TRANSCRIPT EPISODE 25 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #25: all about dr. rankins

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00:00                                This is a personal episode today. I'm telling you all about me and my journey to getting to where I am today.

00:13                                Welcome to the All About Pregnancy and Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not necessity for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:45                                Hello and welcome to another episode of the podcast episode number 25 to be exact. Thank you for spending some time with me today. Now, the podcast recently crossed 10,000 downloads. As a matter of fact, we're a bit closer to 13,000 now, so thank you, thank you for your support! And I thought with that milestone that it would be a nice time to kind of pause and reflect and share with you how I got to be to this point. This is certainly not where I thought I was going to be in my career and in my life. And I figured it'd just be nice to kind of share a little bit of my story. So let's go ahead and hop right in.

01:31                                I debated how far to go back and I decided, you know, if I'm going to tell it I might as well go ahead and tell it. So let's take it all the way back to growing up. I grew up in a very loving household. I had a happy childhood for sure. My parents have been married for 56 years. They still live in the same house where I grew up. You know, no childhood is perfect, but I really have no complaints. My mom was a math teacher. She taught math for 50 years, 35 years in public school and another 15 or so in community college and at the college level. My dad was just a hard working guy. He didn't finish college, but he worked really hard. You know, I learned a lot about my work ethic from him. He worked his way up at UPS into a managerial position and then took an early retirement option from there. I have two sisters. One is 10 years older than me. She unfortunately passed away nine years ago or from a rare type of ovarian cancer and then my other sister is 14 months younger than me and she works in special education and again, like I said, happy childhood, no complaints and it certainly set the foundation for me to get a great start in life.

02:53                                Now fast forwarding a bit, I went to college at Spellman College in North Carolina A&T State University. I majored in mathematics and mechanical engineering and I majored in math because I liked high school calculus, there's no other way to like really put it. I just liked high school calculus and I was like, huh, I really like this. Maybe I'll major in math. That was really the thought process that went on in my head. And then the engineering piece was, because it was a dual degree program, a dual degree engineering program where you did three years for the math degree and an additional two years for the engineering degree. And it just kind of seemed like smart, oh, it's just an extra year and I'll get another degree, an engineering degree. So that makes sense. So that's how I ended up majoring in math and mechanical engineering.

03:43                                Not that I had these big aspirations to be an engineer. It just, I knew I liked science and I liked math, so just kind of fell into place that way. While I was in college, I spent a year studying, an academic year, studying abroad in Kenya. So between the three years I was at Spellman and the two years I was at North Carolina a. And. T I spent to academic year in Kenya where I lived with families traveled around on my way home. I visited Egypt for about a week and then London. So that was quite the, quite the experience and something that I will never quite forget. I also won't forget the meaning and value of having an experience at a historically black college and university and HBCU. There's something so uplifting about being around women, especially Spelman is an all girls school who look like you and who are doing such amazing things.

04:43                                It's certainly help set the foundation for me being the strong and confident woman that I am today. And I will always, always be appreciative of my HBCU experience. Same thing at A&T. It was a little bit different because I started later there, but I also created some lifelong friendships there as well, just being in that really supportive and nurturing environment and having people around you who look like you doing some fantastic things. So I decided to go to medical school shortly after I got back from Kenya. So just right around when I was starting A&T and I always look back and think, you know, or when people ask like what made you decide to go to medical school when you were majoring in math and mechanical engineering? And my story was always that, you know, when I was in Kenya I saw some hospitals, which I did that kind of shocked me in the sense of how things are different there and people were kind of out in hallways and it wasn't the same level of care.

05:50                                So even though I did see care in a foreign country, that was different. Actually, the truth about what really prompted me to go to medical school was just the, I felt pulled to it. I felt called to it. There no other way to put it. I remember looking at myself in a mirror and seeing myself wearing a white coat and the idea of medical school just kind of got planted and grew and grew and it was just, it was just calling me literally. I was just pulled to it. So I decided to apply to medical school. It was a little bit of a tough process because I had to take some extra classes and all that kind of stuff. The MCAT gave me a teensy bit of trouble so I didn't get into as many schools as I would have liked. So I got into two schools, got waitlisted at one, ended up going to Eastern Virginia Medical School where because they gave me some money really and also because it was closer to home.

06:46                                And medical school was a pretty good experience. I don't have a lot of complaints there. The first year was tough. I almost failed the class, a class called histology, which has no bearing or meaning in the practice of my medicine today. It's like looking at stuff under slides, like you take samples of tissue and you'd look at it under slides and see what it looks like. It's kind of like mostly useless I think in terms of what I do unless you do it or are a pathologist. But as an Ob Gyn I very useful anyway, but I guess it is good to kind of understand and have a background of those things. So that's why you do a lot of different things in medical school. So other than that first year of medical school was, was pretty good. Ultimately I graduated in the top 10%, 12% somewhere like that of my class. Graduated Alpha Omega Alpha Honor Medical Society for the most part. Again, it was a good experience. I did have a couple of experiences where I felt like I was being questioned or I don't know what the right word is because of my abilities or my abilities were being questioned. I remember at the induction ceremony for Alpha Omega Alpha, and one of the faculty members like repeating over and over again.

08:08                                You're here? Like you got inducted into AOA, like you, oh my gosh. Like really? Okay. And it was just obvious that he was, you know, surprised to see me there. And then I had another instance where on a rotation for internal medicine and I had an attending physician basically pull me in his office and say that I was lazy and that I needed to shape up and all this kind of stuff, which was a stark contrast to my experience on other rotations. Thankfully the director of the clerkship knew better and kind of stood up for me in that regard. But those experiences were a little bit disorienting in a sense. It's always difficult when you have those experience to experiences to know, is it because this person is a jerk? Is it because they're treating me this way because I'm black? Are they treating me this way because I'm a woman? Is it both? So all of that kind of plays into to those experiences and how they, they, they play out.

09:16                                But thankfully those things didn't, didn't set me back. I also started having hints of some of the work that I do now in terms of being an advocate for and reducing disparities in healthcare and that kind of thing. A friend of mine and I organized a very well received seminar on diversity and this was before diversity was a big thing. This was back in, this would have been 2000 I guess. So we organized this seminar on diversity and that was just kind of the start of me dipping my toe into things to support reducing disparities in medicine.

09:56                                Now it came time to decide, okay, what the heck am I going to do? I'm about to graduate from medical school. Where do you want to pursue as your career? And I debated between general surgery and Ob Gyn. I knew that I wanted to do something with my hands. Like I liked doing procedures and so surgery and Ob Gyn both have procedures, but I much preferred having female patients. As a matter of fact, I had a couple of bad experiences with male patients. Where they were like hitting on me kind of thing. Unfortunately, I think a lot of women in medicine go through that and ultimately undecided. You know what, Ob Gyn is the right field for me. I can help take care of women. This is going to be good. This is going to be good. And I actually thought starting out that I was going to be a gynecologic oncologist, a Gyn oncologist is a Gyn cancer specialist. They take care of women who have ovarian cancer, cervical cancer, uterine cancer, so all the female reproductive organ cancers. And I was 100% convinced that I was going to be a Gyn oncologist.

11:06                                Now gynecologic oncology is a competitive fellowship. So when it came time to apply for residency training, I applied to some of the most competitive programs. And for those of you who don't, maybe don't understand exactly how medicine works. So you go to medical school for four years and then after you leave medical school you do your residency training in whatever field or specialty it is that you're interested in. And the residents in training, residency training programs vary in terms of length. Something like pediatrics is three years. Internal medicine is three years. Ob Gyn is four years general surgery is longer, five or six years. So anyway, I was at the point where I needed to apply for residency programs. So I thought I was going to do this competitive fellowship. So I applied for some big programs and because I had done well in medical school, I got interviews at tons of programs. I probably interviewed it 11 or 12 residency spots including Harvard, University of Pennsylvania, Johns Hopkins. So I was very fortunate in that regard. Now it came down to decide, okay, I've interviewed at all these places. And then what's next is something called the match where you put in the places where you want to go in the order that you want. And the place has put in their match list who they want to be in their programs. And then this big system kind of matches it up. So came time to make my match list. And I quickly eliminated those northern programs cause I realize that I can't do the cold weather. I am not a cold weather kind of girl, so a coal, you know, 2010 degrees, zero degrees anywhere wasn't for me. So I narrowed it down more so to places in the south. And ultimately ended up at Duke, which I absolutely loved.

12:56                                Duke was not my first choice. I had actually chosen someplace that was in a bigger city because at the time I was single and I thought that being in a bigger city would give me a better opportunity to meet someone. Alas, it was meant to be that I would be a Duke and that was really an enjoyable time for me. Don't get me wrong. Residency was tough. There were times when I cried, where I was frustrated. My first year was still under the 120 hour a week work rule where you could work up to 120 hours a week in residency. And that was considered okay. After that it changed to 80 hours a week, which, which definitely made it a little bit better. But overall it was a really good time at Duke. One I was around some really smart and interesting people and I also was around a lot of other African American physicians and there aren't a lot of us. So it was really, again, uplifting to be in this environment. My chairman at the time was the first black chairman of the Department of Ob Gyn at Duke and only like the fourth or fifth chairman in the history of department period. And there were also several other black male and female residents, many of whom are lifelong friends.

14:24                                As a matter of fact, a group of us have like a group text chat that we keep in touch with with each other and we now try and see each other about once a year. So again, it was just a really supportive environment and I also married my husband during residency during my chief year, December of my last year, we got married. Now my husband and I, Falcon and I had actually dated when I was in medical school, but he broke up with me, which of course I will forever and always hold in my back pocket is something that I can pull out. But we got back together in my third year of residency, like in March, April, we started emailing each other and then dating and got engaged in July, and married in December. So all in the same year, March reconnected and then December of that year got married and we're going on almost 14 years of marriage now. So that worked out very well.

15:27                                Now I decided not to do Gyn oncology, just came to the realization that it wasn't quite for me, but I definitely felt like I wanted to stay in academic medicine. I really thought for sure that I was going to spend my career being in an academic environment. I liked being in academics where you're on the forefront of things happening and things changing, research, that kind of thing. So I thought for sure I was going to be an academics. So in thinking about ways to stay in academics, I decided, you know what, I like research, let me do this research fellowship. I'm going to do a two year research fellowship and then have a career combining patient care and research. So I did this two year research fellowship just down the street at UNC Chapel Hill and that was a little bit of a tough time for me. It was great in that it was an incredibly supportive faculty and students who I was in the program with, but I did become acutely aware for the first time that I was the only black person in the department and that can feel isolating. You know, like I said, in college, I went to a HBCU in med school. I had been around other black students and residency I was in this environment with other black physicians and at UNC there, there weren't any. It was just me. I definitely felt a little bit of imposter syndrome.

16:57                                I felt a little bit of a lack of confidence and worry in my skills. When you're the only black person in an environment, you feel this innate pressure that you almost represent your whole race. So I was kind of dealing with all of that in the process. Not that anyone was mean to me or anything like that. As a matter of fact, everyone was supportive, but it was just kind of some of my own internal dialogue going on.

17:25                                Now also during that time I got pregnant with baby number one and ultimately had a preterm delivery. You can go back to episode five of the podcast to hear my birth story in, in detail, but the short story is I went into labor at 32 weeks delivered by c section. She also had an intestinal malformation, a rare intestinal malformation that happens in about one in, I don't know, five, 7,000 pregnancies, something called Duodenal Atresia. And she had to have surgery two days after she was born. She spent a month in the Nicu. But again, you can go back to episode five of the podcast to hear that in more detail. She's perfectly fine and healthy now. And again, I had a lot of support when I went through that difficult time. I was also getting a master of public health in the process of while I was doing the fellowship training. And one of my fellow students, Millie, she's a gastroenterologist and we had a project that was due and she was like, so I'm going to do most of the work on the project and that's just how it's going to be. So I will never forget Millie for that. Thank you. And then a faculty member actually drove out to my house to check on me and see how I was doing after I gave birth.

18:41                                So, tough time, but it was, I was grateful to be in a supportive environment and not have to worry and be able to go see my daughter in the Nicu and all of that kind of stuff. And she was born towards the end of my fellowship. So fellowship was coming towards an to an end and I decided that I wanted to go back to my old medical school and be on the faculty there. I enjoyed the time, like I said, in medical school and I wanted to be back home. So I applied or wrote and asked for a job there. Got It. Also got some funding for research. So I was really excited to go back home and it was a great environment. Again, it was good to be back near family and the faculty. The chairman was very supportive. However, I did struggle with research. And research requires that you kind of narrow down and pick a single thing and become an expert in that and I was just having a really hard time doing that and I just couldn't quite get started with research, couldn't quite get anything going.

19:54                                Now looking back, it turns out because research wasn't the right place for me and my talents, but it took me a while to see that. It would be several more years, in fact, before I stepped away from research and kinda came to this path I am now on, to start to see some of the seeds of how I was really drawn to pregnancy. I thought about doing research on centering pregnancy, which is group prenatal care. It's a model of pregnancy where there are group visits for women who are due around about the same time. It's a great model of care. Women enjoy it and the outcomes are great, especially for low income women. So I kind of thought about studying that or starting a program and I also found that I really enjoyed being on labor and delivery with the residents and spending my day on labor and delivery and supervising and teaching them there.

20:45                                Now I did find office practice challenging. I always felt like I never had enough time to actually spend with patients, hence I was chronically behind. That will actually come into play a little bit later when I talk about how I started integrative health coaching. And then also while I was there on my first job, baby number two was born and no issues with that pregnancy. She was born totally full term. You can hear her birth story also on episode number five of the podcast. I had some issues around having a repeat c section and the choices that I made about that, but again, episode five it's where you can learn all about that.

21:21                                So I decided or I felt like rather maybe I needed to be at a bigger place with more resources in order to help me do research. So I moved to another job and it was a nice place to be in terms of support and the people being nice. I was back in an environment though where I was the only black person and I felt that sort of pressure again. However, this time I was a bit better equipped to deal with. I felt more confident. I'd been out a while. It wasn't the first time I'd had to deal with that sort of situation. So even though I was the only one, it didn't feel like as much of a weight this time again. However, though I struggled with research. I couldn't quite get research off the ground, couldn't get things going. It just, it felt like a chore and something that I had to do and not something that was really enjoyable. So things came to a head when, I call it the blowup or the revelation in my life, where I knew that I was going to have to go 100% clinical. And what I mean by that is up until that time I'd had some what's called protected time to do research. So I had time that was paid for, for me to work on my research. And the way that works is that you use that time to get grants and then once you get your grants that grant money will cover the time for you to do your research. But I hadn't gotten grants, I hadn't been doing the research, so I knew that I was going to have to be 100% clinical in order to support my salary. So went into this meeting with the department chair and of course he told me, you know, because you haven't been doing the research, which I was fine with, but then he said this, which literally turned me upside down, rocked my world, all of this and that. And it was that it was, he said this, it was recommended that you be fired. And that just literally stopped me in my tracks.

23:24                                And the reason that was recommended that I would be fired was because I hadn't done the research. Now most of the time in environments, at least to my knowledge, if you don't do research, then you can be clinical. It's not necessarily the the end of the world. And it was just, it was just a big shock to hear that the conversation was there, that I could be fired and there wasn't a concern about me being in clinical. I'm a good clinician, a great clinician, I would dare to say, and I had patients who loved me, all that kind of stuff. So I certainly still could be a value to the department in a clinical capacity. So for them to say that it was recommended I be fired was really hard. And to add insult to injury, he said it came from one of the administrative people within the department in medical school who was a black woman, the only black woman up, you know that higher up in that position and that made it even harder. This came from out of nowhere. It just felt like I was in some sort of topsy turvy world. I was sitting in his office like boohooing and just really frustrated, sad, depressed, all of the above.

24:36                                So I left that meeting and very quickly I decided that I had to go, you know, you ain't gone fire me because I'm gone quit, kind of. My attitude flipped real quick and I just felt like I couldn't stay in this, this place that clearly didn't want me to be there. That was a really tough time for me, like a really tough time. I remember just not knowing at all what I was going to do. The girls were settled in school, Falcon was in school. We couldn't move, you know, we had moved already a couple of times and it was just starting to affect everything I was doing.

25:18                                I remember one morning standing at the coffee maker and I have forgotten to put the filter in, and coffee was just running all over the place and I was just standing there because I was frustrated and depressed and thinking about what I was going to do. So as God would have it, universe, whatever you want to call it. I went to my annual Ob Gyn appointment and of course I had been praying about this. I'm a praying person, I'm not as terribly religious person, but I am a spiritual person. So I've been praying, thinking all those kinds of things. And I went to my annual ob Gyn appointment and she asked me how I was doing and she could tell that I was not well, and so I spit out the whole story and she said, you know what, there's an opening at the hospital for something called a hospitalist. There's a hospitalist position open. And I was like, hmm, okay.

26:17                                So long story short, I looked into the position as a hospitalist. This was totally different than what I thought I was going to be. Hospitalists do shift work basically. So as a hospitalist, I come on my shift, I take care of whoever's there and I leave. And so I was going to be doing shift work and I was going to be stepping outside of academics, I was going to be leaving academics for a community environment. And remember I said, you know, had been in these big academic places and I thought for sure I was going to spend my career in academics. So this was really a big leap and change for me, but I had to do something cause I knew I couldn't stay where I was and I kind of sat and said, you know which options seem worse? Did it seem worse to stay in a place where I felt like I wasn't wanted and I wasn't happy or did it seem worse to try this new thing? Not knowing exactly how it was going to turn out. And it felt much, much worse to stay in a place where I knew I wasn't happy. So I took the leap and became an ob hospitalist and I absolutely positively love, love, love being a hospitalist.

27:25                                And I think that's for several reasons. One, it was the first time that I was really the one hands on doing the deliveries. Before that I had been in academics where there were always residents, which are physicians who are learning how to be an Ob Gyn. There were always residents around, so I was mostly kind of supervising deliveries, but now as a hospitalist it was me and I was right there and part of that moment. And that felt very gratifying and satisfying for me. And it was also my first exposure to see how things are done in a community hospital. There can be a bit of a difference between what happens in academics and in the community. Academics very much kind of plays by the book and does things according to the evidence base and guidelines as Kinda the foundation for academics. But in truth, most babies are born outside of an academic environment. They're born in community hospitals. And I started to see the difference of how things were practiced, how doctors were running back and forth from their office to deliver babies in the middle of seeing patients. That kind of thing didn't happen in academics or at least not in academic environments that I was in.

28:38                                I started seeing things like depending on the doctor, some doctors have been really high episiotomy rates. Some doctors were not supporting trial of labor after Cesarean or VBAC. Some doctors were automatically doing c-sections for twins because it was more convenient and it didn't take as long. So I just kind of started to have my eyes opened to how the experience can be really different depending on the hospital where you go and depending on the doctor who you have during your pregnancy. Now detour a little bit. Shortly after I became a hospitalist, I went and got training as an integrative health coach and that sparked from my desire. Remember I said that I found office practice frustrating that I felt like I didn't have enough time to spend with patients. In many ways I felt like a bit of a pap smear factory. And I felt like I wasn't really helping women to make changes in their lives and I came across this integrative health coach training program.

29:43                                I had a former faculty member who was a Ob Gyn who left ob Gyn or in order to practice integrative medicine. So I called her up. I talked about it was she was doing and becoming an integrative health coach felt like a way for me to both, a away from me to add, like actually helping women make change in their lives in a lasting way and more than you can do in just like an annual appointment. So I went back and did my integrative health coach training at Duke and they have a integrative medicine program. Outstanding training, excellent training. So glad I did it. Very much so a holistic approach to health as the foundation. So not just your physical health, but also how other things affect your health, like your nutrition, how your relationships affect your health, how your actual physical environment affects your health, how the connection between your mind and your body affects your health, your spirituality or religion, how does that influence your health? How does getting rest and being able to rejuvenate yourself affect your health?

30:50                                So I learned this truly holistic approach to health and how you use that to live a healthy life and a healthy lifestyle. And so I started out, I did the training and I started out wanting to do one to one coaching virtually. So me coach one person virtually via the phone or online. Now for a number of reasons that didn't quite work out. And a lot of it had to do with things like marketing and helping people understand the value in health coaching because this is typically paid for out of pocket and not covered by insurance. And I'm not naturally good at marketing. So there was a little bit of challenges for me in difficulties with that and kind of getting one to one coaching off the ground.

31:37                                And I was on a podcast talking about health coaching and the host of the podcast asked me about delivering babies. And then afterwards she said, you know what, when you were talking about delivering babies, you lit up. Oh my gosh, you can tell that you are so passionate about what you do. And I stopped for a second and I said, I'm passionate about delivering babies. I really do enjoy it and it is really important for me to help women have a great experience giving birth. So I stopped for a second. I sat back and I said, hmm, how can I combine the best of this health coaching training and what I've learned from that and this great holistic approach to health and combine it with what I do and my day to day job in delivering babies, and I came up with this idea for an online childbirth education class and hence The Birth Preparation Course was born.

32:40                                The Birth Preparation Course is my online childbirth education class that leaves women knowledgeable, prepared, confident and empowered going into their birth. Even though I could talk about this all day every day because I'm really proud of the work I put into it, I did everything for this course. It took me almost a year to make. I surveyed pregnant women before I did the course to make sure I included things that were important to them. I did all the videos and did all the slides. I did all the editing, I'll put it all together. I'm super proud of it and it's a great resource if you're looking for a childbirth education. And again, I combined that holistic approach with what I know from delivering babies. For instance, the very first lesson of the course is mindset because those types of things are really important.

33:30                                So anyway, I created this great online childbirth education class, ran with that. I initially started a blog afterwards because I also wanted a another way to provide ongoing information about pregnancy. The course is more so about birth, but I wanted a way to provide additional information. So I started a blog, but quickly within a few months I changed to a podcast and that's where I am today. I created the All About Pregnancy and Birth podcast, which I absolutely love, and then also added the free Webinar on how to make your birth plan, which is actually a tiny piece of what's in the course. So that free Webinar on how to make your your birth plan. This has been like the best decision of my life ever. I am at a place now where I absolutely positively love, love, love what I do. I am so very clear that my purpose is service. My purpose is to be of service, not just to pregnant women, which I am, I'm in service of pregnant women both through my day to day work of delivering babies are helping deliver babies because women really do all the work but helping deliver babies. I'm of service through this podcast through the cores, um, through the, the information that I put out when social media being of service to pregnant women, but I'm also of service in other ways. I'm of service to the private physicians whose patients that I take care of. I help them to be able to step away from the hospital and be well rested and rejuvenate and know that their patients are well taken care of. So I just really, really love what I do and I'm so happy and grateful to be in the position that I am today. Realizing the privilege that it is, the honor that it is. So thank you. Thank you. Thank you.

35:24                                Now. I do have to be honest, I was not always this type of provider or doctor where I understood how much that women should be at the center of their birth experience. I have very clear understanding of that now, but I wasn't always that way. As a matter of fact, I remember a time when I would roll my eyes at birth plans, with the running joke, you know, it's an express ticket to the OR anytime somebody has a birth plan. And kind of thinking about why did I feel that way? Where did those thoughts come up? And really I think it just comes back to Ob Gyn and the specialty and how it's founded and the way things are taught and perpetuated. Ob Gyn is a specialty that is truly founded on patriarchy and paternalism. Hands down when you go all the way back to J. Marion Sims, who's considered the father of modern gynecology. He invented the speculum, he has like statues of them in certain places in America. He did horrific experiments on slaves in order to, you know, in the name of science and medicine, denying them pain medicine saying they didn't experience pain.

36:47                                If you look it up, you can read more about all of the details, but even closer to today, back in the forties fifties where women were strapped down during labor, they were tied to beds. They were given cocktails of medications without any real consent to make them not be present during that experience. And even today we don't have that lingering sense of strapping women down, but we do still certainly have this, this culture that we are in control of birth and not the woman being at the center of her birth. Even using terms like allow in the hospital, we don't allow you to get up, we don't allow you to eat is if somehow we have control over what you do in your body's like that control the sort of assumed.

37:37                                So that's kind of the system that I was a part of and have been a part of, I'm embarrassed to say that I've participated in in some ways, but as a friend of mine needs to say at one of the friends that I was talking about earlier who's part of that Duke female Ob Gyn Group. Our field needs a mass deprogramming process for sure to get rid of and back away from that patriarchy and paternalism. Now when I thought about like what was the defining moment for me, like was there something that caused me to really change and I can't really say that there's a specific defining moment that made me realize how what we were doing was wrong. I think it just came with over time as I worked on myself as a person, as I did things like meditation. As I read personal development books, worked on spirituality, I just came to look at things in my life in a little bit more critical way and I just have evolved over time in a good way to an understanding that we can and need to do better for women during pregnancy and birth.

38:52                                One thing I do think that helps is that I do have a strong natural, innate sense of empathy. I remember watching Super Soul Sunday one Sunday with Tara Westover, she's the author of the book Educated, New York Times Bestseller. I haven't read it yet. She was talking about how it was hard to put yourself in someone else's shoes. And I have to say that that is not hard for me. That's actually something that comes fairly easy for me is that I can for a minute and look at another person's perspective. So I think that that has played a big role in helping me understand and appreciate women's experiences during pregnancy and birth. Also, of course my own experience having a preterm birth that certainly had something to do with it. And again, just like I said, over time growing and working on myself as a person and being able to just expand and grow and evolve in a good way.

39:49                                So what is next for me? Where am I going now that I have the podcast going and the course going well, I'm definitely interested in figuring out how I can help with that deprogramming process. Like I said, that needs to happen from within our specialty and being a physician champion for making changes in our specialty, how we need to put women at the center of their birth experience. I'm also very interested in issues of consent, but I'm talking about consent for some of those smaller, more common things that actually probably have a bigger impact on women's experience during birth. I'm talking about consent for something like cervical exams. I have countless times gone into a room, very pleasant, very friendly. Hey, I'm Dr Rankins. I'm just here to check your cervix. We can see what's going on with your progress. Go ahead and put your ankles together, let your legs flop out. Try to relax. You're going to feel my two fingers and never and once in that conversation did I just stop and say is it okay if I check you? Okay, you see what I'm saying? You see that difference?

41:05                                That little difference is important and it helps to create a better relationship and help put women at ease and of course we should be asking before we stick our fingers in anybody's vagina, but I can tell you that that sort of stop and ask before we do this thing is not a normal part of Ob Gyn and again it goes back to that patriarchy and paternalism. Of course consent for things like breaking water, stripping membranes, that doesn't always happen and that's something that should absolutely happen. I know that culture change is hard, it's also complicated and we need to do some things from within our specialty to make it easier for physicians to put women at the center of their birth.

41:50                                We need to work on some things like physicians having better work life balance where they aren't being pushed to see more patients, less time, where they aren't being asked to add like 15 things in the electronic medical record, where they aren't asked to work these super long hours and all of these kinds of things that can lead to what's called compassion fatigue and just not being able to have anything to give of themselves because they're so exhausted from the day to day things of work. So those are areas that I'm interested in from within our specialty and trying to figure out what I can do to help make change and do that deprogramming that we so desperately need.

42:32                                And then some other new things that I'm super excited to share with you that I have in the works as that I'm going to start offering a service where I will personally review your birth plan and then we'll have a 30 minute Skype call or phone call about it. So I'm super excited to start offering that service and that's going to be a limited availability. So if it's something you're interested in and you want to know about it right away, then hop on my email list because that'd be the first place that I announce where it happens. And if you want to get on my email list, you can go to www.ncrcoaching.com/email. The other service that I'm going to offer is I'm going to start offering one page downloadable pdf summaries of each episode. This will be way more than what's in the show notes and then of course not quite so much as in the 20 something page transcripts that are available. So this'll just be a one page summary of all the key points in the episode as well as links to any pertinent resources and now add comments about questions you can ask your doctor about this particular topic if you need to.

43:41                                I think these will be great if you're a person who likes to print out stuff and have it there as a resource to go back to. And it's also I think great for the Doulas, and childbirth educators for you to have some additional information to have in your tool bag to have that available for you. So again, these one page, downloadable pdf summaries of the episodes with all the pertinent information links and additional questions to ask. So I will be offering that service again soon, and hop on my email list to be notified when those are available.

44:11                                Okay, so that is it for this episode. Thank you for hanging in there with me as I share my story and always feels a little bit uncomfortable talking about myself in so much detail. So thank you for the support and the kind warm and welcoming place to do so. Come join me in the All About Pregnancy and Birth podcast community on Facebook to continue the conversation. Let me know what you think. Were you surprised about anything? What you found interesting? I always, always love hearing from you or DM me on Instagram, just give me a shout out and let me know. Now, of course, if you are not subscribed to the podcast, then please subscribe to the podcast in iTunes or wherever you listen to podcasts. And if you feel so inclined then go ahead and leave that honest review, especially in iTunes. It helps other women find the show and I may give you a shout out on a future episode.

45:05                                Now next week on the podcast, it's a birth story episode and Jordan is going to share her story of having a vaginal delivery. She was very happy with her experience, but there are a couple of surprising things that I was a little bit surprised about myself. Her story's not exactly typical, I would say, so come on back next week to hear that, and until then I wish you a healthy and happy pregnancy and birth.

45:32                                Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan, as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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