February 2024

Kristin Revere and Kristin Mallon discuss how certified nurse-midwives support women in all stages of life.  They also chat about how Kristin Mallon transitioned to supporting menopause and feminine longevity when she co-created FemGevity.   

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Kristin Mallon today.  Kristin is the CEO and co-founder of FemGevity.  She is a CNM, MSRNC OB and is a highly accomplished and passionate board-certified nurse midwife with over 20 years of experience in women’s health.  Her expertise in menopause and feminine longevity has made her a respected and sought after expert in her field.  Kristin is dedicated to providing the highest level of care to her patients. 

Welcome, Kristin!

Thank you so much for having me!

I am so excited to chat with you about your background.  From what I read on your bio, you actually started as a DONA doula in Maryland.  So let’s explore your passion and pivot in so many different ways in women’s health.

Yeah, so I started as a doula.  I knew I wanted to be a midwife, so while I was in school, I worked as a doula, and then once I got my nursing degree and then ultimately my midwifery degree, I transitioned from that type of support because now I was able to work as a midwife.  There’s a lot of blending and lot of understanding both roles really well because I had been a doula before I became a midwife.

Yes, so that emotional support and physical support and just being with women in pregnancy and then transitioning to more of the medical aspect of care.

Right.  Exactly.

So for our listeners who are not familiar with nurse midwifery, would you mind sharing a bit about how you work with women in pregnancy, childbirth, and the postnatal phase?

I think unfortunately “midwife” and “midwifery” is really confusing in the United States.  When you go outside of the United States, I think most of the people of whatever country it is – Central America, South America, Europe, Asia – they understand midwife kind of means midwife, and there’s one word for midwife, which is someone, a medical professional whose sole job is to help women during pregnancy, maybe a little bit of the time getting pregnant, delivery, labor, and the postpartum period.  It’s a very specific medical role, a very specific niche.  In the US, it’s really confusing, and most of the time when I meet people, they’re like, oh, you’re a midwife?  You deliver babies at home.  You have no medical training.  You were trained by a group of women in the Amish country.  That’s a very common misconception that people have about midwives.

Most midwives in the US, over 90% – I think some years it’s even as high as 96% of midwives – work in the hospital setting.  They work in a very acute care setting, and only about 6% or 4% or 5%, depending on the given year and depending on the state, are actually working in the home.  So the majority of us are working in hospitals.  I think even that is confusing for the average American.

And then within midwifery, we have certified nurse midwives, which is what I am.  I’m technically a board-certified nurse midwife.  Midwifery does have a certification board.  We have certified midwives who have the same type of board certification that I have, but they don’t have a nursing degree.  They’re not a nurse.  We have lay midwives, which are midwives that are just trained in the communities, very similar to doulas, but they tend to have a little bit more understanding of the medical aspects of things.  And we have professional midwives.  Not all states recognize all of those.  All 50 states recognize a certified nurse midwife.  Not all states recognize all of those other types of midwifery.  And so it’s very confusing and I think overwhelming for the average consumer.  It’s hard in the US, I think, to understand midwifery fully.

I agree.  And I definitely agree about the assumption that most people think of midwives as a homebirth midwife versus a CNM or working in a hospital.  A birth center could be freestanding or attached to a hospital, for example.

Right.  And now a lot of hospitals – I mean, we’ve evolved so much.  I’ve been working in this field for 20 years.  We’ve evolved so much.  Now we have birthing pavilions.  We have birthing adjuncts.  We have birthing wings.  We have birthing hospitals.  There’s so many different venues for birth to take place.  And I think it’s even people that I know very personally – I don’t think they have a full breadth of understanding of all the options that are really available to women in the US when it comes to birth.

Exactly.  In one of my area hospitals, we have a birthing suite which looks less like a hospital room.  It’s pretty cool, and it’s attending only by a CNM.

Right.  There’s so many different opportunities.  And my experience – I’ve really only worked in the New York City Metro area, so New York City, and I’ve worked in New Jersey, northern New Jersey, which is where the bulk of my practicing has been.  For my schooling, I went to NYU.  I went to John Hopkins, which is in Maryland.  Very limited experience in Maryland during my schooling.  But it’s very regionally based as well.  So my friends that I went to midwifery school with – I know a lot of midwives.  I’m very fortunate to know a lot of them.  When I hear about what it’s like in Chicago versus what it’s like in LA versus Boston and San Francisco, it’s very different than what it’s like in New York, and even it’s incredibly different from New York to New Jersey, and we’re four miles apart.  We’re separated by a river.  So it’s really hard, I think, for women to understand their options.  A lot of women don’t think about their options until they’re already pregnant, and it’s kind of like this rush to get it situated and to get it sorted out.  Some women do think about it ahead of time, but I think the majority are kind of trying to put together the pieces of what childcare looks like in the US during pregnancy.

Yes, good point.  So Kristin, who would be eligible to work with a certified nurse midwife as a patient?

I was a high risk midwife.  I’ve attended over 2000 births.  I did the majority of the births in the hospital setting.  Very few in a birth center and even less at home.  And I never risked – very, very rarely did I risk anyone out.  I had the fortunate opportunity to work with a maternal fetal medicine specialist as my collaborating physician.

That’s amazing.

So we were only sending people out of our practice that had really complicated things.  You know, needed fetal surgery.  Almost zero.  And in a year, sometimes zero people got risked out.  Some midwives can only take low risk women, the absolutely low risk women.  Sometimes anemia will make a woman need to transfer.  Diabetes, high blood pressure, breach – the baby being in a breach position.  So I would say that any woman – and I know a few midwives who work like myself and work with a maternal fetal medicine specialist.  They work with a very high risk doctor.  Anybody is eligible for midwifery care.  Really, any woman.  I mean, very few – less than 0.01% of women would be ineligible for midwifery care.

That is amazing.  And as you mentioned, it depends on the hospital policies, the state, and it can be very different in other areas.

Yeah, and a lot of it really has to do with the collaborating physician.  So what the collaborating physician’s comfort level is with that particular midwife.  This is just kind of a generalization, which I think there isn’t really in birth.  I think it’s almost impossible to make any generalizations.  But most of the time, the longer a midwife works with any given doctor or any physician group, the comfort level between the two of them or the groups of them in terms of what they can handle is going to only increase exponentially as the years go on.

That makes perfect sense, yes.  Thank you for that explanation.  And of course, insurance covers nurse midwives in the hospital.

Yes, so insurance – we were very fortunate to get a bill in legislation passed in 2022 called the No Surprises Act.  This means that pretty much any woman with insurance can go to a midwife in or out of network.  The way that bill works, labor and delivery is considered an emergency.  So it pretty much has opened up the field.  Even if your midwife is out of network, you can still use that midwife.  And I think a lot of midwives and consumers, patients, don’t fully understand this bill and don’t understand the full benefits of this bill.  This is a bipartisan bill that was passed by both sides.  Not many bills are so bipartisan.  Patients were getting surprise bills.  You would go to a hospital.  You would see an anesthesiologist.  You would see a plastic surgeon because you busted your lip open and you needed some stitches.  And then you were getting this huge bill from an out of network provider.  Because that has stopped, that has enabled birth workers to have access the benefits of this bill, which include being out of network and being able to bill an insurance that has in network only.  So I think it’s a really – and I’m happy to talk to anybody so that they can understand it, or they can have it explained to them.  But for midwives and consumers both, your insurance now will cover an out of network midwife.

Wow.  Well, you are definitely educating our listeners and certainly myself, so thank you, Kristin!

My pleasure!

As far as the role of a doula, how do doulas and nurse midwives work together during labor?

I think this is another kind of big, convoluted understanding in the birth community to people who are outside of it.  A lot of people think midwives are doulas, and it’s just – they’re not the same.  Doulas, as you know, being a doula, are really nonmedical professionals that really are about emotional, physical, spiritual, mental support.  And the midwife is really more about the physiological process of labor, the path of labor, the progression of labor, the safety of the labor, and kind of the captain of the labor ship, making sure that it’s on the right course, safe, effective.   I think that these two roles get confused.  I think every woman should have a doula.  So whether they have an OB-GYN or they have a doula, I think every woman should have a doula.  I think that should be standard of care.  I think that should be a no brainer.  I think we would see a huge shift in birth from a cultural perspective if that was the case.  So how doulas work with midwives is they really kind of work as part of the birth team.  The birth team usually consists of a medical professional – either a midwife or an OB-GYN – the family or whatever family members that entails; it could be one, could be friends, could be ten people – and then a doula is there to kind of be the bridge between the world of medicine and family.

Beautiful.  And as far as prenatal visits, how are visits with a nurse midwife different than an OB appointment?

So I don’t know that they necessarily have to be.  The practice that I had was called Integrative OB-GYN.  I was the only midwife in that practice, and there were four doctors.  The visits were no different between myself and the OB-GYNs.  Very comprehensive, 30 minutes to an hour each, really about making sure the woman and her family and support network felt comfortable, educated, understood what was going on, and we gave her tips and tricks to prepare along the way.  So I don’t know that they necessarily have to be.  I do think there’s a difference between the in-network model of birth and childbirth care, which is more of a number.  You show up.  And I think that can happen in midwifery or OB-GYN, where you show up, you come in, you get your heartbeat checked, you get your blood pressure and weight and urine, and then you’re kind of just moved through and you’re kind of like a number in a system.  I think that’s a very in-network model of care that doesn’t support how birth is really meant to be, which I think is much more in the out of network model of care where the clinicians, midwives or OBs, have the luxury, because the reimbursement rates are higher for providers in an out of network model, to take the time with women that they really need.  I am such a big proponent for having birth move to an out of network model, especially because we had this gift given to us from the 2022 No Surprises Act.

Yeah, that makes sense.  I certainly had the latter experience, out of network, and had longer appointments and worked with both nurse midwives and OBs with both of my pregnancies.  I just felt like there was a lot more time for questions and a lot more emotional connection in some of those appointments.

Absolutely.  And I think that’s the number one difference between the two models of care, midwifery or physician based.

That makes sense.  And then as far as the postnatal care, what does that look like?  It sounds like it depends on the model and may not be much different.  In my community, I know that some of my clients are able to see their nurse midwives sooner after delivery rather than waiting for that six week appointment.   But it may be, again, different depending on the practice.

Yeah, I think that the postpartum care in our country is pretty atrocious.  We give women, if you’re in a birthing center or at home – I mean, home is probably a little bit better, but in a birthing center, you’re given 24 hours of support, and then you’re seen once or twice in a six month window after that.  I think pediatricians, to be honest, are picking up a lot of the slack that’s left by the significant dearth in the postpartum care that we have in the US.

Absolutely.

Generally, it’s the same thing like you said in an out of network model.  Physicians and midwives are doing the same thing when it comes to labor, birth, pregnancy, childbirth, postpartum, typically.  So when people ask me what’s the difference, I’m like, there’s really no difference.  The difference between a midwife and an OB-GYN is that I’m not doing advanced gynecology.  I’m not doing fibroid removals, myomectomies, ovarian cyst removals.  I’m not doing any type of high end fertility, IVF, those types of things.  So when it comes to the pregnancy and the care, they really kind of do the same thing.  It’s kind of about what type of provider or what culture within a group of providers do you more resonate with, versus it being midwife or doctor.  And then for postpartum care, like we said, in the out of network model, you’re going to get a little bit more than in network model, but not much.

And nurse midwives can certainly see patients beyond that postnatal visit, with well woman care.  Can you explain a bit more about the role of a nurse midwife beyond the birth?

Yeah, so nurse midwives are very similar, like I said, to your regular OB-GYNs.  They can do anything that has to do with wellness, prevention, and your average gynecological care, like a yeast infection, a UTI, need birth control, need for birth control counseling, and mild primary care work.  A lot of us are very well versed in the management of blood pressure postpartum or hypo- and hyperthyroidism, very similar to our OB-GYN counterparts, just because of the sheer volume of women that we work with and their health challenges that come up with them just naturally being a woman and being 44 when they give birth or 34 when they give birth or 24 and the sequelae of what happens after that.  So it’s really more about – I think for midwifery versus an OB-GYN, it’s really about finding and connecting with a person or a group of people, a group practice, that you like and that you resonate with because a midwife can do pretty much what a lot of internal medicine can do; not all, but a lot, and then also what an OB-GYN can do in a primary care setting, like in a wellness, preventative, annual, yearly check in kind of setting.  I think that providers specifically all kind of sometime have different niches, and this is where I also kind of tell my friends and family, like, if they do have more of the complications that go along with gynecological care or women’s health – breast concerns, fibroids, ovarian cysts, endometriosis – that’s really when you want to seek out a specialist within that type of medicine, anyway.  So if you have endometriosis or suspected endometriosis, you don’t really want to go to an OB-GYN or a midwife.  You want to go to an endometrial specialist, someone who is an OB-GYN and then within their day census of who they’re seeing on any given day, they’re seeing 20 patients in a day, half of them are endometriosis cases that they’re working with, and then that’s really their expertise and their specialty.

The same thing with ovarian cysts or PCOS or menopause, perimenopause.  Those are really niche specialists that I think the general OB-GYN or the general midwife is probably not the best person to go to when those kind of issues arise.

That makes sense.  Speaking of perimenopause and menopause, how did you come to found FemGevity?

I’ll be honest, I don’t think that – again, there’s so many things in our system – and I try to be an optimist in my life.  Maybe I’m not coming across that way right now.  But I think that unfortunately, the US does not support birth workers in the way that it should, and so burnout is very high.  And I’m no exception.  I fell into that kind of category where it’s very difficult for birth workers to kind of continue because there’s no respite.  The system, in terms of making a living out of this job, does not have built in respite where you can rest and rejuvenate and refresh and then come back to the system renewed and able to continue a career that could be 20 years, 30 years, 35 years.  I, like most birth workers that I know, unfortunately, had to kind of hang up my hat of birth and transition.  It worked out well for me because my clientele that I had worked with for 15 years was older, and they were kind of in their post-reproductive years.  It kind of made sense for me, and it worked out.  I always believe everything works out, anyway, so it kind of worked out that my clients who I’d had for years and decades were asking me different questions.  They were asking me questions more about perimenopause, menopause, post-menopause, the longevity medicine.  And so I was able to morph my practice into that type of practice and then become a specialist and niche into that field and that area.  So now I would say, if you’re looking for someone in perimenopause and menopause, I am that type of expert, whether it’s OB-GYN physician or midwife, I am that clinician to come to when you have questions about those issues and concerns because I’ve been doing it as an overlap of my birth practice for about 10 years.  And so that’s kind of where FemGevity was birthed, no pun intended, because of that transition ramping up so much in my own practice and in my own life.

So as far as working with you, how do our listeners connect, and what is the process like?  Is it a mixture of in person and virtual?  Fill us in a bit more.

What we’re doing now – so what FemGevity Health is doing – anyone can go to the website, femgevityhealth.com, and take a look at what we’re doing.  But it is a virtual type of care because we’re not meant to replace OB-GYNs and not meant to replace primary care physicians.  We’re not the go-to for a pap smear or any of those types of situations that need hands-on and need in-office.  We’re very specifically managing hormonal shifts that happen after 40.  And that kind of looks different in lots of different areas.  All of our visits are virtual, and so we’ll have a virtual appointment, an initial consultation, usually advise lab ordering, depending on what’s going on.  Most of the time, we’re recommending labs.  We also have functional medicine or longevity medicine labs that we offer, like gut microbiome tests, micronutrient testing, allergy and food sensitivity testing, genomics.  And those tests help us put together all of the pieces about how to properly balance hormones in different decades of a woman’s life.  It’s all done virtually because we can mail the kits to women’s homes or if they need bloodwork, we can send them to their local LabCorp or Quest Diagnostic or a BioReference lab and get the bloodwork done, and then we’re able to kind of consume all of that information virtually and then come up with treatment plans and recommendations based on what’s going on.  It enables us to keep the cost down for women because we don’t have the overhead of a brick and mortar practice, and we don’t have to have a whole bunch of staff and a lot of overhead that goes with having an in-person office.

That’s fantastic.  And you do offer free consultations?

Yes.  We offer a ten-minute free consultation at FemGevity Health if women aren’t sure if what they’re experiencing is something we can help them with.  And we also do Instagram Lives on most Monday nights around 8:30 or 9:00 p.m. Eastern time where we also answer questions live that people send us, as well.

Perfect.  So you’re on Instagram, as you mentioned, @femgevity.  And you have a website.  Where else can our listeners find you?

We’re on all socials.  We’re on Facebook.  We’re on TikTok.  We’re on LinkedIn.  I’m on LinkedIn personally as Kristin Mallon.  And we also have live chat on our website.  We have a Contact Us form.  We have email.  So it’s really easy for people to reach out.  People can call or text us, as well; call or text FemGevity Health if they want to have a chat conversation via text about what they’re experiencing or going through and they don’t want to get on a free consult or they don’t want to make a phone call.  Lots of ways for people to reach out and get the information they need.

And the website is femgevityhealth.com?

Yes.

Any final tips for our listeners, Kristin?

Yeah, I think we’ve really covered a lot.  What I say about birth specifically, so for the people who are more interested in birth and childbirth, the real experts to kind of consult with are people like yourself, like the doulas of the community or a lot of times there’s – I know it seems kind of strange, but WhatsApp, Facebook, or some sort of communal chats that have a lot of really good information about birth, birth workers, who to go to, what type of places to go, and it’s usually very regional.  So I always kind of encourage women to get involved in their regional group chats, doulas, birth workers, because a doula from Ohio isn’t going to be able to really tell a woman in Oregon a lot about opportunities, resources, support, et cetera.  I think that’s my best tip for birth.  For perimenopause and menopause and hormone balancing specifically, which can happen – some women have unbalanced hormones, unfortunately, in their 20s, even – you really want to seek out an expert like ourselves.  For women that are 40-plus, a lot of what they’re experiencing is probably perimenopause or changes in their hormones or shifts in their hormones because I think a lot of women just sweep it under the rug.  They’re tired; they’re fatigued; they’re not sleeping well; they’re having more anxiety or depression or night sweats or insomnia, and they just think it’s aging or they just think it’s having little kids.  And there’s usually something shifted that we can help them balance.  It’s not always HRT and hormones.  A lot of what we do is with diet, lifestyle, supplements, nutraceuticals, to help them get back on track.

Fantastic.  Well, it was wonderful to have you on, and thank you so much for sharing your wisdom, Kristin!

Thank you so much for having me!  It was great to talk with you.

IMPORTANT LINKS

FemGevity

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Kristin Revere and Dr. Annie Bishop discuss how Webster Certified Chiropractic Care can be beneficial during pregnancy.  They also discuss other options for prenatal and postnatal support.

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am excited to chat with my friend Dr. Annie Bishop of Rise Chiropractic Wellness.  Welcome, Dr. Annie!

Thank you so much, Kristin!  I’m so pumped to be here again.

I’m excited to chat with you!  It’s been a bit.  We’ve had you on over the years, multiple times, as well as Dr. Rachel.  But our topic is all about the importance of overall chiropractic care during pregnancy, but especially focusing on the Webster technique.  So let’s dive into that.

Awesome.  Thanks, Kristin!  So I really wanted to talk about Webster technique: what it is, why people seek us out, and why it’s so important as a preventative measure for your pregnancy.

So the first thing is that Webster technique was started by Dr. Larry Webster, who was a chiropractor, and he developed this technique that was specific to the anatomy of the pelvis to help moms during pregnancy to make sure that everything was in good alignment.  So that’s been taught now over the last couple of decades to a lot of different chiropractors.  So when you’re searching for, like, prenatal chiropractic, Webster technique is really the certification that you want to check for.  So that has been kind of going on with ICPA, which is the International Chiropractic Pediatrics Association, for several decades now.  They’re the ones who do the training.  Both Dr. Rachel and I have taken that training, as well as some other advanced perinatal techniques.  It’s really important at helping support women during their pregnancy and help support their bodies.  I wanted to go in depth a little bit with what Webster technique is, what it’s actually looking for, and why it’s so important from a neurological aspect, from an overall body tone, how your biomechanics are changing, that aspect.  That’s what I wanted to focus on today.

Beautiful.  Before we begin, you did mention some of your certifications, as well as Dr. Rachel’s, but give us a bit about your background.  I know you have many certifications.  Why did you choose to work with women in childbearing years versus all of the different focuses and types of chiropractic care out there?

Oh, thanks for that question, Kristin.  So both Dr. Rachel and I went to Life University.  We actually went at different times.  She’s my best friend’s oldest sister.  After she graduated, she told me where to go, so I followed suit.  But while there, you take some family, like pediatric and pregnancy, courses in the curriculum, and then you can take some optional ones if you’re really into it.  I think it was during those ones when I was learning about neurodevelopment and all of that when I became really interested in this idea of helping babies and helping with that neuro development, making sure babies are on the right track, and the impact that you can have in a kid’s life that way and in a person’s life.  And a lot of that initial help with infants starts in pre-conception through pregnancy, so doing the prenatal and pregnancy support was a really important aspect of that.  It’s helping moms just have their best possibly pregnancy.  I mean, both Rachel and I are women.  We care a lot about women’s health and are very huge proponents of just women’s health in general and having good doctors and not dismissing women and being really supportive of their whole journey.  That became really important to both of us.

And then when Rachel got pregnant with her twins, we realized how absolutely important and vital it is to have good chiropractic care throughout the pregnancy and how supportive that is.

Absolutely, not only with relieving discomfort, especially with twins, but certainly positioning.  It is so important for vaginal deliveries to have both twins head down, as you know.  I know you worked on Dr. Rachel.

Yeah, absolutely.  And she carried those twins to 39 weeks and had two eight-pound babies.

I was her doula.  She was amazing!

Yeah.  It’s so important.  It’s great support for the mom’s body, for the position of the baby, for all of these factors that go into having a good birth.  That also leads the way so much to prevent birth trauma, to prevent interventions so that baby has the best outcomes, too.  That’s why we’re so passionate about what we do.

So if our listeners see a general chiropractor and then they become pregnant, is that something that you temporarily switch over to a Webster certified chiro, or is there any co-care if they have this longstanding relationship?

That’s a really good question.  It’s up to the comfort of the individual.  I would say if your chiropractor doesn’t have any pregnancy training, I would switch during your pregnancy.  There’s just a lot of important things and changes in your body that you want to have someone who is really educated on it and really prepared for it.  We have a lot of moms who will come to us just during their pregnancy and then go back to their old chiropractor afterwards and take their families there and stuff, too.  We have no problem doing that.  It’s kind of like medical doctors.  You have different specialties, and some people are really good at some things.  I think that’s a really important thing when it comes to chiropractic.  We should really focus on each other’s strengths and give people the best care possible, right?  Having somebody who’s really well trained in perinatal care during your pregnancy is going to be so much more supportive, and then switch back to your old chiropractor afterwards.  I think that’s great, especially if you have a great relationship with them.

Or if your chiropractor is not a pediatric chiropractor, the way your practice is Webster as well as pediatric.  Then potentially having a pediatric chiropractor adjust baby, and then transition as the child ages to a general chiropractor.

Absolutely.  Babies are not just littler, smaller spines.  They have a lot of differences, too.  You want someone who, again, knows and is really good at adjusting kids and works well with kids.

So, Dr. Annie, what are some of the top reasons that your patients seek out a Webster certified chiropractor?

A lot of times, people seek out Webster certified chiropractors because they’re pregnant, but also because a lot of times, it goes along with pregnancy discomfort, what they’re feeling, changes in their body, but also because baby is malpositioned.  I feel like that goes along with the Webster technique.  Usually when baby is not in the right position, moms will start seeking out Webster technique certified chiropractors.  I want to talk about all of that, too, how it all works together.

Webster technique is kind of based on ways to prevent dystocia, which is difficulty during labor.  And so if we go into Williams Obstetrics, which is the textbook that OBs use in their education and their schooling, there are three main causes of difficulty during labor.  There’s power, passage, and passenger.  Those are the three things that they talk about.

Power is talking about the uterine contractions and how well neurologically your body is able to communicate.  The uterus is a huge muscle, and it gets its innervation from the upper lumbar and also from the sacral plexus, too.  It gets those nerves from the spine, coming and talking to the muscle of the uterus.  The power component of that is really making sure that there’s good neurological communication there, which ties directly into chiropractic.  We want to make sure everything is in good alignment so that communication can work well, so that when your uterus and all the muscles are contracting, it’s all working together symmetrically and working together really well.

The passage is looking at the pelvic opening and the shape of the pelvis and how all of that moves during pregnancy, too.  During labor, the pelvis kind of opens up.  You know, the sacrum kind of kicks back.  The pelvic floor muscles have to be pliable and movable so that the baby can have the best chance of going through the birth canal.  If there are subluxations in the pelvis – that’s really what Webster technique is looking at is how the pelvis alignment is working, how everything is working together, because if ligaments are tight on one side, if muscles, pelvic floor muscles, are tight on one side, that’s all going to cause more intrauterine constraint, which is also going to lead into the next one, which is the passenger, which is the baby trying to come through the birth canal.

If there is twisting in the pelvis, if there is intrauterine constraint because of those ligaments or muscles, baby is going to have a harder time getting into the right position and getting into that head down, ready to go position.  Those are all the three main components, and Webster technique addresses each one of those in kind of a different way.  Chiropractic is working with those subluxations to make sure there’s good neuromuscular communication.  We’re making sure everything is in good alignment so baby has the best chance of doing the right thing.  And then we also work on ligaments in the belly and stuff, too, to just give baby optimal room.  Innately, they should be able to get into the right position.

Right.  And what is the best time in pregnancy to start seeing a chiropractor?

I would say the earlier the better.

I would agree.

I think we have the best outcomes.  The earlier you start – I mean, there’s so many factors to chiropractic, too.  It’s not just about being uncomfortable or having the correct biomechanics, making sure that things are in alignment.  There’s so much to the stress component of that sympathetic and parasympathetic balance in the body.  Making sure your body is recovering well and that you’re just functioning as well as you can.  I would say that I think everyone should be under chiropractic care, everyone with a nervous system, but especially early in your pregnancy, you are going to feel so much better.  Your body is going to adapt so much better to the stresses and the challenges of pregnancy.  Then we can just support you all the way, too.

Exactly.  And so for our listeners who may be seeing a physical therapist, how does that relationship connect between a Webster certified chiro and maybe getting certain exercises from their physical therapist to relieve discomfort?

Oh, I think that’s awesome.  I love it when people are so invested in their pregnancy and they have all of the tools.  It’s the best.  Pelvic floor therapy is super important, too, both pre- and post.  But also, yeah, working with a PT just to – I think, again, I go to a  PT monthly just to keep my body working the way it should, to make sure I’m doing the right exercises and balancing my muscles and stuff, too, in addition to getting adjusted weekly.  I think both are so super important, and they work so well together.  So if you have a PT and they’re working with you on strengthening, the beauty of strengthening the muscles in a well-aligned position is just like chef’s kiss.  Just perfect.  They work so well together.

Agreed.  I do feel like there’s a misconception that if someone is seeing a chiropractor, they don’t need PT.  I’m glad you cleared that up.  Or if they’re seeing a physical therapist, then – and obviously, some people, if it’s self-pay or limited HSA funds, or insurance only covers so many visits, they might really try to optimize their budget.  But as someone who is nonmedical, it makes sense for me, if a client has the time and funds or insurance, to utilize all of the options for support that they can.

Oh, yeah.  Absolutely.  And realistically, there’s a lot of different things that you can do, and really finding what works for your body and who’s willing to work with you on it.  I think it’s the best option.  We do those scans in our office that are, again, no radiation.  They’re all functional tests.  And we give our recommendations, but we’re always willing to work with people.  If they’re like, well, I’m doing this and this also.  It’s like, great.  This is supportive care.  So let’s see what we really need, and then if you’re doing all these other things at home, we can kind of modify that because you’re already putting yourself a step ahead of someone who’s only doing this one thing.  It’s a little different because, again, things work synergistically.

Right, exactly.  And I would say certainly I’ve sent some of our clients to you if baby is breach or is malpositioned, for those positioning issues, or, again, discomfort.  But there’s also some of those last minute calls that you would get for someone who maybe has a VBAC and wants to optimize their changes for a vaginal birth after Cesarean or someone whose baby is measuring big and they really want a vaginal birth, so they want to get that extra support from a Webster certified chiro.  What else are you seeing?

Those are big ones.  I mean, we do get the 36-week patients who are like, my baby is breach.  We just found out on ultrasound.  What do we do?  And it’s like, okay, we’re going to do probably close together visits and just try to optimize whatever time we have and also send you to someone who does body balancing technique.  We’re going to hit the ground running and just try to optimize whatever time we have.  Obviously, more time is more beneficial, but we’re always willing to work with those situations because we get it.  A lot of times, you don’t get the ultrasound until that point, so you don’t necessarily know.

Exactly, and then you need to make decisions.

Exactly, but yeah, we’re always willing to support any of those kind of game time things.  But I would say those are pretty big ones.  You kind of nailed it on the head with, like, the breach baby positioning.  VBAC support is huge.  We have a really good success rate with VBAC support, which is so exciting.  There’s also great care providers in town, too, willing to do VBACs, and I think that’s awesome.

And even with induction pending, wanting to get your body as ready as possible if that induction conversation comes up with a provider and you aren’t seeing a chiropractor – similar to what you described with a breach baby, trying to get in as many visits as possible before the induction date would be beneficial.

Yeah, that’s a great point.  Inductions are stressful on the body.  And so the better adaptability and the more ready your body is to have a baby, the better outcomes you have with the induction, too.  That’s a really, really good point, too.  Just again supporting moms, getting them as ready as possible so that their body can handle what’s coming.

Right.  And then certainly reducing headaches or balance issues.  I could name off 20 reasons why I send my clients to you.

Or the SPD.  No one knows what to do with the symphysis pubis dysfunction, which is awful, but we can adjust it, which is great, and that helps.  So if it hurts when you go up the stairs or why you try to put on your pants one leg at a time, it helps a ton.  But that’s the benefit of your body working more efficiently is a lot of those symptoms go away, and it’s not just about the headaches or the pain and stuff, but it helps a lot with those things, too.  Let’s not discount pain; it’s a huge motivator, for sure.

Yes.  And then also in a women-owned practice, supporting women.  When I go in for adjustments or to work on the diaper drive with you, I hear – it’s almost like confiding in that close relationship you would have to your hair dresser.  It’s like you are following their journey.  You’re offering emotional support the way a doula would.  It’s truly a sense of community.

I think that’s my favorite part of our practice.  We do the open adjusting.  There’s so many mom conversations.  Kids will be playing in the corner, and moms are just chatting, like, oh, what do you do about this?  Where do you guys go to play?  What parks do you like?  Just little conversations like that.  And I just love to be witness to that.  But that’s going with moms through – we have a lot of second and third time moms right now that we find out so early in their pregnancy because we’re one of the first providers they can tell, one of the first people they can tell.  We’re just so thrilled for them because a lot of them, sometimes it’s taken a little while to get pregnant again and stuff, and so we celebrate that with them.  We work with them through their pregnancy journey.  They can tell – there’s no shame in our office.  You can tell us literally anything, and we’re just here to support.  And then getting to enjoy that birth, getting to go through all the highs and lows of pregnancy, all the highs and lows of motherhood, and just create a community around that – I love it so much.  I love that aspect of our practice.  And that’s what just keeps us motivated and keeps us wanting to do more and more of this work.

Yes, and I think your practice is unique is that you do home visits and you do have that follow the journey from pregnancy to early parenting with the pediatric aspect of your practice.

Yes.  Home visits are so fun.  Getting to meet baby – sometimes it’s before a lot of the other family members get to, too, which is – what an honor for us, with a mom where we’ve helped support her pregnancy, to then be like, here, adjust my baby, too.  It’s such a tremendous honor to be a part of their lives like that.  I love the home visits.  I think it’s so fun to feel like an old-timey doctor, bringing my whole kit over to someone’s house.  That’s a big fun part.  We always offer those during pregnancy.  We love to follow up with moms, too.  We understand that your focus now is on your baby or recovery or any of those things, and so we always want to check in with you, but not push too much.

And then in pregnancy, if someone’s on bed rest at home, of course you can help there, since you do home visits.

Absolutely.  And if there’s a home birth, too, with stalled labor, we can come during the labor process.  There’s a lot of things.  Even after a Cesarean birth, we can still adjust seated.  There’s always ways that we can modify.  If you’re on bedrest, if there’s certain things, like if you have an incision, we can adjust you different ways, and we’re very flexible with that, too.

Exactly.  So what are your final tips for our listeners, Dr. Annie?

Oh, find a chiropractor that loves you like us and wants to just support you and be psyched about your birth outcomes.  I feel like we have such a good community of birth workers in this area that all feel the same way that we do.  If you’re listening in a different area, find a birth team that really cares about you.  In Grand Rapids, we’re so lucky because there’s so many doulas, so many midwives.  At Gold Coast, you guys crush it all the time with your classes, with your support, with your Becoming course, to just support moms as they are and as they show up and just love them and help them through this challenging time.

It’s such a vulnerable time, and I do love that you have the all-inclusive that we do at Gold Coast.  We follow families through the first year with our day and overnight support.  And so we get to know them on a much different, more intimate level, and you have a very similar model. 

Yes.

You did mention resources for our listeners who live elsewhere.  Remind us again on how to find a certified Webster chiropractor in your area.

Anyone who’s taken a Webster certification and keeps up on it will be listed on the ICPA website, which is icpa4kids.com.  But if you Google ICPA, too, it will take you to the website.  And then right on the main page, it says Find a Doc.  You can type in your address, your ZIP code, even just city name, and it will populate who’s closest to you.  It will show who’s Webster certified, who has a CACCP, which is the certification that I have.  It’s the pediatric certification.  And then there’s also a DACCP, which is a diplomate, which I’ll probably work on here in a couple of years, too.  Those are the different levels of pediatric and perinatal certification, but if you’re pregnant, find somebody who’s at least Webster certified.  I think that would be just tremendous support for you.

Excellent.  And how can we find you?  Fill us in on social.  I know you’re everywhere on social.  Your website, all of it.

Oh, we have a lot of fun on social.  We are on Instagram.  We’re @risewellnesschiro.  Facebook, same thing.  Our website is risewellnesschiro.com.   You can find us on any of those.

And you do Facebook lives.  You have in-office events quite frequently for listeners and clients who are local.  As you mentioned, there’s so much going on.

Oh, yeah.  We like to do Yoga Bumps and Bagels in our office.  We’ve got Jessica, who’s a pediatric OT, working out of our office.  She’s doing a bunch of events every third Saturday now.  Tummy time support, breastfeeding support, all sorts of things.  And then we host Fit For Mom classes, too.  So we like to have events in our office, for sure, and just make it a safe space for moms.

Well, thanks so much for chatting with us, and we’ll include all those links on the blog.  We’ll have to chat again soon, Annie!

Yes.  Thank you so much, Kristin!

IMPORTANT LINKS

Rise Chiropractic

Find a Webster chiropractor

Birth and postpartum support from Gold Coast Doulas

Becoming a Mother course

Kristin and Danika discuss ways parents can prep for baby during pregnancy.  They also touch on the role of social media in parenting.

Hello, hello!  This is Kristin with Ask the Doulas, and I am so excited to chat with Danika Sanchez today.  She is the president and owner of Baby Steps Concierge Nursing.  Welcome, Danika!

Thank you so much!

I would love to have you fill our listeners in a bit about your impressive background in nursing.  I’d love to hear how you transitioned to this role as more of a concierge support in the postnatal phase.

Okay.  Well, I am one of those people that kind of changed careers late in life and decided I really, really, really wanted to work with babies.  So I went back to college at age 40, went through nursing school, and started in the NICU, which is where I wanted to be.  That’s the neonatal intensive care unit, all the little preemies or ones that need a little extra support.  I worked in that department at a couple different hospitals for about four years, and then I decided I wanted to see what it was like upstairs in our hospitals upstairs where the moms are.  So I’m now a postpartum nurse, helping parents after the baby is born from the time that the baby is born until they go home from the hospital.  And, you know, you’re only in the hospital now for 24 to 48 hours after your baby is born, which is very little time, and the first, I would say, at least half of that time, most of the parents I have conversations with have zero recollection of anything we spoke about when they first got there.  And it’s not anyone’s fault.  You are tired.  You’ve been in labor.  You haven’t eaten.  You haven’t slept.  You’re excited; you’re overwhelmed.  There’s a lot of things.  So doing my best to try to get them ready to go home and teaching all the skills and the swaddling and the feeding and the diapering and all those things, and it was one week in particular, I had three different sets of families say, we are not ready to go home.  Can you just come home with us?  And I laughed and said, oh, ha ha, I wish.  That would be great.  But by the third time, I was like, well, maybe.  Maybe there is a way to make that happen.

There’s a need.

Yep.  That’s where this company was born.  And that is what we do.  We just help ease that transition from having the baby to being at home with the baby and figuring out, what does that look like for your family, because every family is different, as well, right?  So what does that look like for your family?  What skills do you want more practice with?  We give the first bath in the hospital, but that means you didn’t give any baths before you got home.  So, yeah, just being there to answer questions, to be hands-on support, to help you figure out what next, or how do I know if my baby is hungry or tired or whatever.  All of my employees are nurses as well.  They all work either in NICU and/or postpartum, so we all have experience with not only babies in a variety of ways that babies are different, but in helping parents to learn to be a little more confident in that role of being a new parent.

That makes sense, and it’s much different than, say, the role of a postpartum doula or a newborn care specialist in that you have that nursing medical background.

Right.  So especially if you have a baby that is going home maybe from the NICU or has a feeding tube or is on oxygen or has a wound, something that needs maybe a little extra care, even though you are fully able to do those things on your own.  I’m sure if your baby has a wound, the nurses and doctors showed you how to change the wound dressing.  But it’s scary.  It’s still scary, and it’s scary to do it on your own for the first time at home.  So we do have that nursing license and background and experience to kind of help you get more comfortable with those situations, as well.

Beautiful.  So what are your tips to help parents prepare for their new role?

That is the big question!  I mean, everyone nowadays is taking childbirth classes or going to a class at the hospital before they give birth, but those classes tend to focus so much on the labor part, which absolutely still needs to be addressed.  That’s scary, of course,  But then I think there’s kind of a drop off in what to expect after that.  And so when we have brand new parents coming up to our floor after giving birth, they’re like, we don’t know anything.  We don’t know how to diaper this baby.  I mean, everyone kind of knows how to put a diaper on, but –

Some dads may not have, though.

Some dads may not have.  Also, I had this family, I walked in, and they were like, we need more sheets.  This poor baby has peed through his diaper every single time the last four times, and I was like, okay, how about we talk about diapering?  There’s probably some things we can do better so that there isn’t a leak next time.  And sure enough, a couple little adjustments and he was like, oh my gosh, I never even thought about that.  And then they never called for more sheets after that.  There’s lots of little tips and tricks, and this is where social media is both wonderful and overwhelming.  There are – I mean, myself included, I have little videos on YouTube of how to diaper, how to swaddle, how to bathe, how to do those things.  But so do a million other people.  There’s a lot of information out there.  And it can be overwhelming.  You don’t know who’s right or who’s wrong.  And to be honest, with most of these things, there’s not necessarily a wrong way.  I mean, there are a couple wrong things.  Like, don’t ever leave your baby alone in the bathtub.  That would be wrong.  But there’s swaddle baths and there’s submersion baths and there’s different types of bathing, different ways of doing it.  One isn’t necessarily better than the other in general, but one might be better than the other for you and your baby.  Some babies have preferences.  It sounds odd to say; I think people don’t realize it.  Those babies have that personality before they even come out.

Right, and twins can even be so different from each other.

Absolutely, 1000%.  And it cracks me up; even the babies in the NICU.  The preemies that are born at 28 weeks, they already have personality.  Where I think it’s helpful to have someone be there with you and be hands on with you is that we can go through all the different options.  Like, okay, let’s try this, this time.  And if the baby didn’t seem to like it, all right, let’s tweak it and try it this way next time.  And really help narrow down what’s going to work best for your family, your baby, your sanity, all that stuff as a new parent.

And some people as you mentioned – you know, you have all of these YouTube demonstration videos, but some people need the hands-on learning.  Every individual has a different learning style, so having someone in home to help can be beneficial.  Others need more written instructions or watching a video is great for them, and they can figure out swaddling or baby wearing or feeding questions and so on.

I agree.  I do think hands-on still is beneficial for everybody at some point.  And also people, I think, don’t take into account that it’s different when it’s your own baby.  I had another couple, and they – this was in the hospital.  They had had their baby, and the wife says, oh, we’re not really going to need you.  I’ve been a caregiver forever, and my husband – whatever, he was a nanny.  And I’m like, oh, well, that’s great!  Those people called me every 15 minutes.  They were like, did we do it right?  Does this look okay?  She doesn’t seem to like it.  So you can have knowledge before you go into the situation, but it’s so, so different having the actual baby there, having to touch, hold, handle.  Some of the videos I have up on my YouTube channel is how to pick up the baby.  I’ve had dads going, I don’t really know how to hold it.  How do I grab it?  How do I pick it up out of the bassinet?  There’s just so many things you don’t really think about and aren’t real until the baby is actually there and you’re trying to maneuver it and you’re so afraid because they just seem so tiny and fragile.

Right.  I’m interested to hear – it sounds like you made videos based on what your clients were asking for help with.  What are the top questions or concerns that you’re hearing from new parents?

It’s definitely the picking up, holding, swaddling.  Those are big ones.  Diapering, of course.  Feeding is a big issue.  I don’t really have a video up yet on feeding, but a big issue that we have is some babies take longer to what we call transition, so to get used to being out of the womb and being out here in the regular world.  Some take longer than others, and the ones that take longer tend to not eat very well, or they’re very sleepy and they don’t latch very well, and parents get very panicked, which I understand.  A lot of it is just kind of reminding parents that there is a transition period.  Every baby is different.  Your baby might just take a little bit longer to transition.  Here’s what we can do in the meanwhile.  And other babies that maybe have to have formula for some reason or their parents can’t breastfeed or don’t want to breastfeed – there are certain ways of feeding, of holding the bottle, that are better than others for certain babies in certain situations.  So we’re going to get some feeding ones up.  I also had a client call me once.  Her baby had been discharged from the NICU two weeks prior, so we thought everything was going great, and she called me one day, and she’s like, oh, my gosh, he was eating great, and now he’s not eating at all.  What do I do?  And I said, I’ll be right there.  And I came over and we fixed it within ten minutes.  It just was the wrong sized nipples.  So there are different sized nipples and different flow rates, and those need to be adjusted for different babies at different times.  And so there’s just a lot of that kind of stuff that it’s hard to know when, and you can read as much as you want about it, but until you experience it, you don’t really fully understand what you’re looking for, what to watch out, kind of some of those signs.

I love it, yeah.  Every baby is so unique.  There is no manual that will be the perfect solution for every question.

Exactly.  If I can mention one other thing, it’s this kind of soap box I jump on all the time with swaddling.  Everybody likes to swaddle.  They put the babies arms down next to their sides, and they swaddle the baby.  Well, some babies hate that.  They break out of that so easily.  So I ask all my mamas, when you had your ultrasounds, did your baby ever have one or both hands up near their face?  And sure enough, they’re like, yes, she always had her right hand up, and I’m like, then let’s swaddle her with her right hand up.  If you think about it, this baby has had access to her right hand her whole entire life, her whole nine months or whatever.  And now we’re taking that away from her.  She’s in a new environment.  She’s cold.  It’s loud.  It’s bright.  And we’re taking away the one thing that soothes her and comforts her, which is being able to have her right hand up near her face, sucking on her thumb or just touching her face or whatever.

It makes perfect sense.

You can swaddle your baby with one or both hands out and still have it be a very tight, efficient swaddle.

And now there are so many different types of swaddles.  Some have the arms up, like Love to Dream, and others are more the traditional with arms down. 

Yeah.  And some babies like the arms down, and that’s okay, too.  But again, it’s all about figuring out what’s best for your baby.  And as new parents, I don’t know if you remember, but our biggest fear is that the baby is going to cry.  We think that crying means we’re doing something wrong.  And it can mean that, but it also – that’s how they communicate.  So sometimes we need for them to cry so that we know what’s going on and what they need.  But parents in the hospital when they first have the babies are just so afraid to hear their baby cry.  They think that they’re failing the baby.  They think that they’re failing parenthood.  A lot of it is just like, hold on a second.  Let’s take a deep breath.  We’re going to be okay.  And let’s take a moment and figure it out.

Perfect.  Yes, because babies can sense if you’re anxious or upset, so then they become more distraught and will cry more.  So if you take that moment and pause and breathe and relax, it can be better for everyone.

I am a huge, huge, huge proponent of energies.  The Dog Whisperer is one of my favorite shows, and what he always says, right: it’s not the dog’s problem, it’s the owner.  The owner is uptight.  The owner is anxious.  It is the exact same with our babies.  If we are anxious and uptight, our baby is going to be on edge.  If we are calm, our baby will be more calm.  It’s easy to say, of course, but as a new parent, it’s hard to find that center, to find that calm place when you don’t know what you’re doing and you’re panicking and you’re trying to hurry and fix something but you don’t really know what you’re doing.  So, yes.  Deep breaths, take a deep breath before you go over to the baby, and then finding the people that can help you.  Finding the resources, finding whether it’s a company like me, a doula, or just a family member or a friend.  But finding someone that can also kind of help center you and remind you to breathe.  That’s a big deal.

It is.  Absolutely.  So let’s transition to social media and how that affects parenthood.

Okay.  So I mentioned earlier, it’s both good and bad.  I think there’s a lot of good information, but there’s also just a lot of extraneous information that just gets overwhelming.  I had a client who bought five different bathtubs for her baby, because she’s like, number one, everything that I saw on social media had some reason why that was the one I needed to buy, and she was like, I’m afraid of getting the wrong one, and I’m going to make sure I have them all.  Well, she also kind of got herself into a panic over a bathtub.  So I’m all for doing your research; that’s fine.  But your baby doesn’t need five bathtubs.  We can probably start with one, and that should be fine for a while.  So there’s kind of this pressure, maybe, on parents before the baby comes to have all the latest gadgets and make sure that they have every single piece of supply or equipment that they might possibly need.  The Snoo; the Snoo is wonderful.  If you don’t know what the Snoo is, it’s a bassinet that kind of vibrates based on the baby – the activity of the baby.  So if the baby cries more, the Snoo will actually vibrate faster.  And we use it in the hospital a lot for babies that are going through withdrawal.  But some parents have it, as well.  It is very, very expensive.  It is thousands of dollars.

It’s even expensive to rent, because they do have rentals.

Yes.  But some parents are like, oh, I’ve got to have a Snoo.  What if my baby is fussy?  I need to have the swing; I have to have the – you don’t have to have everything right off the bat.  It’s okay to start with just the baby, and let’s see how it goes from there.  You might have a really chill baby that doesn’t need any swinging at all whatsoever.  I also show my parents all the time, as soon as you get your baby in the car seat, buckled in the car seat, swing the car seat a couple times, and a lot of times that calms them.  Most babies hate being put into the car seat, but kind of swing the car seat back and forth just a couple times.  That tends to calm them down enough so that you now are not dealing with a screaming baby.  So your baby might just need that.  And you might not even need the swings and the Snoo and all the other gadgets.  I think there’s an overwhelming aspect on social media regarding gadgets and supplies and equipment for babies.

Exactly, and what works for your friend might not work for you.

Exactly.  Exactly.  Or like you said, even your first baby might be different from your second baby.  Or Twin A might be different from Twin B.  You just never know.  The place where – let me talk about the good of social media.  There is a movement – it’s still kind of grassroots, but there is a movement towards postpartum mental health being much more important and talked about than it is currently, and for that, I love, love, love social media.  There are some phenomenal people to follow, pages to follow, and trauma – with birth trauma, as well, Birth Trauma Mama is one of my favorites.  And there’s so much support there for women who have gone through a delivery that didn’t go as expected or are experiencing postpartum depression, baby blues, how to tell the difference between the two.  There’s also more evidence showing that dads are going through postpartum depression at a rate that we didn’t realize before.  It’s not a huge, really high incidence, but the fact that it’s even out there is something a lot of people weren’t aware of at all.  I think social media is fantastic for finding support for whatever your particular situation is.

Yes.  And I do love the vulnerability in the current social media movement.  More authentic, like showing a messy house and kids being happy and the joy of parenting versus having to have the Pinterest and Instagram perfect life.  I definitely agree with everything you said about just people being open about their struggles and that making it easier for others.

Yes.  Absolutely, 1000%.  That’s definitely the good side of social media, for sure.

Yes.  And I would say the negative or confusing side of social media is getting into some of the mom and parenting groups on sites like Facebook where if that’s the only information source, you could be given incorrect information, bad advice from other moms who are not experts like yourself. 

Right.  And that’s a very good point.  Consider the source.  Any time you see anything anywhere, consider the source.  If it’s just, this is my first kid and so I’m writing articles on how to raise your kid the best way ever, that might not be a completely reliable source.  Make sure you’re looking – and it’s okay to read those things, but also fill in with articles from pediatricians.  Fill in with articles from RNs, from doulas, from people who have education, like formal education and experiences and licensing in those areas so that you can, like you said, see what’s real, what’s not real, what’s safe, what’s unsafe.  I haven’t, luckily, seen too much out there that’s completely unsafe, but it only takes one.  It only takes one person to give bad advice to have something really bad happen to your baby.  So definitely something we want to be aware of.

Exactly.  So how can our listeners connect with and find you?

We can be found online at babystepsnursing.com.  We are getting our YouTube channel all up and running there.  We have some article resources on there.  There’s an inquiry tab if you ever have any questions about either our services or just something related to baby.  You know, we’re more than happy to answer any questions that you have.  So those are kind of the best ways.  We are also on Instagram @babystepsnursing.  I’ve been posting some of the YouTube videos up there lately.

I’ve seen those, yes.

Okay.  We try to be very down to earth.  This is not a formal – you don’t have to have a degree to understand these videos.  These are for everyone to hear, for everyone to follow, and if you have any suggestions or if anyone wants videos on more topics, we’re more than happy to do more of those.  So yeah, those are kind of the best ways to get ahold of us.

And your location geographically for listeners who do want that in person support?

We are in the Los Angeles area, but we can travel pretty far.  I would say LA to San Diego for the most part.

That is a far distance, yeah.

It is a far distance, but there’s not a lot of services out there like ours, to be honest, that we have found.  So we want to help as many people as we can, and to be honest, we do work with the LGBTQ community and with surrogates, and I have some dads who are going to be having triplets.  They weren’t expecting triplets, but they’re getting triplets.

So they’re getting help; good!

They’re getting help because they have to transport these babies.  The babies are going to be born in South Dakota, but the dads live here and are like, there’s only two of us.  We need to transport three babies.  Can we get anyone to help travel?  Yes, absolutely, we can do that.  So we can help technically across the country.  We also can do a lot via Zoom.  Obviously, the hands on stuff can’t be done via Zoom, but we can always have conversations if you just have a quick question.  We can talk about some preliminary things before you go to the hospital.   A lot of that can be done via Zoom so therefore can be kind of anywhere in the country, as well.

Beautiful.  What an amazing service.  Any final tips for our listeners?

Oh, my biggest tip is always build your village or find your village.  Make sure that you know who you can reach out to for different things.  We all have friends that have various roles in our lives, and that’s going to continue into parenthood.  So make sure you have the friend that you can call and vent to without feeling like a horrible person, because you’re going to have a day where you’re going to be like, I don’t think I can do this parenting thing.  Find the friend that will make you laugh because laughing will take you so far in parenting.  Find the friend that has the resources that did it before you, that says, oh, you know what, when my baby had trouble eating, we used this bottle, and it worked for me.  Maybe you should try that one.  Just make sure you have people around you that can support you and that you are comfortable reaching out to because that’s the important part.  So many times, we’re just plowing through.  We’re just putting one foot in front of the other, trying to get through the day, maybe just trying to get through the hour.  But we have to be aware enough to ask for help if we need it, and having a list of people at top of mind or written down next to your phone so that you don’t have to think about it.  You can just look down that list and be like, oh, my gosh, yes, I need to call my mother or I need to call my neighbor.  It can really, really be helpful for stressful times.  I would say the biggest tip is find your village, build your village, yeah.  Find your resources.

Excellent advice.  I loved having you on Ask the Doulas, Danika.  Thank you for sharing all of your tips and wisdom with our listeners.

Thank you for having me on!  This was great!

IMPORTANT LINKS

Baby Steps Concierge Nursing

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Kristin Revere chats with Bianca Sprague of Bebo Mia about the rising need for doulas and how their care transforms family experiences.

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Bianca Sprague today.  Bianca is a passionate educator and advocate in the doula community, focusing her expertise on supporting women and queer individuals in the fields of fertility, birth, and postpartum care.  As a self-identified super lesbian and a dedicated mother, Bianca brings a unique perspective to her work, emphasizing the importance of balancing professional doula responsibilities with personal life, especially for mothers.  She is deeply committed to addressing issues like queer care, combatting fatphobia in medicine, and exploring women’s rage and its implications.

Welcome, Bianca!

Thank you so much for having me.  I’m really happy to be on the show.

Yeah, I can’t wait to dive into this important topic.  We’re going to be chatting about exploring the rising need for doulas and how their care transforms family experience.

I have a lot to say on this topic!

Let’s start with a bit more about your background, and then we’ll get into exploring the topic.

Yeah, so I came into doula – I mean, I would say most people come into doula work because they either had a really incredible birth experience and they want to make sure everybody has that, or they have a terrible or traumatic birth experience and they want to make sure nobody has that.  And I sat – out of all the statistics, I sat somewhere in the middle.  So my plan was actually to be an OB-GYN, and it wasn’t until the birth of my daughter that I realized the relationship I wanted to have to birth was way more the relationship my doula had, versus my doctor.  And I actually could very clearly identify that I was not prepared to perpetuate the harm that comes from a system that is designed to have us not trust our bodies.  I mean, if we look at the stats for birth outcomes in Canada and the US, our medical system is not looking so good.  I remember pacing after my birth – like, I’m bouncing.  You guys can’t see me, but I’ve got that newborn bounce with the hands on the chest.

It never goes away.

It never goes away.  And I remember pacing with my daughter.  She was days old, and I was like, what just happened to me?  I had the birth that I wanted, but I didn’t have it where I wanted it.  I was in a hospital suite, and I really wanted a homebirth.  And I was like, that was way too hard for me to have an uninterrupted experience.  I felt a lot of rage around it.  I felt cheated and robbed.  And I knew that I didn’t want anyone to feel like how I felt.  I also was in an unsafe living situation, so I very quickly – you know, once you become a dependent with a dependent in a cycle of abuse, I was like, I’ve got to get out of here, and I need to change the world, and I need to protect birth.  And so I started my doula organization, and so that was about 16 years ago.  Now, we train birth workers and folks who work in fertility, birth, and the postpartum period.  And then I think as of right now, we’re in 49 countries, which is pretty wild.

That is amazing!  So much growth!  Tell us a bit about your training organization.  I know some of our doulas have gone through your program.

Yeah, so my organization is called Bebo Mia.  You can find us at bebomia.com.  My experiences as a parent have caused me to want to go into doula work, and then the experience I had with my doula training, which at the time, I loved, but it wasn’t until I went to my first birth that I was like, oh, I’m wildly unprepared because you can’t learn everything you need to know in a weekend.  Then I started building a community where we were building a training together of all the things we’d wished we had.  That’s really how Bebo Mia came to be.  We used to teach in Toronto, and then we had so much – you know, there was a lot of requests from people who lived outside of Toronto.  We moved exclusively online in 2012, so we’ve been teaching in the digital space for a while.  We really want people to come out and go into the field of doula work feeling really supported, understanding how to run their business, understanding feminist values, and having them and their family ready for the type of work they’re going to do.  Tying into the question that we’re talking about today about the rising need for doulas, there’s something particularly magical about doula work.  It’s a cycle.  And so doulas protect birthing and new families, and the work of being a doula also is really healing for the doula and their families because you get to be that voice you didn’t have, or you get to reconnect to that feeling of empowerment that you did have if you were supported in your birth.  So I would say being a doula – not only have I protected hundreds and hundreds – no, thousands of families over the almost 20 years, I also became a better parent and a better partner and a better human and had a better relationship with myself.

Beautiful.  And I feel like your program is one of the first in the fertility space.  There are a lot more fertility doula trainings, but you were early on seeing that important need.

Yeah, I mean, anybody here listening – how you got pregnant impacts how you feel about your pregnancy, which impacts how you experience your parenting journey.  I mean, we know – recently, you had somebody coming on talking about their IVF journey and the risks of postpartum depression.  We see this.  We can’t break up, which is why in our training, every person leaves certified as a fertility, birth, and postpartum doula because it is one journey.  It’s not like you can just look at any one part of it in a vacuum.  So that’s something that we’re really proud of to have that.  We also were the first to remove gendered language of the training organizations.  We were the first to adopt an anti-racist, anti-oppression policy.  And we are the first and only to include therapy for all of our students and alumni so that we send healed healers out into the world rather than folks who have their traumas activated or just reliving it in a cycle with their clients.

Changing the system, and not only the work as a doula, but training future doulas to better support families.  I do feel like – I’ve been a doula over 10 years, and certainly, there’s so much more awareness about birth doulas.  Postpartum doula interest is rising, and awareness is becoming more common.  I felt like people knew about postpartum doulas in urban cities like New York and Chicago, but in Grand Rapids, Michigan, I had to do so much education in the past.

Yeah, I bet.

It is exciting that doulas are getting a lot of national publicity and the field is growing with more and more people.  I’m sure you’re seeing through your training program that people want to consider doulas as a profession.

Actually, the market research is very promising.  I look at it as promising because it means lots of folks are interested in becoming doulas, which I love because I want to train really amazing, grounded, healed doulas.  But it also – I get really excited that it’s expected to double over the next ten years, the market.  But more importantly – I mean, I love that I’ll have students, but my main focus is to have the field of reproductive health protected and have it be a place of safety and joy rather than a place of survival and trauma and the goal of just surviving.  I’m very excited to see how many families are reaching out to inquire about doula support, especially postpartum, which is on the rise.  Anybody that loves squishy babies, there’s definitely a need for you to go out and help parents.  It is really exciting to see how many more families are inquiring about doula services, as well as how many more states are really increasing their awareness and insurance programs for doulas.  As a field for both people who want to work as doulas as well as families who want doula care, it’s looking really, really great.  I’m excited.

I am, as well.  And Medicaid has expanded for birth doula support in many states, including Michigan this past year.  That certainly makes a difference.  And then programs like Carrot Fertility covering both birth and postpartum has been a real breakthrough.

Yeah, there are some good things on the horizon.  Check out what’s available locally.  There’s also lots of doulas who have really cool programs that they support under-resourced families.  So if you are a low or no income family, you should check out your local doulas and see what they have, what kind of programs.  We have a program, as well, where we have scholarships, so if anybody’s interested in becoming a doula who’s under-resourced, you can head over to bebomia.com/scholarships, and you can find out all about that.  We don’t want any barriers to folks accessing doula care or becoming doulas.

Love it.  So Bianca, for our listeners who are not familiar with doula support, whether it’s birth doulas, postpartum doulas, share with us a bit about how doulas can transform your pregnancy, birth, and postnatal journey.

What a good question!  So doula care comes down to supporting through the three pillars of physical, informational, and emotional support.  And so if you ask most doulas, they’d say they support birth or parenting or the trying to conceive journey.  But what I think is the best part of doula care is that it really allows parents to have that pause and to feel like they are making informed choices throughout their reproductive health journey.  And so unfortunately, what’s happening in our current system is there’s a real – this goal of risk management.  And so we have all these really wonderful obstetric tools that are there if we need to jump in and save somebody.  So I like to think of the medical system like a lifeguard, if it’s functioning properly.  If you were out swimming, in a crisis, the lifeguard would run into the water and help you.  But otherwise, they let you swim because you’re doing your thing.  And so these tools are available, but just like if every lifeguard jumped in and grabbed your arms and legs and tried to do the motion of swimming with you, we’re going to run into more issues than if they just let people swim and jump in if there’s a crisis.  And so we have these tools – so I don’t want anybody listening to think any one of the tools have any judgment associated to them.  All of the tools we have save birthers and they save babies and they’re wonderful.  What happens, though, is we have this practice-based care rather than evidence-based care, and so when we go into our hospitals or our birth centers, all the tools just come at us.  And typically, without consent because this belief is, if we use all these life-saving tools all the time, this will make it extra good.  It’s like when kids are like, well, if one piece of cake is great, I bet five is really great, and it’s not.  We’re actually seeing a decline in outcomes when we use all the tools, and it’s not recommended by ACOG or the SOGC, and those are the governing bodies for Canada and the US for obstetrics, or the World Health Organization.  Everyone is saying, doctors, stop doing this.  We need somebody in that room with clients saying, doctors, stop doing this, and literally, like, stopping it if the client is not being listened to.  So it’s really about protecting our clients, whether we’re doing an egg retrieval or we’re going in for an induction or we’re at home and trying to decide where baby should eat or where they would sleep or how they would eat.  You really want somebody there that’s going to help you navigate through the actual research around the topic you’re struggling with, as well as giving you the space to use your intuition because you do know what you want and you don’t want, even if you’re not sure why.  You have this leaning towards one of the options.  Your body does know.  We want parents to feel really empowered and to trust that they know how to make the right decision, and if they get to have that protected in birth, they have that reinforced, that they’re ready to be parents.  And they go into parenting feeling really empowered and knowing that they know what is best for their baby and their family, rather than having the complication of noise around them.

Exactly, yes.  And I feel like there’s so much importance in that preparation during pregnancy, whether it’s taking a childbirth class, understanding your options, getting resources from your doula, like a prenatal yoga class or a therapist.  Really feeling like birth isn’t just happening to you, like you have this education and support team behind you.

Oh, that exactly.  We really want birth to be happening through you and not to you.  I love when my clients at the end of the birth, no matter how it went – we’re also open to having that pivot, like, I really hope it’s going to look like this, but I’m prepared if it’s going to look like this or this or this.  And so even if they don’t get their first choice, my clients, like 95% of the time at the end are looking up at me like, this is exactly – like, this was right.  This felt great because they chose it and they felt really present and that they got to say no when something was a no, and they got to say yes when it was a yes.

And certainly a doula’s presence in that postnatal phase.  If they’re not seeing their provider for six weeks and they have questions, we have that follow-up visit, or sometimes depending on the doula, multiple visits and check-ins and just knowing that you have someone that you can reach out to if you’re struggling with feeding and need a lactation consultant.  Or if you need to know if your hormone fluctuations are normal, for example. 

Yeah.  I mean, your doula is really this combination best friend and walking Wikipedia in your pocket at all times.  Whatever your questions are, you have that support.  We’ve lost that experience of the village and those intergenerational relationships within families.  That’s been severed.  That’s been severed.  Thank you, patriarchy, for rearing your ugly head yet again.  We have to pivot and we have to create something that is going to create the best outcomes for families, working with what we’re working with.  And a doula can really fill a lot of those gaps that have been left by the shift of how we’re birthing in this really isolated way, and then we go home into the postpartum in a really isolated way.  And one of my favorite parts of postpartum doulas – I think it’s the particularly magic element of postpartum work is that there’s so much focus on the baby after the baby is born.  It’s all about the pregnant person during the pregnancy, and then it’s like they’re forgotten, and they really should be centered because if they are well and centered and nurtured and taken care of, they can do a really great job with the baby.  Between the combination of kind of being an afterthought or being an extreme afterthought, as well as the fact that everybody feels like they are entitled to comment or recommend once you have your baby, it creates this really interesting place of isolation and suffering for parents because they have to keep explaining that they’re not spoiling their baby or they’ve chosen to – whatever, keep the foreskin intact or they’re having the baby sleep in their bedroom or not in their bedroom.  Like, all the myriad of choices that parents get to make for their children, they’re always questioned and challenged.  And a postpartum doula might be the first person that that parent has been listened to with no judgment and they don’t have to defend their choices.  I know when I do postpartum work – I mean, I haven’t done it in a few years because I’m mostly teaching, but to just watch people stare at me, waiting to defend themselves.  They’ll be like, so I think I’m going to start just pumping, and I just don’t – I just don’t think it’s working, and, you know, I know that, like, if I pump, they’ll still get milk from my body – and they’re just going so fast.  And I stop, and I’m like, if you want to pump, that’s fine.  Do you need help cleaning your pump?  Do you know how to use it?  And to watch their shoulders drop of, like, I don’t have to defend myself, and this isn’t wrong.  I’m like, great.  Do you want to talk about why you’ve chosen pumping?  Tell me about it.  Otherwise, let’s get you set up and get you some more water and we’ll talk about what a pumping schedule can look like.  And to see that they’re like, you’re not going to make me explain myself or tell me why it’s bad.  And I’m like, are there any other changes you’re thinking about for feeding your baby?  Tell me about those.  And just watching, and they’re like, wait, what is happening?  Everybody has something to say about what I’m doing and if it’s the best thing and if I’m a good parent.  And a postpartum doula salt of the earth, like, just going in and letting new parents know that whatever they’ve chosen is perfect, and they don’t have to do that dance of defending why they’re parenting the way they are.

Exactly.  It’s such a good description of the work that we do postpartum.  Even looking at moms’ groups and all of the judgement if somebody is posting a question, let alone family or friends giving advice.

It gets real – I don’t even go in parenting groups.  Sometimes I’m like, oh, I should see what parents are talking about when it comes to sleep because I’m on this nurtured sleep revolution where I’m really trying to talk about sleep in a different way, and I’ll stick my head in, and it is terrible in there.

It is.

It’s terrible.  People start with the most harmless question, and then by the end of it, how did we tie this back to these deep rooted valued and judgments when all they wanted to know is, is this car seat – I don’t know, do you like the color of my new car seat?  At the end, they’ve been told they’re a bad parent in 14 different ways.  Oh, man, it’s pretty wild.  But I mean, we do see really, really magical statistics around parents who have the opportunity to have doula support.  There’s actually pages and pages and pages of studies showing just the improvement in birth outcomes as well as in parenting outcomes around mental health, the ability to feed from their body if that’s what somebody’s choosing to do.  Like, there’s so many really great things.  And we actually, over 2020 – I don’t know if everyone remembers how wacky the world got.  And we actually had a really unique environment where we got to – you know, there was lots of areas of research that came out because when else have we ever had in modern history these really bizarre circumstances where the world was shut down and medical had shifted?  We have really great research from this.  And we had the opportunity to see what happens when care providers have no witnesses.  And yes, I’m using that language very intentionally.  What happens when doulas are not allowed in the birth space?  What happens if for a certain period of time when even partners or family members were not allowed in the birth space?  What happens when people went into those birthing suites with the doors closed and they were left alone with doctors?  And so we have this – I think they did it over 14 months, and the maternal and fetal outcomes were abhorrent.  And when we look at mortality, morbidity, and stillbirth and depression – it was so bad.  And so I found this fascinating.  I mean, I was devastated to see how many birthers for those 14 months had to experience birth in these ways and then go into their parenting journey after these extremely terrible – after the environment was so not conducive to joy and protection and empowerment.  But it was a huge wakeup call for folks that do want to protect birth and for parents.  So we’ve actually seen a huge rise of parents being like, oh, hell, no, when they’re going into their birth again, if they did have a birth or they heard about births over the pandemic.  So from this terrible experience, we are seeing this rise for people wanting doulas, for people demanding more from their hospitals, for the ability for – this was one of the major turning points for insurance being – there’s been a fast track for insurance policies in so many states.  Tricare stood up and listened and they’ve improved their care.  Everybody was like, oh, man, we actually can’t trust the medical system as far as reproductive healthcare.  So really great things came from this, but it was very stark.  The outcomes plummeted over that time, and it was purely because we didn’t have witnesses and protectors in the space.

I’m so thankful that doulas were considered essential in Michigan due to our governor, and most hospitals followed suit.  As long as a doula was certified, they were able to go through the process and support.  So I had very few clients that I wasn’t able to support during the early pandemic.

That’s amazing.  It was not great in Canada, the lockdowns, so I managed because I know the midwives really well.  I was doing homebirths and still allowed, but doulas weren’t even allowed to be present at homebirths.

Devastating.

Oh, it was, like, 18 months.  And there were some hospitals that literally no one could come to the hospital, and no one was allowed in for birth or postpartum.  I think especially in Ottawa, they had it for the longest, but I believe it was almost – don’t quote me on this, anybody, but I believe it was about 60 days where it was no contact, that people birthed alone, alone, and went to the postpartum floor alone, alone.  Like, nobody went into their rooms.

That is just – I mean, devastating overall, for the partner, for the doulas, for the nurses who are obviously overwhelmed when they don’t have doulas supporting in the hospitals.  Wow.

Yeah, it was bad.  There was a time where they actually got pretty dragged, but they weren’t even allowing folks to Facetime or Skype.  Oh, man.  I can’t believe the babies – like, I hope we do some really great community care for these parents, which can still happen even years later, just to really protect and reconnect and do some healing around that because these circumstances were just really not ideal for all these families to be growing and feeling really confident in their ability to parent and to trust themselves and know that they feel safe.  There’s a lot of aftercare that will need to be done for this.

I totally agree, and as you mentioned, the positive aspects of all of that is that we have some good research for the value and benefit to doula support and the need for support in general, partners being there and the importance they make.

Oh, for sure.  You know, birthing, you require the people that make you feel the most safe around you.  We need the environment that really lets that oxytocin flow.  That’s that love hormone.  And you want to just feel safe and relaxed and have that ability to let go and trust your body as much as you can in labor, and the conditions of a cold room with all the lights on and not your people that you love the most around you?  It’s not the best environment for you to feel really safe and relaxed and to let those hormones and those muscle groups do what they need to do.  We always say as doulas that we want people birthing in similar circumstances to how they would probably have sex.  No, I know not everybody likes a dark room, and some people are a little more interested in something zanier, but most people have a certain circumstance that involves privacy and intimacy and security and the ability to feel comfortable and vulnerable, and so we really want to try to recreate that as much as possible, even if you are birthing in the hospital.  We can do that with lighting and music and candles and different scents, if that appeals to you and your hospital says okay.  And then your people: people that keep you safe and they’re cheerleading and protecting you and creating this bubble of safety for you.

Yes.  So any final tips for our listeners, Bianca?

Well, if you are not sure about doula care, I would highly recommend checking out some of the research because some of the things that you might be the most worried about – like, you might be worried about an episiotomy, or you might be worried about if you’re going to be able to feed from your body or not, or worried about a postpartum mood disorder or a C-section or an operative birth or a belly birth, whatever term feels the best for you.  If any of these are your worries, doulas are the fixes for them.  And so you can check out some of the research there.  You can literally just Google “benefit of a doula” and there will be journal after journal after journal.  And if you are curious about becoming a birth worker, we’ve put together a page for you that you can check out at bebomia.com/ask.  And there’s a code there, too, if you want to find out more about our classes and services, and it’s ASK15, and you’ll get 15% off of everything.

Love it!  And you’re also on quite a few social media networks, if you’d like to share those, Bianca.

Yeah, sure.  You can find us at – you know, pick your channel, and it’s /bebomiainc.  And you can check us out.  Our TikTok is just growing, so it’s not the best place, but our Instagram is awesome, and we have lots happening over on Facebook and on YouTube, so you can hang out with us there in all of those places.

Love it.  Well, thank you so much for spending time with us today and sharing all of the great need items for both birth, postpartum, as well as fertility doulas.

Thank you so much for having me, Kristin.  I really love your podcast, and I love everything you guys are doing.

I feel the same way about you!  Thank you so much, Bianca.

IMPORTANT LINKS

Bebo Mia

Birth and postpartum support from Gold Coast Doulas

Becoming a Mother class