Podcasts about uterine

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

Dr. Fiona Lovely is a longevity, health and wellness expert with specialties in menopause medicine, functional neurology and functional medicine.  She is speaking to the topics of women's health around perimenopause and menopause.   Uterine fibroids are a very common concern for women who are still menstruating.  They are the cause of extreme and chronic pain, heavy bleeding and there aren't great treatment options available.  Today I welcome Dr Suzanne LeBlang to the show to discuss a novel therapy for treatment of fibroids - focused ultrasound.   I had never heard about this treatment until Dr. LeBlang shared her knowledge.  This conversation highlights how the non-invasive technique can treat uterine fibroids using thermal ablation, without the need for incisions or injections.  This is also available for many other health concerns such as thyroid nodules,  Parkinson's disease, breast tumours, tremors and others.  It has been FDA approved since 2004.  Overall, this episode underscores the importance of non-invasive treatment options for women's health concerns, with focused ultrasound emerging as a promising alternative for various conditions. Dr. LeBlang is the Director of Clinical Relationships at the Focused Ultrasound Foundation (FUS) and was trained as a neuroradiologist.  You can find out more about this treatment option at fusfoundation.org or on Instagram here.     Thank you to our sponsors for this episode:

Uterine fibroids are a type of non-cancerous growth and more commonly found in African American women. Dr. Karen Berken with Willis Knighton Bossier discusses treatment options and surgical management of uterine fibroids.

Send us a textIn this deeply personal and emotional episode, host Deborah Niemann shares the heartbreaking story of her goat, Coco, who experienced a uterine rupture and hemorrhage during a challenging kidding in 2013. Deborah takes listeners on a journey through Coco's life, from her birth to her tragic passing after giving birth to quintuplets. This episode not only honors Coco's memory but also provides valuable insights into the risks of uterine tears and hemorrhages in goats, how to recognize the signs, and what steps can be taken to prevent or address such emergencies.Key TakeawaysUterine ruptures can occur during difficult births, especially when there is excessive pressure or improper handling during interventions.Goats are horizontal animals, so internal bleeding may not be visible externally. Instead, blood collects in the abdomen.Warning signs include mental absence, lethargy, pale eyelids (indicating anemia), and disinterest in kids or milking.Lessons Learned from Coco's ExperienceRecognizing Symptoms: If a goat seems mentally absent or unresponsive after kidding, check for anemia by examining their eyelids. Pale eyelids can indicate severe blood loss.Importance of Veterinary Relationships: Having an established relationship with a vet ensures quicker access to help during emergencies.University veterinary hospitals can provide 24-hour care and specialized expertise if local vets are unavailable.Risks of Certain Tools and Procedures: Tools like kid pullers (wire nooses) can be effective but carry risks of causing uterine tears if not used carefully.Procedures like fetotomies (cutting up a fetus for removal) are especially risky in small goats like Nigerians due to limited space in their uterus.Postpartum Care: Small uterine tears can heal naturally but may lead to infections.Severe tears often require surgical intervention or result in fatal hemorrhaging.Preventative Measures: Avoid breeding smaller does with larger bucks to reduce the risk of oversized kids causing birthing complications.Always ensure hands are clean, nails are trimmed short, and gloves are worn when assisting with kidding to minimize risks of tears or infections.Resources MentionedDeborah's book: Goats Giving Birth Previous podcast episodes: Blood Transfusion in GoatsAnemia in GoatsSee full show notes here >> https://thriftyhomesteader.com/uterine-rupture-and-hemorrhage-in-goats/ To see the most recent episodes, visit  ForTheLoveOfGoats.comWant to support the content you love?Head over to -- https://thrifty-homesteader.ck.page/products/love-goats-tip-jarThanks for listening!No one ever said raising goats was easy, but it doesn't have to cost a fortune or drive you crazy! You just need the right information. Click here to learn more about our Goats 365 membership.

Hi everyone, This week I am joined again by Dr David Owen an obstetrician here at KEMH. We sit down to discuss uterine inversion - an acute obstetric emergency. Luckily this condition is relatively rare - however because of this there can be challenges in recognising and treating this condition even amongst experienced individuals. Should you be unlucky enough to encounter this rare condition, now having listened to our discussion you will be better prepared and confident you know what is required! Thanks again David for your research and preparation for this episode! References Uterine inversionPararajasingam, S.S. et al.BJA Education, Volume 24, Issue 4, 109 - 112 Unfortunately (as of Feb 2025) this article is not yet open access - but it is very good if you can get it through your hospital or college library.. Uterine Inversion for the layperson - Cleveland Clinic https://youtu.be/bYIPkNfPDUI

In this episode, we're joined by Kelsi Wendling, IVF warrior and TikTok creator. She shares her journey with IVF whilst being diagnosed with Uterine Didelphys.Listen to the full episode now, and subscribe to The Ribbon Box podcast today to listen to more like this.Follow Kelsi's journey on TikTok @kelsidouble.u and Instagram @kelsidouble.uSupport this podcast at — https://redcircle.com/fertility-spingboard/exclusive-content

Aisha's episode is full of wisdom and inspiration! With her first two births, Aisha worked so hard to deliver vaginally, but ultimately had two undesired Cesareans. She was told in the operating room that she had uterine dehiscence, was given a special scar, and should never try to deliver vaginally. But her intuition was telling her a different story. She dove into research. She found a community and listened to podcasts like The VBAC Link. She knew a VBA2C was possible, and she knew she had to try. Aisha's VBA2C journey involved interacting with supportive and very unsupportive providers, hiring a fantastic doula, being proactive with labor comfort measures, planning for the unexpected, staying firm in her desires, asynclitic positioning, and pushing her baby boy out in just 45 minutes with a nuchal hand!Aisha's WebsiteThe VBAC Link Blog: VBA2CNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. It's The VBAC Link, and we have a VBA2C story coming your way. Have you ever wondered what VBA2C means? If you haven't noticed, in the VBAC world, there are a lot of acronyms. VBA2C is one of them. That means vaginal birth after two Cesareans, meaning that you have had two Cesareans and want to go for a vaginal birth. Big question, what are the chances of having a vaginal birth after two Cesareans? Is it possible? The answer is simply, yes. It is totally possible. Myself and Aisha are living proof today that it is possible. In fact, your chances of a successful VBA2C are similar to those of just a VBAC with one Cesarean. ACOG recommends that VBA2C is a safe option, so today, I want to quickly go over a little bit more instead of a review about some education on vaginal birth after two Cesareans and share a little bit more of our blog. Like I said, ACOG recommends that vaginal birth after two Cesareans is actually a safe option. They say, “It is reasonable to consider women with two previous low transverse Cesarean deliveries to be candidates for TOLAC.” Now, again, there's another one of those acronyms. TOLAC- trial of labor after a Cesarean. I know that is triggering for some. It is pretty much just the medical term of saying that you are having a trial of labor after a Cesarean, so try not to let it impact you too much. But, “for TOLAC and to counsel them based off of the combination of other factors that affect their probability of achieving a VBAC.” There are lots of things that people might go look through to see if you are eligible for a VBAC after two Cesareans. Now, I'm sure you have probably heard this before, but proven pelvis. If you haven't had a proven pelvis, meaning that your baby has come out vaginally before you've had a vaginal birth or a Cesarean– now when I say this, sometimes we have a vaginal birth, then we will have two Cesareans, and someone wants to go for a VBAC again, so they would be considered a proven pelvis or cervix to a medical staff. But if you haven't had a “proven pelvis”, I hope you guys can imagine my air quotes right now, that doesn't mean that you shouldn't be considered as someone who should have a VBAC. It says in our blog, “More important to note, there is no mention of a requirement to have had that previous vaginal delivery.” I wanted to point out that it really is not a necessary thing. I hadn't had a vaginal birth before. My cervix also hadn't made it to 10 centimeters before, so just know that it is still possible. Quickly, there are things that you can do to reduce uterine rupture, and there are also things you can do to increase your chances of VBAC. Again, it's going to be in our blog. I'm going to send you over there after the episode so you can go and read more about it, but some of the things that you can do to minimize the risk of uterine rupture is staying away from induction. Now, can VBAC be induced? Yes, they can. Yes, yes, yes, yes, you can, so I don't want you to totally freak out right now. But, staying away from induction for VBAC is better than going to get induced. It does increase our chance of uterine rupture, and it does increase our chances of other things like interventions that are unnecessary. Unless it's absolutely necessary or totally desired, try to stay away from induction. Avoid augmentation of labor so things like Pitocin and other drugs to cause the uterus to contract more than it naturally would. Okay, let's see. Avoid providers who aggressively intervene or want to manage your labor or come at you with fearmongering tactics. You guys are going to hear some of that here, and honestly, I think it's a common thing with these stories. We are getting a lot of fearmongering here. Providers, if you are listening, knock it off. Goodness gracious, we do not need to add fear to something that has been looming over us because VBAC has such a bad rap in the world, and it's so scary. Again, air quotes, guys. Just stop with the fearmongering. Avoid providers who are going to build you up with things– I should say tear you down, but fill you up with things like, “Your baby is looking too big. I don't know. We should probably induce. I don't know if your baby is going to be able to come out because you are really small, and that baby is looking really big. Oh my gosh, you have to have an epidural. Oh my gosh, you have to have your baby by 39 weeks.” There are so many things. It's annoying. Okay, going back to avoiding rupture. Avoid or delay things like getting an epidural until at least the end if possible because we do know that sometimes when we get an epidural early in labor, it can bring things like interventions, and we are getting Pitocin that is too high and other things like that. There are so many other things here, you guys. I'm going to make sure that the link is in the show notes. I don't want to take too much of our time, so we can make sure that Aisha can share her beautiful VBAC after two Cesarean stories and all that she had done to lead up to this experience. You guys, it's a good one. Something that is very different about this episode is that she actually had a dehiscence with her second which in a lot of the studies and literature for rupture, a dehiscence is often confused or combined with uterine rupture.I really love that this is a different type of story here, so gear up and enjoy. All right, Aisha. Thank you again so much for being here. As we were talking about earlier, VBAC after two Cesareans is so highly requested in our community. So without further ado, I want to turn the time over to you. Aisha: Thank you so much for having me. This is surreal. I feel like this pushed me in some ways. It was a goal of mine. I'm like, “If I make it and do my VBAC after two Cesareans, I'm going to send my story to The VBAC Link.” Yeah. I've listened to you guys. It's been literally almost four years listening to you guys all of the time trying to visualize my birth after hearing other people's stories. It's such a blessing, and I'm honored to be here to be honest. Meagan: Well, thank you so much. Aisha: Of course. Yeah. I mean, if we start from the beginning with my whole birthing journey, I got pregnant in 2018. I really wanted to try out the whole natural route, so I went with a midwife here in Canada. It's covered by the government so whether you go to a midwife or OB/GYN, it's honestly the same thing. It depends on what type of care you want to have. I chose to go with the midwife, and I chose to give birth at a birthing center for my firstborn. Labor started. I never ended up giving birth naturally obviously. I ended up having a 60-hour labor. Yeah. After 60 hours, they declared me failure to progress, and I think my cervix was a bit swollen at that point. The baby had made the meconium in my tummy. Meagan: Oh, yeah. Stressing out is common. Babies poop sometimes, and it doesn't always mean an emergency or anything like that, but when it's happening and other things are happening–Aisha: Exactly. I think I started having a fever and other things like that. At that point, they came to see me. They were like, “Before things turn into an emergency, let's go and have a simple C-section.” I felt very defeated. I worked very hard for a natural birth. I did 40 of those 60 hours all-natural, but after seeing I wasn't progressing– when I was with my midwife, I was 2 centimeters after 40 hours, and at that point, I requested to be transferred to the hospital to get an epidural. When I got the epidural, it worked a little bit on half of my body, but I was having back labor. My baby was posterior, so it did not do much for those pains there. I can say in the moment, I was quite relieved to have the C-section, so everything could be over, but I know afterward, I know womanhood is not defined by how you birth your baby, but I think at that point because that's what I envisioned, I never envisioned a C-section ever in my life, and it affected me. It affected my self-esteem a little bit. Right after that, me being me, I'm such a planner and such a researcher. I researched to see if it's possible to have a vaginal birth after a Cesarean, and I discovered the whole VBAC world. I signed up in all of the Facebook groups that I could find about VBACs all around the world. I was reading stories. I discovered The VBAC Link at that point. I started listening to the podcast. I also requested, through my midwife, my notes to see what happened. Meagan: Your op reports. Yes. Aisha: I'm like, “Okay. I need to know why I had a Cesarean, why a Cesarean was made, etc.” I checked. I sat down with my midwife at six weeks postpartum. Honestly, it wasn't anything really. They just said it was failure to progress. I had dilated to a 7, and that was that. She was like, “Okay. You can come back when you get pregnant again. You need to wait 2 years or 18 months before you get pregnant again.” Meagan: Mhmm. That's very common.Aisha: That's what I did. I got pregnant when my firstborn, I think, was 15 months. I gave birth exactly two years later almost to the dot. That labor started. Everything was going great. I remember for that pregnancy, I tried to always sit leaning forward, doing all of those exercises because my baby was posterior. I wanted a good posture. I did all of the things. It was in winter here, and in winter, Canada is not the best. I wasn't walking as much and it was COVID too. It was the COVID lockdown. With my first, I was going to the mall a lot, but during the lockdown in 2021, all of the malls were closed. I wasn't going outside much, but I was doing rounds in my house going up and down the stairs and stuff like that. When labor started, I really tried to focus. I think I was doula-ing myself. I never got a doula, but I was doula-ing with all of my research what I knew to do. At some point, I felt like it was time to go to the midwife. I was going there. They checked me. I was at 2 centimeters again. After laboring for 15 hours, then I was a bit defeated. I was like, “No, the same story is going to happen twice.” I continued laboring there. At some point, the contractions were back-to-back with no breaks. At that point, I was like, “Let me be a smart girl and get the epidural again.” She checked me. I was at 3 centimeters. I wasn't progressing fast enough for me. I think I was just in too much pain. I wasn't getting any breaks.I went to the hospital. I think the car ride there did something because it was a 20-minute car ride from the birthing center to the hospital. I was 7 centimeters. Meagan: Whoa. You went from a 3 to a 7 in 20 minutes? Aisha: In 20 minutes. Then I was like, “Okay, it's happening.” I got there. My midwife had already called the hospital and sent my papers. The anesthesiologist was waiting for me. I got the epidural within 5 minutes. They checked me. I was at a 9. Yeah, it went really fast. I was like, “I'm getting this VBAC.” Everybody was excited. I was giggling and laughing. My midwife came in. We were waiting for the last little bit. They checked me. I was 9.5, but baby was stationed pretty high. They were like, “Okay, let's try to bring baby down.” They made me change positions, but as they were doing that, the baby's heart rate dropped. It wasn't picking back up. At that point, it turned into an emergency C-section. The doctor looked at me. She was like, “Your baby is in distress. We don't know why. Nothing is going on. Nothing is changing. We are bringing you to the OR and get baby out. We don't have a choice.” I was so sad. I was at 9.5. I was almost there, but it did not happen. When I was in the operating room, the doctor screamed to me, “Aisha, never do this again.” I'm like, “Why?” She never gave me any more explanation, so me being me, when I was done giving birth, I requested the notes again.Meagan: Hey, listen. This is what I would suggest for anybody and everybody who has had a C-section. Go get your notes. Go get your notes. Aisha: They give so much insight because nobody knows unless this is the only thing that remains with you. You don't have the people to talk to. I saw the notes. I saw that my C-section scar had started to open. I think they called it a dehiscence. Meagan: Dehiscence? It was past a window. It wasn't just stretched. It actually had dehissed. Aisha: Yes. My midwife was like, “Probably that's the reason why she told you to never do this again and not to go for a VBAC again because the uterus had started to open.” Because it had started to open, when she cut me up, it gave me a J-scar so my scar–Meagan: You have a special scar too. Aisha: I have a special scar too. At that point, I'm like, “Okay.” My midwife told me, “If you have a third baby, unfortunately here, we can only follow a VBAC after one Cesarean. We cannot follow a VBAC after two C-sections so you will have to go the OB/GYN route.” Then I got scared because I'm like, “My God, I'm going to have to go to the medical professionals. They're going to turn me down,” and stuff like that. Me being me, I contacted my own personal OB/GYN. I went to see her. I wasn't pregnant or nothing. I wasn't planned on being pregnant anytime soon, but I knew I wanted a third child. I went to him. I was like, “Listen. This is my story. This is my situation. I really want to try for a vaginal birth. I know it can happen.” I went on the Facebook groups again. I registered in all of the VBAC after multiple Cesareans. I went and checked VBAC special scars. I went into all of those groups. I saw it was possible. Women were doing it all over the world. I was like, “Why not me? My body is also capable. Plus, I got to 9.5. That means my body is working. I just had unfortunate circumstances.” That's what I thought. My doctor was like, “You know what? Get pregnant. Come back, and we'll talk about it.” She wasn't closed off to the idea. Fast forward, I got pregnant earlier in 2023. I lost that baby due to miscarriage. I got pregnant again in September. That was a surprise pregnancy. I wasn't really planning for it. When I got pregnant, I was like, “Okay, this is it. This is it. We're going to try to do everything we can to make it happen.” I know for the first 20 weeks, I also tried to relax and release. I felt like my body held so much tension, and I feel like that can hold up to birth. I was trying to go and deal with all of those traumas and things like that that I hadn't dealt with in my previous births. Meagan: Traumas, triggers, past experiences, the tension that is being harbored in our body. It's weird to think that, but really, we can harbor tension whether we relate to it as trauma or not, and it can really impact us. Aisha: It can really impact us. After my second birth, I had gone to pelvic floor therapy. I had been to that for a couple of months, then stopped 6 months prior to getting pregnant officially with my last baby. When I got pregnant, I went back to see my pelvic floor therapist. I'm like, “Listen. I'm pregnant. This is what we are planning. Right now, I just want to make sure that my muscles down there are okay. I want to do the exercises. I don't want to do too much, but just prep my body slowly and surely.” We did exercises. That was the first 20 weeks. The second 20 weeks, I'm like, “Okay. Now is the time to ask the questions.” I would see her every 6 weeks, and within those 6 weeks, every question that would come in my head, I would write in down in my notes and go and ask her the questions so she could answer. I asked her to review my op reports so I could have another opinion. I was asking her a lot of questions about VBAC after two Cesareans. I got that my doctor wasn't VBAC-friendly, but I think she's pro-women's choice. She goes with what you want, and she supports you wholeheartedly in your decisions. I remember asking her questions about VBACs after two C-sections. She kept telling me, “Aisha, I think you need to realize that new studies have shown that there is not much risk after one or two Cesareans. It's almost the same. The percentage doesn't go up. There's not much difference. If you've had a C-section, you have the same chances as if you've had a second C-section. That's what the studies are showing.”I asked her about my dehiscence, and she's like, “A lot of women who didn't have a C-section can have a dehiscence, but with some women, we don't see it because they're not getting opened up.” She's like, “It happens more than you think. It doesn't mean that it's because of your scar that you had the dehiscence. It could have been that's just how your body reacted.” After all of those affirmations, that reassured me a little bit. I was not risking my baby. At the same time, you read stories, and you just don't want to make foolish decisions even though in your heart, you know what you want. When you listen to the outside world, it can influence a little bit of how you are thinking, and you are trying to make a wise decision. That was me in that second part of my pregnancy. However, the one thing she told me was, “The one thing that can make or break your VBAC, though, is getting a doula.” Every time she would see me, she was like, “Did you get your doula? Did you get your doula? Did you get your doula?” So I went. I got a doula who also had a VBAC. It was very important to have someone who had the experience of having a VBAC. I feel like when your team knows how badly you want it and what it means to you, I feel like it changes a lot for your game. I remember having my little prebirth classes with her, and she kept telling me, “You need to build a team who believes in your goal more than you believe in your goal because at some point during the birth, you're going to doubt yourself, and you need people who are going to reinforce you with confidence and positivity.” Meagan: Positivity, yes. Aisha: Yes, and that you can do it and that your body was meant for this. Of course, within that too, we also prepped for the occasion of a possible C-section, how to have a gentle C-section, and things I wanted to have. For me, it was very important for me to see my baby's being born. That's something I never experienced with both of my daughters. I heard them cry, but it was this wall in front of me. I never saw them come out of me. We also prepped for that, but yeah. We did a lot of prepping. She suggested that I go see an osteopath. With my second daughter, and my first VBAC, I had seen a chiropractor, but she told me that an osteopath might help loosen up some muscles. I went to see that person. It felt good, then I did acupuncture at the same time which I think was maybe just to release and relax and let go. I think there were a lot of little things that I did in order to just not hold on to all of the stress– writing letters and closing up chapters. I feel like it allowed me to just let go of the traumas that I had. Fast forward to my due date for my second baby. I lose a good part of my mucus plug. I sent it to my doula. She was like, “Okay, I think your body is starting to work.” Now, I can say I was starting to have contractions, but my way that I think I handled this birth was denial. The whole time that I was having those contractions, I kept saying, “They are painful Braxton Hicks. They are painful Braxton Hicks, and that's what we are going to do.” I kept walking a lot and every day, I was taking an hour walk. During those hour walks, that's when I was listening to the podcast and listening to stories and literally looking for VBAC after two Cesarean stories and hearing what women went through and their tips and tricks. That happened at my 40-week due date. Then the contractions kept going. During the daytime, they would spread out a little bit. At night time, they would be every 10-15 minutes. They would wake me up from sleeping, so I knew deep down that something was going on, but I was not trying to put my heart into it. I'm like, “They are just Braxton Hicks.” That kept on going for two days. At 40 weeks and 3 days, I had my doctor's appointment. I remember waking up that morning and being like, “Oh, those Braxton Hicks are really pushing.” I remember my husband was like, “Do you think we should go and drop of the girls at their godmother's?” I'm like, “You know what? No. I don't think this is it.”I had my appointment that afternoon. I have a friend of mine who lives next to my doctor's office. She had a 6-month-old baby at that time. I'm like, “Let's drop the girls off at my friend's, then afterward, I can snuggle up the baby because I heard oxytocin might help everything get going.” I went to see my doctor. My doctor asked if I wanted to get checked. That's one thing too, I went through the whole pregnancy not wanting to get checked. I knew that dilation means nothing. Meagan: Yes. Aisha: There is also how effaced you are and the baby's station. Those are also other things that you must know. You can be at a 10 and be stationed at a -2. It doesn't mean your baby is still coming. There are a lot of little details that I discovered. Meagan: We don't talk about it. We don't talk about it. We focus so highly on that big 10 number when there is so much more. It's funny because with my clients, they'll be like, “Oh, I got checked, and I was only this centimeter.” I'm like, “I don't even care about the centimeter. What were you effaced?” They're like, “I don't know. They didn't say anything.” Next time you get checked, ask because that number is a cooler number. Let's get effaced. Let's do that. Even then, we know that can change. We can go from thick, hard, and posterior to completely open and thin. It all varies, and it varies quickly, but there are so many other things to focus on than just that big 10 number. Aisha: Exactly. That's why I never asked to get checked the whole time. I'm like, “I'm going to go like that without checking. That will be bad.” When I got there, my doctor knew. She was like, “You're not getting checked, right?” At every appointment, she would ask, and I'm like, “No, I'm not getting checked today.” She asked, “Are you having contractions?” I'm like, “I lost my mucus plug last night. I'm having painful Braxton Hicks.” She's like, “How painful?” I'm like, “Well, people contract and call it Braxton Hicks.” She's like, “Keep doing what you're doing, however, when you go to the hospital if ever you don't give birth by 41 weeks, we have to send you to do a non-stress test to the baby, and the hospital will read your report, and they're going to force you to have a C-section. Be ready.” She was prepping me. She was like, “I'm going to write in your file that it's VBAC after two Cesareans. We've talked about it. You're going to do a trial of labor. I'm letting it go.” She was okay with letting me to go at least 41+5 and 42 weeks. Meagan: Or what evidence shows, okay. Aisha: She wasn't giving me any stress. She told me that the one thing that was giving me confidence was the fact that my body went into labor twice, and my body knows what to do. I left that appointment. I went to my friend's house. I snuggled up with the baby. Every time I would take the baby, my contractions, the painful Braxton Hicks, would be every 5 minutes. They would come more often than not. The moment we left her house, I'm like, “Okay, I don't have the baby no more, but the painful Braxton Hicks keep going.” In the car ride, it was a 20-minute car ride to my house. I got to my house. I didn't say nothing to my husband. I took my daughters. I went to give them a bath. I was showering with them actually. It was a shower. I was showering with them. I was on my knees, and at some point, I had to stop and be like, “Okay. Those Braxton Hicks are quite painful.” I gave the girls a shower. I dressed them up. They went to bed. I came downstairs to my husband and was like, “You know what? Yeah. The Braxton Hicks are becoming more and more painful.” He was like, “Okay. Do you want me to pack up the car?” I'm like, “No, they are still Braxton Hicks. We are not there yet.” Then what really made me believe that I was in labor was whenever I am in labor are my bowel movements. I think my body releases and cleans out.Meagan: Common. That's very common. Aisha: I went to the bathroom twice in the span of 30 minutes. I looked at him, and I was like, “I think we're in labor.” That's the moment I used contractions for the first time. The contractions were there. I just went to the bathroom twice. Okay. Eat and drink because those are two things I never did with my previous labors. One thing my doula told me during the prep was, “You need to hydrate your body because the muscle that is dehydrated is a muscle that is going to contract even more. Maybe that's why you were contracting and your contractions with your second labor were back to back with no breaks.” I'm like, “Yeah, I wasn't drinking water. I was so dehydrated. My lips were all cracked. I was not drinking an ounce of water.” When my husband heard, “Okay, labor is starting,” we started drinking. I ate dinner. It was around 9:00 PM. We bought those maple waters because we heard maple water is filled with electrolytes. I started drinking that. Then we went upstairs. I'm like, “I'm going to get some rest and try to sleep a little bit since it's nighttime.” I went to bed. It wasn't comfortable. I stayed for 15 minutes, then I'm like, “Okay, I'm going to go in the shower.” My husband ran a shower. It wasn't helping. We ran a bath. I went in the bath. I stayed there for maybe 30 minutes. It was not comfortable, then I got up. I went to pee, and then I had my bloody show. Everything was out. I sent a photo to my midwife and my doula. She was like, “Okay. Get ready. I think your body is really doing a lot right now.” In my head, I'm like, “Since my body is doing its work right now, let me help it. I'm going to sit on the toilet.” I heard it's a dilation station, so I'm like, “I'm going to sit there, then hopefully, if I'm in pain, let me make it effective.” I go. I sit there. Believe me or not, that was the best position for me. Meagan: I loved it too. I loved it too. Aisha: I loved it. I was at peace. I had the light turned off, the rain sound going, and I was literally sleeping. When I say sleeping, I was snoring. I was waking up slightly just for contractions, then I was going back to bed. I never timed any of my contractions. We were not going to focus on timing. We were going to go with how we feel, and the sounds and stuff like that. Yeah. I stayed there, I think, for 2.5 hours or 3 hours on the toilet. Meagan: Wow.Aisha: It felt so good. I had a pillow. I slept there. At some point, you can hear in my sound that it was a bit more there. My doula was hearing me. She told my husband, “You know what? I think this is time. You guys need to pack up the kids and go to the hospital.” We are about 35-40 minutes away from the hospital, so we had quite a drive. My husband packed up the car, and around 2:00 AM, we left to the hospital. I remember prior to labor, I told myself, “I'm going to give myself a coping mechanism. As long as I'm home, I'm just going to do nothing and try to take it in.” Once I'm in the car, I bought those combs. I was going to have the combs in my hand for the car ride, then once contractions are really unbearable, I'm going to grab the second comb. In the car ride, I had that one comb. I took it.  We went to the hospital, but the contractions were so great. I had time to do curbside walking around the hospital when we got there. My girls' godmother came and met us at the hospital so we could transfer the girls. While they were doing that transfer, I was doing curbside walking. I was taking photos. I was like, “I need to take photos of my girls.” I was in such a happy mood. The contractions were spread out which was a first for me because with all of my other labors, the moment I got to the hospital, it was an emergency and I could not control myself. We got there. We got to the hospital. I was able to give them my name and fill out my papers. I was really clear-minded. I went into triage and I was a bit scared because with my other labors, when I got checked, I was at 1 centimeter or 2 centimeters. I was going to see what I am, but you know what? We can handle it because the contractions were still spread apart. If I was a 2, I would still be good. I lay down. I got checked, and they told me I was at 5 centimeters. I thought, “Oh my god.” I asked, “What is the station and how effaced am I?” Then they were like, “You are 80% effaced, and you're at the station -2.” I'm like, “Okay. This is it. We're doing it.” They were like, “We are admitting you. You're not going to go home.” I was so excited. However, that's when the battle started. They took my file and came back. Meagan: Darn it. Aisha: They said, “We see you had two Cesareans already. Usually, you need to have a C-section after two C-sections.” I'm like, “I discussed with my doctor, and she was okay with me doing a trial of labor. They were like, “Well, no. This is not usually how things go. We usually don't do that. There's a lot of risk for your baby.” I'm like, “Yeah. I know the risk and I'm okay with it. It's something my doctor and I discussed. We are very at peace with it.” Then they sent me the doctor on call. The doctor came, and she was like, “I need to explain to you the dangers of what you are about to do. Your baby might die when you have a second C-section.” Then they brought up the dehiscence. “After a trial of labor, you had a dehiscence. This is not good for your body to have a dehiscence. You are more prone to uterine rupture.” All of those notes were observed by my doctor, and she was completely fine with it. Literally, the doctor looked at me, and she was like, “I can see nothing I'm going to say will change your mind. You're quite informed.” I'm like, “Yeah.” She was like, “I'm going to have you sign these release papers so you can release the hospital of anything.” At that moment, you feel like you're doing something not great because you're like, “They're making me sign this paper.”Meagan: Yeah, you feel like you're pushing against everyone in the professional world who have done multiple years of school and what they are suggesting. It feels off. Aisha: It feels off, but you what? That's why I was talking about releasing and really listening to me. That made me feel so much more at peace because I'm like, “I have to listen to that voice inside. Aisha, you can do this. You have prepped for this literally for four years in the making since your first C-section. You're educated. You know the risks. This paper is not going to make the risks change. You were okay with it before they presented that paper to you. You can still be okay with it after.”They gave me the paper. I signed everything, and then they asked me, “Well, we need to keep you monitored, however. We need to keep you monitored, and we need to have the easy access port installed in case.”Meagan: The hep lock, mhmm.Aisha: I told them that I didn't want it because it wasn't in my birth plan. I was like, “I don't want that.” I also had a super cute pink, floral hospital gown. I was like, “I'm going to wear that. I don't want to wear their hospital gown.” I think it was just mentally to feel like you are the birther, and you are the principal actor in the event. I didn't want to feel like a patient.They came. They were like, “You need to change.” I'm like, “I don't want to change. I want to keep my gown.” I had to sign a release paper that it was okay if they cut off my gown. I said, “Listen, the gown is made for that. There are buttons all around the back, but if you have to cut it off, cut it off, but I'm keeping this on.” At the end, I felt like I had to be somewhat political a little bit and give them a little so they could stop bugging me because they were breaking my bubble with the constant questions and the constant arguing.Within all of that, I was still having contractions. I'm like, “You know what? I'm going to let them monitor the baby, and I'm going to let them do the easy port so they can stop casting their opinions on my VBAC.” I know my doula was a bit scared especially for the monitoring because they were like, “The second the heart rate drops, they're going to use it as a way to send you to the operating room.” I know the second they put the monitor on, the baby's heart rate went down during the contractions, and it went right back up after. One of the nurses was like, “See? Your baby's heart rate is already going down. This is why we need to keep it.” I had the doula on the other line. She was coming to the hospital. I asked, “The baby's heart is going down.” She was like, “Aisha, it's normal that your baby's heart rate is going down during a contraction. He's literally getting squeezed. It's just normal practice. If it comes back up, it's completely fine.” Every time, they would pass those comments. The baby's heart rate dropped a couple of times, probably 7-8 times over the whole labor process, but every time, they would make a comment, “Oh, see? It dropped again. Oh, see? It dropped again.” But it kept picking back up the whole time.Anyway, I got admitted to my room. They tried to do the easy access port. I have small veins, so it literally took the anesthesiologist to do it. The whole nursing team failed to do it. I kept telling them to do it in one spot that people usually have better luck. They did it everywhere else, and in the end, it was that part that functioned.By the time they did the easy port access, it was around 7:00 AM. I got to the hospital around 4:00. It was around 7:00 AM. I asked to be checked again because, at that point, I was doing dances. The contractions were so intense, I was not happy. I was not laughing no more. I was still having breaks between them, but it was really taking everything out of me. At that point, the whole time before that, I was really enjoying the contractions. They were coming. I was like, “Oh, this is nice. I'm getting to meet my baby.” I loved the feeling to be honest. People find me weird when I say that I love contractions, but at that point, it was not fun anymore. I was going against the wall and doing those squat dances and moving my body left to right. I requested doing a check. They checked me. They were like, “Oh, you're at 9.5 and 100%.” However, baby was still stationed at -2. I'm like, “Oh no, baby is pretty high up.” My doula and I started to do some positions to get baby down. We did those for 30 minutes, but like I said, the contractions were really, really, really pushing it. I requested to get checked again. I know my doula was like, “Nothing probably happened.” She was right. Nothing happened. It was still the same, 9.5 and effaced at 100%, and still stationed to -2. At that point, I'm like, “Okay, I'm going to request the epidural.” I was seeing stars. Every time I would go through a contraction, I would see stars. At that point, I was literally, I think, mentally checked out. I was fighting against the contractions because every time a contraction would start, I would tell myself, “Okay, now you need to survive this next one.” It was no longer about enjoying it. Meagan: Surviving it, yeah. Aisha: It wasn't, “You know what, Aisha? It's four breaths. Take four deep breaths and it's done.” It was more of a survival mindset. I was like, “I'm going to take the epidural and be calm and be good.” They came. They gave it to me. They gave me a very tidbit because I was still walking. I could still feel. Yeah. I was still walking with the epidural. I could still feel everything. It just took off the edge. I think the contractions and the pain was in the front of my belly, and the back pain was gone, but I could still feel the pressure. While the anesthesiologist was giving me the epidural, my body was starting to push. I would have that feeling and everything. I think he gave me a tiny bit. Anyway, the second epidural was done, it was already shift change, so the night nurses were gone. The new nurses were in, and I think when I say the team makes a difference, they were angels sent. They were so kind. My doula went to see who was the doctor on call for the daytime, and she came to see me. She was like, “If you didn't have your own personal OB/GYN, this is the one who you would have wanted to have. This one here, that doctor here.” Then she came. She was super happy.She was like, “Okay, I see you're trying for a VBAC. The whole floor, when I heard about your case, they were saying that you had a uterine rupture. I'm like, ‘That's not right. Her doctor wouldn't have let her do a trial of labor after a rupture.' I went through your file, and I saw that you only had a dehiscence. It's very common.” She literally repeated the same thing that my doctor said. She was like, “A lot of women who didn't even have a C-section end up having a lot of dehiscence. It's just that we never know because they are never opened for a C-section to mark it down.” She was like, “It's completely common. We're going to do this.” She was like, “You've been at 9.5 for 2-3 hours, and your baby's station hasn't descended. Let's see what's going on.” She brought an ultrasound machine, and she performed the ultrasound on me. She literally saw that it was the baby's head's position. His head was slightly crooked to the left. Meagan: Asynclitic, mhmm. Aisha: Exactly. That's when I'm telling you that I love these people. I'm still having butterflies thinking about them. They came with the Miles Circuit. They came with the sheet with the images, and they're like, “We're going to do those.” I'm like, “The Miles Circuit!” They're like, “Yes.” I'm like, “Oh my god. You guys are my people.” We started doing the Miles Circuit. I did every movement for 30 minutes. I held it for 30 minutes. I did the cowgirl, I think they call it. Meagan: The flying cowgirl. Aisha: Exactly. Then after that, they came back. My doctor thought the baby's position had changed, but my water hadn't broken yet. She was like, “I'm going to break your water. The worst case scenario is that your baby's heart doesn't handle it, but I think that's going to make us go to the next level.” She broke my water. Literally, within the time she broke it and went to check, I was ready to go. That was literally all it took. She was like, “Okay, we're going to start pushing.” I know in my birth plan, I said that I was not going to push on my back lying down. I went on my four knees. I went first in my knees. I was holding onto the bed, and I was pushing that way. But I was so tired. I hadn't eaten in a while. I was still drinking, so drinking was good, but I hadn't eaten. My doula gave me candy. That helped me, but I remember in that exact moment, in my thoughts, “Aisha, your baby did it. This is your time now to help your baby. This is it. You've waited four years for this moment. This is it. This is all you've wanted. You need to find strength somewhere and make it happen.” I looked at them. I'm like, “I'm going to lie down.” I laid down, and my doula gave me this blanket. They attached this. Meagan: Mhmm, some tug-of-war. You did some tug-of-war, mhmm. Aisha: I was pulling on it when I was pushing, and my mom and a nurse were pushing my legs up. Yeah, then I pushed. I pushed. I pushed, and at some point, my body was pushing automatically whenever the contraction would come. It would literally do that. I would bear down by myself. I know the doctor kept looking at me. She was like, “Wow. This is awesome.” Yeah. I think I pushed for 45 minutes, and then he was born. My husband is actually the one who caught the baby. Meagan: Oh, yay. Aisha: That's what we wanted. We caught him. We did not know the gender, so it was really fun to see that it was a boy after two daughters. Once he was born, they put him on my chest. Everybody was crying. I know the nurses were crying. The doctor was crying. I've never had a hug from a doctor, and she literally came to my bedside and hugged me. She was like, “This is the moment. We don't see this often, so thank you for letting us experience this.”I know for a lot of the nurses, it was almost the shift change. It was almost 3:00 PM when he was born. One of the nurses looked at me. She was like, “My shift is ending in about 30 minutes. I need to see this. I need to witness this happening.” Then, yeah. He was born, and I think I had a first-degree tear, but it was on the outer labia. It was because when he was born–Meagan: Superficial. Aisha: Yeah, he had his hand on his face like a Superman. Meagan: Oh my goodness, so you had a nuchal hand, too? Oh my gosh.Aisha: Yeah, in the photos of it, it's so precious. My doula took photos, and you can literally see his hand coming out. Yeah. It was great because that evening, that night, the doctor came back on her shift. She heard that I gave birth. She came to apologize, literally. She was like, “I heard that you gave birth vaginally. Congratulations. I'm so sorry for not supporting you in that sense. There is a risk, and not every woman ends up having great stories like yours.”Meagan: Oh gosh. Aisha: “But we are happy for you.” I was just happy that I proved them wrong and that I made history in that hospital having a VBAC after two Cesareans. It happens. It's possible. I'm just happy that I listened to that voice inside, and that all of the noise around me did not affect my initial desires. Meagan: Yeah, and overall, your final decision, right? We've talked about this. I call it static. There's a lot of static that, I feel like, looms over VBAC moms. At least it did for me, and I do see it sometimes with my clients. It's their friends, their family, their providers, or whoever it may be, they are looming with this unnecessary static. Aisha: Yes. Meagan: A lot of it is, “Well, there's risk and what if's.” Oh, you name it. So many of these things, and really, I took a whole bunch of notes of little nuggets of your story. I can relate in a lot of ways with your story. It's similar to mine with how things unfolded. From the very beginning, you started off right. You started off right. You found the provider. You found the team. You got the support. You got the education. You dove in, and like you said, this was four years in the making. It took you four years to learn and grow and have this experience that you wanted. Sometimes, it takes one time to try. I say “try” with quotes, but to go and have a trial of labor, and it maybe not work out like mine and your situation. And then, okay, we learned from those two situations. Now how can we learn and grow from those situations and change and develop this next situation? It's so weird. My mind right now is really heavy on my daughter's reflections. They do reflections at school. It's a big art thing. Her topic is overcoming imperfections. Sometimes, in the birth world and especially as women, as you were saying earlier in your story, we have this thing that if we don't do it this way or if it doesn't happen this way, maybe our motherhood is stripped away, or we failed, or our baby failed. We can go as far as our baby failed us or whatever it may be. Overall, no situation is perfect. There are just always imperfections, and what do we do with the situation to grow and transform?I mean, really. I went over some of it, and then just learning more about hydration and how important food is and fueling our bodies. Aisha: Yes, yes. It's a marathon. You cannot run a marathon without an ounce of water or without food. You see it when you see people doing half marathons. There are people on the sidelines giving them water. Meagan: They're fueling. Aisha: Right. They're fueling. It is important and necessary. Knowing that the providers, as much as yes, we do have faith in them, they are there to help us, and they are there. I don't want to say this in a bad way, but they are working with us and for us. Do you know what I mean? They don't have the final say. We have the final say. That doctor who was there, when I told you about the dream team, she never ever does hospital rounds. She usually just does prenatals. Even the nurses said, “We usually see her once or twice a year. She never comes.” That ended up being the one time a year that she came. She looked at me and said that she is a pro-choice woman. She was like, “When a woman makes a choice, even if they fail, she will be happier, and she will be able to cope with the results way better than if someone strips her of that choice and obliges her to do something she did not consent to do. The outcome of that will be way harder to overcome than if she is the one who made the decision regardless of the result. That is way better.” Meagan: It's so true. Aisha: I wholeheartedly believe that. I know I had to really see in myself if that doesn't work. I know sometimes, we go into labor very naively. I feel like every first-time mom and even second-time sometimes, that can happen especially if let's say you were going for a vaginal birth, then you have a C-section, then you're trying for another vaginal birth, it's still in some sense the first time that you are going to experience this sort of experience. You're still going into it naively and blindly. Like I said, I never knew a C-section could be an option. The second time, I'm like, “It cannot happen to me twice.” After it happened to me twice, I planned for it. I planned in the circumstance that there would be a C-section, what do I want to happen? I knew I had my guidelines, and at least it wouldn't be a shocker and a hard pill to swallow. I would have been okay because I had my trial of labor.At the end of the day, your baby does decide how they want to be born. I feel like one thing I would advise all mamas and even fathers or partners, we need to include them to that. I feel like talking to your baby makes a whole lot of a difference. I got that advice from my osteopath where he told me a story about his wife about to be wheeled into a C-section. He came. He spoke to their daughter who was in the womb. He was like, “This is your moment. You decide. If you want to go to a C-section, do it. If not, this is the moment to change things.” His wife ended up having a vaginal birth right at the moment that they were going to. I pulled my husband up at some point I remember when I was starting to push. He came and saw the baby, then he was like, “This is your moment. You decide how you want to be born. You choose, and your mama is going to help you do this.” I feel like having that communication, our babies sense everything, so being connected to that too is so important. It's so important. Meagan: Absolutely. Absolutely. Circling back really quickly, if we do all of the things, if we take the VBAC education course, listen to the stories, learn more, read more, learn the stats, hire the team, and all of the things, we do our fear clearing processing about past experiences and all of that, and then we go in and be fearmongered like they were trying with you, and fearmongering by definition is that “it causes fear by exaggerated rumors of impending dangers”. There were big things that were said, but if you hadn't done the research and the education, you easily may have been fearmongered. Sometimes, it's even easy to be fearmongered even with the education. I will say that straight up. When you are being told that your baby could die, that word is very, very triggering. But you were able to have the education and be like, “No. I understand what you are saying. I respect what you are saying. I am going to continue moving forward this way.” But if we would be fearmongered and not have the education and then later learn the education, overall, our experience and view and our feelings postpartum would be a little bit rougher because we are learning these things that we could have learned before. That's why education is one of the biggest tips that we can give because you need to be educated along the way because it is easy for someone to come in. Look at you, Aisha, “No, no, no, no.” How many times did you have to say, “I understand, but no, no, no, no.” It sucks that that's the reality, and trust me, it ticks me off so much. Aisha: It is. Meagan: I wish it would change, but if we aren't educated and armed with that team, with that power, with our experience, then we are more likely going to fold in those situations. Aisha: It is completely true. At some point, even one of the nurses told me when they were trying to do the easy port that I needed to stop moving because this was going to end up with a C-section, and they really need to do the easy port. I had to tell her to never repeat the word “C-section” in front of my face. It sucks that for women or people experiencing multiple Cesareans or even one Cesarean when they are trying to do a vaginal birth that they need to constantly fight for it. Meagan: Yes.Aisha: But you do need to stand your ground and really focus on what you want. The fears will come, but that's a moment where you need to rely on the education that you have and all of the process. You spent 9 months preparing yourself, and all of those months must count for something. You're not going to be that one person. That's what I was telling myself. In the case that yes, the unfortunate happens, I was at the best place at the best time, and I had the best team. That was my thing. I trusted in my team that everything would be fine. But no, definitely. Yeah. You need to believe in yourself and in your project. Meagan: Yes. Oh my gosh. Well, this episode is just jampacked with all of the nuggets of information, guidance, suggestions, and empowering feelings. Oh my gosh. Thank you so much for being here with us today and sharing with us your beautiful story.Aisha: Thank you. Thank you for having me. Thank you so much. It's a dream. Meagan: Oh my gosh. Well, congratulations again.Aisha: Thank you so much.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.  Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

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How can we make life-changing treatments like uterine fibroid embolization (UFE) more globally accessible? To help answer this question, Dr. Janice Newsome and Dr. Azza Naif share what they're doing in Tanzania to make UFE a standard option in fibroid care. Dr. Newsome is a Professor at Emory University and Dr. Naif is an IR attending physician at Muhimbili University of Health and Allied Sciences (MUHAS) and a member of the first generation of Tanzanian IR trainees. --- This podcast is supported by an educational grant from: Varian, a Siemens Healthineers company https://www.varian.com/ --- SYNPOSIS The doctors focus on patient education, overcoming cultural barriers, training of IR specialists, and the economic aspects of UFE. The discussion highlights the importance of making women's health treatments accessible worldwide and adapting procedures to fit local resources while maintaining high standards of care. --- TIMESTAMPS 00:00 - Introduction 05:25 - Patient Care in Tanzania 16:28 - Challenges in UFE Adoption 21:38 - Equipment and Techniques for UFE 34:26 - Post-Procedure Follow-Up Care 41:16 - Cost and Accessibility of UFE 47:01 - Future Goals for Fibroid Care --- RESOURCES BackTable VI Podcast Episode #318 - Back on the Road2IR with Dr. Janice Newsome, Dr. Judy Gichoya and Dr. Fabian Laage Gaupp: https://www.backtable.com/shows/vi/podcasts/318/back-on-the-road2ir BackTable VI Podcast Episode #104 - Bringing IR to East Africa: The Road2IR Story with Dr. Fabian Laage Gaupp: https://www.backtable.com/shows/vi/podcasts/104/bringing-ir-to-east-africa-the-road2ir-story Road2IR: https://www.road2ir.org/

Uterine fibroids are a common yet often misunderstood health issue affecting millions of people worldwide. In this episode, we shed light on what uterine fibroids are, how they can impact overall health and well-being, and the role physical therapy can play in managing this condition.

In this insightful episode, Prof. Chapman explores the complex reasons behind recurrent miscarriages, from immunological factors to uterine health. He discusses the science of embryo rejection, the role of stress in pregnancy outcomes, and the potential benefits of supportive care during early pregnancy. With a focus on evidence-based practices and hopeful perspectives, Prof. Chapman provides valuable guidance for those facing the emotional and physical challenges of miscarriage, reassuring listeners that there is hope for future pregnancies. Explore the 'Prof. Michael Chapman - The IVF Journey' Facebook Page, your reliable destination for cutting-edge insights and guidance within the realm of In Vitro Fertilization (IVF). Don't miss out on the IVF Journey podcast; stay informed with the latest episode updates. Tune in for expert discussions and valuable information on navigating the intricate path of IVF.

Listen to today's episode to hear Meagan talk all about bicornuate, unicornuate, arcuate, and septate uteruses, uterine didelphys, and more.Though there can be complications, research is limited, and vaginal birth is often possible. Chat with your provider about your birthing desires, and don't be afraid to get multiple opinions!A Case of Vaginal Birth after Cesarean Delivery in a Patient with Uterine DidelphysUterine DifferencesSuccessful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine SeptumNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. Welcome to The VBAC Link. This is Meagan, and I am solo today. We will not be sharing a VBAC or CBAC story, but we're going to focus on our topic of the week. That is uterine abnormalities. So if you haven't listened to Flannery's episode last week, or I should say earlier this week, go check it out. Flannery has a bicornuate uterus, and we talked a little bit about the different types of uteruses, and her journey, and what happened or what was most common with her bicornuate uterus. But today, I wanted to talk a little bit more about the different types of uteruses. It's kind of weird to think about, but we do. We have multiple shapes of our uteruses. I don't think it's really talked about a lot, so I thought it would be cool to jump on today and talk a little bit more about the uteruses. But, we do have a Review of the Week, so I wanted to jump on and share this review. It says, “I now recommend this podcast to every mom who will listen, even first-time moms. I tell them this is the podcast I wish I would have listened to before our first traumatic birth. It helped me process, learn, and heal so much after my son's birth. Two years later, pouring into numerous books, online courses, and more, we are preparing for our October VBAC. Their podcast has by far been the most favorite resource hands down. Thanks, Julie and Meagan, so much for what you do.”Thank you guys for your review. That review was left on Google, so if you wouldn't mind, press pause in just one moment, and go leave us a review. Your reviews help other Women of Strength come and find this podcast, find the blogs, find the course, find the doulas. You guys, I love this community so stinking much and believe that every mom, just like the reviewer said, and even first-time moms should be listening to this podcast. These stories that you guys share are absolutely incredible. The information that we share is invaluable. If you can, go to Google. Type in, “The VBAC Link” and leave us a review, or leave us a review wherever you are listening to your podcasts. Okay, everybody. Like I said, we are going to be diving into uterine abnormalities. We talked a little bit about Flannery. She had a bicornuate uterus. What is a bicornuate uterus? A bicornuate uterus is a heart-shaped uterus meaning the uterus has two horns making it look like the shape of a heart. With bicornuate uteruses, there are some things to know. There can be a higher chance of a breech baby. I'm going to share my source here with you. It's pregnancybirthbaby.org. We're going to have this in the show notes. I think that it is just so great. It's such a great visual and understanding on the different types. So yeah. They've got two horns. It doesn't reduce your chances of having a baby or getting pregnant. It can increase things like early miscarriage or an early preterm baby, or like I said, it can impact the position of the baby. But it's possible. VBAC is possible with that. The hardest thing about uterine abnormalities is there is not a ton of evidence or deep studies to dive into how it's impacting people who want to go on and have a vaginal birth or go for a, in the medical world, TOLAC or trial of labor after a Cesarean. If you have a uterine abnormality, it's something to discuss with your provider. Know you don't have to go with that first answer. You can get multiple opinions. Okay, another uterine abnormality or shape is– oh my gosh, you guys. Don't quote me on this. I will butcher how to say these. I will try my best. It's a didelphys uterus. It means that your uterus is split in two, and each side of your uterus has its own area. it also can increase your chance of having a premature birth, so if that is something that you have, I think that's something you want to discuss with your provider knowing that you could have a premature birth. We also know people who have premature VBACs all the time, but it's something to discuss. There's acruate, and that is a uterus that actually looks really similar to a normal-sized uterus but has a deeper dip in the top of the uterus in the womb. It doesn't affect your fertility. It can increase just a little bit of a later miscarriage. That is something to discuss, although sometimes providers will want to induce if everything is looking well at an earlier gestational age. Also, this one can impact the position of your baby, so being aware of that. Then there's septate. Again, I don't know. Sorry for butchering this, you guys. If you're a medical professional, sorry. It says, “A septate womb has the wall of a muscle that comes down the center of the uterus, and then it splits into those two areas and is divided by a membrane or a tight band of tissue.” It reminds me of a rubber band. It splits it down. It can also impact fertility and, again, increase the possible risk of miscarriage in the early stages or cause a premature baby. Once again, discuss with your provider if you have this what that means and what that means for VBAC birth in general. Then, let's see. There's also retroverted. That's a uterus that tips further back instead of that forward stage. Again, there are so many different types and shapes of uteruses. Sometimes we don't know what we have until we have a baby who is born. Sometimes it's once we have a Cesarean where they are like, “Oh, hey. You have this type of shaped uterus.” If you really feel like you need to know or you are having issues or anything like that, dive in with your provider and see if they can tell you what shape of uterus you have.Like I said, little is known about the outcome of VBAC with uterine abnormalities, but there is an article and it was back in 2019. It's called “A Case of Vaginal Birth After Cesarean Patient Who Has a Uterine Didelphys”. I want to talk a little bit more about that. As a reminder, that is the one that is split in two. If I recall, I think they even have their own cervixes. That can be interesting. But this is going to be a little bit more on this. They talk about it. There are only a few studies. The studies are low, like 165 women in the one study. It shows that those women with abnormalities found were statistically less likely to have VBAC. Again, we know that a lot of the time, these people have babies who are in less ideal positions or they are going into early preterm labor. There are things to be said about that. But the other small study is literally teeny tiny. It had 25 women with uterine abnormalities reported, and a VBAC rate was similar to women with a “normal” uterus. There are things to say there.Now, the other study showed that they were less likely to experience uterine rupture than women with normal uteruses, but then this one said that the uterine rupture rate was higher. So such little information. I mean, really, it's little information that I have been able to find so far. I'm going to dive in deeper and update you, but yeah. It says, “The actual rates in VBAC and uterine rupture in women with uterine abnormalities are more likely to be similar or less favorable than those women with normal uteruses.” So, keep that in mind. It goes on and says, “Some authors hypothesized that uterine abnormalities, especially unicornuate uteruses, are associated with decreased uterine muscle mass. So when we have decreased uterine muscle mass, that means it may not contract as effectively or strongly as it needs to, so that can lead to other things like arrest of descent or we were not getting into that active phase of labor, needing things like Pitocin and things to augment labor or they may have a harder time pushing out the baby because the uterus isn't helping as well. So we may have a higher chance of an assisted delivery like a vacuum or forceps. With all of this said, you guys, I want to leave it here with you to encourage you to speak with your provider, and get multiple opinions. If you have been told that you can't VBAC because of a certain situation, dive a little deeper with questions with your provider because again, the hardcore evidence is not really there. It's just low. I mean, it's there, but it's low. There's another article that says that uterine abnormalities are common in the general population with an estimated range of 1-15 per 1000% women. We know that there are people out there who have uterine abnormalities. I don't feel like it's talked about a ton, and that's why I wanted to come on today and talk a little about the different types, and of course, share with Flannery's episode with a bicornuate uterus showing that she still did go on to have a VBAC and it is possible. So if you have a uterine abnormality, please know that it doesn't mean you're just completely off the table. It still can be an option. Discuss it with your provider. Check out the links. I will include them in the show notes today more on those uterine abnormalities, and what it means, and what these studies are showing. There was another one that said that a septate uterus is clinically significant because it has been shown to be associated with adverse pregnancy outcomes including, like I said, that preterm labor and malpresentation. So it's a thing that can cause malpresentation and can cause preterm labor, and even miscarriage. But does that mean that you can't have a vaginal birth? Another thing to ask your providers if you have any of these things are, “Okay, if my baby is in a less than ideal position, say, breech or transverse, does my uterine abnormality or my specific case rule me out of having something like an ECV?” Varying rates of ECV success have been reported, and we're also not doing them enough. We are not seeing them being done enough, even though they have a lot of success. But the question is if you have a uterus that is a little different, do you qualify? Ask the questions. Be informed, and if you have any questions, let us know.And hey, if you have a uterine abnormality and you are listening, and you had a VBAC, I would love to hear from you because we have people who are searching for stories with uterine abnormalities. I know that our community would love to hear your story. You can message us at info@thevbaclink.com or if you are a provider who maybe knows a lot more and specializes a lot in uterine abnormalities, I would love to chat with you and discuss a podcast episode in the future. Thank you guys!ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Flannery joins us today from Connecticut sharing her story of an unexpected C-section at 35 weeks due to oligohydramnios, breech presentation, and concerns with her baby's kidney functions. She was also transferred to an unfamiliar hospital for its surgical capabilities. Though she was terrified, her anesthesiologist was calm and reassuring. The toughest memory of Flannery's birth was not being able to kiss her baby before he was swept away to the NICU. She was determined to do everything in her power not to have that happen again the second time. Knowing she had a bicornuate uterus, she worked hard to keep her baby's head down from the very beginning of her second pregnancy. She switched to a midwife practice, carried her baby past her due date, went into spontaneous labor, and had an intensely beautiful unmedicated hospital VBAC!NICU Free ParkingTypes of Uterine ShapesAFI ArticleNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. We have our friend from Connecticut. And you know what? I didn't ask. How do you say your name? Flannery: It's Flannery. Meagan: That's how I was going to say it. Flannery: Yes, good job. Meagan: We have our friend, Flannery, here from Connecticut and she has a bicornuate uterus. This week's focus is on different shaped uteruses or uterine abnormalities as I'm air quoting. We know that people have them. People have different-shaped uteruses. Sometimes that can impact things like breech babies or even a provider's ability to support– I don't want to say ability. It's their willingness to support, especially in VBAC. We're going to be diving into that. She's also a NICU mama so for other NICU mamas, she might have some tips for you along the way. She just told me before this that she was a labor and delivery nurse before she had her first. Flannery: Yep, and then I switched over. Meagan: Now she switched over to postpartum. She knows the field, so we might talk a little bit about labor and delivery nursing and the postpartum world. Flannery: Yeah, definitely. Meagan: Awesome. Okay, well let's get into your stories. Flannery: Okay, thank you. I'm so excited. I would listen to this podcast all the time when I was pregnant. At the end, when they say, “If you'd like to share your VBAC story–” and I would say, “I will be sharing my VBAC stories someday.” Meagan: I love that. “I will be sharing my story”, and here you are sharing with all of the other Women of Strength coming to learn and grow and feel empowered. Flannery: Yeah, I loved it. My first pregnancy was actually an unplanned pregnancy. I had just gotten married. I just started a labor and delivery nurse job. I was noticing that I wasn't feeling great, that I had some bleeding which I thought was my period, so I just was like, “You know what? Let me take a pregnancy test just to reassure myself because there is no way that it will be positive.” It was, and I was so shocked. I remember taking the tests, seeing the two lines, and my heart dropping. I thought to myself, “I am not ready to be a mom. I can't believe that I am having an unplanned pregnancy. This is so crazy.” I was only 25 which I know is not that young, but up here in Connecticut, it's pretty young. Meagan: Is it really? What's the average for first-time moms? Can I ask?Flannery: I'm guessing 30-32. Meagan: Okay. Flannery: None of my friends had babies yet or anything, so I felt very alone and obviously very shocked. Yeah. I had no idea how far along I was. I went to the dating ultrasound with my husband at the hospital where I worked, and they put the wand on my belly. There was a full baby in there. It wasn't a bean. It wasn't a little heartbeat, but it was a baby. They said, “You're 11.5 weeks along.” Meagan: Oh my gosh. Really?Flannery: Yeah. I was beyond shocked. Meagan, I had no idea that I was pregnant. I didn't have any symptoms. I was having some bleeding, so I thought that had been my period, but nope. Meagan: Oh my goodness. Was it implantation bleeding? But then that would be too late. Flannery: I don't know. I think maybe just how some people get first-trimester spotting or bleeding after sex or exercise or something. I'm thinking that's what it was. Meagan: Crazy. Flannery: I know. I had skipped the first trimester, and that terrified me because I wasn't on a prenatal. I was having some wine. I was just like, “How could I have missed this? This is embarrassing. I'm a nurse.” Meagan: “I'm a nurse.” Hey, listen. It happens. People talk about it. I'm sure that was such a shock not only to see those two pink lines and that you were not having babies with any of your friends, but then you skipped the whole first trimester. Flannery: Crazy. It was crazy. It took a while to wrap our heads around it. Then during the ultrasound, hearing the ultrasound tech saying, “Have you ever had an ultrasound of your uterus before?” I was like, “No,” not thinking anything of it, just focusing on the baby, and then I got a call from my doctor a few days later, and she was like, “So, it looks like you have a bicornuate uterus. Have you ever heard of that?” I was like, “No. I've never heard of that before.” She said, “Basically, your uterus is shaped like a heart, and it should be shaped like a balloon.” I was like, “Okay. That doesn't sound too bad.” We hung up. I went on Google and Googled “bicornuate uterus”, and let's just say the stuff that comes up is not reassuring at all. It's so scary. It says things like, “Risk of preterm delivery. Risk of stillbirth. Risk of infertility. Risk of malpresentation.” It just went on and on. Postpartum hemorrhage, and all of this stuff, so I really broke down. I remember just crying and crying to my husband, “I've had this crazy birth defect my whole life, and I've never known it.” I didn't know how it was going to impact my birth or anything. That was definitely scary.Meagan: Did they tell you anything about how it could impact your pregnancy or your birth? Flannery: Not really. This was a general GP doctor that I was seeing, so she didn't really go into it with me, but I definitely spoke about it to the midwives that I was seeing once I established care with them. They were just like, “Yeah, it can cause baby to be breech.” That was all they told me about it. Meagan: Okay. Flannery: Yeah. I was doing a lot of research looking for podcasts and everything about bicornuate uterus and all of the things that go along with it, but I couldn't really find much. This was a few years ago, so maybe three or four podcast episodes about bicornuate uterus, breech, and malformation. I think now there are more, but at the time, it was really hard to find information. Meagan: Yeah. I still feel like it's 2024. What year are we in? We are almost in 2025. We are in 2024, and it still is. There is still not a ton. It's not a beefy topic. Flannery: No, it's really not. I think that some people don't know they have it until they get pregnant which was in my case, and they have an ultrasound. It's hard to tell later on in pregnancy if you have it because your baby will stretch out the uterine space, so you can really only tell in the first trimester if you have an ultrasound. Meagan: Interesting. Good to know. Flannery: So my pregnancy progressed pretty normally after that. I was very stressed at this new job in labor and delivery that I was working in. I was seeing really scary births all of the time, traumatic births, and some good ones too, but it put this idea in my head that you cannot plan your birth. Things are so out of your control that there's no reason to have a plan because you're just going to be disappointed anyway. All you can do is go with the flow. That was my attitude at the time. It's definitely changed since then. It was definitely interesting trying to be a first-time mom and also learn how to be a labor and delivery nurse and reconcile the two experiences that I was seeing. Meagan: I bet. Flannery: Yeah. Meagan: I bet that would be really challenging. Flannery: It was. It was interesting. I established care with some midwives who I worked with. They were highly recommended, but I didn't really feel like they were giving me the midwife experience that I had heard so many people rave about. I felt like they really treated me like a coworker instead of a first-time mom when I was going to their appointments. I was fine with their care. I wouldn't say it was the best or the worst by any means. Then I realized around 25-26 weeks, “Gosh. I'm really feeling this rock under my ribs all the time. I think that's the baby's head. I think the baby is breech.” Then at 28 weeks, I had a growth scan because you have to have growth scans if you have a bicornuate uterus, and they were like, “Yeah, sure enough, the baby is breech.” The midwives told me, “Okay, you can do some Spinning Babies and put an ice pack near the baby's head and play music down low,” and all of those crazy things that you hear. I was like, “Yeah, sure. Okay, I'll try it.” I did a few inversions, but they gave me terrible heartburn, so I was not super consistent with that. The baby just wasn't budging week after week. Eventually, it came to about 35 weeks, and I was getting another growth scan. I had just worked a very tiring shift at work. I went to get my ultrasound. I was dozing off as she did it. She stopped the ultrasound, and she said, “I'm going to send you over to your midwife's office. Go over right now.” I walked over, and the midwife was like, “Girl, what's going on?” I was like, “I don't know. I just had this pit in my stomach, but I had no clue what was going on.” She was like, “You have no fluid. Get back to the hospital. You're going in as a patient now, and we're going to try to rehydrate you.” I was like, “What? What is going on? No fluid? What does that mean?” I guess they had found in ultrasound that my baby's left kidney was super dilated, and my fluid was low which is called oligohydramnios. I know you've talked about this on the podcast before, but I think they measure it with an AFI. It's supposed to be over 8. Mine was a 4. Meagan: Really low. Yeah, below 5. But they were just going to rehydrate you. They weren't going to induce you? Flannery: Not yet, no. They wouldn't have induced me anyway because my baby was breech. Meagan: Which is good. They wouldn't. Yeah. Flannery: They were going to try to rehydrate me first and see how that went. It did, and they decided to give me some steroid shots too. My favorite midwife came in, and she said, “We're going to do these steroid shots, and we're going to see if the rehydrating works. I know you've been working hard. Maybe this is just a dehydration situation because you haven't been able to take care of yourself properly.” I was like, “Okay”, then she made a comment about delivery at 37 weeks. I was like, “Oh, this is a delivery-type situation.” It had really not sunk in with me yet that this was that serious. She was like, “Yes. Oligohydramnios can cause stillbirth. It's very serious. Probably what we are looking at is two weeks of monitoring, and then delivery at 37 weeks which will be a C-section unless your baby flips.” I was like, “Oh my god. Okay.” Meagan: Yeah. But with the fluid, did they want to continue giving you fluid? Did they encourage your hydration with electrolytes and everything? Flannery: Yes, they did. I was chugging water like a maniac for a few days and coconut water and all of this stuff and getting IV fluid. It did come back up a little bit to a 6, maybe. Meagan: I was going to say, did it fix it at all?Flannery: I was still getting a bunch of ultrasounds, then it went right back down to a 4. They said, “We're going to have you consult with maternal-fetal medicine at a bigger hospital on March 9th. My baby was due April 11th, but this was a lot earlier than I was expecting anything to happen. We went to this appointment to get this more detailed ultrasound, and the doctor comes in. She seems very nervous. That's not what you want. You don't want a doctor to seem nervous.No. She's like, “It looks like your baby's left kidney is non-functional. It's just a cluster of cysts.” Meagan: Oh no. Flannery: I was like, “Oh my god.” I was so terrified. I just had no clue. This didn't show up on the 20-week ultrasound or anything. She was like, “And your fluid is still super low.” We did an NST. They sent us home, and I was just waiting around at home with my husband for my midwife to call to make a plan. I was like, “Am I going back to work tomorrow? Am I going to be having this baby?” She called me, and she was like, “So, this isn't what I was expecting to tell you today, but I've been consulting with the neonatologist here and some OBs. Since you've already had your steroid shots, we want you to go to the hospital now to have your baby tonight.” She was like, “Don't rush down the highway in the snow. This is an urgent, not an emergent situation. You'll be in good hands.” I was like, “What in the world?” I was so taken aback. I didn't believe it. They were also transferring me to a different hospital from the one that I had worked at and had planned to deliver at. Meagan: Is it because of the NICU situation?Flannery: Because of the NICU, yeah. This bigger hospital had the capability for surgery, and my hospital did not. It was a situation where it was a small hospital and a situation that they weren't really comfortable with. We hopped in the car and drove through this big snowstorm. I was just crying and shaking. We had no idea. We were both terrified. We had no idea what we were about to walk into.When we met our OB, she walked into the room. She just radiated calmness and kindness and peace. She was just an angel. She made us feel so safe. They were monitoring the baby and putting my IV in. I was still trying to wrap my head around the fact that I was having a baby tonight. Meagan: Yeah. Flannery: I was wondering, “Is this baby going to be okay? What is going on here?” We walked down the hall to the OR. I kissed my husband goodbye. I remember just thinking, “Okay. Here we go. There's no going back now.” The only way I could stay calm was to surrender any of the control that I thought I had and really just trust in God and trust in the people who were going to do the surgery on me. I lay down on the table and the anesthesiologist was so kind. He was petting my head and talking to me. My husband came in and they were setting up the drapes. My doctor who I had just met leaned her head over and she said, “This is where I had my first daughter.” That just made me feel so happy. Things are going to be normal again. She had a C-section too. It made me feel very safe. Everything went really well during the operation. I remember I could see the reflection of the operation in the lights that they have above you. I bet other moms will know what I am talking about, but they have these big OR lights, and I could kind of see what they were doing which was crazy.Meagan: You can. They're like mirrors. Flannery: I know. They should come up with something better. Meagan: Yes. For those who don't want to watch or see anything, just turn to the side. Flannery: Close your eyes. Meagan: Close your eyes. Turn to the side. Flannery: Yeah. They said, “After a few minutes, okay. Here he comes. Then he's out.” I didn't hear anything. I heard someone say, “Okay. I need to take him.” I could tell that was the neonatalogist saying they needed to work on him a little bit. They took him over to a corner where we couldn't see or hear anything that was going on. We could just hear people talking. Eventually, we heard a little cry. My husband started to cry. I looked at him, and I smiled. I just felt relief that he was alive, but I didn't feel anything. I just felt this nothingness. Meagan: I can so relate to that. Flannery: Yeah. It's so strange. It's just not what you're hoping to feel in this big important moment. Meagan: Mhmm. Flannery: I remember the neonatalogist after a while, he was breathing on his own. He had peed and pooped. They showed us pictures of him. She walked over with him in his arms in this little bundle of blankets. She stood pretty far away, maybe 6 or 10 feet away. She was like, “Okay. You know the plan. We need to check his kidneys in the NICU. What's his name?” I said, “I don't know. I need to see his face.” She flashed the blanket at me and flashed it down so I could see his face. I couldn't see anything. I said, “I don't know. I don't know what his name is,” and she walked out with him. That is just the worst memory from that whole experience. The surgery itself was really good. The care I had was great, but I'll never get that moment back. She could have brought him over to give me a kiss or see his face. It was hours until– Meagan: Touch or kiss his face.Flannery: It was so long until I could see him and meet him in the NICU. I just think about that all of the time. I did get to go meet him after a few hours. He was doing great. I didn't recognize him at first when my husband rolled me over to his isolet in the NICU which was hard, but as soon as I held him, I just had this overwhelming rush of love. It hasn't changed to this day. He's just such a joy.He turned out to be fine. His kidney was normal. It's resolved on its own, and it wasn't a cluster of cysts like they had thought. Meagan: Yay.Flannery: Yeah. He's doing great. He's a very rambunctious, very smart 2.5-year-old now. Meagan: Good. Flannery: Yeah. I'm so grateful that I have him now. I'm so grateful that I accidentally got pregnant with him.Meagan: Yes. He was meant to be, and he was going to make sure that he was.Flannery: He totally was. Yeah. Yeah. Meagan: I'm sorry that you had that experience. I want to say it's unique, but it's not. That sucks. Flannery: It's totally not. Meagan: I hope that as people are listening, if they are in the birth world of labor and delivery nurses or OBs or midwives or whatever it may be, please be mindful of mom. Please be mindful of mom. Don't forget that she doesn't feel these things because does. She needs to see her baby. She needs to touch her baby. She needs to kiss her baby. If it is a true emergency, true emergency, understandable. But in a sense of this, it doesn't sound like it was a true emergency.Flannery: It wasn't. It wasn't. Meagan: They went over, and they took a lot of time with your baby, and then came and left. They didn't need to just come and leave. Flannery: Right, right. Especially when baby is breathing on its own and stuff, you can take 10 seconds to let mom give baby a kiss.Meagan: It will impact mom. Flannery: It totally will. Meagan: Here you are 2 years later still feeling mad. You're like, “I still think about that.” I saw it. I saw it in your eyes as you were telling that story. You feel that still. That's there. I hope that people can remember that protocols and what you think needs to happen and all of these things do not trump mom. Flannery: Totally. Totally. Meagan: Right. Yeah. So, having a NICU baby, how long– what was the exact gestation?Flannery: He was 35 and 5. Meagan: Okay, so it was a preterm Cesarean as well. Flannery: Yes. Meagan: Did they have to do any special scar or anything like that because it was preterm? Flannery: No, thankfully not, but he was very stuck up in my ribs. He had the cord around his neck, and there was meconium. I know that he needed to come out that way because I don't think he could have flipped if they did an ECV. I don't know if he would have tolerated labor if he was head down even. Meagan: Yeah. That's definitely an early baby, but good that all is well for sure. Flannery: Yeah. He did great. It was a rocky start, but he's doing great now. Meagan: Yeah. Yeah. Do you have any advice for NICU moms listening? Flannery: Yes. There is this foundation that will pay for your parking costs while you're in the NICU. I didn't know about it in time. Parking can get very expensive when you are visiting your baby. If you just Google, “Parking Foundation for NICU parents,” I'm sure it will come up because I can't remember the exact name. Meagan: I'm going to look it up. I'm going to look it up while you start your next story. We'll make sure to have it in the show notes if I can find it. Flannery: Yes. Yes. Meagan: Okay, keep going.Flannery: My next pregnancy, I was determined to do everything right this time. I was like, “You know what? The last pregnancy was so rocky and so unexpected that this time, I'm going to do everything right, and therefore nothing can go wrong.” I think people have that feeling a lot which is so irrational, but we can't help it. I did go back to see my OB who delivered Freddy, my son. I just loved her. I thought she was wonderful. I just wanted to see what her opinion was about why I had those complications in my pregnancy and see what she thought about a VBAC because even though I wasn't sure if I could have a VBAC, I was interested in it. She listed out all of these rules that she had about VBAC, about, “You can't be preterm. You have to go into labor naturally,” and all of the things that you say are red flags on the podcast. Meagan: I'm like, all of the normal things, but they are all red flags. Flannery: Yes. I mean, I loved this doctor, and I think if I was going to have a repeat C-section, I would have gone back to her because she is awesome, but that wasn't the experience that I wanted to have this time. I did a little research, and I found this midwife practice that everyone recommended to me. I decided to go with them instead. This pregnancy was super uneventful. I was very conscious of taking care of myself and taking walks a lot and prenatal yoga and being on top of my vitamins and all of that sort of thing. I was very religious about positioning and Spinning Babies because I was like, “If I can just get my baby head down from the beginning, I think that I can do the VBAC,” because with a bicornuate uterus, you have less time to flip them, so with a normally shaped uterus, baby can flip up until the very last minute if they are breech, but with a bicornuate uterus, first of all, you have more of a chance of baby being breech and less of a chance for them to flip based on the shape of your uterus. There's just not as much room. I was trying to sit on my yoga ball and doing all of these stretches. I was thinking, “Gosh. This is so unrealistic. Who's not going to sit on their couch for 9 months? I have to be sitting on my couch. I can't be walking 3 miles every day,” but then I'd go back and forth in my head like, “Do you want a VBAC or not? You have to be religious about this.” You don't have to do everything I guess is what I'm trying to say. You'll try your best, but you have to do what's right for you, but you can't go to the extremes.Meagan: I love that you pointed that out. With my second baby, I was doing the red raspberry leaf. I was doing the dates. I was doing all of the things, and even with my third baby, I was the one who didn't sit on the couch for 9 months. I still had a posterior baby. I will just say that I still had a posterior baby. I had a head-down, but still a posterior baby. Actually, he was still going breech too throughout pregnancy. Yes. He was such a stinker. But, I did do all of those things. I did the dates. I did the tea. I did all of it. For me, With my third, I had to dial back a little bit and say, “Okay. I'm going to do everything I feel is right for this pregnancy.” Dates wasn't one of those. I actually didn't do the dates thing. I know there is some evidence on that, but I just didn't do it. It didn't feel right to me, but I did other things like chiropractic care. I did drink tea. I hired a midwife and decided to go out-of-hospital and hired a birth team. I did birth education. I think the biggest thing is to do all of the things that stick out and call to you. There are so many things. We give so many tips. Some tips might not apply well to you. Walking 3 miles is a lot. Flannery: It is a lot. Meagan: It's a lot, but if you can walk a mile, that's better than not walking any. Flannery: Right. Meagan: Right? So trying to go and find what is sitting right for you in this pregnancy, this baby, and in this birth, and doing those things and then knowing you did all of the things you could that felt right for you. Flannery: Yes. Totally. I totally agree. Meagan: I knew I could do all of these things and baby might still be breech. Baby was breech at my anatomy scan, and then again at 28 weeks at my other growth scan. I remember going into the midwife and just saying, “What can I do?” She was kind of saying, “Nothing will supersede the shep of your uterus. You can do everything. Why don't you just visualize because at least then you will feel like you're doing something?” I was so mad after I left that appointment. I was like, “You can't tell me that I can't do anything to make this baby flip and that it's all down to the shape of my uterus.” I kept trying. I was 28 weeks and I was going to the chiropractor and acupuncture and inversions. This time, I was really good about the inversions even though it gave me heartburn. It worked. The baby did flip. I remember actually listening to a podcast episode from The VBAC Link, and it was about someone who was trying to flip a breech baby. She flipped her breech baby. I was like, “Okay. This gives me so much hope. I can do it.” It paid off because baby did flip. I was so happy. Yeah.At one ultrasound, they did pick up an issue with the kidney. I remember being so upset because it was the same issue that my son had, but very mild. The baby had been breech at that point. I was like, “I'm trying so hard. I'm doing everything right, and it's not working.” History is just repeating itself. That's what it felt like to me, but we ended up finding out that the kidney resolved at the next ultrasound and the baby had flipped. It was like, “Oh, my prayers are being answered.” I couldn't believe it. I was so happy when we got the results from that next ultrasound.We just continued doing the prep. I had planned. I was planning to deliver in the hospital. I had a doula who was amazing. She was just with me every step of the way talking me down when I was anxious and telling me all of the different things I could try and come up with plans for repeat C-section or vaginal birth. I had really wanted to go without the epidural because I didn't mention this, but I had gotten a spinal headache from my spinal last time, and that was just awful. It was almost worse than the C-section pain. Meagan: I've actually heard that because nothing really takes it away full-on. Flannery: Yeah, except lying down. Meagan: Lying down, yeah.Flannery: I was trying to visit my baby in the NICU. I couldn't just be lying in the hospital bed all day. So I was like, if I can avoid an epidural just so that I don't even have the chance of having a spinal headache again, that's what I'm going to do.I was reading Ina May. I was watching all of the YouTube videos and doing everything that I could, but it got to be a lot. It got to be like, oh my gosh, so much work to prep for this birth. The whole time, you don't know if it's a given if you're going ot get that VBAC.Meagan: I know. Flannery: Sometimes, it can feel like, why am I doing this?Meagan: Yeah. Yeah. It is hard. It is hard because we don't know until it's done. Flannery: Exactly. Until it's 100% over. Yeah. Meagan: Yeah. Flannery: Yeah, so you know, 37 weeks came. 38 weeks, 39 weeks. I was feeling overdue basically since 35 weeks. Meagan: I'm sure. I bet you were like, “I don't know how much longer I can go.” Flannery: I mean, I was definitely hoping to make it to term this time and I was so happy that I did. It was a big, big moment when I hit that 37-week mark, but then I just kept going and going and going. I was like, “Am I ever going to go into labor? What am I doing wrong?” I was walking. It was the end of July and it was so hot out. It was hard to get out there and walk. I eventually hit my due date which was July 25th. I got a membrane sweep on that day which was not super fun. It made me lose my mucus plug and have a few cramps, but nothing else. I was very hopeful that it would kickstart labor, but it did not. Eventually, I thought, “I just have to let go. The baby will come. You might have to have an induction, but you just have to relax.” Finally, finally, 5 days after my due date, which I know is not that long, but it felt long. Meagan: It feels long. It feels long when you are almost 6 weeks after you had your first baby.Flannery: Yes, exactly. I woke up in the middle of the night and I had this period cramp feeling. I was like, “Oh my god. Is this it? Am I in labor?” I managed to calm down and go back to sleep. I put my hand on my belly and was like, “Am I going to get another cramp?” They came, and they came, and they started coming every 20 minutes. Eventually, I had to wake my husband up because it was pretty painful at that point. Maybe 2-3 hours in, I squeezed his hand. He was still sleeping, and he was like, “What's going on?” I was like, “I think I'm in labor.” He said, “I was having a dream that your water broke.”Meagan: Oh my gosh. You guys were both willing it in.Flannery: Yes, exactly. It was like we were on the same wavelength. The contractions kept coming, but they just felt like mild period cramps. I had a midwife appointment at 8:15. They said to go in to see if I was in early labor. She checked me and said I was 3 or 4 centimeters dilated and almost completely effaced. She said, “Your cervix feels labory.” I said, “I think that today is the day.” I was convinced it was prodromal labor or going to fizzle out or something. We went all the way back home. My plan was to labor at home for as long as possible and have my doula come over. I said goodbye to my little 2-year-old. My mom was taking him to hang out with her while we were in the hospital, and I remember she had him say to me, “Good luck, and be strong.”The sound of his little voice saying that to me literally just sustained me through the entire labor. It was replaying in my head in the hardest moments. I could just hear him saying that and it meant so much to me. Yeah. We just hung out at home. I was getting pretty irregular timed contractions. I was wondering why they weren't getting closer together because sometime they would be close together. Sometimes they would be spaced apart, but they were definitely getting stronger. I got in the bath or the shower. I was leaning over, and swaying and moaning, doing all of the things that you're supposed to do– the low-toned moaning and the breathing. I eventually had my doula come over after one really bad contraction. I was like, “What's going on? Why isn't it picking up? Why aren't they getting closer together? Should I go to the hospital? What's going on?” I was really afraid of the car ride because it was about 40 minutes in the car. She said, “I think what is happening is that you have this mental block about the car ride,” because this whole time, I was like, “What if I have the baby in the car? What if I have the baby in the car?” I heard a lot of stories about car babies, and I actually recently had a patient who had a car baby at work. She was like, “I think you have this mental block, and once you get to the hospital, your body is going to let you get fully into labor. So I do think you could go.” I was like, “Okay, okay. Let's go.” I called the midwives and let them know we were coming. My favorite, favorite midwife was on, the one I had hoped this whole time was going to deliver my baby.She was only on for a 12-hour shift, and it was already halfway through her shift. I was like, “Oh gosh. I'm glad she's going to be there.” We drove to the hospital. It was this very hot, very bright, and humid day. I was like, “I don't want to be here. I just want to be in a cold, dark room.”I remember as we turned onto the street that the hospital is in and pulled in the driveway, my contractions boom, boom, boom were ramping up. I was like, “Ashley (my doula), you are so right. This is exactly what happened.” I got into triage. I was making a lot of noise. It was very intense at that point. They checked me. I was 4 centimeters and 100% effaced. I wasn't too disappointed that I wasn't further along because I was like, “This feels pretty intense. I think things are really happening.” But they said, “You picked a very popular day to give birth. There are no rooms available on labor and delivery.” I was like, “No.”Meagan: What?Flannery: I was especially nervous because working in the field, I've seen how a busy unit can really affect the care that is given. It shouldn't be that way, but it totally is. Meagan: It's the reality sometimes. Flannery: Yep. My sister-in-law had recently given birth on a very busy day. She had a very difficult birth, and a very not attentive staff, so that was one of the things I was really afraid of is that I was going to give birth on a super busy day, but my care was excellent thankfully. We eventually waited in triage for a room to be ready, and it was a tub room that became available. There was one tub room in labor and delivery. I was so excited to get in that tub. I jumped right in as soon as we got there. Not jumped, waddled right in. It felt so good. The water felt amazing, but I did find it very hard to maneuver and get in the right position to work through a contraction in the tub because it was weirdly shaped. I didn't stay in there super long, but I was very surprised at how intense the contractions were which sounds silly, but they just really took over. I was hoping to use some coping techniques like music or my rebozo. I brought my massage gun. I brought this whole toolkit of stuff, but in the moment, all that was going through my head during a contraction was cursing and, “I need the epidural. I need the epidural.”I was squeezing my husband's hand so hard. My doula had this spiky, silver ball that you could use for counterpressure so I was squeezing that in my hand so hard breathing. I labored on the toilet for bit. I was in the bed. I was moving around. I could not be lying down. They were having to use continuous monitoring which I didn't really mind. The nurse was very good about not being intrusive about that. She would just follow me around with the monitor. The midwife, who I was hoping to have, was just there with me the whole time. She was holding the monitor onto my belly and speaking kind words to me. I remember going through this terrible contraction and looking over at her. She is just sitting serenely in her rocking chair just looking at me. In my head, I was like, “How can you be so calm? Help me. Do something.” Meagan: I can relate. Flannery: Being present. Meagan: Do something. Help me.Flannery: Help me. Help me. Meagan: Sometimes just being present is what you needed. Flannery: It is. It totally was. She was super hands-off, but in the moment, you're like, “Come on. Somebody do something to help me.” Eventually, I was just sitting on the toilet. The midwife had dimmed the lights. My husband was there speaking to me. I had been making these very loud moans through each contraction, and then during one of them, I started grunting, and I knew exactly what that meant. I was pushing involuntarily. I had been hoping to feel the fetal ejection reflex, and I think that's what this was because my body completely took over. There was no way that I could have not pushed during these contractions. The pain of the contraction was so intense, but it would go away when I pushed. Then I would just feel this really uncomfortable pressure, but at least the pain of the contraction was going away. I had been pushing for maybe 5 minutes, and my midwife was all excited. I was like, “Okay. Please, can you check me?” She was like, “No, just go with your intuition. Listen to your body.” I was like, “No. I need you to check me.” I did not want to be pushing on an incomplete cervix. She did, and I was a 9 and 100% effaced. She was like, “Okay, you can definitely push. That cervix is just going to melt away.” Yes. I tried the nitrous while I was pushing, but I really hated how it restricted my breathing. It also made me throw up everywhere. Meagan: Really? Flannery: Yes. Meagan: Interesting. Flannery: Yes. So much puke. It was so embarrassing. It was splashing on everyone's shoes. I was like, “Oh my god. I'm so sorry.” I pushed on the toilet for a little bit, and then I moved over to the bed. I went over to the bed because when I was on the toilet, I felt something coming out between my legs. I reached down, and it was the bubble of amniotic fluid. It hadn't popped yet. Meagan: Your bag of waters, yeah. Flannery: My bag of waters was coming out. I think I said to my husband, “Do you want to touch it?” He was like, “No.” Meagan: It just feels like a water balloon.Flannery: It felt exactly like a water balloon. I went over to the bed. I got on my side, and I was pushing so hard just totally going with my intuition, but it wasn't the type of peaceful breathing that people tell you to do like the J breathing or anything. There was no way I could breathe through these contractions and these pushes. I was totally holding my breath and bearing down, but that's just what was right for me in the moment. They were saying, “Can you feel the baby moving down?” I was like, “No. Not at all.” I think that's because the bag of waters was still intact. I couldn't feel anything except this really uncomfortable pressure. They said, “Put your fingers inside of yourself and see if you can feel a baby's head.” I put my fingers past the bag of waters, and I could feel the baby's head right there. I pushed, and I could feel the baby move down. It was the most incredible, coolest moment of the birth. I loved that. My midwife said, “Okay, baby's definitely feeling the squeeze.” Her heart rate was going down a little bit. She said, “Turn onto your left side, and with this next contraction, let's have the baby.” I pushed as hard as I possibly could, and just felt this release of pressure. I had no idea what was going on, but I had this cold cloth over my face so I couldn't see anybody, but I heard cheering. Then I felt this warm, wet baby come up onto my belly. I was laughing and crying, and everyone was saying, “Yay! You did it!” I was just like, “Oh my god, what happened?” Meagan: Just like that.Flannery: It was surreal. It was incredible. She started crying right away. We didn't know she was a girl. My husband looked down between her legs. We both looked at the same time and said, “It's a girl.” I said, “I knew you were a girl.” She just stayed with me the whole time right onto my chest. It was just the best feeling. I was so, so overjoyed. Meagan: That is so amazing. It's so amazing with VBAC how the whole room sometimes can just erupt with joy and, “You did it!” and screams and joyful laughs. Oh, man. Flannery: Yeah. It was beautiful. It was so, so intense in a way that I hadn't been expecting it to be. It was a calm, beautiful birth, but the intensity of the contractions and the way that my body completely took over, and I was just along for the ride. I was just riding the waves. It was crazy. Meagan: Truly riding that wave. We talk about it in HypnoBirthing and riding the wave, but that wave came over, and like you said, your body was just like, “Okay, I've got this. Let's go.” Here you went, and this baby came out pretty quickly it sounds like.Flannery: Yeah, she was born at 7:23 PM. I had felt my first contraction at 2:00 AM or something. It wasn't the shortest labor, but once I got to the hospital, it was 5 or 6 hours. It was pretty quick in the end there. She came out en caul. Her head did. Meagan: She did?Flannery: As her body came out, it popped, so she was almost en caul I guess which I thought was so cool. Meagan: Oh my goodness. That is so awesome. I love that. I've seen a couple in my doula career, and it is so cool-looking. A lot of people have said, “Oh, vaginal birth can't have encaul babies.” Oh, yes they can. Yes, they can. 100%. Flannery: Yes. Meagan: I love that you had mentioned, “Once I got to the hospital–”. Sometimes I've had this with doula clients where I'm noticing this pattern of inconsistency and a lot of the times, the client is saying things like, “Should I go? Should I go? Is it okay to be here still? How much longer should we stay?” They are saying these questions because inside, there's a lot going on. I had a client where I said, “You know what? I think we should go. I think you are going to feel safer there. It seems like you are going to feel safer there.” The second we got there, things ramped up. Doctor didn't even make it. The baby slipped out on the bed. Seriously, the second she got there, her body released. It was almost like her epidural. Sometimes, with an epidural, we get an epidural and our body is able to relax. If our mind is not confident or comfortable, we can't let our bodies sometimes. So I love that you pointed that out. I wanted to talk a little bit more really quickly on the types of uterine abnormalities or different types of uteruses. As she was saying, you have a bicornuate uterus which means it's a heart-shaped uterus. I'm probably going to butcher these names especially if you are a provider and you are listening. I don't really know how to say these words. There's an arcuate uterus which is similar to a bicornuate uterus, but with less of a dip in the heart shape. It's like an oddly shaped heart. It's asymmetrical in my mind. That's how I envision it. There's an arcuate uterus, which means there's a divide down the two parts of the membrane wall. Then there's a unicornuate uterus, which is when the fallopian tube has an irregular shape to it. Then I always butcher this one. It's didelphys. I don't even know how to say it. Flannery: Sorry. I can't help you on that one. Meagan: I'm going to stop trying. That is when you are born with two uteruses which does happen. One baby can be in one uterus, and we can have another uterus over here. Those are all abnormalities of the uteruses. Of course, we have different shapes, sizes, and all of the things. I wanted to just have a link in the show notes for that as well so you can read more on each of those types of uteruses. Then tell me if this is the right link. I found Jackson's Chance Foundation.Flannery: Yes. That's what it is. Meagan: Why parking matters. Flannery: Yes. Meagan: It looks like this is inspired. It's a foundation inspired by another person's story, another NICU baby's story. It said that–Flannery: Yeah. I believe that Jackson's parents set it up. Meagan: Yeah. Wow. This story is precious and inspiring. Wow. These parents are incredible. Then it does show that you can donate or sponsor a parking pass. They talk about the why and all of that. This is so awesome. I'm going to make sure that we have that in the show notes. If you know a NICU baby, or you know someone who is going to have a NICU baby, don't be like Flannery and find out later. This is how we all learn, and this is how. We find out when it's too late, then we have to go to show on. So, thank you for sharing that tip. I've actually never heard of it, but that's probably because I'm not a NICU mom.Flannery: Yeah. Yeah. I hope it helps someone. Meagan: Yes. Thank you again so much for sharing your story.Flannery: Oh my gosh, this is amazing. Thank you so much. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

“Whatever happens, I just want it to be peaceful, and I want to be present.”Kerri is a labor and delivery nurse born and raised in Kentucky. The only thing on her first birth plan was not to have a C-section, yet it became her reality. We know many of you can relate.She had a medically necessary induction at 36 weeks due to preeclampsia. Kerri describes her experience with getting magnesium, aka a “flu in a bag”, seeing double and going in for a C-section. Her surgery was straightforward, but Kerri felt very out of it and disconnected. Kerri was very intentional about her plans for a VBAC. Her birth team was on board and supported her requests. Throughout her pregnancy, Kerri's greatest desire was to feel present for the moment of birth no matter the outcome. When labor stalled and baby had a hard time engaging, Kerri felt peaceful about requesting a second C-section. With things happening on her terms, Kerri's birth was the peaceful and healing experience she hoped it would be.Evidence Based BirthⓇ - The Evidence on VBACEvidence Based BirthⓇ - COVID ResourcesNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength. We have a CBAC story coming your way today. If you did not know what CBAC means, that is Cesarean Birth After Cesarean. This is a topic that a lot of people avoid. I don't know, tell me, Kerri, who is sharing her story today. Do you feel like CBAC stories are sometimes avoided when you are preparing for a VBAC?Kerri: I think so. I know I avoided that as I prepared for my own attempted VBAC. Meagan: Yeah. Kerri: Yeah. I think that CBAC is something that we try to avoid because we all hope for that VBAC. Meagan: Yeah. We overlook it and it actually breaks my heart. I encourage everyone to listen, especially if they are wanting to VBAC, every VBAC story, but as well as every CBAC story for a lot of reasons. One, understanding maybe what led to another CBAC and two, the healing and the fact that it can be a peaceful experience. It's not the end. There are so many things to CBAC, I think, that are missed. It's the same thing with uterine rupture stories or things like that. I'm not wanting that, so I don't want to listen to that. Now, I don't want to shame anyone if they skip over a CBAC story, but I really encourage everybody to listen to all of these stories because they are empowering. They are uplifting, and they are going to help you grow in ways that you may not even know. Before we get into cute Kerri's episode, I wanted to share a review. This was actually left a little bit ago too, actually. It was in 2022. No, 2021. It says, “Going for my VBAC after two C-section in 2022”. It says, “Thank you so much for this valuable resource. I have been listening to your podcast since early in my second pregnancy. I found out I was expecting again 9 months after my CBAC, and I was immediately and depressed that I would be going through all of that all over again very soon. I am now 14 weeks, and I'm drawing strength every day from the stories you share. Thank you, thank you, thank you. I have hope this time that it will be different.” Now, that's another good note to have. Even if you do have a CBAC, that doesn't mean that's the end. That also may mean you find healing in that, and you want future CBACs, right? You want to schedule that CBAC. I love that note about healing and strength. That's what all of these episodes are doing. Okay, Kerri. I am so happy that you are here. You are in Kentucky.Kerri: Yes. Meagan: Okay, were you in Kentucky for both of your births? Are you from Kentucky?Kerri: I have lived in the same small town my whole life. I live just outside of Lexington. It's a little bit bigger than it used to be, but it's still a small town to me. Meagan: Okay. Kerri: I have lived in Lexington my whole life. I gave birth at the same hospital where I was born. Meagan: Yeah, me too. I would say I'm boring. I'm boring. I haven't been anywhere, but I don't think it's boring, actually. I love Utah. I've been born and raised here. I actually gave birth at the same hospital for my C-sections and with the same provider who gave birth to me. Kerri: Oh, that's so funny. That's wild. Meagan: Kind of crazy, huh. Well, thank you so much for being here today and sharing your beautiful stories. I'd love to turn the time over to you. Kerri: Yeah. I'm so excited to share. I've listened to this podcast quite a bit since my first C-section, so I'm really excited to be on today.Meagan: Well, thank you for being here. Kerri: My first pregnancy was already a surprise pregnancy. Me and my husband had just gotten married, and a month and a half later found out we were pregnant. It was already quite a bit of a surprise being pregnant. You know, pregnancy went well. The first trimester went well. Around 28 weeks, I had gotten COVID. This was November of ‘21. COVID was still fresh. I had gotten COVID, and I made it through that. I thought everything was going well, but from that point on, I just was feeling more and more sick. I had been a nurse for a while, but I was a new nurse to labor and delivery. I was working night shifts, so I just really attributed the way I felt to working nights. I'm just pregnant. I'm working the night shifts. This is probably what's wrong with me. Around 35 weeks, I just started feeling miserable. I had an appointment with a provider who wasn't my provider, but he was a provider I had worked with. At that appointment, my blood pressure was elevated. He said, “Let's just get a preeclampsia panel, and do a 24-hour urine just to be safe and see what's going on.”I did that, and I turned in my 24-hour urine. I went to work that night. That shift was miserable. I don't know how I made it through that shift, but I did. I got off that morning, and the provider called me that morning. He was like, “You have preeclampsia. You cannot work anymore. You're on light duty at home, and you're being induced at 37 weeks.” That was already quite a bit of a shock. I had been around birth just enough as a labor and delivery nurse. I had just already in my head pictured this beautiful birth experience that you see on Instagram, and I'm like, “This is already not happening for me.” He tells me that. I'm home for a few days, and I'm just feeling more miserable as I'm home. After that phone call a few days later, I checked my blood pressure, and it's severe at home. It's over 160/110. Being the nurse I am, they say nurses make the worst patients. I was just like, “I'm going to ignore this for a little bit, and we'll just see if this gets any better.” I check it again later that afternoon, and it's still super high. I called my husband, and we decided to go to the hospital. We get there, and my blood pressure was high, but it was not severe enough to do anything about it. They were like, “Let's just keep you overnight and see what you do.” Over the 24-hour period of being there for observation, my blood pressures just went up and up. I had some more severe, and they were like, “You know, it's time to have a baby.” I was just shy of 36 weeks at this point. They started a magnesium infusion to help with the preeclampsia.Meagan: Blood pressure. Ugh, did it make you feel yucky?Kerri: Oh, yes. Magnesium is awful. I feel for anybody who has to be on that. It was awful. We call it flu in a bag, and it truly is that. Meagan: Flu in a bag. Okay. I've never heard of that, but I can understand that based off of the way I've seen my clients feel. Kerri: Yeah, that's exactly how you feel. Flu in a bag. It just makes you feel yucky. We started that, and we started the induction process. We started with the Foley bulb. We put that in. That was in until the next morning, and it comes out. When it came out, I think I was 3 centimeters, but not very effaced. It was just an artificial 3, a Foley bulb 3. They were like, “You know, your cervix isn't very favorable. Let's do some Cytotec.”We did a few doses of Cytotec. They rechecked me after that. It was still not very favorable. I think this was the evening at that point. They were like, “Let's just take a break, let you have a meal, and we'll try this again.” We do that, and then we start Pitocin. We did that all night. The next morning, my provider checks me. I'm finally a 4. I was ecstatic. I was like, “Oh, I've made some change.” I was really excited. They checked me. I was 4. They break my water, and they're like, “Let's just see what happens.” I had gotten an epidural at that point because I was already pretty miserable from being on magnesium and all of these induction agents. I was like, “I really need some rest.” I was already epiduralized. The nurse who was taking care of me at the time was a really good friend of mine. She was like, “Let's do everything that we can to try to have this baby vaginally.” She did Spinning Babies. We did all of the positions that we could. They checked me again later and I was a 5. I was ecstatic, like, okay. We're doing something there. A few hours later, I'm starting to feel pretty miserable, more miserable than I had felt before. I look over at the computer, and I'm seeing double. I call out to my friend. I'm like, “I don't know if this is normal, but I'm seeing two of everything.” She was like, “No, it's not.” She calls my provider. He said, “Let's draw a magnesium level. Let's see what's going on.” So they did. My magnesium level was high. They decided, “Let's just recheck you. We'll see you if you made change. If not, we'll have to have a section.”They checked me. I was still a 5 at that point. They decided with everything that was going on, it was probably in the best interest of the situation to have a section. I agreed, but I was heartbroken. My whole pregnancy, my only birth plan was don't have a C-section, and at that moment, that was my reality. Everybody who was with me that day, they were my coworkers. They witnessed me have a full-blown panic attack over it, but everybody made it through that with me. They loved on me, then we finally went back to the C-section. I'm pretty out of it from the magnesium at this point and just having labored so long. They started the section. I felt like I could feel more than what I probably should have been able to feel. I let them know, and once they got the baby out, they gave me ketamine just to help with my pain. I was knocked out for 12 hours, so I don't remember my baby's birth at all. Meagan: That's hard. Kerri: Yeah. It was really hard. I feel like the moment I actually realized I had a baby was the next morning. There's a video where I'm like, “Oh my goodness.”Meagan: Yeah. Yeah. Were you feeling any better by then?Kerri: I was still under magnesium, but I was feeling better. Meagan: Good. Kerri: The protocol, at least at the hospital that I work at in, is magnesium 24 hours postpartum just to make sure you still don't– Meagan: Yes, that is how it is here too, then they'll recheck things and if blood pressures are still elevated or anything like that, and if levels are elevated, then they'll remain, and if not, then they'll take you off. Kerri: Yeah, we did that for 24 hours. Once that was off, I finally got to go up to the mother/baby unit. I started to feel more normal at that point, but just that whole experience, I felt like I was just not even a part of. I was just there having the baby, but I didn't feel like I was actually there having a baby. Meagan: Yeah. Yeah. Did that carry onto the postpartum and future as stuff to process for you, or did it feel okay? Kerri: That was very hard for me because I worked with birth every day. I got to see these beautiful moments of people having their baby, and I didn't feel like I had gotten that. I don't remember my baby being born. You know, it's different. I had pictures, but nothing quite as good as remembering that. That was very hard, and it really affected me for a long time. You know, it still does. I would have loved to have been present in that moment. That just wasn't the reality for me. Meagan: Yeah. Have you done things to work through that, or anything to suggest for someone who maybe have experienced that or have been put under anesthesia where they just couldn't remember or be present in their birth?Kerri: For me, my faith is something that is very important to me. Praying and talking with God about it has really been helpful for me. It was still a beautiful moment. I've come to terms with that. Meagan: Good. Good. Okay, so baby number two. Oh, I was going to ask you, with being preterm, did they do a special scar or anything, or were they able to do a regular low transverse?Kerri: Just a regular low transverse incision. Meagan: Awesome. Awesome.Kerri: Yeah. So baby number two, we knew we wanted another one, and honestly, as soon as we were in that hospital room, I remember I told my husband that I never wanted to have a C-section again. When we started thinking about number two, we were going to start working towards having a VBAC. When she was around 20 months, I found out I was pregnant. Prior to the pregnancy, I had done a ton of research on what is the best way to get a VBAC, and what is the best way to prevent preeclampsia which is silly because we know preeclampsia can't necessarily be prevented. Meagan: Yeah, there are things we can do to try to reduce the chances, but there's nothing that we know for sure, concrete that this is what you can do to make sure you don't get it. Kerri: Yeah. My provider did have me start taking low-dose aspirin early on in the pregnancy, and I didn't get it again, but you know, I did all of this research like, what can I do? Looking back now, I think I put too much pressure on myself to try and prevent it. I found out I was pregnant when she was 20 months old, and we were so excited. We were just thrilled. We just couldn't even describe that. I was so excited to start doing what I could in the pregnancy to get my VBAC. That's all I could think about was my VBAC. I remember praying to God. I just prayed that this pregnancy I could have my successful VBAC. Then as the pregnancy got closer to delivery, in my head, I'm like, “I could have another C-section. I need to start thinking about this.” So then I shifted my mindset. I was like, “You know, if I have to have another C-section, it's okay. All we want is a peaceful delivery.” So that's what I kept telling myself every day in my prayers. I was like, “Whatever happens, I just want it to be peaceful, and I want to be present.”Meagan: Yeah, I bet that was a really big deal for you.Kerri: Yes. I just kept saying that every day. That's what we're going to do. Peaceful delivery. Present delivery. I kept telling my coworkers because they were rooting for me. We were going to make this a better experience. My provider the whole pregnancy was great. She was very VBAC-supportive. I did a lot of research prior to the pregnancy about who I wanted to see, and I worked with these providers. It was a hard choice to make. I work with great providers, but I feel very confident in the provider I picked. She took such great care of me, and I'll forever be grateful for her. Towards the end of the pregnancy, me and her had a chat about what are we going to do to get our best attempt at having a VBAC? I ultimately decided that I wanted to be an induced VBAC. Not necessarily that I wanted to be induced, but I needed the peace of mind. I already had a lot of anxiety just because of the last pregnancy, and I just needed an experience where I could at least expect something. This may not end in a successful VBAC, but I really want to try. We scheduled the induced VBAC, and she was like, “This might not work.” We had a lot of conversations about that. She was like, “Induced VBACs aren't always successful,” which I appreciated her saying as a provider. I was like, “This is what I need just for my peace of mind.” We scheduled an induction. Everything was going great. I went in at night. I had gotten a Foley bulb again. My cervix wasn't favorable necessarily. I was 39 weeks on the dot. Maybe if I would have waited a little longer, I would have been more favorable. At that point, I wasn't the most favorable, but I still wanted to go through with it. I had wrapped my head around that that day was going to be her birthday and we were going to go through with it. We started with the Foley bulb, and it stayed in for what felt like forever. They put it in at midnight. It did not come out until 11:00 AM the next day. I was not expecting that because last time, the Foley bulb did not stay in that long. This time, I had made it to 39 weeks, and I was thinking that my cervix would do more, and it just didn't. My provider came in. She was able to get it out. She broke my water, and I was at a 4 at that point. It was ready to come out, but it didn't on its own. I wasn't expecting that. I was expecting a little bit more. Meagan: That can happen. It can be in for up to 12 hours and not fall out. That can happen, but I'm sure after your previous experience, you're like, “Wait. Why isn't this out yet?” Kerri: Yeah. We did that, and I decided she was going to break my water. Me and her and my nurse who was taking care of me was a really good friend. We were like, “Let's just get an epidural because we know that there is a bit of a higher chance for uterine rupture for being an induced VBAC or TOLAC.” Meagan: Were you feeling contractions at this point?Kerri: I was. I was feeling contractions. That was something, I kept telling my husband, that I was really excited about. With the last experience, I was really out of it having been on magnesium and having gotten an epidural so early. I just didn't even feel like I got to experience labor at all. Like I said, I didn't feel like I was a part of that experience. I was really excited this time to be able to experience contractions. While they were very, very painful, I was very grateful to have that experience. I had asked for a few doses of fentanyl. Meagan: Fentanyl?Kerri: Fentanyl, yeah. We used to do [inaudible], but right now, we have fentanyl. I had asked for a few doses of fentanyl, but I really tried to tough it out because I was like, “I really want this experience.” The whole pregnancy, I had been prepping for how I was going to manage labor while I didn't have an epidural. I had a friend who I worked with. She is also a doula, and she is going to school to be a midwife. She had talked me through a few different things that I could do. I had really prepared, and I was really excited to be able to experience some contractions. Meagan: Yeah. Kerri: But we had decided, “Let's get an epidural just to be safe.” We got an epidural, and everything was smooth sailing. We got the epidural. We started some Pitocin. I had asked for peace of mind for me, an IUPC which is the intrauterine contraction monitor because I wanted to know what my uterus was doing. If I was going to be an induced VBAC and I'm going to have a higher risk of rupture, I wanted to know exactly what my uterus was doing, so I asked for one of those to be put in. They put one in. My contractions were adequate. We were moving along. I'm just ecstatic at this point because I'm like, “I have never had adequate contractions. Last time, I made progress, but nothing like this.” I was very, very excited. Throughout the course of the day, me and my friend who was taking care of me decided that we were going to do every Spinning Babies position that we could do. My epidural was just perfect enough. I was able to help move by myself and do all of these positions that I had planned on doing. It was great. I was so excited. They checked me, and I was a 5. I was excited that I had made it a little bit farther than what I had thought I would because last time, I had stayed at a 5 forever. I was at a 5, and I was expecting to just keep making progress. A few hours later, they checked me again, and I was still a 5. My provider is like, “Your pelvis feels very tight, and your baby's head is not applied at all.” So then, I felt crushed in that moment. I had been planning on having this successful VBAC, and it doesn't feel like it's going to happen. Prior to the induction, I had been living in the Miles Circuit and doing everything I could to get her the best engaged she could be. She wasn't doing it. She said, “We'll give it a few more hours.” Meagan: What were your MVUs at this point? Sorry, I just interrupted you. Kerri: I think they were 200. They were adequate. Meagan: Mhmm, cool. Kerri: My contractions had been adequate for a while, and I wasn't on very much Pit. Meagan: Good. Kerri: I was thinking that things were going great. She was like, “We can keep going if you want. I'm going to stay with you. I'm going to do your delivery regardless of the outcome.” We decided we were going to keep going. A few hours later, I get checked again. I'm still 5. Her head's still not applied. My friend who was taking care of me was about to leave because her shift was over. She was like, “We can call it right now, or we can give it another shot.” She said, “You'll never get this experience again, so if you want to keep going, keep going, but if you don't, it's fine.”Kerri: I decided, “I want to keep trying.” I kept trying. Then a few hours later, I was checked again. I was still a 5. Her head was still not engaged, so we decided that we were going to have another C-section. That was heartbreaking. I remember in the moment feeling a little heartbroken, but also feeling at peace about it all in one. Meagan: Yeah, which is important. Kerri: Yeah. We go back for the section. I was nervous about having another section just because my first one was so traumatizing. I wasn't sure how it was going to go. I was really nervous about anesthesia. Is it going to hurt this time? Am I going to be knocked out because I'm feeling too much? The anesthesiologist who took care of me decided, “Let's just give you a spinal.” My epidural had fallen out actually, so she said, “Let's do a spina. Let's make sure you are the most comfortable you can be.” They did that. They started the section. I couldn't feel anything which I'm already thrilled for. I remember just laying there, and I felt so present during the whole thing. My baby came out, and I remember being a part of that moment. There was a clear drape, so I was able to see what was going on. My provider– I feel like we had developed such a good bond. She did everything to make sure that it was a good experience for me and to make sure I was present. Something that was important to me was that my baby would be with me a little bit longer while I was in the OR. I didn't have my baby with me last time, so I really wanted that. I didn't necessarily do skin-to-skin, but I got to hold her. She got to be with me the whole time, and it was perfect. She got to be with me during recovery. That whole birthing experience was just the most beautiful thing.Meagan: Good. So you have been able to walk away feeling positive about a birth experience. Kerri: Yes. That's not something I thought I would get with a C-section. After my first, I had a lot of postpartum anxiety. I had very negative feelings towards C-sections. I didn't enjoy seeing my scar. To me, that was just a reminder of what my body had done to me. I felt betrayed by my body, and for the longest time, I just was ashamed of the fact that I had a C-section. After that experience with my second, I was very proud that I did have a C-section because reality hit me that this isn't the most ideal way to give birth to a baby, but it happens, and thank God they are available, and I have two beautiful babies because of my C-sections, so I'm very, very thankful for them now. Meagan: Yes, good. Good. Kerri: When my husband and I decide to have another one, I'm like, “This will be great because I think that for me, I'll just have another repeat section, and it will be scheduled. It's going to be great, and I'm excited about it.” But it's just something to be able to look back and be able to think of this as such a positive experience as opposed to my first. I wasn't proud of my birth story at all. It was something I carried with me for a long time, and now, I'm thankful that I can have a different perspective about it. Even about my first, my first birth was beautiful in its own way.Meagan: Yeah. It's hard because you don't want to only think about those births as negative or traumatic. You want to pick out the positivity from it, but sometimes it is hard to see all of that, so it's been so great to hear that you– one, it sounds like with your labor, it really was a lot of your choice along the way. You decided this was something you wanted. Your team went with you and then walked with you along the way. In the end, it was able to be something that was a lot more healing. Even though it was still a Cesarean, it was a healing experience for you. You got to have your baby that whole time, and you got to grow through that experience. Like you said, you may choose to have a third C-section, and that's okay. I think that's one of the things I love about this podcast is that it's not if you choose a C-section, you are shamed. That's just not how it is. Everyone needs to choose what is best for them and their individual circumstances. I love that you've been able to go from the furthest end of the extreme to coming back, and then possibly if you have another baby, it sounds like something that you are already looking forward to having an even different experience. I love that you've been able to have that and you can share these stories and you can hold onto these good feelings because it really is important. Kerri: Yes. Even as a labor and delivery nurse, I feel more positive about taking care of women who have C-sections because for the longest time, every time I went into the OR, it brought up feelings from my own first C-section. It was hard to be the best nurse that I could be when I was dealing with my own feelings, so I'm thankful now that I have this perspective of, “This is beautiful in its own way.” Every birth is beautiful. You're bringing your baby into the world. Who cares how it happens? I think we get so wrapped up in God made our bodies to give birth a certain way, and that's just not the reality for some people. I'm thankful we live in a society where C-sections are readily available and we can have them. They can be just as beautiful.Meagan: Yeah. CBACs really can be. My second C-section was very, very healing. I think it was exactly what I needed to have healing from my first birth that I didn't realize I didn't heal from. I was really, really grateful that I had the experience. Again, it wasn't the birth I desired, but it was such a better and healing experience for me. I was really, really grateful for those. Okay, I have two things that I want to talk about. One is preeclampsia. Not even just preeclampsia, but COVID. I was just wondering, as a labor and delivery nurse, have you seen things like preeclampsia or placental issues or anything like that from people who have had COVID during pregnancy? Rebecca Dekker has such an incredible blog, and I'm going to make sure to link it here. I have seen this weird connection with pre-e with a placenta or placental issues that have had COVID. I was just curious if you've seen anything like that. Kerri: You know, I feel like that is something that we've seen more of. I will say I started working as a labor and delivery nurse in 2021, so I can't speak for what nurses saw prior to this, but I do feel like I see a great deal of preeclampsia, especially during that COVID time. Women were having more complications. More women are getting more sick. I don't know if there's a correlation, but I will say that as far as pregnancy goes, it does seem like a lot of pregnancies are becoming more high-risk.Meagan: Because of that? Because of COVID?Kerri: I don't know if it's necessarily COVID or just the way we eat, the way we take care of ourselves, but I feel like during COVID, there were a higher number of combinations whether there's a correlation or not. Meagan: Yeah, that's interesting. I just barely read the most recent update. I need to dive into that more, but I was wondering as a labor and delivery nurse if you had seen that. You mentioned with your first that they had tested you, and your magnesium levels were too high. Are there things that can reduce magnesium levels? Obviously, maybe lowering the magnesium levels that are given, but are there things that can be done in that situation to lower their magnesium levels?Kerri: If your magnesium level is high, we can give you the reversal drug which is calcium gluconate. We can give you that, but we are already inducing, you and it's high, and you're not making very much progress, at that point–Meagan: The provider may not be wanting to do that. Kerri: Yeah, delivery is the best option.Meagan: Yeah, for preeclampsia, which we do know. I was just wondering if there was such a thing that could help. Kerri: Yeah. Ideally, just do what you can to deliver. But you know, that's something that people should talk to their provider about in that moment. Meagan: Yeah. I agree. I agree. Then last but not least, I just wanted to share a little bit more because I think a lot of people do question induction and VBAC. What are the risks? Sometimes, the risks seem astronomical, and sometimes they are not to some people. Everyone takes it differently. I wanted to share some evidence on that. With the risk of induction, it does increase just like you had mentioned. It does increase the risk of uterine rupture when we are induced. It's about a 1.1% if you have Pitocin and about a 2% if you have prostaglandins, and then of course, we know misoprostol. How do you say that?Kerri: Misoprostol, but however you want. Meagan: Yeah. I saw misoprostol, but I've heard people say MYsoprostol. It is about 6%. It definitely increases with certain things that you do. It's about a 1.1%. Uterine rupture in general is just around 1%. It increases it ever so slightly, but it's really important to take the right precautions. A Foley bulb is a fantastic way to start jumpstarting labor, but sometimes it does need to have a little bit of an opening, at least 1 centimeter. Kerri: Where I work, we don't do Cytotec for TOLACs. Meagan: Most people shouldn't.. Kerri: It's a 1 to 1 assignment. Your nurse who is taking care of you wouldn't have another patient. Meagan: Interesting. Kerri: They make sure that all hands are on you and make sure that your uterus is okay. When it came down to me when I was thinking about wanting to TOLAC and hopefully have a VBAC, I looked at the risk. I think it's important. I listened to a podcast. I think it was by Jordan Lee Doulie. She had an OB on her podcast talking about VBAC. He said, “It's important to remember that there is a risk whether you're having a repeat section or you're having a TOLAC.”I really took that to heart. For me, the risk of uterine rupture is small enough that I want to try. I know that I'm going to be in a hospital. I know I'm going to be monitored, and if that's something that's happening, I know I'll be taken care of quickly. I was okay taking the risk. I think that has to be such an individual choice. It does carry risk as well, so that's why I needed to at least give it a shot. I'm somebody that I fully support whoever wants to have a VBAC after two sections, but for me, that's not something I want to do. But as with everything, you have to look at both sides of it and make your decision. Meagan: Yeah. I think that's what we talk about on this podcast. Learn the risks. Learn the facts. Learn what the evidence says, and then follow your heart. What feels right? I appreciate you so much for coming on and sharing your journey. I do love how much you were able to be a part of your birth that second, and then also your postpartum experience is so important. Kerri: Oh yeah. I'm 11 weeks postpartum now, and I just have to say that my mental health this time is so much better, and my recovery post-C-section was so much better. I really have such positive things to say. It was such a good experience. I'm forever grateful for everybody who took care of me. I'm forever grateful for my provider. I just love her dearly and am just so thankful for her. Meagan: Good. I'm so grateful for you. I'm so glad you had that support and that loving team. Thank you again for sharing.Kerri: Yes. Thank you so much for having me on here.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

In this episode, we review the high-yield topic of ⁠Abnormal Uterine Bleeding (AUB) ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠from the Gynecology section at ⁠⁠⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠ Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

CancerNetwork® spoke with John Paul Diaz, MD, about uterine transposition, a surgical technique aiming to preserve fertility in women undergoing radiotherapy for pelvic tumors. Diaz is the chief of gynecologic oncology, director of robotic surgery, director of the Center of Excellence in Minimally Invasive Gynecologic Surgery at Baptist Health, and lead physician for Clinical Trials in Gynecologic Oncology at Miami Cancer Institute.  Of note, Diaz discussed the outcomes associated with 2 procedures conducted at his practice, as well as challenges associated with the development and implementation of the procedure. Additionally, he spoke about the next steps in developing and raising awareness of the procedure. Diaz foregrounded the discussion by highlighting the simplicity of the procedure, which he stated was similar to a hysterectomy. Unlike a hysterectomy, uterine transposition entails a temporary relocation of the uterus to the anterior abdominal wall, which preserves it for fertility while removing it from the radiation field. Furthermore, Diaz described the collaboration between Baptist Health and Memorial Sloan Kettering Cancer Center, including a partnership with Mario M. Leitao, Jr., MD, FACOG, FACS, who holds the largest series in the United States in performing uterine transpositions. He explained that the collaboration was conducive for expanding patient populations that may benefit from this surgery. Diaz then underlined outcomes related to 2 uterine transposition procedures he conducted at Baptist Health. He described a favorable outcome with one patient who had completed the procedure 3 months prior who may be able to become pregnant in the future. The second patient was undergoing radiotherapy, with plans to undergo the second stage of the surgery in following months. Diaz then highlighted a distinction between uterine transposition and other fertility preservation measures in that it preserves the entire uterus so patients can still carry a child, whereas other radiation therapy techniques do not. He then highlighted patients who are eligible for this procedure, particularly among women who want to preserve their fertility with pelvic tumors requiring radiation that might otherwise sterilize the uterus. Challenges related to the development and implementation of the procedure were discussed, with particular emphasis placed upon quality of life following treatment. Additionally, he emphasized the idea of patient-driven improvements in treatment outcomes, which he hoped could be applied to help more women preserve their fertility. Diaz continued by emphasizing the novelty of the procedure, explaining that experiences with it are growing while surgery success rates increase with global collaboration and technique sharing. He followed by underscoring the primary goal of cancer eradication, stressing that treatment for progressing disease takes precedence over fertility, and in those situations, fertility may be compromised. He further outlined key short-term outcomes in patients undergoing uterine transposition, particularly as they related to maintaining uterine perfusion and mitigating post-operative complications. For long-term outcomes, he highlighted the goal for patients to be disease-free and capable of carrying a live birth. Additionally, Diaz underscored a challenge related to raising awareness for this procedure, highlighting efforts he has undertaken to inform surgeons in the colorectal cancer field about the availability of this procedure as an option for this patient population. He suggested that colleague identification of eligible patients, effective referral, and increased proliferation of procedure knowledge may be effective in overcoming this challenge. Diaz concluded by highlighting next steps for the procedure as they relate to expanding access for patients, increasing knowledge of the procedure among physicians, and developing novel techniques for uterine preservation during radiotherapy. He highlighted the “exciting” development of this procedure, which he suggested might have been inconceivable a few years ago, in achieving better outcomes for young women diagnosed with pelvic tumors.

Today I'm continuing on to part 2 of this Q&A session. We'll hear all sorts of listener-submitted question recordings, starting off with a query about how to properly use HRT for people who have issues such as adenomyosis. Another question leads us into a discussion on using progesterone suppositories and dietary changes, such as adopting a paleo-based diet, to manage these conditions. We then transition to the complexities of hormone therapy amidst challenges like Lyme disease and mold exposure. Later, I'll address the unique challenges faced by breast cancer survivors considering hormone therapy, offering both hormonal and non-hormonal strategies for relief.   In this episode: How to effectively manage hormone levels for uterine health, including adenomyosis and fibroids. Why progesterone suppositories can help mitigate estrogen-driven growths in uterine conditions. How inflammation and immune activation influence uterine health and potential hormone imbalances. Why a paleo-based diet and supplements like calcium D-glucarate aid in reducing inflammation. How phytoestrogens like urolithin A impact estrogen receptor activity and overall wellness. How bioidentical creams can alleviate menopausal symptoms such as hot flashes. Why estrogen dominance can lead to symptoms like water retention and heat intolerance. Cycling tirzepatide and why many women choose to remain on it. How hormone therapy considerations differ for breast cancer survivors with severe PMS. Proof that using HRT can prevent cancer from returning. Why understanding breast cancer types is crucial before considering hormone replacement therapy. How community feedback contributes to improving hormone therapy products and services. The use of methylene blue for taking care of post-cancer symptoms.   If you're trying to balance your hormones, head to www.beamminerals.com and use code HORMONE for 20% off your first order.   Try ALIGN today and feel the difference.

A round-up of the main headlines in Sweden on November 1st 2024. You can hear more reports on our homepage www.radiosweden.se, or in the app Sveriges Radio Play. Presenter: Babak ParhamProducer: Kris Boswell

Send us a textWelcome to the October Q&A with Cynthia & Trisha. What's the most absurd thing that you've ever heard said to a woman in labor or to you? Today, we kick it off by sharing your anecdotes and our responses.  In our regular episode, we answer:If I am planning a free birth how do I know if I have a placenta previa and what should I do? I am twelve weeks pregnant and have extremely sensitive nipples while breastfeeding my toddler. Will this get better or should I stop breastfeeding?How often do home births transfer to the hospital?Why do so many women planning unmedicated hospital births end up choosing to get pain medications?In the extended version available on Patreon and Apple Subscriptions (always ad-free) we address the risk of uterine rupture after a VBAC for a planned home birth, what, if anything, can be done to avoid induction if you have Cholestasis of pregnancy, what gentle sleep training (or support) means, and if you can decline induction with well-controlled gestational diabetes. In our Quickies segment: Is body odor postpartum is it normal? Why is a VBAC called a TOLAC? Should home birth midwives always carry oxygen? Plus caffeine in pregnancy, postpartum dryness, birthing the placenta in the tub, leaking and letdowns, infant percentiles, and how we take our coffee plus whether our own children appreciate the work we do in the world.Ep #229 The Risk of Risk-Based Approach with Sara Wickham**********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 promo code: DOWNTOBIRTH for all sponsors.DrinkLMNT -- Purchase LMNT with this unique link and receive a free 8-day supply.  Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Dr. Natalie Crawford answers common questions about the uterus.  Questions answered: What are the implications of having uterine scarring now that I am done having children? What are your thoughts about finding fluid in your uterus after beginning your IVF cycle?  How long does it take for the body recover and go back to its normal period after hysteroscopy? Could having a tight uterus be a factor in unexplained infertility? Should I consider surrogacy after multiple failed transfers? 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. Hello Fresh - Get 10 FREE meals at HelloFresh.com/aaw. 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

It's Q&A time again, where I take on listener questions and provide all the answers you need to know about menopause, perimenopause, and a lot more. We kick off the session with a question about optimal female testosterone levels, and I'll explain the issues that come up when women are prescribed male dosages rather than a personalized plan. We explore the intricate connection between hormones and sleep, discussing the benefits of red-light therapy, GLP-1 peptides, and various sleep aids such as oral progesterone and THC products. The questions also lead us into a discussion on chronic illnesses like Lyme disease and how they affect hormonal balance, fertility, and overall health. Additionally, I'll provide some tips for managing HRT during perimenopause, including progesterone cycling and dosage challenges.   In this episode: How testosterone replacement therapy can and should be tailored for women's unique hormonal needs. What role testosterone plays in women's health. Common misconceptions about testosterone lab test results. How red light therapy and full-spectrum light therapy can enhance energy and combat seasonal affective disorder. How sleep aids like oral progesterone and marijuana-derived products can improve sleep quality. Why optimizing hormone levels is so beneficial for weight management and mood stabilization. How chronic illnesses like Lyme disease affect hormonal balance and fertility. How different hormone delivery methods impact HRT effectiveness and symptom management. What challenges women face with progesterone cycling and breakthrough bleeding in post-menopausal HRT. Why some women experience breakthrough bleeding on HRT and how to address it. Why monitoring hormone levels is essential for managing inflammation and maintaining health. How the interplay of cortisol, thyroid, and sex hormones affects women's overall well-being. Why personalized approaches are vital for effective hormone replacement therapy. What benefits higher dose vaginal progesterone suppositories offer in stabilizing uterine lining during menopause.   Get 10% off Sleep Breakthrough By BiOptimzers products at https://bioptimizers.com/hormone with coupon code HORMONE.   For a limited time, you can save 20% off a 90 day bottle of Just Thrive probiotic at https://justthrivehealth.com/discount/Hormone with coupon code: HORMONE   Links mentioned in episode: Mitolux Vit D red Light Therapy Box: Use this link for 10% off your order. Timeline Urolithin A: 10% off with coupon HORMONE. Happy Mammoth: For a limited time, you can get 15% off Hormone Harmony and on your entire first order at happymammoth.com just use the code KM15 at checkout.   Are you in peri or post menopause and looking to optimize your hormones and health? At Hormone Solutions, we offer telemedicine services and can prescribe in every U.S. state, as well as in British Columbia, Alberta, and Ontario in Canada.   Visit karenmartel.com to explore our comprehensive programs: Bioidentical Hormone Replacement Therapy Individualized Weight Loss Programs  Peptide Therapy for weight loss    Interested in our NEW Peptide Weight Loss Program? Join today and get all the details here.   Join our Women's Peri and Post Menopause Group Coaching Program, OnTrack, TODAY!   Your host: Karen Martel Certified Hormone Specialist, Transformational Nutrition Coach, & Weight Loss Expert   Karen's Facebook Karen's Instagram

On this week's listener episode, we welcome Kate. After a relatively uncomplicated IVF pregnancy, Kate went into spontaneous labor at full term and experienced a peaceful labor and delivery at the hospital. After her daughter was born, she suffered a postpartum hemorrhage and 3rd-degree uterine inversion. Kate shares with us her experience of waking up under paralytics and processing her feelings of both fear and gratitude as she navigated healing post-birth trauma.On this episode, you will hear:- PCOS, infertility and IVF- third-degree tear and hemorrhage- mass transfusion protocol and hypervolemic reaction- 3rd degree uterine inversion- uterine artery embolization- the use of paralytics- experiencing "final thoughts"For more birth trauma content and a community full of love and support, head to my Instagram at @thebirthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Get a second opinion on your uterine fibroid embolization (UFE) technique. Dr. Gary Siskin joins host Dr. Chris Beck for an in-depth discussion on his approach to uterine fibroid embolization, detailing techniques, tools, and embolic agents. Dr. Siskin is an experienced UFE practitioner, professor, and Chair of the Department of Radiology and Chief of the Division of Vascular & Interventional Radiology at Albany Med Health System in New York. --- This podcast is supported by: Merit Embolotherapy https://www.merit.com/solutions/embolotherapy/ --- SYNPOSIS Dr. Siskin shares his journey and evolution of his specialization in GYN-related interventional radiology procedures. The doctors cover various aspects of fibroid embolization, including its effectiveness compared to surgical options like myomectomy and hysterectomy, the referral and evaluation process, and considerations for fertility preservation. Pain management strategies and postoperative care are also explored, emphasizing the importance of patient education and interdisciplinary collaboration to promote less invasive treatments. --- TIMESTAMPS 00:00 - Introduction 04:45 - Building a Fibroid Practice 08:35 - Workup and Consultation 17:01 - Recurrence and Re-Embolization 20:27 - Pre-Procedural Workup and Technique 30:18 - Embolization Endpoint 36:07 - Accessing the Correct Uterine Artery 48:49 - Post-Procedure Patient Care --- RESOURCES List of Publications by Dr. James B. Spies (PubMed): https://pubmed.ncbi.nlm.nih.gov/?sort=jour&term=Spies+JB&cauthor_id=24436560

In this episode, Tracey Davidoff, MD and Joe Toscano, MD discuss the September 2024 Evidence-Based Urgent Care article, Urgent Care Management of Abnormal Uterine Bleeding in the Nonpregnant PatientIntroducing the September Issue: Abnormal Uterine BleedingUnderstanding Abnormal Uterine Bleeding: Etiology and PathophysiologyUrgent Care Evaluation of Dysfunctional Uterine BleedingDiagnostic Studies for Abnormal Uterine BleedingTreatment Options for Abnormal Uterine BleedingContraindications and Cautions with IbuprofenTranexamic Acid: An Underappreciated TreatmentManaging Unstable Patients with Abnormal Vaginal BleedingSpecial Patient Populations and SituationsGenital Mutilation and Piercings: Cultural and Medical ConsiderationsCutting Edge Treatments and ControversiesRisk Management and Legal PitfallsKey Points and PearlsConclusion

Click here to send me a quick message :) We hold so much in our wombspace. Stories, trauma, imprints, births, losses, past sexual experiences, and even more energetic qualities like our creative energy or feelings of safety.So, even if we aren't experiencing any issues "down there" we could still benefit from some regular caretaking just to tend our tissues.But if you *are* someone (like many of us) who's got anything from menstrual cramps to fertility challenges to trauma history to endometriosis or PCOS or irregular cycles or bladder pain or even creative blocks...it's likely that some extra presence and care would be a powerful option for you. Naturopathic physician, herbalist and bodyworker, Dr Kathryn Kloos has synthesized many years of working hands-on and clinically with thousands of patients and has developed her own practice of supporting multi-layered healing in the wombspace with a variety of techniques, including something she calls "uterine unwinding."Combining hands-on presence in the pelvic bowl with somatic dialogue, uterine unwinding is a practice that encourages a client to listen deeply to what's present in the pelvic bowl and invites both awareness and possibility to change the imprints or stories that are alive there.Unwinding and retelling the stories in those tissues. We talk about all of this and much more, including some actual cases from Kathryn's practice in this week's episode.Listen to learn:why Kathryn finds bodywork to be a key to pelvic carehow her own personal cancer journey exemplifies her somatic dialogue techniquewhat uterine unwinding is and how you might explore some of this practice in your own body either solo or with a practitionersome inspiring and hopeful stories of womb, fertility and trauma healingabout the possibility of generational trauma getting stuck in our tissuesone simple practice to ground you in your body and pelvisResources:Today's shownotes: Get links to Kathryn's online course, website, moreSign up for the Natural Contraception course waitlist (coming soon!)Episode 10: Traditional womb healing practices w Sondra HamiltonEpisode 61: How to heal trauma with embodied listening w Dr Emily WilsonEpisode 119: Clearing, releasing, tending womb trauma w Dr Sarah WylieIf 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 concerns.Support the show

Full article: Utility of ADC Values for Differentiating Uterine Sarcomas From Leiomyomas: Systematic Review and Meta-Analysis Aric Berning, MD, discusses the AJR article by Woo et al. that presents a systematic review and meta-analysis of the role of ADC values in differentiating uterine sarcomas from leiomyomas.

Abnormal Uterine Bleeding.. don't be scared. Learn how your gynecologist evaluates abnormal uterine bleeding. Know what to expect. Be prepared. You can understand the process.

In this episode of The Happy Hormone Club Podcast, hosts Tina Pruitt and Dr. Scott Resnick dive deep into the often-misunderstood topic of hysterectomies and abnormal uterine bleeding, especially as it relates to perimenopause.They address key questions submitted by our listeners, shedding light on what a hysterectomy really entails, when it's a necessary solution and the impact it can have on a woman's health.They also explore the difference between hormonal and anatomical causes of abnormal uterine bleeding and how to make informed decisions regarding treatment options and delve deeper into the complexities surrounding abnormal uterine bleeding and the various causes, both anatomical and hormonal.This episode is packed with valuable information that empowers women to take control of their uterine health and make informed decisions alongside their healthcare providers. Whether you're dealing with unexplained bleeding or simply seeking to understand your body better, this episode offers practical advice and expert insights.Here's an overview of what was discussed:Introduction to Hysterectomies: Understanding the basic definitions and differences between types of hysterectomies, including total, partial, and oophorectomy.Personal Story: My own experience with a hysterectomy at 45, and how it led me to a deeper understanding of its impact on women's health.The Role of Mainstream vs. Natural Medicine: How a balanced approach can provide the best solutions for managing perimenopause symptoms and other health concerns.Hormonal vs. Anatomical Causes of Abnormal Uterine Bleeding: Differentiating between causes such as estrogen dominance, fibroids, and polyps, and understanding their impact on menstrual cycles.Importance of Proper Diagnosis: Why thorough medical history, physical exams, and correctly timed ultrasounds are crucial in diagnosing and treating abnormal uterine bleeding.Empowering Women: Encouraging women to advocate for their health, understand their bodies, and ask the right questions when consulting with healthcare providers.Diagnostic Precision: Why getting your ultrasound at the right time in your cycle is crucial for detecting issues like polyps and fibroids.Saline Infusion Sonography (SIS): Learn how this advanced ultrasound technique can help outline the exact anatomy of the uterus, providing clear insights into potential issues.Understanding Fibroids: Discover the impact of fibroids based on their location in the uterus and how they might contribute to symptoms like pain, discomfort, and abnormal bleeding.Modern Surgical Approaches: The benefits of hysteroscopy for removing polyps and fibroids with minimal invasiveness, compared to outdated blind procedures like D&C.Hysterectomy Considerations: Discuss the situations where hysterectomy might be necessary and why retaining the ovaries can be beneficial for long-term health.Hormonal Imbalances: Understanding how hormonal imbalances, particularly the high estrogen-to-low progesterone ratio, can lead to abnormal bleeding and the simple steps to correct it.Functional Approaches: Explore non-surgical methods to manage hormonal imbalances, including the use of bioidentical progesterone, weight management, fiber intake, and supporting detox pathways.Click here to learn more about The Happy Hormone MethodTo learn more about the Happy Hormone Club and stay updated on upcoming episodes, be sure to subscribe to the podcast and follow us on InstagramDOWNLOAD THE CHECKLIST FOR THRIVING IN PERIMENOPAUSE: https://happyhormoneclub.clickfunnels.com/perichecklist Learn more about Dr. Scott and Download his Free E-Book: https://scottresnickmd.com/OUR WEBSITE: www.happyhormoneclub.comCONTACT US: info@hyaf.caMEDICAL DISCLAIMER: http://happyhormoneclub.com/medical-disclaimer 

Hello there!In this episode of The Dairy Podcast Show, Dr. Adrian Barragan discusses management strategies for maintaining low inflammation during the transition period, focusing on cow welfare, fertility, and effective management strategies. Dr. Barragan shares new research findings and explores the implications of uterine disease diagnostics and treatment. Listen to this episode on all major platforms to stay ahead in dairy cattle management strategies."We have come up with some very interesting results on the concept of high-priority cow groups, which are at higher risk of having exacerbated inflammation."Meet the guest: Dr. Adrian Barragan is an Associate Research Professor and Extension Veterinarian at Penn State University. With a background in veterinary medicine, he earned his PhD and MS degrees from The Ohio State University, where he focused on modulating systemic inflammation in transition cows. His research focuses on developing disease prevention practices to improve cow welfare and fertility. With extensive experience in dairy cattle management, Dr. Barragan aims to enhance dairy operations through innovative management strategies.What you'll learn:(00:00) Highlight(01:25) Introduction(05:15) Managing twin pregnancies(14:33) Identifying high-priority cow groups(17:18) Uterine disease diagnostics and treatment(23:31) Balancing intervention and recovery(28:56) Metritis protocol recommendations(31:36) Final three questionsThe Dairy Podcast Show is trusted and supported by innovative companies like: Natural Biologics* Adisseo- Berg + Schmidt- ICC- Diamond V- Acepsis- SmaXtec- Trouw Nutrition- Protekta- Volac- dsm-firmenichAre you ready to unleash the podcasting potential of your company?

Send us a Text Message."In this episode ofTaco Bout Fertility Tuesday, we're diving into the world of uterine polyps—those little 'hitchhikers' that can set up camp in your uterus. Dr. Mark Amols breaks down everything you need to know about these benign growths, from what causes them and who's at risk to how they can impact your fertility. Whether you're trying to conceive or just curious about your reproductive health, this episode will give you the knowledge to understand and manage uterine polyps. Tune in to learn the signs, symptoms, and best treatment options, and discover how to keep these unwanted guests from overstaying their welcome!"Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

In this episode, we review the high-yield topic of⁠ ⁠Uterine Rupture⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Reproductive section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Join Nikki Keefe, an interventional radiologist, as we delve into the complexities of uterine fibroids and the disparities in treatment access. Despite uterine fibroids affecting up to 70 percent of women and causing severe symptoms like heavy menstrual bleeding, pelvic pain, and infertility, many, especially Hispanic and rural patients, are unaware of uterine artery embolization (UAE), a minimally invasive and effective treatment option. Nikki will discuss the various treatment options, the benefits of UAE, and the significant barriers to awareness and access, highlighting the urgent need for improved education and health care equity. Nikki Keefe is an interventional radiologist. She discusses the KevinMD article, co-authored by Matt Patetta, MD, Maureen Kohi, MD, Gloria Salazar, MD, Kira Griffith, and Josh Walker, "Overcoming disparity in access to uterine artery embolization." Our presenting sponsor is Nuance, a Microsoft company. Do you spend more time on administrative tasks like clinical documentation than you do with patients? You're not alone. Clinicians report spending up to two hours on administrative tasks for each hour of care provided. Nuance, a Microsoft company, is committed to helping clinicians restore the balance with Dragon Ambient eXperience – or DAX for short. DAX is an AI-powered, voice-enabled solution that helps physicians cut documentation time in half. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. DAX Copilot can be easily enabled within the workflow of the Dragon Medical application to bring the power of ambient technology to more clinicians faster while leveraging the proven and powerful capabilities used by over 550,000 physicians. Explore DAX Copilot today. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. Discover clinical documentation that writes itself and reclaim your work-life balance. VISIT SPONSOR → https://nuance.com/daxinaction SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme I'm partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus

Women of Strength, how many of you have “failure to progress” on your operative report as the reason for your Cesarean(s)? Meagan and Julie talk ALL about failure to progress today– how it led to their own Cesareans and how after breaking it down, they both realized that neither of them actually qualified for that label. When is it failure to progress and when is it failure to wait? What does failure to progress actually mean? This is an episode you will want to listen to over and over again. From learning all of the ways a cervix changes other than just dilation to all of the possible positions you can try during a lull in labor, Meagan and Julie share invaluable current research and personal experiences on this hot topic! ACOG Article: Limiting Interventions During Labor and BirthAJOG Article: Safe Prevention of a Primary Cesarean DeliveryThe Journal of Perinatal Education: Preventing a Primary CesareanOBG Project ArticleThe VBAC Link Blog: Failure to ProgressHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello. I am with Julie today and we are going to be talking about failure to progress. If you have been diagnosed with failure to progress– and I say diagnosed because they actually put them on our op reports like it's a diagnosis of failure of progress meaning our cervix does not know what to do. It cannot make it to 10 centimeters or it hasn't or it will not in the future, then I am telling you right now that this is definitely a great episode for you. Even if you haven't been told, it's going to be a great episode because we are going to talk about some other great things in the end about what to do in labor position-wise and all of the things. So we're going to get going, but Julie apparently has a Review of the Week. We weren't going to do one, but she says she has a Review of the Week. So, Julie? I will turn the time over to you. Julie: This is my review. Are you ready? Meagan: I'm actually really curious. Julie: “I'm so excited. Thank you so much, Meagan and Julie. I love The VBAC Link!” Signed, lots of people everywhere. Meagan: I love it. Julie: We don't have a Review of the Week so I just made one up. Boom. There. Signed, AnonymousMeagan: All right, you guys. Failure to progress: what it is and what it isn't. Let's talk about what it is. What does it mean? Essentially, it means that your provider believes that your cervix did not progress in an adequate amount of time and there's also failure to progress as in your body may have gone into or you are going in for an induction and then they couldn't even get labor going which we all know is usually not the case that your body really couldn't do it, but failure to progress is when your cervix does not continually dilate in an adequate amount of time. Would you change anything about that, Julie, or add anything to that? Julie: Sorry, I didn't hear half of that. I was just going through it. I was going through the things just to make sure that we are 100% accurate on what we are about to say. Whatever you said, yeah. That sounds great. Yeah. Let's go with it. Meagan: Failure to progress– the cervix is not dilating in an adequate amount of time. Julie: Basically, yeah. Your cervix isn't changing so you've got to do a C-section because it's not working basically. Meagan: Okay, so what it isn't– do you want to talk about what it isn't? Julie: What it isn't? It isn't– sorry, I'm trying to say it. Meagan: It isn't true most of the time. Julie: Most of the time it's not true. It isn't what we think it is and if it is, it's not a sign that your body is broken. It's not exclusion. It's not a reason to exclude you from trying for a VBAC. It's not your fault. It usually is a failure from the system where people are in a rush or in a hurry and just not knowing how to move past a stall in labor or not understanding the true flow of how some labors take. I mean, I was diagnosed with failure to progress. You were diagnosed with failure to progress and I know that both of our literal clinical outlook at the time we were diagnosed with failure to progress was not true failure to progress. Meagan: Mhmm. Julie: According to what the actual guidelines and requirements are. So I always say, yeah. What you said, it is not true. Meagan: It is not true.Julie: We joke about that and use it loosely. Sometimes it is true. I've seen one true failure to progress diagnosis in over 100 births, but I feel like most of us listening and most of us who have C-sections have them because of failure to progress. Now, mine when I was in labor, I was not told failure to progress. I was told fetal heart tones, but that's another topic for another episode– what we are told versus what is in our op reports. So yeah, let's do a little plug-in about getting your op report. Find out what is actually in the notes that say why your C-section was called because it's not uncommon for what it was written down to be different than what you were told in the moment. I feel like having an accurate clinical understanding of what your Cesarean looks like on paper to another doctor who is reviewing your birth is super important. Meagan: Absolutely. I agree and also, I think that it's important to note that if you have been told this and you have doubt in your body, that it is normal to have doubt because we have been told that we can't do something and that our body can't dilate, but I also want to plug-in that really try not to believe that. Try your hardest. Do whatever you can to not believe that. It's going to help you. Believe the opposite. Believe that your body can do it. Believe that you were most likely set up in a less-ideal circumstance that created that result, right? Like an induction– it was a failure to descend, not progress, but I just recorded a story the other day where her water was broken at 6 centimeters, baby came down wonky. They couldn't get baby out and they diagnosed her with CPD. There are these things that are happening a lot of the time where we are walking in to be induced way too early or really any time we are being induced could be too early especially if it's just an elective. It can definitely be too early and our body is not ready so our body is not responding or our body is overwhelmed because it's been given so much so fast and it doesn't know what to do so it doesn't react the way a provider wants it to by our cervix dilating. It almost is reacting in the reverse way where it's tense and tight and like, No. I'm not ready and I'm not letting this baby out. Don't you feel like you've seen that? Julie: Yeah. We've seen lots of things. I feel like that's the tricky thing. We as doulas and birth photographers really do get to see the whole gamut of everything from home to birth center to hospital and everything. I feel like we have such a unique perspective on how labor is managed in and out of hospitals and how stalls or lulls in labor are managed in both places. Let me tell you, it's often way smoother and in my opinion way better outcomes when you are out of the hospital and that happens. Meagan: Mhmm. Labor at home as long as you can. Yeah. I mean, one of the stories that I just recorded was an accidental home birth. It was not her plan, not even close, and it will for sure come across that way when she is telling the story, but there were so many things that she did within that labor like movement from the shower to the toilet to walking down the stairs to moving back to the toilet. There was all of this movement that sometimes doesn't happen in a hospital or we've got, like I said, “Let's break your water. Let's do these things.” We've got these interventions that may help, but doesn't always. It may also cause problems. Okay, so we have some updates for you on the safe prevention of a primary Cesarean delivery that Julie has found and then we also want to talk about what is adequate labor too? What does that mean and where do we decide or where does a provider decide if labor is not adequate? Julie, do you want to talk about this for a minute on what you found from the OB/GYN Project? Julie: That's just a really nice summary. I really like it because it is all laid out really nicely. I am seeking out different pieces of information because there is updated information so I'm just looking for that. I'm not quite 100% certain I can speak to when it came out. Evidence-Based Birth has some great information. They did a podcast episode on the Friedman's curve. We know that dilating 1 centimeter an hour is based on the study that Friedman did. That's incredibly flawed but there is new updated, more evidence-based information that has come out. I'm trying to find out when it came out actually because the Friedman curve was established I think in 1956 and let's see. In the 2010's there were big shifts in the evidence. In 2014, ACOG had a study. Maternal Fetal Medicine published new guidelines on labor progress. Okay, so 2014 it looks like which is actually not that new anymore because it's 10 years later. That was, I think– I don't think it's actually shifted that much at all. I'm just trying to figure that out right now. I'm sorry. Let's see. The Practice Bulletin– yeah. You go. Safe Prevention of the Primary Cesarean Delivery. Meagan: I think we are looking at approaches to limit interventions during labor and birth, but we know that a lot of the time when we are introducing interventions, that is where we often will receive a failure to progress diagnosis because we are really introducing things, like I said earlier, when the body is not quite ready or the baby is not quite ready. Maybe the baby was already too high and was trying to make their way around and into the pelvis but now we've got an asynclitic baby or a transverse baby or an OP baby.This one, Number 766 which we will have in today's show notes actually originally replaced the committee of 687 in February 2017. The 766 was in 2019 and reaffirmed in 2021. Something that I like that it goes through is recommendations for women who are at term and spontaneous labor it happening. It talks about admission upon labor. It talks about premature rupture of membrane or rupturing of membranes which I think is a big one. Really, through my own experience but also doula experience, I've seen so many people go through membrane rupturing whether artificially or spontaneously and then nothing is happening so we go in and we get induced. Or we are told the second our water breaks that we have to go in, then labor has not started yet so we are intervening. One of the things it says is, “When membranes rupture at term before the onset of labor, approximately 77-79% of women will go into labor spontaneously within 12 hours. 95% will start labor within 24-28 hours.” I just had this experience with a VBAC client just the other day. Her water broke and within about 9 hours, she was starting to contract and within less than that, she actually progressed really quickly. Baby was born. That was really great but then there are situations like myself where it takes forever for labor to even start. It took 18 hours for my very first contraction with my second baby to even start and then by 24-28 hours, I was in a repeat C-section because my body didn't progress fast enough according to my provider.It says that, “The median time to delivery for women managed expectantly is 33 hours and 95% had delivered by 94-107 hours after rupture of membranes.” I think that is something also really important to note that if your water breaks, it doesn't mean we're just having a baby right away. It doesn't mean that our body is failing because we haven't started labor. 94-107 hours after the rupture of membranes is when the baby had been born. That's some time. We need to allow for the time. Julie: That's why I hate it when hospitals say, “If your water breaks, come in right now.” No. Meagan: I know. My provider did that too because it makes sense in our heads. They're saying, “Oh, just come in because we have to monitor baby because of infection and all of this stuff.” But we also have to take a step back and realize that once we go into that environment, one, that's a new environment. We're not familiar with that. All of those germs in that environment, we're not accustomed to. We're not immune to them. And then two, we know that the second we go into labor and delivery units, what happens? They want to check our cervix which means–Julie: Bacteria. Meagan: There is bacteria that is possibly being exposed to the vaginal canal, right? Even if it's a sterile glove, that still raises chances. Julie: Yeah, sterile gloves really are not as sterile as people think. Meagan: There are these things to keep in mind, but it's so hard because for me, I had premature rupture of membranes. My body didn't start labor, but I was told failure to progress after 12 hours for only reaching 3 centimeters. I was told failure to progress. I just really liked that. I mean, I like a whole bunch of this but I really liked that part of the rupture of membranes because I think so often we are told, “Oh, your water is broken. You're not progressing. You are a failure to progress.” Or we are not progressing so we have to break our water to try and speed our labor up and then that doesn't happen and then we are failure to progress. Can you see the problem here? Julie: Total problem. Meagan: It's a problem. Julie: It is a problem. So many problems. It's fine. I just dropped two different links to the updated guidelines because it's really funny. I've been going down the rabbit hole now while you've been talking so if I'm repeating things like I tend to do on you sometimes, please forgive me. I just think it's interesting. There is starting to be a shift in pulling away from Friedman's curve and going into a different way to consider an actual progression of labor which is a really cool, nice little shifty-shift here. I feel like maybe let's talk about what failure to progress really is. What are the guidelines for it? What is real failure to progress versus what you've probably been told about it? First of all, let's just talk about– nothing. Meagan: Can we use my own birth example just as a starting point to what this evidence is showing us or what the guidelines are? My water had broken spontaneously. It took a little bit to start labor. Within 12 hours, I was 3 centimeters and was told that my pelvis was too small and that I was failure to progress. Water broken, I was 3 centimeters 12 hours into labor. all right, Julie. What am I? Am I real, true failure to progress or not? Julie: No, you're not. Absolutely not, are you kidding me? Because you were still in the first stage of labor. That is the number one thing. According to clinical guidelines, it is not failure to progress until you're in the second stage of labor which is at least 6 centimeters dilated. So guess what, friends? If you got called failure to progress before you were 6 centimeters dilated– mine was labeled failure to progress at 4 centimeters so that rules me out. I mean, there are lots of things that rule me out and Meagan. But if you are less than 6 centimeters, it is not failure to progress. Meagan: Yeah, it even says right here. “Active phase arrest is defined as a woman at or beyond 6 centimeters dilation with ruptured of membranes who fails to progress despite 4 hours of adequate uterine activity or at least 6 hours of oxytocin administration with an adequate uterine activity and no cervical change.” Can we talk about that too? Adequate uterine activity. You guys, at 3 centimeters with my water broken, I was still not in an active pattern to progress. It takes time. Our uterus doesn't just start contracting regularly and adequately. It takes time. Then at that, I was only on oxytocin for 2 hours. Julie: Pitocin. You were on Pitocin. Meagan: Sorry. That's what I meant. Pitocin. I'm looking at the word oxytocin administration. Pitocin. Julie: We all know the truth. Meagan: We all know that Pitocin is not oxytocin. Julie: That is a soapbox for another day. Meagan: I was only on Pitocin for 2 hours. 2 hours. At the top, it says, “Slow but progressive labor in the first stage of labor should not be an indication for a Cesarean. With a few exceptions, prolonged late phase greater than 20 hours in a first-time mother and greater than 14 hours in a multi (so a mom who is not a first-time mom) should not be an indication for Cesarean as long. As the mother and the baby are doing well, cervical dilation of 6 centimeters should be the threshold of an active phase of labor.”Julie: Exactly. That's it too. Later on after this, we're going to talk about all the different ways a cervix can change because can I just tell you what? Someone says, “I'm 5 centimeters. I'm still 5 centimeters, great. Cool. What else has your cervix been doing? We're going to talk about that in just a second.” But yes, that's the thing. It's not failure to progress before 6 centimeters. It has to be 4 hours of adequate uterine activity which means strong, consistent contractions. Contractions that are strong enough. We could talk about the Montevideo units which is another measurement of the strength of contractions. We're not going to talk about that because we just don't have time, but are your uterine contractions strong enough? Yes? Then it's got to be at least 4 hours without cervical change. No? Then great. Let's do Pitocin and the inadequate amount of uterine activity. It says 6 hours or more of Pitocin without adequate uterine activity. If you've been on Pitocin for 6 hours and your contractions– which has caused that adequate contractions– and there is still no cervical change, then you are failure to progress Let's talk about cervical change though because the cervix goes through so many things. When I was doula-ing, I talked about this a lot in our second prenatal visit about how a lot of times you'll be like, Oh, cervical change. Yeah, dilation. Am I 4, 5, 6, 7, 8? But listen. The cervix goes through changes in 6 different ways. It moves forward so from posterior pointing backward toward to your spine. It straightens out to a more downward position. It softens so it goes from hard like your forehead to hard like your nose to softer like your chin. It softens. It effaces which means it thins out so it starts thick. It thins out which is effacement. It dilates obviously which is the opening and then baby's station like where baby is in the pelvis. Baby drops down, rotates, and descends. If you were 3 centimeters at your last cervical check and 60% effaced and 2 hours later at your next cervical check, you are 3 centimeters and 80% effaced, your cervix has thinned by 20% which is a good amount of cervical change. Meagan: Good change, yeah. Julie: If you were 6 centimeters and your baby was at a -2 station and at your next cervical check, you are 6 centimeters and your baby is -1 station which means your baby is lower in the pelvis, that is a cervical change. All of these things are shifting so I feel like it's important that when we are talking about failure to progress or when we are talking about labor progress that we consider all of the things the cervix does.I was just at a birth yesterday– not yesterday, two days ago. I don't know. It was all night and it was long for me. All night is long. It doesn't matter if i was there for 6 hours or 20 hours. If it was all night, I'm going to call it long as I'm getting older. The client was still 4-5 centimeters but the cervix was a lot softer or stretchier I think at the one before this. Oh yeah, your cervix is super stretchy now. Those are all great cervical changes even though the dilation number hasn't changed. Meagan: Yeah, so coming forward, thinning out, really softening up, baby dropping– all of these things are signs of progression and so it's something to keep in mind if a provider is like, “Well, you've been sitting at 6.5 centimeters now for 9 hours,” or whatever, but at the same time, your cervix went from 40% to 80% thinned and it went from super posterior to more mid-line and baby went from -3 to a 0. These are changes. These are absolutely changes and there are so many things that go into that. If a baby is high and not well-applied because they are trying to work their way down to the pelvis and our cervix is working on coming forward, there is so much that goes into that where now we're going to have a baby. If that change was made, now maybe we can have a baby that was well-applied to the cervix creating good pressure. Uterine activity is getting stronger. Things are progressing in the right way.So in the ACOG thing, it does say that in contrast to the prior suggested threshold of 4 centimeters which we know is very outdated, the onset of active labor–Julie: Right, that was according to the Friedman's curve. Friedman's curve called active labor at 4 centimeters but now we are getting all of this new information that yeah, it's probably at 6. I feel like when you and me started as doulas 9-10 years ago, it was 4 centimeters, but a couple years after that, everything started shifting into 6. So it's actually not that new, but kind of new. Sorry, keep going. Meagan: Yeah. I want to get into our positions really quickly, but it does say even in here, the onset of labor for many women may not occur until 5-6 centimeters. May not occur until then and then we know that sometimes around 6 centimeters, it takes some time. We're going to make sure all of these links here are in the show notes so you can check it out. Meagan: But we only have a few minutes left so I really want to talk about positions, okay? So positions in my opinion can truly change failure to progress. Julie: Yes. If there is a lull in labor, they're getting close to calling a C-section, what can we do about that? Nobody wants to hang out at 4 centimeters forever. Nobody does so what can we do about that? Yes, Meagan? Sorry, go ahead. Meagan: Movement. If you do not have an epidural, obviously movement is a lot more free. Moving around, just walking. Just flat-out walking. If we've got a higher baby and we're trying to get a baby down, really think about that femur rotation turning out. You can walk and sometimes I've had my clients do this little step dance thing where you step really wide and out and then left and right and left and right. We are doing this weird-looking dance thing, but you're grooving. Julie: You're grooving. Meagan: That can really help. Or thinking about really big asymmetrical movements so put your leg up on the bed or on a stool or on a whatever and leaning over. Bigger movements and outward movements. If you have an epidural at this point, same thing. Rotate on your side and really open those knees up really, really wide. Try to keep those movements consistent. If you're exhausted and you have an epidural because you need sleep, I really, really believe in sleep and I think it's very powerful. Find a good position. Sleep in that position and when you wake up, get going. Get active. But every 5 or so contractions, if you can, if not, make it 8, make some changes. It doesn't have to be too dramatic. It sounds weird, but if you are at home, crawling up your stairs. Crawling up your stairs on your hands and knees is weird but it works or standing up and down going from the side– one side going down, standing back up, turning and walking back up, turning around, doing the other side down and coming back up. Those things are going to help. Doing big figure 8's or hip dips. As the baby gets lower, all of those things are really still important. We are going to be less focused on big open wide because now we're going to want to get baby in and then down. So if you think about a pelvis, when the femur rotation goes out, the bottom goes in. Femur rotation in, bottom goes out. Thinking about these movements as you're laboring and as you're working through these things, as you're in these positions. Think about our hips, our pelvis, and even doing some cat-cows in labor is really good. We know there is the flying cowgirl. That is a really good one in labor too to get baby down and in. Julie: Walcher's. Meagan: Walcher's is not as fun, but it can be very good. Julie: It is magical. I've seen it push labor through so well. I had a doctor once at the U come in. I had a client who was 5 centimeters. Baby wasn't looking too great. She had been 5 centimeters for a while and we were doing Walcher's. They came in because the heart rate– Walcher's sometimes makes it hard to get a fetal heart rate so the nurses come in. They were talking about C-section and they were prepping, bringing in all of the C-section stuff for her partner to get ready. They were like, “You can't do this. Baby's heart rate is not tolerating it.” I'm like, “No. It's just not picking up the heart rate.” I'm like, “Okay, just one more contraction.” One more contraction later, she comes up and starts pushing 2 minutes later and her baby is born. the doctors are freaking out because, “Oh my gosh, the bed's not designed to labor like this.” Not everyone, sorry, but those are a little couple of pushbacks I've gotten sometimes. Meagan: It's weird-looking. It's funky. It's uncomfortable. Julie: Yeah. It's curious and some staff at hospitals do not– if they see something new and they don't know about it, they automatically assume it's not good because they need to keep everything in line and to the protocol and all of those things. But yeah, it's just really a magical thing. Meagan: There's also the abdominal lift. You can abdominal lift. I think actively moving through the contraction which can get really hard in that active phase, but through the contraction can actually help. Hands and knees, sacrum, and all of those things. Holy cow, there are so many positions. Julie: Yeah, can I just touch back? When you said about the epidural, I love when you're not resting, I think sometimes it's easy to get discouraged if you want an epidural but you also want to move during labor. I want to expound on that a little bit because you can move with an epidural still and here's how you do it. My favorite labor position with an epidural is sitting up in the throne. You lay the head of the bed all the way up, drop the feet down, then you crisscross your legs. Put the peanut ball under your right leg. Five contractions later, peanut ball under your left leg. Five contractions later, criss-cross your legs again or stretch them out straight and then repeat. Do you know what? There are so many magical ways that that helps. It keeps your pelvis moving and shifting and growing. I swear that is the most magical position for laboring with an epidural because you are upright. Baby is going to move down. The pelvis is moving and shifting so it creates lots of movement and space and I have seen that progress labors relatively quickly to how they have been going before we set up the throne so many times. I love that. I will swear. I will die on that hill. If you are failure to progress and things aren't moving, sit up, drop your legs, get the peanut ball. It doesn't even have to be the peanut ball. Maybe you don't have one in your hospital but stack a couple of pillows but put one leg up. Put your foot flat on the bed so your knee is making a triangle. I don't know how to describe it the right way and then drop it and put the other leg up and then criss-cross your legs then stick them out straight like two little sticks. Meagan: Every five. Every five, have subtle changes. Every five, subtle changes. Keep that in mind when you are laboring. Women of Strength, know that failure to progress is rarely truly failure to progress. We get it. We've been told the same thing. We see it all of the time as doulas. There's more. There's more and don't feel like you have to say, “Okay” to a Cesarean if your cervix hasn't dilated to a certain amount that the provider is wanting. Assuming you and baby are doing well, you can always ask for more time. Okay, we are on a soapbox. We could probably continue for a whole while longer, but Julie, thank you for joining me today and talking about failure to progress and what it is and what it isn't. Julie: You're welcome. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Click here to send me your Q's, comments, lovenotes, or a quick message here :) What comes up for you when you think of offering yourself gentleness?I think for many of us, we don't feel time for things like slowness, soothing, gentleness, tenderness, caretaking our own selves. We're often preoccupied with any number of other roles and responsibilities in life, and as women and folks with wombs, we've often been socialized to place ourselves at the bottom rung of importance.Even when we DO have time to tend to ourselves, we often choose distraction or stimulating activity over quiet self time that truly offers our own bodies, hearts, minds and spirits a form of gentleness.Many of us don't even believe we deserve that. It's just something we give, not something we receive. I want to shift the frame around all of this and turn the mirror onto you and invite you to explore what gentleness can look like and feel like in your own life. What herbs may be supportive for you to release tension in your tissues, or soften what feels hard, or soothe and calm your mood and mind?And what other practices are available to you that you could easily incorporate into your daily or weekly or monthly routine to help you soothe and tend yourself?In today's episode, I invite you to consider what a "gentleness practice" could look like and feel like for you -- and encourage you to make your own "gentleness in a bottle" tincture with some of the herbs that help to calm, soothe and nurture your unique needs. Listen to learn:what a gentleness practice could mean for youherbs to soothe tension in your tight tissues and achy musclesherbs to soften and moisten your GI, vaginal and urinary tractherbs to calm your mood and mindmy favorite herbal oil to use for belly massage (+ why belly massage matters)several simple practices you can adapt into your OWN gentleness practicea song to include in or inspire your gentleness practice :)Resources:Today's episode: Get link to Rosalie's poem and moreFree guided meditation: Womb connection + clearing meditationEpisode 18: Uterine tonics (to nourish + support your womb)Episode 19: Pelvic softening wisdom w Chaya Leia AronsonEpisode 32: Motherwort love - an herb for every season of your wombEpisode 49: How to create a sacred window in transitional timesSupport the Show.

Draw inspiration from Lori and learn to pass on God's courage and his valor through your example, as well through his Word. -------- Thank you for listening! Your support of Joni and Friends helps make this show possible.     Joni and Friends envisions a world where every person with a disability finds hope, dignity, and their place in the body of Christ. Become part of the global movement today at www.joniandfriends.org   Find more encouragement on Instagram, TikTok, Facebook, and YouTube.

Send us a Text Message.In this powerful episode, we sit down with Katie, a mother of six, who shares her harrowing experience of birth trauma and medical negligence. Katie's story of a uterine rupture during an induced labor led to severe disabilities for her daughter and life-altering consequences for her own health.Despite having no prior c-sections, Katie suffered a uterine rupture after the use of Pitocin - a complication that went unrecognized for far too long. She takes us through her journey, from the ignored warning signs to the aftermath of the birth, including her daughter's ongoing health challenges and her own loss of reproductive capacity.But Katie's story doesn't end there. Learn how she transformed her traumatic experience into a mission of education and advocacy, working tirelessly to spread awareness about birth choices and the potential risks of certain medical interventions.This episode offers crucial insights into patient rights, the importance of informed consent, and the need for attentive medical care during childbirth. Katie's narrative is a testament to the strength of maternal instinct and the power of turning personal tragedy into a force for positive change.Whether you're an expectant parent, a birth worker, or simply interested in maternal health issues, this episode provides invaluable perspectives that could change the way you think about childbirth practices.Content warning: This episode contains descriptions of birth trauma and discusses infant health complications. Listener discretion is advised.Connect with Katie on Instagram HERE and TikTok HERE. To sign up for our newsletter visit our website and blog: www.goldenhourbirthpodcast.comFollow Liz on Instagram here and Natalie hereFollow us on Facebook here.

In this episode, we discuss four tips for uterine inversion. Then, we discuss mistreatment and abuse of trainees in OB/GYN plus physician suicide. Finally, we answer a question about closure of peritoneum. 00:00:02 Managing Uterine Inversion in Obstetrics00:13:39 Combatting Harassment in Medical Training 00:25:41 Addressing Mistreatment in Medical Training 00:31:13 Workplace Mobbing and Bystander Dynamics 00:37:29 Identifying and Addressing Workplace Abuse 00:59:30 Listener QuestionFollow us on Instagram @thinkingaboutobgyn.

Allison and Sarah discuss pelvic organ prolapse, a common condition where pelvic organs descend due to weakened vaginal tissue walls. In this episode we cover the following:Types of prolapse:- Cystocele (anterior wall, bladder)- Rectocele (posterior wall, rectum)- Uterine prolapse (top support system, uterus)Common causes of prolapse:Childbirth, particularly vaginal birthsHypermobility conditions like Ehlers-Danlos syndromeAging and hormonal changes during menopauseSymptoms of prolapse:- Heaviness in the pelvis- Difficulty emptying bowels or a feeling of incomplete evacuation- Symptoms worsening after physical activity or by the end of the dayExplanation of the grades of prolapse:- Grade 1: Mild, slight mobility at the top of the vaginal canal- Grade 2: More noticeable bulging into the vaginal canal- Grade 3: Visible at the vaginal opening- Grade 4: Tissue protruding outside the vaginal openingTreatment options:- Non-surgical: vaginal estrogen, pelvic floor physical therapy, pressure management techniques- Pessaries: internal support devices fitted by a gynecologist- External support garments and compression wear- Surgical options for severe cases, with considerations for recovery time and second opinionsImportance of exercise in managing prolapse:- Moderate exercise reduces prolapse risk compared to sedentary lifestyles and extreme heavy lifting- Emphasis on proper pressure management and pelvic floor recruitment during activitiesEpisode ResourcesClick HERE for free access to the Bowel Massage videoFollow us on IG @thev.movementJoin our newsletter or email us info@thevmove.comMusic by POW/Sunset Beach courtesy of www.epidemicsound.comFind a PT near you!

Every pregnancy and birth experience is different. That is true for everyone, but especially for Kristen. Kristen joins us from Provo, Utah, and shares her experiences with an initial vaginal birth, a diagnosis of omphacele with a Cesarean and infant loss with her second that left her with a special scar, an induced, medicated hospital VBAC with her third, and she is currently expecting twins!Kristen's journey has not been easy, but she has learned and grown so much. She talks about how a safe and supportive birth team truly makes all the difference. Your intuition will help guide you to the best provider for you. When you know, you know!Meagan concludes the episode by touching on some myths and facts about doulas. The VBAC Link Blog: Myths and Facts About DoulasThe VBAC Link Blog: Special ScarsSpecial Scars, Special HopeNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 01:50 Review of the Week04:02 Kristen's first vaginal birth09:41 Coping with grief and hospital communication issues15:17 A low transverse incision with a J extension19:59 Finding VBAC support in Salt Lake23:10 Foley induction at 41.5 weeks29:29 Changing plans30:37 Myths about doulas38:55 Facts about doulas41:05 Kristen's advice to other women with special scars43:26 Listening to your intuition when choosing a providerMeagan: Hello, Women of Strength. Thank you for joining us for another amazing episode here at The VBAC Link. Today's story is from someone who is local to me which I think is always kind of fun to have someone who when they are telling the story, I know the birthing place, I know the provider, and here I even know the doula so that is super exciting. Welcome, Kristen to the show. Kristen: Thank you, Meagan. Meagan: Thank you so much for being here and I'm excited for you to share your stories. I would like to get into a review really quickly so then we can do that. Kristen: Sure. 01:50 Review of the WeekMeagan: Okay, we have a reviewer from Apple Podcasts and it says louuuuuhuuuu. I think that's how it is and it says, “Very Inspirational.” It says, “I knew I wanted a VBAC with my third pregnancy, but I wasn't sure if it was possible. However, I knew I didn't like being flat-out told no at my first appointment. Listening to the podcast was definitely the start of me really researching birth and looking into my options. I ended up with a successful HBAC” which is home birth after two Cesareans, actually HBA2C, “and I definitely don't think I would have had the courage or believed it was possible without the podcast. Thank you, Meagan, for all of the work that you do to provide this information.” And thank you, louuuuuhuuuu. I don't know how to say it. I'm just butchering your name. If you are still listening, thank you so much for your review, and as always, we love your reviews. They really do help the podcast. They help Women of Strength find these incredible stories and information just like she was able to receive. You can drop that review at Apple Podcasts or Google or wherever you listen to your podcasts. 04:02 Kristen's first vaginal birth, Cesarean, and infant loss experienceMeagan: Okay, Kristen. Thank you again so much for joining us. I would love to turn the time over to you to share your stories. Kristen: Well, thank you. It's hard to know where to start. There are a lot of details to mine. We had our first little boy in April of 2018. That was its own experience. That was a vaginal birth honestly. That was as hard as it was as a first-time mom and a first-time pregnancy/birth. It had its own set of interesting details to go along with that but we soon found ourselves unexpectedly pregnant with our second one just four months later after he was born. Meagan: Really soon. Kristen: Yeah, they would have been 11 months apart. I say would have been because my daughter who I had via Cesarean ended up passing away a few hours after she was born. She had a few congenital defects and when we got our first ultrasound, we found out she had a condition called omphalocele which means she had some of her organs on the outside of her body in a little protective sac. It was mostly her liver. I saw the ultrasound. I looked at it and I was like, That doesn't look normal. It was one of those moments where the ultrasound tech was like, “I'm going to get the doctor.” Your heart sinks and your heart drops. At the time, it wasn't a big deal after the doctor came to us and talked to us and said, “She'll be fine. You can deliver safely. It would most likely be a scheduled C-section.” I was expecting that from the very beginning because it wasn't just, “Oh, this is going to be a big baby. This is going to be a big baby with a large–”Meagan: 100% necessary Cesarean. Kristen: Exactly. 100% necessary. Meagan: Yes. Kristen: That was to be expected even though I was like, Darn. I don't want that, but obviously, I wanted her to be her in the best and safest way possible because this is just such a crazy anomaly. That was around 18 weeks and then around 24 weeks, we were at Maternal-Fetal Medicine at our local hospital down here where I live in Provo, Utah and they discovered something else which is a lot more serious. She had a diaphragmatic hernia which means her diaphragm didn't really develop all of the way and allowed some of her other internal organs to be pushed up into her chest cavity. Meagan: Oh wow. Kristen: Whatever was left in her abdomen was pushed up. I think some of her spleen was in there and pushed. They essentially squished her lungs so they couldn't develop all of the way which is essentially what happened at the end of her life. That's not something– we've grieved and healed a lot from that but it's also something that I consider one of those things that now I can be there for somebody else now who has gone through infant loss in whatever way that means. I can be a sounding board for anybody else who has been there. Meagan: Yeah. It's crazy how sometimes we have some of the most unfortunate or horrific experiences that we could ever imagine going through and life-jarring and after we get through them, we are still super there but we are also stronger in a weird way where you can be that support for other people and you can relate. It's just this weird but most amazing thing that there are people like you who are like, I went through this really not great experience, but now I'm here and I want to support those who need it. Kristen: Yeah, totally. It took a long time to get there. Meagan: I'm sure. Kristen: She was born on March 25, 2019 and so she would have turned 5 this year. We celebrate her birthday as a family every year. Meagan: Good, yes. Kristen: My 6-year-old is excited because we always release a balloon up for her and he said, “I'm so excited. My sister's going to get this balloon.” It's still very innocent and sweet. We love being able to do that as a family because she is very much still to us a part of our family. Meagan: Absolutely. That just gave me the chills thinking about your little boy doing that. That's so awesome. Kristen: He's very tender-hearted and sweet. It's one of those things that means a lot to him. Even though he was barely one when this happened, he wouldn't have remembered her at all. Anyway, with those things going on, her outlook from the very beginning was bleak. That was a hard piece of the puzzle to deal with, but it also plays into what happens later. Although this was a scheduled Cesarean and absolutely necessary, we wanted to give her every possible chance just in case she could beat the odds or whatever. Me as mom, I'm like, There is still a 20% chance this could be okay. That's something. It's not nothing. Meagan: Exactly, yeah. Kristen: You've got to hold onto something and that's what I did. 09:41 Coping with grief and hospital communication issuesKristen: The Cesarean itself was fine. The process in the hospital for me, nothing went overly wrong with me physically. But afterward, that was where it gets a little complicated. We had to leave the hospital with just my husband and myself which was obviously very hard but we also had a few different things that left me baffled and confused but really frustrated. Anyway, the first thing was that after our daughter had passed and while I was recovering, the hospital staff didn't seem to be on the same page with a lot of things. First being their communication. I remember it was the anesthesiologist who came in the day after my daughter had passed and they asked, “Oh, how are you? How is your baby?” Did you not read the notes? Is there not a sign on the door that says she's not with us anymore? I had to clarify. Of course, he was very apologetic. “I'm so sorry.” Okay. That seemed like one of those things where it's like, okay. You should have been informed. I don't know why. After that, we had the resident doctor and the doctors in training at the time. He comes in and says, “We had to do a mid-transverse incision on your uterus and so you should plan on Cesareans from here on out. It's not safe and don't plan on having a vaginal birth.” It's like, “Okay, no one told me that was happening.” I felt like there was again that lack of communication and just that misstep between doctors and the other providers and stuff. I was told that in the hospital as I was recovering so that was another blow of course because I was very much expecting, Okay, I know I can have a vaginal birth after a Cesarean. That's totally a possibility. I go in with that strand of hope again for myself thinking that I could totally do this later. I've heard it's possible. I've just got to find somebody who can help me with it. I'm fine, then someone tells you like your reviewer today. I hate it when someone tells me no. Don't tell me no. Don't do it because I will literally make it my life's work to prove you wrong. That was really hard to hear, of course, in that setting and in that moment. It's really deflating to hear that. But I was like, Okay. If that's what they think, that's fine. I'm going to prove them wrong later. Whatever. I'll do it.Then we ended up going home. I ended up calling back the doctor's office saying, “Okay. You said mid-transverse. What does that actually mean?” I was trying to clarify things. Meagan: It's higher up. Kristen: Yeah. The nurse who answered said, “Well, we had to do a mid-transverse incision. We had to make more room for your baby to get out.” I was kind of expecting that they might have to do that. They did forewarn us that it may be a possibility but no one ever said that was what happened in the hospital when we were delivering her. Anyway, they never told us that happened until I called back and said, “Hey, what actually happened?” She said, the nurse I remember was like– it still makes me baffled why you would say something like this– but she goes, “We had to show a mid-transverse incision with a double-J extension,” so one on either side. Meagan: On each side? Wow. Kristen: Yeah. That's what she told me. She said, “Think of it like a smiley face on your uterus.” It's like, why would I ever think of it like that? It was just the weirdest verbiage. Why would you say that to somebody? I don't know. I was like, Okay. That was weird. Why would you say that to me? Then it gets even better. You can request your op-notes. Meagan: Yes. Kristen: I did that. I requested them. I feel like people are just going to be doing the facepalm like, Oh my gosh, seriously? What were these people thinking? On my op-notes, they have little bullet points. The first one says, “Uterine incision”. The uterine incision they told me they had on there said “classical”. Meagan: Oh. Kristen: Which is wrong, totally wrong. Immediately beneath that, it says, “Detailed C-section notes”. Then it says, “Mid-transverse incision. Patient should not labor in the future.” That was the note. First it says classical. Then it says mid-transverse incision. Then they tell me I have a mid-transverse incision with a J extension or double J's. What do I have? What did you do? Meagan: Yeah. Yeah. 15:17 A low transverse incision with a J extensionMeagan: That's frustrating. Kristen: Yeah, so fast forward to when I have my new provider. We're pregnant with our third now or we were at the time. He was a wonderful, wonderful guy and a wonderful provider. He said, “Do you know what? I'm going to go off of the actual written notes from the person who says they were watching the procedure.” It's like, oh that's really smart. They said I have a low transverse incision with a single J extension to my right side. Meagan: Wait, so different again? Kristen: Different again. So I was like, Oh my goodness. Where does this end? It stopped there, thank goodness. Yeah, he said, “I'm trusting more the person who was basically looking and saying, I was here in the moment taking physical notes and this is what was done. I'm trusting this more than somebody's bullet points.” Meagan: Everybody's bullet points, yeah. Kristen: Exactly. Meagan: And the nurses who are just randomly saying what they did. Okay. Kristen: Yeah, exactly. Exactly. Meagan: Wow. Kristen: So I was like, “Thank goodness I have you to translate for me,” because I was like, What did they do to me? I have no idea. Probably any other doctor who wasn't super VBAC-friendly would be like, “Well, this is too risky. I don't want to take any chances.” Meagan: So technically you have a special scar. Kristen: I do. I have a special scar. Meagan: Low-transverse with a J. Kristen: With a J. In those op-notes, I actually did notice just the other day when I was reading them again, it said that they extended it bi-laterally which in my mind, I didn't call and ask obviously, but in my mind, that would translate to making the low transverse incision just a little bit longer. Again, I don't know. But at least at the bare minimum, I have a low transverse incision with a J extension. So yes, I have a special scar. It was one of those crazy things like, Oh, now I've got to look this up. Again, I'm gung-ho at this point about, I can do this with a special scar. I've listened to the podcast. So many women have done it. I can do it too. I've just got to find somebody who is willing to meet me in the middle. Meagan: Support you. Kristen: Yeah and like I said, luckily I did up in Salt Lake where it's not too far of a drive from where we are from. It was definitely worth it. He said, “It shouldn't be a problem from what I'm reading. We'll just go with it and if anything changes, I'll keep you posted.” He was just supportive from day one which was super awesome. Meagan: He's wonderful. Kristen: Anyway, so yeah. That's the complication from my fun story. Hope that all makes sense. Hope we are all able to piece that together. Sorry. Meagan: Well, that's so hard because it's like, I'm being told this and this and this so what is it? All of these things impact my decision or maybe it doesn't. But you want to take all things into consideration so it's frustrating to not know what you have. Kristen: Right, totally because yeah, like you said, it could totally impact somebody's decision. Meagan: It could affect somebody's decision, yeah. 19:59 Finding VBAC support in Salt LakeMeagan: Okay, so you found out it was a low transverse extension J special scar. You found a provider up here in Salt Lake that was like, “Yep, okay. We're going to do this.” How did that go? Kristen: That was really good. Honestly, it was one of those things where you start looking online first and then go from there. I just found his name. At the time, unfortunately he doesn't practice that anymore, but he had his own little personal video posted about that. I was like, I feel this. I'm getting really good vibes from this guy and I really like it. So I called his office. I scheduled myself in. Great. Okay. Then yeah, it was really comfortable from day one. I told him. I said, “I've got some weird things going but at the same time, I am really motivated. I'm really determined to do this.” He was like, “Okay. I'm with you.” Meagan: There was something about him that brought this overwhelming sense of calm when he was with you. Kristen: Mhmm. Meagan: Fun little side note, I was actually under his care as well for my VBAC. Kristen: Oh cool. Meagan: For a little while until I decided to go out-of-hospital. Kristen: Yeah. Meagan: Yeah. He's just awesome. Kristen: Yeah. I completely agree 100%. Meagan: He transformed the VBAC community here in Utah. They just flocked to him because there was just something about him that wasn't anywhere else here in Utah. Kristen: Yeah. Now you're giving me chills. I'm going to get emotional about it because I feel like it's so true. Meagan: Yeah. Yeah. He's a special OB for sure. Kristen: Yep. It does. It makes you sad that he's not doing that anymore but at the same time, I'm sure he is one of those doctors who will refer you to somebody who he trusts and you can be like, Well, if he trusts them then I can feel safe about it.Meagan: Yeah. Yeah. And you hired a doula. Kristen: I did. I hired a doula. Meagan: Who was one of my clients. Crazy, huh? Kristen: She's one of my good friends. I was like,  You know what? I'm going to do a total 180 on this one. It was the best thing ever and the best decision ever. It happened to work out super nicely because my husband was there, yes. He is the best– she calls them daddy doulas. He's the best daddy doula, but he had to take some breaks too and having that other person there was like, If you weren't here, I don't know what I would do because I feel like my husband needs a break and I have to do this by myself, but no. I wasn't left by myself. It was one of those things that helped with the whole VBAC process go so much more smoothly especially because it ended up being an induction. Meagan: Oh, okay. Kristen: Yeah, so just add more to my docket here of fun things that I chose to do. 23:10 Foley induction at 41.5 weeksKristen: We ended up going to 41.5 weeks with my daughter and at that point, I think this is probably biased but I feel like a lot of OBs, not matter how supportive they are, they are like, “Well, we could go this far if you wanted to, but it's getting to that point.” It's like, Okay, fine. It was my choice obviously to do it. We went in for the induction. I chose to use the Foley bulb. I had never done that before. That was hands-down so much better because my son was an induction as well and about the same time. My babies just go late. They are just 41+ weeks and they are still just cozy. So with him, it was not the same. They tried to push me in and out with a much faster style of induction. I was not a fan. The one, I was like, Okay. This is going to be different. Like I said, a 180. With her, it was a very slow, gentle induction and yeah. She arrived and it was pretty awesome just to feel at the end of the day like, Yeah, maybe an induction wasn't exactly how I pictured this to happen, but my thoughts and feelings that I put out there into the universe was just that, I want a VBAC and I want it to go well. And it did. She's here. She's 3 now. It was one of those things that gave me that really big sense of accomplishment and that “ha” moment like, “I told you I could do it.” Meagan: I understand that “ah-ha” feeling so much. I definitely did that when my son came out as well. 25:10 Pitocin, epidural, and pushing for 10 minutesMeagan: You mentioned it was a lot slower of an induction and things like that. A lot of people don't think that it's really possible to do a low and slow induction. You started with a Foley then what happened from there? Did they start with Pitocin right after that? Kristen: They did. They started with Pitocin and we had to have some conversations with the nurses too. It was another reason I was glad I brought my doula. They started going a little bit faster than I wanted. I remember being a little bit earlier on and I was like, These contractions should not be on top of each other like this already. They were again, really good about backing off and letting me do it. Again, like I said, there are still things I would change but I feel like we all maybe have this ideal, I want it this way, especially for me. I'm very much like, I want this and this and this to happen. I have to be realistic. It's not going to go exactly how I want it to. There are some things I can tweak and change along the way, but having a realistic viewpoint of how things might go is good. Meagan: Yeah. Kristen: Yeah. They ended up starting Pitocin and I was trying to go as natural as I could for as long as I could. I think I got to about 5 or 6 dilation and then I was like, Okay. I think I'm ready to just get a little relief. So yeah. I got an epidural. Again, then my brain switches over to how my induction births were different. With my son, I was cranking that thing up to 10 as high as it would go. It was my first time doing it. I didn't know how it works. I ended up with him being flat on my back. I couldn't feel my legs but with her, I was like, I don't need to do that this time. So I was a lot more, that education. It helps having prior experience. But yes, it was as low as I could bear. I could still move around. I could sit up. I think I was even on my hands and knees for a little bit with it too. Meagan: Awesome. Kristen: Yeah. Having my doula there, she was wonderful helping. We were doing rebozo and stuff like that. Again, it was all of the good, natural stuff that I was looking forward to. Meagan: Yes. Kristen: Yeah, so I got myself to a 5 or a 6 and then I had a little help, but yeah it didn't really take much longer after that. It's hard to remember all of the details but once I got to a good place, they ended up breaking my water which was fine. After that, it only took a couple of hours to get her down and out. I pushed for 10 minutes and she's here. Meagan: Nice. Kristen: She's our biggest one, 8 pounds, 14 ounces. Well within normal range. Meagan: Yes. Kristen: But still it's just so funny how the nurses react, “Oh my gosh. She's big.” Not really. For you, maybe. I don't know. Meagan: I swear. Anytime the babies are over 7 pounds, they are like, “This baby is huge.” I'm like, “No, the baby is not that big. It's perfect.” Kristen: Right? I know. She had a full head of hair. That was their biggest comment. “Look at all of that hair.” It was so funny. Meagan: I love that.Kristen: But yeah, she was much more alert than my son was when he was born. Again, just different vibes, a different environment and a different style. Meagan: It probably wasn't as long so he didn't have as much in his system too. Yeah. Kristen: Exactly. Yeah, but it was one of those things where she came and then it was like, oh my gosh, that sense of relief. It went off without a hitch. In my mind, I was like, This was just perfect. 29:29 Changing plansMeagan: I love that you mentioned things along the way like change with induction. There are things within our labors and things that may not go exactly as we envisioned or wrote down on paper, but there are so often times where we can sit back and decide, Okay, yes. I'll go for an induction. Okay, yes. Let's try a Foley this time. Okay, I'll actually go for that epidural. We're changing plans or making decisions and in the end if we were part of that decision, it really resonates differently for our minds. We feel better about the experience even if it wasn't exactly how we would have put it on paper. Kristen: Yeah, exactly. Meagan: I love hearing that you were like, Yes. This was a good experience and I got my doula and I had my provider and honestly, you were in a really great hospital. I really, really like them. 30:37 Myths about doulasMeagan: I wanted to share a little bit about doulas because obviously, I love them. Kristen: Sure, yes. Meagan: I am a doula and so maybe that is biased, but I really had a long labor myself and was able to truly benefit from doula support. Like you mentioned, my husband was exhausted and he got to a point where he was starving. He needed food and I remember he actually left the birth. He full-on left the birth to go get food. He felt very confident that I was in good hands and I was being supported. I love that so much, but there are a lot of things that people think about doulas that aren't necessarily true. I wanted to go over some myths and then some really good pros and facts about doulas. Number one is that doulas are expensive. Now, doulas– Kristen: False. Meagan: It's so funny because after services with our clients, a lot of the time they will be like, “You are worth your weight in gold. You need to charge more.” Kristen: Right. Meagan: When you see a doula who ranges from $800-$2000, that is a lot of money. That is a lot of money, but then when you break it down and look at really what a doula offers–Kristen: Totally, from start to finish, correct me if I'm wrong, you can hire them as early as you want and then, especially for me, it was the postpartum support that was a really big deal so it's not just, “Okay, I was here. I helped you while you had your baby. See ya. Good luck. Let me know if you need anything.” No, “I'm going to bring you supplies.” Of course, my doula is a little bit more special because she was one of my friends. Meagan: But she is amazing. Kristen: She is. She is wonderful. Meagan: Her natural ability to care and help you feel supported, she–Kristen: Mhmm. She has this way of connecting with people that is quite rare, I think. Meagan: Yes. I love that. And myth number two is that doulas replace the birth partner. Kristen: Like we just both said, nope. They don't. Meagan: I think that they help the birth partner. A lot of people don't realize that doulas are there for our partners as well. It's definitely more focused on mom because mom is giving birth, but there is a lot that partners go through during childbirth that really is important to be loved because you are in a very vulnerable state. You are watching someone who you love so much go through a very big event and they are also bringing another human into this world who is yours. There is a lot of fear and uncertainty and desire to help but again, uncertain as to how and needing rest and things like that. As doulas, we are never there to replace a birth partner ever unless that is something specifically where you are like, “Hey, my partner is not going to be here. I would like you to replace and be there in place of that.” But no, we definitely don't do that. Myth number three, doulas are the same as midwives. Just before we started recording, I was telling Kristen how even to this day in 2024, people are like, “What do you do?” I'm like, “I'm a birth doula.” They're like, “Oh you catch babies?” I'm like, “No. I don't.” “Oh, you do this?” I'm like, “No, I don't do any of that.”We're not midwives. We are doulas. We are there for loving, educational support and information and all of those things, but we are definitely not trained midwives. We work with midwives and OBs. Another one is that doulas are only for the mother which is kind of what I was just saying a second ago. No, we are not only there for the mother. Doulas are hippies who chant and sacrifice chickens during birth. Kristen: That is quite the specific myth. Meagan: That is very specific. This is something that was on our blog, but it was something that someone said and we are like, Oh, yeah. Okay. This is perfect. We are putting this as Myth #5. Kristen: That's hilarious, yep. Meagan: But really, we are hippy. We are hippy. Kristen: That's funny. Meagan: Okay, maybe. Maybe doulas are a little bit more natural-minded. That's true, but just because someone wants an epidural or even a scheduled C-section or doesn't want to go in and do weird sacrificing of chickens apparently, I don't know, that doesn't mean it's true. We don't. We are there to support you and we are going to be there in the way that you want us to be there. Doulas only support home or unmedicated births. This is a big myth. So many people when I start telling them about what I do, they are like, “Oh, so you just only do home births.” I'm like, “Actually, it's a rarity. It's more rare to do a home birth than a hospital.” I would say that 97% of our births are in-hospital. As far as medicated go, we don't support them, that is B.S. Kristen, you are living proof that that is not true.You guys, it is not for us to judge anybody on the way they birth. We are there to love and support them. If that means that they choose the epidural route, that means they choose the epidural route and that is great. We support them. So, no. If you are wanting to get an epidural and you don't know if you want to hire a doula because you want an epidural, let me tell you. We as doulas do a lot actually with epidurals. Sometimes when there are epidurals at play, we actually have to work differently. It's more in a different way because there is more to do as far as movement. You can't just get up and move. Kristen: Yes, it's true. Meagan: Right? Or being on hands and knees, you need that extra support. Whatever it may be, we are now restricted a little bit with movement so as doulas, we are going to be doing more with epidural. A lot of people think if I got an epidural, a doula is not worthless or it's pointless. Go ahead. Kristen: Sorry to interrupt, but if I hadn't have had my doula when I got my epidural, I probably wouldn't have known if I could actually do certain positions. I was like, Oh, well I have this epidural so I'm not really supposed to move. No, actually you can do this. And laying down, due to my prior induction was like, I know it's bad. Don't lay on your back. She was like, “Well, actually if you sit yourself up just a little bit, you're actually going to be just fine. This is actually okay. It's like, “Okay. I'm so glad you are here. If you weren't here, then maybe the nurse would have told me I'm okay or maybe she would have helped me. Nope, probably not. She's got her own stuff that she's doing.” Yeah, that was a really big deal for me too especially for a VBAC and an induction on top of each other. I've got so many things in my mind while you're giving birth. I can get this baby out with no problems. I can do this. That's where your focus is so having that doula say, “Hey, you know what? Change this a little bit,” and being there to support you in that way was awesome. Meagan: Absolutely. Absolutely. I love that you pointed that out. 38:55 Facts about doulasMeagan: Here are some facts. Doulas help you cut costs. There is a 39% decrease in the chance of having a Cesarean which is an increased cost a lot of the time. Some insurances are amazing, but there is that. There's a 15% increase in the chance of having a spontaneous vaginal delivery which is non-induced. We know that induction is also an added expense. A 10% decrease in the need for any medication for pain relief, a 41-minute average reduction in the length of labor, a 38% decrease in a low 5-minute APGAR score, and a 31% increase in satisfaction for the overall birth experience. Holy cow. This is what a stat says on our blog. It says, “In the U.S., an epidural alone costs an average of $2,132.” Now, this was written back in 2021 and we know that since a lot of things in our lives have happened, things have increased. I would put money on that that is definitely more now for sure. There are a whole bunch of other facts on here. We're not going to go over all of them, but I would encourage you to check out our blog. It's going to be listed in the show notes. We're also going to list in the show notes a couple of other groups especially if you are a special scar listener, we want you to know about an amazing group. Did you ever go to Special Scars, Special Hope? Kristen: I did not actually. Meagan: Okay, that is a Facebook group and honestly, it's amazing for special scars. We're going to link that. We'll have a special scar blog so you can read more about special scars and their chances. Definitely check out the podcast even more for some more special scar episodes. If you are looking because you have a special scar, know that there are risks involved, but there are also very high chances that you can. You do need to find the support. Do you have any other tips, Kristen, that you would suggest for moms who may have special scars or gone through similar experiences like you where you were not even exactly sure what happened? 41:05 Kristen's advice to other women with special scarsKristen: For me, it's always come down to not just doing research by yourself, but take your time with everything. I think we get into this, I have to find this supportive provider right now and if it doesn't work out the first time, then we get flustered and stressed about never being able to find the right person. If it didn't work out the first time, then I'll never be able to find it. I took my time and really tried to do my research honestly even before we got pregnant with our daughter who we had the successful VBAC with. As soon as I was mentally and emotionally ready to start thinking about having another baby, I was telling myself, I can do this. Granted, like I said before, no one is going to tell me no. That's just my motivation. I know some people where that might be intimidating to think about. I just don't know. That's okay. Accept yourself where you are and go from there. If it's something that you want to pursue, then do your research on providers and find women who have been there. I think that was a big deal for me knowing that, Oh, there are a pretty decent number of people who have had special scars like me. It's not impossible to make it happen. Like we said about my particular provider, it's almost like that cliche phrase, “When you know, you know.” Meagan: When you know, you know. Kristen: It's like, Oh, I found my provider. That's just how it was for me personally. I know it may not be like that for everybody, but yeah. You take your time. I'm sure you guys have had many, many episodes in the past where it's like, I changed providers halfway through. It probably happens all of the time or more often than you think it does. Don't be afraid to say, “You know what? I'm not feeling the support exactly how I want right now so it's time to go a different route. Be confident in that. That's it. 43:26 Listening to your intuition when choosing a providerMeagan: Absolutely. One of the things I want to talk about when you were saying that is even if you were with a provider that the world is saying they are supportive of VBAC– I want to take it personal and share my own experience. I was with probably the most supportive provider in Utah at the time and I felt very, very good but then there was something that was telling me I should switch. It seemed so weird. It seemed so weird, but I had to take the time to really ponder and listen to my intuition and I had to follow that. I couldn't deny my intuition. I know Julie and I for years talked about it and I'm still talking about it today. Follow your intuition. Sometimes it might not make sense to someone else and that's okay, but if it makes sense to you and it feels true to you, then follow it. Follow it and take your time like she said. Kristen: Totally, yep. That was a big deal and now that we found out that this is our fourth pregnancy now that I'm on right now. I'm pregnant right now expecting twin girls in August and who knows how this is going to go obviously, but I'm shooting for another VBAC. Here we go. Meagan: You've got this. Kristen: This is a very different scenario. Meagan: Very. Kristen: Every pregnancy is so different. They say that. You hear that all the time. “Every pregnancy is different. Every kid is different.” But I feel like seriously, okay. Everyone is so different. Meagan: You ring it real true. Kristen: So this is a totally new way to navigate this. From what I understand correctly, every birth after even if you have had a vaginal birth between like I did, I had a Cesarean and I had a VBAC, this is still considered a VBAC so this will still be considered a VBAC twin birth. Wish us luck and hopefully, I will have some updates later for you. I don't know.Meagan: Yes, please keep us posted and congratulations on the pregnancy and congratulations ahead of time on your birth. Yes, please keep us posted on how things go and thank you so much again for being here with us. Kristen: You're so welcome. Thank you, Meagan. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Our Sponsors:* Check out Dr. Mom Butt Balm: drmombuttbalm.comSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

“I did it. They said I couldn't, but I did it.”When planning for her VBA3C, Shannon got just about as much kickback as someone can get. She was ambushed. She was coerced. She was given the scariest information. Shannon joins us from England today and talks about how each of her four births brought her to where she is today. By the time she was pregnant with her fourth, she was ready to advocate. She was ready to fight for something she had never gotten to experience. Though none of her providers were supportive, Shannon stayed grounded. She made her desires known and stood by them. Shannon labored unmedicated for just over 14 hours. Then to everyone's surprise, she pushed her fourth baby girl out vaginally in 14 minutes!The VBAC Link Blog: Is VBA3C Right for You?The VBAC Link Blog: VBAMCHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 04:04 First pregnancy and birth08:31 Second pregnancy and scheduled repeat Cesarean10:56 Third pregnancy14:04 A heartbreaking third Cesarean17:42 Postpartum during COVID19:55 Fourth pregnancy24:37 Getting ambushed28:40 Shannon's VBA3C birth36:32 “We are all so proud.”38:30 VBAC after three CesareansMeagan: Hello, hello. You are listening to The VBAC Link. We have our friend, Shannon. Are you from England? Where are you?Shannon: England, yeah. New Cambridge. Meagan: Okay, see? I'm so glad my mind is remembering. You are in England and you guys, she is recording. It is quite late there. She is such a gem to stay up and record and share her VBAC after three C-sections. Shannon: Three. Meagan: Yes. Her fourth was a vaginal birth. Uno, dos, tres. I can't even say. I can't even pretend that I know Spanish. Let's be honest. So three, you guys. After three Cesareans and we know in our community that this is definitely something that people want to hear. People want to hear these stories because it is harder to find the support. They want to hear what people are doing, how they are navigating through, where they are finding support, and what they are doing to have their vaginal birth after multiple Cesareans. We are excited, Shannon, for you to share your stories today. 01:07 Review of the WeekMeagan: We do have a Review of the Week so we're going to get into that and then we'll dive right in. Okay, so this is from morgane and it says, “I'm Not Alone.” I love that title because Women of Strength, you are not alone. This community is so incredible and we're all here for you. It says, “This podcast has provided so much comfort for me in coping with my unplanned Cesarean and now planning for VBAC in March. The transition to motherhood has been somewhat lonely for me since most of my friends are not mothers and hello? Pandemic.” So this is a little bit ago, right? It says, “I am also an aspiring doula and spurred on by these ladies and their work. So thankful I stumbled across this group.” Oh my gosh. It says, “Us women really are strong.” I love that. Us women really are strong. I could not agree more. You guys, you are strong. You are capable and you have options. If that is not anything and everything that we talk about on this podcast, then I'm doing it wrong and you need to let me know on your next review. As just a constant reminder, if you wouldn't mind leaving us a review, that would be so great. You can leave it on Apple Podcasts, Google, or you can even email us. 04:04 First pregnancy and birthMeagan: Okay, Shannon. Uno, dos, tres– three. I'm saying it correctly now. After three Cesareans, you have had quite the different journey with each birth. Shannon: Yeah. I think each one taught me a little bit more and I probably wasn't ready for a vaginal birth with my first three. I think that while looking back on my journey it's difficult, I think it led me to where I am today. Meagan: Me too. I'm right there. Amen. Same. I love birth and I've always loved birth, but I do not think that I would be here right now with you today if it weren't for my experiences. Shannon: Yeah. I think the same. I'll get into where I am now when we're after my fourth, but had it not happened the way it did, I wouldn't be where I am now. Meagan: Who you are today. We grow and we learn and we inspire and here you are sharing your story. So let's talk about baby numer one.Shannon: Okay, so I was 19 when I had him. I just assumed that he was going to come out that way, that he was going to come out vaginally. It was going to go well. There were going to be no complications and it didn't turn out like that. I was due in the end of May and I think I was about a week over due. I went into the day unit here. It would be just where you would go if you had concerns that were slightly more than you would go to your midwife for but not enough that you would need to go to the labor ward for. Meagan: Kind of in between? Shannon: Yeah. Here, you have a midwife who is assigned to your GP surgery, your doctors, and they are usually who you see throughout. It's supposed to be a continous midwife, but it can chop and change. You don't see that midwife usually in the hospital so you deliver with someone completely different. Meagan: Oh, okay. Shannon: Yeah, so you don't get that continuity of care in labor. So I went to the day unit because I was having some hip pain. It was really difficult to walk and because I was overdue and I was already booked in for an induction purely because I was overdue, they brought my induction forward. I think I was 8 days overdue when I went in. I was induced. I had the pessary induction and it worked pretty quickly. It worked within about an hour, an hour and a half. Meagan: Oh wow. Shannon: They didn't believe me. They told me that it couldn't happen that quickly. Meagan: That's not super normal but it can happen. Shannon: They sent my husband home and left me on my own for three hours before they summoned me. I was 5 centimeters which is when they take you over to labor ward. I was wheeled over. I called my mum and my husband. Then it's kind of a bit fuzzy. I don't remember a lot from his birth. I remember that they broke my waters and there was meconium. They put the monitoring clip on his head. Meagan: The FSC, the fetal scalp electrode? Shannon: Yes. They put that on him and I was managing fine on the gas and air. Meagan: Was it nitrious? Shannon: Yes, yeah. Meagan: Okay. Shannon: Yes, the gas and air. It was about 3:00 in the morning and they told me that the anesthetist was going home and if I wanted an epidural then that was my last chance. I felt pressured so I got the epidural. All stalled from there. I didn't move off the bed. I think I got to 10 centimeters at 10:00 the next morning so I'm now 9 days overdue. I pushed. Nothing happened. They wheeled me to theatre. I think I started pushing at 11:00 and he was born at half 12:00 so lunchtime. He was a big baby. He was 9 pounds, 13. Meagan: Okay. 08:31 Second pregnancy and scheduled repeat CesareanShannon: That was that. I recovered and didn't think anything of it. 18 months later, we decided to have our second. I fell pregnant I think within the first month. It happened quite quickly. I did my research. I wanted a VBAC. I actually got signed off for an HBAC.Meagan: Home birth? Shannon: Yep. It was all going fine. Then I got to 32 weeks and I panicked because my mom is our only childcare and she lives about an hour. I didn't know how quickly I would labor because I had never labored spontaneously. I didn't know what was going to happen. So I booked a routine section. That was booked for 39 weeks. At 38 weeks and 3 days, I went into again, the day unit because I had reduced movements. They put me on the monitors and his heart rate was quite erratic. It wasn't settling. It was either quite high or quite low. There was no middle ground. I think they put me on there for about 4 hours and they just weren't happy so they brought my section forward to the next day. Meagan: When I read your note, I'm like, I don't know why, but that got me. If baby's heart rate is that erratic and they are that concerned, it would be that day and then. Shannon: Yep, but they were happy for me to go home and come back the next day. Meagan: Yeah. Yeah. It's just convenience. It seems, I am not going to say, but it seems like it was more of like, Well, it's already going to happen so we will make it for tomorrow. We'll give you this as a good reason why to validate it. Shannon: Yeah, no I agree now. At the time, I don't think I thought about it like that. Meagan: Of course not, no. Shannon: Yeah, because with my fourth, with my VBAC, I went through a lot of what happened before. I definitely think it was a case of they didn't want me to come back with more reduced movements and just sit there so because the section was going to happen anyway, they just thought– Meagan: Mhmm, let's do it. Let's move it up. Shannon: Yes. He was born at 38 and 4. He was 10 days early and he weighed 8 pounds, 11 ounces. Again, he was quite a good size. Meagan: At 38 weeks, yeah. 10:56 Third pregnancyShannon: So then we decided to have a third. It took us a long time to get pregnant with her. It took us 14 months which was our longest conception. Our first one was four months and then a month so it took a while. She was due the 11th of April, 2020. I got to, I think it was about 30 weeks when talk of the pandemic was rolling in. We were like, Oh, it's fine. We don't need to worry about it. And then it all blew up. I had to go to midwife appointments alone, the hospital scans alone because I had to have growth scans because my babies are big. Everything was fine. I did want a home birth again with her, but they kept me waiting. I wasn't signed off until 37 weeks. They kept me waiting a long time to sign me off for that, but it was all signed off and we were good to go. I was feeling good despite the pandemic because we were in lockdown by the time she was due. I think the lockdown was called a month before she was born. Lockdown here for the first time was called on the 23rd of March and she was born on the 23rd of April. I remember I went into hospital and I had a growth scan at 40 weeks. She was absolutely fine, no issues. She was measuring fine. The water levels were fine. The placenta looked good. They gave me a sweep and sent me on my way and said, “I don't think I'll see you next week. You'll have this baby by the weekend.” It didn't happen. I got to 41 weeks and I went back for another routine growth scan. I remember going in the car on my own obviously and I felt good. I thought that they were going to say that everything was fine again and that they were quite happy for me to just carry on. It didn't go like that. I should probably mention that my hospital's policy is that if you haven't had your baby by 41 and 4, so 41 weeks and 4 days, they either induce you or they give you a section. That's their policy. I had this growth scan at 41+3. I went in, had this growth scan, and I was on my own. I didn't have any support. It was about 3:00 in the afternoon. She scanned me. In a week, my placenta had aged. It calcified and it was failing. Those were the reasons she gave me that she needed to get my baby out the next day. She gave me the pre-op swabs. She took my blood and she basically told me to come back the next day at 11:00. I had no time to prepare. I had no time to research. I had no time to ask questions. It was, “This is what's happening. You're going to do it.” Meagan: See you tomorrow. Shannon: Yep, basically. Meagan: Was baby's heart rate struggling? Shannon: No, she was fine. Meagan: She was fine. Shannon: She was fine. There was no reason at all. Meagan: That's interesting. Okay. 14:04 A heartbreaking third CesareanShannon: Then it was a mad dash too because I am the only driver in my house. My husband doesn't drive. Obviously, having a section means we can't go anywhere. Meagan: Yeah, and during the pandemic on top of all of it. Shannon: Yeah. It was a mad dash that night to get enough food in. House deliveries were like unicorn dust so to get enough food in, I had to arrange childcare with my mom. Otherwise, I was delivering alone. Again, she still lives an hour away in a different county. We were sure what the rules were because here, you weren't allowed to cross county lines. Meagan: Oh no way. Shannon: Yep. It was difficult. She did come up and she did look after the boys. I did see her before I went into delivery, but I didn't see her again until baby was 6 weeks old. She had gone home by the time I came home so that was difficult. I went in. I think I got to the hospital at 11:00. I was pulled down to theatre at 2:00 and baby was born at 3 minutes past 3:00 in the afternoon. She weighed 9 pounds, 4 ounces, so again, she was a good size. I got back to the recovery ward. My husband stayed with us for an hour and then he left. He wasn't allowed to come back. I still had my catheter in. I was still numb. My phone was dead and I was just left because I couldn't get anything. Every time you had to call a midwife in, they had to put in new PPE on and it just took so much longer. I didn't get wheeled around to the actual recovery ward until about 1:00 in the morning. They admitted to me that they had forgotten about me. I was just in this room on my own. Meagan: I'm so sorry. Shannon: Yeah. They wheeled me into recovery. I still had the catheter in. That didn't come out until 7:00 the next morning so I was bed-bound with this new baby. They came around and took my observations. My temperature was raised which is normal after a section, but I was told that I might have COVID, that my baby might have COVID. I would need to be separated from my baby and we wouldn't be able to leave the hospital for 3 days. Meagan: Stop it. Shannon: No, honestly. Meagan: I am feeling very frustrated for you right now and very saddened. Yeah. I feel a little enraged because this shouldn't have happened. These things didn't need to happen to people. Shannon: I know and the more that I talk to other people who have had babies during the pandemic, it's not unusual either. Meagan: No, it's not. It's maddening. Shannon: It is. It's strange now to talk about it without either filling up or actually crying because it has taken me a long time to get to this point. Meagan: To process. Shannon: Yeah. She said she would come back in an hour. I remember, obviously, I had my catheter in so I didn't have to get up and go to the toilet. I was just downing water trying to get my temperature down. She came back at 4:00 and I did get my temperature down because I didn't have COVID. It was a strange experience. There were six beds in this ward, but I was on the end bed and there was a woman diagonally to me and there was a woman two beds over and that was it. There was no one else there. It was eerie. It got to the point where I couldn't do it anymore so 26 hours after my baby was born, I discharged myself and I went home. I was not staying in there any longer. 17:42 Postpartum during COVIDShannon: Even after that, I got home and I spent the first week in tears. Motherhood wasn't new to me. She was my third baby, but giving birth during a pandemic was a completely different experience. I don't know what it's like over there, but here you have a midwife check in at day 3 and day 5 and then you get signed off at day 10 by the midwife then you get sent to a health visitor who then looks after you until your baby is about 5 then they go to school. Meagan: Wow, I like that. We do not have that. We are just told, “We'll see you in 6-8 weeks. See ya.” Shannon: Oh. Meagan: Then you just go home. Yeah. It's very different for a lot of home-birth people, but that's how the hospital is. It's like, “We'll see you in 6-8 weeks and we'll see you then.” That's really it. Shannon: That's interesting. I didn't know that. Meagan: Yeah. It's not great. Shannon: No. So on day 3 and day 5, I had to go to a clinic. They usually go to your house especially if you've had a section, but because of the pandemic, I had to go there, and being the only driver– my husband can drive. Meagan: You can't even drive after a section, really. Shannon: My husband can drive but we had to stick the old plates on. We made it there but it wasn't great. Yeah, we did that. We do have a 6-week check. It's with a doctor. That was over the phone and then you get introduced to your health visitor. Normally, they come over to your house. That was on the phone. And then that was it. We were just left. No one met her until she was 6 weeks old. She was the first granddaughter because I'm the oldest and my husband is an only child. She was the first granddaughter after two boys. No one met her until she was 6 weeks old. I spent the first week in tears trying to process everything that happened. It was a difficult time. After that, we said we didn't want another one so we locked it away somewhere and didn't deal with it. 19:55 Fourth pregnancyShannon: And then we decided to have a fourth. I had to come to terms with it. This is the reason why I'm here now. I found out I was pregnant in October 2022. It was a difficult journey to get my VBAC. It was the biggest fight that I've ever had to do. When you find out you're pregnant, you contact your GP surgery and then you are assigned a midwife. The midwife I had this time was the same one I had with my third pregnancy, but the first appointment, she was actually off so I saw someone completely different and she was horrible. I only live 9 minutes from the hospital. Meagan: That's really close. Shannon: Well, I know from listening to your podcast that women travel for hours. Meagan: Way far, yeah. Like to other countries sometimes even. Shannon: Yep, but 9 minutes was too far for them. She said that 9 minutes was too far. The paramedics might not get to me in time. If I bleed out, I'm going to die. If baby gets stuck, I'm going to die. I'm putting my birth experience over a live baby.Obviously, they know I care about the safety of my baby but that's obviously their job. I left that appointment in tears. It was a great start. It didn't improve from there, really. I think spent the next, I think your booking-in appointment is about 8-10 weeks so I then spent the next 30 weeks listening to your podcast, and researching stats, risks, benefits, and percentages. I lived, breathed, and slept statistics for VBACs because she probably 99% is our last baby. We've now got two of each so we don't need any more. I knew that this was my last chance to get the birth that I wanted. Off the back of my booking-in appointment, they referred me to the consulting midwife at the hospital. She is higher up than a community midwife or just a midwife on the ward but not quite the head of midwifery. She's kind of somewhere in the middle. I had a few appointments with her and while it was beneficial, it still felt like I was banging my head against a brick wall because she wasn't listening to what I wanted. Every time I would come back with a statistic or a risk that she had– like if I corrected her, then I'd just get a “Mhmm, yeah. Okay,” or a patronizing nod. Meagan: Like, Yeah, sure. You think you know what you're talking about but you don't. Shannon: Yeah, kind of. At this point, I was 28, a mother of three and I was about to have my fourth. They were treating me like a child or that's what it felt like anyway. So I went to every appointment knowing that's what I wanted. I read off my stats, my risks, my percentages and told them I wanted a home birth. They again weren't for it. They tried everything they could to get me into the hospital. We have a midwife-led unit and we have the labor ward. The labor ward is more for ordinary births like if you are going for the epidural and you want the more hospitalized birth whereas the midwife-led unit is more of a hands-off. That's usually where the birth pool is. Meagan: If you want more of a medicated versus unmedicated, those are the differences here. Shannon: As a VBAC after three sections, normally there would be no way on earth that they would have signed me off for the midwife-led unit. I was too high risk. However, to get me into the hospital, they signed me off for the midwife-led unit. Meagan: Nuh-uh. Shannon: Yeah. That's the option they gave me because I was close enough if there was an emergency, but I wasn't too far away. That was their trump card. Meagan: Okay, okay. 24:37 Getting ambushedShannon: I still said no. I still wanted a home birth because that hospital was the one I had my daughter at during the pandemic and I did not trust any of them after being lied to by the consultant and coerced into having that third section. I just didn't trust them to do what I wanted. Meagan: Yeah. It makes sense. Shannon: Pardon? Meagan: I said it makes sense that you didn't feel that they were completely trustworthy. Shannon: So then I got to 36 weeks and I had a routine midwife appointment at 36 weeks. I walked into the room and my midwife was there but so was the head of community midwifery. I wasn't told she was going to be there. I was ambushed. She basically said to me that– I have it written down because I made a post at the time. She said that basically, my baby would die if I carried on with my plans to home birth, that there was a risk of shoulder dystocia, and hemorrhage that would both result in death. A delay in the paramedics getting to me so that would be death. I didn't want a cannula inserted as a routine at the hospital so that would be a risk factor. I have a high BMI so again, that goes against me and they said I had low iron because I was refusing blood tests so that again was something that went against me. I was told that if I hemorrhaged and lost around two pints of blood that I would die, that my veins would have shrunk so they wouldn't be able to get a cannula in me. I was told that they wanted to send three midwives to my birth. They normally send two but for some reason, they wanted three. I was told that my previous experience should be put to one side because it happened during COVID and it's not representative of how it is now. I was told that I was making the entire midwifery twitchy. Meagan: Oh my. Shannon: Oh, the midwife I saw at the first appointment, the one who made me cry, she was one of the ones who was on call and they told me if she was on call, would I go to hospital and I said, “Maybe.” In my mind, I'm thinking that they were trying to put her on rotation to get me into hospital. Meagan: Sneaky. Shannon: Yep. I was told that the head of community midwifery's responsibility is to make sure I'm comfortable with the risks but it's also her responsibility to make sure her midwifery team isn't traumatized by my birth. I was also told– oh, they wanted my husband to be at the home birth assessment as it's their responsibility to make sure he is aware of the risks of death so he is not traumatized like I hadn't spoken to him about any of this. Meagan: Oh my gosh. Oh my gosh. Shannon: On my way out of that appointment, my midwife, the one who had supported me as best as she could said to me that she can't wait until I give birth so that it's all over. Thank you. Meagan: Oh my gosh. Shannon: Yeah. So that was that. Meagan: Wow. What a way to feel loved. Shannon: I know. Again, I had to go to these appointments alone because my husband was home with the three kids, and my mom, again, lives an hour away. I don't have the support here so I had to go to these appointments on my own and to be faced with two midwives who are just coming at you with these scary statistics, it felt like I was ambushed.I think I sent an email then and complained. I got this really lengthy email back but it was basically filler but it had happened already. 28:40 Shannon's VBA3C birthShannon: Yes. So, my birth. She was due on the 1st of July but I always thought she would be due somewhere between the 25th of June and the 28th of June. I remember the 27th of June, I needed to go and get new brake pads and discs put on my car. It was the last thing I needed to do. I sat in the mechanic's feeling a little bit uncomfortable and a lot of pressure. I think I was about 39+3 at that point. I was just really uncomfortable. I sat there for about two hours and I was just like, Ugh, why is this taking so long? Meagan: You were ready to move on. Shannon: Yeah. The next day, my husband went into the office and I remember messaging him, I think you should have stayed at home today. Something just doesn't feel right. I feel a bit off.I woke up on the morning of the 29th of June and I had hip and leg pain which isn't unusual for me. I've got hyper-mobility syndrome so my joints are extra bendy anyway so to wake up with pain is quite normal, especially in pregnancy. It was half-7:00 in the morning and my husband thought it would be a really good idea to cut his hair for him. It's half-7:00 in the morning. I'm nearly 40 weeks pregnant and I was doing his hair. Then I felt a twinge. I was like, I don't recognize that pain. I'll keep an eye on it. They turned into contractions. I had my first contraction at half-7:00 in the morning and they got stronger. I said to my husband, “I think you need to sign off now. This is it. It's happening. I'm going for a bath to see if they go away or if they stay.” We had a food delivery come in that day. We had an Amazon delivery come in and we had I think the carseat base was coming in as well that day. So in between my contractions, I was having to go to the door a deal with all of this stuff that was going on around me. The contractions stayed and they didn't peter off. They just stayed. At this point, I was on all fours in the living room mooing like a cow which is bizarre because, with my first one who was my only experience of labor, my mum said that I was eerily quiet. It was different to make noise this time. My husband rang my mom and let her know what was happening and then he rang the hospital. They told me that the home birth service wasn't available that day so I'd have to come into hospital. It was only after he told them my name that that happened. We'll leave that just hanging there. Meagan: Yeah. Shannon: Then I burst into tears because I thought that as soon as I go into hospital, that's it. I'm not going to get my vaginal birth. They're going to find some reason to section me and that's it. My mom came and drove us to the hospital. She was staying with the kids anyway. I think I got to the hospital at about 3:00 in the afternoon. They examined me and I was 4 centimeters so I was allowed to stay. They took me into the room and I stayed there until I had my baby. I just labored. I don't remember a lot of it to be honest. When they say you go to another place, you go to another place. Meagan: You do. Shannon: The gas and air were amazing. I did try the birth pool but we had an issue here where they had to have air vents fitted in the rooms with the gas and air and they weren't done in the birth pool. I was in the birth pool for about an hour, but I wasn't allowed the gas and air. The pool was all right, but the gas and air were helping me more. I went back into the room with the bed and even though I said to my husband, “I don't want to be on my back,” I was on my back for most of the time. That's where I was comfortable. When I was in the pool, I said no to the continuous monitoring. I just wanted intermittent with the monitor. We didn't know what she was. At this point, we had no idea what she was but they couldn't find her with the Doppler. They asked me to get out of the pool and put me on the bed and they were going to scan to see where she was. I couldn't roll onto my back at this point. I was on my side and I couldn't roll on my back to get them to scan me to see where she was. Then I opened my eyes and the consultant that had lied and coerced me into my third section was in the room and I specifically said I don't want to see her. She was standing at the end of the bed and she said to me, “How long are you going to push for?” I said, “As long as I need to. As long as me and my baby are safe,” and she left. That was the end of it. I didn't see her again. Meagan: Oh my gosh. Shannon: Yeah. That was that. They managed to scan me and they found her. She was just really low. That's the only reason they couldn't find her. She was fine. She was happy. It went on again for about another couple of hours of moving from all fours on the bed to my back and I remember sitting up on my knees upright and I felt something go. I was like, “Okay, I think my waters have gone.” They had a look and they had gone on their own. I didn't have to have them pop like last time. There was no meconium. It was all good.I remember spacing out for a while going to that other place. I came to and it was burning. That ring of fire is real. It was real. I said, “Okay, it really stings. Something has changed.” The midwife lifted up the sheet and she said, “Oh, there is the head. Quick!” They had to scramble to get everything they needed. My husband was texting my mum so I got all the time stamps. They saw her head at 3 minutes past 10:00 at night and she was born at 14 minutes past 10:00. She slid out and we found out she was a girl which my husband told me which was what I wanted. I remember saying, “I did it. They said I couldn't, but I did it.” They wanted to get her a yellow hat because we didn't know what she was but because she came out so quickly, they only had a blue one so she's got a little blue hat and yeah, she was here. It was amazing. I did have two second-degree tears. They did only repair one and I wish they had repaired both because going for a wee afterward with the open one was hell. Meagan: Yes, not fun. Shannon: But I would take that over a section recovery any day. I was going to the park with the kids 3 days post-birth. I was walking around the house. I was able to go up the stairs. It was amazing. Yeah, I did it. They told me I couldn't and that I would die or she would die. Meagan: They really put up a fight and tried so hard. Let me tell you too, I don't know the right word but to stand up to that type of pressure, oh my goodness. That is hard. That is very, very hard. The fact that you did and it's not like it didn't affect you. Of course, it affected you but you were able to go and you were like, “Listen, I know the research. It's in my favor. I'm okay. I believe that it's the best choice because I really have researched it and truly believe that it's the best choice for me and my baby.” They just tried so hard to not let that happen. 36:32 “We are all so proud.”Shannon: They did. I think it was the next morning and I was just sitting in my room with my baby quite happy. The head of midwifery came into the room and I had met her once before. She said to me, “Well done, you did it. All of our phones were going off last night because it was flagged that you had gone into labor and we were all waiting to see what had happened. But you did it vaginally and we are all so proud. Well done.” I was like, “Well, you didn't tell me that at the time, did you?” Meagan: You're like, “I wish you had cheered for me in my pregnancy and not made me feel like I was crazy or scheming my husband,” or all of that. Oh my goodness. Shannon: Yeah. Meagan: You have gone through a lot on top of your birth and trauma there and recovering from all of that. You have grown so much and achieved so much. You should be really proud of yourself. Shannon: Thank you. I am. I think that like I said at the beginning, if it hadn't happened the way that it happened, I'm going to train to be a doula in May and June. Meagan: Yay!Shannon: Because I don't want other women to go through what I went through. Like I said, if it hadn't happened the way it happened then I wouldn't be here today. I'm grateful for the experience, but I wish that I had more support at the time. Meagan: Right, totally. I mean, that's definitely something that led me to the doula and obviously here where I'm at too. I think through these birth experiences, it's hard to deny that fire inside of you when you feel it. Right? You're like, I want to help people not have the experience that I had and have a better experience to the best of my ability. I'm sure that you will do it and you're going to take this passion and you're just going to flourish and touch so many lives. I'm so excited for you. Shannon: Thank you. 38:30 VBAC after three CesareansMeagan: Okay, so let's talk about VBAC after three C-sections. I think this is sometimes a hard one because we do have providers throwing out things and blank statements like, “If you hemorrhage, if this, if this, and if this, you and your baby will die.” When we hear those things, it is very scary and very overwhelming. When it comes to VBAC more than two after multiple Cesareans and more than two, the stats are harder to find. Did you find that it was really harder to find? There are not a lot of huge Cochrane studies at least that I know about where they have studied VBAC after three Cesareans specifically. Shannon: Yep. Meagan: We are often told by providers that the chances of uterine rupture are astronomically higher than our typical VBAC or VBAC after two Cesareans. For people in your area in England, what did you find local study-wise for your stats? I'm curious to see the difference. Shannon: I didn't. There wasn't anything, no. I remember I had to relay as much information as I could on VBAC after multiple Cesareans because I remember them saying to me that after two Cesareans, the risk of uterine rupture doubles and when they say that to you, you're like, Oh my god, that sounds really scary. What they don't tell you is that it only doubles from 1% to 2%. There's not much here that is different because there really isn't a lot. There was not support especially not from my hospital or anywhere like that for me. I just had to do it on my own. The internet is your best friend. Meagan: Yeah, I know. This darn internet can be your best friend and your enemy at the same time. That's why we are here and why we have our blog and all of the things because we want people to be able to find that best friend side of the internet and really dive in. We do have a blog on vaginal birth after three Cesareans. It is titled, Is VBAC After Three C-sections the Right Choice For Me? We will have it here in the show notes so definitely check it out. In it, we talk about how uterine rupture makes the idea of VBAC very scary. The word itself, “rupture” makes it very, very scary. When I think of something rupturing, it doesn't look pretty. It's something that we want to talk about in its real form. Uterine rupture happens. When it does, it is typically an emergent situation. However, it doesn't happen very often and when we're talking about VBAC, the world feels like, and I'm talking about world as in other countries too, it is bigger than it is like you were saying. It happens in really less than 1% of people so they are showing that with VBAC after multiple Cesareans, it might be slightly higher around 1.2%. It's just so hard. What I think is unfortunate is that it's not being offered enough to show the real stats, but what this podcast and what Facebook and all of the groups out there, the VBAC groups are showing, is that VBAC after three Cesareans is possible. It is possible. Do your research. Find the support and you did it. I mean, I'm going to say that you did it without support. I mean, you had support from your husband and stuff, but to the fact that they were showing up at the end of your bed like, “How long are you going to push for?” That type of stuff is not combined with the definition of support for me by the way and ambushing you and those things. You got through it without that much support backing you up in this decision. That is where we are shy here. I think that we don't offer the support. One, if you're listening and you're a provider and you offer VBAC after three Cesareans, please let us know so that we can chat with you and get you added to our list. If you've had a VBAC after three Cesareans and you are listening and had support, please message us so we can add your provider to the list because VBAC after three, four, and all of the Cesareans may not be the best choice for everyone, but for those who want it, let's try to get the information out there. Read up. Get the information. Like I said, it's going to be in the show notes and the blog. We have our course. There's not a ton out there on vaginal birth after multiple Cesareans so find what you can. Read what you can. Find the stats and do what's best for you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Our Sponsors:* Check out Dr. Mom Butt Balm: drmombuttbalm.comSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Episode Description In this episode, we covered: Common period and cycle changes in perimenopause  Uterine fibroids, polyps, endometriosis and adenomyosis Is it estrogen dominance or progesterone deficiency? Can you “regulate” your periods in perimenopause? What's behind painful & heavy periods? How your gut is tied to your periods 7 ways to improve perimenopause periods Supplements I recommend for heavy/painful periods   AS MENTIONED IN THIS EPISODE:  MACA: Grab the Maca I recommend HERE  FISH OIL: Grab the Fish Oil  I recommend HERE (code: claudia123). WORK WITH US: The Hormone Rescue Program   SOURCES:  https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/irregularities https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717552 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818825/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473414/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994343/ https://www.ncbi.nlm.nih.gov/books/NBK499959/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924872/ https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0049744&fbclid=IwAR2IXQnDSVyqtfCBV-bD4XDtI6e44kG5q47DBWCzufLGQoejr4WYW0EcrUY https://pubmed.ncbi.nlm.nih.gov/16117603/ https://www.sciencedirect.com/science/article/abs/pii/S0965229918307969?via%3Dihub   To Connect with Claudia Petrilli:  Instagram LinkedIn Facebook Website FREE GIFT: Peri-What?! The Must-Have Guide for Navigating Hormone Changes in Your 40s WORK WITH US: The Hormone Rescue Program QUESTIONS? EMAIL: claudia@claudiapetrilli.com LOVE THE SHOW?!  Please subscribe, leave a 5-star rating, review, and share, so that other women can find this podcast for guidance and support through their perimenopause journey! 

Today we'll take a bit of a dive into the mechanics of how a uterus contracts. This is actually really important because drawing meaning from patterns of uterine contractions is how many doctors and midwives manage labor. I'm talking with Dr. Roger Young today, an OB scientist who studies, among other things, the details of how a uterus contracts.Dr Young's paper on Uterine contractions (with illustration):https://www.sciencedirect.com/science/article/pii/S0002937822008602#fig1

In today's episode of The Wholesome Fertility Podcast, Mike Berkley shares his personal journey with acupuncture and herbal medicine in fertility treatment. He highlights the value of integrative medicine in fertility enhancement. Mike explains how acupuncture and herbal medicine improve fertility by increasing blood flow to the ovaries and testes, enhancing egg and sperm quality. He also discusses the importance of preparing for IVF and the timing of treatment.    Mike Berkley, LAc, FABORM, is a licensed and board-certified acupuncturist and a board-certified herbalist. He is a fertility specialist at The Berkley Center for Reproductive Wellness in the Midtown East neighborhood of Manhattan, New York. Infertility can be a daunting journey for couples longing to start a family, which is a reality Mike faced with his wife. Luckily, she sought the guidance of an acupuncturist and herbalist who possessed some knowledge of reproductive issues. Despite initial disappointments, after undergoing acupuncture and herbal medicine treatments for seven months, the couple became pregnant and carried the child to term without any complications. Their once seemingly elusive dream had become a beautiful reality thanks to the remarkable effects of acupuncture and herbal medicine. This experience led Mike to obtain his degree in acupuncture from the Pacific College of Oriental Medicine's New York campus and his National Board Certification in herbal medicine. Equipped with the necessary license and fueled by an insatiable thirst for knowledge, Mike studied Western medical approaches and the ancient wisdom of Chinese medicine about infertility treatment. Through rigorous study and invaluable clinical experience, he developed unique acupuncture protocols and proprietary herbal formulas, tailoring them to each individual or couple seeking his assistance. Mike is also a member of several organizations, including the Acupuncture Society of New York and the American Infertility Association. He is writing a book on reproductive disorders and Chinese medicine and hosts his groundbreaking seminars nationwide. Mike has witnessed firsthand the life-changing potential these ancient practices hold for couples struggling with infertility. Together, he can help transform your dreams into reality and create a world where the joy of parenthood knows no bounds.   Website: www.berkleycenter.com Instagram: https://www.instagram.com/mikeberkley56/   For more information about Michelle, visitwww.michelleoravitz.com   Click here to find out how to get the first chapter of "The Way of Fertility" for free.    The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility Facebook:https://www.facebook.com/thewholesomelotus/         Transcript:   Chapters   00:00 Introduction and Personal Journey 00:30 Discovering Acupuncture and Herbal Medicine 05:16 The Limitations of Western Reproductive Medicine 06:33 The Value of Integrative Medicine in Fertility Treatment 08:59 How Acupuncture and Herbal Medicine Improve Fertility 20:16 Living in Accordance with Nature and the Impact on Fertility 26:11 The Mind-Body Connection and the Importance of Mental and Emotional Health 28:48 The Impact of Acupuncture on Blood Flow 32:35 The Heart and Uterus Connection 33:49 Contact Information     Michelle (00:00) Welcome to the podcast, Mike. Yeah, I'm actually really happy to have you. And mike berkley (00:02) I'm thrilled to be here. Thank you for having me.   Michelle (00:07) read about your story and I find it fascinating that you guys started out as patients, kind of like how I was. I was working in New York, really close to you, for doing architecture. So completely different life, completely different world. So I went in for my menstrual irregularities and then everything started getting resolved.   for the first time with acupuncture. And I know you guys were also moved by it with your own journey. So I'd love for you to share your story and how you got into this type of work.   Mike berkley (00:39) Sure, I'd be happy to. So, while I was in acupuncture school, my wife and I were trying to have a baby. And we couldn't. And I had, she had anti -sperm antibodies and I had, I don't remember, motility issues or morphology issues or something. And she went to a...   She didn't go to a reproductive endocrinologist. She went to a gynecologist and he wanted to do some IUIs. And then she met or heard about an acupuncturist and herbalist in New York. And she went to this one.   And the woman gave her herbs and acupuncture and gave me some   then two months later, I was I think I was working and going to school. I can't remember so long ago, but she called me. My wife called me and said that she was pregnant and I didn't know anything about medicine in any way, shape or form. And I said, how do you know?   And she said, well, I peed on the stick. And I said, well, that's all well and good, but I don't believe in that. You better go to the doctor and get a blood test. And she did. And now I have a 29 year old son. Yeah. So I got very inspired at that time to pursue knowledge in the realm of reproductive medicine.   Michelle (02:03) amazing.   Mike berkley (02:17) And so I spent many years studying Western reproductive medicine. I don't mean officially, I didn't go to medical school, but on my own, I studied a lot of Western reproductive medicine and a lot of acupuncture and a lot of herbs. And I've been treating fertility cases exclusively. Like I won't treat a neck or a back or a headache. I've been treating fertility cases exclusively for 27 years.   Michelle (02:29) Yeah. Amazing.   So that's awesome. I mean, I personally love working with fertility. I first started, it was more general, but I just love it. And the rewards are like insane. You know, when you get the positive pregnancy pictures sent to you and it's really incredible and people are shocked. Oftentimes, because they're like, there's no way. I mean, sometimes five years of nothing like Western medicine. And I think one of the common things is that people think that IVF is a guarantee. Do you find that?   Mike berkley (03:17) Of course, of course. I mean, it's, you know, our lives as acupuncturists and herbalists are very interesting, gratifying and ungratifying. I'll give you an example. This has happened to you. It's happened to any acupuncturist listening. Patient does four failed IUIs and three failed IVFs.   Michelle (03:18) Yeah.   Right. Right, or it helped me relax through the process.   Mike berkley (03:43) And then you work with the patient for three months and she does an IVF and she gets pregnant and has a baby. And then I've had patients more than one say, well, you know, it's possible that that what you did helped me. And I'm like, yeah, it's possible, you know.   Exactly, exactly. I love that one. You know, it helped me relax. So I think that I'm I think more and more individuals more more couples more women more men are becoming aware of the the efficacy and the value of You know complementary medicine or integrated medicine acupuncture herbs You know diet In the context of fertility enhancement   Michelle (04:16) Mm -hmm.   Mike berkley (04:34) And I often say to patients, I say, listen, you can go to the best reproductive endocrinologist in the world. I don't care who it is, but that person cannot improve your egg quality. They cannot improve your lining quality and they cannot rectify your husband's sperm DNA fragmentation. I can. So therefore,   Michelle (04:37) Mm -hmm.   Mm -hmm. Right.   Mike berkley (05:03) We should work as a team. And I'm saying this to the patient, but I'm also saying it to society. And I'm saying it to reproductive endocrinologist. The best type of medicine is integrative medicine. You can do something I can't. I can do something you can't. Let's do this. Let's try again.   Michelle (05:05) Right, 100%. Everybody has their blind spots, you know, and their strengths. I mean, we don't have the technology, we can't go in there and extract eggs. Right.   Mike berkley (05:32) That's right, but who cares? You know, a good car mechanic can fix an engine, but it doesn't mean he can make an engine. So it doesn't matter that we don't have the technology. It doesn't matter that we're not reproductive endocrinologists. What matters is, is that for an IVF to work, you need four things. You need a good egg, a good sperm.   Michelle (05:36) Right.   Mm -hmm. Right.   Mike berkley (06:00) And so the reproductive endocrinologist cannot offer a patient good eggs and good sperm and good line. In fact, there are patients that come to me and they say they have a five millimeter lining and the doctor will give them either transvaginal Viagra or something called Trentol and Neupogen. And these medications will thicken the lining and they still have implantation failure. Why? because a thick lining or within normal limits lining, a 10 millimeter lining doesn't convey that it's a good lining.   Michelle (06:31) Definitely. And of course I've asked this question a lot. I love asking questions that I can answer them too, but obviously every acupuncturist says it in a different way. So,   Mike berkley (06:38) So I think that as acupuncturists and herbalists, we have a lot to offer a patient suffering with infertility for sure.   Michelle (07:00) I'd love for you to talk about how acupuncture and herbals can help somebody who's trying to conceive.   Mike berkley (07:08) Sure. So I'm gonna kinda speak around a little bit, but it'll all make sense in the end. So blood is nothing other than a taxicab. Blood is nothing other than a messenger service. When we inhale, the oxygen gets into the blood and the body is oxygenated through blood flow.   When we eat food, our nutrient products get into the bloodstream and nutrients are disseminated through the blood. FSH and LH coming from the pituitary get to the ovaries via the blood. And so I'm gonna step back for a second and say what I say to patients.   You have a heart that's beating. It's disseminating blood throughout your body. But there are two things that are happening. Number one, that dissemination of blood is generalized. And number two, you're 40 years old. And your blood flow is not as good as it was when you were 20. And if you're not 40, you're 37 or you're 36. Same case. Your blood flow is not as good generally as it was when you were running around in the playground at nine years old. You exercise less, you do less in general, I'm speaking.   And so now to acupuncture, what acupuncture does is it improves and elevates hemodynamics, which means blood flow. And when a patient says, well, my heart is doing that, though that's true, with the utilization of acupuncture, you're improving hemodynamics to a specific area, which is the ovaries.   Michelle (08:57) Mm -hmm.   Mike berkley (08:58) Blood, therefore, is you're increasing the delivery of oxygen, electrolytes, nutrients, and hormones to the ovarian milieu. Not only that, but you know when a taxi cab takes a passenger to the airport and the passenger gets out, the taxi cab doesn't want to drive back to the city empty. They want to take a passenger back to the city.   It's a 45 minute trip from JFK to New York City to Manhattan. So they don't want to go back without a passenger. Well, blood is the same thing. So when you're increasing blood flow to the ovaries, you're delivering these essential products, but the blood is also picking up debris. What is debris? Debris are dead cells. Now, of course, during this conversation, both of us have lost a billion cells. They've died and they've regenerated. But what happens to the cells that die? Well, they get emitted through the sweating, exhalation, urination, defecation. This is how we get rid of toxins in the body. But again, because our digestive functions are not necessarily great, because our hemodynamics are not necessarily what they could be, by stimulating blood flow to the ovaries, you're delivering the good and helping to take back the bad which is the dead cells. So you're actually taking this garden that's not getting a lot of rain and it's not getting a lot of sunshine because the trees are like this over the garden. So when you're doing acupuncture herbs, you're cutting down the tops of these trees and you're going like this. So the garden is now getting all this sunshine and the rain is able to hit the flowers. And in a month, the flowers are joyous, beautiful, smiling, looking at everybody and winking at them and saying, hey, I'm a beautiful rose, look at me.   And so that's kind of, I think that the analogy or the metaphor is to how acupuncture improves egg quality. And the same is true with sperm quality. You're causing improved and increased hemodynamics to the testes and the same thing happens as with the ovaries. So it's the testes and the ovaries are really homologues. They both do the same thing. One creates eggs, one creates sperm and...   Michelle (11:09) Mm -hmm.   Mike berkley (11:23) …stimulating blood there, we're improving the quality of the contents. Now let's talk about herbal medicine. So herbal medicine is much more sophisticated, in my humble opinion, than acupuncture. Acupuncture is very sophisticated and very effective in all areas, whether you have pain or infertility. But the thing about herbal medicine is that you can construct an herbal formula that specifically deals...with the overall presentation of the patient, in my opinion, in a more powerful, efficacious manner. So for example, if you have a patient with polycystic ovarian syndrome who's five foot five and weighs 250 pounds and she's 40 years old, and then you have a PCOS patient who's five foot five and she's 29 years old and she's 110 pounds, they're both suffering with...   Michelle (11:56) you   Mike berkley (12:23) lack of proper menstruation, they're both suffering with infertility. So when you use herbal medicine on those patients, you're not just treating PCOS, treating this woman who's 250 pounds, this woman who's 120 pounds, this woman who's 40 years old, this woman who's 29 years old. So the herbs are very pinpoint accurate in what they do and how they work. And...   The beauty of herbal medicine is that one can create a very specific formula for this patient. So this patient is suffering with infertility, but she also has constipation and chronic headaches and...   Michelle (12:56) you   Mike berkley (13:05) She's got low back pain. So you can give her herbs to deal with all of that stuff. And so acupuncture is efficacious in the same manner. So really, what's the difference? So there's a couple of differences. As I said earlier, in the perspective of herbal medicine, you're taking it orally. It's internal medicine. It's having an effect on the organs, on the follicles.   Michelle (13:16) you   Mike berkley (13:34) the ovaries, on the testes, et cetera, et cetera. But I'm going to say something that's even more interesting. Let's say that you or I had a really bad headache. And we said to our partners, honey, I have a splitting headache. Could you please massage my shoulders and massage my head? It would really make me feel better. And our partners say, of course, of course. And they stand. I'm sitting in this chair and my wife comes.   Michelle (13:46) you   Mike berkley (14:03) me and starts to massage me and she's massaging my head and maybe in a half an hour I feel better. Let's retell that story. The same exact scenario except before my wife starts to work on me I take three Advil. Now what happens is instead of my headache dissipating in 30 minutes it dissipates in 15 minutes. Why?   Michelle (14:22) you   Mike berkley (14:32) because I'm being treated from the outside in, which is the massage, and I'm also being treated from the inside out, which is a three Advil. And so when you use these together, you're increasing the efficacy of the treatment. And so I think using acupuncture nerves together, they do similar things, but they also do different things, and they certainly potentiate each other's efficacy and power.   Michelle (15:00) Yeah, for it's very complimentary. Now, typically somebody comes to you and says, I'm starting IVF in a month. Sometimes I'm like, okay, I kind of wish you came here a couple of months before. So for people who are listening, if they want to prepare for IVF or really just prepare their body and their egg quality, how early...   should they come to you? Like how long does it take really for everything to take effect?   Mike berkley (15:30) So it's a great question. So again, I'm going to talk about sperm and egg. Again, the similarity is quite fascinating. It takes three months for a spermatogonia, an immature sperm, to reach a mature sperm. And it takes three months for a primordial follicle, which is...speck of dust to turn into a 20 millimeter follicle. It is the 20 millimeter follicle that the egg is retrieved from. So three months before a transfer is the, you know, is the gold standard. It's the best thing to do. But what I will say to patients, because I get this kind of situation all the time, is listen, you're having a cycle, you're having a transfer next month. That's okay. Let's start tomorrow.   Yeah, but you just told me it takes three months. No, no, no, no, I understand. But let's start tomorrow. I'm going to tell you why. If you do the transfer and it works, you've thrown out a couple of hundred dollars on some sessions. So what? I'm going to continue to treat you twice a week for 13 weeks to help prevent miscarriage. Why for 13 weeks? Because 90 % of miscarriages occur viable for the 12th week. In the event, in the most unfortunate event,   Michelle (16:29) you   Mike berkley (16:52) that the cycle fails. We've already started treating you now. So then in the subsequent cycle or the cycle subsequent to that, you'll have much better egg quality. You know, I don't know if you know Warren Buffett. Warren Buffett is one of the greatest investors in the history of America. And somebody said to him one time, Mr. Buffett, when is the best time to invest in the stock market? And he said, today.   And the point of the story is you can't really time the market. Invest if it's high, invest if it's low, dollar cost average. Invest 100 bucks every month for the rest of your life and you'll be okay. And so that's kind of like this. Invest in the treatment even though your transfer isn't a month. Doesn't work out? Okay, we've still improved follicular quality. Does work out? It's all good. I'm gonna continue to treat you twice a week for 13 weeks. You're gonna have a baby.   Michelle (17:47) Yeah. That's a good perspective for sure. yeah, I mean, what are some of the things that you see? Cause cause I feel like the way we're living right now is impacting our bodies in so many ways. And Chinese medicine, really the heart of it is living in accordance with nature, living in accordance with our own nature. And what happens is when we live outside of that and against our normal flow, that's when we start to get patterns and symptoms. So living in New York, I remember having a lot of really kind of like climbing an uphill battle because it is go, go, go. And so some of the things that I tell people who are not close to here, wanted to get coaching calls is even getting a grounding matter somehow finding ways to living in more flow. And what are some of the things that you see?   Mike berkley (18:43) So I think everything that you just said is true, real and valid. However, I'd like to say that unfortunately, and remember, this is to the listening audience. This is my opinion only. I do feel it's next to impossible to get to one's nature. I do think it's next to impossible to be really settled, really like, able to exhale. Why do I say this? I say this because the world is at war, because there is intense poverty, there's joblessness, there's crime, there's all kinds of negative things. Of course there's many beautiful things, but there's many negative things. And so how can people possibly exhale?   So it's very difficult to become kind of, you know, one with nature and one with yourself and this kind of thing. I do think, however, that even though it's difficult to achieve, that the achieving is not the goal. The trying is the goal. The journey is the goal. One will probably never reach the destination, but it's okay because through the journey one's psychic and mental and emotional and physical health can improve. So even though I don't see a path to ultimate improvement, I don't see a path to ultimate health, I do think that there is a mind -body connection for sure. It's completely unassailable. And I think that people, I don't really get involved with this kind of thing too much in my own practice. I'm very, very clinical, but that doesn't mean that I don't totally embrace what you're saying. I think people should do yoga. I think they should meditate. Listen, I'll tell you an example of exactly, I'll put a patient in the room and I'll come to take the patient out and she's laying on the table with the cell phone.   You know, this is terribly destructive to the patient and he or she doesn't understand that. And I'll say to them, listen, you have 30 minutes of your entire life that you cannot be bothered by anybody. You can just be free. You're in this room on this table with beautiful music and it's a lovely room and you're taken care of here.   Michelle (20:53) yeah.   Mike berkley (21:22) put the phone down, man, and B, and it's really hard because people need that constant stimulation. I need it. The first thing I do when I wake up is I check my phone at 6 .15 in the morning. You know, it's mental illness. It's mental illness. It's craziness. But I do think that trying to be at peace is very important, not only for fertility,   Michelle (21:26) Yeah.   It's an addiction for sure. Yeah.   Mike berkley (21:49) but for life, for happiness, for joy. And so, as I say, I don't have meditation classes here or yoga classes here, but I strongly recommend that patients do engage in those activities. And I also think people should go to the gym. I think people should work out three days a week.   Michelle (22:09) yeah.   Mike berkley (22:10) and work out pretty hard. I don't mean hard like a professional athlete, but you know, don't get on the treadmill for five minutes. Like work. You know, listen, we have this thing called liver -chi stagnation, right? It means that, you know, the chi is stuck and people are stuck. And as a result of being stuck, inflammation occurs and they're angry and they get headaches and they're bitter. Guess what happens to the stuck chi when you move, when you exercise, the chi becomes unstuck and the   Michelle (22:37) Right, yeah.   Mike berkley (22:39) Exercise makes you feel better psycho -emotionally and when you feel better psycho -emotionally, you'll be better off physically   Michelle (22:47) 100%. I remember, so when I was in New York in the craziness just over firm, you know, that's the only way you can really survive there. You have to like show that you're a good quality employee. And I remember I found Acupuncture and what I found that it gave me is this flow.   in my life where I was able to still withstand and have that pressure, but I felt more resilient. It like, it increased my ability to adapt more than anything else has. And that was one of the things that I was so amazed by. But then it really made me realize whole beings that have so many different aspects to ourselves and how one...   part, if we work on our own energetic frequency and chi, it impacts our life and it impacts our how we can think and how we feel.   Mike berkley (23:47) I agree with you. You know, another problem that I see quite frequently is, you know, there were two kinds of patients. There are patients that are very self -aware, and they exercise and they meditate and they do yoga and they eat properly.   And then there are patients that they may not be overweight, but they don't eat well. You know, they drink Coca -Cola and they eat French fries and listen, guess what? There's nothing wrong with drinking a Coca -Cola and having French fries, you know, once every two months, once a month. It's all good. Chinese medicine is about yin and yang. What does yin and yang mean? Balance. It's all good. But when you have French fries and burger and ice cream tonight, you smoke a joint tomorrow and you, you know, you don't go to the gym for three days. You know, this just...   Michelle (24:07) Mm -hmm.   Mike berkley (24:36) it's just going to have negative attributes. It's going to create negative outcomes, certainly physically. So I try to encourage patients to eat properly and I try to give them some type of helpful diet plan if I think they need it. But I think nutrition and diet are very important for health in general. And certainly in the world of infertility, many of the   Many of the causative factors can really be, I don't want to get too technical, but they can kind of originate with what's called free radicals, reactive oxidative species, and these things cause inflammation in the body. And if you have inflammation in the uterus or inflammation in the testes, inflammation in the testes kills sperm. Inflammation in the uterus is going to kill an embryo. So we need to be careful about what we're eating from the inflammatory point of view.   You know, the inflammation point.   Michelle (25:37) Right. Yeah. Gut health is everything. interesting how the spleen and stomach are center. That's their location. The direction is center because, and it really is, it's such a symbol of how important it is in creating blood. And actually speaking of blood flow that you were talking about before, did you ever see, there was something on Instagram, somebody took a sample of blood before and after acupuncture.   it was shocking. Like you could see it literally move everything that you learn in textbook about how it improves chi and flow. You could see the blood cells being a little bit more stuck together from the before. They're a little more stuck together and very slow moving. The after the blood cells not only are not stuck together, but they're more round.   Mike berkley (26:30) Interesting.   Michelle (26:30) They're more round and they're moving fast and flowing. They're not right next to each other. It's crazy. And that was mind boggling. And I actually, so I shared it on my Instagram. I'll forward you the link. And I shared it on my Instagram. And interestingly enough, I had a lot of acupunctures, because we all learn this in theory. That's the theory. We don't really often see this with our own eyes. So I think that a lot of   Mike berkley (26:45) Please.   Michelle (27:00) acupuncturists that saw this were like blown away. They're like, my God, this is exactly what it says in the textbook. And to actually see it with your own eyes is amazing.   Mike berkley (27:09) So I'm going to share a little story with you that's completely apropos of the story that you just told   I'm going to tell you a story that's a little bit different than what you told me, but it's the exact same outcome. So about 10 years ago or 12 years ago, there was a study done. First of all, let me talk about the uterine artery impedance index. The uterine artery impedance index is an index that determines the flow through of blood through the uterine artery.   Uterine artery at its end point has branches that come out and enervate the ovaries. So the ovaries are getting their blood through the uterine artery. And so the more patent and effective the uterine artery is, the more blood will get to the ovaries. And so there was this little study done.   where they did a transvaginal ultrasound with a color doppler. And for the listeners who don't understand that, you know, when you have an ultrasound and the doctor looks at the monitor, it's all black and white and gray. But with a color doppler, the monitor is color. You can see all color. It's not just gray. And so they did these transvaginal ultrasounds with a color doppler to determine the uterine artery impedance index. The higher the index,   the lower the amount of flow through of blood through the uterine artery. So they took a bunch of women, they did this and they wrote down the uterine artery impedance index numbers. and by the way, when they did the transvaginal ultrasound, you could either see no blood or just a little blood in the uterus, in the uterine lining. Then acupuncture was given to the patient and...   Michelle (28:37) Mm hmm. Mm hmm.   Mike berkley (29:00) 25 minutes after acupuncture was done, they repeated the transvaginal ultrasound with a color Doppler and two things happened. The uterine artery impedance index dropped like three or four points and you could actually see a red line right across the uterus. So you could actually perfectly well see evidence of enhanced blood flow into the uterine environment which   you know, really I'm talking about the ovarian environment, but you don't see it on the ovaries, you see it on the uterus. And it was fantastic. So it's exactly what you're saying, a little bit of a different study, but the same outcome.   Michelle (29:43) more specific to fertility. Yeah, that's amazing. Wow, incredible. So fascinating. I mean, it is really fascinating when we get to see with our own eyes, something that has been, you know, taught for thousands of years, and to actually see science and you know, I look also housing the mind   Mike berkley (29:45) Absolutely. Yeah. Pardon.   Michelle (30:04) that also reflect that in modern science, but the heart math and the heart -brain coherence that they're finding is pretty much proving the whole idea of the heart housing the mind.   Mike berkley (30:04) you   So I don't even, I don't know anything about this. This is all brand new news to me, but it sounds really fascinating. I love.   Michelle (30:22) Yeah.   It is. And this is why I love talking to acupuncturists. Cause you just told me something that I did not, I thought I heard about it, but I didn't hear it in that detail. And I'm learning so much talking you. So this is why I love coming together with fellow acupuncturists because I always, always learn something new.   Mike berkley (30:44) as do I from you, thank   Michelle (30:46) of course I could talk to you for   But I would love for you to   can people find you or find more about you?   Mike berkley (30:53) Yeah, thank you so course, I'm Mike Berkeley and my website is berkeleycenter .com, which is B -E -R -K -L -E -Ycenter .com. And I'm happy to speak to anybody, answer anybody's questions. There's no charge for that. And I'm a plain, simple, down to earth guy. And I'm just here to help people.   Michelle (30:55) Yeah.   Yeah. You got the New Yorker mentality that I miss that I'll be honest, the culture of New York, I really miss since I've moved. So it kind of brings me back home to like, you know, the accent and all that. So Mike, it was great meeting you. I really enjoyed our conversation and thank you so much for coming on today.   Mike berkley (31:35) Well, I want to say it was an absolute pleasure and an honor to meet you. I enjoyed our conversation so much and thank you so much again for having me as a guest. I'm grateful.

Today, I am thrilled to bring you our seventh AMA episode. I am super excited to connect with all of you today to share valuable insights and answer your questions about dysfunctional uterine bleeding, hormone replacement therapy, perimenopause, and menopause. I will also be addressing queries on blood loss thresholds and dysfunctional uterine bleeding and offering strategies for managing endometriosis and cravings.  Join me as I answer many questions from listeners, shedding light on all these critical concerns and several more. I love doing the AMA episodes, and I know you love listening to them, so keep your questions coming! IN THIS EPISODE YOU WILL LEARN: How an estrogen and progesterone imbalance could cause persistent bleeding  How much blood loss should there be in a menstrual cycle? Why some women crave sweet and salty foods at night during perimenopause and menopause Strategies for managing cravings during perimenopause and menopause How endometriosis often links to autoimmunity and digestive issues Why would someone experience unusual symptoms like itchy ears, crankiness, and bloating in menopause? Various hormone replacement therapy options for perimenopause Why you should implement lifestyle changes before considering HRT The benefits of oral progesterone for sleep and bone health Join my free Facebook group to have me answer your questions personally, or you can send your questions to my admin team (support@cynthiathurlow.com) Connect with Cynthia Thurlow Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com

Hayley joins the show today sharing her breech Cesarean and unmedicated hospital VBAC stories. Meagan and Hayley dive deep into the pros and cons of getting an epidural and why providers tell women so many different things when it comes to epidurals and VBAC!While Hayley had the dreamiest birth she could have imagined and everything went according to plan, her postpartum experience with prolapse was not something she was prepared for. Hayley shares her symptoms, what she wished she knew, and what she has done since to recover and feel like herself again. Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 02:47 Just-in-case epidural04:16 Dr. McGuire's insight on epidurals08:42 Using an epidural as a tool10:44 Hayley's first pregnancy and birth12:00 Doing VBAC research before pregnancy13:51 Hayley's second pregnancy18:15 Labor begins20:16 Going to the hospital24:20 Pushing27:05 Hayley's prolapse experience32:01 Symptoms of uterine prolapse35:29 Prolapse can happenMeagan: Hello, hello Women of Strength. You guys, I am excited about today's episode. I love talking about VBAC obviously, but specifically, we are going to talk a little bit about unmedicated versus medicated. Our friend, Hayley, from North Carolina has had a beautiful unmedicated hospital VBAC so I want to also talk about the opposite side of that and talk about medicated VBAC. We have so many people in our community that I see type, “I want a VBAC, but I don't want to go unmedicated and my doctor says I have to. I can't have an epidural” or the total flipside of that where, “I really want an unmedicated VBAC, but my doctor says I can't go unmedicated. I have to have the epidural.” Did I just say that correctly, Hayley? Hayley: Yes, yeah. Meagan: It's either one or the other. We've got providers telling people they can't have an epidural or they have to have an epidural. So I wanted to just talk a little bit today before we get going on those two topics. First of all, let's talk about unmedicated birth. Hayley and I are living proof today. We are on this episode that unmedicated VBAC is 100% possible, achievable, and safe. A lot of those providers come out and say that they can't go unmedicated because they say it's not safe. In the rare chance, we know that uterine rupture happens but it is rare. In the rare chance of a uterine rupture, that is where they say that is not okay. Or they will say things like, “But you wouldn't want to be knocked out for your birth,” which is scary. I don't want to be knocked out for my birth and I know people have. A lot of the time, it is not the most pleasant experience. Yeah. Okay, so let's talk about that. Unmedicated vaginal birth is unmedicated vaginal birth. That's what it is. I'm just laying it out there. Yes, we have a slight increase in uterine rupture. Yes. What happens if we have a uterine rupture and we are unmediated? A lot of the time, we are noticing that there are signs of uterine rupture. When we get an epidural and a spinal, we go back and have a C-section. Simple as that. Or if it is a true medical emergency, yes, there is that small risk of needing to be put under. Small risk and small risk equal risk of course, but it's low. 02:47 Just-in-case epiduralMeagan: What about if we have the just-in-case epidural? I seriously sometimes just want to sock someone who says “Just in case”. We don't need to be placing an epidural just to have it ready to dose because guess what? In the event that it is a true emergency and we really do need to go in for an immediate Cesarean, it's the same thing. We get knocked out. I know that these words are kind of big and harsh words. We get knocked out, but we get put under general anesthesia if we don't have anything in our system. Now, let's talk about an epidural. You actually have an epidural placed. It's running. It's dosed and we have a uterine rupture. Guess what? Women of Strength, more than likely, it still has to be dosed further because an epidural is not like a spinal. It's just not. They have to dose it further. With my first Cesarean, I had an epidural. They had to come in, dose it to a deeper extreme so I wasn't feeling my surgery and I had to wait. Right? We are still waiting. It's the same thing. There is always a wait and it takes time. It takes about 15-20 minutes for any epidural to kick in deep enough. 04:16 Dr. McGuire's insight on epiduralsMeagan: Dr. McGuire wrote for Yale Medicine. She talks about this epidural and is it safe and how are they different. She talks about how they truly are different than they were back in the day because they are dosing them lighter. We know that. We have seen that, but we still have some pretty serious risks as well with epidurals even though again, they are smaller. There are blood clots, spinal infections, spinal headaches, them not working, and things like that, and blood pressure. I'm going to say as a doula, I've attended over 350 births. As a doula, I will say a large portion of any client, not just VBAC, who receives an epidural has a blood pressure dip. Even when they have a large amount of fluid because a lot of the time they will cram fluids in to try to help this, but there is some sort of blood pressure dip and baby seems to struggle when that happens. Then it's the cascade– rolling over, move, move, move, move. Baby doesn't recover or mom's blood pressure doesn't recover and we are off to an OR. One of the biggest questions that I think is a really hot debate in the medical world is does an epidural raise your chances of a Cesarean? Most people out there are going to say, “No, it doesn't.” The studies are pretty low, though. I think in one study there were 2,000 people or something like that and they showed it didn't. But I mean, from a doula's standpoint, I know I don't see as many births as these OBs, but I definitely see it seems to do that– the blood pressure drop thing. So is it safe? Yes. Do you have to go unmedicated if you have a VBAC? No. Do you have to get an epidural if you have an epidural? No. Do what is best for you. What she says is, “Those studies we know that have a higher concentration of epidural medicine was associated with an increased risk of Cesarean, though lower concentration we now use actually promotes normal, spontaneous vaginal delivery without assistance.” When she says assistance, a lot of the time when we have epidurals, we have vacuum or forceps assistance because we have lack of mobility. That's what she was saying here. I want to make sure to provide the link and some other links on our blog for epidurals so you can decide what is best for you. But for now, we are going to get into a story of an unmedicated, vaginal birth. 08:42 Using an epidural as a toolMeagan: Okay, Ms. Hayley. Welcome to the show. Hayley: Thank you for having me. It's really crazy to be on here sharing so thank you. Meagan: I talk about how it's crazy to be full-circle where you are listening. You are preparing. All of the people in your ear are motivating and then here you are today sharing your story motivating others in your same space x, y, z months ago. Hayley: Yeah. It's crazy. It really is a full-circle moment like you mentioned. Meagan: Yeah. Well, I am so honored that you are here. I would love to turn the time over to you. Hayley: Sure. So yeah, I also love what you were saying really quickly on the epidural versus not. Full transparency, when I went into this, I definitely recognized that an epidural is a tool and I knew and wanted to prepare myself. If I am– obviously, birth is not pleasant. It's not going to be a walk in the park. But I knew there was a difference between being in pain versus suffering. I really wanted to know that for myself. It if turned into that suffering, I wouldn't have been opposed to helping my body to get my baby. Meagan: To the next point, yeah. Hayley: But there is a difference between being in pain and suffering. Meagan: As a doula, we talk about that a lot where we are like, okay. We are planning to go unmedicated. That is fantastic and then we talk about that pain versus suffering and that transition because when we are suffering, we start having things that come up later. We don't think about it. We are suffering now, but postpartum depression, postpartum anxiety, and postpartum trauma. We have these things that are not worth it, so in the end, you have to do what's best for you and keep you in that positive space and recognize pain versus suffering. Hayley: Yeah. Exactly, so I love that. 10:44 Hayley's first pregnancy and birthHayley: To start this whole story I guess, is back in April 2021, I had my daughter. She was breech. For me, I knew pretty early on that she was breech. She was so active. I knew that, “Oh, you are trying to flip in there.” I did all of the things. I did Spinning Babies and tried all of the things, but it was still COVID time so I just didn't go to acupuncture. I feel like if it wasn't COVID times still, I maybe would have tried more things. But with that being said, I felt like she was literally trying to turn because I'm like, “What are you doing? If you're not flipping, then I'm not sure. Then you can't.” I just felt in my body that there was a reason. I didn't try manually flipping her or things like that. To help with peace of mind, I opted for a Cesarean even though that was the last thing I wanted. I'm terrified of surgeries and needles. I was like, “I do not want this. This is the absolute last thing I want,” but at the same time, I was happy that I could mentally prepare for that instead of it being sprung on me. And honestly, I feel like I had a pretty good recovery with that. At the same time, I knew for any future children, I did not want to have another C-section. 12:00 Doing VBAC research before pregnancyHayley: So fast forward. We moved across the country when she was about 9 months old. I was definitely not pregnant yet, but we were thinking about expanding our family. I had already started researching providers in the area, joining Facebook pages like the ICAN Facebook group in the area and literally preparing even though I wasn't pregnant because I just really wanted to make this. Meagan: That is important. Hayley: Yeah. I just did my research. I really, really wanted to be not in a situation where I'm like, “Oh shoot. I'm pregnant and now I need to struggle to find a supportive provider,” because unfortunately, it's hard to find VBAC-supportive providers. I wish that wasn't the case, but I feel like that's unfortunately the majority. Meagan: The reality, it sucks. It's stupid. I have a lot of words for that, but it is the reality. It is more often that it's hard to find that true support than it is to find the opposite. Hayley: Yep. I remember I made a couple of appointments just to talk with people to be like, “Hey, how do you feel about this? I'm looking to establish care.” I remember I went to two different places. One was an OB and they did have some midwives there, but yeah. They were like, “Well, you can or you can try that,” and I was like, “Cool. This doesn't sound like 100%.” I eventually found a group of midwives. I felt was a total 180 with the way that the care felt. Not that you can't get that with OBs, but they were like, “Yeah. We're going to do that.” It was just like, “Cool. We're going to do that.” Meagan: I love that. You're like, “And great. I was almost not expecting you to say that so fantastic.” Hayley: Exactly. I'm like, “Perfect.”13:51 Hayley's second pregnancyHayley: Fast forward, I then get pregnant with my second. I established care through them. I felt like the whole process was just so chill. Even just with anything, maybe it's just the difference between your first pregnancy and second pregnancy where you are so nervous about everything with the first, but even the ultrasound that just felt very– with my first, they would really make me feel like they were really making sure, not that you shouldn't make sure things are okay, but they just really made me feel like everything was so medical and things could go wrong or something. With my second, they were just like, “Yeah, baby is great.” Okay, cool. Perfect. So that was awesome and definitely not what I expected. Again, it's a different office and a different state. It was a totally different experience and amazing. But I was definitely in my head the whole pregnancy. I did not want this baby to flip. I just kept doing everything I could throughout my whole pregnancy, really working on my mentality and my mindset. I found a doula. I went to a chiropractor towards the end of my pregnancy. I went to pelvic health, physical therapy, and I did all of the things because I'm like, “I want to do everything that I possibly can to make this happen.” That way if I didn't, I would at least know, “Hey, I did everything and I totally prepared.” So mentally, that's just what I needed. But yeah. I was definitely so in my head like, “What if this baby decides to be breech again? I would be so sad.” But luckily, that did not happen. I also fell on my tailbone. I hurt my tailbone when I was 4 months before delivery so that was really not great either because one thing that once I would get into labor, I had so much tailbone pain and that was just something that I was not expecting. So the pregnancy definitely had ups and downs. I feel like maybe you can answer if this is your experience too down the line with pregnancies, but I feel like your body just feels everything so much quicker with the second pregnancy. Like, “Oh, I'm already sore and it's not even the second trimester. What's happening?” Meagan: I believe that. Hayley: Yeah, so I found that really preparing is my number-one tip of doing your research, listening to podcasts, really get in that space of there was no doubt in my mind that I wasn't going to be able to have a VBAC and I feel like that really helped me out when labor came because it wasn't something that I even thought about. I can psyche myself out of I didn't get worried. Meagan: How amazing is that? I feel like that goes again, it's like the full circle of, “Okay. I am educated. I have the support. I have the body and the baby ready to do this.” When we have gaps in our circle where it's like, “Okay, well I'm educated so I feel confident in my ability,” but then we have a provider who is wishy-washy and shutting me down or I have a family member who is like, “Oh, you are really making a bad choice,” or starts questioning us and placing doubt, but then we are confident in our body. We are healthy and all of these things. But when there are gaps, we can't go into birth with that mentality. That's something I wish for every single person going in to have a baby no matter what is just feeling confident and having that mentality of stress-free of the doubt. There are always the what-ifs and the wonders and every birth experience is different, but to not doubt ourselves or our ability and it comes with education, support, and all of those things. Hayley: Yeah, exactly. Like reading my books and listening to stories and being like, “Yeah. My body can do this. This is what people have done for all of time.” Meagan: Forever. Hayley: We can do this. Yeah. Definitely, I agree. If you don't have every single one of those aspects, it just makes things so much harder on yourself and everything. 18:15 Labor beginsHayley: So fast forward, I never went through labor with my first, so I still felt like a first-time mom in the sense that I was like, “Will I know when I'm in labor? What's it going to feel like?” It was February last year. I don't know, whatever day it was. I guess it was the 22nd. I guess I was having cramping. I don't know. They were really mild so I didn't really think about it. I was working and taking care of my firstborn. Looking back, I'm like, “Oh, I guess it was maybe early labor.” But I didn't really think about it. But I had pasta for dinner which I think is hilarious. I just ate pasta because fast forward, I am putting my little one to bed at 7:00 PM and I start getting really bad stomach pains. I'm like, “Is this from my dinner? Is my stomach just upset? I don't know what's happening.” I remember I had to have my husband finish putting her to bed. I was really not feeling good. I was like, “Okay. Am I just really not feeling good? Is this labor? I'm not sure what's happening.” So I get in the shower and I'm like, “All right. Let me just get in the shower and see what's up.” Then my husband comes back in and I'm like, “Hey, I don't want to freak you out. I'm not sure if this is labor or not, but maybe it is.”It's getting closer to 8:00 PM or so and things are really starting to ramp up. I'm like, “Okay, this is probably labor.” I do remember having a thought of, “Shoot. If this is how early labor is and I'm already feeling it like this, I'm worried. I don't know that I can do this.” I had those thoughts. I feel like I quickly got out of that, but it freaked me out. I wasn't prepared for that. I know you can have those thoughts down the line in active labor, but I was like, “If I'm already feeling this and I don't even know if I'm in labor yet, shoot. I'm in trouble.” 20:16 Going to the hospitalHayley: Fast forward, we started timing the contractions around 8:30 or 9:00 at night so only an hour and a half or so after I first had that contraction that I felt. They were already lasting over a minute long and coming 3-6 minutes apart. It got really intense really quickly. I was like, “All right.” We put on Harry Potter. I was like, “Let's just try to get some sleep. Let me rest here.” Jokes on us. We did not rest. We did not get sleep. I ended up calling our midwives and our doula. They were like, “Okay. You should probably think about coming in.” We left our house at 11:00 PM. We live an hour from the hospital or 40 minutes. I was freaking out because one of the concerns I feel like everyone has is, “I don't want to have my baby in the car,” but you don't want to get there too soon. It's one of those things. I really, truly believe though for me-- people say it's nice to labor at home because you are comfortable and I do get that but for me, I wanted to get to my place of birth and I feel like that was a huge thing for me and my mindset. Once I got to my place of birth, I was like, “Okay. This is where I'm giving birth. I don't need to travel.” I relaxed a lot. That was also something I assumed I wanted to be at home longer, but for me, I was like, “No. I need to feel comfortable and in my space.” However, when I got there, I was already 100% effaced, 0 station, and 7 centimeters. Meagan: Nice! Hayley: So I was already pretty far along. Meagan: You pretty much labored at home very well. Hayley: Yeah, exactly. So I was like, “Okay.” But I just really wanted to get to the hospital. I was like, “Get me to my people because I need support.” Meagan: Yeah. Hayley: So we finally get to the room. They had a bathtub which was great so they filled the tub up. I did have an IV placed but they didn't have it hooked to anything. They just had it placed. What was annoying about that was they forgot to tape it when I got in the tub so of course, it fell out. So they literally I think, tried to stick me like 10 times. I'm not even exaggerating. It was a whole situation so that was not fun. Yeah. Laboring in the tub was great and on the toilet was great. But it really, yeah. Once I was there and had my people, I just felt like I was in the zone and everything seemed a lot better than when I was at home in my head just being like, “What's happening?” So yeah. Everything moved really quickly but I wasn't prepared for tailbone pain. Then I mean, I guess I probably should have. It was kind of in my head that this should be a thing because of when I fell, but man. The back pain and the tailbone pain so even things like the double hip squeeze that I thought, “Oh yeah, that's going to help me” were like, no. Meagan: And sacrum, oof. Yeah. No wonder the toilet felt really good because you were able to sit without pressure open and release that. Hayley: Yeah, exactly. That was perfect or hands and knees in the tub because yeah. I couldn't sit. It was a whole thing. I don't remember honestly from when my labor started at home, I don't remember honestly peaking and getting any worse. It just honestly felt the same. Intense from the beginning all the way until the end which was also something that I was not prepared for. I think obviously it is different for everybody, but that was something I was like, “Oh.” I was pleasantly surprised in the sense of at least it wasn't like, “Shoot. I'm totally screwed later,” but also, it was intense very quickly early on and throughout. 24:20 PushingHayley: So fast forward, I feel like now it's 7:00 AM. We get to the hospital at basically 1:00 AM. At 7:00 AM, I'm at 10 centimeters and I feel the urge to push so we start pushing in different positions. One thing I really wanted for myself was to not push lounging on a bed. However, with my tailbone, I felt like everything hurt so it ended up where we tried so many positions but I was kind of semi-reclined just because I felt like I needed that support. I don't know. I told myself to be okay with ultimately pushing in the position that I “didn't want” and being okay with that was something that I was like, “You know what? Listen to what I need in this moment and do what's best.” So it was one of those moments where it was like, “All right. I need to just let go of what I was assuming and do what's best for me.” We pushed for a while. It was 60 or so minutes which was– Meagan: That's actually not bad for a first-time mom. Hayley: Really? I think it was 60, maybe 70 or so. But I do remember pushing being harder than I thought. That was not something that I had prepared for. I feel like for any mamas out there listening, prepare for pushing. Meagan: Yeah. Pushing is hard work. Hayley: It's hard. I think that tired me out honestly more than the labor. It was pushing and I think it was half because I did not prepare as much for it and because obviously at the end of it, you're already tired and exhausted. But yeah. I did not prepare for pushing to last as long either. I feel like I did know that, but mentally, I feel like, “Wait. This is still happening,” and it being intense. But then he finally was born and I just literally grabbed him. My husband was helping catch him, but I literally just took him right away. Meagan: Aw, cute. Hayley: It was great. So then I had this huge high of like, “Wow. I did this VBAC unmedicated. This is great,” then fast forward to postpartum, the nurse had kind of mentioned or my midwife had kind of mentioned, “Oh, you have a slight uterine prolapse.” I was just like, “I don't know what that means. Cool.” They mentioned it as we were in the hospital and it wasn't until afterward that I still was like, “No one is telling me what any of this means. What is this? I don't even know what this is.” They were being so casual about it and I wasn't getting any information. 27:05 Hayley's prolapse experienceHayley: That was something that was frustrating because then postpartum, a couple weeks in when I was starting to have some symptoms of prolapse, I was like, “Well, no one is giving me answers. Nobody told me what this is. Now I'm postpartum feeling confused and in the dark.” It was really interesting to go from this high high of, “Wow. I had an amazing birth, successful VBAC, unmedicated” to now questioning, “Well, what did I do?” You question yourself. Did I do something wrong? Could I have done something differently? Why did this happen? Because no one else apparently had this which is actually not true. It's just not talked about. So that was a very big part of postpartum that I was not at all prepared for. Meagan: Yeah. That's hard. Let's talk a little bit about the symptoms that you were receiving. What symptoms did you have? Hayley: Yeah. So at the beginning, I felt like I was like, “I don't know what this means. I'm not really feeling it. You just said I have a slight uterine prolapse. We'll check that later.” Then you don't go to your visit until however many weeks postpartum. So I was like, okay. But then when I was home a couple of weeks later, maybe two or so weeks, I was feeling heaviness or uncomfortable or pain a little bit. This doesn't feel normal. I felt bulging in the beginning. That emotionally and mentally really got to me. I was like, “Why is my body doing this?” Then I would remember messaging my midwife on the little portal and they were like, “You're really early postpartum. We will talk when we see you,” and no help. I'm like, “Well, that doesn't help me now when I'm not feeling great. It doesn't help me when I'm just like, yeah. They were like, “Most of the time, it will resolve” or whatever. It's like, okay but I'm not happy right now. I'm not feeling great now. So finally, as soon as I did have my pelvic floor PT from before, I emailed her like, “Hey, is there anything you can recommend because I'm not seeing my midwife for a while? No one is really helping me out.” She was like, “Yeah, you can come in. I can't really do an exam yet because you are still so early, but I can see you. I can talk to you. I can look at things and see what is happening.” So that was really helpful. What's interesting is now, I'm however many months postpartum, but even I feel like a month or two when I could go onto my pelvic floor PT, she didn't see any sort of uterine prolapse, but I think I have a slight bladder cystocele so I'm not sure where the uterine thing happened in the beginning of when I delivered and they had said I had uterine prolapse, but now, it looks like it's just a slight cystocele. But what's frustrating about what I've noticed with people with prolapse is a) the grades don't seemingly matter in that you can be a grade 1 prolapse which I think technically I probably am, but if you are having symptoms, then let's get that figured out because so many times, people would be like, “Well, it's not bad” or “I don't even see anything,” but it's like, “Okay, well I am feeling these symptoms and it is mentally causing me– it's making me in my head. It's making me depressed. It's making me upset about my body so let's find someone to actually work on that with me instead of dismissing that was huge because yeah. I don't have a grade 4 prolapse or grade 3 or whatever it is that you consider back, but if it's making my day-to-day and me not be able to do things, then that's a problem. Meagan: Yes. I love that you are talking about that. Women of Strength, at least here in the U.S., take way too long to be checked in on after having a baby. Six weeks is mind-boggling to me. A lot happens in six weeks. We have a lot of hormones shifting. We have a lot of recovering. We have a lot of things that may need to be addressed earlier on or that can start helping us with our mental health. There are so many things. I agree. If you are experiencing any type of these symptoms and your heart is like, “This isn't good or this is affecting me,” reach out to someone. If you're OB or your midwife's office is like, “We'll see you at six weeks,” go to that pelvic floor PT. Review with them. 32:01 Symptoms of uterine prolapseMeagan: I want to talk about some of the symptoms of uterine specifically and what it is. Uterine prolapse occurs when the muscles and tissues in your pelvis are weakened. We know that through childbirth, that happens. We push and sometimes when we push longer hours or whatever, we can weaken that. But most people with uterine prolapse are a little older. They are 50-80 years old but it can happen in childbirth. So here are some of the symptoms. Leaking of urine, inability to completely empty your bladder– so you go to the bathroom, you stand up and you're like, “Oh, there's more,” or you start leaking more. That heaviness down there– so I had a cystocele as well. It's so weird, but I remember wanting to sit on the corner of the couch or on the edge of the couch just to put some counter pressure. Do you know what I mean? Hayley: Yep. Yep. Meagan: That bulging, lower back pain which a lot of the time we are like, “Oh, back pain. We are nursing. We are recovering. We are hunched. Yeah, that's normal.” Lower back pain is not necessarily normal. Aching or feeling that in your lower abdomen or down in your pelvic area and even severe constipation. We know that after childbirth, especially if we have an epidural or we've had a lot of intervention and stuff like that, constipation can happen. A lot of people get iron supplements and stuff like that to have that be lessened, but these are symptoms that truly need to be discussed and not ignored for six weeks because like Hayley was saying, it can start wearing on our mental health. I remember wanting to go out and walk around the block with my kids and just wanting to hold myself down there because it was so bulgy and achy. Hayley: Yes. Meagan: According to a study, it said that around 35% of women who have recently given birth suffer from prolapse. 35%. That's a lot of us, you guys. A lot of people. The cystocele is when the wall between the bladder and the vaginal wall weakens so we can't kegel. It's not tight. It's weakened so it comes down. Again, if you are experiencing any of these symptoms, know that it's not necessarily something you have to just deal with. And yes, it will probably resolve in time, but you could also probably get some help sooner rather than later and help yourself mentally not worry about that. I have a friend who had a pretty high-grade prolapse. She ended up scheduling which is totally fine. She ended up scheduling C-sections for the rest of her births because she was so terrified of having that issue because she did have bladder and fecal issues. When you are peeing and pooping yourself, that's not fun. It's not fun, but you can get the support out there and you deserve the support and you do not need to be pushed off for six weeks. Make sure to follow your heart and get the help you need. 35:29 Prolapse can happenHayley: Yeah, exactly. I think another thing that I would have loved to have known, I feel like no one talks about prolapse. When I went through my pregnancy classes or even just with the doctor or with my midwife, no one ever mentioned, “Oh, this could happen. This could be a complication. This could happen after birth.” No one ever mentioned that to me, so I was like, “I don't even know what this is,” then I felt really alone like, “Why am I the only postpartum person who has this happen?” Meagan: Right or that's just talking about it. Hayley: In reality, I'm not. Meagan: No, you're not. Yeah. There are a ton of risk factors, but giving birth is easily the highest risk. Think about the amount of pressure that we are putting on our pelvic floor and our organs when we are pushing out a baby. I think that is another reason. I know you did this. I know you went to pelvic PT beforehand, but especially if you've had this in the past or you are thinking about this, talk to your pelvic floor PT and say, “Okay. Can you give me some guidance on pushing? Can we talk about how to try to avoid this?” I actually had another client– my other one was just a friend. I wasn't her doula, but this was a client. She had some pretty rough PT things and had to go through a lot of PT. That was her thing and they said, “As soon as you feel this, I want you to change positions. I want you to push differently. I want you to breathe differently.” She believes that her work before and her work during and her different style of pushing helped. Baby came out really fast. She actually didn't have any pelvic issues which was a really grateful thing for her because she had a pretty severe complication. Yeah. It doesn't always have to be that so that was another message. If you have it, it doesn't have to be like that next time or it doesn't mean it's always going to be like that next time. But know that if you are having that, you're probably not the only one. 35% of us, that's a large chunk of people. That's right up there with the Cesarean rate. It's quite high. Hayley: That's true. Meagan: So know that it's okay to talk about it. It's okay to open up. You do not have to deal with it. You can get help and you deserve it. Hayley: Yeah. Yeah. Exactly. I feel like for a while, I just cried to my husband and he was like, “It's okay to feel this way.” Stop blaming yourself. Really getting out of your head. You didn't cause this and yeah. You can absolutely get help. If people are pushing you off, let's find somebody else then who will talk to you in the meantime because your mental health matters. How you are feeling matters because yeah. Now, here I am getting close to a year postpartum and I'm feeling so much better, but it's because I've been listening to my body and I've been working with a PT doing exercises and supporting myself and working on drinking water, not getting constipated like you said and all of these things. Again, were there times in my postpartum journey when I was like, “This is not what I want to be dealing with?” Yes. But you can absolutely– it does get better. If you're feeling this way, it sucks and you feel like it's never going to get better. I get it. I was there, but it really does and you're not the only person. At the same time, I don't want to scare people. This may not happen to you either for sure. But if it does, listen to yourself and you can get help. Meagan: And that's the message, right? It's not going to happen to everybody but it does happen and it's important to know that you don't have to ignore it. You don't have to suffer in silence. You can get help and have a better postpartum. There are tons of things– I think I've talked about this– in my postpartum journey where I was like, “I got the birth I wanted, but I'm so frustrated that these things are happening.” You can also have both of those feelings. You can be super happy for your birth but also really frustrated with your postpartum journey or vice versa where you're like, “I had a really crappy birth, but man, I'm so grateful for this postpartum journey.” You can have those feelings together. You don't have to be quiet because you had the birth that everyone knew you wanted. Hayley: Right, exactly. It doesn't diminish how proud I am of having a natural VBAC and doing that even though at times in the beginning, I did question that. Meagan: Oh yeah. Yeah. That's natural. Hayley: But looking back, I'm like, “That's amazing.” I'm so proud of myself that I achieved a VBAC and had an unmedicated one. It's just crazy to me. Meagan: Absolutely. Well, thank you for sharing your story today. Hayley: Thank you for having me. I know I can talk a lot. Meagan: It was wonderful. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Hearing about risk is hard. Interpreting risk is even harder, but deciding which risks are comfortable for you is an essential part of birth!Meagan and Julie discuss how to tell the difference between relative and absolute risk, and what kind of conversations to have with your provider to help you better understand what the numbers mean. They also quote many stats and risk percentages around topics like blood transfusions, uterine rupture, eating during labor, epidurals, Pitocin, AROM, and episiotomies.  And if you don't feel comfortable with accepting a certain risk, that is OKAY. We support your birthing in the way that feels best to you!Risk of Uterine Rupture with Vaginal Birth after Cesarean in Twin GestationsJournal of Perinatal Education ArticleWhat are the chances of being struck by lightning?Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 02:52 Review of the Week06:08 Determining acceptable risk for you and your provider 08:00 Absolute versus relative risk15:21 More conversations need to happen25:29 Risk of blood transfusion in VBAC, second C-section, and third C-section30:37 Understanding the meaning of statistical significance 32:05 “The United States is intervention intensive” 36:27 Eating during labor and the risk of aspiration under anesthesia43:03 Epidurals, Pitocin, AROM, episiotomies, and C-section percentages44:43 The perspective of birth doulas and birth photographersMeagan: Hello, hello everybody. Guess who I have today? Julie!Julie: Hello. Meagan: Hello. It's so good to have you on today. Julie: Of course. It's always fun to be here. Meagan: It really is. It's so fun. When we sit and chat before, it just feels so comfortable like that is the norm still for me even though it has been a while, it just feels so normal and I love it. I miss you and I love you and I am so excited to be here with you today. You guys, we are going to talk a little bit about risk. We know that in the VBAC world, there's a lot of risk that comes up. I should say a lot of talk about risk that comes up whether it be is it safe to even have a VBAC? Is it safe to be induced? What are our real risks of uterine rupture? Is it safe to VBAC with an epidural or without an epidural? What about at home out of the hospital? Is that safe? I don't know. Let's talk about that today. Julie: Let's talk about it. Meagan: Let's talk about it. I think it's really important to note that no matter what— and we're going to talk about this for sure today, but no matter what, you have to take the risks that you are presented and that is given and still decide what's best for you. That risk doesn't mean that is what you have to or can't do. Right? So I think while you are listening, be mindful or kind of keep that in the back of your mind of, “Okay, I'm hearing. I'm learning.” Let's figure out what this really means and then let's figure out what's truly best for you and your baby.02:52 Review of the WeekI do have a Review of the Week so I want to hurry and read that, then Julie and I will dive into risk and assessing. Julie: Dun dun, we're ready. Meagan: We are ready. Okay, holy cow. This is a really long review, so—Julie: You can do it. Meagan: Thank you to Sara R-2019 on Apple Podcasts for leaving this review. I love how Julie was like, “You can do it,” because she knows that I get ahead of what I'm reading in my mind and then I can't read, so let's see how many times it takes to read this review. Julie: You've got this. Meagan: Okay. It says, “A balanced and positive perspective.” It says, “As a physician myself I think it is unusual to find balanced resources for patients that represent the medical facts but also the patient experience and correct for some of the inaccuracies in medicine. This podcast does an amazing job of striking this balance!“I had an emergency C-section with my daughter 2 years ago. Despite understanding that the CS was medically appropriate and my professional experience, I still found the whole experience to be mildly traumatic and disappointing. This podcast was the main resource I used to help prepare for my second child's birth and my plan to have a VBAC. I am now holding my new baby in my arms with so much pride, love, self-confidence, and trust because I had a smooth and successful VBAC.“I am thankful for this podcast which gave me ideas, confidence, strength, and a sense of community in what is otherwise a very isolating experience. I especially appreciate the variety of stories that are shared, including VBAC attempts that result in another C section so that we can all prepare ourselves for the different outcomes. No matter what happens we are strong women and have a welcome spot in this community, even when we may feel alone with our thoughts and fears. Thank you, Julie and Meagan!Julie: Aw, I love that. Meagan: Yes, that was phenomenal. Congratulations Sara R-2019. If you are still listening here, congratulations and we are so happy for you and thank you for your amazing review. 06:08 Determining acceptable risk for you and your providerMeagan: All right, Julie. Are you ready? Julie: Here we go. Here we go. Can I talk for a minute about something you mentioned before the review? You were talking about risk and how it's not a one-size-fits-all because we were talking about this before. We all know that the uterine rupture risk is anywhere between .2%-1% or whatever depending on the study and what you look at. The general consensus among the medical community is .5%-1% is kind of where we are sitting, right? Now, some people might look at that risk and be like, “Heck yeah. That's awesome. Let's do this,” especially when you look at a lower risk than that that it's a catastrophic rupture. Some people might look at those numbers and be like, “This feels safe. Let's go.” Some people might look at those numbers and be like, “This feels scary. I just want to schedule a C-section.” Meagan: No, thank you. Julie: And that's okay. It is okay. However you approach risk and however you look at it is okay. We're not here to try and sway anybody. Obviously, we're The VBAC Link, so we are going to be big advocates for VBAC access, right? But we're also advocates for having all of the information so you can make the best decision no matter what that looks like. But also, I think another very important part of that is finding a provider whose view of risk is similar to your view of risk so that you guys have a similar way to approach things because if you find a provider who thinks that 1% risk of VBAC is really scary, it's not going to go good for you if you think a 1% risk for a VBAC is acceptable. So yeah, I just want to lay that out there in the beginning. Meagan, you touched on it in the beginning, but I feel like provider choice in risk is really important there. Meagan: It is. Julie: For sure. 08:00 Absolute versus relative riskMeagan: It is and also, one of the things we wanted to talk a lot about is absolute risk versus relative. So many times when people, not even just the actual percentage or 1 out of 5 is shared, it's the way it's shared. The way the words are rolling off of the tongue and coming out can be shared in a scarier way so when we say 1 out of 5, you're like, “Okay, that's a very small number. I could easily be one of those 5's.” It's the way these providers sometimes say it.  A lot of the time, that's based on their own experience because now they are like, “Well, I am sharing this number, but I'm sharing a little extra behind the number because I've had the experience that was maybe poor or less ideal.” Does this make sense? Julie: Yeah. Meagan: Sometimes the way we say things makes that number seem even bigger or even worse or scarier. Julie: Right. It really comes down to absolute risk versus relative risk, right? Relative is your risk in relation to another thing that has risk. Absolute risk is the actual number. It's like 1 in 10. That is an absolute risk. You have a 1 in 100 chance of uterine rupture. That is an absolute risk. Your chance of uterine rupture doubles after three Cesareans. That's not true. That's not true. But that's a relative risk. I really like the example that I feel is really common for people to relate to is stillbirth after X amount of weeks. Evidence-Based–Meagan: That's a huge one. Julie: Yeah, it's a big one that gets thrown around all of the time and it sounds really scary when people say it. I love Evidence Based Birth. They have this whole article about due dates and risks associated with due dates and why due dates should really be adjusted and look at differently. They don't say that. They just present all of the data, but what I really like about that is they have a section here about stillbirth and they talk about absolute risk versus relative risk. I feel like that would be a great thing to start with. I'm just going to read it because it's so well-written. They said, “If someone said that the risk of having a stillbirth at 42 weeks compared to 41 weeks is 94% higher, then that sounds like a lot.” Your risk of stillbirth doubles at 42 weeks than if you were to just get induced at 41 weeks. Your baby is twice as likely to be stillborn if you go to 42 weeks. Meagan: Terrifying. Julie: Okay? 94% higher. That's almost double. That is scary. For me, I'd be like, “Uh, yeah. That is super scary.” Meagan: Done. Sign me up for induction. Julie: Right? Sign me up for induction. But when you consider the actual risks or the absolute risks, let's just talk about those numbers. 1.7 per 1,000 births if they are at 41 weeks. Stillbirth is 1.7 per 1000 births. At 42 weeks, it's 3.2 per 1000 so it's a .17% chance versus a .3% chance so you are still looking at really, really, really small numbers there. So yeah, it's true. 3.2 is almost double of 1.7 if you do the math. Sometimes math is hard so that's fine. We have to get out the calculator sometimes, but while it's true to say the risk of stillbirth almost doubles at 42 weeks, it could be kind of misleading if you're not looking at the actual numbers behind it. So I think that it's really important when we're talking about risks and the numbers and statistics to understand that there are different ways of measuring them and different ways of looking at them and different ways of how they're even calculated sometimes. So depending on how you look at them, you could even come up with different risks or different rates which can really sway your decision. We're not talking about a 5%-10% double which is still true. It's still double, but it's just a really small number. Now, I also want to do a plug-in for people who have been in that .3%. It might as well be 100%. I can't even imagine the trauma of having to have a loss like that. I can't. I have supported parents through that. I have documented families like that and documented their sweet babies for them. I can't imagine the pain that goes with that. But I also think it is very important to look at the actual numbers when you are making a decision. Now, maybe that .32% is too high for you and that's okay, but maybe it's not and that is a risk you are willing to accept. I feel like approaching it like that is so much better. If somebody ever says to you, “This risk of that is double” or whatever, I don't know. I'm just going to make up some random stuff here like, “If you drive in your car to school, you have a 1 in 10 chance of getting in a car crash but if you drive on a Wednesday, your risk doubles so now you have a 2 in 10 chance or 1 in 5 chance of getting in the car crash,” so maybe you would want to avoid driving to school on Wednesdays, but maybe you wouldn't. But if you say you're risk is higher of dying in a car crash if you go to school on Wednesdays, they would be like, “I'm not leaving the house on Wednesdays or ever.” I'm not leaving the house today because it's so dog-gone cold and I'm warm in my blanket. I don't know. I feel like looking at it like that. Actually, 1 in 10 is really high for getting in a car crash, but I don't know. I just feel like looking at that is really important for providers telling you, “Oh, your risk of uterine rupture doubles if we use Pitocin so I'm not going to use Pitocin.” Okay, we're looking at a small increase to an already small risk. We know that any type of artificial induction could lead to an increased risk of uterine rupture especially if it's mismanaged, but what we do know is that it's not– I don't want to say that because that might be wrong. When you are presented with the actual numbers, yes. It might double. I don't know what the actual numbers are, to be honest off the top of my head. I feel like maybe it doubles, but if you are already looking at a .2% to a .4% or a .5% to a 1% chance, what's the tradeoff there? What are your risks of just scheduling a repeat C-section instead of doing an induction? Is that worth it to you? What are the risks associated with repeat Cesareans? Are they bigger than that of using Pitocin to induce labor? What is that compared to the other one because there is another that is relative risk? The absolute risk is what the percentage is. I'm not even going to say the number. But if there's a risk of rupture using Pitocin relative to the risks that come with repeat Cesareans, those are risks that are relative to each other, so how does that compare? Because when we talk about it in just that singular form or that singular amount of risk without considering the other risks that might be associated with it because of the decisions we made from that risk– am I making sense here? Then you know, I don't know. I feel like there is just a lot more conversation to have sometimes when we are talking about risk. 15:21 More conversations need to happenMeagan: Yes. There are. There is a ton more conversation and that is what I feel like we don't see happening. There's a quick conversation. Studies show that 7 minutes are spent in our prenatal visits which is not a lot of time to really dive into the depths of risk that we are talking about when we say, “We can't induce you because Pitocin increases–”. This is another thing I've noticed is significantly. You have a serious–. Again, it comes down to the words we are using. Sometimes in these prenatal visits with our providers, we do not have the time to actually break down the numbers and we're just saying, “Well, you have a significantly higher risk with Pitocin of uterine rupture so we won't do that.” When we hear significantly, what do we do? We're like, “Ahh, that is big.” You know? Julie: Yeah. Meagan: We're just not having the conversation of risk enough and again, it's kind of being skewed sometimes by words and emotion. We were talking about this before. I remember we made a post– I don't know, probably a year and a half ago maybe. It seems like a while ago about the risk of complications in a repeat Cesarean meaning you have a C-section and then instead of going for a VBAC, you go for a repeat Cesarean which as you know, if you've been with us, is totally fine and respected here from The VBAC Link. A lot of the time, we don't talk– and when I say we, I mean the world. We don't talk about the actual risk of having a repeat Cesarean, right? Don't you feel like that, Julie? I don't know. As a doula, I feel like our clients who want to go for VBAC know a little bit more of the risk of having a VBAC, but they have not been discussed at all really with the risk surrounding a repeat Cesarean. We made a post talking about the risks of repeat Cesarean and I very vividly remember a lot of people coming at us with feeling that we were fearmongering.Julie: Or shaming. Meagan: Shaming, yep. A lot of people were feeling shamed or disrespected. People would say, “You claim to be CBAC supportive, but here you are making these really, really scary numbers.” Anyway, looking at that post and going into what we've talked about, in some of those posts, we did say things like, “You are going to have a 1 out of 10 chance of X, Y, Z,”Julie: Or twice as likely to need this. Twice as likely to need a blood transfusion or 5x more likely to have major complications. Things like that. Meagan: Yeah. We would say things like that. I remember specifically in regards to miscarriage. It's a very, very sensitive topic, but there are risks there. So a lot of people were triggered. In the beginning, we talked about the way providers say things and the way they put them out on paper and the absolute risk versus the relative and way they do that. We're guilty of that too. Right here at The VBAC Link, we were like, “This is the chance. These are the chances. You are 5x more likely to X, Y, Z.” So know that I don't want to make it sound like we are shaming anybody else for the different ways that they give the message of risk. Am I making sense? Julie: Yeah, and you know what? I feel like sometimes it's just about giving people the benefit of the doubt. We want to give providers the benefit of the doubt just because it's probably something that they've continuously heard and spoken and that's okay because we do it too sometimes. We go on that thing like, “Oh my gosh, maternal death.” I think the risk of maternal death is 10x higher in a C-section than it is in a VBAC which sounds really scary and makes me never ever want to have a C-section again, but when you look at that, it's .00001% to .0001% or whatever is 10x more. It is such a small level of risk, but it is higher. I feel like trying to look at both absolute and relative risk for any given thing together is really, really important. Yeah. Give people the benefit of the doubt. Give us the benefit of the doubt. We are in such an awful cultural climate right now where it's easy for people, especially on social media to jump on the attack train for anybody when we feel triggered or when we feel like people are being unjust to us or to other people and I hate that so stinking bad. Whenever I catch myself with those feelings, I try to take a step back and I've actually gotten pretty good at that, but it's so easy for us to get on that bandwagon of just railing against people who present information in certain ways or railing people without getting all of the information about that person.Before I go off too much on a soapbox in that direction, yeah. I feel like your provider when they are saying those things is probably not trying to coerce you into anything. Our providers, especially our hospital providers are incredibly overworked. They are incredibly stressed. Their time management skills have got to be off the charts because they are so overloaded with everything and they just don't have time to automatically sit down and explain things. But you know what I have found? Most of them, when you stop them and ask questions, they are more than happy to answer and explain. Sometimes, they are just repeating things they have heard all the time or that they have learned at some point or another without giving them a second glance. Do you know what? We all do that too. Me, Meagan, you listening right now. We all do that. We hear things. We regurgitate them. We hear things. We regurgitate them and we don't even think about questioning or challenging those things until somebody else brings it up to us to question or challenge those things. So, don't be afraid to ask your provider for more information or ask them what the real numbers are to those things. I have a really special place in my heart for our CBAC moms because there are lots of things that they are working through, so many emotional things, but I challenge not just people who have had a repeat Cesarean that was unwanted, but people just in all life, when something triggers you online, stop and explore that. Stop and question because that is probably an area of your life that you could use a little healing and work on. It could be a little bit of work. It could be a lot of work, but usually, when something triggers you, it's a challenge to look into it more because there is something that your body and mind have an unhealthy relationship with that needs to be addressed. Julie: Anyways, circling it back to risk. Meagan, take it away. Meagan: I just want to drop a shameless plug on our radical acceptance episodes that we did, so kind of piggybacking off of what she just said. We dive into that a little bit deeper in our radical acceptance episode. It really is so hard and like what she said, our heart goes out to moms that have a scheduled C-section that didn't want to schedule a C-section or felt like they were in a corner or felt like that was the best option, but not the option they wanted. There are so many feelings, but definitely go listen to radical acceptance part one and part two. 25:29 Risk of blood transfusion in VBAC, second C-section, and third C-sectionMeagan: I just want to quickly go down a couple of little risks. Blood transfusion– we have a 1.89% or 1 in 53 chance of a blood transfusion with a VBAC. To me, 1.89% is pretty low, to me, but it might not be to some. I don't know, Julie. How do you say the other? Okay, then blood transfusion in a repeat Cesarean is 1.65% in the second C-section. It's lower. So for vaginal birth, it's higher. I'm not good at math. Julie: No, vaginal birth, yeah. That's true. So 1 in 53 for VBAC versus a 1 in 65 for a repeat Cesarean. Yes, right. Meagan: For a third Cesarean, the chances of a blood transfusion go to 2.26%. Julie: Yes, so it's like 50% higher than if you have a VBAC for the third Cesarean, but it's slightly lower for the second C-section. See? I feel like we could have talked about this before, but I don't know if we say it often enough. When you are talking about overall risk for VBAC versus C-section, when you are looking at just the second birth, right? So first birth was a C-section, what are you going to do for your second birth? The risks overall are pretty similar for vaginal birth versus Cesarean. The overall total risk is pretty similar as far as your chances of having major complications and things like that. But when you get into three, four, five, six C-sections and vaginal births, that's when you really start to see significant changes in those risks. See? I used the word “significant” again, but we're going to talk about where the more C-sections you have, the higher your chances of having complications you have. The more vaginal births you have, your chances of complications actually go down. So when you are looking at if you want more than two kids, that might be something that you want to consider. If you are done with two kids, then that might be something that is not as big of a player in your choices. So yeah. Meagan: Yeah. Then there are things like twins. So when I was talking about it earlier, the word significantly, there was a systematic– I almost said something– systemic. Julie: Systemic review? Meagan: Yeah, see? I can't say it correctly. I can't. Published– oh, I'm trying to remember when it was published. We will get it in the show notes. It talks about the risk of uterine rupture with twins and it does say. It says “significantly higher in women with twin gestation”. That's kind of hard, I feel like because again, like we were saying, some reviews and studies and blogs and all of these things wouldn't say the word significantly. They may share a different one. I'm going to see if I can find the actual– maybe Julie can help me while I'm talking– study. Okay, it says three out of four studies in a group of zero cases of uterine rupture. Notably, the study with the largest patient population reported cases of uterine rupture in both groups and demonstrated a significantly greater risk of uterine rupture in the VBAC group. Meanwhile, the other three studies found no significant difference between rates of uterine rupture among groups 31-33. Nevertheless, the study shows that electing–”Okay, so I'm just going to say. It says, “Electing to have a PRCD reduces but does not eliminate the small risk of uterine rupture.” So what I'm reading here is that in some of them, it showed significantly greater, but then in 3 out of 4 reviews, and I don't even know actually how many people were in each of these reviews, but in 4 reviews, one had a greater risk and three didn't really show much of a difference, but we see that in the very beginning right here. “Uterine rupture is significantly higher in women with twins.” What do you think? If you are carrying twins and you see that, Julie, significantly higher enters into the vocabulary at all, what do you think?Julie: Well, I think I would want to schedule a C-section for my twins, probably. Meagan: Probably. 30:37 Understanding the meaning of statistical significance Julie: I want to just go off on a little tangent here for a second. I think it's really important when we are talking about studies that we know what statistically significant means because sometimes if you don't know much about digging into studies and things like that which I'm not going to go into too much right now– Meagan: It's difficult. Julie: It is difficult. It's really hard which is why I'm not going to go into it because I feel like we could have a whole hour-long podcast just for that. Statistically significant really just means that the difference or the increase or the change that they are looking into is not likely to be explained by chance or by random numbers which is why when you have a larger study, the results are more likely to be statistically significant because there is less room for error basically. A .1% increase can be just as statistically significant as a 300% increase because it just comes down to whether they are confident that it is a result that is not related to any chance or external environmental factors. I feel like it's really important to clarify that just because something is statistically significant doesn't mean that it's big, catastrophic, or a lot, it just means that it's not likely to be due to chance or anything random. 32:05 “The United States is intervention intensive.” Meagan: Yeah. I love that. Okay. There was one other thing I wanted to share. This was published in the Journal of Perinatal Education and it is a little more dated. It's been 10 years or so, but I just wanted to read it because it was really interesting to me. It doesn't even exactly go with risk and things, but it just talks about your chances which I guess, to me– do you know what I”m trying to say? Julie: They kind of go hand in hand. Meagan: To me, at least, they do. So when I read this, I was like, “Well, this is interesting.” I just wanted to drop it here and I think it's more just eye-opening. It says, “Maternity care in the United States is intervention intensive.” Now, if we didn't know this already, I don't know where I've been in the doula world for the last 10 years. Right? You guys, as doulas, obviously, we're not medical professionals, but as doulas, we see a lot of intervention and a lot of intervention that is completely unnecessary and a lot of intervention that leads to traumatic birth, unexpected or undesired outcomes and then they lead to other unnecessary interventions. It's the cascade. We talk about the domino effect or the cascade of interventions, but this is real so for them to type out, “Maternity care in the United States is intervention intensive–”Julie: You're like, “Yeah, where have you been?” Not you, but the writer. Meagan: Yeah, the writer. Yeah. It says, “The most recent national survey–” Now, again keep in mind it is 2024. This has been a minute since this was written. Julie: About 10+ years. Meagan: 10-12 years. Just keep that in mind. But it was interesting to me that even 10-12 years ago, this was where we were at because I feel like since I started as a doula, I've seen the interventions increase– the inductions, the unnecessary Cesareans increase a lot. Julie: Some of them, yeah. Yeah, especially inductions and Pitocin. Meagan: Not all of the time. I cannot tell you that in 10 out of 10 births that I attend, this is the case but through the years of me beginning doula work and what I have witnessed, it's increased. At least here in Utah, it seems that it has increased. It says, “The most recent national survey of women's pregnancy, birth, and postpartum experience reports that for women who gave birth in June 2011-2012,” so a little bit ago, “89% of women experienced electronic fetal monitoring.” Okay. Julie: That seems actually low to me for hospital births. Meagan: It does seem low because to me–Julie: I wonder if there had been a ton of stop and drops or something. Meagan: I don't know, but I agree. 89%. I feel like the second you get into the hospital, no matter VBAC or not, they want to monitor your baby. Julie: Strapped onto the monitor, yeah. Meagan: It says, “66% continuously.” So out of the 89%, it says 66% were continuously meaning they didn't do the intermittent every 30 minutes to an hour checking on baby for a quick 15 minutes to get another baseline, they just left that monitor on them which makes me wonder why. Usually, when a client of mine goes in and has that, they're like, “Oh, your baby had a weird decel so we are going to leave the monitor on longer,” and then they don't say anything. They just keep it on there. Maybe that's– I don't know. It says, “62% received intravenous fluids.” Julie: IV fluids. Meagan: Which to me, is also a lot. 36:27 Eating during labor and the risk of aspiration under anesthesiaMeagan: “79% experienced restrictions on eating.” 79%. You guys, we need to eat. We need to fuel our bodies. We are literally running a marathon times five in labor. We shouldn't be not eating, but 79% which doesn't surprise me, and “60% experienced restrictions on drinking in labor.” Why? Why are we being restricted from drinking and eating in labor unless we have other plans for how labor may go? Julie: That's exactly what it is. They're preparing you for an emergency Cesarean. That's what they're doing. That's exactly what restricting non-IV fluids is. It's not only that, but it is preparing you for the incredibly low risk of you having to go under general anesthesia, and then even people that go under general anesthesia have an incredibly low risk of aspirating and that is what it's coming down to. Don't even get me started on all of the flaws in all of the studies that went over aspiration during general anesthesia anyway because they are so significantly flawed that we are basing denying women energy and fuel during labor based on flawed studies that are incredibly outdated and on incredibly low risk during an incredibly already low risk. I mean, you probably don't want to down a cheeseburger while you're having a baby. I don't know. Maybe me. Just kidding. Even I didn't want a cheeseburger, but I wanted some little snacks, and some water to keep you hydrated. Yes. Oh my goodness. Let's please stop this. Sorry. Stepping off the soapbox. Meagan: You know, there is a provider here. I actually can't remember her name. It was way back in the beginning of my doula career and actually, it was in an area that is not one of my more common areas to serve. It was outside of my serving area. Anyway, we were at a birth and there was an induction. I remember being in there with her and the provider, an OB, walks in and is like, “Hey, how are you doing?” He was so friendly and kind and asked some questions like, “How are you feeling? What are you thinking about this?” Then she was getting ready to leave and she turned back and said, “Hey. I just thought about this. Have you eaten anything?” The mom was like, “No.” She was like, “Uh, you need to eat.” Julie: Yeah!Meagan: She had an epidural at this point. The mom was like, “Wait, what?” She was like, “You need to eat.” I literally remember my jaw falling, but had to keep my mouth up because I didn't want to look like I was weird. Anyway, I said, “That's something I've not usually heard from an OB especially after someone's had an epidural.” She was like, “Oh, I am very passionate about this.” She was like, “When I was finishing up school and graduating,” she had to write some big thing. Julie: Her dissertation probably. Meagan: Time capsule, I don't even remember what it was called. Some really, really big thing. She was like, “I specifically found passion about the lack of eating and drinking in labor.” She was like, “I did all of this stuff and what I found was you are more likely–” Here comes risk. “You are more likely to be struck in the head twice by lightning–” This is what she said. “Twice by lightning than you are to aspirate in a Cesarean after having an epidural.” Julie: I love this lady. Who is it? Meagan: I can't remember. I will have to text my client. Julie: Where was it? What hospital? Meagan: It was up in Davis County. Julie: Oh, interesting. Meagan: It was not an area for me. I said, “Whoa, really?” She said, “Yeah. You need to get that girl some food.” I was like, “Done. 100%.” Julie: More likely to get struck by lightning. Meagan: More likely to get struck by lightning twice in the head than you are to aspirate in a Cesarean after receiving an epidural. That stuck with me forever. Literally, here we are 10 years later. Julie: I love that because first of all–Meagan: I don't have documentation to prove that. She just said that. Julie: That is 100% relative risk. Aspirating during a C-section relative to getting struck by lightning twice. So that's cool. What are the numbers? I know that the numbers are super incredibly low and I feel like when you put in context like that, getting struck by lightning twice, I don't know anybody that's been struck by lightning once and who has been alive to tell about it. I know of a friend whose sister got struck by lightning and died when she was very young. I only know one person in my entire life who has been struck by lightning. Meagan: I just looked it up really quick. I don't even know if this is credible. I literally just looked it up really quickly. It says that the odds that one will be struck by lightning in the US during one's lifetime is 1 in 15,300. Julie: Wow. Meagan: Okay. Julie: So twice that is 1 in 30,000. That's a freaking low risk. Anyway, what I'm saying is that I love that OB first of all. I feel like from what I've read about aspiration under general anesthesia during a C-section seems right in line with those numbers and those chances because it's so rare, it's almost unheard of especially now with all of the technology that we have. It's fine because I'm not going to go on that soapbox. I love that. I love that analogy and that we're talking about that because 10 years from now or when our daughters are having babies, they're going to talk about how their poor moms couldn't eat when they were in labor because of the policies just like we talk about the twilight sleep and how our poor grandmas had to undergo twilight sleep when our moms were being born. I feel like that's just going to be one of those things where we will look back and be like, “What were we thinking?” 43:03 Epidurals, Pitocin, AROM, episiotomies, and C-section percentagesMeagan: Okay, I'm going to finish this off. It says, “67% of women who gave birth vaginally had an epidural during labor and 37% were given Pitocin to speed up their labors.” Sorry, but come on. That also may go to show, that we're going to do an epidural episode as well, that epidural maybe does really slow down labor. Maybe it really does impact the body's response to continuing labor in a natural way, so 31% of those people had to have help and assistance. It says, “20% of women had their membranes artificially ruptured,” which means they broke your bag of water artificially with the little whatever, breaking bag water hook thing versus it breaking spontaneously. Julie: Amniohook. Is it an amniohook? Meagan: Amniohook, yeah. “17% of women had an episiotomy.” I don't know. Julie: I feel like those numbers are probably lower now. Meagan: I think that's changed, yeah. “31% had a Cesarean.”Julie: That is right in line with the national average. Meagan: It is, still. “The high use of these interventions reflects a system-wide maternity care philosophy expecting trouble. There is an increasing body of research that suggests that the routine use of these interventions rather than decreasing the risk of trouble in labor and birth actually increases complications for both women and their babies.” 44:43 The perspective of birth doulas and birth photographersJulie: I believe it. Do you know what? Can I just get on another tangent here because I know that you all love my tangents? I really wish that somebody somewhere would do something and I don't know what that something is, to get the voices of birth doulas and birth photographers heard because this is why. Doulas and birth photographers– I've said this before. We see births in all of the places. We have a really, really unique point of view about birth in the United States because we attend births at home. We attend unassisted births. We attend births at home with unlicensed providers. We attend births at home and births at birth centers with licensed providers. We attend in-hospital births with midwives and we attend in-hospital births with OB/GYNs and some of us are lucky enough to attend out-of-hospital births with OB/GYNs because there are a handful of them floating around. We see birth in every single variety that it takes in the United States. I really wish that someone somewhere would do something to get those voices lifted and amplified because I feel like yes, a lot of that is going to be anecdotal, but I feel like the stories there have so much value with the state of our system in the relationship between home and hospital birth, how birth transfers happen when births need to be transported to hospitals, the mental health of the people giving birth, the providers and the care, and all of that. I feel like, like I said, somebody should do something to do something with all of that information that we all carry with us. I think it could provide so much value somewhere, right? I don't know what yet, but if anybody has an idea, message me. Find me on Instagram at @juliefrancombirth. Find me. Message me if you have any ideas. Maybe write a book or something. I don't know. Meagan: I've wanted to do an episode and title it “From a Doula's Perspective”. We could do that from a birth photographer and all that, but it's crazy. It's crazy. Julie: We see it all. Meagan: There was a birth just the other day with one of our sweet, dear clients where the provider was saying things that seemed scary even though the evidence of what was happening was really not scary, went into a scheduled induction, and the way they were handling it, I felt so guilty as a doula and I was like, “This is going to turn Cesarean. This is not good.” Sure enough, it did and it broke my heart because I was like, “None of that needed to happen,” but again, it goes to us deciding what's best for us. That mom had to decide what was best for her with the facts that we were giving, what the doctor was giving, and all of these things. Again, we don't judge anyone for the way they birth, but it's sometimes so hard to see people not get the birth they wanted or desired, or to have people literally doubt their ability because someone said something to them. Julie: Yeah. Meagan: You know–Julie: Yeah. I agree. It's just interesting. Anyways. Meagan: We are getting off our topic of risk, but risk is a hard conversation to have because there are different numbers. It can be presented differently and like I said, it can also have a tone to it that adds a whole other perspective. So know that if you are given a risk, it's okay to research that and question it and see if that really is the real risk and if that's the evidence-based information. We like to provide them here like we were saying earlier. We may be guilty and I hope you guys stick with us if we share some that might be a little jarring on both sides of the VBAC and C-section, but we love you. We're here for you. We understand risks are scary. They are also hard to break down and understand, but we are here for you. I love you guys and yeah. Anything else, Julie?Julie: No. I just want to say be kind to each other. Give each other the benefit of the doubt. Do everything you can to make the best decisions for you. Trust your intuition and find the right support team. We're all just trying to do our best– us at The VBAC Link, you as parents, providers as providers, and if you feel like you need to make a change, make it. Meagan: Make it. All right, okay everybody. We'll talk to you later. Julie: Bye!ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Dr. Natalie Crawford answers your voicemail questions specifically about the uterus and fallopian tubes. Questions answered: Given my history with D&C, Uterine septum and abnormal semen analysis, should I do IUI or IVF? I have a unicornuate uterus and PCOS. I just had a failed IUI. I want to go straight to IVF but worry about ovulating on one side. My friend was told her Fallopian tubes have alternating blockage. Her doctor recommends a procedure to fix this and I was wondering what your thoughts were on this procedure.  What causes calcification in the uterus? I just had surgery to remove stage 1 endometriosis and my husband and I are TTC. What supplements do you recommend? We have moved Fertility In The News to the weekly newsletter in order to keep the podcast more evergreen. If you want to sign up go to nataliecrawfordmd.com/newsletter to sign up! 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: Apostrophe- Get your first visit for only five dollars at Apostrophe.com/AAW or use the code AAW at checkout. 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. 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