Healing After Miscarriage, Postpartum Support, and Prepping a Birth Plan with Meg the Midwife

Podcast Episode #359: Healing After Miscarriage, Postpartum Support, & Prepping a Birth Plan with Meg the Midwife

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Healing After Miscarriage, Postpartum Support, and Prepping a Birth Plan with Meg the MidwifeTopics

  1. Reintroducing our guest, Meg the Midwife [1:53]
  2. What I had for dinner last night [4:20]
  3. Preparing for baby number two [10:16]
  4. Healing after miscarriage [15:20]
  5. Postpartum support of hormones [16:49]
  6. Advice to partners for support [27:34]
  7. Giving birth at home [31:55]
  8. Preparing the birth plan [37:49]

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Healing After Miscarriage, Postpartum Support, and Prepping a Birth Plan with Meg the Midwife  Healing After Miscarriage, Postpartum Support, and Prepping a Birth Plan with Meg the Midwife

You’re listening to the Balanced Bites podcast episode 359.

Liz Wolfe: Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal bestseller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a lake in the mystical land of the Midwest, outside of Kansas City.

I’m the co-creator of the Balanced Bites Master Class, with my podcast partner in crime, Diane. And together we’ve been bringing you this award-winning podcast for more than 6 years. We’re here to share our take on modern healthy living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account for our weekly calls for questions. You can ask us anything in the comments.

Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Before we get started, let’s hear from one of our sponsors.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; Liz, I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal.

The NTA’s nutritional therapy practitioner program and new fully online nutritional therapy consultant program empower graduates with the education and skills needed to launch a successful, fulfilling career in holistic nutrition. To learn lots more about the NTA’s nutritional therapy programs, check out their free Nutritional Therapy 101 course as well, go to http://www.NutritionalTherapy.com. There are workshops in the US, Canada, and Australia, so chances are you’ll be able to find a venue that works for you.


Liz Wolfe: Hi folks! We’re back again with another episode centering around Baby Making and Beyond, with my partner in Baby Making and Beyond, Meg the midwife. Back on the show. Welcome back my friend.

Meg Reburn: Hi.

Liz Wolfe: Hi! I will do a quick background once again, in case you missed episode 357. And if you missed it, go back and listen to it. But Meg was also on the show in 2016, so listen to episodes 261 and 263 as well.

Meg hails from the great white north. That means Canada. And hangs her hat in British Columbia. She is a registered midwife, pregnancy educator, women’s wellness coach, writer, and former faculty member at Mt. Royal University.

Meg has a bachelor of science with honors in health, and has a special interest in both functional nutrition, women’s hormone balance, and nutrition for female athletes. Meg is currently working with women both as a midwife and a wellness coach. She likes to call her style of practice an evolutionary approach, believing that the body has the innate wisdom to care for and balance itself given the proper time, attention, and care.

When she’s not busy with work, Meg create space to do the things she enjoys. These days, that takes the form of long distance trail running, swimming across big scary lakes, rock climbing, and general mountain adventuring. It’s her jam to help women find their healthy balance so they can feel great and do more of what makes their heart sing.

So I have a question for you.

Meg Reburn: Sure.

Liz Wolfe: Ok; so this is probably a no-brainer. But rock climbing outside.

Meg Reburn: {laughs}

Liz Wolfe: That’s vastly different, obviously, than a rock climbing wall at the gym. But do you completely hate rock climbing walls at the gym? Or is that enough to keep you going when you can’t actually get out to a mountain?

Meg Reburn: It’s totally enough to keep me going.

Liz Wolfe: OK.

Meg Reburn: It’s still fun. But then you take the element of being out in nature out of it. And there’s a certain element of problem solving when you're rock climbing outside. There aren’t holds that are colors or flagged like there are at a rock climbing gym. So you have to kind of figure out where all of the holds that you need to put your feet are. So the cerebral part of me really enjoys that. And you can get up a lot higher. So you can go multiple pitches up in the air. Which the adventure seeking side of me really likes.

Liz Wolfe: Oh my goodness.

Meg Reburn: I know.

Liz Wolfe: I can’t. I can’t handle it.

Meg Reburn: It’s not for everyone, but it’s certainly for me.


Liz Wolfe: Alright. Well, let’s talk about last night’s dinner.

Meg Reburn: {laughs} Oh-ho.

Liz Wolfe: {laughs} On that note, let’s talk about last night’s dinner. What did you eat for dinner last night, Meg? Did you eat anything to fuel your adrenaline workout? Your adventure? I'm thinking the most I’ve climbed today is 2; not two sets of stairs, but two stairs into my ranch house. {laughs}

Meg Reburn: {laughs} I actually had an interesting dinner last night. It’s interesting that you ask that. I’ve been experimenting with different game meats. And I had ostrich burger last night.

Liz Wolfe: How was that?

Meg Reburn: You know; I think I prefer elk or bison. It’s almost a little too lean. Ostrich is a really lean meat. But it’s a bird that is; it looks like a burger. It’s a reddish meat. It has lots of iron in it. It has lots of protein in it. I just wanted to try something new, and I found this ostrich. So I had an ostrich burger.

Liz Wolfe: {laughs} “I wanted to try something new, and I found this ostrich.”

Meg Reburn: {laughs} So I ate it!

Liz Wolfe: So hey. Wondering if you want to have dinner with me? I mean, be my dinner.

Meg Reburn: Sauerkraut and ketchup. Because I am a big fan of all things ketchup. And I had some sweet potato fries, and it was delicious.

Liz Wolfe: That does sound delicious. You and Diane. Diane says; we have fundamental differences in how we pronounce the names of condiments. And Diane says “mayo-nnaise.” And I say mayonnaise. She’s probably right, just from how it’s spelled. How do you?

Meg Reburn: Mayonnaise.

Liz Wolfe: You say mayonnaise?

Meg Reburn: I just say mayo. I don’t even bother with the rest of the syllables. {laughs}

Liz Wolfe: Fair enough. I guess I generally do say mayo. But you said “cat-sup.” And I say ketchup.

Meg Reburn: Maybe that’s a Canadian/American thing.

Liz Wolfe: Very well could be. And completely inconsequential. But I had ketchup for dinner last night, too. With my meatloaf. My loaf of meat. Gluten free meatloaf, of course. Because I guess most meatloaf has some breadcrumbs in them or something like that.

Meg Reburn: Yeah, usually.

Liz Wolfe: Yeah. But I had some delicious meatloaf. I can’t even remember what I ate with it. There were some carbs in or around there somewhere. But just the last couple of days, I’ve been craving meat. And it’s really interesting to me, because I’m not at any point in my cycle that I would have thought I would be craving meat. But I’ve really been craving meat. And shrimp. Which is so weird. Because I never in my entire life have enjoyed shrimp. I would never eat it. I would never get excited about it. But the last two times I’ve been out to eat. I went out to dinner the other night with my husband, Spence, to Anton’s Taproom in Kansas City. Which is an awesome place. They serve grass-fed meat. They’re totally non-GMO. They had cut everything at their butcher counter to order. It’s just amazing.

Meg Reburn: Whoa. That sounds delicious.

Liz Wolfe: It’s great. And they have this; {laughs} not hydroponics. Aquaponics system on site, where they actually raise their own tilapia in these aquaponic systems. The waste from the fish actually feeds this aquaponic garden that they have. It’s a really cool set up. And one of the cool things about them, also, is that they are dedicated to employing; oh gosh, I don’t know how you would say. If you would say felons, or men who have been released from prison; non-violent felons, and giving them a job and helping them become productive members of society again. Which I think is really cool.

Meg Reburn: Wow, that’s cool.

Liz Wolfe: Yeah. Anyway. Went there the other night for dinner, and saw shrimp on the menu, and I was like, “Need that.” That has never happened in my life. And then a couple of days later, I ordered shrimp again. Very strange.

Meg Reburn: I wonder if it’s not about the micronutrients that you need, but about the protein. Because you’ve been lifting very heavy things recently. I wonder if you’re getting jacked.

Liz Wolfe: Very true. That could actually be it.

Meg Reburn: Maybe you're just beefing up.

Liz Wolfe: Yeah. If that had happened; because I have been working out quite a bit. Not quite a bit, but consistently for the last couple of months. But the first few weeks and months were very much just about alignment and corrective exercise and getting things firing properly. And we have, over the last few weeks, really ramped things up. So that could be a big part of it, for sure.

Meg Reburn: Mm-hmm. Just doing a little body repair.

Liz Wolfe: Yeah.

Meg Reburn: It’s delicious body repair.

Liz Wolfe: It is. Interesting stuff. And of course, the shrimp had lots of nice salt on them. That’s good too.

Meg Reburn: It never hurts.

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Liz Wolfe: OK. So we’re going to continue with our questions from last week about everything Baby Making and Beyond. Not the program in particular, but we’re going to be talking about baby making, and things beyond that. And we’ve got a ton of questions that came in via Instagram. So we’ll just jump into those. And you can share your wisdom with us.

Meg Reburn: Sounds great. Let’s do it.

Liz Wolfe: Alright. First one. This is from Shelby. “My baby is now 9 months, and we’ve decided that we want another one. We’re still breastfeeding. Any key nutrients I should focus on to replenish my body for baby number 2?”

She does not specify whether she wants to breastfeed up until pregnancy or she wants to stop breastfeeding and then replenish. So there’s a little bit of wibblyness to this timeline. Maybe she wants to continue breastfeeding while she’s pregnant. I’m not sure. But do you have any ideas for her?

Meg Reburn: So the big things that seem to get depleted while you're breastfeeding; certainly the things that I’ve done research on are essential fatty acids are a really big one. So DHEA in particular. I read a study just recently; actually, just linked it and sent it to you, Liz, for you to read it too. Where they have found that women’s DHA levels go down by up to 50% by six months postpartum. So if she’s planning on getting pregnant again, that’s something that she might want to pay attention to.

All of the fat-soluble vitamins; vitamin A in particular, she’d want to pay attention to. And I know we’ve talked about vitamin A retinol before, and the importance of getting it in your diet, or taking it in a supplement form. The supplement that I like the most is just beef liver supplements. So if you're not going to eat liver three to four times a week; which I don’t think anybody does. Take it in a capsule form. Vital Proteins makes a really good one, but there are a few others that you can choose from. So try to take that a couple of times a week.

B-vitamins are also really important. B12 in particular. If your B12 is low, which can get depleted with breastfeeding, it can predispose you to having miscarriages. So that’s a really big one. Vitamin D is also a really big one, just for overall health and wellness and hormone function. Those are the big ones that I can think of.

Essentially, it’s all of the nutrients. She wants to just make sure she is getting a diet that is incredibly nutrient dense. She’s focusing on eating colorful foods on her plate, and having good quality proteins and good quality fats. And don’t stress out too much about getting certain this that, and the next thing. Just focus on the overall big picture.

In Baby Making and Beyond, we’re going to make it really easy to figure out what you need to eat every week, every day to make that happen without thinking too hard about it.

Liz Wolfe: Perfect. It’s hard, but the answer is; you need all the things. As many of the things as you can. I don’t want people to feel bad about it, but really load yourself up there. Because breastfeeding is demanding, let alone the demands of growing another baby and remaining sane.

Meg Reburn: And I guess we should mention calcium, too, now that I think about it. Calcium is one of those things that if you're having multiple babies, especially back to back, our calcium levels will suffer. It’s important to remember that your baby and your next baby won’t necessarily suffer. Babies tend to get what they need; but at the expense of their moms. So I think in past episodes I might have referred to babies as parasites.

Liz Wolfe: {laughs}

Meg Reburn: {laughs} Maybe I’m going to do that again. I don’t know.

Liz Wolfe: We can call babies life suckers.

Meg Reburn: {laughs} Blood suckers.

Liz Wolfe: Only cuter.

Meg Reburn: They’re really cute. But they do; they take what they need at the expense of their mom. So it’s important for you, but it’s not the end of the world if you just can’t fit it in right away. Just do your best. Honestly, do your best.

Liz Wolfe: Yeah. And if the best you can do is remember to eat. Because I know; right around 9 months. Right around the time that my daughter started to become more mobile, I feel like I just stopped eating. I just forgot to eat all the time.

Meg Reburn: If I; for a breastfeeding mom, if you have to pick one perfect food. I was asked this the other day. If you're super buys, and you can’t eat, and you’re faced with your cupboard, and you have 30 seconds to make a decision and to get it into your mouth, pick up a can of wild canned salmon. It’s got calcium, it’s got essential fatty acids, it’s got protein. And power that back.

Liz Wolfe: I like it.


Liz Wolfe: Alright. This one is from, I can’t figure out a good way to pronounce that. So I’m just going to say, this one is from Instagram. “What’s the best way to heal and reset hormones post-miscarriage?” Your thoughts, Meg?

Meg Reburn: Post-miscarriage. That can be a really tricky time. But the big thing to remember is that the body will do this on its own. You don’t have to do anything in particular except rest, relax, heal your heart is the big one. Heal your heart. Talk to people. Be sad if you need to be sad. I think we’ve talked about this before; again, in a past episode about loss. Grief and loss. Have gentle loving kindness for yourself. That’s a really huge one. Be patient. But your body will reset its own hormones in one to two months.

We used to tell women that they had to wait 3 months after miscarriage to try to conceive again, and we now know that’s not true. You can conceive the next time you ovulate if you feel ready to do so. But essentially, your body will do what it needs to do. Just trust that it will.

The only exception to that would be is if your miscarriage was caused by a hormone imbalance that your doctor or primary care provider has recognized. And then that would be something to talk to them about. But pretty simple answer. Don’t do anything. Just relax and recover.


Liz Wolfe: Alright. “Pregnant with baby number two, and I definitely had a tough go after my first in regards to hormones and attempting to find some emotional stability. I know there are certain times when your hormones dramatically shift postpartum. My question is, is there anything; dietary protocol, etc., that can be done to support women postpartum in regard to their hormones?”

This is a really good question. {laughs} I’m like; I don’t know.

Meg Reburn: Well, we can’t do anything to balance your hormones postpartum when you're breastfeeding, because we don’t want to do anything that would affect that beautiful dance of hormones that is required for breastfeeding. But I think; when I was reading some of those questions on Instagram, there were so many people that had questions about postpartum mood. And how our hormones and just how our body adjusts to mood postpartum. And that’s something I think is really important to talk about.

Postpartum mood and anxiety; it kind of happens for a bunch of reasons. It can be a combination of chronic sleep deprivation, which has made people clinically insane. When they’ve done all those sleep deprivation studies, people go nuts when they’re sleep deprived. Women need to be really aware of that, and just gentle with themselves that this is a temporary situation. It will get better. Your baby will sleep a little bit better as time goes on. But that’s a big factor.

Fluctuating estrogen and progesterone levels. Estrogen and progesterone usually take a total nosedive after baby has been born, and during breastfeeding. So for women that are sensitive to low estrogen and low progesterone levels mood-wise, that can really affect how they feel.

And then it’s a huge change of life. Any sort of giant life change creates the possibility for anxiety and depression. So having a new baby in the household is a giant life change and a giant adjustment. Which can take your brain a little bit of time to catch up to what life looks like. And to create routines. So those are kind of the main things that cause an imbalance of mood.

But how to support it? One big thing, we’ve talked about before, but making sure that your thyroid is getting tested. If your thyroid is low postpartum; which it often can be. It can predispose you to feeling anxious and depressed. So if your thyroid is low; test it. If it is low, fix it. That should help.

There are some things you can do to support your mood from a diet perspective. Vitamin D has some interesting research on it. It seems to work at a cellular level to support the immune system. It seems to directly affect the HPA axis. That’s the hypothalamic pituitary axis that is associated with stress levels and cortisol. Vitamin D seems to modulate that a little bit and can help with mood. So making sure you're getting adequate vitamin D in your diet, or as supplement form.

Vitamin B deficiency seems to affect postpartum women. We’re not totally sure why, but theories around homocysteine levels are associated with rates of high postpartum depression. So making sure you're getting adequate B vitamins. So keep taking your prenatal vitamins. Those are loaded with B vitamins. Take them through breastfeeding. Super important.

Other trace minerals, like selenium and zinc, which should be in a good prenatal vitamin have been associated with postpartum mood. And then essential fatty acids, particular DHA, which we talked about in the last episode, too. I think I mentioned last time that DHA is needed and it doesn’t return to pre-pregnancy levels until 6 months after breastfeeding. So making sure you're getting enough DHA in your diet will be important.

And making sure you’ve got good support. And if you don’t have good support; seeking out good support. And support can come from anyone. It can come from family. It can come from friends. You can hire some support. Find a postpartum doula to help you during the night times, if night times are hard for you and you need a little bit more sleep. Create a plan to support yourself. Because when you are supported, your baby is supported, and your mood will be supported.

Liz Wolfe: Yes. It does. My experience; I did hire a postpartum doula, and it was lovely. But for the most part, I struggled with letting go. So she might have had my baby, but I could not calm down enough to relax and take a nap. Or even when I had the doulas with me overnight, I could not relax enough to let go of that responsibility. Because I was just in such high gear. And I feel like I’m aware of that now, because I’ve been through it once. And perhaps this woman preparing for baby number two has kind of had that perspective at this point on her first go-round, and maybe it will be a little bit easier for her. Who knows.

But I want to say; I know it can be really scary when you’ve been through a really tough time with baby number one and you're anticipating that it will be that same way with baby number two. Don’t make that a self-fulfilling prophecy. Just be open. Be aware of your triggers and the way you're feeling, of course. But don’t be so scared of what might happen that you kind of talk yourself into a corner about it. Because I know many women who have a completely different experience with baby number two. It’s not guaranteed, but it happens.

Meg Reburn: And they trust that; hey, their kid is doing ok. And they figured it out. And they can let go of some of that. Baby number two; a good example of that is, a soother falls on the floor and then a mom sterilizes it with baby number one. With baby number two, a soother falls on the floor, mom licks it and sticks it back in baby’s mouth.

Liz Wolfe: {laughs}

Meg Reburn: And it’s good. It’s all good. It’s going to be ok.

Liz Wolfe: It’s going to be ok. Yes. And I think another thing to keep in mind; and it can be so hard. Because first of all, there are a ton of really great postpartum resources that I just kind of research and keep in your back pocket. So if you're thinking; “Oh my gosh, I just need to call somebody. Or text somebody. Or talk to somebody.” There is postpartum support international. There are a couple of other postpartum support associations that are really, really wonderful and can kind of link you up with somebody quickly to talk to.

But I recognize that a lot of times the big mountain to climb is; “Yeah, I know I need to get out of the house and talk to a therapist. Just dump my thoughts on somebody and cry in a safe space.” But the thought of getting out of the house; finding a baby sitter. Finding a therapist that you connect with; which can be a journey, sometimes. All of that stuff can feel like this completely insurmountable hurdle to even get to the place that you need to go to take care of yourself mentally. But I encourage people; if you have to drag your kids with you. If you have to nurse that baby the entire time you're talking to a therapist. That’s fine. Just get there.

Meg Reburn: And you know, there are a lot of therapists now that will see you over Skype. And you don’t need to leave your house. So if that’s an issue, go for it. And you know, your care providers will have a lot of resources. Therapeutic resources. So different therapists that they have worked with that have helped women in their community. So you should be able to find someone locally through your primary care provider.

I know, in the midwifery practice I work at, we have about four or five therapists that we work with that we can refer women to. And they see women, sometimes in their own home. So a good postpartum and/or prenatal therapist might come to you. Or she’ll see you via Skype. Or he will see you via Skype. Or maybe you need to take that hour; hour and a half for yourself to try to get out of the house and do something just for you.

Liz Wolfe: And all of that stuff; those types of mental health stress relief type of stuff. That all factors into having a favorable hormonal environmental. Obviously, when you're nursing, and postpartum. There are certain things that your hormones are going to do, just because that’s what they do. But you want to have as few extra mitigating circumstances as possible.

Meg Reburn: Totally.

Liz Wolfe: And all that mental health stuff is going to open the door to that. The only other thing I want to add, because I talk about this all the time. I’m like a broken record, I feel like. But I’m going to say it anyway. Expressive writing. And I mentioned this in the last episode that Meg and I recorded together. Go to my interview with David Hanscom. Who wrote the book, Back in Control. Or go to BackinControl.com to learn about what expressive writing is and how to do it. You don’t have to leave your house. You don’t have to do anything other than have a pen and paper. Dump all of your fears, all of your anxiety, anything you're thinking about. Even if it’s just one word. Over and over and over again and you're just writing it to get it out of your system. Do that. Because it’s free and you don’t have to go anywhere. And that for me personally has been the most powerful tool in my toolbox.

Meg Reburn: Cool.

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Liz Wolfe: Next question. “I’m not pregnant; my daughter is 3.5. But I want to know what advice do you have for dad’s or partners pre, during, and post pregnancy to support the mama to be? I know my husband would have loved some advice, tips, and things to know to expect. I know this could be valuable to others. Thanks!”

Ok, you answer this, Meg. {laughs} Because you're the one…

Meg Reburn: I love this question.

Liz Wolfe: That has served many, many couples.

Meg Reburn: I absolutely love this question. I think that dads and/or partners; our partners don’t necessarily have to be men or dads. But certainly our partners kind of miss out on this. And I think it’s really important that we talk about how they can help support us as pregnant women. And how we can help support them.

I actually asked a bunch of dads that I know the things that helped them the most. And I got a handy list. So I’m going to go through this list, one at a time. A big thing is to be ready and have a plan. I think a lot of men need to have a plan. They need to have a tangible list of chores that need to get done. Don’t just make a theoretical list. Actually make a written list. I think that has helped a lot of men figure out just what needs to be done. So that their partners can relax. Feed themselves, feed the baby, and feel like the house is being taken charge of essentially. That’s a big thing.

Try to anticipate her needs with breastfeeding support. So in the early days, when you're basically just feeding your baby and sleeping, and there’s really nothing in between, try to anticipate her needs. Is she planning to feed again in an hour? Has she eaten anything? Does she have a glass of water by her? Can you make her a smoothie so that she can sip it while she’s breastfeeding? Just try to focus around her needs as she’s breastfeeding, and anticipate them. That’s helped a lot of dads.

So maybe making a feeding schedule, if you're on a schedule. And that will help dads plan for the next few hours to come. Same thing if she’s pumping; offering to feed the baby via bottle or however you're planning on feeding. If she’s breastfeeding, and then she’s pumping, and then she only has an hour between feedings before she has to do it all over again, offer to do the bottle feeding piece of it. That can be really helpful.

One dad told me the big thing that helped his family the most was to take the baby out for a walk every day to give his partner some time to reconnect with herself. So she can either just take a nap, or do some yoga, or take a shower and wash her hair, or have a bath, or do whatever the heck she wants. But just taking charge of that. One hour a day, go for a walk. And that helped him really connect with his baby, too. Outside of the house, and just have that one-to-one time with his little person that he really cherished and found to be a beautiful thing.

The other thing one dad told me was to trust your male intuition. I know we talk a lot about female intuition, but men have a dad intuition too, that you have to learn to tap into and really trust. Which I think it was pretty cool that this man recognized that.

The other thing one dad told me at one point was to look at the big picture of the first year. Men tend to get so caught up in the role of “providing” and supporting that they miss out on a lot of the actual family bonding time that happens. Spending more time than you might think is necessarily snuggling with your partner, snuggling with your new little baby, and just spending time together. Not doing anything, but just being. I think that’s a really beautiful thing. And it helps the whole family unit bond and stay strong, rather than just survive. It helps them thrive.


Liz Wolfe: Love that. Alright. This is a question that we weren’t able to answer the last time around, but I’d like to answer it today. “What, if any, are the serious risks of giving birth at home? I suffered a third-degree tear during the delivery of my first child, and would really like to give birth at home for my second. But I’m wondering what the protocol is for midwives who attend a home birth if there is a tear.”

And obviously we talked in the previous episode that we did together, Meg, about how you have worked in across homebirth and into hospital environments. Because that’s how it works in Canada. Whereas in the United States you have that kind of handoff, where you have engaged the services of a certified professional midwife, CPM, for a home birth in the United States and you end up needing to go to the hospital, they kind of have to hand you off at the door in most places.

Meg Reburn: Yeah. So why don’t we just talk about safety of homebirth first. Safety of homebirth is something that your midwife should go over with you in detail over a series of a couple of different conversations. But essentially, what all of the research has told us that is homebirth is a completely safe option for low-risk women who are being attended by a registered midwife who is trained to deliver babies at home. And has a reasonable backup plan in place.

Homebirth is incredibly safe. Some studies that have been done in Canada have shown that it’s actually safer than hospital birth when all of those other guidelines are followed. You're with a registered midwife; you’re a low-risk woman; and you have a reasonable backup plan. So super safe for most women.

Risk of homebirth; some emergencies can’t be predicted. Many emergencies can be predicted, however some can’t. And women who are planning to give birth at home are just ok with those small additional risks. And that there’s just no other way to get around that. Midwives are completely trained and equipped to deal with those emergencies that we can’t necessarily predict. So midwives carry medications to stop bleeding. They are trained in emergency maneuvers to get babies out that get stuck. They are trained to do IVs and to do catheters. So there’s lots of things that we can do at home to manage these emergencies.

It’s important to talk to your midwife about all of the different circumstances that would happen and find out how she would manage them. You can essential ask your midwife, and she should be able to go through things in great detail with you.

One of those things that happens that’s not necessarily an emergency is tears. And having a third-degree tear is such a bummer. Literally, it’s a bummer.

Liz Wolfe: Womp, womp.

Meg Reburn: Womp, womp. I know. So for people that don’t know about tears; it’s quite common to have what we call a first or a second-degree tear. Which means those are tears that just kind of go into the vaginal skin, or into the vaginal wall. They’re easily repaired, and well within a midwife’s scope of practice to repair at home. But third-degree tears and fourth degree tears usually involve some part of the rectal sphincter or anus, and need to be repaired by a surgeon in a hospital, sometimes requiring antibiotics after you’ve had that tear repaired. So that’s absolutely a reason to transport from home to hospital.

Midwives will usually; if you’ve had a third-degree tear, your chances are slightly higher that you could have another third-degree tear. However there’s lots of things that midwives do to help prevent tears such as delivering a baby’s head slowly and gently. Using warm compresses. These things can be done at home. And in the rare case that you do have another third-degree tear, you could just plan to transport into the hospital for repair of that tear. It’s not a contraindication to having a home birth at all.

And in my experience, I’ve had women that have had third-degree tears. Even one woman who had a fourth-degree tear with her first baby, and had a totally intact perineum with her next. So it’s certainly not a reason to give up the birth at home that you’d like. But it’s certainly something to talk to your midwife about. And talk to her about what she does to help prevent tearing.

And the other really important thing to make sure you ask your midwife is what her backup plan is. What her transportation plan is. How you would get to the hospital in different circumstances. Obviously, if there is an emergency that happens at home, you're probably going to be transferred by ambulance. If you live in a rural area, I would encourage you, if your midwife doesn’t suggest it already, to preregister with the ambulance service so they know exactly how to get to your house. Not all houses have street signs, but they should have fire numbers. So it’s important that you talk to your ambulance service so they know how to get to you in case of an emergency.

But just ask lots of questions. In Canada, our transport plans and all of our homebirth guidelines are regulated by the College of Midwives in the province that we practice. And I’m guessing state by state there would be a similar; although there’s not a college of midwives, there would be a similar licensing body that should outline all of those things. So just be curious.


Liz Wolfe: This is such an interesting question to me. Because I had considered a home birth, and then I ended up wanting to go with a birth center staffed by CNMs, that was backed by several hospitals in the area. And I had a situation in labor that required the transfer from the midwife clinic to the local hospital.

We had a lot of questions that we’re not going to be able to get to about things like, what’s the safety of ultrasounds, what’s the safety of X, Y, and Z during pregnancy. And one of the things that I tried to do during my pregnant was limit those types of, I guess you could call them interventions or procedures. And in hindsight, I just think to myself; man. If I had just had the dang ultrasound, we might have known about this and we could have predicted it and things would have gone very differently.

I still can’t say that that would have been the optimal scenario, because at the very least I got to go into labor naturally. Which I think is probably a good thing. I actually have some suspicions that it is a more important thing than maybe we generally give credit for.

Meg Reburn: I would agree. Yeah.

Liz Wolfe: Yeah. We get really kind of consumed with C-section versus vaginal, epidural or no epidural, and the effect on the baby after that. But I don’t really hear people talking about spontaneous versus induced labor.

Again; this is a really loaded topic because so many women are making so many different choices for so many different reasons. And I happen to support all of them. I really, really hope that women have supportive providers that are helping them make decisions that they feel comfortable with, because that’s such a huge part of the battle.

But at the same time, I have become more pro-monitoring than I was previously, just based on my own particular experience. And it’s interesting in the assessing of risk. Where you're saying; the risks to home birth are very low. Or the risks of hospital birth are this. And then you have the people that stuff actually happens to. And some of them would say; if I had known that I fit into this risk category, I would have made a different decision. It’s not so much about probability, it’s more about what actually ends up happening. You know what I mean?

Meg Reburn: Yeah. It’s all about hindsight sometimes.

Liz Wolfe: Yeah. It’s so interesting. And that’s neither here nor there; it’s just one of those. And one of the things I was wondering about this person who asked the question is whether she suffered this third-degree tear in the hospital. And for that reason, was wanting to birth at home because of that experience. Or if it would be a second home birth; that type of thing. You just never know what’s driving someone’s decision to do one thing over another.

Meg Reburn: Totally. I agree. And I think when I first became a midwife, a lot of years ago. Or when I was first starting to even consider this journey, and I was working as a doula. I was such a Birkenstock; well, I’m still a Birkenstock wearing {laughs}. Granola crunching, anti-intervention, anti-ultrasound. Not to say that there’s anything wrong with that. But my views on it, and my personal opinions on it have changed over the years, because I’ve seen so much. And I’ve seen literally thousands of pregnant people and babies come into the world.

And I have become more; I guess, I wouldn’t say pro; certainly not pro-intervention. But strategic interventions. Because I’ve found that those things can actually prevent some of the other outcomes. SO, maybe getting that extra ultrasound is a great thing. Maybe we find out something about the baby that might tell us where it’s the safest place to deliver. Or maybe we can find something out so that we can correct it before it actually creates a problem. And can actually make a birth outcome better.

Liz Wolfe: You know, it’s just so interesting. Because we tend to see in so much black and white, like you were alluding to before. And I just continue in life. The thing; you know when you think about white cars, you start to see white cars everywhere. It’s like; I think about this spectrum of extreme to extreme. And starting to realize that the truth is usually somewhere in between these two extremes. And now I see this everywhere.

And when it comes to the birth community, I feel like we have this false dichotomy of; you're either all interventions, all hospital; or you're all crunchy, all homebirth. Birthing in the forest type of thing. And the two sides just don’t come together enough. And I think the truth of that is, and the truth of life is, that we are primal beings in a very different environment from what is optimal for us to thrive. And we can change things about our environment, and how we live. We can change a lot of things to kind of bring our environment into alignment with what our body needs. But at the same time, I think it’s reasonable to expect not that we will have trouble laboring and birthing. But that there are certain things about life, and about our bodies, and how we move through the world that might have an impact on our journey through pregnancy and birth.

So, that is to say I think it is both accurate and marginally inaccurate to say, “our bodies were meant to do this. Everybody can do this.” Not everybody can do this without a little bit of help. And that’s fine. I just hate the fact that women are running around feeling guilty for having gotten an epidural. Or for having a grown a posterior baby. Or whatever it is. Because I really think the truth is, there are a litany of factors that could lead us to benefit from one intervention or another. And we can only do the best we can, and hopefully use these interventions judiciously versus beating ourselves up for not being strong enough, or primal enough, to give birth in a squat position in the woods. You know?

Meg Reburn: Totally. And you know; we can still do a lot of those things. I’ve become; I wouldn’t say I’m pro, I’m not pro-epidural. I’m pro-smart use of epidural these days. Because I’ve seen the power of what they can do to facilitate a beautiful vaginal birth. And epidurals that are used correctly; man, you can still deliver in a squat, in a semi-squat. You can still have this beautiful vaginal birth that, perhaps had you not had the epidural, could have lead to C-section and a different outcome. I think it’s important not to place blame on ourselves, like you said. Talk to your provider about all of your options, and really get well-informed with a good prenatal class, too.

Liz Wolfe: Yeah. And start talking to your provider early on, so you can really get a sense of how supportive they are and how many resources they’re willing to point you towards. Or if they’re just like, “Yeah, we’ll deal with that on the day.”

Meg Reburn: Yeah. That doesn’t cut it. {laughs}

Liz Wolfe: Yeah, that’s not so good. Just keep in mind; we’re just moving levers. There are a thousand different levers. And yeah, for some women, they get an epidural and maybe it affects breastfeeding. X leads to Y and Z. But for a lot of women, that’s not how it works. There’s something beautiful about the fact that we can’t predict how things are going to go, and there’s also something scary about it. Again, there’s that balance. Two things can be true at the same time. But understand that just because you choose to do one thing doesn’t mean this other horrible thing is going to happen.

You hear so many horror stories from people. In some of the VBAC groups that I’m in. It’s like; “If you do that, then you're starting a cascade of interventions and you're going to end up in a van down by the river.” Whatever it is. And it’s just not true. You just have to do what’s right for you, as gentle as you possibly can in the moment. Just make adjustments as you go. With your provider.

Meg Reburn: Yeah. And the other piece is the knowledge is power piece. I don’t remember what 80s superhero said that. Maybe it was GI Joe? I don’t know.

Liz Wolfe: {laughs} Is that the eggs in the skillet? No, that’s your brain on drugs. Never mind.

Meg Reburn: {laughs} No. But knowledge is power. And the more knowledge you're given, both before you have your baby and also during labor. So that’s why it’s really important to have good continuity of care with your care provider. Which is why I think midwives are so spectacular. Because one midwife will stay with you for most of your labor, unless your labor goes really long. And then for safety reasons she might have to tap out, and another midwife might have to tap in.

But having the continuity will help your provider keep you up to date as to what’s happening through your labor and help give you choices that you can make. And give you the proper information you need to make the choices as your labor story unfolds.

Liz Wolfe: Love that. Ok, I think that’s all we’ve got for today.

Meg Reburn: I think so too.

Liz Wolfe: Thanks for coming on with us for two whole episodes.

Meg Reburn: It’s my pleasure.

Liz Wolfe: As a reminder, everyone can visit Meg at MegReburn.com. And visit us at BabyMakingandBeyond.com. You can sign up for emails to get updates on our upcoming program/community/masterpiece.

Meg Reburn: Which is coming, soon!

Liz Wolfe: Which is coming. It has to.

Meg Reburn: We have never been closer than we are right now. It’s magic.

Liz Wolfe: Yes. It’s coming. Alright, that’s it for this week. You can find me, Liz, at http://realfoodliz.com/ Join my email list for free goodies and updates that you don’t find anywhere else on our website or on the podcast. While you’re on the internet, leave us an iTunes review. See you next week.

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