelmed like, “Oh my gosh. I'm not 40 weeks yet though.” I'm 39 and 4. We had actually went out with some friends that morning. We took our kids somewhere and my mom was there. I remember my mom putting us back in the car. She got all emotional and she was like, “I just feel like it's going to be so soon.” I was so frustrated I remember because I was like, “No, mom. I'm not 40 weeks. It's fine.” She's like, “Call me as soon as something happens.” I'm like, “Mom, we have time.” Little did I know I was going to have a baby that night. Later that afternoon, I decided, I need to go to Costco. I need to stock up. My best friend was like, “You are crazy to go to Costco on a Saturday. That is going to put you into labor.” Sure enough, that is exactly what it did. I went to Costco and got everything I needed. I ran into Target and my first contraction started. I had Braxton Hicks most of my third trimester so I was very aware that this was different the first time it happened. But again, that doula mind, I was like, This could be nothing. I'm just going to ignore it. We're going to continue on. They kept coming as I finished my shopping about every 10-15 minutes apart so when I left, I decided to text my husband and say, “Hey, this could be nothing but just so you know, I've had some contractions. They are about 10-15 minutes apart. We'll see what happens.” They had started at 6:00 PM when I was out. I finished up getting when I needed, came home. My girls were already asleep on the couch and my husband put them to bed. We ate dinner. My son hung out with us for a little bit and things continued to pick up. I was like, Okay, this is definitely happening I think. At about 7:00, I alerted my midwife just to let her know, “Hey, it's probably going to be a long night, but I'm definitely having contractions.” I let my doula know and our photographer. I got everybody in the loop. After I ate, I was like, “I'm going to get in the bath with some Epsom salt and try and relax. See if I can relax these contractions enough to maybe get some rest.” In my mind, I was like, This is going to be an all-night thing. Let's see if I can get some sleep. But that is not what happened. I got in the bath for maybe 10 minutes. I had a few contractions and was like, I cannot sit like this. This is not comfortable. I called my mom and I was like, “Hey, I'm having contractions. Don't worry about coming over yet though. We've still got plenty of time.” Thankfully, she ignored me because she was about 50 minutes away at the time. She ignored me and got in the car and came anyway which was a huge blessing because things continued to pick up really quickly. My husband continued to set our room up and the birth pool up but also tried to support me through contractions. Thankfully, all of our kiddos at this point were asleep upstairs which was something we had just prayed about because I wanted them close by, but I also knew that I just needed my space especially with them being so young. So that was such a blessing. They were all asleep. It was just me and my husband. So around 9:00 PM, my mom thankfully arrived which was a blessing because moments before, I was like, “Okay, you need to tell my mom to come,” because things were just moving really, really quickly. I particularly found a lot of relief in one position and that was the position I wanted to stay in. I was on all fours on the ground rocking back and forth on my yoga ball and everybody said, “Hey, try this. Try this.” I was like, “Nope. This is what's working for me. I just want to continue doing this,” so that's what I did for a long while. Shortly after my mom got there, we called my doula to tell her to go ahead and come because she was about 45-50 minutes away as well. With that phone call, she was able to tell because I had prior talked to her as well that things had definitely picked up. We were definitely probably in full-blown active labor. She had told my husband, “Go ahead and start filling the birth pool,” because anybody who has had a birth pool knows that it can take some time. He went ahead and started to fill the birth pool while my mom stayed by me, helped support me, and my doula left and was on her way. Shortly after that, my water broke. A lot of pressure, a lot of pressure, then my water broke. I remember being so panicked telling my mom, “Please check for meconium,” because I just kept thinking about Lyla and the situation that I had with my prior daughter. I said, “Check for meconium. Check for meconium.” She looked and everything looked fine. Following my water breaking, I moved right into transition. It was game on at that point. My husband called my midwife. He said, “Okay. We definitely need you to leave and come.” Thankfully, he had gotten the pool all ready so the pool was ready. Warm water was in. I was able to get in and that was about 10:45 PM. I was able to labor through transition in the water which was a huge blessing. I'm one of those who loves to be in the water. I love to be in the bath. I find it to be very relaxing. I remember at this point telling my mom, “I feel like I'm getting no breaks.” I still at the time did not know I was in transition. Looking back, I was very easily able to identify the phases, but when you are in it, even having that knowledge, you're like, “No. There's no way. This is going to go all night. How am I going to do this? I'm not getting any breaks.” But I had so much great support and my doula arrived not long after I got in the pool. She was doing some counterpressure and giving my husband some things to do to help. I have a lot of tension in my face so giving him some suggestions of things he could do. Not long after getting in the pool, that fetal ejection reflex definitely kicked in. I had heard obviously people talking about it. I had studied it in my work becoming a doula, but until you really experience it, you're like, Wow, this is no joke. People are like, “How am I going to know when to push?” Oh, you will know. Your body is going to do it whether or not you want it. That is exactly what happened. My body was doing these little pushes without me even doing anything. Soon after, I started to really lean into that and continue with that pushing. I remember feeling such relief when I got to the pushing phase because it was very challenging. It was giving me that purpose through contractions and something I could focus on. I actually got a little bit of relief when I was doing some of the pushing. I remember being really thankful for that. My photographer arrived. My mother-in-law arrived during that time and my midwife team got there at about 11:15. I already started pushing a little bit, but I remember although yes, it's challenging to not have an epidural, it was also so amazing because having had the experience of Lyla where I pushed for 5 hours and they were like, “Well, she's not moving. She's in a bad position. She's stuck.” I could feel nothing. I could feel everything. I could feel the progress of my baby being moved down frequently during pushes. I could feel her in the birth canal. I could almost feel the progress I was making at different times with her which was so motivating and so helpful for me. That was just such a night and day experience from my prior experience pushing with Lyla and then after about an hour and 15 minutes give or take a little bit, my daughter, Charlie, made her way into the world. It was about 12:25 AM and it was a beautiful, beautiful, beautiful experience. She was born in the water. Literally, my overwhelm of emotions following was like nothing I could ever really articulate in words. The oxytocin was on full blast. I was on this birth high and having had prior C-sections, one of the downfalls of a C-section is that you are on so much medication and so many pain meds that I always felt like when I came out, I was in a haze like I didn't really know where I was and things like that so to be so present and to literally feel my hormones doing what they were designed to do was such an overwhelming experience. I remember talking to my husband about that days later and I was like, “It was just such a high after she was born.” This was obviously my first experience getting to hold the baby post-birth so that was very emotional for me getting to pull her up to me and have her right there and just be able to hold her. My husband was there and people who we loved most were just surrounding us. It was a very, very beautiful, overwhelmingly positive experience. One of the benefits of home birth is that you get to move from the pool or wherever you gave birth to get comfortable in your bed. So that was just awesome. I remember when they got me comfortable in my bed, I was looking at my birth affirmations wall. I had a bunch of stuff hanging up by the pool and I remember thinking, “Oh my gosh. Thank God that's done. that was the hardest thing I've ever done,” then a minute later, I was like, “I feel like I'm going to have to do this again.” I was so overwhelmed with the experience and the emotions. My husband and I got to lay in bed. We got to cuddle our girl and pray over her. Everybody was so great. They were cleaning everything up. My mother-in-law was making food for everybody. It was just such a beautiful experience. Then about an hour into it, we decided to do just her newborn checks and have the midwife look her over, weigh her, and stuff. We knew she was big. There was no denying it when she came out, but never once did I look at her and be like, “Gosh, she's a giant baby. She's so much bigger than Lyla,” or anything like that.We weighed her and everybody made their guesses. She ended up being 10 pounds, 10 ounces, and 22 inches long. The 9-pound, 2-ounce baby that they said I could never push out and could never have had her vaginally, I ended up going on to have a 10-pound, 10-ounce baby girl. She also had a nuchal hand. Her hand was up at her face when she was born which can make things a little bit more challenging, but I delivered her and I had no tearing. It was just such an amazing redemptive story after being told, “You never could have birthed this 9-pound baby. You're never going to have a vaginal birth. The door is closed for you,” and really have the exact opposite happen. I went on to have a much larger baby and she was great. She was healthy and had no issues. My children were just thrilled the next morning to wake up and come and meet her. To this day, they will still bring it up. “Do you remember when Gigi brought us downstairs and we had a new baby?” It was such a beautiful, redeeming story for all of us, my husband included. I think sometimes we forget how much of an emotional experience it can be for the dads and especially to see their wives go through so much so it was just so healing for both of us. It was just such a beautiful experience. I feel like I could go on and on about it. I had the best postpartum care. For those who aren't familiar, with a home birth, your midwife comes to see you multiple times. Mine came to see me six times. She came at 24 hours, 48 hours, 72 hours, one week, and two weeks, so she was constantly there checking on me, checking on my baby girl, and it was just care like no other. All I had known was I had major abdominal surgery then 6 months later, they brought me in and were like, “You're cleared for everything.” It was so overwhelming and this go around, I had somebody who was like, “How are you doing mentally? How are your emotions? How are things healing? How is your nutrition? Are you resting?” All of these things are so, so important for postpartum, and I think so many women don't even realize these things about what postpartum should really look like. I will forever be thankful for that care as well. That was just unlike anything I had prior experienced obviously as well. So yeah. I mean, overall, it was such a beautiful experience. I'm so thankful for how it played out. The Lord had answered so many of our prayers throughout and I'm so, so thankful to my midwife who believed in me and in my body's ability to birth my baby no matter the size and that team of people who I had, I will forever be grateful. Meagan: Are you willing to share your midwife with those in your area who might be feeling restricted because of the lack of support in your area?Brittany: Yes. I will say I had a certified professional midwife. I live in North Carolina. I live outside the Charlotte area in Monroe. We are very lucky. We have such a fantastic group of midwives in the Charlotte area of certified professional midwives. There are truly multiple great midwives. My midwife's name is Brooke. She is just the best of the best. She is a dear friend of mine and I have been really lucky as a doula to get to work with some of her clients and still see her at births and things following. If you are in the Charlotte area and you are considering home birth, things can be a little bit hairy because we do have some restrictions in regards to certified nurse midwives compared to certified professional midwives, but feel free. I think in the show notes, my information will be there. I would be so, so happy to help guide anybody in this area and give you a list of names of some really, really great providers who support VBAC or VBAC after multiple Cesareans because it can be a hard world to navigate whether you are in the hospital system or planning a home birth. It still can be really hard to navigate if you don't know where to look. Meagan: And can people find you somewhere if they have any questions they can write you to on your own doula page? Brittany: Yes. Yes. You can find me at Joyful Beginnings Doula Care. You can find me on Facebook and Instagram. I also have a website at joyfulbeginningsdoulacare.com. Please feel free. I love nothing more than helping guide moms in finding that right support and then also obviously, I love working with VBAC moms as a doula. But you can find me there. Feel free to reach out. I love doing whatever I can to just help other women have more positive experiences especially when it comes to VBAC because that's really, really hard sometimes. Meagan: Absolutely. It is. It's hard and it's frustrating that it's hard so it really takes a village to find the right support. Let me tell you. I've been taking little notes along the journey of your story and there are so many things.One, you had a preterm Cesarean so that's a thing and we don't even have time to go through all of these things so while she was sharing, I was like, “Ope, we have a link for that. Oh, we have a blog for that.” We have so many blogs. We have all of it. I already sent it off to our amazing transcriber, Paige, who will make sure that this is all in the show notes. But preterm Cesarean, then a close duration between Cesarean and her TOLAC that ended in a CBAC. Talking about red flags in finding the right provider, processing the birth, and co-care– I wanted to explain for anyone who didn't know what co-care means. I love that you pointed out to the fact that it's really, really great for some people and it's not great for others. I think that if you're interested in co-care or if you are interested in it, you need to tap into you as an individual and the type of place that you're in because co-care can be amazing and it can be tricky because of what Brittany said where you can go and you can be getting this information from a hospital and then this information from your home birth midwife or your birth center midwife and they are not the same. They can pull your mind out of a very positive space and start putting a lot of doubt and questions. So if you're going to do co-care, I think it's super important no matter what, but you really, really need to know your facts because it's going to be important and it will likely come into play where someone might say something and it's the opposite of what the other professional is saying so you need to know what the evidence is. Big baby– I'm going to include a blog about big baby if you are being told that you have a big baby or if like Brittany, you were told that you would never, ever get a baby out of your pelvis because your babies are too large and it was a whole pound plus bigger baby for her VBAC. Oh my gosh, what else? I love that you also talked about something that is so unique to home birth in my opinion and I just wanted to touch on it really fast. That is the care after. Here in the U.S. and I know that if you are not listening from the U.S., it's very different outside of the U.S. Here in the U.S., it is very standard to have the type of care like what Brittany described even with a Cesarean. It's an abdominal surgery. It's a pretty big deal to have surgery or to have a baby vaginally and to not be seen, called, or asked anything for six weeks. Six weeks– let me tell you how much can happen in six weeks. A lot can happen. I love the uniqueness that home birth does offer and I love that you even felt that and that you saw it yourself. You saw the difference of 24 hours, 72 hours. You're getting those mental checks. You're getting, “How are you sleeping? How are you eating? Where are you at? What are you doing?” We're getting those check-ins. It is so important. It is so important. So if you are birthing at a hospital and you are likely going to be in the traditional line of the six-week follow-up, I highly suggest with checking in with a postpartum doula or getting someone who is a professional that can check in on you– a therapist even if you have gone through therapy. Have a 72-hour checkup with your therapist after birth. If that means you just talk and you're like, “All things are peachy. Great.” There are things in the U.S. that we have to do where we, unfortunately, have to take it upon ourselves to take care of our mental health because it's just not the way the standard care is. I'm going to leave it at that. Brittany is shaking her head. She's like, “Mhmm, yeah.” Do you have anything to add to that? Brittany: The only thing I would add to piggyback off of that especially if you are a VBAC mom, take the time. Do the research. Reach out to a local doula who you know is VBAC supportive if you need extra help doing this but take the time to find a provider who is supportive and not tolerant because your providers and your birth team, the people you are allowing into your birth space, can truly make or break your birth experience. I have witnessed it. I have experienced it so do your due diligence on the front end. It is not always easy, especially navigating the hospital system, but there are people out there. A lot of local doulas do know, “Hey, I've had a lot of great experiences with this OB/GYN when it comes to VBAC”, or “Hey, stay away from this practice.” Do your due diligence. Find a team who really believes in your body's ability to birth your baby vaginally. They need to believe in it as much as you do and just take the time to educate yourself. I believe that education is the key to empowerment. That's such a big piece of the work that I do with my moms leading up to birth with both birth and postpartum but take that time. Educate yourself. Find a team who believes as much as you do in your VBAC. Meagan: I am just going to leave it right there because I think that is a nice way to zip it right up and complete this beautiful episode. Thank you so much for sharing. Congratulations. I love so much that your kids still talk about, “Remember how she brought us downstairs?” So awesome. I'm so happy for all of you and congrats again. Brittany: Thank you so much for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands