TRANSCRIPT EPISODE 65 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #65: Amy's Birth Story - Trusting Your Intuition About Your Labor And Delivery

Transcript

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It's a birth story episode and it's one that fits well in our current times.

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Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a practicing board certified OB GYN, who's had the privilege of helping hundreds of moms bring their babies into this world. I'm here to help you be knowledgeable, prepared, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at www.ncrcoaching.com/disclaimer. Now let's get to it.

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Hello, and welcome to another episode of the podcast. This is episode number 65, thank you for being here with me today. On today's episode we have a birth story and although this particular birth story did not happen in the midst of COVID-19 it could easily describe a birth that is happening now. So I chose this story because I wanted to help you get a sense that although things are different during our current times, so much about birth is still the same. So on today's episode we have Amy Cole. Amy lives in Maine with her husband and son and she's a middle school counselor. She loves the outdoors, hiking, swimming, camping, whitewater rafting, and Amy shares her experience of having a vaginal birth in the hospital. Overall, she is very happy with her experience. However, as is the case with birth, some things went great, some things were not as great.

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So Amy shares her story of how her water broke at 39 weeks during her prenatal appointment. After she was checked in the office, like her water broke on the exam table, she talks about how she was able to stick to what she felt was right for her during her labor and birth. And then she also talks about the parts that were not as great, including a not so perfect epidural and having an episiotomy done without consent. So you are going to learn a lot from Amy's story.

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Now before we get to Amy's story, don't forget about my free online class on how to make a birth plan. It's recently been updated to reflect changes in giving birth related to COVID-19. Over 1000 women have registered for this class just in the last month. And I have been blown away by the responses of how helpful women have told me that it is via comments or direct messages or emails. And I've been really, really grateful for all of that. I am here to serve and I am here to help women have a beautiful birth. So I'm so glad that I'm able to provide this great free resource for you to help you make a birth plan that works for you to help you have that beautiful birth even in the midst of these crazy times. So definitely check out that free class. It's www.ncrcoaching.com/register. All right, let's get into today's episode with Amy.

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Nicole: Thank you so much Amy, for agreeing to come onto the podcast. I am super excited to have you share your birth story today.

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Amy: Yeah, thank you. I'm excited too.

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Nicole: Yeah. Well why don't you tell us a little bit about yourself and your family?

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Amy: So I grew up in New Jersey, but I now live in central Maine cause I went to college here. I met my husband at the University of Maine in Orono and then just stayed.

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Nicole: I haven't never been there, that sounds cold to me.

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Amy: It is. Yeah, it is. I don't know. I mean, yeah, it's pretty cold up here, this winter wasn't too bad. So, but normally, yeah, every winter you kind of think, why do I live here? And then the summers are really, really nice. So every summer I was always like, Oh, I love it here. I'm going to stay. And then, I don't know, I just got sucked in every year. Fin's from Northern Maine. So he's always lived here and so here we are.

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Nicole: Okay.

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Amy: And then we just had our first kid last May, Conrad, and we have a dog and a cat. I don't know what else.

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Nicole: Awesome. Yeah. Do you work outside the home at all?

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Amy: I'm a middle school counselor and...

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Nicole: God bless you.

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Amy: Yeah, it's fun.

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Nicole: Yeah, it's a calling, I would say for people who work with children, especially middle schoolers I think are the most challenging kind of age group.

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Amy: I think so.

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Nicole: Yeah. Yeah, I know. At least that was when I was a little bit of a trouble maker when I was in middle school.

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Amy: As a student, I didn't really like middle school, but you know, I made it. So will they.

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Nicole: Exactly. Exactly. All right. So, how about we just hop right in then into your story? Let's talk about before, you know I like to hear about birth stories of course, but I think in order to understand the birth we got to understand a little bit about the pregnancy. So what was your pregnancy like? What was your prenatal care like?

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Amy: It was a pretty easy pregnancy. So when you work at a school, I don't know, maybe you've heard this before, a lot of us try to time it so that we can have our kid and then back it up into summer.

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Nicole: I have definitely heard that before.

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Amy: My husband and I definitely were trying really hard to have to conceive at a certain time so that I could have this longer maternity leave and somehow we nailed it. It was perfect.

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Nicole: Nice.

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Amy: So I found out I was pregnant at the beginning of September in 2018 and yeah, it was pretty easy. I feel like nothing really significant happened. My OB GYN office is a group, so I saw a different doctor every week. I think there's, I want to say there's four of them and I liked all of them so they just made sure every appointment they made sure I had, I saw a different person more or less each doctor, two or three times so that I could get comfortable with each of them.

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Nicole: Okay, gotcha.

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Amy: I thought that was fine. I guess I didn't really know any different, you know, my first baby and all I thought...

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Nicole: Yeah. So you got a chance to meet all of the different doctors in the practice and kind of get a feel for cause it could, they told you up front that it could be any one of them who was there?

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Amy: Yeah.

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Nicole: Gotcha. And how did you feel about the care you received?

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Amy: I mean I thought it was great. I was very happy with that office. Everyone was always super friendly. I know I've heard people say they don't get a lot of time with their doctor, I guess since probably because my pregnancy was so uneventful, I just didn't feel like any more time and they never like rushed me out or anything. They always were like, what can I help you with? What kind of questions do you have? And I was always like, I don't know, I'm good. So I thought it went well.

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Nicole: Good, good, good, good. So did you do anything in particular to like get ready for birth or during your pregnancy? Like read books or take classes or any of that stuff. Okay.

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Amy: I definitely read books and just scoured the internet. And we took one class at the hospital that was a one day, six hour long kind of workshop thing, which was pretty good.

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Nicole: And how did you, how did you, I guess how'd you like it, how'd you feel about it? Um, and did you have any expectations going into the class? Maybe?

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Amy: I guess I didn't really know what to expect. Their description of it advertised that they were going to give you a tour of the birth center, which I realized I could have just done anyway. But I was like, Oh, I really want to tour the birth or so let me, that seemed like the selling point. But then I was like, well we should also probably do a birthing class. So my husband and I went and it was just, I want to say 9 or 10 couples around the table. And they showed us a lot of videos of people giving birth and how they dealt with labor. And I appreciated that they showed kind of one of every type of, like there was someone who had a C-section, someone who chose to not have any drugs of any kind.

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Amy: Someone who did have an epidural, someone who used intravenous drugs. So they showed a little one of each and all that kind of stuff. I don't know. I thought that was good. And the nurse who put on the class told like her personal story, which I really appreciated cause I feel like she, I don't remember all the details, but I felt like she had a unique birthing experience and then she had postpartum psychosis, which was really interesting. I never heard of anyone having that. So she told us about that. So I liked that.

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Nicole: Right, right, right. And it didn't, it didn't scare you. Did it scare you or me?

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Amy: At the beginning of my pregnancy, I don't know why I was worried about this, but I told my husband, I was really worried about postpartum depression. He was like, do you think you're going to get it? And I was like, I don't know, but people get it. And so I definitely was worried about it, but I don't know why.

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Nicole: Well, I mean, I can't understand. It's a real concern. So yeah, I can totally see being worried about it.

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Amy: And I listened. There's another podcast I listened to. My cousin's good friend does it, and she had postpartum depression and talked about on her podcast. I was like, oh my God, this is like a thing. It could happen to anybody. And it comes out of nowhere, sort of. I don't know. That's kind of the information that I thought I got, so.

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Nicole: Gotcha. Gotcha. Well, it sounds like you were going to be ready if it did happen.

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Amy: I was trying. Yes.

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Nicole: Yeah. Yeah. And then what, what kind of books did you read? And I'm curious what you didn't like internet stuff or Facebook groups or any of that kind of stuff.

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Amy: Oh my God, I did go on Facebook groups. Those were kind of crazy. Okay. I can hear it in your voice. I don't know if you've ever seen the Facebook mom groups, but they get pretty wild.

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Nicole: Really?

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Amy: There's some that are like, I was in a couple, I don't know, I was literally just trying to get as much information as I possibly could. And so there's some that are labeled as more supportive and then some that are like, I don't remember the exact term, but basically uncensored and people just seem to get mean on those. A lot of mom shaming and stuff like that.

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Nicole: Oh that's not helpful.

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Amy: Yeah. So I am no longer in those Facebook. I really liked Emily Osters books Expecting Better. And then I also bought Crib Sheet, the other one that she had. And I like those cause I like how those were kind of just like data with like a little bit of her opinion in there, but kind of like I'm just going to let you make your own choice. So I liked that.

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Nicole: Okay. Okay. So out of all the things you did, you felt like her books were helpful. Was there anything else that you found particularly helpful?

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Amy: A website, Alpha Mom that I liked, whoever runs that website, she posted a week by week, what you can be expecting in pregnancy situation and her own experience. But it was really relatable and I like how she wrote it. So I'd check it every week and be like, yes, oh my gosh, me too. So I liked that website. I think that was about it. Someone gave me one of those classic what to expect when you're expecting books, but I kinda just browsed it. And then I also, oh, someone gave me one of those girlfriends guides to pregnancy, which I read some of it and I did like some of that one. But my favorite was the Emily Oster's books.

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Nicole: Okay. Okay. I have to confess, I have not read those and they're on like my to do list to read because I've heard some people say that they do. They do like them.

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Amy: Yeah. Yeah. She basically just presents a lot of data, which I think is more helpful than someone just being like, this is what I think that's right. Yeah.

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Nicole: Kind of letting people draw their own conclusions. Yeah. Now, was there anything in particular that you felt like you wanted for your birth? Like were you looking for information to support a specific experience or you just were kind of getting all this stuff you wanted all the information you could I guess.

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Amy: Yeah. I was pretty open. When we got a piece of paper, like a form from the hospital that was like a birth plan where you basically could just select choices and I mean they said you could bring any sort of birth plan you wanted or you could just use their form or you could have nothing, whatever you wanted. And so I pretty much walked in there just being like, hey, the only thing I really care about is that we get the baby out safely. And I wanted an epidural.

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Nicole: Okay. So you knew from the beginning that you wanted an epidural?

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Amy: Yeah, I did have a moment where I was like, oh, I want to just do this all natural. And my husband was kind of like, but why? And so we talked about it and I was like, yeah, I guess I think it's really amazing how when women give birth without any sort of intervention like that, but eventually we kind of came to conclusion. I was like, I don't really feel super passionate about it. It just sounded cool. And then I was like, I'm kind of a baby. I am afraid of how much pain this will be. And so, and I didn't, I wasn't opposed to an epidural. So we discussed it and settled on yeah, let's, let's get an epidural.

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Nicole: Gotcha. Yeah. And which there's absolutely nothing wrong with that. Did you feel like you had any pushback, been any from any friends or family or anything about that decision or it was easy to get to?

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Amy: I don't know. I feel like maybe I put off this vibe, at least with my friends and family, don't question me because nobody usually ever does.

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Nicole: Well good, good. I'm glad you weren't. It cause some, it's, it's, you know, I swear people get pushed back sometime either way, but if the choices they make, so that's great. Yeah, yeah. What about stuff like delayed cord clamping or skin to skin contact?

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Amy: Oh yeah, most of that was standard at our birth center. So which was stuff that I wanted but I was, you know, not super worried about it because it all was their common practice so.

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Nicole: Gotcha. And was this, was this a free standing birth center or birth center? Within a hospital?

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Amy: In a hospital, yeah.

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Nicole: Okay. Did they have a separate L and D or did they just call their labor and delivery a birth center?

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Amy: Um, I guess they just called it a birth center.

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Nicole: Okay. No, no, no, it's totally fine. I'm just curious what different models are. Like there's some hospitals that have like what's called like a separate birth center for like low intervention, low risk people and then like the regular L and D has other stuff.

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Amy: Oh yeah. Okay. No, that was their only L and D area they had, I think. I want to say 10 rooms and they had in the, within that area there were rooms for C-sections and then lower intervention rooms, on the same wing. And it was in the hospital, but kind of like you can get to it through the hospital, but it was kind of separate. It's a really small hospital.

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Nicole: Gotcha. But they tried to make it feel like not quite so hospitaly it sounds.

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Amy: I think they did a good job.

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Nicoel: Oh nice. Okay. I think that's how birth, cause it's like it's not a disease. It's a normal medical thing. So, well why don't we talk about what your labor and birth was like.

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Amy: Yeah. So this is what I think was, I don't know, I just hadn't heard this happen before. But basically when I was 39 weeks pregnant, I went in for my 39 week checkup and at 38 weeks they offered to do a cervical check. And they did. And I think I was one centimeter dilated maybe, you know, something kind of insignificant. And after that, at 38 weeks, I think my mucus plug started to come out over the next week. And so I was like, oh, what did she do up there? And then the following week at 39 weeks, I got another cervical check and I think she said I was 70% effaced already, but still only maybe one or one and a half centimeters dilated. And so it was my doctor and she had an intern with her and they left the room and were like, okay, you could get your clothes back on and we'll see you next week if not sooner.

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Amy: And I was like, okay, great. And so when I got up off of her table, my water broke. Except for, I think she broke my water when she gave me a cervical check. So I stood up and it just leaked out and I was alone in the room at that point and I was like, what do I do? I like just stood there for a sec cause it was kind of a steady trickle and I looked around, I was like, okay, I'm just gonna like just try to put my clothes back on. So I could hobble out into the hallway and ask for somebody. And luckily the receptionist had a window, right diagonal from the room. So I stuck my head out. I was like, can I get a nurse or the doctor back in here real quick?.

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Amy: I think I might've even said like, I think my water broke and they were like, oh yeah, of course. So the doctor and her intern rushed back in and she was like, I don't think I've done that before. So it seems like she'd probably broke my water on accident.

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Nicole: Was she particularly aggressive with it, was it like a painful check?

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Amy: I thought it was kind of painful but I, you know, I thought they were supposed to be cause it was the week before too. And she tested the fluid to make sure and it was, yep, yep. I broke your water, you're staying. And I had come straight from work. My car was in the parking lot. I had my lunchbox from work in my car, which I just thought funny cause it ended up staying there for five days. So I texted my husband in the room while I was waiting for the doctor to come. She had left the room for a second and I was like, hey so my water broke and I have to stay here. And it was probably 3:30 in the afternoon and he works an hour away from the hospital. And so he just dropped everything. Had to drive down. We had our dog at doggy daycare, he had to pick up the dog. He had to pick up my bag at home and run all these errands.

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Amy: But there wasn't really a hurry cause I wasn't really in labor yet. And so my OB's office was also attached to the hospital so they just had me walk right up to the birth center and check in. Which is another reason why it felt like a hotel. Because when I first got there I wasn't in labor, I just got comfy put on the TV. So, yeah, that was, that was how it started.

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Nicole: Okay. Did they give you the option at all of going home and coming back?

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Amy: No, she didn't. I mean, she didn't suggest that and I think I just got immediately nervous, Oh my God, this is happening.

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Nicole: Gotcha. Gotcha.

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Amy: I didn't even think like, I probably had a little time, I just was like, okay, yep, I'm going right up.

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Nicole: Right, right, right. Okay. I can imagine that felt like what, what's going on? Like what? Like you probably run your head through the various, you know, run the scenarios through your head of what's going to happen, how it's going to start and like none of that involved that.

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Amy: Yeah, no, for sure. I mean, I guess I imagined traditionally that I would start having contractions. I actually kind of just thought I would have them at work. That was my fear and I would have to go up to one of my bosses and be like, hey, I'm in labor, got to go. So, I mean that wouldn't have been that big of a deal, but I just was like I just really just don't want to be at work when I go into labor, I want to be at home and well it was neither.

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Nicole: So you get to the hospital or get to the birth center and get settled in. So then what happens from there?

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Amy: So then they were talking about inducing me because they, I guess, what is it like, I don't know. They didn't want a certain amount of time, I think they were giving me 12 hours before my cut off. Well then they were going to make me get induced. But they were like, do you want us to induce you because you're not really in labor and you know your water broke so you'll have to be induced if you don't go into labor. And I was like, Whoa, can we just wait? Like I don't know. Let's see what happens. And I have no idea why I felt so confident that I didn't need to be induced. But I remember just thinking like, no, I'm good. I'll go into labor, it's fine.

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Nicole: Right, right. Well, I mean that's not a bad bet. I mean, about half of women will and within six hours after their water breaks, but then after that we don't have a whole lot of data. So it's not, it wasn't, your instinct wasn't off.

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Amy: I mean, I didn't even know that, but yeah. So my husband finally gets there, he's kind of trying to listen to the doctor and he's like, well maybe you should get induced. And I was like, no, let's wait. And they were like, all right, that's cool. You can wait. But if you're not like having any contractions by like four in the morning, we're going to have to induce you. And I was like, okay, that sounds fair. That's fine. So they kept checking on me or you know, checking the baby, everything was fine. And then, so I got in there at 3:30, I did start to get contractions at night, but it was like probably like nine, 10 o'clock at night. And they were like pretty light. So the nurse would check on me and I was like, yeah, no, I feel something.

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Amy: They're like, okay, but you're talking, you're good. It must be pretty small. And I was like, yeah, yeah that's not that bad. And she was, they were like, you should probably try to get some sleep cause you're probably having a baby tomorrow. And I was like, yeah. And then I don't even remember if I fell asleep. The contractions progressively got much more aggressive to the point where I was like, I'm not sleeping. This hurts. And my husband was trying to sleep on the little cot thing and I'm just sitting there in pain. But despite the video where they show you get up, walk around, bounce on a ball, I just wanted to lay there and just wait for it to pass every time. So that's what I was doing. And eventually the nurse came in and was like, huh, it seems a lot worse now.

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Amy: You seem like you're in pain. I was like, yeah, when can I get an epidural? And so at around sometime in the middle of the night. I dunno, it was probably three in the morning. I think the doctor who was on call then who was one of the male doctors, which is, I had no problem with that except I swear he has bigger hands because when he went to check me I was like, oh my, oh my, it hurt way more than either of the other doctors that had done it. But apparently I was all of a sudden seven centimeters dilated.

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Nicole: Okie dokie then. Then indeed you had been laboring.

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Amy: The doctor was like, wow, that was wow. He just seemed like amazed that I went into labor on my own quickly and then accelerated to seven centimeters dilated. And he was like, whoa, you're gonna have a baby soon. I was like, yeah, so that epidural?

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Nicole: Like can you do that, or please find the person who can.

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Amy: So luckily they called in the anesthesiologist. There was another woman in labor in the room next to mine I guess. And they were hitting her first. And I was like, okay. So they're like, yeah, we have to give you that. They have to give you, what is it, saline first. So they're like, well you have to do this first. And I was like, okay. But yeah, eventually I got the epidural. That was amazing. It worked perfectly. And I got to fall asleep for a couple hours before they woke me up and were like, you're 10 centimeters dilated. Hooray.

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Nicole: So yeah, that all like went pretty, I mean relatively quickly. Yeah. And then was it just your husband that was with you?

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Amy: Yep. Yeah. And several nurses that were coming and going. All really awesome nurses.

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Nicole: Did you ever, did you consider a doula at all during your pregnancy?

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Amy: I mean I had heard of a doula, but I didn't really know much about it until after. So for next time I kinda am definitely thinking about it, but I didn't really know what they did.

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Nicole: Gotcha, gotcha, gotcha. And then do you feel like you said that the nurses were there and everybody treated you well and respectfully and all that stuff?

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Amy: Yeah, I thought the nurses were awesome. They were so helpful. If I needed anything or if I didn't know what was going on, they were really great. I mean, there was only, I think it was just the me and that other woman, the birth center while we were there. So they, you know, they weren't super busy. That was probably helpful. So they felt really attentive.

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Nicole: Oh, that's good. That's good. Yeah, that's, I mean really they should be attentive no matter how many patients there are, but it certainly helps when it's not as busy. So that's great. And you never felt like you were, did you ever feel coerced or like, I don't know, pressure to do anything that you didn't want to do?

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Amy: Not really. They did seem like they kind of were trying to lean me towards getting induced during the night, but they were very respectful when I was like, nope, I'm still good. But the doctor kept mentioning it and being like, Oh, okay. But yeah, so I mean, and it wasn't really even him as much as the fact that he kept mentioning it made my husband be like, are you sure we shouldn't listen to the doctor? And I was like, no, we're good.

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Nicole: Gotcha. Okay.

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Amy: But I thought they were really respectful, so.

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Nicole: Okay. Okay, good. That's good to know. So no complaints, it sounds like about your care. Yeah. Okay. So then you got completely dilated and then it was time to push?

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Amy: Yeah, I mean, I guess I fell asleep for a while. So then I think I started pushing it like 11:00 AM the next day and I don't know, I pushed for two and a half hours or so.

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Nicole: Okay. Which actually for first baby with the epidural is not bad.

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Amy: Okay. I have no idea. I was like, this feels really long. And even though I had the epidural, which I think was working well, there was this weird spot on my hip that would, every time I had a contraction, I felt extreme pain in that spot. And my doctor was like, well, that's good. You know, you're having a contraction. I was like, yeah, but it sucks.

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Nicole: Right. We call it a hotspot. Yeah. Where sometimes you just have a spot where there's just not great coverage.

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Amy: Okay. Yeah. So I did feel things, but it wasn't, I mean, I know they always say you kind of forget how bad it was. So now I'm saying it wasn't that bad, but I feel like it was pretty bad.

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Nicole: Gotcha, gotcha. And then pushing, you felt like the nurse was with you and helping you?

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Amy: Yeah, she had one of my legs and my husband had the other. Oh, I did get really, actually the night before, before I got the epidural and after when I was pushing, I got really nauseous a couple of times and I threw up a couple times. I don't know if that's like a normal thing that happens, but.

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Nicole: Super common.

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Amy: Okay. And at one point the nurse was like, Oh, sometimes it helps to like rub an alcohol swab under your nose and that will take away the nausea, which did the opposite for me. I threw up as soon as she did that, I was like, Nope, didn't help. Thanks. Thanks for trying. Yeah, it was kind of rough. But in between contractions I felt fine, which I'm sure is pretty standard and there was like a solid five minutes in between every one of my contractions.

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Amy: So in between I just felt like we were just all sitting around one point. I was like, can we put the TV on? We watched a Friend's marathon the whole time I was in labor. And it was the episodes where Rachel is pregnant, so I was like, Oh, here we are.

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Nicole: That is hilarious.

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Amy: Yeah, it was interesting.

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Nicole: Yeah, for sure.

(00:30:11):

Amy: Yeah, so I pushed for like two and a half hours, which to me felt like forever. And I give my doctor a lot of credit. So the woman who ended up delivering my baby, it was the same woman who broke my water. She came back for her next shift and I really liked her, but I feel like she never gave me any false hope. Like she wasn't like, you're almost there. And I wanted her to say that, but I think she was like, you're not almost there. I'm not going to tell you that. So I really, I appreciated that in the end, but I was like, can she tell me how far it is? Like when's this thing going to come out? And at one point she asked if I wanted to try the vacuum. I was like, yes, yeah, let's do it.

(00:30:54):

Nicole: Okay.

(00:30:55):

Amy: So she tried that and I mean I couldn't really see, but my husband said she was like pulling on it so hard that her arm was shaking and at one point the vacuum flew off his head and she went backward and I thought, I was like, did he come out? That was not the case.

(00:31:17):

Nicole: That, yeah, that is called, this is so interesting to me. Hearing you describe the experience from the other side that is called a pop off when the vacuum literally pops off the baby's head.

(00:31:31):

Amy: I was like maybe he came out, she was like, no, no. She just like went flying and I was like, Oh, okay. So then she, I don't know if she just felt like it wasn't working, but she was like, I'm going to put the vacuum down. You got this. And I was like, okay. And she also gave me an episiotomy. I think she cut me twice. So this was a part I was really unclear about. After the fact I listened to a lot of birth story podcasts and such, and I have now heard that episiotomies aren't really done very routinely anymore. So I was like, wow, you just like went for it and didn't even ask me. So I didn't know if that was normal?

(00:32:12):

Nicole: It's not normal. Well I take that back. It's, unfortunately for some people it is normal not to ask, but it should not be. Episiotomy is not that routine at all anymore, cause it's mostly unnecessary.

(00:32:29):

Amy: Yeah. So I just let, now I just keep thinking what would have happened if she didn't do that? Would it have been easier to recover because Oh my gosh, it was so painful after. And I had a friend who actually gave birth the day before me and she just tore and I remember seeing her post a picture online one day of her wearing jeans and I was like, how did you put jeans on? I could barely handle wearing like big giant shorts, just nothing touching that. It was just too much. So I was like, Oh, that must've been why? Because I had an episiotomy and she just got to tear naturally. I assumed that like why her recovery wasn't quite as bad.

(00:33:12):

Nicole: So does she, so I guess so she put the vacuum on and then she said, okay, well nevermind. How much longer did you push before Conrad was here?

(00:33:21):

Amy: I feel like that was like in the middle, so I want to say like maybe another hour.

(00:33:26):

Nicole: Really?

(00:33:27):

Amy: I think so. It's a little bit of a blur, but I know it was a while. It wasn't a couple more pushes or anything like it was normally a while.

(00:33:36):

Nicole: Okay. And then when did she, when do you feel like she cut the episiotomy? Like right as he was being born?

(00:33:43):

Amy: No, she did it twice and I think once was after the vacuum and then once might've been a little closer to him being born. They were a little spaced out and I don't remember exactly when, but it was definitely in the second half of pushing.

(00:34:05):

Nicole: And you remember like seeing her with the scissors?

(00:34:09):

Amy: She announced it, but she didn't ask me, so I knew she was doing it and I guess I didn't think. Yeah, I was in the middle of giving, giving birth. I didn't think to be like, no, no, no, please don't do that. I just kinda, I mean at that point I was kind of like, get the baby out, do whatever.

(00:34:26):

Nicole: Right, right, right. So she was just like, I'm going to do an episiotomy.

(00:34:29):

Amy: Yeah. Okay.

(00:34:31):

Nicole: My mouth is kinda hanging open. I mean just because this is just not typically how, I mean obviously I don't see a lot of other doctors and how they deliver, but usually it's like right at the end when baby is crowning and maybe you need a little extra room for baby to come quicker.

(00:34:49):

Amy: Okay. I think that the second one was at the end. I'm pretty sure. But she had, she had definitely sent me twice and once was a little earlier.

(00:34:58):

Nicole: Okay. Well that, that is, that is not typical. I will say that. Yeah, that is not, yeah. No.

(00:35:06):

Amy: I had no idea.

(00:35:07):

Nicole: Yeah. Yeah. And I will say that it should not have been like, I'm gonna do an episiotomy. It should've been a discussion, especially if it's not an emergency.

(00:35:16):

Amy: Yeah. I mean as far as I know, it wasn't an emergency.

(00:35:20):

Nicole: Right. Well, I can tell you it's not if you were allowed to, I shouldn't say allowed or if you pushed for another any length of 30 minutes, you know, period of time, then it wasn't an emergency.

(00:35:32):

Amy: Yeah. Every so often they would check the baby's heartbeat and stuff. And he was always fine. So I don't know. Yeah. I remember talking to my husband after, you know, I've actually heard and read that it's not common to get an episiotomy. I don't know why she did that. And I mean, he doesn't know either, but he kind of like made me feel better cause he was like, well, would you rather have them done that or how to C-section? I was like, well, I guess I'd rather have an episiotomy. But was that really necessary?

(00:36:07):

Nicole: Right, right. Exactly. Okay. So then I guess let's talk about the moment when he was born and then, how you feel about the experience now. So what was it like when he finally came out?

(00:36:22):

Amy: Well, it was amazing. Yeah. He came out and they put him right on top of me. And like I started bawling basically and it was just really exciting and I felt amazing and that whole flood of, Oh I'm done and here's my baby. So really exciting. That all just feels like such a rush, not that they rushed me but just like a rush of excitement. That's what I meant. So he, yeah, he was adorable. He was perfect when he was born. My husband got to hold him. They asked my husband a couple times if he wanted to cut the cord and he said no every time. And they were like, are you sure you don't want to?

(00:37:11):

Amy: And he was like, I really don't. And then he got to hold him and so Conrad took his first poop on my husband when he was holding him, very sticky and my husband had to throw a shirt away and it was like perfectly time cause I had like basically just given him the baby and I was like, Oh thank God. I'm messy enough.

(00:37:39):

Nicole: That it's funny. That is funny. Well like first poop one day out, I love it. I love it. So then how was your recovery in the hospital?

(00:37:48):

Amy: Oh yeah. So after he was born, we were holding him. They brought in the thing the weighs and measures him and all that stuff. So he didn't leave the room. And while this is all going on, the doctor's still down there, trying to have my placenta come out. She had me push a couple times, but I was so distracted, like this was very minor and she sewed me up, which I couldn't feel cause I still had the epidural. So all of whatever's going on down there I like was pretty, not like distracted. Like I wasn't paying attention for one. The euphoria, my baby's here, which I was happy about because I was like, wow, she's really stitching something up. And yeah, I was just so excited to have the baby finally. So, that all seemed fine. And I mean, overall I didn't think anything was out of the ordinary. I mean, and maybe it wasn't. But you know, it hurts down there and once the epidural wore off and I remember the nurse coming in and being like, okay, you have to go pee. And I was like, wait, what?

(00:38:57):

Amy: So she had escorted me in to pee, and showed me how to use the peri bottle and everything. And then I basically just got to lay in bed for several days. They kept me there. I went in on Thursday, but I had the baby on Friday and they kept me there until Sunday, which coincidentally was Mother's Day. So that seemed really nice. They were really helpful with the baby. They were really helpful with helping me breastfeed and they would at night offer to take the baby to the nursery for a few hours if I wanted to sleep. And I was like, yeah, you could do that. That sounds great. So overall, like that whole experience was awesome, I thought.

(00:39:43):

Nicole: Okay, good. Good. And you felt like breastfeeding was going okay?

(00:39:47):

Amy: Yeah, I mean it was really hard at first. They were having me pump, I guess to get some milk flowing, I'm assuming, I don't know, I don't know what the baby was getting when he was trying to latch to me. I think he kept falling asleep and so they had me pump and I was getting small amounts of colostrum and they were syringe feeding him that after. So, they were having me try to feed him for how long and then pump right after that every three hours, which is pretty exhausting throughout the night and exhausting. But, and they never, I really appreciated that they never once were like, you should give him some formula to like supplement or like you're not really making anything. You should give him formula. They never suggested that.

(00:40:34):

Amy: So I never even thought like, I don't know, I guess they didn't make me feel worried that he wasn't getting anything and they're like, he's fine. This is plenty. His stomach is the size of a marble. He's great. So I really liked that they're very pro breastfeeding.

(00:40:50):

Nicole: Okay. Okay, good, good, good, good. And then physically you said you were just in a lot of discomfort. How long did that last?

(00:41:00):

Amy: Oh, I felt like it really hurt for like a week and then the second week it wasn't quite as bad but still kinda hurt. And then I think after about two weeks it was pretty okay. But for the first week after I was limping around my house, ice packs around the clock. I was like, man, how do people do this, this is painful, right? I was like rotating all these things on and it was, I just found it to be incredibly painful, but I thought, Oh, this must be whatever everyone feels, this must be normal.

(00:41:45):

Nicole: Right, right. Were you taking pain medicine?

(00:41:48):

Amy: Yeah, they gave me just like 800 milligram ibuprofen. But I definitely took that for two weeks straight.

(00:41:55):

Nicole: Okay. Okay. Okay. And then did do you recall her saying what type of tear you had or anything like that? Like a number to it?

(00:42:04):

Amy: No. And I did ask her one point how many stitches did I get? And she said, well, I wouldn't really worry about how many, it was more like a seam. And I was like, what does that mean? So I had no idea.

(00:42:18):

Nicole: Yeah. It's like we use one long stitch and kind of put it all together. So it's not individual stitches, so clearly that the analogy doesn't translate well.

(00:42:29):

Amy: In my mind she was saying, there's so many stitches you might as well not worry about it. And I was like, Oh my gosh.

(00:42:35):

Nicole: Gotcha, gotcha, gotcha, gotcha. Okay. Okay. And then when did you have your postpartum visit?

(00:42:44):

Amy: At six weeks.

(00:42:46):

Nicole: Six weeks? Yeah. Did you feel like that was too long?

(00:42:50):

Amy: Yeah. I kinda do cause by, I mean at that point, I felt pretty okay. But before that and I don't know, I'm not one to really complain. I always think like, this must be what it's like. Like I've never had a baby before, but I feel like early before that would have probably been better cause I would have liked to be like, is this healing okay? Does this look right? But I just was like, well, it's getting better every day, so it must be fine. It was kind of what I figured, but I wouldn't have hated if they recommended a sooner appointment.

(00:43:22):

Nicole: Gotcha. I mean, we're getting better. We're trying to say women should be, we should touch bases with women, whether on the phone or in person within the first three weeks after birth, especially for first time moms.

(00:43:34):

Amy: I guess this isn't the same, but the lactation consultants called me a bunch of times and texted me, which I kind of thought it was awesome to check on how that was going. But yeah, I don't think anyone checked on me personally.

(00:43:49):

Nicole: Yeah. Yeah. And then how do you feel like, did you have any trouble with postpartum depression?

(00:43:55):

Amy: No. I actually, I mean I was pleasantly surprised. I think because I brought it to his attention, my husband was like really on top of it. He'd always be like, how are you feeling? How's everything going? Are you happy? Do you feel like I'm helping enough? And I was like, I'm fine. Calm down. We're good, we're good, we're good. Yeah. I appreciated it. But at the same, I was like, you're a little overkill. But he was good and at the pediatrician's office, they make you fill out a form every single time you go in. I think that's great. And I've never had a problem, so I'm like, I wonder like what the process is. If I did answer a question that flagged them, I'm just curious, so I don't really know what that, what would happen.

(00:44:39):

Nicole: Yeah. Yeah. So we end up referring to either a counselor or a psychiatrist. Yeah, yeah. Ideally we should have resources connected. Some communities have better resources than others, but there should definitely be like what to do next if somebody does need help.

(00:44:57):

Amy: Yeah, there is a support group at my hospital. I've seen signs for it, but I don't really know much else about it other than that.

(00:45:06):

Nicole: And then at your postpartum checkup, did you see the doctor who did the delivery or somebody else?

(00:45:13):

Amy: I did see my doctor who did the delivery. She's a nice person and I liked her, but that was interesting how she just said, how's everything going? Do you want me to check out what it looks like down there? And I was like, I mean I guess not. It seems fine. And so she never checked anything.

(00:45:34):

Nicole: Okay. That's interesting...

(00:45:36):

Amy: It was also sort of my fault. But I guess I kind of just...

(00:45:39):

Nicole: It's not your fault. I think we forget that we do this hundreds of times, for you it is your first time. Right. And you know, we should be able to provide women guidance. So this is definitely really eye opening. I think in some ways we think, maybe we need to ask a different question or ask it a different way or just say, Hey, like, let me just take a peek and make sure everything looks okay. It doesn't have to be like, you can just look from the outside. Usually you don't have to look all on the inside, but, okay. And so you were kind of like, well, if she's saying that I don't have to do it, then I don't...

(00:46:21):

Amy: Yeah, I guess she was like, does everything like feel okay? Do you, does everything feel fine? I was like, well yeah, it does. So she was like, okay, well I don't have to look down there. I was like, Oh, okay. Which seems kind of weird, but I guess I just got nervous and was like, she's saying it's probably fine.

(00:46:40):

Nicole: Right, right. And then did you, what were your thoughts during that six weeks or when you saw her about the episiotomy?

(00:46:49):

Amy: I know, I think at that point I still didn't realize that it was like so uncommon. I think it took me awhile for it to like really think in that like that didn't need to happen. Like I think it took me a while, a couple of months.

(00:47:04):

Nicole: Okay. Okay. Did you have any, I don't know what the right word is, not guilt, but just like being angry even, or like frustrated or just confused or how did that make you feel?

(00:47:19):

Amy: Yeah, I mean, I wasn't, I'm not, I wasn't really that angry about it. I guess I kind of just, and I mean, I know that, I know now that it's not how it should have gone, but I was like, well, I know better for next time. And like, that's fine. I think my husband and I would like another kid and I was like, you know what, next time I'm gonna make sure that I talk about that in my birth plan or whatever I have to do to make sure that doesn't happen again. And I don't know, I just, I think I just am the type of person that doesn't really dwell on things that I can't change. So I just want to think about what I can do next time is kind of my thought.

(00:48:00):

Nicole: Gotcha. But it does seem like, and I'm not trying to stir up any controversy or anything, I'm just trying to get an honest assessment of how you feel, but it does seem like it bothered you.

(00:48:08):

Amy: Yeah, it definitely did bother me. I just, I feel like it wasn't to the point where I was gonna like say anything or complain to the hospital or anything like that, I guess.

(00:48:20):

Nicole: Gotcha. Gotcha. Okay. Okay. And while I'm thinking about it, was she an older physician by chance?

(00:48:27):

Amy: I mean, I don't think she was that old. If I were to guess, she was probably, I mean I guess she's probably in her fifties, so no, not especially old.

(00:48:38):

Nicole: Right. Yeah. It tends to be physicians that are older who do episiotomies, at least in my experience, more routinely because that's how they were trained. And sometimes it's harder for them to let go of that. So that doesn't entirely surprise me.

(00:48:51):

Amy: Yeah. And I think, I mean out of the four doctors at that office, the three of them were kind of older and one of them was pretty young. I bet she was around my age, like 30. But I didn't see her while I was giving bith. I think she checked on me once when I was in labor, so that was about it.

(00:49:18):

Nicole: So overall, how do you feel about your experience?

(00:49:21):

Amy: I have a really positive view of how it went. Overall I was very happy I got to have a vaginal birth. I was happy that I got an epidural and then I didn't have any negative effects from that. I was happy my baby came out perfectly healthy and also that he was born precisely on time for me to get my exact amount of maternity leave.

(00:49:51):

Nicole: Right, right.

(00:49:51):

Amy: So yeah, I mean, and I really liked the hospital. I thought all the nurses were amazing. Everyone was just super nice and respectful. So overall I have a really positive view of it and am certainly planning on having my next kid there if that works out.

(00:50:10):

Nicole: Gotcha. But it sounds like you still have some, you would do things a little bit different the next time.

(00:50:16):

Amy: Yeah, I think it's helpful to kind of know what to expect next time. Except I'm still like, wow, what if next time I have a kid I go into labor on my own like at my home, which is what I thought was going to happen. But I'm like, this time I might not really know what that means.

(00:50:32):

Nicole: It'll be the same, like how your contractions started ramping up in the hospital except you'd be at home.

(00:50:37):

Amy: Yeah, I just think it's that whole, I feel like they talk about this a lot, like in the birthing class and stuff, when you should decide to go to the hospital. And I was like, I didn't have to think about that. I was already there. One of my really good friends had had a baby like five months earlier and it was her third baby, but for some reason she kept showing up at the hospital. They kept sending her home. They were like, well, you're not really far along enough yet. They sent her home two or three times and then the last time she had gone home, she, I guess, I don't know how the details, but they tried to get back to the hospital and she ended up having her baby in the car on the side of the highway.

(00:51:22):

Nicole: Oh, okay. Okay.

(00:51:24):

Amy: Well, I was like, I mean, so she had told me that story not too long ago and I was like, Oh my gosh. Okay, well that was your third kid. That probably won't happen to me. But why did they send you away?

(00:51:35):

Nicole: Yeah, I can understand. For first babies, I have not seen that happen before. A third kid, things can go quick and obviously they did for her. Yeah.

(00:51:49):

Amy: And then she was like, Oh, it was like a 15 minute drive to the hospital. We did not make it.

(00:51:54):

Nicole: Right. Right. Sometimes when babies, I hate to, I don't want to like scare anybody, but sometimes when babies come like fast and furious like that, there's no, it doesn't matter. You could be wherever the baby's just going to come. So there's not a whole lot to interrupt that process, obviously.

(00:52:11):

Amy: She has unmedicated births, all of her births were unmedicated. So I knew like that wasn't really a thing for her, but I was like, that happened to me and I couldn't get an epidural? Oh my God. I was like, I guess I'd survive. It sounds like it was really quick, but that's just that like freaked me out.

(00:52:28):

Nicole: Right, right, right, right. Well you did great getting to seven centimeters without an epidural.

(00:52:34):

Amy: Yeah. I guess I just didn't, I didn't know. And it seemed like, I mean this didn't really bother me, but it seemed like none of the nurses believed how much pain I was in. They were like, you seem fine. And I was like, I guess. How much more worse does it get, like, bad? Can anyone explain this to me? So I just kept thinking like, it must get much worse. And then they were like, wow, you're way further along than we thought. I was like, Oh, okay.

(00:53:02):

Nicole: Everyone expresses pain differently. And it sounds like you don't express it very, like you weren't like screaming or yeah.

(00:53:11):

Amy: More clenching.

(00:53:14):

Nicole: Yeah. Right, right, right. And so they didn't see some of those cues or signs that maybe things were progressing faster than they realized, obviously.

(00:53:24):

Amy: Yeah. So I was pretty proud of myself when they told me I was at seven centimeters. I was like, I made it pretty far. I'm ready for an epidural.

(00:53:32):

Nicole: Yes. Yes. I will put in a tiny plug if you next time, if you want to go the distance, I'm sure you could.

(00:53:37):

Amy: Oh my gosh. I don't have anything against epidurals, but part of me feels like it's really bad ass to do it without it.

(00:53:47):

Nicole: Right. If you got to seven, the rest of it is usually not that long. So I'll put that plug in your ear. How about that? Alrighty. So overall happy with your experience, but then if you had to pick something that you weren't happy about, it would be the episiotomy part?

(00:54:05):

Amy: Yeah, for sure. Which I'm glad I know now.

(00:54:09):

Nicole: So let's, just to wrap up, what is your favorite piece of advice that you would give to other women as they get ready for their birth?

(00:54:19):

Amy: I know not everybody can be really just open to anything, but that would be my advice. Just don't try to over plan because, and I've heard other people give this advice a hundred times, but it really truly is the best advice, I think, is that you can't plan your birth to the minute at all. So just accept that and be open to things changing in your plan.

(00:54:50):

Nicole: Absolutely. Birth is an unpredictable process.

(00:54:54):

Amy: We didn't really have a plan, which I don't know if you could be that type of person. I'm not a super planner per se. So if you can just not have a plan, I felt like that was kind of nice because everything seemed like it was going the way it should.

(00:55:11):

Nicole: Gotcha. Gotcha. So maybe not have a rigid plan, but maybe have an idea of what to expect, do you think?

(00:55:19):

Amy: Oh yeah. Yeah. And I mean, I guess it would be nice to know what common practices are so that I could be like, please don't cut me open.

(00:55:29):

Nicole: Gotcha. Gotcha. Yeah, for sure. Absolutely. All right. Well thank you so much for sharing your story. I really appreciate it. Yeah. Yeah. Where are you online, anywhere, anything like that?

(00:55:41):

Amy: Instagram. It's @AJCole230, I think although I'm private on Instagram, but that's only because I'm a teacher and I don't want any of that.

(00:55:52):

Nicole: Oh yeah, don't, yeah. My family is teachers. I understand you can't be...teachers have to hide online.

(00:56:00):

Amy: Oh yeah. It's @AJCole230. So I mean, as long as you're not one of my students, I will happily accept a friend request.

(00:56:10):

Nicole: Gotcha. Yeah. Yeah. All right. Well again, thank you so much for being here and we'll have to hear what happens when you get pregnant again and how the birth goes the next time around.

(00:56:21):

Amy: I'm nervous, but yeah, thank you. I feel that when the memory starts to fade and then next thing you know you're like, well that's not that bad. And now they're sleeping through the night and then, yeah. And then next thing you know, baby number two. And our son started sleeping through the night perfectly at three months and he still does. So I feel like we're a little spoiled there.

(00:56:46):

Nicole: Like sleeping all the way through the night?

(00:56:48):

Amy: He sleeps from like 8:00 PM to 7:00 AM.

(00:56:51):

Nicole: Oh my God.

(00:56:52):

Amy: Has ever since three months.

(00:56:55):

Nicole: Nice. That is very nice.

(00:56:57):

Amy: Yeah, I do not know what happened. It was like a fluke.

(00:57:01):

Nicole: Right? The door is open for the next time around for sure. It could even be more like eventful, but hopefully not too eventful.

(00:57:12):

Amy: Yeah. Yeah.

(00:57:13):

Nicole: All right. You take care of Amy.

(00:57:21):

All right. So wasn't that a great episode? I love Amy's attitude about how she has really just a positive and upbeat and looking forward kind of attitude about things. I think that's a really great perspective on how to approach life. Now, you know that after every episode I do something called Nicole's notes where I talk about my top three or four takeaways from the episode in the conversation. So here are Nicole's notes on my episode with Amy.

(00:57:51):

All right, number one, I love that Amy stuck to what she felt was right for her during her labor and birth. She knew that she wanted an epidural and she went with an epidural and then the harder part is that she stuck with her instinct of holding off on being induced. Now I'm not saying that not being induced is better than being induced. What I'm saying is that it's good to take in all the information and in Amy's case, she took in all the information about how her water was broken, but she wasn't quite in labor yet. She could wait, she cannot wait, and then she checked in with her instincts and what her inner voice was telling her and she went with what felt best for her when she took all of that information in. Now sometimes that can be hard. Like Amy mentioned, her husband said, don't you want to just listen to the doctor? And you know he probably wasn't doing that to be difficult or anything. I get why people want to do that or have that sentiment. You don't want to seem like a troublemaker. You think this is the doctor, this is what they're saying, but it's important that you take your intuition into account. We have it for a reason and this can be hard when the person you're dealing with is nice.

(00:59:17):

Amy also talked about repeatedly how the doctor was a nice person, but I think it's always great if you're having some hesitation or some concern about something to just step back for a second and check in with yourself and see how you feel. Now, you need to do that in the context of getting a broader sense of the information in general and that's where that B.R.A.I.N acronym comes in handy. If you haven't heard of before, let me tell you what that is.

(00:59:42):

So B.R.A.I.N is whenever someone is presenting an option to you for what to do during your pregnancy and birth. The B.R.A.I.N acronym is B. What are the benefits? R. Is what are the risk? A. What are the alternatives? I. What is your instinct telling you? What is your intuition telling you? And then N. Is what happens if we do nothing? So check in with those things. Check in with your intuition. I think it's an important thing to do and to utilize. We have that voice for a reason.

(01:00:17):

All right, number two, episiotomy. Amy's story about episiotomy should never, ever, ever be done without consent. Now obviously Amy has made peace with what happened to her with the episiotomy, and she knows how to approach it next time. But let me tell you these stories of episiotomies being cut without consent really infuriate me every single time I hear them. It's such a prime example of how we devalue women's rights to make choices about what happens to their own bodies. And it's something that's so invasive. I mean, it's literally cutting a woman's body. And the truth is, it really does not take that long to explain why an episiotomy might be necessary. The few times that I've done an episiotomy and I haven't one done done one gosh and probably I know over a year, it doesn't take that long to explain.

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Usually it's when the heart rate is low and baby needs to be born quickly and it may go something like, Hey Sarah, your baby's heart rate is dangerously low. We need your baby to go ahead and be born. So I'd like to cut a small a episiotomy in order to make more space for your baby to be born quicker. When I explained that, everybody's like, okay, I get it. Baby's heart rate is low, baby needs to come out, let's do it, let's get it done. So it doesn't take that long to explain. And if someone doesn't explain why an episiotomy is being done, then it's probably because they know that there's not a medical reason why it should be done, that they're just trying to speed up the process of birth.

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All right. So the last thing I want to talk about is don't stay in environments that are unsupportive. So in Amy's case, she talked about how some of the Facebook groups she was in were unsupportive, how some of the Facebook groups were like mom shaming and things like that. Do not stay in environments like that. Another example of staying in an environment that's unsupportive is sticking with a provider who you know does not fit your philosophy for birth or isn't really attentive to your needs. Please don't stay in that sort of unsupportive environment change if you need to. So if you need a new provider, find a new provider. There are other Facebook groups out there. I will talk about my own Facebook group All About Pregnancy and Birth. It's a great no judgment, no shaming zone. We have about 800 women in the group now and it's a really supportive environment. The community manager, Keisha does not tolerate any foolishness, judgment or shaming. Thankfully we haven't had that pop up, but I can tell you if we did, then those members would not be allowed to stay in the group. I also don't tolerate judgment or shaming as well, so really a supportive community. It's All About Pregnancy and Birth. You can find that on Facebook and I'll link that up in the show notes as well.

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All right, so that's it for this episode of the podcast. Be sure to subscribe to the podcast in Spotify, Apple podcast, wherever you listen to podcasts. I would also love it if you leave a review in Apple podcast. It helps other women find this show. Of course, I love to hear what you think about the show and it helps the show to grow. I also do shout outs on episodes of folks who leave me a review, so please do that. If you feel like you appreciate what I'm doing here, I would love to hear about it and one of those reviews. Also, don't forget about my free online class on how to make a birth plan that works. Over 1,000 women have gone through the class and just the last month or so and found it very, very helpful with that updated information, giving birth during our COVID-19 times. You can register for the class at www.ncrcoaching.com/register. It's an on demand class offered several times a day, so do check that out.

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Now next week on the podcast I have Alice Turner. Alice is a doula and childbirth educator and her work focuses specifically on getting partners ready for their role as a support person. So this will be a really informative episode, so do come on back next week for that. And until then, I wish you a beautiful pregnant and birth. Thanks so much for listening to this episode of the all about pregnancy and birth podcast. Head to my website at www.ncrcoaching.com to get even more great info, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class on how to make a birth plan as well as everything you need to know about the birth preparation course. Again, that's www.ncrcoaching.com and I will see you next week.

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