Podcasts about uterine

Click here to send me a quick message :) Holy mama! This week is monumental and I want to honor it with you because this podcast would be nothing without the community of thousands of listeners who have tuned in over time. THANK YOU.Today marks episode 200!! So I decided to craft a simple episode highlighting the power of celebration -- to embody the practice of celebrating (including 2 of my biggest celebrations from this podcast journey) and invite you to join me in this podcast party too.A lot of times we associate the buoyancy of summer with joy and celebration. But ancestral traditions across cultures also come together in the darkest nights of the year to find and bring the light into the darkness, often together, often in celebration. So, while this time of the year has a very different quality than bright summer days, it is an entirely appropriate time to tune into quiet reflection and receptivity AS you are also finding the guiding light and celebration.So please join me in celebrating Herbal Womb Wisdom's 200th episode!! In whatever ways feel great for you.Resources:Today's shownotes: The medicine of celebrationJoin the waitlist: Natural Contraception, The Herbal WayEpisode 19: Pelvic liberation and softening w Chaya Leia AronsonEpisode 61: Pelvic wisdom - healing trauma w Dr Emily WilsonEpisode 77: Myofascial release for pelvis + chest w Lindsay CourcelleEpisode 119: Clearing womb trauma w Dr Sarah WylieEpisode 141: Uterine unwinding w Dr Kathryn KloosEpisode 192: Pleasure as medicine w Dr Emily WilsonIf you loved this episode, share it with a friend, or take a screenshot and share on social media and tag me @herbalwombwisdom.  And if you love this podcast, leave a rating & write a review! It's really helpful to get the show to more amazing humans like you.  ❤️DISCLAIMER: This podcast is for educational purposes only, I am not providing any medical advice, I am not a medical practitioner, I'm an herbalist and in the US, there is no path to licensure for herbalists, so my role is as an herbal educator. Please do your own research and consult your healthcare provider for any personal health concerns.Support the show

Join Dr. Karen Berken, OB-GYN with Willis-Knighton Women's Health Associates, as she discusses innovations in women's reproductive health. She explains hysteroscopic uterine surgery, cervical procedures, and the importance of HPV and Pap screenings for early detection and prevention. A must-listen for anyone interested in women's health and wellness.

Uterine fibroids explained Guest Bio Dr. John Lipman, MD, is the Founder and Medical Director of the Atlanta Fibroid Center, a state-of-the-art medical facility that specializes in the nonsurgical treatment of uterine fibroids and has cared for women from throughout the world.

On today's episode of The Wholesome Fertility Podcast, Michelle dives into one of the most emotionally challenging topics on the fertility journey,  repeated miscarriages and failed embryo transfers. While these experiences can feel devastating, Michelle explains that they're not always inevitable. With the right testing and deeper understanding of hidden factors like thyroid health, uterine microbiome, immune responses, and even sperm compatibility, many pregnancy losses and failed transfers can actually be prevented. This episode sheds light on overlooked tests, lifestyle changes, and integrative approaches that can make all the difference in achieving a healthy pregnancy. If you've been through multiple losses or are preparing for a transfer, this conversation is filled with empowering insights and practical next steps that could change your path forward. Key Takeaways: Discover why thyroid imbalances and undiagnosed autoimmune issues can silently sabotage implantation. Learn how the uterine microbiome and inflammation might be the missing piece in your fertility journey. Find out which antioxidant-rich supplements and lifestyle shifts can boost egg and sperm quality. Understand how immune or clotting factors can interfere with pregnancy — and what tests can uncover them. Explore how emotional healing and nervous system regulation can prepare your body to receive new life. Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care. Join me inside The Wholesome Fertility Collective. https://www.michelleoravitz.com/thewholesomefertilitycollective  Vaginal Microbiome test: https://www.fertilysis.com Use coupon code WHOLESOMEFERTILITY Ready to discover what your body needs most on your fertility journey? Take the personalized quiz inside The Wholesome Fertility Journey and get tailored resources to meet you exactly where you are:  https://www.michelleoravitz.com/the-wholesome-fertility-journey For more about my work and offerings, visit: www.michelleoravitz.com Curious about ancient wisdom for fertility? Grab my book The Way of Fertility: https://www.michelleoravitz.com/thewayoffertility Join the Wholesome Fertility Facebook Group for free resources & community support: https://www.facebook.com/groups/2149554308396504/ Connect with me on social: Instagram: @thewholesomelotusfertilityFacebook: The Wholesome Lotus

Uterine fibroids explained Myomectomy and hysterectomy are two common surgical options presented to women with uterine fibroids, but a less invasive alternative is often overlooked. In this Live Foreverish episode, Dr. Mike and Dr. Crystal sit down with Dr. John Lipman to discuss the uterine fibroid embolism procedure and how it is transforming women's lives. #LELEARN #EDULFsocial Guest Bio Dr. John Lipman, MD, is the Founder and Medical Director of the Atlanta Fibroid Center, a state-of-the-art medical facility that specializes in the nonsurgical treatment of uterine fibroids and has cared for women from throughout the world.

Infertility isn't always about age or hormones—sometimes the real culprits are hidden, silent root causes that standard medicine rarely investigates. In this powerful conversation, we explore the cutting-edge research and clinical insights that are changing the way we understand fertility struggles and recurrent pregnancy loss.Joining me on this episode is Dr. Natalie Underberg, a leading voice in functional medicine, women's health, and fertility. She runs her own private practice, and she is also the founder of FIG Wellness, a faith-based supplement company known for its science-backed formulations and their leading HIS&HERS prenatal vitamins — world-class products that feature industry-leading doses of crucial nutrients like 900 mg of choline, setting a new standard in perinatal nutrition and were formulated specifically by Dr. Natalie and her husban,d Dr. Jake.Dr. Natalie has helped hundreds of couples achieve natural pregnancies by uncovering and addressing the root causes of hormonal imbalances, PCOS, gut dysfunction, and recurrent pregnancy loss. She is also the creator of The PCOS Collective and The Pregnancy Prep Academy — educational programs designed to empower women to take control of their health and fertility with personalized, root-cause care.Her work blends clinical expertise, real-life experience, and faith-centered guidance to support couples in stewarding their health and fertility naturally, without unnecessary medications or fertility procedures.

This episode discusses the varied etiologies and a basic workup for a common gynecologic complaint: abnormal uterine bleeding. (Originally released July 2019)  Twitter: @creogsovercoff1 Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee Visit www.acog.org to learn more about the CREOG National Residency Curriculum coming Fall 2025.

In this episode of The Birth Trauma Mama Podcast, Kayleigh sits down with Christine, a mom of four, to share her harrowing and powerful story of surviving a rare and life-threatening birth and postpartum experience.After being induced at 37 weeks for hypertension, Christine's delivery with her fourth son, Caden, started calmly, until everything changed. What followed was a series of medical emergencies including a cervical tear, uterine rupture, hemorrhage, and emergency exploratory surgery, followed by multiple re-hospitalizations and near-death experiences in the weeks after giving birth.Christine opens up about the long physical and emotional recovery that followed, from memory loss and PTSD to regaining her strength through pelvic floor physical therapy, and how her desire to understand what happened to her body led to deep reflection on communication gaps in healthcare.Together, Kayleigh and Christine explore:

Uterine cancers are common, serious, and still too quiet — it's time to speak louder. This episode examines public invisibility and stigma, what all women need to know about symptoms and self-advocacy, and the power of storytelling to influence policy, funding, and culture.Featuring lived experience voices from Shirley, Mina, Ann, Carley, Alex, Ali, Ruth and Jane, alongside expert insights from Professor Alison Brand AM, this episode amplifies patient voices and highlights the importance of advocacy. Let's break the silence — share this, fund this, and help drive change. 

Uterine fibroids (1:30), community-based residency training (6:40), glucagon-like peptide-1 medications (9:00), heart failure with preserved ejection fraction (12:30), intravenous vs oral iron (15:40), nicotine e-cigarettes for smoking cessation (18:10), and spooky health trends—are they real or fake? (20:10; music: Tocatta and Fugue in D Minor, Kevin MacLeod, CC-BY-3.0).

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Things get even darker, wetter, and more horrifying as our intrepid crew delve deeper into Qliphoth. Farnesse and Isidro gain some much needed confidence thanks to our old pal McGuts the Crime Struggler (80s kids will understand that obscure reference…maybe), and some very powerful beings emerge to both help and hinder our heroes: Slan, Skull Knight, and the essence of Darkness itself!

In this episode of The Birth Trauma Mama Podcast, we are joined by Angel, who shares her powerful story of birth, near-death, and healing after a rare and life-threatening complication: uterine inversion.Angel describes how her labor started smoothly and seemed “perfect" until the unexpected happened. What followed was a cascade of emergencies, including massive blood loss, emergency surgery, a hysterectomy, and days in critical care. Angel walks us through the terrifying moments of saying goodbye to her husband, the prayers she whispered before surgery, and the relief of waking up alive.But her story doesn't end at survival. Angel opens up about the aftermath, the postpartum depression she never expected, the shame of feeling broken despite being grateful, and the ongoing work of therapy, community, and healing.In this episode, Angel shares:

On The Down Low – Season 2: it's time to start talking about uterine cancersThe body often whispers before it screams — and recognising those early whispers can save lives. In this episode, we explore the importance of listening to symptoms like abnormal bleeding, and the role of risk factors such as obesity, hormones, lifestyle, and genetic predispositions including Lynch Syndrome. Through lived experience stories from Carly and Ruth, and expert insights from Professor Alison Brand AM, we uncover how prevention, risk assessment, and early diagnosis can change the future of uterine cancers.Know someone who needs to hear this? Share it, talk about it, and help break the silence around uterine cancers.Season 2 was produced by ANZGOG, with the generous support of GSK and Eisai.

Kimberly Peters, a stage four uterine cancer patient at UC San Diego Health, urges government leaders not to cut science funding. She warns that reduced federal support risks delaying vital research and life-saving cures. [Health and Medicine] [Show ID: 41071]

Kimberly Peters, a stage four uterine cancer patient at UC San Diego Health, urges government leaders not to cut science funding. She warns that reduced federal support risks delaying vital research and life-saving cures. [Health and Medicine] [Show ID: 41071]

Kimberly Peters, a stage four uterine cancer patient at UC San Diego Health, urges government leaders not to cut science funding. She warns that reduced federal support risks delaying vital research and life-saving cures. [Health and Medicine] [Show ID: 41071]

In this episode, Dr. Doug Waterman from Virtus Nutrition explains how management and nutritional strategies influence uterine involution and overall reproductive success in dairy cows. He discusses key factors like inflammation control, calving management, and omega-3 supplementation to improve cow health and future productivity. With today's high value on herd replacements and beef-on-dairy calves, every pregnancy matters more than ever—making proactive transition cow management essential. This episode is sponsored by Virtus Nutrition.

Kimberly Peters, a stage four uterine cancer patient at UC San Diego Health, urges government leaders not to cut science funding. She warns that reduced federal support risks delaying vital research and life-saving cures. [Health and Medicine] [Show ID: 41071]

Kimberly Peters, a stage four uterine cancer patient at UC San Diego Health, urges government leaders not to cut science funding. She warns that reduced federal support risks delaying vital research and life-saving cures. [Health and Medicine] [Show ID: 41071]

Study Discovers Increased Cancers After MRNA Vaccines, Bret Weinstein- Covid & mRNA: Harms and Damages Exposed Bret Weinstein- Covid & mRNA: Harms and Damages Exposed (NEW!) REMINDER: CDC Didn't Track VAERS Safety Signals John Campbell- Increased cancers after mRNA vaccines   Study- Covid & mRNA: Harms and Damages Exposed (NEW!) | DarkHorse https://youtu.be/zkrbZmYuRoY?si=_0yO0y5ftLacoVJ1 Bret Weinstein 512K subscribers 25,699 views Sep 5, 2025 A new article on the harms and hazards of both SARS-CoV2 and the mRNA biologics said to counter the virus. Full Episode: https://youtube.com/live/wQWkKrM3Dt8 Mentioned in this segment: Zywiec et al 2025. COVID-19 Injections: Harms and Damages, a Non-Exhaustive Conclusion. Journal of American Physicians and Surgeons, 30(3): https://jpands.org/vol30no3/zywiec.pdf ***** Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.com Heather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.com Our book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://amzn.to/3AGANGg (commission earned) Check out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org   REMINDER: CDC Didn't Track VAERS Safety Signals | DarkHorse https://youtu.be/u3UAyr6s7xc?si=VUoenskCyMdViArS Bret Weinstein 512K subscribers 16,906 views Sep 5, 2025 RFK Jr. fires the new director, after which other CDC officials resign, and eight former directors of the CDC pen a letter to the New York Times arguing that Kennedy is a hazard to our health. Bret Weinstein and Heather Heying discuss "The Plot Against Kennedy" in Episode 292 of The Evolutionary Lens. Full Episode: https://youtube.com/live/wQWkKrM3Dt8 Mentioned in this segment: NYT op-ed #2 from former CDC directors: We Ran the C.D.C.: Kennedy Is Endangering Every American's Health: https://www.nytimes.com/2025/09/01/op... Bret and Heather 132nd DarkHorse Podcast Livestream: 50 States not in a Roe https://youtube.com/live/usP2D_qGUZs CDC didn't monitor VAERS for COVID safety signals (June 2022): https://childrenshealthdefense.org/de...   Increased cancers after mRNA vaccines Watch this video at- https://youtu.be/3dnIGqUlluc?si=sDbAdXTgOsCiCLev Dr. John Campbell 3.25M subscribers 143,152 views Sep 5, 2025 COVID-19 vaccination, all-cause mortality, and hospitalization for cancer: 30-month cohort study in an Italian province https://pubmed.ncbi.nlm.nih.gov/40881... https://pmc.ncbi.nlm.nih.gov/articles... https://www.thefocalpoints.com/p/brea... The rate of first hospitalization for cancer of any site Unvaccinated group: 0.85% Vaccinated group (one or more doses): 1.15% N = 296,015 population Hospital admission with a cancer diagnosis, 3,124 (p less than 0.001). Vaccination with at least one dose Colon-rectal cancer HR: 1.34 Breast cancer HR: 1.54 Bladder cancer HR: 1.62 After three or more vaccine doses Breast cancer HR: 1.36 Bladder cancer HR: 1.43 All significant After one dose (180 days after) Rate of first hospital admissions for cancers All cancers: up 23% significant Colorectal: up 34% significant Lung: down = 10% Breast: up 54% significant Uterine: up = 75% Ovarian: up = 65% Prostate: up = 1% Bladder: up 62% significant Thyroid: up =58% Haematological: up = 33% After three dose (180 days after administration of third dose) All cancers: up = 9% Colorectal: up = 14% Lung: down = 5% Breast: up=36% significant Uterine: up = 20% Ovarian: up = 86% Prostate: down = 3% Bladder: up=43% significant Thyroid: down = 3% Haematological: up = 5% More about the study Population-wide cohort analysis Evaluating the risk of all-cause death and cancer hospitalization by SARS-CoV-2 immunization status. National Health System official data, entire population, Pescara province, Italy Followed from June 2021 (six months after the first vaccination) to December 2023. 296,015 residents aged ≥11 years Hospital admission with a cancer diagnosis, 3,124 16.6% were unvaccinated 83.3% received ≥1 dose 62.2% ≥3 doses. Compared with the unvaccinated, those receiving ≥1 dose showed a significantly lower likelihood of all-cause death Cancer hospitalization was significant only among the subjects with no previous SARS-CoV-2 infection Some cancer risks went down after 1 year (relative to 180 days) (But breast, ovarian and bladder went up at one year relative to 180 days after 1 vaccine dose) Given that it was not possible to quantify the potential impact of the healthy vaccinee bias and unmeasured confounders, these findings are inevitably preliminary.  

Did you know that you have bacteria in your uterus? And that the types of bacteria there may impact whether you get pregnant or not. We talk all about this and many other things we are discovering are impacting fertility with our guest, Dr. Jaclyn Smeaton. She is a fellow naturopathic doctor who has focused much of her career on fertility, and we can't wait to share this informative episode with you.This episode is sponsored by:Redmond Salt >> Click here and use code HEALTHYMOTHER to save 15% on your order.Needed >> Click here and use code HEALTHYMOTHER to save 20% off your first order.Lumebox >> Click here and use code HEALTHYASAMOTHER for $260 off.Resources From This Episode:DUTCH testWatch the video episode on YouTube HERE!Stay Connected With Us:Healthy As A Mother: www.healthyasamother.comInstagram: @healthyasamotherpodcastDr. Leah: www.womanhoodwellness.comInstagram: @drleahgordonDr. Morgan: www.milkmedicine.comInstagram: @morganmacdermottRedmond LifeRedmond Life | Real Salt & Clay | Re-Lyte Electrolyte Hydration PowderYour one stop shop for all things Redmond. We carry pure, natural sea salt and bentonite clay mined from an ancient salt deposit right here in Redmond, Utah. From Real Salt to Re-Lyte Hydration electrolyte mix, try one of our US-mined products today.needed.Radically better nutrition for fertility, pregnancy, and postpartum.Prenatal vitamins leave most women depleted, so we redesigned the Prenatal Multi from the ground-up, and paired it with the Omega-3 (DHA and EPA), Collagen Protein, and Pre/Probiotic that mamas need. Take them before, during, and after pregnancy (and while breastfeeding) for optimal prenatal and postpartum nourishment.LumeboxLUMEBOX discount linkDutch TestPrecision Analytical (DUTCH TEST) - Test Kits, Providers & PatientsExplore DUTCH Test kits for comprehensive hormone testing, provider resources, patient support, and educational webinars. Contact us for more information.

In this episode of The Dairy Nutrition Blackbelt Podcast, Dr. Doug Waterman from Virtus Nutrition explains how management and nutritional strategies influence uterine involution and overall reproductive success in dairy cows. He discusses key factors like inflammation control, calving management, and omega-3 supplementation to improve cow health and future productivity. Listen now on all major platforms!"Uterine involution typically occurs within 20 to 50 days, but various stressors can significantly extend this recovery period."Meet the guest: Dr. Doug Waterman, Eastern Technical Sales Director at Virtus Nutrition, LLC, brings over 30 years of experience in the dairy industry, specializing in nutrition and supporting field nutritionists. His expertise spans reproductive health, inflammation control, and optimizing cow performance through targeted nutritional strategies.Liked this one? Don't stop now — Here's what we think you'll love!Renee Smith: Omega-3 Benefits in Dairy Dr. Daniel Rico: Vitamin D3 & Omega-3 Effects on Cattle Stress - Part 1Dr. Daniel Rico: Omega-3 & Vitamin D3 for Cow Health - Part 2  What will you learn: (00:00) Highlight(01:39) Introduction(02:37) Uterine involution basics(04:19) Calving difficulties impact(05:09) Key management strategies(07:07) Inflammation and reproduction(08:47) Omega-3 research findings(11:02) Closing thoughtsThe Dairy Nutrition Blackbelt Podcast is trusted and supported by the innovative companies: Virtus Nutrition* Kemin* Afimilk* Adisseo* Priority IAC- Zinpro

In this episode, we dive into the latest research and practical strategies for managing uterine disease in dairy herds. This discussion highlights both challenges and opportunities in managing one of the most common issues affecting dairy cows.

Once a Cesarean , always a Cesarean - you must have also heard this common notion. Fortunately, this is far from truth. Yet , So many women feel cornered and helpless when they become pregnant again, like the decision has already been made for them. In this episode, we're getting real about that phrase and why it's not the whole story.We get into the  actual evidence and physiology behind uterine rupture — what it is, how likely it is (with facts, not fear), and why it's also something that can happen to first-time moms. We'll also share the real advantages of choosing a VBAC over a repeat C-section, and why VBAC is worth considering — even when the system in India is yet reluctant to support itAnd if you're feeling confused, overwhelmed, or unsure what to believe — we've got you. We'll walk you through what actually makes sense and share our best advice for giving VBAC your best shot.Plus, we're giving away a Free Childbirth Guide to support you on your journey — because informed choices start with empowered information. Tune in now, share with a friend, and remember — this is your body, your baby, and your birth. You do have a voice and a Choice!Support the showSign up for Childbirth Preparation Programs! visit https://birthagni.com/services#childbirth-preparation-programs https://birthagni.com/copy-of-services#breastfeeding-preparation-program This episode is supported and made possible by podcast recording and hosting tool Zencastr, it is impeccably made! Use my link : https://zen.ai/vxmuJUgYKKGTF3JuTuFQ0g to sign up and record flawless remote podcast , USE my code : BIRTHAGNI Support the show:https://birthagni.com/birthagnipodcast#donate If you like what you hear, leave us a rating on Spotify app and answer the question at each episode! a review on Apple podcasts. Share on Whatsapp/Insta/FB Share on Instagram and tag us @divyakapoorvox ...

JCO PO author Dr. Alison M. Schram at Memorial Sloan Kettering Cancer Center shares insights into her JCO PO article, “Retrospective Analysis of BRCA-Altered Uterine Sarcoma Treated With Poly(ADP-ribose) Polymerase Inhibitors.” Host Dr. Rafeh Naqash and Dr. Schram discuss relevant genomic and clinical features of patients with BRCA-altered uterine sarcoma and the efficacy of PARPis in this population. TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, podcast editor for JCO Precision Oncology and associate professor at the OU Health Stephenson Cancer Center. Today, we are excited to be joined by Dr. Alison Schram, Associate Attending Physician and Section Head of Oral Therapeutics with Early Drug Development and Gynecologic Medical Oncology Services at the Memorial Sloan Kettering Cancer Center, and the senior author of the JCO Precision Oncology article titled, "Retrospective Analysis of BRCA-Altered Uterine Sarcoma Treated With Poly(ADP-ribose) Polymerase Inhibitors." At the time of this recording, our guest's disclosures will be linked in the transcript. Dr. Schram, thank you for joining us today. I am excited to be discussing this very interesting, unique topic based on what you published in JCO PO. Dr. Alison Schram: Thank you for having me. Dr. Rafeh Naqash: What we like to do for these podcasts is try to make them scientifically interesting but at the same time, keep them at a level where our trainees and other community oncology professionals understand the implications of what you've published. So I'd like to start by asking you, what is leiomyosarcoma for those of us who don't necessarily know a lot about leiomyosarcoma, and what are some of the treatment options for these uterine sarcomas? Dr. Alison Schram: Uterine leiomyosarcoma is a rare subtype of uterine cancer, and it represents about 1% of all female cancers in the reproductive tract. This is a rare malignancy that arises from the myometrial lining of the uterus, and it is generally pretty aggressive. In terms of the standard therapy, the standard therapy for uterine leiomyosarcoma includes chemotherapy, generally combination chemotherapy, but despite a few regimens that tend to be effective, the duration of effectiveness is relatively short-lived, and patients with advanced uterine leiomyosarcoma eventually progress and require additional therapy. I will say that localized uterine leiomyosarcoma can be treated with surgery as well. Dr. Rafeh Naqash: Thank you for that description. Now, there are two aspects to what you published. One is the sarcoma aspect, the leiomyosarcoma, and the second is the BRCA mutation. Since we are a precision medicine journal, although we've discussed BRCA a couple of times before, but again, for the sake of our listeners, could you highlight some of the aspects of BRCA and PARP sensitivity for us? Dr. Alison Schram: Yes. So BRCA is a gene that's important for DNA repair, and BRCA mutations can be either inherited as a germline mutation, so one of your parents likely had a BRCA mutation and you inherited one copy. In patients who have an inherited BRCA mutation, the normal cells tend to have one abnormal copy of BRCA, but if a second copy in the cell becomes altered, then that develops into cancer. And so these patients are at increased risk of developing cancers. Specifically, they are at an increased risk of developing ovarian cancer, breast cancer, prostate cancer, pancreatic cancer, and a few others. These cancers are considered BRCA-associated tumors. Alternatively, some patients, more rarely, can develop BRCA-altered cancers completely sporadically. So it's a mutation that happens in the tumor itself, and that can lead to impaired DNA repair and promote cancer progression. And those patients are not, they don't have any inherited risk, but just a random event caused a BRCA mutation in the tumor. The reason this is important is because, in addition to it being potentially important for family members, there are certain treatments that are more effective in BRCA-altered cancers. And the main example is PARP inhibitors, which are small molecule inhibitors that inhibit the PARP enzyme, and there is what we call synthetic lethality. So PARP is important for DNA repair, for single-stranded DNA repair, BRCA is important for double-stranded DNA repair, and in a patient that has a cancer that has a BRCA mutation, that cancer becomes more reliant on single-stranded DNA repair. And if you inhibit it with a PARP inhibitor, the cancer cells are unable to repair DNA, and the cells die. So we call that synthetic lethality. PARP inhibitors are FDA approved in several diseases, predominantly the BRCA-associated diseases I mentioned: breast cancer, ovarian cancer, pancreatic cancer, and prostate cancer. Dr. Rafeh Naqash: That was very beautifully explained. Honestly, I've heard many people explain BRCA before, but you kind of put it in a very simple, easy to understand format. You mentioned this earlier describing germline or hereditary BRCA and somatic BRCA. And from what I gather, you had a predominant population of somatic BRCA, but a couple of germline BRCA as well in your patient population, which we'll go into details as we understand the study. You mentioned the second hit on the germline BRCA that is required for the other copy of the gene to be altered. In your clinical experience, have you seen outside of the study that you published, a difference in the sensitivity of PARP for germline BRCA versus a somatic BRCA that has loss of both alleles? Dr. Alison Schram: So we will get into what's unique about uterine sarcomas in just a minute. In uterine sarcomas, what we have found is that the BRCA mutations tend to be somatic and not germline, as you mentioned. That is in contrast to the other diseases we mentioned, where the vast majority of these tumors are in patients that have germline BRCA alterations. So one thing that's really unique about the uterine sarcoma population and our paper, I believe, is that it is demonstrating an indication for PARP inhibitors in a population that is not characterized by germline BRCA alterations, but truly these by somatic BRCA alterations. If you look at the diseases that PARP inhibitors are validated to be effective in, including the, you know, the ones I mentioned, the BRCA-associated tumors, there's some data in specific context that suggests that perhaps germline alterations are more sensitive to PARP inhibitors, but that's not universal, and it's really tricky to do because the genetic testing that we have doesn't always tell you if you have two hits or just one hit. So you need more complex genetic analysis to truly understand if there is what we call a biallelic loss. And sometimes it's not a second mutation in BRCA. Sometimes it's silencing of the gene by hypermethylation or epigenetics. Some of our clinical trials are now incorporating this data collection to really understand if biallelic loss that we can identify on more complex genetic testing predicts for better outcomes. And we think it's probably true that the patients that have biallelic loss, whether it be germline or somatic biallelic loss, are more likely to benefit from these treatments. That still needs to be tested in a larger cohort of patients prospectively. Dr. Rafeh Naqash: In your clinical experience, I know you predominantly use MSK-IMPACT, but maybe you've perhaps used some other NGS platforms, next-generation sequencing platforms. Have you noticed that these reports for BRCA alterations the report mentioning biallelic loss in certain cases? I personally don't- I do lung cancer, I do early-phase lung cancer as well, but I personally don't actually remember if I've seen a report that actually says biallelic loss. So after this podcast, I'm going to check some of those NGS reports and make sure I look at it. But have you seen it, or what would be a learning point for the listeners there? Dr. Alison Schram: Exactly. And they usually do not. They usually do not explicitly say, “This looks like biallelic loss,” on the reports. The exception would be if there's a deep deletion, then that implies both copies of the gene have been deleted, and so then you can assume that it's a biallelic loss. But oftentimes, when you see a frameshift alteration or a mutation, you don't know whether or not it's a biallelic loss. And you may be able to get some clues based on the variant allele frequencies, but due to things like whole genome duplication or more complex tumor genomics, it's not clear from these reports, and you really do need a more in-depth bioinformatic analysis to understand whether these are biallelic or not. So that is why I suggest that this really needs to be done in the context of a clinical trial, but there is definitely a theoretical rationale for reporting and treating patients with biallelic losses perhaps more so than someone who has a variant of unknown significance that seems to be monoallelic. The other tricky part, as I mentioned, is the fact that there could be epigenetic changes that silence the second copy, so that wouldn't be necessarily evident on a DNA report, and you would need more complex molecular testing to understand that as well. Dr. Rafeh Naqash: Sure. Now, going to your study, could you tell us what prompted the study, what was the patient population that you collected, and how did you go about this research study design? Dr. Alison Schram: It's actually a great story. I was the principal investigator for a clinical trial enrolling patients regardless of their tumor type to a combination of a PARP inhibitor and immunotherapy. And this was a large clinical trial that was being done as a basket study, as I mentioned, for patients that have either germline or somatic alterations with advanced solid tumors that had progressed on standard therapy. And the hypothesis was that the combination of a PARP inhibitor and immunotherapy would be synergistic and that there would be increased efficacy compared to either agent alone and that patients who had BRCA alterations were a sensitive population to test because of their inherent sensitivity to PARP inhibitors and perhaps their increased neoantigen burden from having loss of DNA repair. So this large study, it's been published, really did show that there was efficacy across several tumor types, but it didn't seem to clearly demonstrate synergy between the immunotherapy and the PARP inhibitor as compared to what you might expect from a PARP inhibitor alone, and in addition to a couple of cases, perhaps attributable to the immunotherapy. So maybe additive rather than synergistic efficacy. However, what really struck me looking at the data was that there were three patients with uterine leiomyosarcoma with BRCA deletions who had the best responses of anyone on the study. So incredible, durable responses. One of my patients with a complete response that continues to not have any evidence of cancer eight years after the initiation of this regimen. And for those of us that treat uterine leiomyosarcoma, this is unheard of. These patients generally, as I mentioned, respond, if they do respond to chemotherapy, it's generally short-lived and the cancer progresses. And so a complete response nearly a decade later turns heads in this field. The other interesting thing was that these uterine leiomyosarcoma patients had somatic alterations rather than a germline alteration with a second hit, and the diseases that are best validated for being responsive to PARP inhibitors include the BRCA-associated diseases, the ones that you're at increased risk for if you have a germline BRCA mutation, including breast, pancreas, prostate, and ovarian. And so it was very interesting that this disease type that seemed to be uniquely sensitive to PARP inhibitors with immunotherapy was also different in that patients with uterine leiomyosarcoma don't tend to have a high frequency of BRCA alterations, and in patients that are born with a BRCA alteration, there doesn't seem to be a clearly increased risk of uterine sarcomas. So this population really jumped out as a uniquely sensitive population that differed from the prior indications for PARP inhibitors. Given this patient and these couple of patients that we observed on the combination, in addition to some other case reports and case series that had started to come out in small numbers, we wanted to look back at our large cohort of patients at Memorial Sloan Kettering to see if we could really get a better sense of the numbers. How many patients at Sloan Kettering with uterine sarcomas have BRCA alterations? Are they generally somatic or germline? Are there unique features about these patients in terms of their clinical characteristics? How many of them have received PARP inhibitors, and if so, is this just luck that these three patients did so well, or is this really a good treatment option for patients with BRCA-altered uterine sarcomas? And so we did this retrospective analysis identifying the patients at Sloan Kettering who met these criteria. So in total, we found 35 patients with uterine sarcomas harboring BRCA alterations, and the majority were leiomyosarcoma, about 86% of them had leiomyosarcoma, which is interesting because there are other uterine sarcomas, but it does seem like BRCA alterations tend to be more often in the leiomyosarcomas. And 13 of these patients with uterine leiomyosarcoma were treated with PARP inhibitors in the recurrent or metastatic setting with about half of those patients having an overall response, so that's a significant tumor shrinkage that sustained, and a clinical benefit rate of 62%. And if we look at the patients that had these BRCA2 deep deletions, which was the patient I had that had this amazing response, the overall response rate jumped to 60% and the clinical benefit rate to 80%. And we defined clinical benefit rate as having maintained on the PARP inhibitor without evidence of progression at six months. So this is really impressive for patients with a difficult to treat disease. And we couldn't do a randomized controlled trial comparing it to chemotherapy, but looking retrospectively at outcomes on chemotherapy studies, this was very favorable, particularly because many of these patients were heavily pretreated. So to get a sense of, you know, how this might compare to chemotherapy, we tried to use patients as their own internal controls, and we looked at how long patients were maintained on the PARP inhibitor as compared to how long they were on the treatment just prior. And we used a ratio of 1.3 to say if they were on the PARP inhibitor for 1.3 times what their previous treatment was or longer, that is pretty clearly better, more of a benefit from that regimen. And the majority of patients did meet that bar. So 58% had a PFS ratio greater than 1.3, and the average PFS ratio was 1.9, suggesting, you know, you would expect the the later lines of therapy to actually not work as well, but this suggests that it's actually working better than the immediately prior line of therapy, to me, suggesting that this is truly a good treatment option for these patients. Dr. Rafeh Naqash: Very interesting. And you mentioned that individuals with tumors having deep deletions were probably more responsive. How did you figure out that there was biallelic loss or deep deletions? Was that part of an extended analysis that was done subsequently? Dr. Alison Schram: So the deletions reported on our report, if it's a biallelic deletion, that is the one biallelic molecular alteration that would be reported. So those are, by definition, biallelic, and I think that that may be one of the reasons that's a good biomarker. But also, what's interesting is that if you have both copies deleted of BRCA, you can't develop reversion mutations. So one of the the known mechanisms of resistance to PARP inhibitors in patients who have BRCA alterations are something called a reversion mutation where, if you have a frameshift alteration, for example, in BRCA that makes BRCA protein nonfunctional, you can develop a second mutation that actually puts the DNA back in frame, and a functional protein is now made. And so a mechanism of resistance to PARP inhibitors is actually reverting BRCA to a wild-type protein, and then BRCA's synthetic lethality no longer makes sense and is no longer effective. But if you've deleted both copies of BRCA, you don't have the ability to restore the function, and you can't develop reversion mutations. And that's perhaps why, you know, my patient and others have had these prolonged responses to PARP inhibitors because you don't have the same ability to develop that mechanism of resistance. Dr. Rafeh Naqash: I remember thinking a year and a half back, I had an individual with prostate cancer and with BRCA2, and using liquid biopsy, I had a reversion mutation that we caught. In your practice, have you seen the utility of doing the serial liquid biopsies in these individuals to catch these reversion mutations? Dr. Alison Schram: Yes, absolutely. And in patients that have the ability to develop a reversion mutation, serial cell-free DNA can catch it, but the caveat is that it doesn't always. So if you see an acquired reversion mutation in cell-free DNA, that can be helpful, particularly if you're planning on putting the patient on another line of therapy that might require a dysfunctional BRCA. So if you're putting them on a clinical trial with a PARP combination and the rationale is that they're sensitive because they don't have a functional BRCA, you would want to know if they developed a reversion mutation, and serial cell-free DNA can definitely identify these reversion mutations. Some of the major clinical trials in ovarian cancer have done serial cell-free DNA and have demonstrated the utility of that approach. The caveat is that some of these reversion mutations are not readily caught on cell-free DNA because they're more complex reversion mutations, or they're not, the part of the gene that develops the reversion mutation is not tiled on the panel. And so it doesn't always catch the reversion mutations. Also, depends on the cell-free DNA shedding, depends on the tumor volume and other factors. And we published a related paper of a patient, it was a really interesting case of a patient with prostate cancer who was on a PARP inhibitor and developed what appeared to be a single reversion mutation on one sample, had negative cell-free DNA, single reversion mutation in a tissue biopsy, and then developed disease progression. And we did an autopsy, and the patient kindly consented to an autopsy, and at the time of autopsy, there were 10 unique reversion mutations identified across 11 metastases. So almost each metastasis had a unique reversion mutation, and only one of them had been seen premortem on a tissue biopsy and not on a cell-free DNA. But that autopsy really drove home to me how much we're missing by doing clinical testing in real time and we really don't know the entire genomic complexity of our patients by doing single samples. And theoretically, cell-free DNA can catch DNA from all the metastases, so you might think that that would be a solution, and it definitely can catch reversion mutations that are not seen in a single biopsy, but you really need to do it all. I mean, you need to do the tissue biopsy sampling, you need to do cell-free DNA, and probably one cell-free DNA test is not enough. Dr. Rafeh Naqash: Thank you, again, for that very nice explanation. Now, one quick provocative question. I remember when I was training, the lab that I used to work in, they used to do a lot of phosphorylation markers for DNA damage response, like phospho NBS, RAD51. Have you seen anything of that sort on these biallelic BRCA mutations where tumors are responding, but they also have a very high signature on the phosphorylation side, and it may or may not necessarily correspond to HRD signatures, but have you noticed or done any of that analysis? Dr. Alison Schram: I think that it would be great to do that analysis. And some of the work we're doing now is actually trying to dig a little bit deeper in our cohort of patients to understand are these HRD-positive tumors? Does HRD positivity correlate with response to BRCA alterations? In terms of the functional assays, I would love to be able to do a functional assay in these samples. One of the challenges is that this was a retrospective study and many of the patients were previously treated as standard of care or off-label with these agents, and so we didn't have prospective tissue collection, and so we're really limited by the tissue that was collected as part of standard of care and the consent forms that the patient signed that allow us to do genomic and molecular testing on their samples. So, I think that is hopefully future work that we will do and others will do. Dr. Rafeh Naqash: Sure. Shifting gears to your career trajectory, I'd like to spend a couple of minutes there before we end the podcast. So Dr. Schram, you've obviously been a trailblazer in this space of drug development, early-phase trials. Can you give us a brief synopsis of your journey and how you've successfully done what you're doing and what are some of the things that drive you? Dr. Alison Schram: Well, thank you for saying that. I don't know if that's true, but I'll take the bait. I've been interested in oncology since college and was always very interested in not only the science of oncology but of course, treating patients. And in medical school, I did basic science research in a laboratory and it was very inspiring and made me want to do research in oncology in addition to clinical care. When I became an oncology fellow, I was presented with a very difficult question, which is, “Do you want to be a lab PI and be in the lab, or do you want to do clinical care and clinical research?” And I couldn't choose. I found a mentor who thankfully really had this amazing vision of combining the two and doing very early drug development, taking the data that was being generated by labs and translating it into patients at the earliest stage. So, you know, phase one drug development in molecularly targeted therapies. And so I became very interested as a fellow in early drug development and this ability to translate brand new molecular insights into novel drugs. And I joined the- at Sloan Kettering, there was the Early Drug Development, it was actually a clinic, it was called something different, and it was very fortuitous. My last year of fellowship, the clinic became its own service with the ability to hire staff at Sloan Kettering, and I was the first ever hire to our Early Drug Development Service. And that really inspired me to try and bring these drugs to patients and to really translate the amazing molecular insights that my colleagues here at Sloan Kettering are discovering, and you know, of course, at other institutions and in pharma. And you know, there 's been an amazing revolution in in drug development over the last several years, and I feel very grateful that I've been here for it. You know, I've been able to take the brilliant insights from my colleagues and put these drugs in patients, and I have the amazing privilege of watching patients in many cases that benefit from these treatments. And so I do mostly phase one drug development and molecularly targeted therapies, and truthfully, I am just very fortunate to be around such brilliant people and to have both patients and labs trust me to be able to deliver these new drugs to patients and hopefully develop better drugs that move forward through FDA approval and reach patients across the country. Dr. Rafeh Naqash: Thank you so much. That was very nicely put. And hopefully our trainees and junior faculty find that useful based on their own career trajectories. Thank you, Dr. Schram, for joining us today. Hopefully, we'll see more of your subsequent work in JCO PO. Thank you for giving us all these insights today. Dr. Alison Schram: Thank you for having me. Dr. Rafeh Naqash: Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Dr. Alison Schram Disclosures Consulting or Advisory Role Company: Mersana, Merus NV, Relay Therapeutics, Schrodinger, PMV Pharma ,Blueprint Medicines, Flagship Pioneering, Redona Therapeutics, Repare Therapeutics, Endeavor BioMedicines Research Funding Company: Recipient: Your Institution  Merus, Kura, Surface Oncology, AstraZeneca, Lilly, Pfizer , Black Diamond Therapeutics, BeiGene, Relay Therapeutics, Revolution Medicines,  Repare Therapeutics, PMV Pharma, Elevation Oncology, Boehringer Ingelheim Travel, Accommodations, Expenses Company: PMV Pharma 

From unbearable pain to feeling no symptoms at all, women with uterine fibroids can have vastly different experiences. While these growths affect a large percentage of women, health advocates say they too often go undiscussed. Ali Rogin speaks with Sateria Venable, a patient advocate and CEO of The Fibroid Foundation, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Dr. John C. Lipman and Dr. Yvette White join the Bullpen for a special interview about Uterine fibroids, a condition that disproportionately affects Black women, and groundbreaking non-surgical treatment to change lives.   Host: Sharon Reed (@SharonReedLive) Bullpen guests: Dr. John C. Lipman and Dr. Yvette White *** SUBSCRIBE on ⁠⁠⁠⁠⁠⁠YOUTUBE⁠⁠⁠⁠⁠⁠  ☞ ⁠⁠⁠⁠⁠⁠ https://www.youtube.com/IndisputableTYT⁠⁠⁠⁠⁠⁠ FOLLOW US ON: ⁠⁠⁠⁠⁠⁠FACEBOOK⁠⁠⁠⁠⁠⁠  ☞ ⁠⁠⁠⁠⁠⁠  https://www.facebook.com/IndisputableTYT⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠TWITTER⁠⁠⁠⁠⁠⁠  ☞     ⁠⁠⁠⁠⁠⁠  https://www.twitter.com/IndisputableTYT⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠INSTAGRAM⁠⁠⁠⁠⁠⁠ ☞ ⁠⁠⁠⁠⁠⁠ https://www.instagram.com/IndisputableTYT⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

From unbearable pain to feeling no symptoms at all, women with uterine fibroids can have vastly different experiences. While these growths affect a large percentage of women, health advocates say they too often go undiscussed. Ali Rogin speaks with Sateria Venable, a patient advocate and CEO of The Fibroid Foundation, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Bryan Kohberger pleaded guilty to murdering four University of Idaho students. During sentencing, survivors and victims' families faced him in court, including a surviving roommate who delivered powerful testimony. In an interview with Major Garrett, House Speaker Mike Johnson expressed concern over the Justice Department's handling of the Epstein case and called for full transparency and accountability. You can see more of Major Garrett's interview, along with his sharp analysis, on "The Takeout with Major Garrett," weeknights at 5 p.m. ET on CBS News 24/7. Dr. Salvador Plasencia admitted to distributing ketamine to actor Matthew Perry before his 2023 overdose. He is the fourth person to plead guilty in the case and faces up to 40 years in prison. Uterine fibroids affect up to 80% of women by age 50 and can cause painful, life-altering symptoms. Dr. Tara Shirazian joins "CBS Mornings" to discuss how diet, exercise and awareness may help. A new Charles Schwab survey finds many Americans believe they need over $800,000 to be financially comfortable, yet a third have no financial plan. CBS News business analyst Jill Schlesinger joins to explain what to do. After retiring, Erik and Karin Vonk combined their love of farming and spirits to create Richland Rum. Nearly 25 years later, their Georgia-made rum is earning high praise from critics across the globe. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Tell us your thoughts on this episode!Dr. Natalie Godbee, gynecologic oncologist at City of Hope in Atlanta, Georgia, talks with Dr. Leah Sherman in a wide-ranging interview on gynecologic cancers. The conversation covers the pros and cons of the HPV vaccine, the symptoms and risk factors for ovarian, endometrial, and cervical cancers, and the benefits of integrative medicine in cancer care. Listeners will gain valuable information on early detection, treatment options, and preventive measures for these complex cancers.Dr. Godbee's bio and links to her social mediaHuman Papillomavirus (HPV) review by the National Cancer InstituteConcerns about the safety of the HPV vaccineDoes the HPV vaccine increase promiscuity in teenagers?Dramatic reductions in pre-cancer of the cervixSupport the showOur website: https://www.thecancerpod.com Become a member of The Cancer Pod Community! Gain access to live events, exclusive content, and so much more. Join us today and be part of the journey!Email us: thecancerpod@gmail.com Follow @TheCancerPod on: Instagram Bluesky Facebook LinkedIn YouTube THANK YOU for listening!

The incidence of early onset colorectal cancer (EOCRC) has been rising prompting the change in change in screening guidelines to 45 years of age for average risk patients. Join us for an in-depth discussion with guest speakers Dr. Andrea Cercek and Dr. Nancy You, where we provide a comprehensive look at the growing challenge of EOCRC. Hosts: - Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center - Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian - Dr. Phil Bauer, Graduating Colorectal Surgical Oncology Fellow at Memorial Sloan Kettering Cancer Center  - Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center - Dr. Andrea Cercek - Gastrointestinal Medical Oncologist at Memorial Sloan Kettering Cancer Center - Dr. Y. Nancy You, MD MHSc - Professor, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Learning objectives:  - Describe trends in incidence of colorectal cancer, with emphasis on the rise of EOCRC. - Identify age groups and demographics most affected by EOCRC. - Summarize USPSTF recommendations for colorectal cancer screening. - Distinguish between screening methods (e.g., colonoscopy, FIT-DNA) and their sensitivity. - Understand treatment approaches for colon and rectal cancer (CRC) - Understand the role of mismatch repair (MMR) status in guiding treatment. - Outline the importance of genetic counseling and testing in young patients. - Discuss racial, ethnic, and socioeconomic disparities in CRC incidence and outcomes. - Describe the impact of cancer treatment on fertility and sexual health. -  Review fertility preservation options. - Identify the value of integrated care teams for young CRC patients. References: 1.         Siegel, R. L. et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI J. Natl. Cancer Inst. 109, djw322 (2017). https://pubmed.ncbi.nlm.nih.gov/28376186/ 2.         Abboud, Y. et al. Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis. Cancers 17, 1500 (2025). https://pubmed.ncbi.nlm.nih.gov/40361427/ 3.         Phang, R. et al. Is the Incidence of Early-Onset Adenocarcinomas in Aotearoa New Zealand Increasing? Asia Pac. J. Clin. Oncol.https://pubmed.ncbi.nlm.nih.gov/40384533/ 4.         Vitaloni, M. et al. Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries. BMC Gastroenterol. 25, 378 (2025). https://pubmed.ncbi.nlm.nih.gov/40375142/ 5.         Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. (2019) doi:10.1136/gutjnl-2019-319511. https://pubmed.ncbi.nlm.nih.gov/31488504/ 6.         Cercek, A. et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J. Natl. Cancer Inst. 113, 1683–1692 (2021). https://pubmed.ncbi.nlm.nih.gov/34405229/ 7.         Zheng, X. et al. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI J. Natl. Cancer Inst. 113, 543–552 (2021). https://pubmed.ncbi.nlm.nih.gov/33136160/ 8.         Standl, E. & Schnell, O. Increased Risk of Cancer—An Integral Component of the Cardio–Renal–Metabolic Disease Cluster and Its Management. Cells 14, 564 (2025). https://pubmed.ncbi.nlm.nih.gov/40277890/ 9.         Muller, C., Ihionkhan, E., Stoffel, E. M. & Kupfer, S. S. Disparities in Early-Onset Colorectal Cancer. Cells 10, 1018 (2021). https://pubmed.ncbi.nlm.nih.gov/33925893/ 10.       US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325, 1965–1977 (2021). https://pubmed.ncbi.nlm.nih.gov/34003218/ 11.       Fwelo, P. et al. Differential Colorectal Cancer Mortality Across Racial and Ethnic Groups: Impact of Socioeconomic Status, Clinicopathology, and Treatment-Related Factors. Cancer Med. 14, e70612 (2025). https://pubmed.ncbi.nlm.nih.gov/40040375/ 12.       Lansdorp-Vogelaar, I. et al. Contribution of Screening and Survival Differences to Racial Disparities in Colorectal Cancer Rates. Cancer Epidemiol. Biomarkers Prev. 21, 728–736 (2012). https://pubmed.ncbi.nlm.nih.gov/22514249/ 13.       Ko, T. M. et al. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 176, 626–632 (2024). https://pubmed.ncbi.nlm.nih.gov/38972769/ 14.       Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A. & Jemal, A. Colorectal cancer statistics, 2023. CA. Cancer J. Clin. 73, 233–254 (2023). https://pubmed.ncbi.nlm.nih.gov/36856579/ 15.       Jain, S., Maque, J., Galoosian, A., Osuna-Garcia, A. & May, F. P. Optimal Strategies for Colorectal Cancer Screening. Curr. Treat. Options Oncol. 23, 474–493 (2022). https://pubmed.ncbi.nlm.nih.gov/35316477/ 16.       Zauber, A. G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference? Dig. Dis. Sci. 60, 681–691 (2015). https://pubmed.ncbi.nlm.nih.gov/25740556/ 17.       Edwards, B. K. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116, 544–573 (2010). https://pubmed.ncbi.nlm.nih.gov/19998273/ 18.       Cercek, A. et al. Nonoperative Management of Mismatch Repair–Deficient Tumors. New England Journal of Medicine 392, 2297–2308 (2025). https://pubmed.ncbi.nlm.nih.gov/40293177/ 19.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Molecular Heterogeneity in Early-Onset Colorectal Cancer: Pathway-Specific Insights in High-Risk Populations. Cancers 17, 1325 (2025). https://pubmed.ncbi.nlm.nih.gov/40282501/ 20.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Ethnicity-Specific Molecular Alterations in MAPK and JAK/STAT Pathways in Early-Onset Colorectal Cancer. Cancers 17, 1093 (2025). https://pubmed.ncbi.nlm.nih.gov/40227607/ 21.       Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. JNCCN 19, 329–359 (2021). https://pubmed.ncbi.nlm.nih.gov/33724754/ 22.       Christenson, E. S. et al. Nivolumab and Relatlimab for the treatment of patients with unresectable or metastatic mismatch repair proficient colorectal cancer. https://pubmed.ncbi.nlm.nih.gov/40388545/ 23.       Dasari, A. et al. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. The Lancet 402, 41–53 (2023). https://pubmed.ncbi.nlm.nih.gov/37331369/ 24.       Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). https://pubmed.ncbi.nlm.nih.gov/37142372/ 25.       Sauer, R. et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. N. Engl. J. Med. 351, 1731–1740 (2004). https://pubmed.ncbi.nlm.nih.gov/15496622/ 26.       Cercek, A. et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 4, e180071 (2018). https://pubmed.ncbi.nlm.nih.gov/29566109/ 27.       Garcia-Aguilar, J. et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J. Clin. Oncol. 40, 2546–2556 (2022). https://pubmed.ncbi.nlm.nih.gov/35483010/ 28.       Schrag, D. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N. Engl. J. Med. 389, 322–334 (2023). https://pubmed.ncbi.nlm.nih.gov/37272534/ 29.       Kunkler, I. H., Williams, L. J., Jack, W. J. L., Cameron, D. A. & Dixon, J. M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N. Engl. J. Med. 388, 585–594 (2023). https://pubmed.ncbi.nlm.nih.gov/36791159/ 30.       Jacobsen, R. L., Macpherson, C. F., Pflugeisen, B. M. & Johnson, R. H. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol. Pract. (2021) doi:10.1200/OP.20.00840. https://pubmed.ncbi.nlm.nih.gov/33566700/ 31.       Ruddy, K. J. et al. Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer. J. Clin. Oncol. (2014) doi:10.1200/JCO.2013.52.8877. https://pubmed.ncbi.nlm.nih.gov/24567428/ 32.       Su, H. I. et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J. Clin. Oncol. 43, 1488–1515 (2025). https://pubmed.ncbi.nlm.nih.gov/40106739/ 33.       Smith, K. L., Gracia, C., Sokalska, A. & Moore, H. Advances in Fertility Preservation for Young Women With Cancer. Am. Soc. Clin. Oncol. Educ. Book 27–37 (2018) doi:10.1200/EDBK_208301. https://pubmed.ncbi.nlm.nih.gov/30231357/ 34.       Blumenfeld, Z. How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries. The Oncologist 12, 1044–1054 (2007). 35.       Bhagavath, B. The current and future state of surgery in reproductive endocrinology. Curr. Opin. Obstet. Gynecol. 34, 164 (2022). 36.       Ribeiro, R. et al. Uterine transposition: technique and a case report. Fertil. Steril. 108, 320-324.e1 (2017). 37.       Yazdani, A., Sweterlitsch, K. M., Kim, H., Flyckt, R. L. & Christianson, M. S. Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation. J. Clin. Med. 13, 5577 (2024). 38.       Holowatyj, A. N., Eng, C. & Lewis, M. A. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol. Pract. 18, 169–172 (2022). ***Behind the Knife Colorectal Surgery Oral Board Audio Review: https://app.behindtheknife.org/course-details/colorectal-surgery-oral-board-audio-review Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Season Five is here, and with it …comes scandal. Not for Josie, no way, but for a national show at KBXV. The time is ripe for a regime change…can the Lonely Hearts nab that precious drivetime slot? If Frank and Joanne want to impress those execs, they’ll need more than a foolproof plan. They’ll need a scheme-proof plan. Look alive, cuties, there are nefarious forces at work. Our favorite dynamic duo will need to outwit new foes while they catch up with old friends. We welcome back callers to ask, “Where Are They Now?” “How Have You Been?” and, “Is That Covered By Your NDA?” Check in with some of your favorites from episodes past and buckle up for the most surprising season yet.   Our cuties this week included Tiffany Cornwell, Tristin Miller, Laura Lee Walsh, Pat Harvey, Jessie Cannizzaro, and Ross Bryant.   JOSIE'S LONELY HEARTS CLUB is a semi-scripted audio drama set in New Mexico’s 2nd-best relationship call-in show created by Maximilian Clark and Rachel Music. Our story editor is Lauren Grace Thompson. Produced by Simone Kisiel and Alexandra Grunberg. Executive Produced by the Good Story Guild. Keep track of us on Instagram @goodstoryguild and join our Discord.  If you enjoyed the show, consider leaving a rating and/or review on your preferred podcast listening platform.   Support us by joining the Great Story Guild on Patreon!   Night night, cuties.

Season Five is here, and with it …comes scandal. Not for Josie, no way, but for a national show at KBXV. The time is ripe for a regime change…can the Lonely Hearts nab that precious drivetime slot? If Frank and Joanne want to impress those execs, they'll need more than a foolproof plan. They'll need a scheme-proof plan. Look alive, cuties, there are nefarious forces at work. Our favorite dynamic duo will need to outwit new foes while they catch up with old friends. We welcome back callers to ask, “Where Are They Now?” “How Have You Been?” and, “Is That Covered By Your NDA?” Check in with some of your favorites from episodes past and buckle up for the most surprising season yet. Josie's Lonely Hearts Club was created by Maximilian Clark and Rachel Music. Our cuties this week included Tiffany Cornwell, Tristin Miller, Laura Lee Walsh, Pat Harvey, Jessie Cannizzaro, and Ross Bryant. Produced by Simone Kisiel and Alexandra Grunberg. Executive Produced by Good Story Guild. Learn more about your ad choices. Visit megaphone.fm/adchoices

The ovarian artery branches from the aorta and supplies blood to the ovary. The uterine artery branches from the internal iliac artery and supplies blood to the uterus. But they link, and in doing so provide a collateral circulation route between the abdominal aorta and pelvic internal iliac artery. Let's discuss.

Have you heard of having a double uterus or double cervix?  The term is Uterine didelphys is a rare condition that happens when you grow two uteruses instead of one. This happens when you are a developing baby. You are born with it. ‌ While developing as babies, girls typically grow a uterus from two channels called the Mullerian ducts. Today's guest was born with a didelphys uterus after 3 laparoscopic surgeries it was confirmed she also had endometriosis, fibroids, and polycystic ovarian syndrome.  That did not stop today's guest from trying to conceive.  La-Anna Douglass began fertility treatments with drugs and still was unable to conceive.  She decided to try IVF and IVF did not work for her leaving her depressed and heartbroken.  In today's episode La-Anna shares her journey to conceiving a baby naturally after 8 years of trying to conceive and her current journey through secondary infertility. This podcast is for you to listen to to learn more about a double uterus and double cervix, but also if you have any underlying conditions like endometriosis, fibriods, and pcos. Become a Sisters in Loss Birth Bereavement, and Postpartum Doula Here Living Water Doula Services Book Recommendations and Links Below You can shop my Amazon Store for the Book Recommendations You can follow Sisters in Loss on Social Join our Black Moms in Loss Online Weekly Grief Support Group Join the Sisters in Loss Online Community Sisters in Loss TV Youtube Channel Sisters in Loss Instagram Sisters in Loss Facebook Sisters in Loss Twitter You can follow Erica on Social Erica's Website Erica's Instagram Erica's Facebook Erica's Twitter

Uterine incarceration in pregnancy, is a rare but troublesome complication. This occurs when a retroverted uterus becomes trapped in the pelvic cavity during pregnancy. This happens when the uterus fails to move forward as it grows, becoming stuck between the sacral promontory and pubicsymphysis. It's more common in women with prior pelvic issues or uterine anomalies. Urinary retention is the most common symptom that occurs because of elongation of the urethra by displacement of the cervix, loss of the urethro-vesical angle, and mechanical compression of the bladder neck. It is estimated to occur in 1 in 3000 patients. How do we release an incarcerated uterus? Is laparoscopy an option? And how can an ultrasound probe help (April 2025publication)? Listen in for details.

Moderator: BobbieJean Sweitzer, M.D. Participants: Jessica R Ansari, M.D., M.S. and Craig M. Palmer, M.D. Articles Discussed: Uterine Tone Numeric Rating Score as an Early Indicator of Major Postpartum Hemorrhage During Cesarean Delivery: A Prospective Observational Study Predicting the Unpredictable: A New Approach to Predict Postpartum Hemorrhage from Uterine Atony Transcript

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Ayman Al-Hendy, MD, PhD, FRCSC, FACOG, CCRP Despite longstanding reliance on surgery, recent advancements have reshaped our approach to uterine fibroids. However, common myths and misconceptions have limited the adoption of newer therapies, leaving many patients unaware of their available options. Join Dr. Charles Turck and Dr. Ayman Al-Hendy as they explain shifting treatment paradigms and patient education strategies in uterine fibroid care. Dr. Al-Hendy is a Professor of Obstetrics and Gynecology and the Director of Translational Research at the University of Chicago Pritzker School of Medicine.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Ayman Al-Hendy, MD, PhD, FRCSC, FACOG, CCRP Despite longstanding reliance on surgery, recent advancements have reshaped our approach to uterine fibroids. However, common myths and misconceptions have limited the adoption of newer therapies, leaving many patients unaware of their available options. Join Dr. Charles Turck and Dr. Ayman Al-Hendy as they explain shifting treatment paradigms and patient education strategies in uterine fibroid care. Dr. Al-Hendy is a Professor of Obstetrics and Gynecology and the Director of Translational Research at the University of Chicago Pritzker School of Medicine.

It's Prostate Week in Podcastistan: what happens when an MRI scan for prostatitis includes the injection of rare earth metals—should you, or shouldn't you? Gadolinium crosses the blood-brain barrier if the barrier is not fully intact—does that affect your decision? Then: a letter from an MD-PhD student at Harvard prompts musings on the federal funding of science, what science is for, how complicit universities and many scientists have been for years, and what to do. Also: uterine transplants for “trans women.”*****Our sponsors:Timeline: Accelerate the clearing of damaged mitochondria to improve strength and endurance: Go to http://www.timeline.com/darkhorse and use code darkhorse for 10% off your first order.Caraway: Non-toxic & beautiful cookware. Save $150 on a cookware set over buying individual pieces, and get 10% off your order at http://Carawayhome.com/DarkHorse10.ARMRA Colostrum is an ancient bioactive whole food that can strengthen your immune system. Go to http://www.tryarmra.com/DARKHORSE to get 15% off your first order.*****Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.comHeather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.comOur book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://amzn.to/3AGANGg (commission earned)Check out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org*****Mentioned in this episode:Gadolinium Contrast Dye: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-gadolinium-based-contrast-agents-gbcas-are-retained-bodyLetter from Harvard: https://naturalselections.substack.com/p/letter-from-harvard/commentsHigher Education Research & Development Survey: https://ncses.nsf.gov/surveys/higher-education-research-development/2023#dataJones et al 2018. Uterine transplantation in transgender women. Bjog 126(2): 152-156: https://pmc.ncbi.nlm.nih.gov/articles/PMC6492192/pdf/BJO-126-152.pdfSupport the show

Send us a textWhat's the one question every woman wants to answer when considering a VBAC? Is it safe for me and my baby? In today's episode, Cynthia & Trisha break down the available data on VBAC, why we should discard the term TOLAC, the actual risks of uterine rupture, whether induced with Pitocon versus a prostaglandin or having spontaneous labor versus expectant management. We present the few cases in which a woman should not choose to VBAC and help mothers understand their decisions should not be driven by statistics alone. If you are considering a VBAC, get a pen and paper and arm yourself with all the stats from this data-rich dialogue. Also: Let's get HavBAC to take! (Inside Joke -- you'll get it when you listen!)**********Watch the full videos of all our episodes on YouTube!**********Our sponsors:Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort.Needed -- Our favorite nutritional products for before, during, and after pregnancy. Use this link to save 20%DrinkLMNT -- Purchase LMNT with this unique link and get a FREE sample packENERGYbits--the superfood every mother needs for pregnancy, postpartum, and breastfeedingPrimally Pure: From soil to skin, primally pure products are made with down-to-earth ingredients that feel and smell like heaven for the skinUse promo code: DOWNTOBIRTH for all sponsors.Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Watch the full videos of all our episodes on YouTube! Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

- Benefits of Vaginal Steaming- Practical Tips and Emotional Release Through Vaginal Steaming - Leiamoon Seat : https://www.leiamoon.com/product/order-leiamoon-steam-seat/?sld=56Code "DrLJj " to save Dr. Lj Johnson, is a beacon of hope in the landscape of women's health. Not just an expert in hormonal balance and gut health, but a warrior who has prevailed in the face of her own chronic illness battles. Her 16-year arduous journey to an endometriosis diagnosis has sculpted her into the dedicated, wholistic functional medicine practitioner she is today. Dr. Johnson's mission is to empower, motivate, and educate women in advocating for their health, ensuring no one experiences the delays and dismissals she endured. Dr. Lj's experience teaches more than survival—it inspires a revolution in healthcare, prioritizing understanding, comprehensive care, and a life unfettered by the chains of chronic illness. If you're seeking a partnership on your hormonal health journey that's built on empathy, expertise, and empowerment, look no further. ⁠https://wholistichormoneexpert.com/ ⁠

In this month's EM Quick Hits podcast: Zafar Qasim & Andrew Petrosoniak on whole blood transfusion in trauma, Justin Morgenstern on calcium pre-treatment to prevent diltiazem-induced hypotension, Kiran Rikhraj on dynamic LV outflow tract obstruction, Anand Swaminathan on resuscitative thoracotomy, Andrew Tagg on uterine casts, and Jesse McLaren on scale & proportionality in occlusion MI ECG interpretation. **Please support EM Cases to continue to be free open access by making a donation: https://emergencymedicinecases.com/donation/

On Monday April 7, 2025, the UK's publication The Guardian wrote, “Surgeons are hailing an ‘astonishing' medical breakthrough as a woman became the first in the UK to give birth after a womb transplant. Grace Davidson, 36, who was a teenager when diagnosed with a congenitally absent uterus, said she and her husband had been given ‘the greatest gift we could ever have asked for'. Grace's sister donated her own womb during an eight-hour operation in 2023. Davidson said she felt shocked when she first held her daughter, who was born by planned NHS caesarean section on 27 February. She was first UK womb transplant recipient to give birth”. Since the first successful uterine transplant in 2011, there have been over 70 live births worldwide. These births have occurred following more than 100 uterine transplant procedures. This episode, we will review the fascinating history of this procedure. We will also answer some questions regarding uterine transplant like can the patient has vagina sex after this? How is this procedure done? Are these babies born vaginally? And which location in TEXAS become a world-renowned uterine transplant center? Listen in for details.

Andrea is a full-scope OBGYN who believes abnormal menstruation is a function of metabolic dysfunction. Instagram:  https://www.instagram.com/consciousgynecologist/ YouTube:  @consciousgynecologist   Website: http://www.consciousgynecology.com/ Timestamps: 00:00 Trailer 01:13 Introduction 05:50 Uterus: overlooked end organ in research 08:01 Uterine fibroids: beyond surgical solutions 13:29 Endometriosis: a gut microbiome disorder 14:21 Gut dysbiosis and endometriosis connection 20:08 Misconceptions about pelvic inflammatory disease 21:29 Shaving products harm natural protection 25:53 Unified approach to nutrition science 28:56 Chronic stress impacts female fertility 33:15 PMDD and menstrual cycle cravings 34:33 Carbs, hormones, and menstrual health 37:55 PCOS diagnosis: a hormonal puzzle 41:52 Evolutionary adaptations in pregnancy nutrition 46:14 Pregnancy, ketosis, and health misconceptions 49:14 Abdominal fat's impact on hot flashes 53:29 Carnivore diet considerations for women 56:15 Where to find Andrea Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs ‪#Revero #ReveroHealth #shawnbaker  #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.

Dr. Natalie Crawford discusses uterine factor infertility, emphasizing the importance of understanding uterine development and potential abnormalities. She explains various uterine anomalies, including unicornuate, bicornuate, and uterine septums, and their impact on fertility. Dr. Crawford highlights the significance of proper diagnostic tools like saline sonograms and MRIs for accurate detection. She addresses common issues such as polyps, fibroids, and adenomyosis, and their effects on fertility. Want to receive my weekly newsletter? Sign up at nataliecrawfordmd.com/newsletter to receive updates, Q&A, special content and my FREE TTC Starter Kit and Vegan Starter Guide! Don't forget to ask your questions on Instagram for next week's For Fertility's Sake segment when you see the question box on Natalie's page @nataliecrawfordmd. You can also ask a question by calling in and leaving a voicemail. Call 657–229–3672 and ask your fertility question today!      Thanks to our amazing sponsors! Check out these deals just for you: Quince- Go to Quince.com/aaw for free shipping on your order and 365-day returns Ritual-Go to ritual.com/aaw to start Ritual or add Essential For Women 18+ to your subscription today. Air Doctor - Go to AirDoctorPro.com and use promo code AAW to get UP TO $300 off today! If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Sunday. Plus, be sure to follow along on Instagram @nataliecrawfordmd, check out Natalie's YouTube channel Natalie Crawford MD, and if you're interested in becoming a patient, check out Fora Fertility. Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textCynthia and Trisha are back with the March Q&A episode! This one kicks off with a fun discussion on things that our Instagram followers think people should know but don't—like how, when you say you're eating a kiwi, you're actually referring to either a kiwi bird or, worse, a person from New Zealand!In today's Q&A episode, we answer these questions:Do I need to schedule a cesarean at 40 weeks if I'm planning a VBAC? My OB says I do.How do I know when it's time to wean from breastfeeding, and how can I do it without feeling guilty?What are my options if my state says it's illegal to give birth at home after a previous cesarean?In the extended, ad-free version, available on Patreon and Apple subscriptions, we cover:My second birth was only 45 minutes long, and my baby was born in the car on the way to the hospital. How can I prevent or better prepare for a rapid birth with my third baby?Will dropping a pumping session with my eleven-week-old baby affect my milk supply?How long is too long to wait to deliver the placenta, and how can I help it come out more quickly?Finally, in the "quickies" segment, we touch on a variety of topics, including alternatives to Pitocin, botox while breastfeeding, swimming in public pools during the third trimester, finances & family planning, and dealing with the awkward situation of being told your baby can't attend a baby shower—and much more!Remember you can watch all our episodes now in full video format on the Down to Birth YouTube channel! Thank you, as always, for your fantastic questions! Keep them coming to our hotline at 802-438-3696. We promise we won't answer! :)**********Our sponsors:Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort.Needed -- Our favorite nutritional products for before, during, and after pregnancy. Use this link to save 20%Use promo code: DOWNTOBIRTH for all sponsors.DrinkLMNT -- Purchase LMNT with this unique link and get a FREE sample packNot a Sponsor but HIGHLY recommended: ENERGYbitsRemember to watch our full episodes on YouTube! Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Watch the full videos of all our episodes on YouTube! Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Originally aired in June 2019 as our 73rd episode, we still often think back to this amazing first conversation we had with Dr. Stuart Fischbein and Midwife Blyss Young!Now, almost 6 years later, the information is just as relevant and impactful as it was then. This episode was a Q&A from our Facebook followers and touches on topics like statistics surrounding VBAC, uterine rupture, uterine abnormalities, insurance companies, breech vaginal delivery, high-risk pregnancies, and a powerful analogy about VBACs and weddings!Birthing Instincts PatreonBirthing BlyssNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hey, guys. This is one of our re-broadcasted episodes. This is an episode that, in my opinion, is a little gem in the podcast world of The VBAC Link. I really have loved this podcast ever since the date we recorded it. I am a huge fan of Dr. Stu Fischbein and Midwife Blyss and have been since the moment I knew that they existed. I absolutely love listening to their podcast and just all of the amazing things that they have and that they offer. So I wanted to rebroadcast this episode because it was quite down there. It was like our 73rd episode or something like that. And yeah, I love it so much. This week is OB week, and so I thought it'd be fun to kick-off the week with one of my favorite OB doctor's, Stuart Fischbein. So, a little recap of what this episode covers. We go over a lot. We asked for our community to ask questions for these guys, and we went through them. We didn't get to everything, so that was a bummer, but we did get to quite a bit. We talked about things like the chances of VBAC. We talked about the chances of uterine rupture and the signs of uterine rupture. We talked about inducing VBAC. We talked about uterine abnormalities, the desire of where you want to birth and figuring that out. And also, Blyss had a really great analogy to talk about what to do and how we're letting the medical world and insurance and things like that really contemplate where we or dictate where we are birthing. I love that analogy. You guys, seriously, so many questions. It's an episode that you'll probably want to put on repeat because it really is so great to listen to them, and they just speak so directly. I can't get enough of it. So I'm really excited for you guys to dive in today on this. However, I wanted to bring to your attention a couple of the new things that they've had since we recorded this way back when. I also wanted to point out that we will have updated notes in the show notes or updated links in the show notes so you can go check, them out. But one of the first things I wanted to mention was their Patreon. They have a Patreon these days, and I think that it just sounds dreamy. I think you should definitely go find in their Patreon their community through their Patreon. You can check it out at patreon.com, birthinginsinctspodcast.com and of course, you can find them on social media. You can find Dr. Stu at Birthing Instincts or his website at birthinginsincts.com. You can find Blyss and that is B-L-Y-S-S if you are looking for her at birthingblyss on Instagram or birthinblyss.com, and then of course, you can email them. They do take emails with questions and sometimes they even talk about it on their podcast. Their podcast is birthinginsinctspodcast.com, and then you can email them at birthinginsinctspodcast@gmail.com, so definitely check them out. Also, Dr. Stu offers some classes and workshops and things like that throughout the years on the topic of breech. You guys, I love them and really can't wait for you to listen to today's episode.Ladies, I cannot tell you how giddy and excited I have been for the last couple weeks since we knew that these guys were going to record with us. But we have some amazing, special guests today. We have Dr. Stuart Fischbein and Midwife Blyss Young, and we want to share a little bit about them before we get into the questions that all of you guys have asked on our social media platforms.Julie: Absolutely. And when Meagan says we're excited, we are really excited.Meagan: My face is hot right now because I'm so excited.Julie: I'm so excited. Meagan was texting me last night at 11:00 in all caps totally fan-girling out over here. So Dr. Stu and midwife Blyss are pretty amazing and we know that you are going to love them just as much as we do. But before we get into it, and like Meagan said, I'm just going to read their bios so you can know just how legit they really are. First, up. Dr. Stuart Fischbein, MD is a fellow of the American College of Obstetrics and Gynecology, and how much we love ACOG over here at The VBAC Link He's a published author of the book Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife, and a Mom. He has peer-reviewed papers Home Birth with an Obstetrician, A Series of 135 Out-of-Hospital Births and Breech Births at Home, Outcomes of 60 Breech and 109 Cephalic Planned Home and Birth Center Births. Dr. Stu is a lecturer and advocate who now works directly with home birthing midwives. His website is www.birthinginsincts.com, and his podcast is Dr. Stu's Podcast. Seriously guys, you need to subscribe.Meagan: Go subscribe right now to their podcast.Yeah. The website for his podcast is drstuspodcast.com. He has an international following. He offers hope for women who cannot find supportive practitioners for VBAC and twin and breech deliveries. Guys, this is the home birth OB. He is located in California. So if you are in California hoping for VBAC, especially if you have any special circumstance like after multiple Cesareans, twins or breech presentation, run to him. Run. Go find him. He will help you. Go to that website. Blyss, Midwife Blyss. We really love them. If you haven't had a chance to hear their podcast guys, really go and give them a listen because this duo is on point. They are on fire, and they talk about all of the real topics in birth. So his partner on the podcast is Blyss Young, and she is an LM and CPM. She has been involved in the natural birth world since the birth of her first son in 1992, first as an advocate, and then as an educator. She is a mother of three children, and all of her pregnancies were supported by midwives, two of which were triumphant, empowering home births. In 2006, Blyss co-founded the Sanctuary Birth and Family Wellness Center. This was the culmination of all of her previous experience as a natural birth advocate, educator and environmentalist. The Sanctuary was the first of its kind, a full-spectrum center where midwives, doctors, and other holistic practitioners collaborated to provide thousands of Los Angeles families care during their prenatal and postpartum periods. Blyss closed the Sanctuary in 2015 to pursue her long-held dream of becoming a midwife and care for her clients in an intimate home birth practice similar to the way she was cared for during her pregnancies. I think that's , why Meagan and I both became doulas. Meagan: That's exactly why I'm a doula. Julie: We needed to provide that care just like we had been cared for. Anyway, going on. Currently, Blyss, AKA Birthing Blyss, supports families on their journey as a birth center educator, placenta encapsulator and a natural birth and family consultant and home birth midwife. She is also co-founder of Just Placentas, a company servicing all of Southern California and placenta encapsulation and other postpartum services. And as ,, she's a co-host on Dr. Stu's Podcast. Meagan: And she has a class. Don't you have a class that you're doing? Don't you have a class? Midwife Blyss: Yeah. Meagan: Yeah. She has a class that she's doing. I want to just fly out because I know you're not doing it online and everything. I just want to fly there just to take your class.Midwife Blyss: Yeah, it's coming online.Meagan: It is? Yay! Great. Well, I'll be one of those first registering. Oh, did you put it in there?Julie: No, there's a little bit more.Meagan: Oh, well, I'm just getting ahead.Julie: I just want to read more of Blyss over here because I love this and I think it's so important. At the heart of all Blyss's work is a deep-rooted belief in the brilliant design of our bodies, the symbiotic relationship between baby and mother, the power of the human spirit and the richness that honoring birth as the rite of passage and resurrecting lost traditions can bring to our high-tech, low-touch lives. And isn't that true love? I love that language. It is so beautiful. If I'm not mistaken, Midwife Blyss's website is birthingblyss.com.Is that right? And Blyss is spelled with a Y. So B-L-Y-S-S, birthingblyss.com, and that's where you can find her.Midwife Blyss: Just to make it more complicated, I had to put a Y in there.Julie: Hey. I love it.Meagan: That's okay.Julie: We're in Utah so we have all sorts of weird names over here.Meagan: Yep. I love it. You're unique. Awesome. Well, we will get started.Midwife Blyss: I did read through these questions, and one of the things that I wanted to say that I thought we could let people know is that of course there's a little bit more that we need to take into consideration when we have a uterus that's already had a scar.There's a small percentage of a uterine rupture that we need to be aware of, and we need to know what are the signs and symptoms that we would need to take a different course of action. But besides that, I believe that, and Dr. Stu can speak for himself because we don't always practice together. I believe that we treat VBAC just like any other mom who's laboring. So a lot of these questions could go into a category that you could ask about a woman who is having her first baby. I don't really think that we need to differentiate between those.Meagan: I love it. Midwife Blyss: But I do think that in terms of preparation, there are some special considerations for moms who have had a previous Cesarean, and probably the biggest one that I would point to is the trauma.Julie: Yes.Midwife Blyss: And giving space to and processing the trauma and really helping these moms have a provider that really believes in them, I think is one of the biggest factors to them having success. Meagan: Absolutely. Midwife Blyss: So that's one I wanted to say before you started down the question.Meagan: Absolutely. We have an online class that we provide for VBAC prep, and that's the very first section. It's mentally preparing and physically preparing because there's so much that goes into that. So I love that you started out with that.Julie: Yeah. A lot of these women who come searching for VBAC and realize that there's another way besides a repeat Cesarean are processing a lot of trauma, and a lot of them realized that their Cesarean might have been prevented had they known better, had a different provider, prepared differently, and things like that. Processing that and realizing that is heavy, and it's really important to do before getting into anything else, preparation-wise.Meagan: Yeah.Midwife Blyss: One of the best things I ever had that was a distinction that one of my VBAC moms made for me, and I passed it on as I've cared for other VBAC mom is for her, the justification, or I can't find the right word for it, but she basically said that that statement that we hear so often of, "Yeah, you have trauma from this, or you're not happy about how your birth went, but thank God your baby is healthy." And she said it felt so invalidating for her because, yes, she also was happy, of course, that her baby was safe, but at the same time, she had this experience and this trauma that wasn't being acknowledged, and she felt like it was just really being brushed away.Julie: Ah, yeah.Midwife Blyss: I think really giving women that space to be able to say, "Yes, that's valid. It's valid how you feel." And it is a really important part of the process and having a successful vaginal delivery this go around.Dr. Stu: I tend to be a lightning rod for stories. It's almost like I have my own personal ICAN meeting pretty much almost every day, one-on-one. I get contacted or just today driving. I'm in San Diego today and just driving down here, I talked to two people on the phone, both of whom Blyss really just touched on it is that they both are wanting to have VBACs with their second birth. They were seeing practitioners who are encouraging them to be induced for this reason or that reason. And they both have been told the same thing that Blyss just mentioned that if you end up with a repeat Cesarean, at least you're going to have a healthy baby. Obviously, it's very important. But the thing is, I know it's a cliche, but it's not just about the destination. It's about the journey as well. And one of the things that we're not taught in medical school and residency program is the value of the process. I mean, we're very much mechanical in the OB world, and our job is to get the baby out and head it to the pediatric department, and then we're done with it. If we can get somebody induced early, if we can decide to do a C-section sooner than we should, there's a lot of incentives to do that and to not think about the process and think about the person. There's another cliche which we talk about all the time. Blyss, and I've said it many times. It's that the baby is the candy and the mother's the wrapper. I don't know if you've heard that one, but when the baby comes out, the mother just gets basically tossed aside and her experience is really not important to the medical professionals that are taking care of her in the hospital setting, especially in today's world where you have a shift mentality and a lot of people are being taken care of by people they didn't know.You guys mentioned earlier the importance of feeling safe and feeling secure in whatever setting you're in whether that's at home or in the hospital. Because as Blyss knows, I get off on the mammalian track and you talk about mammals. They just don't labor well when they're anxious.Julie: Yep.Dr. Stu: When the doctor or the health professional is anxious and they're projecting their anxiety onto the mom and the family, then that stuff is brewing for weeks, if not months and who knows what it's actually doing inside, but it's certainly not going to lead to the likelihood of or it's going to diminish the likelihood of a successful labor.Julie: Yeah, absolutely. We talk about that. We go over that a lot. Like, birth is very instinctual and very primal, and it operates a very fundamental core level. And whenever mom feels threatened or anxious or, or anything like that, it literally can st or stop labor from progressing or even starting.Meagan: Yeah, exactly. When I was trying to VBAC with my first baby, my doctor came in and told my husband to tell me that I needed to wake up and smell the coffee because it wasn't happening for me. And that was the last, the last contraction I remember feeling was right before then and my body just shut off. I just stopped because I just didn't feel safe anymore or protected or supported. Yeah, it's very powerful which is something that we love so much about you guys, because I don't even know you. I've just listened to a million of your podcasts, and I feel so safe with you right now. I'm like, you could fly here right now and deliver my baby because so much about you guys, you provide so much comfort and support already, so I'm sure all of your clients can feel that from you.Julie: Absolutely.Dr. Stu: Yeah. I just would like to say that, know, I mean, the introduction was great. Which one of you is Julie? Which one's Meagan?Julie: I'm Julie.Meagan: And I'm Meagan.Dr. Stu: Okay, great. All right, so Julie was reading the introduction that she was talking about how if you have a breech, you have twins, if you have a VBAC, you have all these other things just come down to Southern California and care of it. But I'm not a cowboy. All right? Even though I do more things than most of my colleagues in the profession do, I also say no to people sometimes. I look at things differently. Just because someone has, say chronic hypertension, why can't they have a home birth? The labor is just the labor. I mean, if her blood pressure gets out of control, yeah, then she has to go to the hospital. But why do you need to be laboring in the hospital or induced early if everything is fine? But this isn't for everybody.We want to make that very clear. You need to find a supportive team or supportive practitioner who's willing to be able to say yes and no and give you it with what we call a true informed consent, so that you have the right to choose which way to go and to do what's reasonable. Our ethical obligation is to give you reasonable choices and then support your informed decision making. And sometimes there are things that aren't reasonable. Like for instance, an example that I use all the time is if a woman has a breech baby, but she has a placenta previa, a vaginal delivery is not an option for you. Now she could say, well, I want one and I'm not going to have a C-section.Julie: And then you have the right to refuse that.Dr. Stu: Yeah, yeah, but I mean, that's never going to happen because we have a good communication with our patients. Our communication is such that we develop a trust over the period of time. Sometimes I don't meet people until I'm actually called to their house by a midwife to come assist with a vacuum or something like that. But even then, the midwives and stuff, because I'm sort of known that people have understanding. And then when I'm sitting there, as long as the baby isn't trouble, I will explain to them, here's what's going to happen. Here's how we're going to do it. Here's what's going on. The baby's head to look like this. It not going be a problem. It'll be better in 12 hours. But I go through all this stuff and I say, I'm going to touch you now. Is that okay? I ask permission, and I do all the things that the midwives have taught me, but I never really learned in residency program. They don't teach this stuff.Julie: Yeah, yeah, yeah, absolutely. One of the things that we go over a lot to in our classes is finding a provider who has a natural tendency to treat his patients the way that you want to be treated. That way, you'll have a lot better time when you birth because you're not having to ask them to do anything that they're not comfortable with or that they're not prepared for or that they don't know how to do. And so interviewing providers and interview as many as you need to with these women. And find the provider whose natural ways of treating his clients are the ways that you want to be treated.Dr. Stu: And sometimes in a community, there's nobody.Julie: Yeah, yeah, that's true.Meagan: That's what's so hard.Dr. Stu: And if it's important to you, if it's important to you, then you have to drive on. Julie: Or stand up for yourself and fight really hard.Meagan: I have a client from Russia. She's flying here in two weeks. She's coming all the way to Salt Lake City, Utah to have her baby. We had another client from Russia.Julie: You have another Russian client?Meagan: Yeah. Julie: That's awesome. Meagan: So, yeah. It's crazy. Sometimes you have to go far, far distances, and sometimes you've got them right there. You just have to search. You just have to find them.So it's tricky.Midwife Blyss: Maybe your insurance company is not gonna pay for it.Meagan: Did you say my company's not gonna pay for it?Midwife Blyss: And maybe your insurance company.Meagan: Oh, sure. Yeah, exactly.Midwife Blyss: You can't rely on them to be the ones who support some of these decisions that are outside of the standards of care. You might have to really figure out how to get creative around that area.Meagan: Absolutely.Yeah. So in the beginning, Blyss, you talked about noticing the signs, and I know that's one of the questions that we got on our Instagram, I believe. Birthing at home for both of you guys, what signs for a VBAC mom are signs enough where you talk about different care?.Dr. Stu: I didn't really understand that. Say that again what you were saying.Meagan: Yep. Sorry. So one of the questions on our Instagram was what are the signs of uterine rupture when you're at home that you look for and would transfer care or talk about a different plan of action?Dr. Stu: Okay. Quite simply, some uterine ruptures don't have any warning that they're coming.There's nothing you can do about those. But before we get into what you can feel, just let's review the numbers real briefly so that people have a realistic viewpoint. Because I'm sure if a doctor doesn't want to do a VBAC, you'll find a reason not to do a VBAC. You'll use the scar thickness or the pregnancy interval or whatever. They'll use something to try to talk you out of it or your baby's too big or this kind of thing. We can get into that in a little bit. But when there are signs, the most common sign you would feel is that there'd be increasing pain super-cubically that doesn't go away between contractions. It's a different quality of pain or sensation. It's pain. It's really's becoming uncomfortable. You might start to have variables when you didn't have them before. So the baby's heart rate, you might see heart rate decelerations. Rarely, you might find excessive bleeding, but that's usually not a sign of I mean that's a sign of true rupture.Midwife Blyss: Loss of station.Dr. Stu: Those are things you look for, but again, if you're not augmenting someone, if someone doesn't have an epidural where they don't have sensation, if they're not on Pitocin, these things are very unlikely to happen. I was going to get to the numbers. The numbers are such that the quoted risk of uterine rupture, which is again that crappy word. It sounds like a tire blowing out of the freeway. It is about 1 in 200. But only about 5 to 16%. And even one study said 3%. But let's just even take 16% of those ruptures will result in an outcome that the baby is damaged or dead. Okay, that's about 1 in 6. So the actual risk is about 1 in 6 times 1 in 200 or 1 in 1200 up to about 1 in 4000.Julie: Yep.Dr. Stu: So those are, those are the risks. They're not the 1 in 200 or the 2%. I actually had someone tell some woman that she had a 30% chance of rupture.Julie: We've had somebody say 50%.Meagan: We have?Julie: Yeah. Jess, our 50 copy editor-- her doctor told her that if she tries to VBAC, she has a 50% chance of rupture and she will die. Yeah.Meagan: Wow.Julie: Pretty scary. Dr. Stu: And by the way, a maternal mortality from uterine rupture is extremely rare.Julie: Yeah, we were just talking about that.Dr. Stu: That doctor is wrong on so many accounts. I don't even know where to begin on that.Julie: I know.Dr. Stu: Yeah. See that's the thing where even if someone has a classical Cesarean scar, the risk of rupture isn't 50%.Julie: Yep.Dr. Stu: So I don't know where they come up with those sorts of numbers.Julie: Yeah, I think it's just their comfort level and what they're familiar with and what they know and what they understand. I think a lot of these doctors, because she had a premature Cesarean, and so that's why he was a little, well, a lot more fear-based. Her Cesarean happened, I think, around 32 weeks. We still know that you can still attempt to VBAC and still have a really good chance of having a successful one. But a lot of these providers just don't do it.Dr. Stu: Yeah. And another problem is you can't really find out what somebody's C-section rate is. I mean, you can find out your hospital C-section rate. They can vary dramatically between different physicians, so you really don't know. You'd like to think that physicians are honest. You'd like to think that they're going to tell you the truth. But if they have a high C-section rate and it's a competitive world, they're not going to. And if you're with them, you don't really have a choice anyway.Julie: So there's not transparency on the physician level.Dr. Stu: So Blyss was talking briefly about the fact that your insurance may not pay for it. Blyss, why don't you elaborate on that because you do that point so well.Midwife Blyss: Are you talking about the wedding?Dr. Stu: I love your analogy. It's a great analogy.Midwife Blyss: I'm so saddened sometimes when people talk to me about that they really want this option and especially VBACs. I just have a very special tender place in my heart for VBAC because I overcame something from my first to second birth that wasn't a Cesarean. But it felt like I had been led to mistrust my body, and then I had a triumphant second delivery. So I really understand how that feels when a woman is able to reclaim her body and have a vaginal delivery. But just in general, in terms of limiting your options based on what your insurance will pay for, we think about the delivery of our baby and or something like a wedding where it's this really special day. I see that women or families will spend thousands and thousands of dollars and put it on a credit card and figure out whatever they need to do to have this beautiful wedding. But somehow when it comes to the birth of their baby, they turn over all their power to this insurance company.And so we used to do this talk at the sanctuary and I used to say, "What if we had wedding insurance and you paid every year into this insurance for your wedding, and then when the wedding came, they selected where you went and you didn't like it and they put you in a dress that made you look terrible and the food was horrible and the music was horrible and they invited all these people you didn't want to be there?"Julie: But it's a network.Midwife Blyss: Would you really let that insurance company, because it was paid for, dictate how your wedding day was? Julie: That's a good analogy.Midwife Blyss: You just let it all go.Meagan: Yeah. That's amazing. I love that. And it's so true. It is so true.Julie: And we get that too a lot about hiring a doula. Oh, I can't hire a doula. It's too expensive. We get that a lot because people don't expect to pay out-of-pocket for their births. When you're right, it's just perceived completely differently when it should be one of the biggest days of your life. I had three VBACs at home. My first was a necessary, unnecessary Cesarean.I'm still really uncertain about that, to be honest with you. But you better believe my VBACs at home, we paid out of pocket for a midwife. Our first two times, it was put on a credit card. I had a doula, I had a birth photographer, I had a videographer. My first VBAC, I had two photographers there because it was going to be documented because it was so important to me. And we sold things on eBay. We sold our couches, and I did some babysitting just to bring in the money.Obviously, I hired doulas because it was so important to me to not only have the experience that I wanted and that I deserved, but I wanted it documented and I wanted it to be able to remember it well and look back on it fondly. We see that especially in Utah. I think we have this culture where women just don't-- I feel like it's just a national thing, but I think in Utah, we tend to be on the cheap side just culturally and women don't see the value in that. It's hard because it's hard to shift that mindset to see you are important. You are worth it. What if you could have everything you wanted and what if you knew you could be treated differently? Would you think about how to find the way to make that work financially? And I think if there's just that mindset shift, a lot of people would.Meagan: Oh, I love that.Dr. Stu: If you realize if you have to pay $10,000 out of pocket or $5,000 or whatever to at least have the opportunity, and you always have the hospital as a backup. But 2 or 3 years from now, that $5,000 isn't going to mean anything.Julie: Yeah, nothing.Meagan: But that experience is with you forever.Dr. Stu: So yeah, women may have to remember the names of their children when they're 80 years old, but they'll remember their birth.Julie: Well, with my Cesarean baby, we had some complications and out-of-pocket, I paid almost $10,000 for him and none of my home births, midwives, doula, photography and videography included cost over $7,000.Meagan: My Cesarean births in-hospital were also more expensive than my birth center births.Julie: So should get to questions.Dr. Stu: Let's get to some of the questions because you guys some really good questions.Meagan: Yes.Dr. Stu: Pick one and let's do it.Meagan: So let's do Lauren. She was on Facebook. She was our very first question, and she said that she has some uterine abnormalities like a bicornuate uterus or a separate uterus or all of those. They want to know how that impacts VBAC. She's had two previous Cesareans due to a breech presentation because of her uterine abnormality.Julie: Is that the heart-shaped uterus? Yeah.Dr. Stu: Yeah. You can have a septate uterus. You can have a unicornuate uterus. You can have a double uterus.Julie: Yeah. Two separate uteruses.Dr. Stu: Right. The biggest problem with a person with an abnormal uterine shape or an anomaly is a couple of things. One is malpresentation as this woman experienced because her two babies were breech. And two, is sometimes a retained placenta is more common than women that have a septum, that sort of thing. Also, it can cause preterm labor and growth restriction depending on the type of anomaly of the uterus. Now, say you get to term and your baby is head down, or if it's breech in my vicinity. But if it's head down, then the chance of VBAC for that person is really high. I mean, it might be a slightly greater risk of Cesarean section, but not a statistically significant risk. And then the success rate for home birth VBACs, if you look at the MANA stats or even my own stats which are not enough to make statistical significance in a couple of papers that I put out, but the MANA stats show that it's about a 93% success rate for VBACS in the midwifery model, whereas in the hospital model, it can be as low as 17% up to the 50s or 60%, but it's not very high. And that's partly because of the model by which you're cared for. So the numbers that I'm quoting and the success rates I'm quoting are again, assuming that you have a supportive practitioner in a supportive environment, every VBAC is going to have diminished chance of success in a restrictive or tense environment. But unicornuate uterus or septate uterus is not a contraindication to VBAC, and it's not an indication of breech delivery if somebody knows how to do a breech VBAC too.Julie: Right.Dr. Stu: So Lauren, that would be my answer to to your question is that no, it's not a contraindication and that if you have the right practitioner you can certainly try to labor and your risk of rupture is really not more significant than a woman who has a normal-shaped uterus.Julie: Good answer.Meagan: So I want to spin off that really quick. It's not a question, but I've had a client myself that had two C-sections, and her baby was breech at 37 weeks, and the doctor said he absolutely could not turn the baby externally because her risk of rupture was so increasingly high. So would you agree with that or would you disagree with that?D No, no, no. Even an ACOG statement on external version and breech says that a previous uterine scar is not a contraindication to attempting an external version.Meagan: Yeah.Dr. Stu: Now actually, if we obviously had more breech choices, then there'd be no reason to do an external version.The main reason that people try an external version which can sometimes be very uncomfortable, and depending on the woman and her parody and certain other factors, their success rate cannot be very good is the only reason they do it because the alternative is a Cesarean in 95% of locations in the country.Meagan: Okay, well that's good to know.Dr. Stu: But again, one of the things I would tell people to do is when they're hearing something from their position that just sort of rocks the common sense vote and doesn't sort of make sense, look into it. ACOG has a lot. I think you can just go Google some of the ACOG clinical guidelines or practice guidelines or clinical opinions or whatever they call them. You can find and you can read through, and they summarize them at the end on level A, B, and C evidence, level A being great evidence level C being what's called consensus opinion. The problem with consensus, with ACOG's guidelines is that about 2/3 of them are consensus opinion because they don't really have any data on them. When you get bunch of academics together who don't like VBAC or don't like home birth or don't like breech, of course a consensus opinion is going to be, "Well, we're not going to think those are a good idea." But much to their credit lately, they're starting to change their tune. Their most recent VBAC guideline paper said that if your hospital can do labor and delivery, your hospital can do VBAC.Julie: Yes.Dr. Stu: That's huge. There was immediately a whole fiasco that went on. So any hospital that's doing labor and delivery should be able to do a VBAC. When they say they can't or they say our insurance company won't let them, it's just a cowardly excuse because maybe it's true, but they need to fight for your right because most surgical emergencies in labor delivery have nothing to do with a previous uterine scar.Julie: Absolutely.Dr. Stu: They have to do with people distress or placental abruption or cord prolapse. And if they can handle those, they can certainly handle the one in 1200. I mean, say a hospital does 20 VBACs a year or 50 VBACs a year. You'll take them. Do the math. It'll take them 25 years to have a rupture.Meagan: Yeah. It's pretty powerful stuff.Midwife Blyss: I love when he does that.Julie: Me too. I'm a huge statistics junkie and data junkie. I love the numbers.Meagan: Yeah. She loves numbers.Julie: Yep.Meagan: I love that.Julie: Hey, and 50 VBACs a year at 2000, that would be 40 years actually, right?Dr. Stu: Oh, look at what happened. So say that again. What were the numbers you said?Julie: So 1 in 2000 ruptures are catastrophic and they do 50 VBACs a year, wouldn't that be 40 years?Dr. Stu: But I was using the 1200 number.Julie: Oh, right, right, right, right.Dr. Stu: So that would be 24 years.Julie: Yeah. Right. Anyways, me and you should sit down and just talk. One day. I would love to have lunch with you.Dr. Stu: Let's talk astrology and astronomy.Yes.Dr. Stu: Who's next?Midwife Blyss: Can I make a suggestion?There was another woman. Let's see where it is. What's the likelihood that a baby would flip? And is it reasonable to even give it a shot for a VBA2C. How do you guys say that?Meagan: VBAC after two Cesareans.Midwife Blyss: I need to know the lingo. So, I would say it's very unlikely for a baby to flip head down from a breech position in labor. It doesn't mean it's impossible.Dr. Stu: With a uterine septum, it's almost never going to happen. Bless is right on. Even trying an external version on a woman with the uterine septum when the baby's head is up in one horn and the placenta in the other horn and they're in a frank breech position, that's almost futile to do that, especially if a woman is what I call a functional primary, or even a woman who's never labored before.Julie: Right. That's true.Meagan: And then Napoleon said, what did she say? Oh, she was just talking about this. She's planning on a home birth after two Cesareans supported by a midwife and a doula. Research suggests home birth is a reasonable and safe option for low-risk women. And she wants to know in reality, what identifies low risk?Midwife Blyss: Well, I thought her question was hilarious because she says it seems like everybody's high-risk too. Old, overweight.Julie: Yeah, it does. It does, though.Dr. Stu: Well, immediately, when you label someone high-risk, you make them high-risk.Julie: Yep.Dr. Stu: Because now you've planted seeds of doubt inside their head. So I would say, how do you define high-risk? I mean, is 1 in 1200 high risk?Julie: Nope.Dr. Stu: It doesn't seem high-risk to me. But again, I mean, we do a lot of things in our life that are more dangerous than that and don't consider them high-risk. So I think the term high-risk is handed about way too much.And it's on some false or just some random numbers that they come up with. Blyss has heard this before. I mean, she knows everything I say that comes out of my mouth. The numbers like 24, 35, 42. I mean, 24 hours of ruptured membranes. Where did that come from? Yeah, or some people are saying 18 hours. I mean, there's no science on that. I mean, bacteria don't suddenly look at each other and go, "Hey Ralph, it's time to start multiplying."Julie: Ralph.Meagan: I love it.Julie: I'm gonna name my bacteria Ralph.Meagan: It's true. And I was told after 18 hours, that was my number.Dr. Stu: Yeah, again, so these numbers, there are papers that come out, but they're not repetitive. I mean, any midwife worth her salt has had women with ruptured membranes for sometimes two, three, or four days.Julie: Yep.Midwife Blyss: And as long as you're not sticking your fingers in there, and as long as their GBS might be negative or that's another issue.Meagan: I think that that's another question. That's another question. Yep.Dr. Stu: Yeah, I'll get to that right now. I mean, if some someone has a ruptured membrane with GBS, and they don't go into labor within a certain period of time, it's not unreasonable to give them the pros and cons of antibiotics and then let them make that decision. All right? We don't force people to have antibiotics. We would watch for fetal tachycardia or fever at that point, then you're already behind the eight ball. So ideally, you'd like to see someone go into labor sooner. But again, if they're still leaking, if there are no vaginal exams, the likelihood of them getting group B strep sepsis or something on the baby is still not very high. And the thing about antibiotics that I like to say is that if I was gonna give antibiotics to a woman, I think it's much better to give a woman an antibiotics at home than in the hospital. And the reason being is because at home, the baby's still going to be born into their own environment and mom's and dad's bacteria and the dog's bacteria and the siblings' bacteria where in the hospital, they're going to go to the nursery for observation like they generally do, and they're gonna be exposed to different bacteria unless they do these vaginal seeding, which isn't really catching on universally yet where you take a swab of mom's vaginal bacteria before the C-section.Midwife Blyss: It's called seeding.Dr. Stu: Right. I don't consider ruptured membrane something that again would cause me to immediately say something where you have to change your plan. You individualize your care in the midwifery model.Julie: Yep.Dr. Stu: You look at every patient. You look at their history. You look at their desires. You look at their backup situation, their transport situation, and that sort of thing. You take it all into account. Now, there are some women in pregnancy who don't want to do a GBS culture.Ignorance is bliss. The other spelling of bliss.Julie: Hi, Blyss.Dr. Stu: But the reason that at least I still encourage people to do it is because for any reason, if that baby gets transferred to the hospital during labor or after and you don't have a GBS culture on the chart, they're going to give antibiotics. They're going to treat it as GBS positive and they're also going to think you're irresponsible.And they're going to have that mentality that of oh, here's another one of those home birth crazy people, blah, blah, blah.Julie: That just happened to me in January. I had a client like that. I mean, anyways, never mind. It's not the time. Midwife Blyss: Can I say something about low-risk?Julie: Yes. Midwife Blyss: I think there are a lot of different factors that go into that question. One being what are the state laws? Because there are things that I would consider low-risk and that I feel very comfortable with, but that are against the law. And I'm not going to go to jail.Meagan: Right. We want you to still be Birthing Bless.Midwife Blyss: As, much as I believe in a woman's right to choose, I have to draw the line at what the law is. And then the second is finding a provider that-- obviously, Dr. Stu feels very comfortable with things that other providers may not necessarily feel comfortable with.Julie: Right.Midwife Blyss: And so I think it's really important, as you said in the beginning of the show, to find a provider who takes the risk that you have and feels like they can walk that path with you and be supportive. I definitely agree with what Dr. Stu was saying about informed consent. I had a client who was GBS positive, declined antibiotics and had a very long rupture. We continued to walk that journey together. I kept giving informed consent and kept giving informed consent. She had such trust and faith that it actually stretched my comfort level. We had to continually talk about where we were in this dance. But to me, that feels like what our job is, is to give them information about the pros and cons and let them decide for themselves.And I think that if you take a statistic, I'm picking an arbitrary number, and there's a 94% chance of success and a 4% chance that something could go really wrong, one family might look at that and say, "Wow, 94%, this is neat. That sounds like a pretty good statistic," and the other person says, "4% makes me really uncomfortable. I need to minimize." I think that's where you have to have the ability, given who you surround yourself with and who your provider is, to be able to say, "This is my choice," and it's being supported. So it is arbitrary in a lot of ways except for when it comes to what the law is.Julie: Yeah, that makes sense.Meagan: I love that. Yeah. Julie: Every state has their own law. Like in the south, it's illegal like in lots of places in the South, I think in Washington too, that midwives can't support home birth if you're VBAC. I mean there are lots of different legislative rules. Why am I saying legislative? Look at me, I'm trying to use fancy words to impress you guys. There are lots of different laws in different states and, and some of them are very evidence-based and some laws are broad and they leave a lot of room for practices, variation and gray areas. Some are so specific that they really limit a woman's option in that state.Dr. Stu: We can have a whole podcast on the legal decision-making process and a woman's right to autonomy of her body and the choices and who gets to decide that would be. Right now, the vaccine issue is a big issue, but also pregnancy and restricting women's choices of these things. If you want to do another one down the road, I would love to talk on that subject with you guys.Julie: Perfect.Meagan: We would love that.Julie: Yeah. I think it's your most recent episode. I mean as of the time of this recording. Mandates Kill Medicine. What is that the name?Dr. Stu: Mandates Destroy Medicine.Julie: Yeah. Mandates Destroy Medicine. Dr. Stu: It's wonderful.Julie: Yeah, I love it. I was just listening to it today again.Dr. Stu: well it does because it makes the physicians agents of the state.Julie: Yeah, it really does.Meagan: Yeah. Well. And if you give us another opportunity to do this with you, heck yeah.Julie: Yeah. You can just be a guest every month.Meagan: Yeah.Dr. Stu: So I don't think I would mind that at all, actually.Meagan: We would love it.Julie: Yeah, we would seriously love it. We'll keep in touch.Meagan: So, couple other questions I'm trying to see because we jumped through a few that were the same. I know one asks about an overactive pelvic floor, meaning too strong, not too weak. She's wondering if that is going to affect her chances of having a successful VBAC.Julie: And do you see that a lot with athletes, like people that are overtrained or that maybe are not overtrained, but who train a lot and weightlifters and things like that, where their pelvic floor is too strong? I've heard of that before.Midwife Blyss: Yep, absolutely. there's a chiropractor here in LA, Dr. Elliot Berlin, who also has his own podcast and he talks–Meagan: Isn't Elliott Berlin Heads Up?Dr. Stu: Yeah. He's the producer of Heads Up.Meagan: Yeah, I listened to your guys' special episode on that too. But yeah, he's wonderful.Midwife Blyss: Yeah. So, again, I think this is a question that just has more to do with vaginal delivery than it does necessarily about the fact that they've had a previous Cesarean. So I do believe that the athletic pelvis has really affected women's deliveries. I think that during pregnancy we can work with a pelvic floor specialist who can help us be able to realize where the tension is and how to do some exercises that might help alleviate some of that. We have a specialist here in L.A. I don't know if you guys do there that I would recommend people to. And then also, maybe backing off on some of the athletic activities that that woman is participating in during her pregnancy and doing things more like walking, swimming, yoga, stretching, belly dancing, which was originally designed for women in labor, not to seduce men. So these are all really good things to keep things fluid and soft because you want things to open and release rather than being tense.Meagan: I love that.Dr. Stu: I agree. I think sometimes it leads more to not generally so much of dilation. Again, a friend of mine, David Hayes, he's a home birth guy in South Carolina, doesn't like the idea of using stages of labor. He wants to get rid of that. I think that's an interesting thought. We have a meeting this November in Wisconsin. We're gonna have a bunch of thought-provoking things going on over there.Dr. Stu: Is it all men talking about this? Midwife Blyss: Oh, hell no.Julie: Let's get more women. Dr. Stu: No, no, no, no, no.Being organized By Cynthia Calai. Do you guys know who Cynthia is? She's been a midwife for 50 years. She's in Wisconsin. She's done hundreds of breeches. Anyway, the point being is that I think that I find that a lot of those people end up getting instrumented like vacuums, more commonly. Yeah. So Blyss is right. I mean, if there are people who are very, very tight down there. The leviators and the muscles inside are very tight which is great for life and sex and all that other stuff, but yeah, you need to learn how to be able to relax them too.Julie: Yeah.Meagan: So I know we're running short on time, but this question that came through today, I loved it. It said, "Could you guys both replicate your model of care nationwide somehow?" She said, "How do I advocate effectively for home birth access and VBAC access in a state that actively prosecutes home birth and has restrictions on midwifery practice?" She specifically said she's in Nebraska, but we hear this all over the place. VBAC is not allowed. You cannot birth at home, and people are having unassisted births.Julie: Because they can't find the support.Meagan: They can't find the support and they are too scared to go to the hospital or birth centers. And so, yeah, the question is--Julie: What can women do in their local communities to advocate for positive change and more options in birth where they are more restricted?Dr. Stu: Blyss. Midwife Blyss: I wish I had a really great answer for this. I think that the biggest thing is to continue to talk out loud. And I'm really proud of you ladies for creating this podcast and doing the work that you do. Julie: Thanks.Midwife Blyss: I always believed when we had the Sanctuary that it really is about the woman advocating for herself. And the more that hospitals and doctors are being pushed by women to say, "We need this as an option because we're not getting the work," I think is really important. I support free birth, and I think that most of the women and men who decide to do that are very well educated.Julie: Yeah, for sure.Midwife Blyss: It is actually really very surprising for midwives to see that sometimes they even have better statistics than we do. But it saddens me that there's no choice. And, a woman who doesn't totally feel comfortable with doing that is feeling forced into that decision. So I think as women, we need to support each other, encourage each other, continue to talk out loud about what it is that we want and need and make this be a very important decision that a woman makes, and it's a way of reclaiming the power. I'm not highly political. I try and stay out of those arenas. And really, one of my favorite quotes from a reverend that I have been around said, "Be for something and against nothing." I really believe that the more. Julie: I like that.Midwife Blyss: Yeah, the more that we speak positively and talk about positive change and empowering ourselves and each other, it may come slowly, but that change will continue to come.Julie: Yeah, yeah.Dr. Stu: I would only add to that that I think unfortunately, in any country, whether it's a socialist country or a capitalist country, it's economics that drives everything. If you look at countries like England or the Netherlands, you find that they have, a really integrated system with midwives and doctors collaborating, and the low-risk patients are taken care of by the midwives, and then they consult with doctors and midwives can transfer from home to hospital and continue their care in that system, the national health system. I'm not saying that's the greatest system for somebody who's growing old and has arthritis or need spinal surgery or something like that, but for obstetrics, that sort of system where you've taken out liability and you've taken out economic incentive. All right, so how do you do that in our system? It's not very easy to do because everything is economically driven. One of the things that I've always advocated for is if you want to lower the C-section rate, increase the VBAC rate. It would be really simple for insurance companies, until we have Bernie Sanders with universal health care. But while we have insurance companies, if they would just pay twice as much for a vaginal birth and half as much for a Cesarean birth, then finally, VBACS and breech deliveries would be something. Oh, maybe we should start. We should be more supportive of those things because it's all about the money. But as long as the hospital gets paid more, doctors don't really get paid more. It's expediency for the doctor. He gets it done and goes home. But the hospital, they get paid a lot more, almost twice as much for a C-section than you do for vaginal birth. What's the incentive for the chief financial officer of any hospital to say to the OB department, "We need to lower our C-section rate?" One of the things that's happening are programs that insurance, and I forgot what it's called, but where they're trying, in California, they're trying to lower the primary C-section rate. There's a term for it where it's an acronym with four initials. Blyss, do you know what I'm talking about?Midwife Blyss: No. Dr. Stu: It's an acronym about a first-time mom. We're trying to avoid those C-sections.Julie: Yeah, the primary Cesarean.Dr. Stu: It's an acronym anyway, nonetheless. So they're in the right direction. Most hospitals are in the 30% range. They'd like to lower to 27%. That's a start.One of the ways to really do that is to support VBAC, and treat VBAC as Blyss said at the very beginning of the podcast is that a VBAC is just a normal labor. When people lump VBAC in with breech in twins, it's like, why are you doing that? Breech in twins requires special skill. VBAC requires a special skill also, which is a skill of doing nothing.Julie: Yeah, it's hard.Dr. Stu: It's hard for obstetricians and labor and delivery nurses and stuff like that to do nothing. But ultimately, VBAC is just a vaginal birth and doesn't require any special skill. When a doctor says, "We don't do VBAC, what he's basically saying, or she, is that I don't do vaginal deliveries," which is stupid because VBAC is just a vaginal delivery.Julie: Yeah, that's true.Meagan: Such a powerful point right there.Julie: Guys. We loved chatting with you so much. We wish we could talk with you all day long.Meagan: I would. All day long. I just want to be a fly on your walls if I could.Julie: If you're ever in Salt Lake City again--Meagan: He just was. Did you know about this?Julie: Say hi to Adrienne, but also connect with us because we would love to meet you. All right, well guys, everyone, all of our listeners, Women of Strength, we are going to drop all the information that you need to find Midwife Blyss and Dr. Stu-- their website, their podcast, and all of that in our show notes. So yeah, now you can find our podcast. You can even listen to our podcast on our website at thevbaclink.com/podcast. You can play episodes right from there. So if you don't know-- well, if you're listening to this podcast, then you probably have a podcast player already. But you know what? My mom still doesn't know what a podcast is, so I'm just gonna have to start sending her links right to our page.Meagan: Yep, just listen to us wherever and leave us a review and head over to Dr. Stu's Podcast and leave them a review.Julie: Subscribe because you're gonna love him, but don't stop listening to him us because you love us too. Remember that.Dr. Stu: I want to thank everybody who wrote in, and I'm sorry we didn't get to answer every question. We tend to blabber on a little bit asking these important questions, and hopefully you guys will have us back on again.Meagan: We would love to have you.Julie: Absolutely.Meagan: Yep, we will.Julie: Absolutely.Meagan: YeahClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands