#214 | Four Ways Waterbirthing Improves Home Birth Outcomes

Can you share with us the most common reasons that waterbirth may actually reduce some of those occurrences, we're not adding the aspect of gravity, which if I have bones at right angles to each other, a shoulder and a pubic bone, gravity is not my friend at this point. Sometimes it can be your friend if the dystocia is somewhere different than a shoulder. But either way, you've got to, you've got to move a baby. And having that lack of gravity in a water birth setting makes it so much easier to rotate. And Richard, it turns out has the gift of, of dystocia resolution. And he came over and he knew what to do and he ate 10 seconds of that baby out. So I am a student midwife, and looking to become a full midwife year by the year end.

You've attended over 600 births, and you have never induced a woman one time.

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

My name is Lisa Marie. I'm a licensed midwife here in California, deeply mentored by Barbara Harper. So I focus on water birth in my practice, for sure. And all the different ways that that it can affect a birth in the home birth setting.

I'm Richard Oxenham, and I am Lisa Marie's main assistant in the work that we do together as a team. And I've done so now for almost nine years. I am a student midwife, as well, and looking to become a full midwife. You're by the year end.

And you're married? Yes,

Yes, we are. Okay, so that's, that's a nice little detail. What a team what a team can you guys, can you share with us how many waterbirth you have attended?

Sure, together, we've been over now. 450.

So we know in this episode, you want to explain to us and to our listeners, the ways in which water birthing makes home birthing safer, or even safer. And we're gonna get into all the details around your knowledge with that, but just briefly to satisfy all the curiosity of our listeners, Richard, can you explain what midwife means? And how few of you men your knowledge are midwives? Well, that the definition for sure is to be with women, in terms of the work of being a midwife. Irrespective, regardless of who you are, in my work in the support that I give, I'm able to bring a facet to our work that's unique, of course, for sure. And it's primarily, first and foremost is to support Lisa Marie in the work that she's providing so that she can stay focused, and really be available to our clients and the people that we work with. And secondarily, it is to be able to support the partners that are a part of the pregnancy and the birth process. We want to make sure that we incorporate and take care of everybody involved.

So Lisa, can you start to share with us a little bit about your water birth experience and the knowledge that you have gained along the way? Particularly the ways in which birth in the water is potentially a safer alternative than out of the water?

Yes, I'm willing to be radical and say that I think it's safer on many grounds. For me, I first got introduced giving birth in water back in 1991, when midwives were underground, and you just had to know somebody who, who knew one. And we were, well, my midwives let me rent their horse trough because we didn't have I'm sure the birth the awkward doula birth tub was the only one that I know of that existed back then. But I couldn't afford that. So having come from a trauma, background of sexual abuse, emotional, you just name it. I have pretty much all of it. My father had died when I was 17. My grandmother had birth all 19 of her children. Well, except for three at home. So I grew up listening to whatever story she came here from Mexico. And I remember having that part of my psyche normalized. You give birth at home, because she was so confident about all her birth stories, until the last three. This was in the 50s Remember when birth associated with sterility was considered progressive and her coming from Jalisco, it was considered I'm going to be modern. And she regretted that she told me because it was scary and she didn't like being on her back. So that was the one thing that I felt very convinced about I think growing up was that's just what you do. I never thought I would do it in terms of helping women do it. it but here we are. So that started my passion for water birth without any training really much I was already birth educator back then 19 or 2022 When I gave birth. So I was very opinionated as a birth worker just really wanting to protect women. Then it morphed into protecting babies and waterbirth seems to provide for all of that. We were so passionate in our practice of getting in this is where butcher comes in handy because he's very sagacious. And when it comes to women's stories that come from severe trauma backgrounds, and how waterbirth help them feel covered, floating and at the same time in control of their bodies, because they can move easier, especially for my, my bigger mamas. They really like that they can be I've had 350 pound moms give birth beautifully at home.

I think there's something to the weightlessness and water that also lifts the emotional weight. It's like that that physical weightlessness, that sensation somehow transmutes into like a lightening of everything a lessening.

That's a really great point. Because when you are, especially when you are burdened with trauma, whether it's sorted or not in your body, sometimes it feels weighty. So that's what you're focusing on, and you feel that discomfort and you get into water, and you're able to actually locate where you're filling your cervix, you can feel your baby descending, it does, it just kind of mitigates other things that contribute to your interpretation of your experience. And we're so radical about this, that it has extended way back way back to the birth team meeting, having who's going to be present has to come to a class that we conducted 37 weeks, and we're pretty, we're pretty firm on this, if you want your mother in law, and your sister's boyfriend, and his pregnant girlfriend to come to the birthday, all have to come to this class. Because through educating them, we can still protect her space, because we're going to be quiet, and we're gonna let her to catch her on baby. We're not even the word lead. We really insist that that we're just servants, we're just coming in under you, under your history under your trauma sorted or not, so that she can have her experience. It's not about us. So we don't have ego, we don't care about catching a baby. So I did that. And then Barbara, I was already a student midwife already. Very big on waterbirth. So we have this confidence and being so about this, I can be chilled my nervous system is always in check when the baby's coming. And I don't have that sense of panic. And we want to extend that deeper knowing to our, our clients that we're helping so that they can have all this confidence we show I have 100 slideshow presentation we do at 37 weeks, it's broken down to homebirth dedikate. Thank you to Jessica Bingham in for that idea. And it morphs into her expectations. What would you like you want a video? Do you want photos? Are they allowed to photo with their phones, your friends that are here and coaching data on a couple of things and it goes into all the scenarios. And he teaches like half the class or actually all of it. We cover transports we just cover all the whole gamut so that everybody's there, especially our family feels really confident empowered to step towards the experience that they are designed to have. And there's video clips of all this, I have video clips of dystocia does have video clips of different kinds of cord wraps with the mothers unwrapping them. And it's by the time we're done by the time we get to our final video, which shows a baby taking 75 full seconds to take its first breath. She's looking around at her mom, she's so happy, but it's a hot day. So if like the Wharton's jelly, still staying liquid, there's just no prompting her. And then she finally does and then takes her first breath is beautiful. She's never without oh two because that cord is just dark and happy.

Can you share with us the most common reasons that mothers may be fearful of giving birth at home or the most common complications that are a kind of childbirth emergencies? Or complications that happen at home and Talk That Talk to us about how waterbirth may actually reduce some of those occurrences?

Yeah, I think for a lot of folks that they feel, you know, our culture has done such a sad job of framing the whole narrative. And given that we come into the whole spectrum of beliefs about what the homeboys might look like, and frankly, what our expertise or lack thereof that we bring to the situation. So I think the major aspect of what people have, it's just a lack of knowledge of what actually it entails. And that's why we try so hard just to normalize it, knowing what to do if something goes wrong because that's always the major question. gymnasts, what are you going to do if your mom bleeds or what are you going to do cleaning is a big one. If something, you know, the baby, the baby won't breathe baby headlines and things of that nature. And so we do a lot of work to get them educated about those elements, but also how to be preventative and be proactive and how they care for themselves. So that when it comes at time that they're more than fine. To know that that's those aren't going to be major issues.

A lot of people don't know, midwives carry full equipment, they don't realize that I can suit you, but I also numb it with lidocaine and sodium bicarb. So it doesn't even burn and that it's gentle. They always think that we account so that we'd have to transport for that. And so once we say, well, actually leading can be prevented most of the time, I haven't had a significant lead in a long time. I can't even remember the last one, because of what we've done to work on preventing it. And would you attribute that to laboring in the water?

I would absolutely attribute part of it to that. Because I know Barbara Harper talks a lot about the science behind how even when you're on your cycle, if you get into a swimming pool, and you can feel your cycle kind of a bait for a while. We have a theory that from a predatory standpoint, if a woman is bleeding and she's in water, she's at risk of attracting predators to her. Right sharks Exactly. Because he can smell it how many go snorkeling when you have your period.

So you had mentioned that water birthing in particular at home increases the likelihood of a safe outcome for mother and baby and lessens the likelihood of a hospital transfer. And I know you have things to say about shoulder dystocia trauma tearing the cord, we can't wait to hear about some of those things. So which one would you like to start with just explaining how water birthing makes any of those potential risks? Lesser.

Let's touch briefly on trauma because that's a big one. I would say that in a water birth. What we've noticed with our mamas is that once they get into water, they're able to open up it just a whole change in their nervous system and they feel safe and covered. So then they're able to continue to let baby descend and let these dilate so that's a big one is just the sense of being covered and not being watched. And being upright so that her her Yoni is more downward. Nobody's taking pictures of it. You know, sometimes that happens even in homebirth.

Whereas vagina is Greek and means the sheath of a sword. A lot of people don't know that, that were relegated to a verb for for something else. So I like Yoni for many reasons, and fry hunted the world to find that word, and finally settled on Yoni in her medical texts. Well, if the vagina is the sheath, it only makes you wonder what the sword is. So right so the sheath is only defined in relation to the sword.

I know some people like the medical terms and children want to be you want to normalize it for them, but it wants to know, which means that can have a choice now that we know what it means we might think differently.

Vagina, I try not to for that reason, plus, that's internal, right? I mean, we teach our children that we teach girls that this is your vagina, but really, they can't see their vagina that's internal. It's really their vulva. And we've been misusing it since. I don't know how long. So we do need to get the record straight, but we certainly don't want to define it in terms of being a sheath to a sword, that's for darn sure. So, okay, so trauma is one that you have observed.

That waterbirth can be safer, not fears, but safer. Right, one of them is the cord. So cord abortion I do know is the thing I see often in videos on Instagram or people stories, the hospital where the cord breaks, and then baby's going to lose all that blood that was Vamped into the placenta. In a waterbirth. Setting, specifically, we educate our moms on that really important pause of the restitution when that head wants to turn to the side, align those, the shoulders up in the anterior posterior diameter, and we've shown the three planes of the of the pelvis at the birth team meeting. So the network how cool looking, their shoulders are now lined up. And so they know that that can be an important pause, to not to not listen to their body more that not to override their body by thinking, Oh, I gotta get the baby out. Like this feels you know, and just being being more cerebral about their birth. This is a reason not to be cerebral, but to be in your body in this mode. MX. Once the baby's out, let's say it's we've had cords twice or three times around the neck, an arm wrapped down and then hooked on the foot. If you just pull that, that up, you could cause a placental abruption or partial anyway, or just break the cord. Or even just that scary feeling from mom, that big adrenaline rush, it feels tight, everything stuck, and she's scared. So I show videos of, especially on a score a scarf cord, you know where the cord just drapes behind the neck, the moms just are sliding it down the baby.

How does water birthing make that situation safer, because we have more time since the baby is staying under the water. And we haven't turned on the breathing reflex by exposure of the trigeminal nerve to the head, I have time to sort the baby, baby's continuing to get all that good oxygen from the court. This is assuming it's a good baby.

They say, uh, Andrew Huberman would say that the eyes are the only organ that are not separate from the brain, they're part of the nervous system, like staring at you and not moving, that's not a good thing. We're gonna bring those babies right up. But if if the babies aren't legally and doing their things you can do can unspin the court and and then do a gentle birth into the atmosphere just like a Lamberth provides. Ironically, we're trying to replicate a land birth in whatever setting, that's kind of what we're doing. We're trying to normalize waterbirth enough, where people realize there's two birds in a water birth, there's the birth out of the mother. But that's not the birth, that's just half. The most important part, of course, is then introducing that you're young into the atmosphere. And we're just whipping all these water babies out and slam them into all those things. Barbara Harper lists that nitric oxide, the gravity, the the ode to all the things that they've never experienced before it can be it can be kind of scary for baby. So ours are very gentle. That's why on my videos, they look a certain way that way.

So So what you're saying overall here is that by giving birth in the water, because the baby's face is not exposed to the oxygen and nitrous oxide, the pause between the birth of the baby's head and the rest of the baby's body can be much longer than in a non waterbirth, where the as soon as the head is out, we're already starting to stimulate those receptors in the face, right, we have more time to wait on the baby, and the natural process there.

One of the complications that we may cause in childbirth, in a hospital in a bed, wherever is the feeling that we need to get involved and get that baby out faster, because the head is out. And we want to kind of tug and pull and move and that baby may not be ready. And this is one of the reasons that we can cause problems at the time of birth or even causes Shoulder Dystocia.

So imagine that for them. If you're the mother who's had that birth, they need to be educated that this is actually why we're not going to touch and then they make sense to them. And they might have some grief about the birth that they had because they realized that the doctor had pulled the baby out or did the manual rotation, and then cause maybe a tear that was not necessary.

So what I'm hearing is that the if it's not a water birth, and the head is out, the baby is now oxygen dependent, which is why there's risk now in completing the birth if there's cord complication or something. But when the baby is in water, the baby isn't oxygen dependent yet that right?

So I think we're talking about in both situations, the baby is still oxygen dependent on the cord blood coming from the placenta. But the difference is that when the baby is born, in air on land, we we've already triggered those first steps in initiating breathing, whereas when they're born under the water, you have more time because you haven't initiated that process yet does that? Would you agree, Lisa?

I would agree. And when we're talking more time, it could be as much as four to eight minutes that I've seen heads out. And they the babies were doing great because there was enough blood flow from the cord and they did great.

And you almost never see that on a limb birth. I mean, it was certainly in a hospital maybe at a home birth, but rarely would you see a baby on the perineum for that long.

Right. Dr. Rachel read mentioned in her midwife thinking, she talks about that it can be out even on a land birth up to five minutes, which you're still not going to see unless it's a very educated provider who realizes that the courts still doing its thing. The transition time of that reflex to breathe can be long for some babies so they can be out with the head up.

So this probably leads us to the third one and Richard maybe you want to start this one but with the head out and having more time. How does a waterbirth make Shoulder Dystocia a little less risky?

Well, I'm not, yeah, we we've we've encountered this probably about a half a dozen times or so in our practice. And what we educate and counsel is that most of the time, once the head is out, we'll wait for the next contraction for the body to come. Sometimes we'll wait to contractions, okay, so whatever their contraction pattern may be, if it's two minutes apart, we'll wait a couple minutes. And we do our best to make everybody feel comfortable with that waiting, we actually set a timer, as a TEAM, to see how it feels to wait for two minutes for something so. But if the body does not come at that point, and it's a dystocia situation, then we're going to go in and take action physically, to help do the rotation for the baby to come out. And the way that the baby's position and side, there's enough room to be able to make it in with a hand, because a baby's shoulders structure is creating an opening a vault for the hand to be able to get in to help with the rotation, and help bring the baby out. And so we will do that in terms of the work for the dystocia.

And you would leave a mother in the tub to do this in the water.

Absolutely. Because again, since we haven't initiated the breathing reflex, we still have extra time to be able to make sure we do a good rotation in the sense that we're getting the proper mechanics and, and the feel to be able to to rotate and help the baby come out.

Would you have her in a hands and knees position? To do that?

Yes, yes.

In terms of the dystocia. Another advantage of the water is that we're not adding the aspect of gravity, which if I have bones at right angles to each other, a shoulder and a pubic bone, gravity is not my friend at this point. Sometimes it can be your friend, if the dystocia is somewhere different than a shoulder, let's say it's maybe it's your spine or a tight ligament somewhere. But either way, you've got to you've got to move a baby. And having that lack of gravity and a waterbirth setting makes it so much easier to rotate. Because I'm not adding all that gravity weight onto these bones that need to spin. And Richard, it turns out has the gift of of dystocia resolution. I was at a birth once that I couldn't get the baby rotate. It was a big baby. And I'm like I need help. As first time I've ever asked him and he came over, he knew what to do. And he ate 10 seconds. And that may be a thing of that as well as the fact that if since they're on their hands and knees, you're not getting the pressure from the tailbone to actually work against you when it comes to dystocia than if it was on his back. Right? Because if they're on their back then right you've got that pressure happening as well to make the the rotation a little bit more challenging. So yes, keeping them on their hands and knees and helping with that is really advantageous.

So what was your trick, Richard, in that situation where you got that baby out in 18 seconds?

Well, she she was stuck in a way that I was able to, like I mentioned with the hint with a vault being open a little bit, being able to get a hand in and help him with the rotation of the top shoulder with a little bit of support on the side. So being able to continue the rotation and knowing that babies rotate to come out, I was able to get in and then help on the bottom side to just get a little bit of momentum so that the top shoulder would continue to rotation by class really and posterior posterior.

Just to make sure I'm understanding this correctly, water birthing is safer in a shoulder dystocia situation not only because it buys you more time, but also because the procedure of actually assisting the baby out is easier when you have water to work with. Did I hear that? Right? Yes, yes. And the look and the position of the mother.

Because the position of the mother can be manipulated out of water or in water. So what do you mean and the position of the mother by the fact that she's still staying in the water and we're moving her to a position of being on her hands and knees? We still haven't initiated the breathing reflex and response and so she's a we're able to get in there at an easier if that's not specific to water birthing. You would put any woman on her hands and knees in this situation, right? Yes, yes. Okay. What he's saying is that it's easier to move like, say of the bigger mama, if if she wasn't on her hands and knees. It's so much easier to just flip her around when she's buoyant. Especially. Yeah, what we've seen makes sense. And also what we've honestly seen in non water situations, whether it be at home or in hospitals is that they they don't do that. They they will try to work and try to maneuver while the moms still on their back.

And all of this maneuvering with the hands inserted in the Yoni is done without an episiotomy. Correct. And would you say that the tissues, the perineal tissues, are they maybe a little bit more flexible in the water?

Well, I'm not willing to say that I don't think that's true thing. I think women are designed so beautifully to accommodate their babies, and even to accommodate help. And I don't know, I know, I asked Barbara Harper about that study where they were saying that, you know, there was more perineal tears and a waterbirth setting. And she's like, I'm like, This can't be I'm not saying this at all. She's like, think about provider error. There's this kind of panic, even with midwives, I see it all the time, heads out. And then they're all in there, of rushing that last part or how they mom push because one contraction did not yield the body and they panic. And then I think that could be causing that residual numbers. I don't find the tear more, or maybe not even less than a waterbirth. It's, I think waterbirth just allows more comfort to take their time.

Yeah, I think it's hard to know, if we do find that there's less tearing in water birthing, it's hard to specifically be able to attribute it to water birthing anyway, because no woman in water will be flat on her back or her head would be submerged. Because right there, she'll be less likely to tear in and of itself. That's interesting. So I think we've named three benefits so far, we need to trauma, the shoulder dystocia. Cord complications. What's next leaving? Alright, let's talk about bleeding.

So Richard is pretty good about assessing the blood after but I'm going to talk about how I think waterbirth can prevent a significant bleed. One is if I want to help avoid a deep tear, I do believe waterbirth is helpful that way in that she can take her time with the stretching, you can do counter support if you want. And then once that placenta is coming, there is I think there is less bleeding, just the fact that she's in the water. I think Barbara Harper would would say the sciences back to that premise. And I'm seeing that in my own practice, they're just not going to believe that much. I used to be scared to do the placenta and the water. And now I'm almost the other way. Like, let's do the placenta here. This is lovely.

Why does bleeding stop when we're in water?

Who knows? But we do know that when you get in the water you're bleeding tends to tends to slow down. And maybe it's Lisa, you had said something about it maybe being a predatory protective benefit, like you're always told don't go swimming, when you have your don't go snorkeling with the sharks when you have your period because they smell that and they'll come after you.

I'm sorry, who's going snorkeling around sharks anyway? What am I missing out? Of course.

And I've done it with my period, by the way. She's alive. Um, so.

But yeah, you're brave. Go ahead.

Also, this may sound kind of not really well, when the baby's up on the mother, and she's able to look at her baby and she's still kind of in that floaty, comfortable state. I do think it also facilitates that placenta coming with ease. And even once it's out, she's all about all about her baby. So that's going to help keep that oxytocin high, which will keep that uterus contracted, we are so fanatical also, about we don't call anybody into the room or call family. When the baby's born, we're maintaining the exact same vibe that got that baby out, so that she can get her placenta out and keep that uterus nice and hard. And so we're not moving moms out of the tub right away. We want to maintain that period of time.

I think remember think that's such an important point, that when the baby is born, that the birth is not over and that we don't act like the birth is over in start taking photos, calling people sharing, getting excited inviting people into the room. It's like that birth is not over until that placenta is born and that might take an hour. What do you always tell people?

Yeah, absolutely. We let everybody know that the pregnancy and the birth is not over until the placenta is birth. You're still pregnant at that time.

You're the interesting thing is you still feel pregnant. I mean, I've birthed my daughter was nine and a half pounds and it's fascinating to me after my son was almost nine pounds, but after each of them came out I still found I still felt 100% pregnant. And the moment the placenta is out you immediately don't feel pregnant at all. And it's a mystery in my own life as to how that can be. I've never heard anyone say that they don't have family coming yet. And I so respect that you do that because Trisha and I just we do birth story processing sessions with women, they share their stories with us women need to process their stories and it's something that we do. And the last woman we met with her baby had a very serious and lengthy Shoulder Dystocia and when her baby did come out, the baby was whisked away and she went a very long period without seeing or hearing about her baby. And and she was convinced her baby had died. And when like 16 staff surrounded her and she thought they were there to give her bad news. And then one of the nurses and the backs that I just saw your baby your baby's okay. And immediately upon feeling her relief, her placenta came out. And I think that says it all. And the fact that you have that reverence, the birth isn't over, she's still in a physiologic state, it's not time to have everyone in celebrating and talking about the baby, she isn't finished.

We're actually scared to interrupt that time. Because of that.

We Yes, we specifically in our training of our of our clients, we have a separate topic about placenta birthing, because if they birth previously, in especially unfortunately, in hospitals, often the aggressiveness of trying to get the placenta out, has caused deep wounds and trauma for them. And so we let them know what it's going to be like in a somber setting, which is going to be 180 degrees.

And since we're talking about safety with waterbirth, another thing that we think that we're also not doing things to interrupt the beginning of labor, I have never induced a labor, I have never used the membrane sweep. And I tell my moms, have I gone past 42 weeks, our law says I'm not allowed to so I can't really directly answer that question. But I will say that the baby knows when to let labor come we'll do other clearing things like, like some counseling or some emotional work on massage. But we're definitely not doing the things in the pregnancy that can then make for an unsafe outcome by implication of just the intervention, which is the last safety point of a water birth. If you have a mother and a tub. Good luck with trying to get to hansy. With her. There's something about the barrier of the water itself that says she's got you know, I've got those, please stay away. That's her space. That's her space. That's her little bubble. And I'm more and more hands off it, the more I learn, you've attended over 600 births and you have never induced a woman not one time. Did you ever determine a woman had all the usual rhetoric IUGR baby too big placenta failing, okay, we have to transfer you out of our care to a hospital for an induction, we just had, actually to Ieg ours last year. And we actually will specifically rule out IUGR and take on these women will do a scan, and then we do a read do it for eight hours and then one seven days later. And if we can track growth, then yeah, and these babies are perfect. And they weren't even properly diagnosed. They just said to your babies small well as they transferred into your care, right, we are seeing so much of that. Just now. It's like every woman has IUGR just because her baby is approaching the 10th percentile on an inaccurately third trimester ultrasound that gets into dating, which isn't what we try to tell Mom, if you're gonna have another baby with us, do not get an early ultrasound at all. Just protect your baby. And we've seen the flip side too. I'm looking thinking back in the nine years we've worked together and all the stories we've heard of previous births were Oh, we have to induce because the baby's too big babies too large. And then we always ask the follow up question. Of course, well, how big was your baby when it was born? And it is never. And I mean, never, in nine years been the number that everybody was claiming it was going to be?

Yeah, right. Ultrasound research shows that ultrasound is not only a terrible indicator for fetal weight. And by the way, footnote fetal weight isn't correlated to birth outcomes. Fetal positioning is, but even so when they look at bell curves of the estimated weight versus the real weight, it is skewed. The ultrasound usually overestimates fetal weight. It's not an evenly distributed bell curve, where it's necessarily plus or minus one and a half to two pounds. They're usually overstating it. But again, the whole premise that weight is the factor that concern that was therein lies the risk to women because they buy that that fallacy. So they're, they're, you know, they do these ultrasounds.

So you're right, there's no we don't say correlation to size and outcome is such an important conversation. I'm so glad we're having it. Because these are the big fears around homebirth.

Once people understand these things, homebirth becomes so much more. You know, you can trust it so much more. It feels so much safer. It feels like Oh, well. We're all worried about these very rare, uncommon thing, outliers. And now when we talk about that we have the tools to manage them, and we do the steps to prevent them from happening in the first place. I mean, the most common reason that homebirth ends up in the hospital is simply because of maternal exhaustion, not because of all these other things that we're talking about. Yeah. Do you believe there's anyone for whom homebirth is not appropriate?

Yes, we have an actual grading scale of concept when we go into consultations, the different elements that we think are important as it relates as to where they're at, in this process, the number one red flag for us is trying to escape another experience, primarily a hospital birth.

I love that. That's so interesting. Can you say more about that?

Well, you know, and we saw this dramatically during COVID. And unfortunately, you know, with such a small practice and broke our hearts, because we can only help, you know, so few because of the work that we do and how we do it. But the amount of oh, you know, we're not being seen, we don't know anybody, we, you know, we can't have anybody in Oh, that was a major thing during that time. But even before and after that, now, a lot of it is, you know, something, I'm just afraid of hospitals, I'm afraid of doctors, I'm afraid of medical, and I don't want to be there. And that is the driver for wanting to not do that. And so therefore homebirth is considered an option. And we, we don't find getting trying to get away from something to try to be the reason why you do something going forward.

Are there any other clinical conditions that you would just sort of like, rule out?

For us and our practice? Of course, we can only we have dictates in our state of how we can practice and what the parameters are between 37 and 42 weeks, we can't do breech or twins at home unless a doctor is present.

One final question. How do you feel about waterbirth outside of the home, such as these wild bursts where women give birth in the river and the lake in the ocean? What do you think about all that?

I've been saying it I think they're super neato, you know, I mean, I don't know if you're just trying to do it to be different or to stand out because you have a following whatever. But the ones I've seen the women seem to be one with nature in those settings. I think it's awesome if that's what she wants. Do it I've saw an ocean once. One that seemed a little uncomfortable because it were sand everywhere. And like maybe that's not it waves and surfers going by. What generic advice do you have for all listeners is irrespective of where they plan to give birth, I would say take responsibility for your birth or just says this all the time to the moms so that you have no regrets. Learn to say no. And hospital policy is not a law against you. You can say no, you're hiring your provider whether it's a midwife, or a hospital, say no. And be firm just say I don't think the magic term I tell people get do the prayer pause. Just tell your provider we would like to pray about that. Doesn't matter your faith.

That routine hep lock is against my religion.

It scares everybody when you say we want to do the prayer pause everybody.

Excellent. I love it excellent good advice.

They can lower their their nervous system tune into their baby and then make a decision based on what feels right to her. There's nobody who's the boss of her body except for the birth mother herself. She knows so claim your birth but take responsibility it's a big responsibility.

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