TRANSCRIPT EPISODE 44 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #44:How Prenatal Chiropractic Can Ease Common Pregnancy Pain with Dr. Elliot Berlin

Transcript

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(00:00)

On today's episode of the podcast, I am interviewing Prenatal Chiropractor, Dr. Elliot Berlin.

(00:12)

Welcome to the All About Pregnancy & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, a 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 a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

(00:44)

Hello, hello. Welcome to another episode of the podcast. This is episode number 44 and I am so glad that you are here with me today. So today's episode is a really good one and well, okay, they're all really good, but I particularly enjoyed this interview. It's with prenatal chiropractor Elliot Berlin. Dr. Elliot Berlin is an award winning prenatal chiropractor, a childbirth educator and also a labor doula. Yes, a male who's a labor doula. His informed pregnancy project utilizes multiple forms of media, including a weekly podcast called Informed Pregnancy. He also does documentary films and a YouTube series to deliver unbiased information about pregnancy and childbirth so that new and expectant parents can be empowered to make informed choices regarding their pregnancy and parenting journey. His work is great. Of course, I'll link it all up in the show notes and it is also quite popular. He has over 10,000 followers on Instagram and over 40,000 followers on Facebook.

(01:51)

Now, I will be honest, this episode is as much for me as it is for y'all. I really didn't know anything about prenatal chiropractic care. I had heard of it here and there. Honestly, I really didn't know much about chiropractic care in general, so I learned a ton in this episode and I know that you are going to learn a lot too. Now, before we get into today's episode, quick question for you. Are you thinking about childbirth education? If not, then you definitely should be! The best way to not feel afraid about giving birth is good comprehensive childbirth education. You're not going to get that information in your doctor's appointments and you really need a good foundation of childbirth education in a maternity system that's not necessarily always designed to support you. Now I know that there are different options for childbirth education. Let me tell you about the option I created called The Birth Preparation Course.

(02:52)

It's my signature online childbirth education program that will leave you knowledgeable, prepared, confident, and empowered going into your birth. It helps you get in the right mindset, understand labor, and know how to push a baby out. Be prepared for those possible things that may come up and also it gets you off to a good start as a new mom. I also cover some not so typical things that you see in childbirth education, like how to safely approach placenta encapsulation, the information about circumcision. So you can check out all the details of the course at www.ncrcoaching.com/enroll. And if you want to kind of take a test run and get some great free information and also get a discount for the course, check out my free online class on how to make a birth plan that works to help you have the birth that you want. Great information in there and you can check that out at www.ncrcoaching.com/register.

(03:50)

Okay, so without further ado, let's get into today's episode with Dr. Elliot Berlin.

(03:56)

Nicole: Thanks so much Elliot for agreeing to come on my podcast. I am so excited to have you here today.

(04:02)

Elliot: Thanks Nicole. Thanks for having me. I'm excited to be here.

(04:05)

Nicole: Yeah. So tell us a little bit about yourself and your work and maybe your family. You have a really interesting story.

(04:12)

Elliot: Oh, thank you. My wife and I are both from New York and when I was little, maybe seven or eight years old, I happened to walk by a CPR class, people training to do CPR on a mannequin, on Annie the mannequin. And when my parents explained to me what was going on, I was fascinated by the fact that you could use, you know, your own body to help somebody else, to bring them back to life and to breathe for them and kind of act as their heart for a little while. It just blew my mind. And so a couple of years later I took my own CPR class and I was equally excited and then it just kept growing from there. I took first aid and responding to emergencies, lifeguard training. By the time I was in my late teens, I was teaching for the Red Cross and soon as I could, I became an EMT at 17 and 18.

(05:03)

Elliot: I started working in ambulances in emergency rooms. And I just loved the element of healthcare where you can use your own body to help somebody else heal, especially during urgent or emergent situations. And I always knew that I was going to pursue medicine. It was a little bit later when I was in college and my father suddenly died. He was young, 48. And I took a quick step back from allopathic medicine, you know, drugs and surgery and just sort of, I still wanted to do health care, but I felt like I wanted it to be on the side of it that was more holistic, you know, working with the body and prevention. And so after I graduated college, I took a year to just sort of reflect and look at all the options and I fell in love with a combination of chiropractic and massage together.

(05:57)

Elliot: And my wife, we got married pretty young, 23 years ago. She fell in love with psychology and she's a person who's very naturally easy to talk to. Our friends always came to her to talk and felt better afterwards and she found her calling in psychology. So we moved to Georgia and you know, I did grad school and chiropractic and massage and she did psychology. And towards the end of it we thought, wow, this is a great time to have a kid, we're done with grad school. And so we followed the instructions, but, no baby came out and that turned into a three year really intense struggle to try to get pregnant. And by the end of it, we weren't pregnant. The doctors didn't think that we could ever get pregnant and we were just broken. We were, our relationship was struggling, our health was struggling, mental and physical.

(06:46)

Elliot: We were financially broke. And before we could pursue other avenues to parenthood, we just needed to take some time to heal. And that's, that's when we ourselves started to dip into the more granola can have things like, you know, yoga and meditation and Chinese medicine. We spent a lot of time working on our relationship in Nebraska. We were living in Nebraska at the time for her internship and they just had miles and miles and miles of bike trails. And that was just the two of us. So we just went bike riding for hours at a time. And about 10 months later we were moving to Los Angeles and we were ready. We felt a lot better and we were ready to kind of tackle however our pathway was meant to be to become parents and start talking about the alternatives. And we didn't get very far cause we found out we were pregnant.

(07:36)

Nicole: Oh wow. Wow. It is so amazing how when you kind of let go and relax and kind of connect with those elements like you talked about, like getting back to that more holistic approach, how pregnancy can come quicker.

(07:49)

Elliot: Yeah. It was almost as if our bodies were saying you're not ready yet. You're not in a good place for this. Just hang in there and you'll get there. And then boom. You know, and then we couldn't shut it off every two years another baby came out and now we have four kids.

(08:03)

Nicole: Okay. Wow. Isn't that wonderful? That's an awesome story. So you and your wife have four children now and then you are a prenatal chiropractor specifically and also a doula. So tell us a little bit about that. Cause we don't hear a lot about males being doulas.

(08:19)

Elliot: There's not too many of us. We're a very small group on Facebook. What happened was when we settled into Los Angeles and opened our practice, we just had a mind body wellness practice, but with a little bit of an eye on boosting natural fertility. And by the end of the first year we had nine pregnancies and it's just snowballed from there helping more and more people achieve pregnancy and then they would want to continue care. And so we found ourselves knee deep in prenatal care, which is a wonderful place to be. And also what happens during pregnancy sometimes, chiropractors and therapists who are not familiar with it, aren't comfortable working on pregnant people. So they refer their clients to us. And over time, you know, other healthcare professionals they do as midwives and obstetricians start to see the benefits and refer their clients to us.

(09:10)

Elliot: So we don't exclusively work on pregnancy and postpartum, but it's about 90% of the practice. Doula care came later because as I would start to work with people during pregnancy and they would have different aches and pains and discomforts, they would eventually go off to labor and delivery and sometimes not have the story that they were hoping for, especially in the more natural minded people would come in and do everything during pregnancy to prepare for an amazing natural unmedicated uninterrupted birth and ended up having sometimes very different experiences and when they would come back for postnatal care and talk about it, it kind of fascinated me like how come so many people are aiming for that and end up going in different directions and sometimes end up feeling really let down about it. And it was when I started to research those things and write about them and then blog about them and then now podcast about them, make documentaries about them that I really ended up knee deep in labor and delivery.

(10:12)

Elliot: And it was just one day I got called, I was, it was a Sunday. I remember pretty clearly, we're in a pet store trying very hard not to buy a pet for the kids. And I got a call from my midwife saying, you know how sometimes you can use chiropractic and massage to relax the body and a baby will move, let's say from breach to not breach? Could you do the same thing for a posterior baby, a baby who's not rotated quite right in a way that's making it hard for the baby to come down? And I said, I don't know. I would do exactly the same thing that I do, which is just to try to help the body help itself. And she said, well, can you come right now? And I was like, where are you? And they were at a home birth that had been stalled for nine hours at nine centimeters.

(10:54)

Elliot: And it was because the baby wasn't in a good rotation. And I was like, sure, I could definitely come now and not buy this Guinea pig. So I ran over there and spent a couple of hours working with this mom who I'd never met, which was kind of interesting too. And things got looser and looser and looser. And after about two hours, the baby just clunked into a better position. 40 minutes later the baby was out at home. Healthy as can be. That's my entry into going to births. You know, after that, that story kind of broke. More and more people would call and say, hey, we've got a back spasm or a baby that's not dropping or not moving. Well can you see if you can come use your body work to help out? And eventually, I remember the first time someone called and said, you know, my friend Rachel said, you came and did massage and body work with her during labor and it was amazing. I want you to come do massage and body work with me and in labor. And I said, well, her baby was stuck. And she said, why do I have to wait for to go wrong? And I thought, I have no good answer for that. And so I remember going to the first birth where everything was right and it was so magical and incredible and it just kind of snowballed from there.

(12:05)

Nicole: Got it, got it. So do you work with folks who have hospital births as well?

(12:09)

Elliot: Sure. We do hospital birth, home birth, birthing center birth, pretty much everything wherever somebody, I think people need to give birth where they feel safe and everybody feels safe someplace else. And pretty much, at least where I live, all the birth settings are pretty doula friendly. They allow their clients to bring doulas in. And so it's interesting, I think that when I see somebody who's not comfortable giving birth at a hospital, giving birth at a hospital, that doesn't look great. And the same for somebody who's not comfortable giving birth out of the hospital, you know, when they're giving birth out of the hospital and they don't feel all that safe, it doesn't look great either. So I go, I go where they feel most comfortable.

(12:49)

Nicole: Which is what we should do is folks who work in the, you know, support women where they need to be supported. And, and where they feel they feel best and trying to help them get their wishes during their pregnancy. I've focused on hospital birth because that's what I know. But I know home birth can be a safe option for lots of women. So, yeah. So what exactly, and you've talked about it a little bit, but what exactly does a prenatal chiropractor do? So what would it be like seeing a prenatal chiropractor during pregnancy?

(13:21)

Elliot: So I mean, I would back up and talk about what chiropractors do because there's, I think some confusion about that.

(13:30)

Nicole: Especially like the difference between like a chiropractor and a physical therapist and all that. So, sure. It please, please tell us about that.

(13:37)

Elliot: Oh yeah, that's a great question. Chiropractors, for the most part, there's a lot of diversity in the different tools that chiropractors bring into their own practice, but for the most part were spinal experts. And so we look at the function of the vertebra and how they relate to each other, how well they move in relation to one another. They should all be freely movable in relation to the vertebra, above and below them. Same for the pelvic bones and really any place where two bones come together to form a joint and where the joints not moving that well. We use chiropractic adjustments to restore motion between those two bones around the joint and especially in the spine and pelvis where those bones are supposed to be protecting nerve roots and the spinal cord and brain. The central nervous system, you know, if there's compression because a vertebra is not moving well or there's a buildup of inflammation or there's a muscle spasm pulling on something that shouldn't be pulled on, then it can affect the way the nervous system acts and the nervous system controls every cell and function in the body.

(14:36)

Elliot: So chiropractors, really what we have in common is that we chase those restricted vertebra or joints in the body and restore them. And there's a lot of different ways to find them and to release them. So if you go to a different chiropractors who might have different experiences and there's other modalities we can bring in, it's physiological therapeutics. Things like massage and heat and ultrasound, electric stimulation, physical therapies, not that different. There's, I think there's more similarities in what we do than there are differences. There are other professionals that also work oftentimes on musculoskeletal dysfunction pain. I would say the differences are in the training and the philosophies and some of the techniques. And within physical therapy there's also a lot of variations and going to different physical therapists who might have different experiences, but generally I find that chiropractors are more focused on manipulation of bones and joints, whereas physical therapists are more focused on exercise therapy.

(15:33)

Elliot: In our office we have both. We have chiropractors and physical therapists and the chiropractors really start by working on restrictions, getting rid of restrictions in the joints and how the bones move, getting rid of tightness that's built up in muscles and tendons, and then the physical therapist will take that same patient and create long-term stability by doing a thorough assessment of where there's muscles that are too weak and not strong enough versus muscles that are too tight and stiff and pulling too hard and use exercise therapy to release the tightness and strengthen the weakness and give them a long-term balance and stability.

(16:07)

Nicole: Okay, so you, that's interesting. I didn't realize that physical therapists and chiropractors can often work together.

(16:13)

Elliot: Absolutely. And when it comes to pregnancy, so it's the same things that we're doing. We don't really do anything to the baby, but we're taking that pregnant body now that with the added strain and the changes in the hormonal effects on how the musculoskeletal system works and the changes in center of gravity and how somebody's sleeping, the sleep positions change when all those changes take place. They oftentimes highlight issues that have been there, but issues that the body can sort of adapt to and compensate for. And so they don't really cause pain and discomfort. But now all of a sudden with all these strains and changes taking place, things that have been there become much more notable, they become highlighted. And so we see a lot of lower back pain and sciatic pain, hip pain, things that may be, were already a little dysfunctional before pregnancy, but now that you're forced to sleep on your side or this growing baby pulling on the lower back, but maybe become more notable and we use the same techniques, the same musculoskeletal release techniques that restore function, alleviate restriction, you know, and then all of a sudden they feel a lot better.

(17:20)

Elliot: So if it's something significant that predated the pregnancy, then prenatal chiropractic may not be magically healing for them. It may not happen very quickly, but things that just come up like sleeping on your side all the time. All of a sudden that pure formless muscle in the upper buttock area just gets super tight and squeezes a sciatic nerve. Once we released that muscle and adjust the joint, it magically goes away. So there's a lot of things during pregnancy that come up. People are always talking how uncomfortable pregnancy can be, but I think most of our patients, certainly when they come in the middle of the pregnancy through the end, generally feel pretty comfortable and enjoy their pregnancy.

(18:00)

Nicole: Well that's good. I think that's a really important point because I think especially as obstetricians, we tend to say like pregnancy is just uncomfortable. Just kind of deal with it. And even though it's normal that you may have these discomforts because of the changes that happen in your body, it doesn't have to be painful. Like there are things that you can do about it. You don't have to accept it as being like, you don't have to be uncomfortable the whole time.

(18:26)

Elliot: I agree. I generally would say that they're very common discomforts of pregnancy.

(18:31)

Nicole: Thank you. Yes, that's what I was looking for. They're common, but they don't have to be like all the time there. Yeah.

(18:36)

Elliot: Yeah. It doesn't mean it's normal. And so oftentimes we can take a look and it's not always the lower back. Sometimes it's the ribs getting compressed and have intercostal pains. Sometimes it's like in the first trimester even we'll see because the relaxin and starts to kick in and and the stability of the joints becomes a little bit compromised. Or if there is nausea and vomiting, you can become dehydrated. And that sometimes causes migraines. The way you're sleeping can compress the nerves that come down from your neck into your hands and all of a sudden you start to feel like you have carpal tunnel syndrome. There are a lot of things that come up and most of them are treatable to the extent where we can get you a lot more comfortable.

(19:13)

Nicole: Yeah, that's awesome. Now, so you didn't go through necessarily any additional specific training to focus on pregnant women? You took the techniques that you already knew and apply them to pregnancy.

(19:25)

Elliot: Right, so any chiropractor who's certified and licensed can, you know, has some training in prenatal care and can work on pregnant women. There are postgraduate classes and certifications that you can get in prenatal care and pediatric care, and I've done some of those workshops as well. Now I teach some of those workshops, both in massage and in chiropractic. So I think that once somebody decides they want to spend time or they have interest in working with this population, it's pretty helpful to go get some additional training because the training in both prenatal chiropractic school, at least my experience in prenatal chiropractic school and prenatal massage training, is minimal. A lot of it has to do with what you shouldn't do. Don't do this, don't do that. And it's not really so focused on what you can do. And so I think that without the extra training, practitioners are oftentimes using their techniques on pregnant people.

(20:23)

Elliot: But once you have additional training and you're using those techniques for pregnancy, and so for example, you know, improving the musculoskeletal function of the low back hips and pelvis, in addition to helping someone feel better also creates a better, more functional environment for the baby. And so towards the end of a pregnancy when a baby's trying to move around and settle into a good position or during labor and delivery, if a baby's trying to move through the pelvis and the pelvis is stiff and tight and rigid, it makes sense that that could be a more difficult journey than if the pelvis was loose, open and accommodating. And that's what the body's trying to do at the end of pregnancy with those big or modal changes, trying to make the musculoskeletal system more loose, relaxed, open and accommodating. But sometimes just life, the things that we do with our bodies make the environment really stiff, rigid and tight. And so towards the end of pregnancy we really keep an eye on making sure that those structures, the lower back and the pelvic bones and all the muscles and tendons and ligaments that interact in that area are as functional as they can be to kind of set the stage for a smoother time for the baby to position well before birth and to move through her body during labor and delivery.

(21:39)

Nicole: Got it. So as far as some of the benefits, definitely you're saying that during pregnancy you can help relieve some of those common discomforts that women experience and then also help prepare their body, their pelvis to have an easier delivery?

(21:58)

Elliot: Yeah, I mean better functions should turn into a better birth. And then also after people come to see us, they generally report better sleep. So some of the things that make it hard to sleep at the end of pregnancy can also be treated. One of the most common is from sleeping on the side. That's how the hips become stiff, tighten and icky. And after just an hour of sleeping on one side, they have to flip over to the other side, flip back and kind of like a rotisserie all night makes for not the most peaceful sleep. And so after massaging into those hips and releasing the joints that attach the muscles, they tend to sleep a lot better, at least for, you know, a few nights or a week at a time.

(22:41)

Nicole: That's awesome. Sleep is super important period, like during pregnancy, during life. So that's great. Now I like to obviously you know, people's stories and is really important, but I'm curious if there have been any scientific studies that you're aware of that look at how chiropractic care helps during pregnancy. Are you aware of any, you know, scientific studies that have investigated this?

(23:12)

Elliot: Yeah, there's a whole bunch. There's an organization called ICPA, which stands for international chiropractic pediatric association and they have a whole slew or they're always doing research and trying to figure out where chiropractic can be helpful and where it really shows itself and where it doesn't. And they have broken down by topic and by category. And it's great to go explore and, and see what the studies show in terms of how beneficial this can be.

(23:47)

Nicole: Oh, that's awesome. I will definitely link to that in the show notes for sure. And I'll take a look myself. You know, I, obviously I invited you on because my audience is pregnant women and I want to provide them with this information. But I'm curious to learn about this stuff too cause it's not something that I know a lot about. And I've heard some folks in the community that I work with, I work with some doulas and things like that, talk about chiropractic here. So I'm excited to go look and learn some more.

(24:13)

Nicole: No, it's great that you're, I'm still curious, intellectually curious and learning. I think a lot of times we get deep into practice and we just get set in our ways and are not that interested in exploring new things. So it's really cool that you're still interested in learning and bringing new things to your practice and to your clients.

(24:31)

Nicole: Yeah. Thanks. Thanks. So if a woman is thinking about going to see a chiropractor during pregnancy, what are some questions she should ask when she visits?

(24:43)

Elliot: So I would say during pregnancy people tend to look for providers that have experience with pregnancy and it makes sense. You know, it's a time that's exciting, but it's also a time where that tiger mother instinct kicks in and you really want to do everything to protect the unborn baby or newborn baby. So I would ask, you know about experience. Like I said, both massage therapists and chiropractors can work on, on pregnant people without any specific additional training. But I think that it's important to know that you're working with people who do have either additional training and/or a lot of experience. So those are the questions that I would work towards. You know, what kind of training have you done, what kind of experience do you have? And the other thing is to also look at the resources you have, your doctor, your midwife, your doula. When there's providers in the community who really focus on pregnancy and postpartum, the other providers in the community know who they are. So those are the kind of things I would look for. Other things are, you know, do you have any specialized equipment for working with pregnancy or do you have any specific techniques? And other thing would be kind of nice to ask about. Are there reasons why I would not be a good match for care during my pregnancy?

(26:00)

Nicole: Oh, that's a good, that's a good question. What are some reasons why women might not be a good fit for a chiropractor during pregnancy?

(26:07)

Elliot: So generally they are, but for example, I have a client right now who is pregnant with her third. And uh, her first two babies came really early. For the first one, her water broke at 33 weeks and then for the second one at 35 weeks, thank God both of her babies are very healthy. But right now she's really uncomfortable and wants to come in to do care for her sciatica. Before I worked with her, I got on the phone to consult with her doctor and I think that's when we do best is when, when your whole team, your allopathic providers and your more holistic providers work together, that's when you get the best care. And so we decided to, to wait until she was 35 weeks before doing anything. And then we talked about contraindications and even with working with her now I'm modifying my techniques so that we don't do anything that might trigger labor and delivery. And the results have been pretty good.

(27:05)

Nicole: Good, good, good, good. So you're really, you know, I like the fact that you're working with other providers. I don't think we do a very good job of that within our healthcare system to work with different types of folks in order to make sure that we're really putting women at the center of their pregnancy and doing what's best for them.

(27:24)

Elliot: Absolutely. And I think that there is like, look, even us having this conversation is a sign that we're headed more in that direction, but I think there is a lot more mutual respect now than there was even 10 years ago. And at least in our community here, we are starting to work more together. In fact, many of our patients in our practice are medical doctors, oftentimes obstetricians who just hear from their patients about the experiences that they have here and then they come themselves during pregnancy. So I think there's a lot more overlap in teamwork coming our way.

(27:58)

Nicole: Well that's awesome. And you're in California too, which tends to be a bit more progressive in terms of these types of things.

(28:04)

Elliot: Yeah. Hopefully setting the path for the rest of the country.

(28:06)

Nicole: Yeah, absolutely. So how often do you recommend a woman sees a chiropractor during pregnancy?

(28:13)

Elliot: That's a good question too. So during our first visit, we do an assessment. Everything we do is both diagnostic and therapeutic. The chiropractic is in the massages. We use tools to figure out what's going on and how well the body responds to our treatment methods. And based on that, we kind of come up with a care plan. Generally when people are coming in for wellness care, there are no major symptoms then, we're just working with them once or twice a month. And as we get closer to the end, maybe the last eight weeks of a pregnancy, we kind of double that. So once or twice, once a week or every other week. When there are symptoms or we're working towards a specific goal in our practice, we rarely see somebody more than twice a week. So it's once or twice a week, for a short time until we achieve that goal. And then we back off to more of a wellness care approach. I would say that the combination of massage and body work that we do with our chiropractic adjustments is a lot different than typical. So when you're going to a chiropractor who doesn't do massage and address the muscles and tendons that way it's more common to come more frequently at the beginning, sometimes two or three times a week until they achieve the initial goal and then back off to a maintenance plan that may be once a week or every other week.

(29:30)

Nicole: Okay. Okay. And then as far as what to expect, like how long are the visits, what does that sort of stuff entail?

(29:40)

Elliot: So again, there's a difference between what we typically do and what chiropractors typically do. From the very beginning, I really fell in love with the combination of massage and chiropractic together, massage, addressing the muscles and tendons, a chiropractic, addressing the joints and the nerves and thereby getting both sides of the musculoskeletal system. That always made sense to me and that's what I always did. And now in pregnancy it works incredibly well, especially cause we can't do some of the imaging like x-ray. I have to use my hands to be the diagnostic tools. And you can't do that with just a quick chiropractic adjustment. So in our office, the typical visit, the first one is about an hour long, after that they're about 35 minutes long. But in chiropractic in general, the other practices that I've worked in before I started my own, that first could be long for the assessment, but then there typically the visits tend to be quick five to 10 minutes at a time.

(30:34)

Nicole: Oh, okay. Interesting. I'm learning so much new stuff. All right. Now is chiropractic care covered by insurance?

(30:44)

Elliot: Sure. Some insurance companies cover it and generally speaking, I would say in our area, PPOs cover it, and HMO's sometimes do and sometimes don't.

(30:56)

Nicole: Your plan may cover it, it may not cover it.

(30:58)

Elliot: Yeah, totally varies from plan to plan. Even with the PPO, some of them don't cover it. And then when they do, you kind of gotta get a little deeper. Like how much do they cover per visit, how many visits per year? It's like everything else. Insurance is a little tricky.

(31:11)

Nicole: Yes, insurance can be such a headache and nightmare both for patients and for providers.

(31:17)

Elliot: Yeah. Even for me and my family, it's a, as a provider it's tricky in and when I try to use it for my family, I usually end up just going out of network because it's so complicated.

(31:27)

Nicole: Oh my God, yes. I'm veering off topic a little bit, but I had this issue with a bill and I was like on the phone with the insurance company and I was like, for God's sakes, I am a doctor. Why don't I understand this if I can't understand what you're putting in this bill, how can anybody understand this? So it's very frustrating. Anyway, so one thing I do want to touch upon real quickly is what are any risks potentially involved when seeing a chiropractor? One thing that I've seen is some caution about working with the neck and specifically something called vertebral artery dissection, which can lead to stroke. So what are some of the risks that may be involved?

(32:06)

Elliot: That's a very good question also. And something that before you do any modality or any intervention I think is always a good question to ask. What are the benefits in order of the risks? Chiropractic is pretty widely recognized as one of the safest drug free noninvasive therapies available for treatment, but nothing is risk free. So I always tell my patients, when you get a chiropractic adjustment, there is a risk of an injury to a bone to the joint itself, to something nearby the joint, like a disc, blood vessel or nerve root. There have been reported instances of dissection after a chiropractic adjustment and that's something to know about. It's a possibility. The incidence is really low, somewhere like one or two and a hundred thousand and not that different. By the way, than been the general population, you can have that type of stroke even with no manipulation.

(32:58)

Elliot: So I think that the benefits are high and the risks are pretty low, but the way that we process risk is that for each individual something may be, they may hear what the risk is and feel like it's risky and another person may hear that risk and feel like it's not risky. And so I think my job is always to explain what the pros and cons are and the incidents and then for that person to choose if it's something they want to do or not do. And that's what we do. Let's look foundation of informed choice even within pregnancy. So sometimes my clients are trying to figure out if they've had us as here in birth, if they want to have a vaginal birth after cesarean or repeat cesarean and just the way you talk to them about it, let's say the risk of uterine rupture, that scar separating during labor is one half of 1% somebody might hear that and feel like, oh, that's a tiny risk. I'd like to do it.

(33:55)

Elliot: And then if you say, but that's the same as one in 200, then all of a sudden it like it's a big risk because I know 200 people. And so I think the terms risky and safe are subjective and as a result, different people will process them different ways, even the same person will process a different way depending on how it's presented. And so, nothing's totally risk-free. We've never had any kind of major complication in our practice to a mother or to a baby, nor have any of our friends, my friends who are chiropractors either, but nothing is 100% risk free.

(34:30)

Nicole: Yeah, I think everything you just said is so like excellent. You know, I am very much in supportive of holistic approaches and quote unquote natural modalities, but I think that sometimes we get caught up in thinking that they don't have any risk or other things don't have risks. It's important to look at everything, whether it's your obstetrician or chiropractor or acupuncture or any herbs or anything that you decide that you want to take and really look at the risk and benefits because they're there for everything.

(35:02)

Elliot: Yeah. And at the end of the day, you're the one who ends up living with the, with the choices that you make. So...

(35:08)

Nicole: Yes, yes. I say the same thing. Like when I'm telling you doesn't really affect me cause I'm going to go home and I'm still be with my family. These are decisions that you have to make. And VBAC is a great one. I personally love VBAC maybe I tend towards the side of encouraging women to pursue it if they wanted to. But that some women here, that number of one, you know, half a percent or that one in 200 and they're like, I don't want to take any risk at all. And then other women, like you said, are like, oh sure, this seems reasonable to me. So it's definitely an individual choice. And we as healthcare professionals have to meet women where they are and help them to make the choices for themselves and not make the choices for them.

(35:59)

Elliot: The tricky part is that the, they don't have the option to take no risk at all because the other choice is a repeat cesarean which comes with its own set of risks and benefits. And so the hard part is to really present as neutrally as we can, just stats, you know, pure statistics. These are in terms of the general property valuation as we know them, the risks and benefits of this choice versus that choice but unfortunately no choice is 100% risk free.

(36:24)

Nicole: Exactly. And which is a lot of what you do in your work with your own podcast. And guys I'm going to link to Elliot's podcast is called informed pregnancy, if you're not already listening, if it's informed is informed pregnancy or informed pregnancy and birth, clearly I haven't had enough coffee this morning.

(36:39)

Elliot: Yeah, mine is Informed Pregnancy and you can easily find it at www.informedpregnancy.com and just because we're on the topic, we also have a couple of documentaries.

(36:48)

Nicole: Yeah, please tell us. Yeah.

(36:50)

Elliot: One of them is called trial labor, which is the documentary all about vaginal birth after cesarean.

(36:56)

Nicole: Oh, awesome. Awesome. So, and this is all in an effort to help women again, make those informed choices, which is how it should be like pregnancy, prenatal care, we should be here. It's a shared decision making process where we give you the information and our knowledge and our expertise based on our experience to help you come to a decision that works best for you. Is that something that you feel like is like you're trying to do or a fair to say or...

(37:24)

Elliot: Oh, 100%, and it's hard sometimes because as a practitioner, I have to give informed consent. I have to kind of explain the pros and cons and my client's really ultimately in the driver's seat and make the decision even if it's a decision that I wouldn't make for myself, for my own family and to support that decision as if it was a decision I would make for myself, for my family, to voice my opinion. But at the end of the day, I'm just a talking head, you know, and the person, like we said earlier, has to make the ultimate decision and accept the consequences of that decision. Pro and con is the patient themselves and that's the way I want to be treated as a patient when I go to see a doctor and that's the way I think that we all need to, you know, ethically and also legally treat our patients as well. As they have always at the end of the day have the authority to make informed consent or refusal to say yes, I consent to that. Now that they fully understand the pros and cons or no, I don't want to do that. Even if you think it's the best thing for me.

(38:26)

Nicole: Exactly. And so it's not so much about like, oh, you should have an unmedicated birth because that's what's, you know, good and best, or oh, you have an epidural, you can have what you want. I'm just here to present you with the options.

(38:40)

Elliot: Exactly. That's one of the great things about our country is you get to choose.

(38:43)

Nicole: Yeah. Yeah, absolutely. So as we wrap up, what do you think is the most rewarding part of your work?

(38:52)

Elliot: I think two things come to mind immediately. One is when I am at a birth, when I have the opportunity, when I'm invited to someone's sacred birth and I walk in and I know their goal, my client, sometimes their goal is I would like to do an a no interventions or unmedicated birth in whatever setting at home or at the hospital. But I walk in and I see fear. I see that this is new and big and intense, and she's not used to it. And her nervous system, her body doesn't feel safe yet. And so you could see her fighting herself, the surges come, they're intense. And she's trying to push away from them, kind of like being a roller coaster, trying to steer it and push my foot on the brake, but there is none and it's kind of almost a little violent looking sometimes that she's fighting herself and expending a lot of energy and it's more intense than it needs to be.

(39:46)

Elliot: More uncomfortable than it needs to be. And then using bodywork, whether it's reflexology on the hands and feet, a little cranio work and massage to kind of help her body feel more relaxed and more safe. And then when that next surge comes, she doesn't jump to fight it right away. There's a little delay. And then it gets even more and more relaxed and she starts to really see that it's not going to be bigger than she is, that she can ride those waves, not fight them and surrender to them. And that shift from what looks like violent and really, truly uncomfortable and painful to something that looks equally intense but sometimes just really beautiful, being a part of that shift and kind of helping her shift that journey on the path that she was hoping for is some of those moments are just ingrained in my, in my brain in ways that will never go away. And the other thing is more philosophical, which is the informed consent that we're talking about. Somebody who just kind of goes into a pregnancy blind and doesn't really know that there are going to be a lot of choices to make it a lot of decisions to choose from and to just share information so that they have a more well rounded knowledge and know to do a little bit of research so that when those choices come up, they come from an empowered place. Both of those re very rewarding to me.

(41:06)

Nicole: Yeah, I agree. For those of us who work around birth, there's nothing quite seeing a woman in the throws of labor. And those, those moments when she goes from like being scared to like, I got this, I can do this. And it's really a privilege to be a part of that.

(41:25)

Elliot: Absolutely a huge honor. And, and it's true, I mean I mentioned that because it's more dramatic with unmedicated and an interventional birth, but it's really true about any kind of birth even, you know, whether they, it is medicated and cesarean birth too, going into it, you know, fearful and then finding that place where you're not afraid and you're surrendering to it and, and really being present for that incredible magical moment in, in time when a baby comes through your body into the universe, it's really special to be a part of.

(41:57)

Nicole: Absolutely. Absolutely. And again, I'll go off on another tangent, but like fear is not a good thing to have. Well, it's not an ideal emotion to have or energy to have around birth. So being able to help diffuse that is important.

(42:11)

Elliot: Yeah, excessive fear can do more harm than good for sure.

(42:15)

Nicole: For sure. So on the flip side, what's the most frustrating part of your work?

(42:20)

Elliot: Again, two things pop into my mind. One we already talked about, which is insurance. I wish I could just open the doors and, and just treat anybody who wants to come in and not have to worry about stressing them with insurance or stressing me with insurance or payments and things like that. It's tough in our system, our systems a little bit broken and people who need access to certain types of healthcare or who would benefit, don't have access. And that's frustrating. And then sometimes people have access to healthcare they don't need them take advantage of it and there's not balanced. So insurance is very frustrating to me. The other thing that's frustrating and there's not a whole lot I can do about it is just sometimes when you're not getting the results you want to get.

(43:06)

Elliot: Someone has a case that that is just outside the textbook, which, which doesn't mean we can't get it, but sometimes it says if their body just has not read the textbook and I'm doing everything that I know should help and they're still in a lot of pain or we don't understand why that baby's breech and not turning and we're trying to make as much natural space for it as possible. And even on ultrasound you can't see anything. I just had somebody who, who was breach with her first baby. She did all the holistic things and the baby stayed breech. She tried an external version. The baby didn't turn, there was no clear sign on why that baby didn't turn and a, you know, her whole birth plan was no cesarean and she wasn't very specific on how the baby was going to come out.

(43:46)

Elliot: She just had, I don't want a cesarean. She ended up having a C-section and while they go really well for some people, in her case she did not have a great experience with it. And so at 20 weeks when her second baby was breech again, she started trying really early to make space for that baby to go down. And once again, her baby would not go down then she tried aversion, again it didn't work again, there's no clear. It's as if like, why is this happening? And we don't always have the answers. And that's frustrating. In her case, she ended up switching to a doctor who does vaginal breech birth and she had a vaginal breech delivery after cesarean, which I think is pretty rare. She had a great experience.

(44:28)

Nicole: Good, good. So what are you especially about when it comes to helping care for women? If I had to guess, I would guess the informed consent.

(44:37)

Elliot: Yeah, absolutely. It's my all day every day because now that we have the podcast, we have questions coming in from all over the place and it's hard to see that in big parts of the United States, there's, when we go to VBAC, for example, there's huge parts of the country where there's no hospital or a doctor or midwife who is able to do or wants to do a VBAC. Which means that those women have to either have as a cesarean that they don't want and arguably don't need or travel really long distances to find a provider or hospital that will support them. And it's hard to see in the, in, in VBAC by definition as the absence of a procedure. They're fighting to not have a procedure, which is very un-American as we talked about before. You should always have the option to consent or refuse.

(45:24)

Elliot: And, and so in my own practice, I struggle with that quite a bit, but globally now through the informed pregnancy project, it's something that's really frustrating. And so it's become a passion of mine to sort of help inform and educate individuals. And so, so they can become advocates and activists and all sorts and band together with other open-minded practitioners like you. So that together we can kind of use our microphone to spread information. And what ultimately happens is enough people will demand, you know, this type of care and then a hospital or a doctor's gonna have to scratch their head and figure out how to provide it or they'll lose the business.

(46:05)

Nicole: Yeah, I agree 100%. Change is going to come from women demanding it and it's not going to, it's, it'll come a lot faster that way for sure, than the other way around because hospitals and they don't necessarily have a, a reason to make change. So they sometimes need a push. So giving this information is, I agree, it's an important part of what we do. And I'm glad that we were able to connect and kind of talk about that a bit.

(46:37)

Elliot: Yeah. And I guess the other pieces, just giving back, knowing what my mother went through to bring me into the world and raised me and my brother and what my wife did to bring our children into the world and raise them and what women do every day. And have been doing for thousands of years. It's you know, as a guy being able to kind of get a glimpse into that world and to really just be intimately aware of what you do with your body to grow a baby and deliver a baby and feed a baby and raise a baby. It's just awe inspiring. And so I find myself in this interesting position where I'm able to give back and at least provide some support to a handful of women that are doing that.

(47:26)

Nicole: Yeah. I just heard a lot of women hit pause and grab their husbands and say, listen to what he just said! Oh goodness. I love that. Love that. So last thing I'll ask is, what is your favorite piece of advice that you'd like to give to pregnant women?

(47:46)

Elliot: Outside of getting informed, which is always going to be my biggest piece of advice, there are so many choices and decisions that you have to make as a pregnant person about pregnancy, about birth, about postpartum, about early pediatric care. Get informed early. Learn what your choices and options are and you make sure your practitioner's on board with you. So that's the next biggest piece of advice. Get informed is one. Number two is surround yourself with people who are aligned with you that you're not going to have to struggle and fight with. You know, if you want a home birth and you're in a hospital, it's different in the hospital than at home. Don't make them, you know, force them to go too far outside their comfort zone. It's not what they know. They're not going to be able to give you their best care when you come in and demand that everything that they do, you want it to be done differently.

(48:31)

Elliot: Try to find providers who already are aligned with you instead of fighting with your provider all the time if you have the option to do that. And then the last thing is, I think when it comes to the labor and delivery is sort of be flexible. You know, I think at the end of pregnancy, there's a starting point and an end point. Hopefully the starting point is you have a healthy baby inside a healthy mom and the end point that you're trying to get to is your destination is a healthy baby outside of a healthy mom. And there are literally a million ways to get from point A to point B. And it's great to explore the different paths and ways to get there and to sway, to say aim for one to say that's the one, if all things are equal, that's the one I'd like to do. But then once you start moving down your map, once you start driving towards the destination. And your journey has begun to be flexible so that if there is a detour on the road, that you're okay switching to a different path and still knowing that you're going to get to the same destination. And so it's important to be informed and important to be empowered and to surround yourself with providers that are gonna support you in your goals and choices. But it's also important to be flexible because birth is kind of unpredictable.

(49:44)

Nicole: It's a very unpredictable and babies do not tell us what their plans are.

(49:48)

Elliot: No, and even though it usually goes really well, you know, ow-risk healthy pregnancies should deliver just fine. Sometimes things come up and you'll have to make choices and if you're, so I just see time and time again for, you're so rigidly bent on going on a very specific path when it's forced to change even when it's really necessary to keep you on the baby healthy, it leaves you feeling really sad afterwards. And if you go into it with more flexibility than that, then I think that you can really improve the postpartum experience.

(50:21)

Nicole: For sure. For sure. Well tell us where people can find you to learn about your podcast, your documentaries that you have. Tell us where people can learn more about you.

(50:31)

Elliot: Well, we've neatly organized everything in one place on Instagram. My Instagram is @doctorberlin, which is spelled out, and on the bio link, there's one link in the bio. If you click on it, it brings you to everything or podcasts or documentaries or workshops. Everything is located in one neat little space.

(50:51)

Nicole: Awesome. Perfect. Well, thank you so much for being here. This was a really great conversation. I learned a lot and I appreciate the opportunity to connect.

(51:00)

Elliot: Thanks Nicole. I look forward to having you on our podcast and sharing your unique approach to obstetrics. It's really refreshing to talk with you.

(51:07)

Nicole: Oh, that'd be awesome. I love it. I love it. All right, well you take care.

(51:11)

Okay, so wasn't that a really great episode? I was telling Elliot before we started recording that he has a really soothing voice. Maybe you might feel that way also. All right, so you know after every episode when I have a guest on, I do something called Nicole's notes and those are my top three or four takeaways from the episode. So here are Nicole's notes from this episode.

(51:33)

Number one. We as obstetricians do not really get a lot of training on how position changes can help move a baby into a better position. I'm fortunate to work in a labor and delivery unit where the nurses are trained in how to do some of these techniques. A lot of them are trained in something called spinning babies, which teaches different techniques to move mom to help facilitate a better position for baby. But unfortunately not a lot of OB doctors get that exposure and it may me worth asking your doctor what the L and D nurses at the hospital where you plan to give birth and know about position changes to help facilitate birth. Just so you kind of have an idea of what you're working with.

(52:17)

Number two, and this is something that I learned on the episode that I did about prenatal yoga, and I'll link to that in the show notes, but it kinda stuck with me and Elliot mentioned it in the episode today too, and that's that pregnancy discomforts are common, but they do not have to be a part of your normal. I think OB doctors tend to be like, oh, it's kind of part of pregnancy and you just sorta have to deal with it, but there are some things that we can do and chiropractic care may be one of those to help relieve some of those common pregnancy discomforts. Prenatal yoga again is another one and that's just something that I didn't necessarily always appreciate.

(52:57)

All right. Number three, love. When he talked about the collaborative aspect, when he said that he, you know, has talked on the phone to obstetric care providers. I think doctors and care on the West coast in general is a bit more progressive about things like that. Unfortunately, our system doesn't do the best job of communicating between different health care providers and much less between something like a physician and a chiropractor. There are a lot of reasons for that. Part of that is lack of time and you know, difficulty connecting. But that's not an excuse. It's something that we really need to strive to do better about so that we're providing good care for women. And then the last thing is that I do want you to remember that nothing is totally risk free.

(53:48)

I know sometimes we get in mindsets that because something may be natural that it has no risk, but as Elliot and I talked about, risk may be lower or different, but nothing is risk-free, so go into whatever you try knowing that, so like everything else, if you decide to see a chiropractor during pregnancy, do your homework, ask about the risks, the benefits, and look for someone who has additional expertise and experience in caring for pregnant women.

(54:20)

All right, so that is it for this episode. Be sure to subscribe to the podcast in Apple podcasts or wherever you listen to podcasts and you know I would love it if you leave a review in Apple podcasts. It always brings a big old smile to my face when you guys leave me those reviews and also helps women find this show and I sometimes do shout outs on the podcast, so subscribe and leave those reviews for me if you don't mind.

(54:48)

Also, don't forget about checking out my signature program, The Birth Preparation Course. It will leave you feeling knowledgeable, prepared, confident and empowered going into your birth. Go to www.ncrcoaching.com/enroll to learn the details. And if you want to kind of take a test run and get a discount, check out first my free online class on how to make a birth plan that works. You can sign up for that at www.ncrcoaching.com/register. Now next week on the podcast, it is the return of birth stories. I love birth stores on the podcast so I'm super excited to bring you one next week, so come on back next week and until then I wish you a healthy and happy pregnancy and birth.

(55:35)

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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