Natural Hospital Birth: Podcast Episode #123

Kristin Revere, co-owner of Gold Coast Doulas talks with Cynthia Gabriel, author of Natural Hospital Birth, about her experience as a doula and health care provider for women, supporting natural hospital births.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello.  This is Kristin, co-host of Ask the Doulas, and today, I am joined by Cynthia Gabriel.  Cynthia is the author of Natural Hospital Birth.  Welcome!

Cynthia:  Thank you!  It’s great to be here.

Kristin:  Yeah, it’s good to connect with you again.  I know in my early days as a doula, you were inspiring to me.  I’m looking at my signed copy of Natural Hospital Birth as we speak.  So, Cynthia, please fill our listeners in, a bit about your personal journey as well as professional journey to becoming an author.  I know you’re a birth worker and educator and researcher.  I’d love to hear more about your story.

Cynthia:  Sure.  I came to birth work through academia.  I was studying families, and families in Russia, in particular, and I ended up working in a birth hospital for a year.  And I just fell in love with birth through that time.  But I also am really grateful that I did come into birth work the way that I did, because I got to see a very, very different kind of birth as my first exposure, and at that time, in that Russian birth hospital where I worked, I got to see 65 vaginal births that happened in a row, with only one birth turning into a Cesarean.  And not one of those people had an epidural or any kind of artificial pain management.  So I just started my birth work with this experience that showed me that birthing people can, generally speaking, just give birth, with very, very little intervention and without expecting pain medication, and that was the expectation there and nobody there expected pain medication.  Things have changed in Russia in the past 20, 25 years, so that may not be the case there, but it was at the time that I was there.  And then I came back to the United States.  I’m a medical anthropologist.  I teach undergraduates.  I teach a lot about reproductive health and birth.  But I also continued working as a doula because I just loved it so much.  I love being at births.  And I realized how unusual my experience was, that most doulas, midwives, doctors, and labor and delivery nurses in the United States can’t say that they have ever seen 65 vaginal births in a row with no medication and only one Cesarean.

Kristin:  No.

Cynthia:  I realized that it was this unique window into the way that I saw birth in the United States.  And the other thing that was happening at that time, the late 1990s, early 2000s, was that if I talked about natural birth, people assumed – they would say, well, you can’t do that in a hospital, as if the hospital itself somehow made it impossible to have a vaginal birth with no pain medication.  And I was like, well, it’s not the setting, because I saw a lot of them happen in the hospital setting where the care providers trusted that things would go fine and didn’t rely on these other ways of doing things.  So it’s not the hospital itself; it’s the attitudes that we bring to birth.  And that made me really start thinking about, what would it take for – you know, what does it take?  Because lots of people manage to have natural hospital births, and what do they do differently than people who do not end up with that experience?  And I do think that we live in such a medicalized environment that it becomes very difficult to pull apart necessary interventions from unnecessary ones, and that makes me very sad, because people who need interventions should absolutely be able to get them, but they should believe that they’re necessary, and I don’t think we have that here.

Kristin:  Yeah, I’d love to hear how that experience then translated into writing Natural Hospital Birth.  I know you mentioned you have two editions now.

Cynthia:  Yeah.  I wrote the first one after coming back from Russia and thinking, you know, sure, I could write some academic articles that a bunch of academics would read, but really, this is information that I hope a lot of birthing people could use.  And so I interviewed about 200 birth givers in Canada and the United States who had had natural hospital births to find out what they had to say about what they did and how they prepared, and I wrote the first edition.  And then I think about three years ago, two or three years ago, we updated it.  The main updates to the second edition are about – there was a change in the definition of active labor, so active labor now is understood to start at 6 centimeters dilation, and that was a change, so the new edition reflects that.  Honestly, that doesn’t change anything for the actual laboring person.  It doesn’t really matter when someone else decides labor begins; it matters when you start feeling things.  But a lot of hospitals now will encourage you to go back home if you haven’t reached 6 centimeters when you get to triage, and I think that’s a great change because it means more people are laboring longer at home and less time spent in the hospital ends up with fewer interventions, I think.  So there’s that change.  And then I also – I don’t know what your experience is, Kristin, but my experience as a doulas is that there are a ton of inductions that are happening these days, and that’s a big change from 15, 20 years ago when inductions were relatively rare in my doula practice.

Kristin:  Yes.  I would agree with you.  I have seen more inductions in the last couple of years than early in my career as a doula, and some of those, you know, are for medical reasons, of course, and I’m seeing more medical conditions with clients than I had as a new doula years and years ago, so that could be part of it.

Cynthia:  I have seen far more inductions in my area than there used to be.  I can’t say that I see more medical conditions.  I’m not sure if you specifically mean during COVID or not.

Kristin:  No.

Cynthia:  No?  Okay, just in general?

Kristin:  In general.  But I tend to specialize – some of my wheelhouse is high risk clients, so there are or tend to be other medical issues, and I’ve had a lot of clients with preeclampsia, as well.

Cynthia:  Yes.  I feel like as a doula coming into – I started in 1998, so it’s been a while, and I feel like there’s a long list of medical conditions, and I’m checking off all the boxes slowly.  Like, I’ve seen one of that.  Now I’ve seen one of that.  So kind of slowly over my career, I’m getting to see a lot of things that I couldn’t have imagined earlier.  But the inductions, I think, are outpacing changes in actual health of people in my area, anyway.  So I added some information about inductions.  I’m in a lot of hospital birth and birth Facebook groups and things online, and that question comes up very often.  Like, their provider is urging an induction, and they’ll ask, does anyone on here have a good story about being able to have an induction and end up with a satisfying vaginal birth?  So there are some tricks to that that I’ve learned from experience.  And I’ll just say one of them, which is our hospital is very variable.  It depends on which nurses you get and your care provider, whether they tell you not to eat during inductions or not.  And inductions can be very long.  They can be one or two or three or four or five days long.  And you have to eat.  So if you have a care provider who’s absolutely insisting that you can’t eat while you’re on some agent, they usually go through two or three different kinds of induction agents, and when you go off one, before you get on the next one, you have to insist on time off to eat and take a shower and maybe take a two-hour nap before you start the next one, or I think the long haul can just really get you.

Kristin:  That’s a great tip, and my clients tend to – not all of them have the phase that you’re discussing, but yes, having some time to rest and get some normalcy, like a shower, before getting into another intervention is very helpful.

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Kristin:  Certainly, I’m seeing more inductions, but I’m also seeing, as you mentioned, because of some of the changes in admission, my clients are getting sent home or staying home longer than they did in my early time as a doula.  The earliest they’re getting admitted, unless there’s a medical reason, is 4 centimeters now, where it was much earlier in labor when I started.

Cynthia:  Yeah, and that is definitely a good thing.

Kristin:  Yes, I would agree!  I’d love to hear more of your other top tips, especially for clients who – your readers who are not getting an induction but laboring on their own and progressing naturally, how they can best avoid any interventions.

Cynthia:  Absolutely.  And I would say my book and my approach is really aimed at people who have already decided that this is what they want.  I don’t really try to convince people they should want this.  I wanted to give birth under my own power and do it naturally and feel everything.  That was really important to me, but I never try to convince people that that’s the way they should give birth.  But if that’s what they want, then there are things they can do to maximize their chances of that, and some of them are things like – I think changing the way that we think about doctors, midwives, and care providers, because I think we are so used to, first of all, being compliant patients, but secondly, we’re looking to them for advice during labor.  But I think that if we realize what their job is, their job is to think of everything that could potentially and possibly go wrong, even if there’s a very small chance that it could go wrong.  So their job is to be constantly thinking of things that could go wrong, and that is a really different job than a doula or your partner or you as the person giving birth, who really needs to not be thinking about every possible little thing that could be going wrong and focusing on just laboring in the moment and getting through this contraction and making progress where you are.  And so they’re just really different jobs, and if we stop expecting our care providers to do the job of cheerleader, of telling us that we’re doing great, that everything is looking wonderful, and remember that their job is to say, well, you know, I’m a little bit concerned about this thing; I would like more information about this in case this thing – you know, if you have a headache and you go to a doctor, they first have to rule out brain cancer before they can tell you that this is just a tension headache; take an aspirin and go to bed.  And it’s the same thing in birth.  They want to rule out all the terrible things that could happen, and so I think it’s a mind shift for birthing people to realize that the people that they should be looking to for advice in the moment are not the hospital personnel.

Kristin:  Right, as far as coping mechanisms and position changes.

Cynthia:  And reassurance that everything is okay.

Kristin:  Right.  Yeah, it’s a different mindset, and as you mentioned, a doula or a family member or certainly a partner or coach in birthing would be a great tool, and of course, advocating for yourself as a birthing person.

Cynthia:  So I think that if you shift your mind about looking for the outside reassurance that everything is going well and develop a team or the internal resources to believe in that, which is hard for first timers.  It’s very hard.  I mean, in cultures where there aren’t doctors attending birth, you know, where it’s a community event and – you know, I’m thinking about gather-hunter societies, where the ideal might be that a person goes off and gives birth by themselves.  Even in societies with that belief system, usually first timers get to have someone with them because everybody knows the first time is more challenging.

Kristin:  Yes!

Cynthia:  So it’s hard to have the internal resources the first time to just believe that, I can do this, everything is going well.  I think other things that people can do are prepare for the specific scenarios where you have time to make decisions, and there’s a lot of things in birth where you have to make, sometimes, quicker decisions than you want to, and actually, you can’t really prepare for them, and you’ll drive yourself crazy if you try to prepare for every possible thing that could go wrong.  But there’s a handful of things that you can prepare for ahead of time during pregnancy, like what if I go past my due date?  What if they tell me my baby is too big in the last two weeks?  What if I’m GBS positive?  How do I feel about being hooked up to an IV during labor?  And there aren’t right or wrong answers, but these are things that you can prepare for ahead of time.  So I tell people that they should really do the research and think through what you would do if your water broke before you felt contractions and what you would do if you went past your due date or they recommend an induction.  And if you have a game plan for that, I think you’re less likely to end up reactively accepting interventions in the moment.

Kristin:  Good point.  So what are your thoughts on birth plans as far as, you know, trying to accomplish goals?  Do you like more lengthy or using a hospital template or having a checklist?  I prefer the term “birth preference sheet” than “birth plan,” but I’d love to hear your thoughts on that.

Cynthia:  Yeah, I think that we actually conflate two very different processes when we talk about birth plans because there’s the process of a person deciding and thinking through what they really want, and then there’s the presentation of that to your care providers.  And those to me are very different things, but people usually use “writing a birth plan” to do both of them.

Kristin:  Yes, to have the conversation with the provider and also let the nurses know what the goals are.

Cynthia:  But also to figure out – like, when they’re writing the birth plan is when they’re figuring out what they want and what would make them feel great; what would make them feel like this was a really satisfying experience.  I feel proud of myself; I feel like I was in control.  Figuring out what makes you feel that way is really important, and I think you have to be as detailed as possible in that process.  But your care providers at the hospital don’t need to know the details.

Kristin:  Sure.  Yeah, they don’t need a five-page birth plan.

Cynthia:  No.  But I think that there’s a lot of emotional work and psychological work in preparing for what kind of labor you want to have.  So for me, I really wanted to feel supported by the people around me, and I’m a social birther.  Not everybody is.  Lots of people are private birthers.  But I’m a social birther, and I feel better when there’s, like, five people in my space cheering me on.  And I love that energy and I just like having a lot of people nearby.  So for me, when I’m imagining a wonderful, satisfying labor, I’m imagining feeling really supported by people.  But that’s not really going to go in my birth plan, the piece of paper that I’m going to give to a nurse or a doctor.  That’s a birth plan that I’m writing for me and my partner and my doula to talk about, like, what I really need.  And also, some people – you really need to think through all the comfort measures.  Like, am I a water person?  Am I words of affirmation person?  Am I a hands-on, massage my back person?  So as a doula, I would say 75% of my clients want hip squeezes and back pressure through their entire labor.  Like, it’s the most common thing people want.  But I don’t even understand that because when I’m in labor, you cannot touch me.

Kristin:  Yeah, with my first labor, I didn’t want to be touch.  But with my second, I wanted hands-on support from my doulas, for sure.

Cynthia:  Yeah, so it even differs birth to birth.   You really have to be open to all these forces inside yourself and trusting of them, and I think in pregnancy, thinking through what feels right for you is a really important process, and probably, for most people, that would be a five- to ten-page document to figure all that out.  And some people are going to talk it out, and some people are going to write it out, and some people are going to draw it out; all the different ways.  But in the end, when you go to the hospital, I think you want something short and sweet that explains your birthing philosophy more than the specific things you want.  So, you know, if you want to have an intervention-free birth with the lowest amount of medicalization possible, then you say that.  That’s your birth plan.

Kristin:  That’s easy enough for any nurse to come in and understand.  And then, of course, most hospitals have the template, so newborn procedures or any other facts can easily be added to that.

Cynthia:  Yeah.  And I think there’ s a couple of things that happen without people asking you, and so there might be a few things you want to put on there to be sure about.  For example – I mean, it depends on your hospital and the area of the country, but in my area, nobody ever does unnecessary episiotomies.  Like, you don’t even need to put that on your birth plan here.  You don’t need to write that because it’s not going to happen.  On the other hand, they are probably going to give you a shot of Pitocin the minute your baby is out to try to prevent a postpartum hemorrhage after the baby’s been born.  So if you don’t want that, you do have to put it on your birth plan because it’s kind of automatic.

Kristin:  Exactly.  Or the difference between delayed cord clamping, cutting it after a minute, to waiting after the cord stops pulsating, and things like that.

Cynthia:  Yeah.  So there are some specific things that are good to put on there because they’re unusual for your hospital or your area, if that’s your preference.  But the things that are kind of standard in your area, you don’t need to write on there.

Kristin:  Right.  Baby-friendly hospitals will have that first hour of skin to skin and feeding time before any newborn procedures, but not every hospital follows that protocol.

Cynthia:  Yeah.  That’s true.

Kristin:  Do you have any final tips for our listeners who are seeking to achieve a natural hospital birth?

Cynthia:  Sure.  I have one more tip that I think is useful, and that is about how to find the right care provider.  And what I tell people is that, if you’re interviewing care providers, you have a choice – not everyone does, but if you have the choice and you’re looking for someone who’s going to support you in a natural birth under your own power, then the way to find that out is not to ask them, what’s your Cesarean rate or what’s your episiotomy rate or how do you feel about this intervention or that intervention.  I think you can cut through all of that, because they all will say, I only do necessary episiotomies.  I only do Cesareans when absolutely necessary.  Nobody says, I do lots of unnecessary interventions.  Nobody.  So you kind of don’t find anything out by asking that question, but what you do, what you can find out, is you can ask them, could you tell me about the last all-natural, unmedicated birth that you’ve attended?  And then instead of paying attention to their words, you pay attention to their facial expression and their body language.  Some people will soften and get a smile on their face and tell you about this lovely birth that they experienced, and other people will kind of tighten up and get defensive and be like, I can’t tell you about any of my clients.  I can’t tell you personal stories, and there’s no guarantee that anything that happened to them will happen to you.  And you’re like, okay.  So to me, the way that they answer that question tells me how supportive they really are.

Kristin:  Right, more than the actual answer itself.  It’s the body language and – yeah.  Yeah, that’s great.  So now as far as navigating COVID, things have changed so much.  What would your advice be since your latest edition came out in navigating a natural hospital birth during this unique time?

Cynthia:  Yes.  So I think that we are not really in the time when they’re telling you that you can’t bring a partner.  I hope we don’t go back to that situation.  I think that a lot of people are – so I think people worry about things like, do I need to wear a mask, which, you know, is just insane in labor.  Like, who can wear a mask and try to labor?  And I’m a very pro-mask person.  Very pro-mask.

Kristin:  But while you’re pushing, it can be challenging.  Sure.

Cynthia:  Yes.  I’m not pro-mask in labor.  I think everyone else needs to be fully protected from you if needed, but you, as a birthing person, deserve to be able to labor without a mask if at all possible.

Kristin:  Right.  Agreed.

Cynthia:  I think people – my clients have really fixed on a lot of the very specific protocols, and I think, really, you know, the larger picture is, how do we help clients and birthing people develop tools so that they can get through a potentially long labor with just their partner?  And that, I think, is way more important than, how long will it take to get the COVID test result back?  Do I have to take a test?  Does my partner have to take a test?  I don’t know.  A lot of the things that people will spend a lot of time trying to figure out, I’m like, yes, these are – I understand that you’re fixating on things that you think you can control, but I think the better place to put the time and energy is to really think through with your partner, if we can’t have a doula there, it’s just you and me.  How are we going to manage when they say, we would like to break your bag of waters to check on the baby?  Like, just gaining more skills than most people have needed in the past.

Kristin:  Right.  I mean, yeah, having that communication, and as you mentioned, for the social birthers, people who want their mother or mother-in-law or want a doula and a birth photographer, having that space of you and your partner, potentially, and luckily, I haven’t seen any restrictions recently on doulas, but we did some virtual doula support for a few of the hospitals that were not allowing doulas for a short while early in COVID, and that worked out, but it’s not the same.  So we were able to give some guidance and get on Zoom or phone calls and try to be helpful, but that in-person connection was missing.

Cynthia:  When I teach childbirth ed, I really try to do as many roleplays as I can, because I think you really have to practice as if – if you don’t have a doula there who’s done this a hundred times, you have to practice to say to the staff, when they’re suggesting something, to say, could we have five minutes to discuss this alone?  It doesn’t come naturally to people to say that.  So I think helping people, or if people – if they’re hearing this and they’re like, oh, okay, that’s something that we could do, if it’s just the two of us or I’m alone, I can say, I need time to think this through, and you could even call someone on the phone if you need to, to get more support.  But to be able to hear a suggestion for an intervention that sounds potentially like an emergency, and so say, I’d like to have five minutes – I think people do that better if they have practiced that.

Kristin:  So true, because it’s not natural to ask for that space.  And if it’s an emergency and they ask, then they won’t have the time, but if it’s not, they can likely make those informed decisions by discussing the risks and benefits and alternatives to whatever is brought in front of them.

Cynthia:  And I think the situations where people later regret decisions that were made, I think they would say that they felt rushed and they had to make those decisions in front of another person.  You know, like in front of the doctor, in front of the labor and delivery nurse.  And I think it feels entirely different – let’s say that they come in, and they recommend going to a Cesarean.  I think it feels entirely different if you’ve sent them out of the room for ten minutes to discuss it, and then you bring them back in and you say, okay, given all the information, we think this is the right way forward.  We agree to this intervention.  That’s different than to have them in the room saying, we think you need to do this, and then you’re like, okay, just do it.

Kristin:  Right.  Yeah, the rushed decision.  That makes a lot of sense.

Cynthia:  So I guess during COVID, I hope that lots of parents-to-be practice saying, “We would like five minutes to ourselves to discuss this.”

Kristin:  Yeah.  That’s a good tip.  It’s been interesting.  I feel like, outside of the mask question that you brought up, a lot of my clients feel uncertain, especially first-time parents, not being able to have an in-person tour of the hospital and being able to ask questions and visually see what their room will be like.  That has been really a big concern with almost every one of my new parent clients.

Cynthia:  Yes.  It is.  You don’t think about how – until you’re facing time without it, like, how reassuring it is to be able to have that mental picture.

Kristin:  Yes.  And, of course, I just have them do run-throughs so they know.  Some of the hospitals have had different parking during COVID, so just being able to get a picture, and some hospitals have virtual tours.  And finding a way where they still feel connected, or calling the labor and delivery nurse station and asking a few questions, if they’re uncertain.  But there have been so many changes, whether it’s partners being able to attend provider visits or hospital restrictions and mask guidelines and so on.  It’s definitely interesting.

Cynthia:  I think, as a doula, the strangest change for me is not being able to just go get food and water on my own and having to rely on the nurses to do that, because in our hospital, you’re not allowed to go in and out of the room.  That feels very strange.  That’s on the doula side, not the birthing person’s side.

Kristin:  Yeah, the coming and going.  Even for visitors; like partners can’t go home and let a dog out and do some of the things that they did pre-COVID.  Yeah, and for inductions, I am missing being able to trade in and out with my birth partner.  I’m pretty much at the hospital as long as my client needs me, until baby is born.  Thankful to be able to support during this time, but it’s very stressful.  I’m seeing a lot more anxiety with clients that I’m supporting and students.

Cynthia:  Yes.  I think we’re all challenged mentally; our mental health through COVID, and certainly, being pregnant and having to, like, do this very big life event with such different restrictions is obviously a huge change for all of us.  I also think that this is a cohort of people who have – my daughter graduated during COVID, and I feel the same way for her and her cohort of people who are – you know, last year and this year, people graduating from high school or college.  You just have a bond with the other people who have gone through this, and if you know that going into it, before you even have the experience, that you are part of a larger group of people, I think that can give you some strength.  I definitely felt that as a birthing person leaning on, my grandmother did this; my great-grandmother did it; my great-great grandmother.  There was only one generation that was medicated, and that was my mother.  Before that, nobody in the entire line, as far as I know, of my life and ancestors – probably none or very, very few of them had serious medical interventions.  So I leaned on that knowledge, and I think that people during COVID, you are doing something amazing that requires strength you don’t want to have to have, but you do, and you are part of a larger group of people who understand it.

Kristin:  Yeah, it’s so true.  And you see all those fist in the air shots with birthing persons with their masks on and holding their baby.  A lot of my clients did some of those poses.  It is a special group of very resilient people, and like you said, our children – my stepdaughter graduated high school during COVID.  She’s had her first year of college virtually.  So just having and finding joy in missing out on some of the things that – you know, the virtual showers and the things that are sort of rites of passage for birthing persons, that they’re missing out on some of that in-person support from family and restrictions with having visitors even after baby in the hospital and in their home, and really wanting to keep themselves and baby safe.  So I know you have a book on the postpartum phage as well.  Do you want to touch on that briefly?

Cynthia:  Sure!  I have a second book that’s called The Fourth Trimester Companion, which is great for people who had any kind of birth, I think.

Kristin:  Yeah.  I would agree.

Cynthia:  And I had a lot of fun researching and writing this book, especially the chapter on postpartum sex.  I used to lead a lot of mother-baby groups in my town, and we would have eight weeks of different topics, and I found the weeks when we talked about postpartum sex to just be so fascinating, healing.  People really just never talk about this.  Your six-week visit after giving birth often is about contraception and, am I ready to have sex physically, but we just don’t really talk about what happens to people postpartum, and it is fascinating.  And so I really enjoyed writing that chapter.  And also writing about all the changing relationships in – I think another thing we don’t think about, especially for a first-time parent, is how power dynamics in families change when you become the parent and you’re no longer just the child.  And people don’t want to think about power as part of family dynamics, but it really is, and it just naturally shifts as new generations get added, and navigating that is really – I would say, some of my doula clients, that’s really what I spend the most time on.  You know, the birth is kind of incidental to helping them figure out how to manage their relationships with their parents.

Kristin:  Yes.  Agreed.  I mean, I do so much, even if they’re not continuing their care with our postpartum doula team, but we have so many conversations about how things will change and having conversation with family members and really preparing for that postpartum phase and setting expectations.  Their roles will change in their families of origin.

Cynthia:  Yeah.  There’s a chapter on sleep.  I think it’s a little different than most of the books that are out there.  I focus – I’ve decided in my life and in my practice as a doula that the problem in our culture is not babies not sleeping enough; it’s parents not sleeping enough.

Kristin:  Agreed.

Cynthia:  I think babies are fine and they get enough sleep, and the problem is we don’t support parents in getting enough sleep.  So I try to help people shift their focus to, how can the parent get more sleep, and stop trying to make the baby sleep longer.

Kristin:  Yeah.  Especially – I mean, newborns need to be feeding, and they’re up, and to try to have them sleep through the night is not doing anyone any good.

Cynthia:  And you can feel like you’re banging your head against the wall.

Kristin:  Yeah.  Some great topics for our listeners, regardless of how they choose to birth.  Everyone can really use a guide to set them up for success after baby.  And I always tell – we have this new Becoming a Mother course that goes through preparing for birth and also preparing for baby or babies, and we discuss sleep and so on.  Really, it’s all about communicating your needs and setting expectations and making priorities and communicating with your partner, because they might envision their role to be much different than what you would like support for.  So asking for help.  So I will definitely recommend this book.  Every week we talk about different books.  I would love to give our listeners and our doula clients and our students some ways to access you personally, as well as your books.  And I know with authors, you might have a favorite site to order books from, so feel free to fill us in on all of the ways that they can order from you or get in touch with you and so on.

Cynthia:  Sure.  So I do most of my posting and online things about my books and work through Facebook, which is Natural Hospital Birth, the name of the page.  That is where I post most frequently.  I’m on Twitter as thebirthmuse.  It’s three words put together, The Birth Muse.  But ordering my book, you know, I like to support my local bookstore or your local bookstores and have them order it.  Usually they can get it in a day or two, most bookstores.  And also, if you ask at a local bookstore, if something like three people ask for a book, they start to carry it, so that’s great for me if lots of people ask for it at their local bookstores because then more people will find it on the shelf.  But I am terrible at mailing books out, so I just direct people to all of the usual ways online to order books because I am terrible at getting to the post office and being a retailer.

Kristin:  Well, you’re so busy.  You wear many hats, so I can understand that.  So obviously,  Amazon and Barnes and Noble and some of the other online book sellers?

Cynthia:  Yes.  And I will tell you that Fourth Trimester Companion is often selling on Amazon for under $5.  The price varies quite a bit, but you can find it there pretty cheap very often.

Kristin:  Great.  Well, thank you for sharing.  I so appreciate your time.  It was great to reconnect.

Cynthia:  Thanks for inviting me!

Kristin:  Thanks so much!  Take care, Cynthia!

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