April 13, 2023

Kristin chats with Jen McLellan of Plus Size Birth, about the misconceptions surrounding pregnant plus size women.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

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, this is Kristin with Ask the Doulas, and I’m here to chat with Jen McLellan today.  Jen is a published author, founder of Plus Size Birth, and host of the Plus Mommy Podcast.  She helps people navigate the world of plus size pregnancy, shares tips for embracing your body, and laughs her way through the adventures of parenthood.  With over seven million page views, Plus Size Birth is the premier plus size pregnancy resource trusted by parents and professionals alike.  As a public speaker, Jen has featured at numerous events, including presenting at the National Institute of Health.  Jen’s also a certified childbirth educator, wife, and mother to a charismatic 12-year-old.  Welcome, Jen.  So happy to have you here.

Jen:  Hi, Kristin.  Hi, doulas.  Hi, listeners.  Thanks so much for having me.

Kristin:  You are my go-to resource for clients who want evidence-based information when they’re navigating the healthcare system with everything from figuring out how to handle interventions or VBACs or connecting with the right provider.  So I am excited to chat with you and see where this goes!

Jen:  I’m so touched.  Thank you so much.

Kristin:  So how did you decide to specialize in such a niche area as a childbirth educator?

Jen:  I think for many of us birth professionals, our story begins with our own births, and that’s my case, too.  And as a plus size person, when I found out I was pregnant in 2010, I went on to Google.  I mean, I called my partner.  Then I went on to Google.  He was at work in the middle of a work review.  Then I went on to Google, and I’m like, “plus size and pregnant.”  And it was like, doom and gloom.  And it was really depressing.  There wasn’t much positive information.  It was really hard to find clothes that would fit my body, plus size maternity clothes.  And I just read that I would have poor outcomes.  But I hired a doula who introduced me to the midwifery model of care, and I just assumed I was having a high risk pregnancy because of my size.  And she was like, nope.  And switching from the obstetrical model of care to the midwifery model of care five months into my pregnancy was one of the best decisions I ever could have made in my life, including hiring that doula, because I had a completely healthy pregnancy as a plus size woman, and I gave birth on my knees in a hospital and was forever transformed.  I could no longer hate a body that had done something so magnificent, and it helped to rewrite all these myths and misinformation I had just believed about myself for so long.  So when my son was four months old, I started blogging, having no idea what that was, and it took over my life, and it just blew up.  And that’s when I became certified as a childbirth educator, and the rest is history.

Kristin:  I love it, and I agree with you as far as searching Google.  There is so much fear-filled information.  So when I came across your website first and later your podcast, it really – I am all about giving my clients uplifting, positive information, as well as, again, the evidence-based facts so they can make their own informed decisions for their care.

Jen:  Right, yes.  There wasn’t information on how to have a healthy pregnancy as a plus size person.  There was just like, “If you get a pregnant in a higher BMI, you will encourage gestational diabetes, preeclampsia,” all these things.  And then because of the internet and weight bias, it was also comments, like “You’re a horrible person for wanting to be a parent in a larger body.”  And I was just like, wait, no, what?  What is this?  So I really worked to create all the resources I struggled to find.  And then becoming a certified childbirth educator gave me a lot of the knowledge and ability and working all the time on continuing education, but also the ability to walk through doors, and I’ve traveled the country speaking to care providers about confronting weight bias in maternity care, and how do we treat people with evidence-based compassionate care?

Kristin:  So important.  And I’m thrilled that you’ll be training my team of birth and postpartum doulas.

Jen:  Yes!  I’m so excited.  Thank you for bringing me on.  Talking to doulas and student midwives is like my favorite thing in the whole wide world.  So often, these people are hungry for this information and want to learn more, and it’s an amazing experience.  And then I get a little more nervous talking to labor and delivery nurses and other care providers.

Kristin:  I feel the same way about nurses, yes.

Jen:  Wonderful.  I love nurses.  Anyone listening, I love you, but you intimidate me a bit.

Kristin:  Yes.  Because, again, we’re nonmedical and getting into – just having that line clearly drawn.

Jen:  Oh, yeah.  I always stay within my scope, and I talk about consumer perspective of what it is like to be plus size and pregnant and the obstacles faced, but also, you know, sharing tips and tricks on things that can help support people throughout pregnancy, labor, birth, postpartum.

Kristin:  Exactly.  So I would love to get into some of the misconceptions, Jen.  I know you mentioned some of them, one that you would need to see an OB and be labeled high risk.  So let’s tackle that one first.

Jen:  Sure.  The American College of Obstetricians and Gynecologists, ACOG, does not state that because someone has a higher BMI, and that would be a BMI of 30 and above, that they are classified as high risk.  However, this is very care provider specific, as well.  So we see, and there’s this common misconception, that people with a BMI above 30 are high risk.  And they will be labeled so, and they will have to have additional screening and testing and oversight.  And unfortunately, there are states, the state regulations around home birth and birth centers that do have BMI restrictions, so it’s really important that you look into your own community and your own state regulations.  There are also a lot of rural hospitals in areas that aren’t as populated that don’t have an anesthesiologist on staff 24/7 that have BMI restrictions.  So it is – that’s why there’s a lot of misconceptions, because you’re like, wait, but I’m not high risk, but I really wanted to go to this birth center, and they have BMI restrictions.  Or I really heard there’s this great OB, and they have restrictions.  So it’s really important as professionals to be aware of BMI restrictions.  I always say that doulas are the gatekeepers of their communities, and they know so well.  Like, who are those fantastic home birth midwives who have worked through all biases around racism and supporting the LGBTQ+ community and people of size, like working through so many layers of biases and know who are those go-to recommendations for those wanting a home birth or what birth centers have BMI restrictions, what don’t.  Those things are so important.  And hospitals, too, right?  Like, we know hospitals two miles apart, three miles apart, can have very different Cesarean birth rates.  All of that is so important for clients of all sizes, but especially clients of size.

Kristin:  And as you mentioned everything as far as restrictions vary state to state, and the midwifery model of care and so doulas are up to date on your options, both in and outside of the hospital.  And you mentioned that you worked with midwives within the hospital system.  So some of our listeners may not be familiar with the role of a nurse midwife.

Jen:  Yeah.  I mean, a nurse – so the midwifery model of care is more individualized care.  It’s a bit more holistic care.  These are highly trained care providers who are trained in birth and postpartum and also wellness care, as well, and often in a hospital setting, there would be – not often; there is in a hospital setting an obstetrician, an OB-GYN who oversees things.  But when I switched from the obstetrical model of care to the midwifery, I was fully with midwives, and it was such a dramatic change from these 15-minute rush, oh, we’re glad you’re 30.  We’re just going to keep an eye on – you know, you’re younger, but you’re bigger, so we’re just going to keep an eye on things.  To, like, 45-minute long appointments where I felt as a plus size person that my midwife was really the first care provider to touch my body with compassion, to empower me to know that I am healthy and was having a healthy pregnancy.  And I remember being like, I read online.  I have big hips and big girls make big babies.  And she’s like, yeah, you have big amazing birthing hips.  Like, you can birth your baby.  It was just so affirming, and it really changed my whole perspective on accessing healthcare as someone in a larger body because for so many people, and those listening, too, who exist in larger bodies, and there might be some topics that we talk about that can be triggering, so please take good care of yourselves.  But for many of us, we have cumulative trauma.  We’ve experienced a lot of weight bias in healthcare.  And so to go into birth and pregnancy, something that most first time people don’t know a lot about, right?  Like, our bodies do this.  It’s amazing.  But we don’t have a lot of education around it, and even if you take a childbirth ed class, like, a bit, but it’s not everything.  So we’re so heavily reliant upon our care team, and that’s why doulas are just such an amazing gift to help provide that education and that emotional support and then that physical support during labor, as well.  So I highly encourage people to look into the midwifery model of care if they’re wanting more of that individualized, holistic approach.  And just because I had an unmedicated birth with midwives in a hospital doesn’t meant that you have to.  In fact, that’s not the norm.  Most people in the hospital setting do have a medicated birth and can still work with midwives, so that’s another misconception, too.  Like, you can have an epidural in a hospital and work with midwives.

Kristin:  Yes.  And again, depending on your insurance and where you are location-wise, nurse midwives may not be an option, or you might have other medical issues that you put at a high risk status that would need to be seen both obstetricians as well as maternal fetal medicine, for example.  So let’s get into how to connect with size friendly care providers and if you have an OB-GYN that you’ve been working with throughout your journey as a woman, you don’t necessarily have to have the same provider for your birth experience, for one thing.  Many people think that just because their yearly appointments, they have an OB, that that is a person that should deliver their baby.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Jen:  Correct.  I mean, there can be some comfort of, oh, you know, I go to this person, and they’ve seen it all, so I might as well work with them through pregnancy.  But like Kristin just said, that’s not always the case.  I think when researching for a size friendly care provider, you want to start by reaching out to your plus size friends who have had babies.  Like, did you like your care provider?  Did you have a positive experience?  Join – even if you’re not a parent yet, join a local moms group, and if you feel comfortable posting, “Hey, any fellow plus size moms here?  I’m a mom to be and really want to find someone who’s size friendly,” you’ll often get many recommendations.  And then do your research.  Google that care provider, whether it’s an OB-GYN, a midwife, a nurse practitioner.  Like, Google them and research.  And then when you’re setting up your appointment, ask if there are any BMI restrictions because unfortunately, that’s not something that is screened for, so often I hear from people that are like, “Oh, I was really excited to go to this birth center, and then once I was there and paid my copay and had my initial experience, I was told I was too big to be seen here,” and that just makes you feel kind of crummy and not the way you want to start off things.  So definitely ask if there are BMI restrictions.  Ask if they see people of all sizes.  Ask if they have larger blood pressure cuffs.  Like, ask those questions, and then when you go for your first appointment, assess.  Are there chairs without arms?  Can you sit comfortably?  Were you provided options for being weighed, including a blind weight where you’re not seeing the number?  You can also stand back on a scale, backwards on the scale.  You can also say, I don’t really want to be weighed right now.  I mean, knowing those things and feeling supported in those things is really important.  And then paying attention to how you’re talked to.  Is everything related back to your BMI, or are you provided with that individualized care looking at your whole health and possibly your birth history and really trusting your intuition and trusting your gut is so, so important.

Kristin:  Right.  And I’m all about having a simple birth preference sheet or plan and using that as a talking point to get on the same page with your provider.  Because, I mean, instead of waiting until you go into labor to have that discussion, so really making sure that you’re being heard, that your questions are answered, and having that conversation with a simple birth plan, and many hospitals can provide a sheet with checklists that are very easy for nurses and providers to read, and I feel like that is such a good point to begin some of those difficult conversations about, say, inductions and again, like you talked about, BMI; any restrictions that you might have for labor.

Jen:  Yeah, and I think specifically for plus size people during that first prenatal visit, because you’re likely not talking about your birth plan during the first, but I think like you said, it’s really important to bring up anything that’s very important to you about birth that may – you know, you can ask your care provider their birth philosophy if you want to connect with someone who’s very medically minded.  That’s great, too, and you want to know that.  Or if you want to connect with someone that’s more holistic and is going to be open to you giving birth in multiple positions – like, I gave birth on my knees in a hospital.  You can give birth in different positions.  You don’t always need to be on your back.  But that might be a preference of your care provider.  And so those are good questions.  But I think really important for people of size is to ask, are there any specific tests or recommendations you’re going to make because of my BMI, and you can point blank at that point ask them, are you going to recommend induction based only upon my BMI?  So you can kind of assess, and for some people, and I’m sure Kristin is the same way, like, you make your own decisions.  We will provide you with evidence based information, but I will support you if you’re like, yeah, there is some evidence to show a lower Cesarean birth rate for people of size who are induced at 39 weeks, and there’s a study I can provide to put in the show notes.  I have a lot of questions about that study, and I think people should ask questions and ultimately make their own decision, but there is some small evidence there.  So if you are comfortable with that, then that’s great, and you want a care provider that might be more hands on.  But if you’re like, actually, I really want, if I’m having a healthy pregnancy, there doesn’t really seem to be another reason to induce.  I want my body to go into labor on its own as long as I’m within a time frame that’s comfortable for myself and my care team.  So those can be some really good questions to kind of assess in the beginning that will give you a really good idea.  Like, will you be labeling me high risk based only upon my BMI?  If they say yes, then if that is not what you want, then you say bye.  Those are important things early on.

Kristin:  You have options as a consumer, for sure.

Jen:  Yeah, yeah.

Kristin:  And so how did you know?  You said that you switched providers later in pregnancy.  What was your point?  Was it a conversation of just not being on the same page?  How challenging was it for you to make a switch?  Because, I mean, some of my clients don’t like confrontation, and they would rather just go through with everything as it is and not have the birth that they wanted than to have a difficult situation or switch providers.

Jen:  I feel that, and I totally cried.  I don’t like to disappoint people.  I don’t like to break up with people.  So I cried when I did, but I now would have handled that situation different.  So why did I switch?  It was when I was five months pregnant, and my doula came for my first – I think it was just even her interview to see if she was the right fit for my family, and she was like, okay, you want an unmedicated birth, but you’re at this posh OB-GYN clinic that has a very high Cesarean birth rate.  Like, you should have a home birth.  And I was like, what?  I just didn’t even think that my body – you know, that I was healthy.  And I was like, okay, well, I know I want unmedicated because my mom had an unmedicated birth with me and my sister and had always talked about it.  I honestly as a big person just was really afraid also of people having to move my body for me and not having control.  So I wanted unmedicated, and I was very – like, that is what I wanted.  And so I was like, all right.  I totally respect people want a home birth, but I just don’t – I didn’t trust my body at the time.  And she’s like, okay, well, then I’m really going to encourage you to interview with these two hospital midwifery programs.  And we went for our first one at Denver Health, which is a county hospital, and I assumed in my naiveness about birth that, oh, this posh place is probably the best.  I don’t know that I’d want to give birth at the county hospital.  And while the county hospital had plastic chairs instead of fluffy couches, it’s one of the best places to give birth actually in the nation, Denver Health.  I don’t know current statistics, but for a very long time, they were one of the lowest Cesarean birth rates in the nation.  Like, it is an outstanding facility to give birth.  So don’t judge, right?  So many misconceptions about birth in general.  It’s really about becoming educated about the facility and the care providers.  And so we interviewed with this one midwife, and we just knew.  It’s like you meet the one, right?  My husband and I knew that we didn’t even need to go to that other interview.  We wanted to be with this midwife because she just immediately made me believe in my body’s ability to birth my baby and just made me feel so empowered.  So then – what I wish I would have done is just called my OB-GYN’s office and been like, “Cancelling.  I’m going to switch care providers.  Have a nice day,” and let the receptionist know.  But I went to my next appointment and let them know, and what was interesting is they said, “Can I ask you why?  Because we’ve had a lot of people been switching care recently,” and I know now, oh, yeah, that would be a red flag.  I’m glad I’m switching, but at the time, I was just like, I’m sorry and I just feel like this is better for me, and I never needed to put myself through that stress.  I could have just called.  So for anyone listening, I feel like we’d know if our care providers are just like, eh, maybe they could be okay.  I mean, we can feel comfortable getting a pelvic exam, but are they making us feel empowered?  Are they giving us time to ask all of our questions?  Are they really listening to our questions or rushing us?  Yes, there are often time constraints, but there’s a balance with that.  And so never, ever, ever be afraid to switch.  And I know there are obstacles and I know it’s not easy, but switching changed my whole life, and I feel like the outcome for my pregnancy and birth.  I am forever thankful that I switched, and I don’t know what would have happened had I not and had I stayed with that other provider at that other facility where she “only allowed” people to give birth on their backs.

Kristin:  Right.  Yeah, and movement is key, and again, doulas support whatever decisions our clients make and however they want to birth, whether it’s at home, in the hospital, medicated, unmedicated.  You had mentioned that earlier about providing the information but being supported.  So I appreciate that.

Jen:  Oh, yeah.  My doula would have been like, you want an epidural?  Great.  It would have been whatever I wanted.  But especially because she knew I wanted unmedicated.  She knew I existed in a larger body.  And when we do, our Cesarean birth rate is pretty astronomical.  I mean, there are a lot more obstacles.  And I think a lot of it is care provider bias against people of size, and we have new studies finally to confirm what anecdotally people have been saying for a very long time.  In 2020, we finally had studies that came out about weight bias specifically in maternity care.  We’d had plenty of studies showing weight bias in health care, but not in maternity care.  So that has come out, and it has really confirmed everything.  And interestingly enough, it’s not just weight bias for people of size.  It’s weight bias for people of all sizes, feeling shamed about their weight, but we see poor outcomes and more things happening to people of size that are just completely unacceptable.

Kristin:  Yes.  So let’s get into VBACs when it comes to – again, you had talked about Cesarean rates and surgical births and BMI potentially being a factor for a lot of decision making.  What are you learning about plus size patients and their VBACs?

Jen:  Yeah, for vaginal birth after Cesarean for people of all sizes, it’s connecting with a supportive care provider.  And interestingly enough, I’ve found especially through talking to other people like Jen Kamel of VBAC Facts that specializes in vaginal birth after Cesarean that care providers that are VBAC friendly tend to also be size friendly because they’re evidence based, compassionate providers.  Not everyone, but more often, that they’re not – we look at it like oh, the fears and the concerns and the increased risks via VBAC.  Yes, but they’re really small, and yet some care providers are like, I’m not supportive of VBAC at all.  And you’re like, but if you look at the evidence, our increased risks are relatively small, so why wouldn’t you at least support someone’s ability to have a trial of labor for a vaginal birth after Cesarean?  So again, it’s really key to connect with a care provider that is size friendly and also supportive of your VBAC.  We can look at the VBAC calculator, and BMI does play into it as something that shows not as strong outcomes.  But also I think it’s important that we look at the evidence, that we know that it takes people during the first stage of labor, people of size, longer.  It takes longer to labor.  We have the evidence to prove that it takes longer.  But the pushing phase can actually be shorter.  So we know now that people need more time.  But often when you’re in a medical setting, there’s a real eye on the clock and not giving people enough time to labor.  So it’s pushing for that extra time.  And all of these things, like, okay, we’re not progressing.  Let’s have the Cesarean.  Let’s go.  As opposed to pushing, like – actually, there’s evidence to show I just need a little bit more time, but when you’re in the middle of labor, that’s not what you’re possibly going to be able to vocalize.  Your doula can talk to you and remind you, but it’s hard to be able to have those conversations in labor.  It’s far better to have these conversations early on with a supportive care provider who wants to support your decision to have a vaginal birth after Cesarean.

Kristin:  100%, yes.  So any other misconceptions that we should address?

Jen:  Oh, gosh, I mean, just the societal bias is tough, right?  Like, we have this idea that only thin white women with perfectly round D-shaped bellies are pregnant, and that’s so far from the truth, right?  And it’s really common for people in larger bodies to have bellies that are shaped more like Bs than Ds, a B belly.  And that’s really common.  It’s common to have an apron belly or a belly that hangs, and that can be common, not just for people of all sizes, but for people who’ve maybe lost a lot of weight or had multiple pregnancies.  I feel like we live in this – we think it’s secret that we’re different, and we’re actually quite common.  We look statistically, and about 60% of women in their childbearing years are classified as overweight or obese, and I hate those words, but that’s the classification for the BMI.  So 60%, that’s a pretty high percentage, and of that, about 36% are in that BMI category over 30.  So these are big percentages, so know that you’re not alone.  Know that you are deserving of evidence based care, and you’re deserving of a maternity dress if you want it, and you’re deserving to babywear if that’s important to you.  And you’re deserving to have a nursing bra that fits if you’re planning to breastfeed.  So all of these resources are available, and I have lists on my website.  They are harder to find, and it is more difficult to have those in store shopping experiences, but know that there are maternity clothing available, and I even have lists that go up to 6x and even 7x options.  So just know that they are out there because I think that there is something so affirming about wearing a belly band, even if you’re not showing yet, because it can take longer to show when you exist in a larger body.  But having some of those items just really helps you to feel pregnant.  So I think body image, how our bodies look, setting healthy boundaries with loved ones and family members who might have well meaning “concern” about your health that just maybe makes you feel icky if they’re like, oh, well, you’re going to get gestational diabetes.  You can let them know, actually, unless you already are prediabetic, the odds are in your favor of not incurring gestational diabetes, and that’s something that can happen to people of all sizes.  There is no one thing that only plus size people incur during pregnancy.  So you can reassure them.  I’ve got a great care team.  They’re focused on my health.  I’m focused on my health, and I just need you to support – love and support me.  And set those boundaries.  People of all sizes; set those boundaries.  They’re so important.

Kristin:  Again, communication during pregnancy versus having difficult conversations day of delivery about who’s in the room with you, if there are restrictions due to the pandemic, who is on the same page because, you know, even in the postnatal recovery time and just that nesting time with your new baby or multiple babies, it’s important to have your family and friends who want to be involved, to have a conversation about boundaries.

Jen:  Yeah.  My motto is boundaries are sexy.

Kristin:  Yes, I love it.

Jen:  Because boundaries are so hard, right?  And they’re confusing, and what are boundaries?  But when you say boundaries are sexy, it just feels affirming.  Like, I am prioritizing myself and my family, and that’s sexy.  So I just make it fun because it is hard to say, I’m not going to have this conversation, or let’s talk about something else.  Like, it can be hard.  But when you remind yourself, hey, I just advocated for myself, and that’s pretty sexy.  Like, that’s how I got over my fear of boundaries.  I’m like, okay, this is my new motto because it is so empowering to put ourselves first.  And I think going back to our whole conversation so far about finding a care provider that’s the right fit for you and needing to advocate for yourself – you’re going to be doing that for your baby, right?  Like, you’re going to want to find the best pediatrician, and if a pediatrician were to make a recommendation that didn’t make you feel good or wasn’t evidence based, you likely wouldn’t go back to that pediatrician.  So care for yourself the same way you’re going to care for that baby because you are caring for that baby while caring for yourself.

Kristin:  Absolutely.  So true.  So Jen – I could talk to you all day, first of all.

Jen:  I could talk to you all day, too.

Kristin:  It has been so helpful, and I love your website for resources.  So again, you mentioned plussizebirth.com.

Jen:  Yeah, that’s for anything plus size, trying to conceive, pregnancy, birth, postpartum.  A lot of postpartum resources, too, like where do I find a breastfeeding pillow that’s large enough to fit my body and all of those things and tips around breastfeeding and pumping for people in larger bodies.  That’s really helpful, as well.

Kristin:  Yeah, my team can’t wait to talk to you about feeding options.  And you’re also on social media.  You’ve got your Facebook page, Instagram?

Jen:  I’m everywhere.  So for everything pregnancy, it’s Plus Size Birth.  But I also am the host of the Plus Mommy Podcast, so my main social following is Plus Mommy.  But you can find me wherever it fits.  For Plus Mommy Podcast, the tagline is: From bumps from bellies, we talk about it all.  So there’s a lot of great birth stories and interviews with experts, but there’s also really fun interviews with people who I admire, like some contestants on America’s Got Talent and The Voice and just amazing humans that are out there living their best lives, existing in larger bodies, and who inspire me.  So it’s a lot of fun, and I hope you’ll tune in.

Kristin:  You’re such a charismatic host.  I love your podcast.

Jen:  Oh, thank you.  Thank you so much.

Kristin:  Thanks so much for your time, Jen, and I appreciate everything you’re doing in this space.  You are amazing.

Jen:  Well, I appreciate you and every doula and every birth professional out there for the work that you do because my life would not look like it does now if it wasn’t for that care and compassion I receive.  So for everyone listening, if you’re a parent or parent to be, doulas are just amazing, so definitely consider.  That was one of the greatest gifts my parents ever gave us was helping to fund our doula fund, so it’s a wonderful thing you can ask from your loved ones, as well, because trust me, you don’t need 14 swaddles.  You do need a doula.

Kristin:  Exactly, I love it.  Thanks, Jen!

Jen:  Thank you!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Kristin chats with Dr. Berlin about the Informed Pregnancy Project.  The Project aims to utilize multiple forms of media to compile and deliver unbiased information about pregnancy and childbirth to empower new and expectant parents to make informed choices regarding their pregnancy and parenting journey.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

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.  This is Kristin with Ask the Doulas.  I am joined today by Dr. Elliot Berlin, and for those of us in the birth working world, Dr. Berlin is a legend.  I’m so excited to have him on.  He’s an award winning prenatal chiropractor, childbirth educator, labor support body worker, and cofounder of Berlin Wellness Group in Los Angeles, California.  Dr. Berlin graduated summa cum laude from Life University of Chiropractic in Atlanta, Georgia and the Atlanta School of Massage.  His separate schooling in massage therapy, body work, and chiropractic formed the backbone of his innovative pre- and postnatal wellness care techniques.  Unique chirosage sessions soothe and relax tight, painful muscles and restore motion to restricted joints.  These 30 to 45-minute treatments effectively address most pregnancy aches and pains in just a few visits and promote a healthy, comfortable, and functional pregnancy and an ideal environment for labor and delivery.  Dr. Berlin’s Informed Pregnancy Project aims to utilize multiple forms of media, from podcasts, YouTube series, documentaries, and online workshops to compile and deliver unbiased information about pregnancy and childbirth to empower new and expectant parents to make informed choices regarding their pregnancy and parenting journey.  Dr. Berlin lives in LA with his wife, perinatal psychologist Dr. Alyssa Berlin, and their four fantastic kids.  Welcome, Dr. Berlin!

Dr. Berlin:  Thank you so much, Kristin.  Thank you for having me, and thank you for the amazing work that you do.

Kristin:  Thank you.  And you are also a doula, correct?

Dr. Berlin:  I am a doula.  It’s an interesting, circuitous route to how I got there, but I am one of the few doula guys.

Kristin:  Male doulas, yes.  I love it.  And I know you from a lot of your filmmaking.  The Trial of Labor, Heads Up, and you’ve done so many film projects related to pregnancy and birth.  That is also amazing.  As I mentioned with your podcast, as well.  So I love that you’re tying all of your work together.

Dr. Berlin:  Yeah, I mean, it’s all – it really is one big bundle that it all complements.  Like, if you’re going to support people in modern day, especially America, in pregnancy, birth, postpartum, parenting, then all the pieces are kind of necessary for holistic support, not just hands-on work, not just focused on body, but also mind and also empowerment through information, which is hard to get sometimes.

Kristin:  Exactly.  And it is nice to have so many online options compared to when I had kids.  So my kids are 10 and 12, and there were very few online programs and options.  You had to find support in your community.

Dr. Berlin:  Yeah.  And thankfully, on the local level, there are communities growing through services like the ones that you offer and communities like the ones that you build.  The village is coming back together.  We had village support, and then we moved away from our villages and had no support.  And things got a little dicey, but slowly as a team, all of us are trying to bring that back.

Kristin:  We sure are.  It’s so important.   So how did you decide to specialize in prenatal chiropractic care, out of all of the different specialties you could have focused on?

Dr. Berlin:  I originally – medicine was my jam.  I was going to do everything medicine.  I pictured myself doing groundbreaking surgery and all sorts of interesting things like that.  From the time I was very little, I was – I saw a CPR class happening, and when I found out that you could use your body to be somebody else’s heart and lungs for a little bit, I decided I wanted to use my body to help other people.  And I pursued at first very basic things like CPR and first aid and lifeguarding, responding to emergencies.  But then as a teenager, I studied emergency medical technician training and started working in ambulances and emergency rooms.  I kind of came to a halt when I was 19 and my father passed away, partially from a medical mix-up.  And I still love medicine very much, and I respect it, but I wanted to be in healthcare on the more natural side of things, supporting the body in other ways, preventing perhaps the need for reliance on drugs and surgeries.  So I took some time off.  I studied complementary forms of healthcare, and I fell in love with the combination of chiropractic and massage, working on the musculoskeletal system from both sides.

Kristin:  That is amazing.

Dr. Berlin:  Yeah.  You don’t have a muscular system that’s in a vacuum from the skeletal system.  They’re deeply intertwined.  So I went to school for both separately, and I squished them together to sort of make the peanut butter and chocolate of holistic healthcare.  And that was the first step.  That really kind of pointed me down this path.  In terms of pregnancy specifically, my wife, who you mentioned earlier, is a psychologist also working in this space.  We were in grad school together, and we were finishing.  We thought, this is a great time to have a baby.  And no matter what we did, no baby would come.  We tried all the natural things.  We tried all the medical things.  Heavy interventions.  And for reasons nobody can explain, they were just like, we don’t think it’s ever going to happen.  You should explore other pathways to parenthood.  And we couldn’t because we were just broke.  Not just financially broke, but our relationship was on the rocks.  Our physical, mental, and spiritual health was gone.  It was quite the roller coaster, and we were young.  We were, like, 25 and 27 years old.  So we decided to just take a little time and heal, to work and not give all the money to medical treatments, to spend time together and find that spark and rekindle the relationship and to work on our health.  We started doing Chinese medicine, meditation, yoga, better nutrition.  And over a period that turned out to be ironically nine months, really ended up in a much better place in every way possible.  And that’s when we moved to Los Angeles, and when we got here, we started to think, what alternative ways to parenthood are there?   But it was a short discussion because we found out we were pregnant.

Kristin:  I love that.

Dr. Berlin:  Me, too.  And then, yeah, every couple years, another baby came.  It was like we couldn’t turn it off.  So we opened our mind body practice, and we had – it was for general health and wellness, but there was definitely an eye on boosting natural fertility.  And the first year, we had a couple babies come through.  And then every year after that, it just snowballed.  There were babies everywhere.  Our patients wanted to continue care with us, and although I didn’t know that much about pregnancy at the time, and certainly pregnancy care, there was nobody else here in Los Angeles that seemed to be working on pregnancy.  So I did as much as research and homework as I could on the providers who came before me and felt confident that I could provide chiropractic care and massage care without harming the mother or baby, and that’s how we got started.  And then once we did enough pregnancy care, then you get a lot of questions about things that I didn’t know answers to, so I’d research the answers, and after having those same questions and answers over and over and over again, decided to put it to paper and write a little blog that became a magazine that we published for several years, and then that eventually turned into the podcast and also our newest project, which is a video streaming service.  So all the different things.  And even attending birth kind of organically rolled.  I’m doing massage and chiropractic right up until the last minutes of labor, and then someone’s in labor, and if it’s going on for a long time or there’s back labor or anything like that –

Kristin:  You can adjust them during the birth and provide hands-on support.  I love that continuity of care.

Dr. Berlin:  Yes, exactly.  And once I was being called to births on a semiregular basis, I thought it would be helpful for me to have additional skills here.  So that’s when I did doula training.  My wife did it with me, actually.  She’s also a doula, and as a psychologist, she would serve as a doula for people who needed a little bit more expertise with either anxiousness or OCD or things like that.

Kristin:  Yeah, past trauma, other medical occurrences.  That makes a lot of sense.  So you likely don’t have much time to do doula work anymore with all of your projects.

Dr. Berlin:  Right.  I never really meant to be a doula.  It’s just that as part of the training, you have to do some births.  Once I started doing birth, people were like, wait, I want the doula who’s going to massage me the whole time at my birth.

Kristin:  I certainly would have, yeah.

Dr. Berlin:  So it kind of spread, and then I was like, wait a second.  I can’t be doing these births all the time because I’m in the office for ten hours a day, and I have a family.  And so I ended up kind of scaling down from being a doula to just doing body work for an hour, two hours, three hours, whatever was helpful.  And then after the pandemic, so many people here decided to do a home birth or out of hospital birth, and many of them not really out of hospital birthers by nature, just not wanting to be in the hospital with everything that was going on.  And so –

Kristin:  Of course, and the visitor restrictions, yeah.

Dr. Berlin:  Yeah, and the masking.  Just so many restrictions.  Really can’t walk around anywhere anymore.  So they were giving birth out of the hospital but not all that comfortable with it, and so they would want a larger cast of support characters.  I was getting invited to a lot of births, and it’s kind of – I would be in the office during the day, birth at night, come back to the office and sleep on the massage table for an hour, get back to work.  So I’ve kind of scaled back from that, too, more recently.  And once in a while, I still end up at a birth.  I leave it to the universe if somehow I’m going to be extremely helpful, I’m sure I’ll end up there, and if not, I won’t.  And I think that works best for everybody.

Kristin:  Yeah.  And it makes sense.  I mean, I feel like there are more and more inductions now after the pandemic, and so if my client has an upcoming induction, I try to get them into their Webster-certified chiro and look into acupuncture and other sources to get things going if their body’s not ready.  So I’m sure you get a lot of those last-minute calls to come in for an adjustment, and then especially with the massage work that you do on top of the adjustments.

Dr. Berlin:  Yes.  So a lot of it is labor preparation with pelvimetry.  There’s this idea in obstetrics that we can measure how big the baby’s head is and how big the pelvic opening of the mom and sort of guess whether that baby is going to have an easy time coming through or the baby’s going to get stuck.  And it goes back many years, all the way to when they would measure with calipers to when they would take the 37-week X-ray, until they realized that was doing harm.  And even today, we still try to guesstimate.  But the American Academy of Family Physicians recommendation currently is not to even measure because the only way you can tell is to try.  And the reason pelvimetry, I think, is so ineffective as a predictor is because it’s looking at structure, anatomy, and not function, physiology.  A baby’s head is a bunch of bones not fused together, so they can mold and come through a space that’s smaller.  If you have a 14-centimeter head, it can mold in and come through a 9-centimeter space.  And the same with the pelvic: a properly functioning pelvis is not one big bone.  It’s a bunch of bones connected by ligaments and cartilage, and there should be movement.  There should be fluid movement in those bones, especially at the end of pregnancy when the body facilitates that with relaxation hormones.  But if where the bones of the pelvis come together, there’s lack of movement, there’s restriction, or the soft tissues that connect those bones, muscles, tendons, and others have excessive tightness and dysfunctional shortening, stiffness, then it’s not going to have the function it should have.  But if it does have the function, it should be able to expand and contract and it should be able to help the baby rotate into all the great positions and move through the body smoothly, even if the baby is on the bigger side, because it can open up bigger than its typical space.  Then afterwards over the first year the baby’s head starts to fuse together, and over the first couple of months, the hormones all dry up, and the stability comes back into the pelvic bones, and they can’t open up as much.  But pelvimetry just looks at the size, but not what it can do.  Can that larger head mold in and become smaller?  Can that smaller pelvis open up and become larger?  They’re designed to do that, but there’s no way to measure how well they’re going to be able to do that.  But one thing we can do – we can’t do much about the head – we can make sure that that musculoskeletal pelvis is as functional as it can be.  And whether you’re giving birth spontaneously or being induced, that is a key component in the functionality of birth.

Kristin:  Yeah, and I’m a big fan of prenatal chiropractic care and movement during labor is so key.  But you’re right, as far as inductions, the big baby is one of the most common, other than advanced maternal age or, obviously now with COVID, having COVID during pregnancy is one I’m also seeing.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Dr. Berlin:  I also think the ARRIVE trial did a big disservice.  It’s one of those examples where a particular study comes out, and a major shift takes place on the ground based on that one study before we even fully understand the way the study was done and what the results mean.  And this happened with the team breach trial in 2001.  They did a study of breach babies born vaginally versus by Cesarean, and the study found there was a small but statistically significantly better outcome for breach babies who were born by Cesarean versus vaginal birth, and immediately the United States and Canada and then the rest of the world followed in suggesting that all breach babies be born by planned Cesarean.  And it wasn’t until two years later that the same group of researchers in Canada, Mary Hannah and group colleagues, found out that there was – by looking at the two-year-olds now, there was no long term difference in health among them.  And then two years after that, another researcher named Glazerman sort of picked apart the way the original study was done, showing that you can’t necessarily take those results and apply them to everybody, meaning some babies are better candidates and some women are better candidates for vaginal breach delivery than others, but there wasn’t a real selection process in the study, and some facilities and practitioners have better equipped staff and machinery to support a breach birth than others.  And so those are just some of the – there are many issues with that study.  And so then in 2006, the United States sort of changes the language.  ACOG says that, okay, maybe vaginal breach birth is a reasonable option for some people if you can still find a practitioner who’s skilled and comfortable doing it.

Kristin:  That’s the thing.  There are so few in my area.

Dr. Berlin:  Yeah, around the country, because once we stopped doing it overnight, how does anybody train on it?

Kristin:  Exactly.

Dr. Berlin:  And without training, who’s going to feel comfortable doing it?  And so it’s sort of a disappearing art, which is what prompted us to make our film, Heads Up: The Disappearing Art of Vaginal Breach Delivery.

Kristin:  Yes.

Dr. Berlin:  And also prompted some of the sort of old timers who always did breach and still do break to start trying to teach others, in particular Dr. Stuart Fischbein, I think kind of got an RV and started driving around the country.

Kristin:  Yes, I heard about that.

Dr. Berlin:  Teaching as many people who want to listen who are still curious.  Midwives, obstetricians, and others all about breach birth.  So there’s an effort to maintain or restore the choice, but it’s an uphill battle.

Kristin:  Yeah, for sure.

Dr. Berlin:  And the same is true with the ARRIVE trial, which essentially had the hypothesis that if we – since babies are fully cooked at 39 weeks.  They’re just getting bigger.  There’s nothing new developing.  And sometimes after 39 weeks, bad things happen in pregnancy.  What if we just got them all out at 39 weeks?  The contrary thought is, well, what kind of harm does that intervention do?  Maybe it will push us into doing a lot more Cesarean births that was unintended, unnecessary, and might have other consequences.  And then the results were a double surprise.  The induction at 39 weeks did not statistically significantly improve morbidity and mortality among babies, and the other surprise was, in that particular study, the induction group at 39 weeks had a lower Cesarean rate than the managed care group, the people who just waited to go into labor or to need intervention for some other reason.  I do a very complete analysis of that study on our podcast, Informed Pregnancy with Dr. Emiliano Chavira who is a maternal fetal medical specialist and OB-GYN, and we really break it down for you to see.  The results were not super clear.  But for many medical practitioners, it has become the sort of Bible of how to manage all pregnancy regardless of age and other factors, that all babies should be out by 39 weeks, by induction, by Cesarean, or other means.  So I think we’re doing a lot of induction for that reason, and it may not be the best idea.

Kristin:  Yeah, I mean, again, that cascade of interventions and unplanned surgical births, which have a long recovery time, and other issues.  So we did talk a bit about informed choices and decision-making, and obviously, all of the resources that you’re compiling are a great way for our listeners to start doing research on their own and being prepared for discussions with their provider if any interventions are discussed or induction is brought up.  So what are your tips for making informed decisions throughout pregnancy and during labor?

Dr. Berlin:  I think the most important thing is to have the right providers around you, the right obstetric providers.  They wield a lot of power.  They wield a lot of knowledge.  But there’s a wide spectrum of approaches to care, especially during pregnancy and everything that follows birth and postpartum.  And some people really do like a paternalistic doctor who will come in and tell you, this is what we’re going to do and not really give you very many choices.  But those patients want someone else to take all the responsibility and make all the decisions, and there are great practitioners like that who are amazing for that.  However, there are also some people who like to be very much in control of every decision that’s made, or at least have sizeable input, and if you’re with that type of practitioner, you’re going to end up being very unhappy.  So there are medical doctors; there are midwife, and in Los Angeles, we sort of have this weird circumstance where you can have almost anything.  We have OBs that are delivering at home.  We have midwives who are delivering at the hospital.  We have birth centers.  So there are a lot of choices.  But you sort of have to know yourself a little bit.  Am I more medical in general?  Am I more natural in general?  Do I like to be more involved in the decision making or have decisions made for me?  And then once you know all of that – and not everybody has this luxury, but if you do take advantage of it, find out who the practitioners are, and do some interviewing early on.  See from that pool of practitioners who are likeminded to you, who do you have the best chemistry with?  And that’s important.  I could see every day, people come out of their OB appointment.  Some of them are ecstatic, like, oh, so uplifting to go there and check in and reassure me.  And other ones come out almost crying every time, either from the way they were spoken to or the way they’re sort of being pushed down an alley that they don’t want to go down.  And that becomes really sometimes dangerous at birth because if you’re not on the same page as your practitioner and they start to recommend interventions, you don’t know, is that because they like intervening, and that’s the way they’re comfortable delivering babies, or because you really need that at that moment?  And when you’re in doubt, then it becomes dangerous.  That’s not a good time to be doubting your practitioners.  So to the extent you have the luxury, it’s nice to be able to know yourself, know the available pool of practitioners, and then find somebody who’s on the same page with you.  I think that’s the greatest, single most important thing for having a good experience, no matter how it goes.

Kristin:  Right.  And I’m a big fan of a birth preference sheet, a birth plan, and having that conversation with your provider, even though that provider may be sharing call with a large practice and may not be the one attending, but having in my experience as a doula, having the okay from the primary provider is helpful.

Dr. Berlin:  Absolutely.  The reason we sort of compile so much data and try to find different forms of media to deliver it in because today there are a lot of choices, and all of us as medical professionals are pulled in many different directions.  There is – you know, if there are going to be two options for you as a patient, and one of them takes all day for me, and one of them takes an hour, and they pay the same, there’s motivation for me to really want to do the one that’s going to take the hour because it pays 24 times better.  And I don’t necessarily have time to do the one that takes 24 hours.  That’s certainly not for everyone.  So I have motivation.  And we’re just human.  I’m not saying that doctors are bad; I’m just saying we’re human.  We all have decisions to make.  And there’s a lot more where that came from.  You know, what will your insurance cover versus not cover?  Sometimes our hands are sort of cuffed by the insurance companies.   They’ll say we’ll pay for this procedure but not that procedure, or this medication but not that medication.  We’ll pay for 2 visits or 12 visits.  And then there’s our insurance, which is looking out for liability, which is risk to the provider, not necessarily directly related to risk to the patient.  Certain procedures may be more liability, more risk of lawsuit or other things like that.  For example, if you go against the community norm, which right now for breach is to do C‑sections for all breach babies, if you’re one of those practitioners who says, you know, it’s your baby, your choice if you want to do a vaginal birth.  You look like a great candidate.  Let’s do it.  That automatically gives the practitioner more risk, more liability.

Kristin:  Absolutely, or VBAC.  I mean, you’re right.  They’re taking on a lot more liability.

Dr. Berlin:  Totally.  And so it’s not as simple as it used to be.  I mean, at some point, I just picture the doctor.  When someone was sick, a family doctor would come over and always have a little black bag.  Inside, there was probably some alcohol, some aspirin, and a thermometer, and that was it.  They took your temperature, and if they thought you were going to live, they’d give you some aspirin and alcohol to keep you comfortable until it happened, and same if they thought you were going to die.  Now, it’s a lot more complex.  And so with doctors and hospitals and everybody really being – any practitioner being pulled in lots of different directions, it’s important to know what the choices are so that you have a voice representing you specifically.  Not that the providers won’t want to represent you; they also have other factors to consider, and some of them may or may not be in your best interests.  And that data is sometimes hard to come by, so the podcast – now in our tenth year, we have 350 episodes.  Some of them are just – each episode, we have one on umbilical cord.  What’s a normal umbilical cord?  How is it formed?  What’s the typical anatomy and how does it work?  What are some things that can be a variation from typical anatomy, and what kind of problems might they cause or not cause and how to mitigate them?  Same for placenta; same for amniotic fluid; same for gestational diabetes and so on and so forth.  And a lot of them are just birth stories where people come, and the ones that are most popular are before and after birth stories where we’ll interview somebody during their pregnancy about pregnancy and their plans for birth, and then on the other side, how did it go.

Kristin:  Yes, I love those.  I send my clients to your podcast for the birth stories.

Dr. Berlin:  Oh, thank you.  I actually like going back and listening to some of them, too.  And really it’s like them processing, what did they learn from the experience that they couldn’t have known otherwise, and what can we as a result learn from that as well?  But more recently, we made two documentaries, one that we talked about, Heads Up.  And I made another one about vaginal birth after Cesarean called Trial of Labor, and it’s four women who share their stories.  They all had previous birth only by Cesarean and now are pregnant again, and they’re hoping for a more empowered experience.  And we had no idea how these births were going to end when we started the project.  We had very little time, and we just recorded and sort of gathered as much information about the process as they were going through it.  And they shared these very personal stories because they want to help you.  They want to help other people.  They want to – the subtitle could be, How to have your second birth the first time around.  How to avoid the mistakes that maybe were made.

Kristin:  Really, that’s what it boils down to.

Dr. Berlin:  Totally.  And you can, but it takes work, and it takes information.  And after we made these films, there was a huge, like, batch flare where we had screenings and online sort of virtual presentations, and we brought it to conferences and festivals, and there was a lot of activity around it and momentum and impact, which was the most important thing to us, and then afterwards, it kind of sort of fizzled out like a match does, and I realized the only thing I know less about how to make a documentary film is what to do with it once you have it.  And I started to talk to other filmmakers in the space.  There are some very, very powerful films, and it was similar for them.  It would come out.  There would be some noise around it.  It would be – you feel really good.  People get information.  And then it would just sort of peter out.  So I had this idea, what if we could take all these iconic films and put them in one place where you can access it online.  You can access it through apps like Apple, Android, Roku, Apple TV, and just consume what you want to consume and leave what you don’t.

Kristin:  It’s ideal because it’s so hard to search for things and to have the convenience is absolutely worth it.

Dr. Berlin:  And they’re all just on different platforms, some of them really obscure, so you’d have to sign up for each one to see it, and some you can only do on your phone, some you can do on other devices.  So that gave birth, so to speak, to this newest project, Informed Pregnancy Plus, and if anybody has way too much free time on your hands or lots of extra money, I recommend starting a streaming platform because that will solve both problems very quickly.  It’s my new baby.  I invest everything I have into it every day.  We have a very small team here, and we are gathering the content, licensing the content, streaming the content, and also producing new content.  So we have iconic films on there like The Business of Being Born.  We have Orgasmic Birth.  We have The Mama Sherpas¸ Breastmilk, The Milky Way, which is also a lactation film, great film.  We have a very fascinating film from Japan called Prenatal Memory, which is a doctor who’s been researching for 40 years now what babies remember from their time in the womb.  And we have a movie called Sick: The Battle Against Hyperemesis Gravidarum, which is an important conversation that doesn’t happen enough.

Kristin:  I haven’t seen that one.  That’s a very important conversation.

Dr. Berlin:  It’s a British film.  We have two that are on the sadder side, but also extremely important, I think, to see and share and talk about.  One is called You Are Not Alone, and it’s a documentary series from Australia about miscarriage.  And another one called Still Loved from England which is about stillbirth.  And our films, Heads Up and Trial of Labor, and another beautiful one called Beautiful Births.  There’s a lot of great exposure and information through those films, and then there’s web series that are just coming in hot and heavy.  Some that we produced, like the real midwives of Los Angeles.

Kristin:  Awesome.

Dr. Berlin:  And a bunch of other web series that are just full of practical information.  We started to put up a mind and body section with medications, with yoga, with fitness workouts.  It’s just growing every day.  And there’s workshops on there.  One of my favorite things is my wife’s workshop called The After Birth Plan, and that is how to prepare your relationship for a baby, how to still like each other after you have a baby together.  All of it’s in one place.  All of it is very easily accessible.

Kristin:  So how do we sign up, Dr. Berlin?

Dr. Berlin:  So online, you can go to informedpregnancy.tv and sign up that way, or Informed Pregnancy Plus has apps on Apple, Android, and Roku channel.  We’ll soon be expanding to more platforms.  But you can sign up on any of them.  Everyone gets a free trial, a three-day free trial, so you can go there, browse around, see the content, and then it’s subscription after that.  It’s around $6 or $7 a month or $60 a year, and you have unlimited, unfettered access.  And notifications as new material comes out and new content is being added all the time.

Kristin:  That’s so exciting.  So our listeners can also find you, of course, at your Informed Pregnancy Podcast, and you’re on quite a few social media channels, and of course you’ve got your website, as well.

Dr. Berlin:  Yes.  So our website has access to everything that we do.  And on social media, I’m primarily active on Instagram but also Twitter @doctorberlin.

Kristin:  Awesome.  Any final tips for our listeners?

Dr. Berlin:  No, I think that we’ve discussed a lot.  I think taking advantage of a local resource like the ones that you offer, Kristin, and also creating your own little community, your own little village.  It does take a village, and I think that when we lived on the village, in the village, on the family property, you were exposed to childbirth all the time.  You were exposed to breastfeeding all the time, and in fact the women of the village would gather around each other and support each other when it was their time.  And when it was your time, they would gather around and support you through the entire process.  And now that we don’t have that anymore, it’s all these new professions have popped up to try to replace that.  You know, we need childbirth educators because we don’t know.  Labor doulas, baby nurses, postpartum support doulas.  This is all the village.  But there’s other things that you can do to build village.  Sometimes you meet them through your doula, through your childbirth educator, through your prenatal yoga or fitness classes.  And then there’s online resources as well that kind of connect you together.  And there’s now more and more online information and online resources that you can use to consume information however you consume it best, by reading blogs or some of the great books.  One of the things we’re doing on Informed Pregnancy Plus is book reviews of baby books and parenting books, little five-minute video book reviews so you can get a lot of information, see which books might appeal to you most.

Kristin:  I love that.

Dr. Berlin:  But you can listen to it on audio.  You can read it in print, and you can now watch it on video.  It’s important to not wait until the very end when choices are being made for you but instead to empower yourself early and be an active decision-maker, be in the driver’s seat.  One final thing I’ll say is – and it doesn’t only have to be this way, but as observations as a male doula at many, many childbirths is, the difference between home birth and hospital birth for me, observationally – and we’ve had both, too, my wife and I – but in the hospital, when I’m observing birth, it’s always the laboring person is asking these questions.  “Can I go to the bathroom now?  Can I have this drink?  Can I have this snack?  Can I walk around?”

Kristin:  Right, because they’re the patient in the hospital.

Dr. Berlin:  They’re the patient in the hospital.  And the system is set up that, you know, almost as if you do what we tell you, like you work for us.  And at home, it’s the exact opposite.  If there’s any asking, it’s like, hey, mama, do you mind if we use this towel?  Is that okay?  Can we go in here?  It’s just a total opposite of empowerment, and even for your laboring at home for a while.  But these are some of the things that you see, like orgasmic birth is something that most people laugh at, like what?  It’s childbirth.  It’s supposed to be the most painful, horrible, and terrible thing ever.  Orgasm seems like the exact opposite.  But when you watch it – this film is an older film that is, I think, finally coming into its time because women are taking the empowerment back.

Kristin:  Yes, I agree.  It’s a great film.

Dr. Berlin:  And realizing like, we have this.  We can do this.  This can be a powerful and empowering experience, but only if you have the right chemical – only if you have the right ingredients, and now those ingredients are more available than ever.

Kristin:  Yes.  Love it.  Thank you, Dr. Berlin.  I could talk to you forever.

Dr. Berlin:  It’s mutual.

Kristin:  Appreciate you so much.

Dr. Berlin:  My pleasure.  Thanks for having me, Kristin.

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Kristin talks with Dr. Amy Beckley, Founder and CEO of Proov about infertility challenges and options.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

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 with Ask the Doulas, and I am excited to chat with Amy Beckley.  She is the CEO and founder of Proov, and Amy is also a PhD scientist.  So welcome, Amy.  I’m so excited to chat with you about both your professional journey and your personal infertility journey.

Dr. Amy:  It is so good to be here.  Thanks for having me.

Kristin:  Share a bit about your professional background, and let our listeners know more about Proov.  And then we’ll get into your personal journey.

Dr. Amy:  Yeah, sure.  So I am a scientist.  I started off thinking I wanted to go to med school, and I volunteered in an ER.  The first time I had to hold the hand of a poor man getting stitches, I about passed out.  And so I decided that maybe that medical field was not right for me.  But I still loved science and how things work and biology, and so I went to school to get a PhD.  I studied pharmacology, so it’s like how things work.  How different body systems communicate to each other, with a special focus on hormones.  So I did things like stress signaling, like cortisol hormone.  I did breast cancer signaling, so what happens when the breast metastasizes to the lungs and how that happens.

Kristin:  Fascinating.

Dr. Amy:  Yeah.  So I just really love science and just wanted to kind of make an impact in the space.  I always wanted to do something – they call it in the field translational, which means take something out of the lab into the world where people can actually use it.  And so that was really my goal, to create something that had an effect, right, like an actual product that was actually changing lives and creating an impact.  There’s so much really cool research that’s done within universities and companies that never comes to light.  So I always knew that I wanted to create that impact.  I couldn’t be a medical provider and do patient-facing care.  I wanted to provide tools for the medical professionals to do their jobs better.

Kristin:  I love it.  So was Proov your first business, or did you have other concepts that you brought into the world before Proov?

Dr. Amy:  No, it’s my first and only.  After I got my PhD, we do what’s called a post-doc, which is like postdoctoral training, kind of like a residency for the medical field, but for science.  And during that, I had gotten married, and I had moved into a nice house and a new, nice neighborhood with a good school.  And we’re like, okay, let’s just have kids.  How hard could it be?  And we struggled and struggled.  And then we got pregnant, and we lost that pregnancy.  And then we got pregnant, and we lost that one again.  It just became very clear to me that it wasn’t easy.  Physicians were missing it.  Here I was, this educated, scientific-minded person: could not get pregnant.  And it was – my diagnosis was unexplained infertility, which is the most common diagnosis you can get.  I was like, man, this field needs – we need to figure this out because we just don’t have the right tools and diagnostics.  My personal journey was I had – my first child was an IVF child.  He is now 12.  It was basically like, we don’t know what’s wrong with you, Amy, and since we don’t know what’s wrong, really the only thing that’s going to work really well is IVF.  It’s kind of like that medical band aid that just kind of fixes everything that could possibly be wrong.  So I went through that IVF process.  Then when we went to try again for our second child, I was like, I really just – I don’t want to do IVF.  I’d rather figure it out.  I mean, I have all these tools and knowledge, and I was connected to a really amazing reproductive endocrinologist and really talented doctors.  Let’s put the science and the medicine together.  Let’s figure this out.  And we came up with this diagnostic where we look at the hormone called progesterone after ovulation.  So progesterone is the pro-gestational hormone.  It is what keeps a woman pregnant, and it prepares the uterus for implantation.  And we weren’t monitoring this hormone enough in that you can’t just go and get a blood test and be like, oh, yeah, everything’s fine.  Just like you can’t go get a blood test for a single glucose.  It doesn’t make sense.  You have to track trends, and you have to make sure that hormone remains elevated.  So we created a urine-based test where we look at the metabolite in urine of progesterone across the entire implantation window, and we look, is it sustained?  Is it elevated?  Does it come down too early?  We can really talk about this idea of a healthy ovulation, and we can look at, are there possible ovulatory disorders?  Because my problem wasn’t timing.  It wasn’t that I wasn’t getting pregnant.  It was that I wasn’t able to stay pregnant.  It was something not to do with timing.  It was something to do with implantation and maintaining a pregnancy.

Kristin:   It’s amazing that you have personal experience that probably just elevated your passion for this work.

Dr. Amy:  Yeah.  I mean, through the course of my journey, I’ve had seven losses.  And I just – at the end, I kind of – I say coming out of the closet, for lack of a better word – but I just kind of – you know, you go through it, and you just don’t want to tell anybody.  You feel like less of a woman.  You feel ashamed.  You’re like, what is wrong with me?  I can’t even conceive.  I mean, look at everybody else.  Look at all these kids.  I closed myself off.  And then after my family was complete, I opened up, and I was like, this is what happened.  This is what I did.  And I just had so many women, friends, privately message me, like I’m going through the same thing.  What did you do?  What can I say?  And I would just educate them one on one on questions to ask, what kinds of tests did they need, things that they could try.  And then finally, one day, one of my good friends that also went through IVF, she called me, and she said, we have to do something.  We have to at least try to fix this because no one else is doing this.  No one else is creating these tools.  Why don’t we just do it?  So we did.  We just bought a bunch of reagents and went down to my basement and kind of – okay, all right, so the literature says we can do this.  All right, I can make some prototypes.  I can get this to work.  Okay.  We launched a crowdfunding campaign and presented it to women, to couples.  Hey, if we built this, would you buy it, and they did.  And so we made it.

Kristin:  I love it.  So you’re getting a response before you’re fully to market.  I love crowdfunding, especially for women-owned businesses because it’s so hard to raise capital.

Dr. Amy:  Yeah, definitely.

Kristin:   So as far as – I mean, obviously, the IVF process is not only expensive, but there are disappointments, the hormone fluctuations.  There are just so many issues when taking that on, and so it sounds like your solution is not only simpler, but more economical for families who are trying to conceive.

Dr. Amy:  Yeah, absolutely.  So as part of IVF, you retrieve the eggs, and then you transfer the fertilized embryo back in, and then you support the luteal phase with progesterone.  It’s usually a big, fat needle, straight to the butt.  It’s not fun.  It’s really painful.

Kristin:   That’s what I hear, yes.

Dr. Amy:  But I asked my doctor – I was like, let’s just skip the IVF part, and I would just like to support my luteal phase with progesterone because I just don’t think I’m making enough of it after ovulation to really support that pregnancy.  And so that’s what I did for my daughter, who’s now nine.  I monitored ovulation.  I timed intercourse.  And I started the progesterone, and I just kept taking it, and then I got a positive pregnancy test, and I continued taking it throughout the entire first trimester, and that was it.  That’s all I did was just add progesterone.  It was like that missing piece because there was no diagnostic out there to tell you that somebody didn’t have enough progesterone to support pregnancy.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  So what does the investment look like for a family?  At what point should they be reaching out to you?

Dr. Amy:  I really like making fertility diagnostics affordable and accessible.  So we are actually FDA-cleared for home use, and so these women can buy these on their own.  They’re on Amazon.  They’re on our website.  We’re launching in a major retailer in a couple months.

Kristin:  That’s so exciting.  I saw you could get them from your website, but yeah, it’s very accessible.

Dr. Amy:  I mean, what’s more accessible than the Amazon truck?

Kristin:  Exactly.

Dr. Amy:  I’ve seen it, some women, they get it the same day.  Two hours later, they show up on their doorstep.  It’s really cool.  Our base kits are $29, so we try to make them really affordable, as well.  And then if you do find an issue and you need a treatment, the medications that typically come in order to treat these types of issues are, like the ones that are covered under your $10 copays through insurance.

Kristin:   Perfect.

Dr. Amy:  Yeah.

Kristin:  That’s so affordable and accessible and simple.

Dr. Amy:  Yeah.  It’s just – we didn’t know that this was an option, so it goes from trying ourselves straight to IVF, and we really want to create that kind of middle ground where it’s like, all right, we’ve been trying a while.  It just hasn’t happened.  Before we go see and RE or think about IVF, why don’t we try Proov, see if we can identify any issues.  And then you’re kind of armed with that knowledge, that if you do identify an issue, your OB can treat you.  You don’t have to go to an RE.  And it really just cuts down that time.  Also, absolutely hated these arbitrary time limits where it was like, you’ve got to try 12 months or have 3 losses to go seek care.  And I was like, what?  Come on.  That’s ridiculous.

Kristin:   And some people if they are delayed, they don’t have that much of a window to conceive, if they’re older.

Dr. Amy:  Yeah.  If we arm them with that knowledge, and it’s like they come in there with, hey, I’ve identified this issue, that speeds up that clock.  You don’t have to do these arbitrary time limits.

Kristin:   I love it.  And so you’re bringing information, then, to your OB.  So tell us a bit more about why it’s important to be self-empowered when managing your own personal healthcare journey, especially with, obviously, pre-conception and conception.

Dr. Amy:  I mean, I just – I think it’s really important to self-advocate for yourself and do what you feel is right.  There is no right or wrong answer.  It’s what right for you and what’s right for your family.  Like, we have a traditional health system that tells you, you have to wait 12 months, and then you have to go to an OB, and then you have to deliver in a hospital.  And like, all these different things.  It’s like, no, you don’t.  If that’s not right for your family, then you don’t have to do that.  Just knowing that there are these resources.  The other thing I like to say is you’re hiring these people to be your care providers.  And if you go in to a medical provider, a doctor’s office, whatever, and you’re not getting the support that you need, you’re getting brushed off, they’re telling you things that you’re like, eh, I don’t know if that’s right for me – fire them.  Go find somebody else.  The best care that you can get is when you have an active conversation between yourself and your medical provider, and it’s a two-way street because you are the expert on you, and that medical provider is an expert in medicine.  And when you put the two minds together, that’s when you see the best treatment outcomes, the fastest, cheapest, best thing for you.  And so if you can’t have that open dialogue and that open conversation with them, you’re going to struggle.  You’re either going to spend too much money or you’ll be going around in circles.  You’re not going to have a good experience.

Kristin:  Agreed.  Trust is everything.  We relay that to our doula clients all the time.  Wonderful advice.  Do you have any other tips for our listeners who are silently struggling with infertility?

Dr. Amy:  Yeah.  One thing I’ve learned is that, like, a mother’s intuition is very, very real and correct a lot of times.  And so if you feel like there’s something wrong, if you feel like they’re missing it, they’re not listening, you should follow that and you should again kind of search for that and think about it because a lot of times, it’s true, right?  People go, oh, well, I don’t know if that’s right.  Maybe I’m just crazy.  It’s like, no, you have those thoughts because there’s a reason.  And so bring them up to your provider.  Think about them.  Try to get solutions based off of that.

Kristin:  I think planning is everything with the appointments being as short as they are.  Just having some talking points written down to make sure you cover everything during your appointment.

Dr. Amy:  Yes, that is a big one, too.  Every time I go into those appointments, I would just get nervous and then they’d say something, and I’m like, okay, and I’d leave.  And I’m like, darn it.  There’s all these things I wanted to ask.  Another really big tip was I had a little post-it note, and I think now we could probably do, like, notes on your phone or something, where as soon as you get a question, you just write it down.  And then when you’re sitting there face to face with your provider and they say, anything else, you go yeah, and you bring out your post-it note or your phone notes, and you go through the questions, and you make sure everything is addressed because you do get – you forget in the moment, and then you don’t ask, or you feel nervous or whatever.  So if you write them down and just read them out, you can get a lot of those answers.

Kristin:  Great tip.   So any other trusted resources to share with our listeners as they’re either struggling with infertility or planning future babies and they’re in that early stage of just talking about wanting to get pregnant?

Dr. Amy:  Yeah, I would say getting involved sooner than later has always been better.  So, for example, the couples that are like, okay, I’m struggling, but I’m just going to wait – they tend to spend more money on fertility treatments than the ones that are more kind of proactive.  I call them the Type Aers.  Like, teachers are huge Type A.  They’re like, all right, I have to get pregnant in this month because then that coincides with summer break.  They’re planning everything out.  So that I suggest.  We at Proov have a lot of information about fertility and resources and testing.  We don’t just do the female side.  We do a male side, as well, so we have a test for looking at modal sperm to make sure he is also functioning correctly because a lot of infertility is the male, as well, and we as females kind of put it all on our shoulders.  We’re the one tracking and using the apps and all this stuff.  And a lot of times, we just forget that it does take a sperm, too.  It’s an egg and a sperm to conceive.  There’s a lot of miseducation out there, as well.  The biggest one is ovulation test.  This is incorrect.  It’s not an ovulation test.  It’s not telling you if you’re ovulating.  It’s telling you, do you have this hormone that spikes before you ovulate, but it’s not actually telling you that you are ovulating and you have a healthy ovulation and you can support implantation.  And so there’s as lot of just misinformation out there that can be very frustrating to women.  Period tracker apps is another one that’s kind of a love-hate relationship where they use calendars, and they don’t know your unique body.  We have couples come in where they’re like, yeah, I’ve been timing intercourse off of my period tracker app for 12 months.  I’m so frustrated it’s not working.  I’m like, well, yeah, because it’s missing your ovulation.  It’s missing the fact that you’re not having intercourse on the right days.  Maybe you’re not even ovulating.  Like, your app doesn’t know your hormones.  It’s impossible to know.  And so I get frustrated with the lack of information or wrong information, but we just – it’s not helpful.  It’s actually harmful sometimes because people think, oh, it’s fine, and then they go straight to IVF because they’ve done everything they can possible do, and they timed intercourse, where it’s just the tools that you were using are just not as accurate as you thought they were.

Kristin:   Yeah.  And their friend may have used IVF with success, so it’s the only option that they know of.  So with this information, I mean, the more options you have, the better.

Dr. Amy:  Yes.

Kristin:   So how do our listeners and doula clients find you?  I know you have a website.  You’re on a lot of different social media channels.  What are the best ways to learn more, to connect, to order?

Dr. Amy:  Yes.  The best place is our website.  There, you can sign up for emails.  We have a bunch of educational content.  There’s a bunch of blogs.  All that stuff is free.  You can do a quiz to see what kind of tests are available that might be right for you.  We have a lot of educational content on Instagram @proovtest.  It’s a great place where there’s scientific tidbits of information.  We really try to educate women and couples to understand these ins and outs of fertility because it can be quite confusing.  We have a really amazing group of users on Facebook.  We have a user and support group on Facebook.  It’s about 10,000 women right now.  You go in, you learn about the products.  You can go in there.  You can talk about the products, what it means.  You can get support.  And then we have – once you graduate, we have a pregnancy group where women who’ve used Proov to get pregnant can talk about their pregnancies in a safe spot.  Those are both on Facebook.  You can also buy it on Amazon, so if you just search Proov Test on Amazon, there’s a variety of different tests and kits that we offer.  We don’t just do fertility testing, but we also have products that support a healthy cycle.  And so we have a couple of supplements that we offer that can really promote healthy hormones and a healthy cycle.  Those are the best places to find us.

Kristin:  Excellent.  Thank you so much, Amy.  It was lovely to chat with you, and I look forward to hearing some success stories from our clients and listeners.

Dr. Amy:  Awesome.  Well, thanks for having me.  I really appreciate it.

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.