#66 | Informed Pregnancy: Interview with Dr. Elliot Berlin

Dr. Elliot Berlin is a chiropractor and doula who has a knack for getting babies to assume the best position for birth.  He's become an integral part of the Los Angeles county natural birth community and is the host of the Informed Pregnancy Podcast.  He believes every woman should have the birth they desire and provides the tools and knowledge he feels make all the difference. In this episode with Elliot, we discuss women's choices when it comes to birth, and the variance in care among providers. Can a breech baby be born vaginally? (Yes!) Does he think all providers should be supportive of VBAC (yes!) Can emotional support and physical skeletal and fascial release make all the difference in a woman's birth outcome? You get the idea...tune in to hear Elliot's take on pregnancy and birth, and his thoughts around providing women with the support, space and respect they deserve.

Spinning Babies - Gail Tully's fetal positioning resources
Colleen Myatt - doula referenced in episode

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Transcript

Their training says letting nature have its way is dangerous. The training is what's the five worst things this can become? And how do we intervene early and often to prevent that from happening. And they, they're not really trained to think of the interventions as having a downside.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Why don't we start the episode with you telling us a little bit about your background and how you got into the work that you do.

Okay, that's great. Thank you for having me. Yeah, I was seven years old. What happened is I walked into a building in Manhattan, I grew up in New York. And there were a whole bunch of people doing a CPR class. And I was completely mesmerized by the whole thing. I said to my parents, what are they doing to that poor girl who has no arms and no legs, and they're just beating her up. And then they explained to me what it was. And I was just blown away by the fact that you can use your body to be somebody else's heart and lungs. And it really planted a seed in my head, like I want to use my life to help other people, you know, in similar way. So I personally medicine from that age. Like I think two years later, maybe it was nine or 10, I started my first CPR class. And then I did first aid in responding to emergencies in lifeguarding. And eventually when I was in high school, my senior year of high school, I did EMT training in New York State. And then I became an EMT, I started working in ambulances and emergency rooms. And when I started college, I started doing pre med, and I wanted to go to medical school. When I was in college, my father died suddenly of a partially of a medical mixup. And it gave me even more respect for how powerful drugs and surgery are. But also made me want to be on the other side, meaning holistic health care working with the body instead of against it. When possible, it's again, I have a tremendous amount of respect for drugs and surgery in the place that they have. But I also think they can do a lot of harm in addition to doing a lot of good. And they're generally not the greatest first line of approach, you know, the entry line of treatment. So I kind of took a year off and explored a bunch of alternatives. I fell in love with Chiropractic and massage. To me, they really go together, you have a musculoskeletal system, not just muscular or skeletal. And I went to school separately for both and share the solution together with the peanut butter and chocolate of holistic health care. And you know, my wife, we met young in summer camp, and we got married a couple years later. And she was in grad school at the same time with me. And we moved out of New York to Georgia for grad school. And she studied psychology. She's an amazing listener and talker and just really great at helping people process what's on their mind. After grad school. One more at the end, we're like, hey, let's have a baby. So we follow the instructions and no baby came out sadly. So we ended up going down this kind of evil path of fertility treatments. Medically, even though we were pretty young, and we exhausted everything they had and about three years time and also ironically, everything we had, we had nothing left. And they had nothing left to offer. And so they said just you guys should explore alternative pathways to parenthood. And we were just literally broke No, no money. No our relationship was was not good. Our individual selves were were broken. And so we just said, You know what, we're young, let's take some time and just fix ourselves. And we really did a lot of things we start eating better. We were in Nebraska, this time for her internship. And so they have hundreds of miles of these beautiful bike trails. And so we would go bike riding for hours together and started to meditate a little bitch and Chinese medicine and, you know, nine or 10 months later we were just finally ready to talk about should you know, should we look at adoption or other egg donation? I don't think we really had embryo donation as a choice might have been an option if it had been available. And either way it just as we started to talk about it. We found out we were pregnant. Mostly she was pregnant. And we

I couldn't agree more.

Yes and a second Anyway, so So yeah, every two years after that another baby popped out like we couldn't turn it off. And when we moved to Los Angeles, we opened up a practice mind body, and together and it was general health and wellness with an eye on boosting natural fertility. And the first year, we were able to squeak out a couple of days for clients. And every year after that, it just snowballed more and more pregnancies. And that's how we both ended up in focusing on pregnancy.

And you're also a doula. So can you tell us a little bit about that?

Yeah, so I mean, I'll be the first one to admit it's a little weird to have a male doula or for a guy to even be a doula, but it kind of for all the people I know, that are male, doulas, it kind of evolves. So I do massage and, and chiropractic care, I spend a lot of time with each of my patients and every visit. It's not like typical chiropractic that's fairly quick in and out. And we do a lot whether they're coming in for symptomatic things, or positioning things or just getting ready for birth and recovering. We do a lot when spend a lot of time together. And so I'm on the journey with my clients oftentimes. And in the earlier stages, I would just see that people go in with a with a plan and do so many things during the pregnancy to stay and be healthy, whether it's working out or yoga or meditation or drinking things that look very, very green to me. And then they go in with this mindset of I want this natural, unmedicated, uninterrupted birth, and oftentimes come out with a completely different story. So part of me, that's how I got involved in in the idea of informed pregnancy trying to help people research and understand the choices and, and how the choices will affect the outcome. Earlier on before you know so I just kept hearing people say I didn't even know that was an option or things like that. But what happened for the doula care is I just, I do a lot of work with positioning. So at the end of pregnancy, when our assumption is babies want to get into the same position we'd like them to get into. And if they don't, there's something blocking, it could be structural, which I can't control, but it could be functional, so low back hips and pelvis, very stiff, tight and rigid. It could make an environment where the baby doesn't have free movement where the body's resisting those movements instead of at least accommodating if not facilitating those movements. And so, a midwife called me one time from birth on a Sunday. I remember because we were at Petco with whole family trying not to buy this guinea pig and the midwife was like, Hey, you know how you can sometimes open things up and breech babies turn? Head down? Can you do something similar for poster babies like to see if they can help rotate the skull off the spine? And I said, I would just do the same thing, you know? And she's like, great, I got a patient for you. I'm like, awesome. I have a spot on Tuesday. And she's like, no, right now, you got to come to Santa Monica. We are in the middle of this birth, it's been going on for 24 hours, she's stuck at nine centimeters for eight hours. baby's not in a great position. You got to come in here. And I was like, Oh, great. We're definitely not buying this guinea pig. So thank you. And I drove over there. It's the first time I went to a birth that was a kid that wasn't like my own birth. So it was a little, like already kind of strange for me. I had never met this couple before. So that was even stranger. I kind of went in there and she was high as a kite on her own drugs. You know, she was just literally Hi. And I was sort of trying to do informed consent. Hi, I'm Elliot brilliant. I'm a chiropractor, massage therapist. My goal is to like massage you and loosen things up. And these are some of the pros and cons risks and benefits. You know, do you want to do it? And she was like, I love you, Mr. Berlin. And I was like, I think that's a yes. You know. And, and to make it even weirder, they were filming this birth for a documentary, which they also didn't tell me before I got there. So they're like six cameras set up everywhere. And all I could think about for the first 20 minutes is like, how does my bald spot looking camera.

So when you said she was hot, she was high.

I can't describe it any other way. It was just in part with the surges coming, you could see that there was discomfort, there was an intensity, but that the intensity was at least split in half between pain and pleasure. And it was like our and oh, at the same time.

Yep.

And that would happen with the massage too as we dig into like her hips and her piriformis and all the things that was very, very fit. But it's not just that she had strong muscles that were also really tight, and that creates such a rigidity. And perhaps why would the baby couldn't turn after about two hours of digging in and melting things away. The baby did clunk into place. She felt the baby move right into place. And she said, some kind of expletive and then she said I think you just saved the birth and then 40 minutes later the baby was out. And that's how I started going to birth after that story came out. Other people would be like, Hey, we have this woman she's having Really bad back labor, she doesn't want to have medication, can you come over maybe help her bad. I just ended up with all these births doing massage and chiropractic not really do the work. But once in a while, get to a birth where it hadn't been going on for a long time, sometimes days. And as soon as I got there, everybody else would just like disappear all the other support people and go take a nap. And I'm alone with this laboring person who I'd never met before, sometimes one in particular in my mind, where it was kind of similar. I went in there, and they literally ditched me the minute I got there. So the midwife and assistant, they didn't even come in with me. They're like, She's over there. They've been up for two days. They just went to sleep. I walked in, and there's a guy and he's like, are you Berlin? Like, yeah, he's like, Oh, thank God, I'm gonna go get some smokes. And he laughs and then it's just me and this lady. And again, I tried to do in form consensus, sort of in a child's pose. I can't even see your eyes. And I'm giving her the informed consent, but it's sort of like you're on the phone and you're not sure if the other person got cut off or not because it's so quiet. And but she's right there. And I'm telling her everything. And then just silence and like, I can't do anything in my mind. I can't do anything until I get some kind of Yes. And so I waited and I said, you know, is everything okay? And then she finally picked her head look straight into my eyes. She like the greener side. You can't forget them. And she said, but I just threw up all over the place. And I was like, Oh, nice to meet you. I'd never even been it was at a birth that I'd never been to the verse and I'm like looking in all the cabinets. Like, where are the other sheets and linens and like, anyway, things started to pick up eventually once we got our group going, and then as labor would really kick into a more active productive pattern, perhaps transition, she's looking at massage, she's holding on to the tablet, massaging her back and hips and she's like, Hey, can you say something you know useful to me and helpful to it's getting kind of intense I'm like, I don't know I just rub stuff in crackling so I was like, You know what, if I'm gonna be at these births, I should do some doula training just so that, like I could be a little more helpful in these awkward situations. So

you say know where to find the sheets when you need them? Exactly like

things secrets like that. And other secrets like am I supposed to if I'm in the hospital, or do I like I got a do I use their bathroom? Or do I go find something like all the scribbles of birth, that I had no idea anyway. You know, I did the doula training with Ana Paula Markel here in Los Angeles. She's amazing. She trains a lot of doulas and my wife was like, You know what, I should come do it with you. And we did it together. And it was fantastic. My favorite part was all the role playing where at some point I was the laboring woman, my wife was my doula. She did a great job, I gotta say. And then yeah, our third partner was the annoying mother in law. So that was a great scenario.

The perfect trio.

I had a client in labor this week for about two days. And I was in contact with her husband a lot. And at one point, I reached out to my mentor, who is Nancy Waner in Boston. She's the midwife who coined the acronym VBAC in her book, silent knife in the 80s. And Nancy said, when a labor lasts that long, it's an indication of fetal positioning. We just had Gail tolia, on the podcast last month. And I wish Yeah, and I wish I had asked her that question, because I know there's I'm always saying that childbirth is we're trying to turn this art into a science by having expectations of how it should progress. But that was the first time in all my years that anyone said, if a labor lasts long, it is necessarily a fetal positioning matter, because I know some labor's you know, just that art of childbirth can cause it to last a long time, being someone who's in the room who can affect the outcome and the trajectory of birth. What's your opinion on that? I don't know if we can ever get to facts. But do you have the same theory that a long labor is necessarily a fetal positioning matter?

I think I could never say with that much confidence, that that's always what's happening. But I think that there's a functional issue. When labor goes on that long. You know, I'll give you different examples that just popped into my head, I sometimes see people get a membrane sweep. And it causes contractions to start happening, but the body is not ready yet. And so you could see like three days of prodromal labor that's maybe feels like labor, it's intense, but it's not really doing anything. I don't know that the baby's in the wrong position. Just have some you know, the way I view it after all the births I've been to is, it's kind of like going to open the safety deposit box at the bank, I have my key the branch routers, their key, we both have to turn them before the thing will open up. And so I see it as the baby has to sort of signal I'm ready the body, the mother's body has to say I'm ready and when they're both ready things can happen. If we try like scratching that safe deposit box open before we have those keys in there, it's just like an open. So I think there's a functional thing that takes place there. It's just one example of many where labor can go on for a long time. Maybe in that case, the baby isn't a good position, she's not ready yet. Oftentimes, I do see like a baby, just not, you can see they're not lined up while their head is tilted. So a synthetic, or, or the baby's just rotated in in a position where it's gonna be really hard to push down any further. And in the body work or other things that they do positional changes, other things that we do that get the baby to shift into a better position. Sometimes very clearly, as soon as they shift, boom, things start to pick up and progress. But I think there's other things like sometimes I just see, like, babies in like a position, but you have a bomb, that's just for some reason to resistance, her body's too resistant to let the baby down. Sometimes, I think because of emotional things like extreme fear, and she's grabbing on for dear life, sometimes physical things. Again, I think that athletic pelvic syndrome, which is if you Google it, you're not gonna find it, it's just a term that I'm coining or billing, I don't know. And it's just this combination of really strong, really tight muscles in the low back, glutes, piriformis, hip flexors, adductors, even around like going sometimes, and the abdominal muscles, like, you know, you normally can't feel them after like 32 weeks, but some people, they're super strong, gripping on for dear life. That's a lot for a baby to push through. And you know, and and so the uterus has to work a lot harder, and sometimes a lot longer to get through there. By the way, with that said, sometimes you see these iron, women just pop a baby out really quickly in two or three hours. So there's obviously it's not an all or none. But those are just patterns that I see. And so I think positioning is probably the most common but there's other things that can also make labor go on for a while.

I think I just want to comment on that as well, that it depends aware in labor, the stall happens. So if it's an early labor, I think it is, I mean, it can also be about position in early labor. But later in labor, especially if you're talking about like second stage installing in second stage, it's almost always about position, but also it's an exhaustion. So if somebody is having a prodromal labor that starts and goes on for days and days and days, once they're inactive labor, it's very easy for the uterus to get tired and the contractions to not be as strong anymore. Even if the baby is in a great position, their labor may stall. And then that can result in a swollen cervix, which can become an impediment later. So I will feel better, especially in case that couple is listening. I'll feel better just reporting. What did happen in this case that I reached out to Colleen might who's a doula that I work with who is certified in spinning babies, and she sent over some exercises for the couples to start working on. And they did. But meanwhile, their midwives were saying, take Benadryl and rest because of probably what Trisha is saying, but they didn't want to take Benadryl, they didn't feel comfortable with that approach. So we went the route of giving them exercises to do. And they did end up with a completely natural vaginal birth, about 10 hours after that. So it just did turn out to be a long labor. And we won't know for sure if those exercises were the game changer. But it's interesting to theorize it almost always seems to be one of those two things or a combination of the two. So if you can fix if you can optimize the position through chiropractic massage, presents spinning babies techniques. And if the woman is exhausted, you get her rest and hydrate and fed then your chances are far more successful.

Yeah, hydration was a big part of it, too.

Yeah, but but positioning is it is almost everything. It really is. You know, it always just comes back to trust. I mean, if when when people ask me if there is one thing that they can do to have a successful birth, it is to come to that place in your body where you trust the process. And that's exactly what you were describing is being able being able to move past that fear to allow your body to do the natural work that it can do and to have full trust and its ability to relax and settle into that. Then it just works.

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So your inspiration and love for humanity expanded, obviously, as you started to get into those birthing rooms. Was there another element of anything that discouraged you? Was there a deeper level of anything that led you to a greater longing for change in some way? And if so, what is that longing? What is that change?

Look, it's back to to what I was saying sort of towards the beginning, seeing people plan and really work hard for a healthy pregnancy, a healthy birth, that were the plan was an intervention, no interventions in the birth. So I think most of my patients are pretty open minded. So even when they go for plan a no interventions there, if I need to do this, or that, of course, I will do this or that, but just being let down with their own stories, their own journeys coming out. And, and this is also towards the beginning, before I started, even really going to birds, coming out with a completely different experience, and then not understanding how they got like, hit by this truck, everything was going fine, and boom, all of a sudden things cascaded really quickly. I think the business of being born kind of really helped get a little bit of insight into that. But people come back and ask about VBAC all the time. Can you help me find a doctor who's supportive of VBAC? And I was like, why aren't all doctors supportive of it, but I just didn't get it. It's not my background, my background is emergency medicine. And so I did some research on like, you know, there is this risk of that happening, it seems pretty small compared to other risks. I'm not sure why they wouldn't do that. And you start to do the homework and you realize, like, the politics and the legalities behind why sometimes a choice is taken away from a patient and individual, even though it's as just safe as other choices that they they have risks that we take in obstetrics all the time, that are sometimes greater than that risk. But that particular choice is taken away, because maybe there's more liability, which is risk to your doctor or, or their institution, which is not necessarily increased risk to you. And it just became abundantly clear that if you don't do your own research and your own homework, you're not going to have the full complement of choices available to you. And so that's why I started doing in four in pregnancy started. We wrote a magazine for seven years, on on different topics within pregnancy, childbirth, and postpartum. And eventually that turned into our podcast, the informed pregnancy podcast, but it's not that also never gets old. Just seeing how, how the system disempowers otherwise strong, healthy women, and makes them believe Christ to make them believe you can't do this on your own. We have to do this for you. And I really have no agenda on what choice a person makes. There are a million ways to give birth in this country. You do that in a strawberry field all by yourself. You can do it at home with a midwife without a midwife. You can do it at a birthing center hospital with a doctor and midwife, medicated unmedicated vaginal surgical I it doesn't matter to me, All that matters is that you know what the options are, you're able to get some relatively unbiased information on what the pros and cons are of each choice. And that when you make those choices, you're surround yourself with people who support you 100% and will do as much as they can to help you achieve your goals. And of course, be open minded as things change sometimes, and, and those interventions become incredible. They become lifesaving, they become miraculous, when when needed. But when overused, or pushed on people who don't need them, they become almost tragic.

I've always found the litigation argument, a very convenient excuse. For example, I ended up firing my own obstetrician midway through my first pregnancy. And it was in part because she admittedly had about a 50% scissoring rate. And she listed literally a dozen reasons as to why she gave them she doesn't like if the mother is too old, too young to then do heavy bla bla bla, and she went on and on. And in the end, she said, Cynthia, I'll be honest with you. litigation plays a big role. And you know, at that point, being so uninformed in the field, I sat there and my thoughts were right. She doesn't want to take any chances. She wants a safe outcome. And of course she does. But when you really do the research, it's the unnecessary interventions that actually caused the adverse outcomes we're seeing so much in the US. And that's the trap I think, because we usually end the discussion with well, providers don't want to take any chances. But they are dramatically resulting in so many more adverse outcomes because we're so free with induction when it isn't necessary. Suzanne, a little too quickly before trying some of the measures that you're talking about. I just think that there's another side to that story. And it comes up so frequently. We talk all the time about the impact of society on this podcast. Because even when we had Dr. Neel Shah on the podcast, he was saying that some hospitals in the US have a 7% scissoring rate and some have a 70% is Aaron rate. And even that little microcosm of a culture in that hospital does have an effect on birth outcomes. So I always feel like the two key issues that we're battling in this country with our high maternal mortality rate. Where we have so many other things going for us are a the system, I think we are putting doctors in a very difficult position to do their work, because they have so many conflicts that they have to address and manage. And I think the second is informed choice. I think so many grown adults walk around knowing so many of their rights in this country, but they don't really know their right to informed consent. And that's something that I wish were just absolutely commonplace. A study was done, I think it was 2007. But it showed 73% of women who received an episiotomy did not provide their consent. So it's like, culturally, this is normal.

My feeling is it's always been that the problem with malpractice is not the practice, it's not so much. It comes from the legal side, it comes from the litigation, it comes from the luck comes from the fact that a doctor is protected. If they do Assyrian. They're always protected if they do as a Syrian, even if there's a bad outcome, but they did this this area, and so they're protected. And all the other risks that come with this this area, and all the other interventions along the way, are overlooked, so long as they went to Syria,

so long as it wasn't negligence. Yes.

Well, I mean, I think that's a excellent point, meaning we reward doctors for doing things not for sitting around with their hands in their pocket. So somebody gets induced, even though they didn't really medically necessarily need to be induced if something goes wrong fed induction they could make the argument, hey, she was past her due date, she was late. And if we had let nature have its way there, it would have been much worse. And and that they're likely to get off. They're very defensible. But if they don't induce and something goes wrong, and they're past the due date, that prosecutor comes in, says, hey, look, they were late, you could have helped, we had tools and he didn't use them. So and that's very hard to defend. And so I think you're absolutely right, Trisha that the system is set up that way, they're rewarded for intervening and punished for just letting nature do its thing. I have two, I think telling episodes on our podcast with obstetricians, one of them very recent is an OB who chose to have a Syrian. And she talks about why she chose to have a C section even though she's young, strong, healthy, very physically fit, brilliant girl. She wanted to have a C section. In fact, her water broke and labor started and she's like, oh, maybe I should just have the vaginal birth. And she still went with the C section because of fear, really, her own fear about what would happen if she allowed her body to birth naturally, what could possibly go wrong? Another one that's a little bit older is an OB GYN who scheduled a C section for herself as well. And then midway through the pregnancy, she kind of was wondering she had this is how she put it Why am I cutting a hole in the sheet rock if there's like a functional door for this baby to come out through? And she meditated on it for a few nights and she's like, it's fear. It's just fear. And for both of them, I think more than fear of seeing things go wrong. It's the fear that's placed on them in medical school. It's the model that they've been taught on, trained on ingrained into them. And so she did a epic for our fear release session with a hypnotherapy. hypno birthing hypnotherapy person around here, and she really worked for the rest of her pregnancy on letting go of that fear. She has an incredible birth her experience at the hospital and and if you listen to it, spoiler alert. She has her next two babies at home with a midwife. This ob has her next two babies at home with a midwife. She became the most popular obstetrician for people wanting to natural mind at birth because that fear that she had for herself. She was also bringing to every patient and every birth. And I think that what I'm trying to get at is these obstetricians would do exactly the same thing for themselves or their own daughters. They're doing for other people. I don't think it's like this intention to use sometimes sure how it affects the schedule or how you get paid or how many people you can see. But I think on a much deeper level, they're doing what they think is going to give the best outcome for mother and baby. And

I think it's the system though.

Yes, it is

for sure. They're training says letting nature have its way is dangerous. Every time something goes even close to the edge of the box. She said the training is what's the five worst things this can become, even regardless of how remote it is to become that, and how do we intervene early and often to prevent that from happening. And they're not really trained to think of the interventions as having a downside, exactly as having an upside.

Well, medical school, the the model of care and medical school is that birth is a potentially pathologic process. And more often than not, it is and whereas midwifery school and doula training is the model is that birth is a physiologic process that more often than not goes, right? Yes, you're learning many of the same things. But you're coming from two completely different concepts of how birth is done. And it's particularly it's particularly that way in childbirth, because childbirth is a time of extreme vulnerability, pregnancy, and birth is a time when a woman is extremely vulnerable, and very willing to put her trust in somebody that she believes knows best. So many of the interventions that happen in childbirth and into her in pregnancy are just, women don't even feel that they should have a decision in it. They don't even feel that they that they they just believe that their provider knows best.

And I do I do see that I do you see that when there are someone who do not want to take responsibility for choices. And so they give all of that control over to their doctor. And that's their preference. And then in that case, I think it's fine if that's what you know, if that's really how you operate and what you want, then at least surround yourself with a doctor who is graded and that type of care. But I think that when you go into a hospital to give birth, there's this sense immediately that you're handing over your your choice in decision making to to the hospital, and that is further perpetuated by the little outfit that you get to wear. This, this gown that, you know, barely covers everything and that there's a little gust of wind, you know, you're exposed, and they get these nice lab coats. And you know, it's just immediately you start to feel like, you know, you work for them whatever they want, you have to do, but the truth is in America, it's the exact opposite. We as providers all work for you as the patient. And that's not made clear enough at all. And it's informed consent or refusal. It's you you have the option to say yes, I want to do this or No, I don't want to do this and you can fire your doctor too. I just had a patient who, you know, she she wanted to give birth without without an IV antibiotics. But she tested GBS positive. Her first birth was precipitous labor, and she assumed the second would be pretty quick, too. And she's like, I'm gonna have a very quick birth. I don't want to have IV antibiotics and her doctors like, Well, you know, we could take away we call Child Protective Services, and she's like, but and then she just switched and had a home birth with a midwife, literally last night, and that went going swimmingly?

Well, your example of going to that birth when the woman was bent over in child's pose, and you needed her consent to even lay your hands on her said everything. Because you asked her question she didn't respond and you demonstrated for anyone listening was that in the consent cannot be implied. You waited till you had eye contact till you had a response she threw up all over you wasn't the response, you needed for informed consent, but you were demonstrating that that is what every single provider actually is supposed to do. That would change things that one thing would change everything.

I definitely, you know, it's a learning curve for us as providers. So I definitely have, by being present in some of those situations, have been able to learn, you know, the right way. I think at first sometimes I'm like, I was called to this birth, I'm supposed to do this. You know, if she's not talking to me, maybe I should just jump right in and do it. It's like it takes I don't know, it's a learning curve. But we all get better over time. So learn to wear a moisture wicking shirt now.

That's a good idea.

So you have seen a lot of vaginal, breech births and a lot of vbacs is that correct?

I will for sure. And also some vaginal breech birth after cesarean. So combining the two, I, I wouldn't, I wouldn't say I've seen a lot of Agile reach where it's, I mean, probably more than most people maybe five or six that have been present, but I've seen lots of people come through my office who choose to vegetal beechworth in Amman, the journey within that way and people I mean tons and tons of people here in Los Angeles we have great VBAC resources. And we have also great h back resources. I don't know who coined that term h back, but because it implies that the house has given birth, it's weird. But sadly in California, midwives are no longer allowed to deliver. It's out of the scope of practice to deliver more 10 breech birth. And, and most of the doctors don't do it. But there still are a handful of mostly old timers who do it and the choices are pretty much alive here. And they are selective in who they take. But if there's a good candidate, they will offer the choice and things generally go really well. Can

you tell us a little bit about some of the misconceptions and myths around breech birth?

Yeah, so I'm going to talk about breech birth. It's called heads up the disappearance of the vaginal breech delivery and Dr. Paul crane is probably in his 80s. Now, I'm gonna say and never stopped. He said when he was a resident that just never even cared if it was breech or whatever it was delivered. And so he said, the real secret about breech birth is so simple. They're really they're just not, not a big deal. I think that as the Syrian birth got safer and safer, we started to apply this question of who's going to be a better candidate versus human birth and vaginal birth and in 2001, this study was published the term breech trial that is essentially in a very simplified way took 1000 women who were breaching and sign them up for vaginal delivery in 1000. They had susteren delivery and they just kind of compare the outcomes of the babies after birth immediately after birth, and they found that it was a small but statistically significant better outcome for breech babies born by cesarean than born vaginally and so based on that the United States and Canada made the recommendation that all breech babies should be born by plans this area typically at 39 weeks. Two years later, the same research group from McGill University that did the original study also did a follow up study on the two year olds and to compare the health of the two year olds that they could find from that study. And they found that there was no no long term difference in health. So that's the first head scratching moment and maybe we shouldn't have taken away that option. But then Dr. Glaser Minh, a researcher from Israel, kind of broke down the study and found a lot of problems with the study. First of all, it's done in I think, 28 or 29 countries, some of which don't have an IQ, some of the areas where they were, have no neck you they don't have necessarily ultra sun, there's not a great way to do selective breech delivery, who's a better candidate and less good candidate. And there are definitely there are risks in delivering a breech, baby vaginally number one, if the whole baby comes out in the head gets stuck having travelin as a big deal. Number two is if the umbilical cord comes out first you have an umbilical cord prolapse and then the baby comes out in the cord gets squeezed between the mother and baby. That's a big deal. And those are not risks that don't exist. They do exist. They're part of the risk benefit analysis. But also when you do selective breech delivery, you start to see that some of those risks are higher or lower for different people in different situations at a patient who had two babies vaginally, both seven pounds, both head down and her third baby happened to be breech, and they didn't catch it until 39 weeks, and then they just immediately center it for a C section. I was like wait a second, she's in a frank breech position. So the butt is down, which typically blocks the cord from coming through mitigating that risk of prolapse. It's also you know, if there's a foot dangling down there, the foot can kind of come through before the cervix is fully open, and setting you up for a better chance of heading treatment. But also she had two babies come through her body, this baby was measuring the same seven pounds, and they didn't get stuck. So her odds of having either of those two complications are extremely low, she actually ended up having complications from her surgery. So it makes you wonder if the risk for her in her particular circumstance would have been lower doing the vaginal birth than doing the Syrian birth. And in fact, in 2006, United States changed their recommendation that perhaps vaginal breech delivery is a decent option for you if you can find a provider who's skilled and comfortable with it. But since 2001, we've really not been training providers to do vaginal breech delivery. And so that option is becoming less and less available. So that's what in a nutshell, what I know about veteran breech delivery. It does have risks like every other choice. No choice is 100% safe. And I think that for a lot of women that are literally not even told that it's an option. They go back and wonder, you know, maybe that would have been a better choice for me.

And like you've given us so much good information today. There's There's so much to digest from from what you've been talking about. Can you share with our listeners some additional resources that you may have for them to go to to learn more?

Yeah, absolutely. I mean, first of all, I just I'm really grateful for you guys having me on here today and For the work that you're doing in general, I think that these conversations, if nothing else, will help people just learn that their choices and options and start to explore and learn and become more active in the decision making team and hopefully surround themselves with people who support their choices and have good experiences. That doesn't always mean it's the experience you planned on. But it's one that was supported, and one that was informed and one that was empowered. And that's our whole mission of informed pregnancies. So we have the podcast every week, we have a new episode of the podcast and form pregnancy. And it's on all the different podcast apps. And we have three basic types of episodes either we're interviewing an expert, and sometimes it's first stories. My favorite are the ones where we do the before and after interview somebody leading up to their birth and then again, after they have the baby to kind of talk about how the experience went. And then we also do a whole bunch of celebrity pregnancy or birth interviews. And we also have the two documentaries. So I mentioned heads up and the other one is about vaginal birth after cesarean. It's told entirely in the voices of for women who are pregnant for the second or third time who previously only had centenarian birth. And now they're on a mission for a different experience. 

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