Is it safer to have a child in the hospital or at home? What about using a midwife? Today I speak with nurse midwife Anne Margolis and we outline what the evidence shows regarding best practices for pregnancy, childbirth and postpartum. The good news is that there are a few simple techniques that can reduce risk, ease stress and improve the health of you and your newborn baby.
Dr. R’s Fast Facts
Big Picture, Less is More When it Comes to Pregnancy, Birth, and Postpartum
- In the United States we are losing more mothers and babies in childbirth than other industrial countries who use midwifery more often
- Over care may impair outcomes
- Decisions should be premeditated
- The more educated you become, ahead of time, the more you can study the pros and cons and make decisions about what you are comfortable with when it comes time to deliver
- When a woman chooses to have her child in a hospital under standard care, she is hooked up to fetal monitors, not able to eat or drink anything (which can affect stamina) and often given medication to stimulate labor which can cause fetal distress
- Monitoring (mom and baby being on monitors in the hospital) may lead to over treatment
- Leads to increased cesarean births, forceps and vacuum deliveries
- Leads to more medication, baby becomes exposed to things like pain meds and antibiotics
- Without being bound to a monitor the mother can move around freely which can help with delivery and pain
- Proper prenatal screening greatly reduces risk and helps guide pregnancy decisions
- Pain relief
- Having the loving support of a Doula or another women helps reduce pain significantly
- Mental preparation during the pregnancy reduces pain in childbirth
- Using different language for pain also helps
- Freedom of movement is important with childbirth
- Unfortunately, with standard medical care women are unable to get up and move while connected to a Fetal Monitoring System
- Immediate skin to skin contact is very advantageous for the newborn
Having A Doula
- Decreases cesarean rate
- Lowers levels of pain and anxiety
- Prepares the mother all throughout the pregnancy for childbirth
Rate of Cesarean Births
- Above 30% in America
- The majority are not medically necessary
How to Decide Where to Deliver
- In Anne’s experience her transfer rate from midwife to physician care is 7%, meaning 93% of her patients are giving birth naturally and vaginally
- If you are a healthy individual who has not had complications during pregnancy, you are a great candidate for a midwife birth in whatever setting you choose
- If the mom or baby has had complications with pregnancy or known heart or blood pressure issues or diabetes, plan to have the baby in a hospital
- If the baby shows irregular heartbeat or any signs of ill health early on, give birth in a hospital
- If the mom goes into labor very early, give birth in a hospital
- As you go through your normal screenings during pregnancy, you will get more and more information about the best environment for your childbirth
- The most common emergencies that can happen are the baby needing assistance breathing and mothers hemorrhaging after birth. Midwives are skilled to handle both scenarios
- Vaccination – She urges women to educate themselves on taking the flu vaccine while pregnant – more in Anne’s blog post here
- With every Cesarean birth, the mother is given antibiotics to prevent infection, this disrupts the natural flora and the baby becomes exposed
- Probiotics are a good idea
- Breastfeeding is very advantageous for the baby as it helps to build their flora
- Immediate skin to skin contact is very advantageous
- Cord cutting should be delayed until cord is no longer pulsing or until after the placenta is delivered
- 10-40 minutes delay usually
- Do not suction baby, babies can actually clear their own lungs
- Heal and relax postpartum for 4-6 weeks at least, from a vaginal birth
Learn More About Anne’s Practice
In This Episode
Episode Intro … 00:00:40
Pregnancy, Birth, and Postpartum … 00:06:50
Over Care May Impair Birth … 00:18:34
Pain Relief & Doulas … 00:20:12
Not Eating During Childbirth & Cesarean Birth … 00:22:56
How to Decide Where to Deliver … 00:26:15
Postpartum … 00:33:20
Closing Thoughts … 00:42:15
Episode Wrap-up … 00:44:00
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Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Anne Margolis. And we’re going to be talking about everything relating birth and successful child birthing and some of the do’s, some of the don’t’s, some of the controversies. We’ll also talk a little bit about the preconception and postpartum period. And it’s definitely a discussion, I think, is at the root of where some of our health conditions come from. And it’s one of the earliest and most fundamental forms of prevention, which is healthy formation of our children and their immune systems. And so it’s definitely a conversation that I’m really looking forward to having.
Anne, welcome to the show.
Anne Margolis: So glad to be here. Thanks for having me.
DrMR: Thanks for bearing with me. I think I rescheduled on you at least twice. And so this will I guess be the third time is a charm here.
AM: It’s fine.
DrMR: So, tell people a little bit about your background.
AM: Yes, I went to University of Pennsylvania School of Nursing. And when I did my obstetric rotation, I knew right away I wanted to go into OB. And my first job as a new graduate, I worked for a medical unit at NYU, university in New York, but then I got into OB. And it was working in the obstetric unit for about four years where I developed a real fear of birth. Because I was seeing more and more and more problems than I ever imagined coming from just healthy, low-risk women and babies during the whole birth process. I was attending more caesareans. I was in the operating room more than I would expect to be. And I wasn’t seeing good outcomes.
So birth is like a crisis, like an ER scene, a medical emergency, a disaster waiting to happen. And it was not always great outcomes. It was scary. And then I had my two babies on the unit. My first two babies on the unit where I worked. And so I was given the royal treatment. But I had every single intervention possible. And I think what really got me into midwifery was what I know now to be my own birth trauma. I just went in, in labor. We didn’t have internet back then. But I took Lamaze and I thought I was very well-educated as an obstetric nurse, Ivy League education and all. But I had all the routine interventions. It seems innocuous. But in a hospital gown, which makes you sort of feel dependent and like they know everything and you know nothing, and you’re sick like an assembly line patient, told not to eat or drink, couldn’t move, attached to an IV and an electronic fetal monitor, and of course, all of this kind of interferes with a person’s ability to birth.
So, of course, I wasn’t dilating fast enough. The doctor kept coming in and telling me, ‘You’re still 4, you’re still 4.” And he wanted—he told the nurse outside the room to hang Pitocin, which I knew what that was, to strengthen the uterine contractions to make everything stronger and quicker and that my Lamaze coping went out the window and then there was an epidural anesthetic. And what happened is my worst fear, they called the STAT emergency caesarean.
Now, here I am in a hospital on the unit where I work and I’m seeing everybody’s panicked face around me. I knew my daughter’s heart rate, my baby’s heart rate dropped so seriously low that they whisked me in and they had minutes to get her out. And this is in a hospital where I’m supposed to feel safe. I was waiting there watching the clock, 10 minutes, 20 minutes, 30 minutes, 45, an hour. Nobody was monitoring me or they were waiting for the assistant surgeon to come. And I was convinced that by now she was dead. The epidural just took over my body. I started pushing and the doctor came running in, was panicked, ‘Get me a vacuum!’ and he cut a big episiotomy and vacuumed her out. And she’s pink and fine and beautiful and they tell me to look at her and everything’s fine. And I was not fine. I couldn’t look. I was like—now I know that’s called birth trauma.
But I was telling my frustrations. Because aside from my own trauma experience, having to rescue a lot of the problems that were caused by the routine interventions done to women as a nurse, I was having to rescue the problems and my hands were tied. And so I was telling my frustrations to a friend of mine. And she says, why don’t you be a midwife, a nurse practitioner. I’m like, I said, “What’s a midwife?” And she explained it and this was—I went to the library and it was like, “Oh, my gosh. I have to do this.” I applied to the oldest midwifery school in the country. And I went and I’ve been a midwife for 22 years now. And it’s like I came home. What a difference! It restored the dignity and the normalcy and celebration in the process of having a baby but it’s also much better, safer outcomes when the midwifery model of care is applied to healthy, low-risk women and babies.
Pregnancy, Birth, and Postpartum
DrMR: And there’s so much great stuff that you say there that I think is worth just echoing it as we move in to the conversation here. And one is, I think people are oftentimes scared, right? These things happen quickly. There’s not a lot of discussion.
And rightfully so, sometimes there may not be a lot of time for discussion and weighing of the evidence and deliberation. But from what I’ve seen and gathered on this issue, there’s not a lot of good information being presented and people feeling like they know everything that they’d like to know. And oftentimes, just as you’re describing, people end up learning what they would’ve rather have had done after the fact and look back and say why didn’t I know about this or maybe they were too fearful to make the decision that they’d like to make, as you said, because you’re in a hospital gown and this very kind of submissive role.
So there’s definitely a lot here I’d like to try to open people’s eyes up to. And we won’t be able to get into everything on this topic, right. But I know you have some additional resources that people can go through to get there. But I want to try to get through a few categories. And the way I’m hoping to organize this is some of the most important issues and what to do and what not to do regarding that issue for pregnancies—maybe we can take a look at the top three or so for pregnancy—for birth, and then for postpartum. Do you think we can proceed through in that kind of organizational structure?
DrMR: Okay. All right. So let’s start then with pregnancy. What would you say are—again, I know we can’t get to all of them. But what are a few of the most important issues and where would you recommend people in terms of here are some things to do and here are some things maybe to avoid? Again, understanding that maybe none of these are absolutes, but just kind of general guidelines for people.
AM: General guidelines in terms of pregnancy—this is why I created my course. I like to remind, to have women kind of return to themselves and get their power back. Reclaim, take responsibility for their health, their pregnancy, and their birth. And remind them that we, as a species, have been delivering babies for thousands of years or we wouldn’t have survived. And that the process works. And that they can do it. And that they are stronger than they know. And that people should make in the pregnancy, I like to review with them all the pros and cons of all the interventions that are possibly, that could be done, the testing and the procedures that are done to women and babies in the pregnancy, in the birth.
So when they’re in that situation of vulnerability, like you said, they don’t have to be there making decisions. They can make those decisions in the pregnancy, prepare for that so that they can find a provider and a setting that’s in alignment. Even though our country ranks like near the bottom as compared to all the other developed countries when it comes to maternal and newborn mortality and morbidity. That means we’re losing more mothers and babies in childbirth than other developed countries despite spending the most money and doing the most intervention, right?
And the countries that have the best outcomes in terms of healthy moms, healthy babies during pregnancy, birth, and postpartum are countries like Europe, Scandinavia, Sweden, Holland where midwifery care is much more predominant for healthy, low-risk women and the obstetricians we need them when medical and surgical complications occur, but those are rare. But when they work together as a team, that’s when we’re seeing the best outcome.
DrMR: So let’s go into more detail about that because I think that’s a great point that you make, which is it doesn’t have to be ‘okay, we’re going to use a midwife which means we’re not going to go a thousand yards near a hospital or ever have any kind of conventional medical intervention’. And I think it’s helpful for people to understand that it doesn’t have to be an either/or sort of decision that they’re making.
AM: No. Midwives work in hospitals.
AM: My goal is evidence-based care and sort of—I call it the home birth midwifery model of care. But it’s evidence-based, physiologic, natural birth, no intervention, unless medically necessary and in all settings, in all settings: Birth center, hospital, and home.
DrMR: So let’s go into a little bit more detail about what you just said regarding other countries that use midwifery more actually have a lower rate of infant mortality because that may be something—
AM: And maternal.
DrMR: Okay. So both mother and baby. So that may run a little bit counter-intuitive to what people are thinking, you’re in a hospital, you have a gown, the whole scenario you described earlier. One might think that that’s the safest. But it sounds to me like maybe when we start pulling on that string, you might be in a “safer looking environment” that might not be the best for the outcomes and other outcomes that may more-so be home-based may be safer. I’m making the assumption there but fill in some of those details for us.
AM: Well, there’s no evidence—like there’s meta-analysis. Evidence-based birth and evidence-based care is looking at all the research and there’s no evidence to support many of the routine interventions that are done to all women who go to the hospital. So that could be—in labor, that could be restricting movement and not allowing them to eat or drink, putting them on their back, having them in bed, continuous electronic monitoring, induction, breaking their water. A lot of the standard routine interventions, there’s no evidence to support. In fact, there’s more evidence that they’re harmful, right?
So the more we can trust the process and allow it to be—as long as there’s no complication and most healthy women have healthy babies, right? So we need to monitor, of course, when I’m as a midwife in the hospital, birth center, or home, I’m there as a lifeguard. But the best intervention and I’ve been to a major conference and this was said by an obstetrician to a group of 500 obstetrical providers in the room. He said, the best intervention at a birth is no intervention. It is actually to knit. Now, this is coming from a very brilliant obstetrician. He said, who here can tell me what is the best intervention to do at a birth? And every seasoned practitioner in the room was wrong and he was making a joke but I’ll tell you why it’s brilliant. He said “It’s to knit.” And that is because it’s this calm, seasoned, experienced presence of a midwife or an obstetrician in the room with eyes open, ears open, heart open, can talk but hands are occupied, right?
So the hands are knitting and not interfering when it’s all going well. Of course, if something is an issue, we need to put down the knitting and deal with it. But the vast majority of time, first, do no harm. Allow it to happen on its own. It works, right? So that, I thought, was just brilliant. His name is Dr. Michel Odent and he is a French obstetrician practicing in England. And also Dr. Marsden Wagner, who was the former head of the World Health Organization Maternal Child Health Department/Division. He’s a perinatologist. He says, what’s the most dangerous thing that a woman can do in labor is actually, because of what’s going on in many of United States obstetrical units, he was saying, is to get out of their house and go to the hospital when they’re in labor.
So my passion is not to convince everyone to have out-of-hospital birthing but to empower women and their families so that with their voice, that they can speak up, that’s where we can create change. We could create change in the hospital setting because not everybody is going to be comfortable or have the option, let’s say, to give birth out-of-hospital. But the UK—the UK, the health regulators, we have the NIH and the CDC. We have our health regulators here, they have the NICE, N-I-C-E, which is the National Institute of Health and Care Excellence, based on all the evidence, they’re urging more midwife-led maternity units in the hospital and out of hospital birthing for healthy, low-risk women. This was published in major news media in the United States. But it hasn’t happened yet. We’re waiting.
Change is slow. That’s what I want women to take home with this and their families. I want to empower them. I want them to know they can speak up. Hospitals are not, and doctors and midwives, we’re not law enforcement people. You have the autonomy and you have the power to speak your voice. Make informed decisions, knowing the pros and cons of all the different testing and procedures. And you decide what you are comfortable with. So then, when you decide that, is your provider and setting in alignment? Because, listen, an obstetrician, thank God, is a surgeon and a medical doctor who is trained and skilled in high risk.
So if a person wants a natural birth and they’re going to a surgeon, it’s going to be very hard to have a natural birth. Because they’re going to someone who is skilled in surgery and in treating everything medically and surgically. But if somebody wants a natural birth, they can find an obstetrician who is, let’s say, more supportive of natural birth or a midwife, that their expertise is dealing with a healthy population and keeping birth normal and protecting the normalcy of it, right. And then when they work in that team, that’s when we’re seeing excellent outcomes.
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Okay, back to the show.
Overcare May Impair Birth
Now, is it your thinking that or is some of the evidence suggesting that working in a hospital and having this higher degree of monitoring may lead to excessive interventions that aren’t actually needed? Is that one of the underpinnings of this?
AM: Oh yeah, it’s a whole cascade. It leads to increased caesarean and forceps and vacuum deliveries. It’s leading to much more medication and neonatal intensive care unit stays. Yeah, so for a woman who is told she has to simply stay in bed and not either drink and be connected to the electronic fetal monitor. So already, she’s increasing her risk for all the other interventions. She’s not going to labor well. She’s going to need medications to stimulate the labor. It can cause fetal distress. The electronic fetal monitoring has not reduced cerebral palsy from oxygen deprivation but it’s increased caesarean section three to five-fold. A lot of times it’s one intervention that just leads to another that leads to another, leads to another.
And I’m amazed, the more I practice, thousands of babies later, after 22 years of doing this, that less is more. That it works. That women just need the space to know that they can do it. Just like when you’re breathing or going to the bathroom. You don’t need everybody watching and monitoring and poking and prodding, right? It just works. I mean, the evidence is showing that physiologic normal birth is the way to go, non-pharmacological pain relief, keeping mom and baby together, close not separate.
Pain Relief & Doulas
DrMR: So what kind of pain relief, as an example, are you advocating or is used?
AM: Well, there’s so much. I mean, there are so much evidence having just the loving support of a doula or another woman, like throughout history women supported women having babies. It was a community family event where the women in the community supported that woman. So to be alone has scientifically a lot of problems associated with that, right? When a woman goes to the hospital, she’s alone. She can’t expect her partner to know exactly what to do for her. And this is just kind of like an accident of history that women have been isolated from birth. When birth was moved to the hospitals in the United States, the early 1900s.
But before that, we were surrounded by birth. And so there was a familiarity with it and all the women in the community and their family would help each other. But now, birth has moved to the hospital and not only we don’t know about it but there’s a fear around it. So part of dealing with the pain, how I help women is in the pregnancy to prepare them, kind of like how an athlete or any major athlete, dancer, mind over matter sort of thing, that they can do it and understanding labor for what it is and that the pain has a purpose and that we use other language.
And there are many different kinds of preparation, like a mental mindset shift. But having the presence of a doula is huge. Studies show that having a doula or somebody like a doula, like a woman who can mother you, mother the mother, has huge decrease in pain, anesthesia and analgesia, epidurals, and narcotics, which affect the baby and also increase the risk of caesarean, that interferes with breastfeeding. So this is like whole chain of events that can happen, right?
So just by having a doula decreases caesarean rate and has so many scientific benefits of just having that support person. And then like we use freedom of movement, freedom of localization like when a woman is not confined to a monitor, and can eat and drink, and can move around, we can dance and she can rock and she can sway and she can use the pain, it helps her get into different positions that help the body, help the baby navigate down the birth canal. So it eases the birth and it eases her comfort.
Not Eating During Childbirth & Cesarean Births
DrMR: Is the main reason that eating is advised against? Is that because it’s contraindicated if someone were to need a caesarean section? Is that where that comes from?
AM: It comes from an archaic. It’s not evidence-based. Only if somebody is going to need like an emergency caesarean, which requires general anesthesia and she’s got food in her stomach that they’re worried if she aspirates, she could choke on the food. But the problem is that’s not supported by the evidence just like would you run the 26-mile marathon or do any major athletic event, which birth—labor is likened to, without hydration and fuel? No, right. So then the uterus is not going to contract well. She does not have the same stamina and that increases the pain. Sometimes that’s what we call dysfunctional labor where the uterus just contracts but it’s not doing anything. And then we like use of the shower and the tub, there’s a lot of different natural remedies.
DrMR: Just a quick follow-up there, to try to get people a relative sense, do you know roughly what the prevalence of needing an emergency C-section is?
AM: Well, you see, that’s the thing. First of all, the United States has one of the highest C-section rates in the world. We’re above 30% now. It’s increasing annually.
DrMR: And there’s a delineation between emergency and planned, right, just for the audience?
AM: Yeah. In terms of the statistics, I would say that the majority of these caesareans are not medically necessary. But the thing is, when—a lot of times, they call a STAT caesarean and it’s not an emergency. So sometimes it’s a false diagnosis of an emergency. But it’s still very rare that a person is going to need general anesthesia. They can give—if there’s a real emergency, they’re very quick, predominant anesthetic is spinal or an epidural, which has nothing to do with the person eating.
DrMR: Got you. Okay, so thank you clarifying. Just to try to give people some evidence to help them feel more comfortable if they were to eat, that should there be an emergency, it’s not to say that you wouldn’t be able to undergo surgery if needed. I mean, there is a slight, slight chance of needing that anesthesia, it sounds like, but it’s very minimal and the other option of having a localized anesthetic is on the table to help. So okay, that makes sense.
AM: Right. And there’s no evidence to support not eating and drinking in labor.
DrMR: Right, to improve the outcome of the labor, right, right with you there.
AM: Right, yeah.
DrMR: Okay. So yeah, I mean, the case you’re making makes a lot of sense. Essentially, there’s this cascade all the way from, I guess, eating and then being hooked up to a monitor and not being able to move to that preempting a C-section or pain medications when they’re not actually needed. And then, of course, we kind of snowball from there.
How to Decide Where to Deliver
Are there any other major issues when the woman is pregnant to be aware of? And what I’m more so driving at is I’m assuming there comes this time when you have to decide to change your course, right, and more of a medical intervention is needed. And I’m sure, that’s probably what most people are most concerned about, which is how do I know if I’m on this more home birth, midwifery train, how do I know when I need to get off that track and get on to the other track? And I’m sure that’s what people probably struggle with is how will I know if I’m doing that at the right time? Would the hospital be the safest place?
And again, we’re making the case here. It sounds like that may not be the case, that may be a false assumption. But one of the assumptions I think people probably make, which is understandable, which is if I want to prevent losing my baby, maybe one of the best things to do is be at the hospital because they’ll know when it’s best to make this diversion to escalating therapies or interventions. So how would you or what would you want for people to know when they need to do that? Hopefully, they won’t need to and it sounds like if they go through the recommendations that we’re outlining here, that they’re going to greatly minimize their chances. But again, I know people will try to think with the worst-case scenario in mind and how can I set myself up to prevent against that. So what would you advise people in that regard?
AM: Right. I practice in hospitals. I practice in birth centers. And I practice at home. And I would say that my transfer rate from midwife to physician care is 7%, right? So that means 93% are giving birth naturally and vaginally. And I am not just—I’m not like this hippie-waving sage. We are very skilled in screening. We take the blood pressure and we’re monitoring the baby’s heart rate and growth. But if a mother, for example, has a seizure disorder on medication, that’s going to be picked up in the history taking when we’re doing prenatal care. If the mother is having triplets, probably the safest place to have that is with a specialist in the hospital, if the baby is preterm, right? If a mother goes into preterm labor and the woman is 27 weeks, that baby needs to be in the hospital. It’s like if a mother has heart disease, right?
So, there are times when women have serious issues like that where it’s safer to be in the hospital. I have a lot of families in my practice that don’t want to do any ultrasound but some do. Evidence does not support routine ultrasound but some people just want to know the sex of the baby or they just want to see that everything is at least looking like it’s developing normally. If we find, for example, that the baby has a major heart defect, for example, that baby needs to be born in the hospital where there’s care for that baby.
But the vast majority of times, if there’s a problem, it doesn’t just suddenly happen like a car accident, right? We’ll see warning signs like a woman’s blood pressure is starting to creep up. But if she comes in and tells me she has insulin dependent diabetes, which we are going to screen for when we do blood test, if she doesn’t know that she has that, then that mom and baby need to be in the hospital, right?
Urgent transfer, like having to have an emergency in my practice, because I don’t like to wait until it’s a crisis. I would rather—I don’t like the way, for example, a blood pressure is going or the baby’s heart rate is not looking good, I’m not going to wait until it’s a crisis to have intervention, right? But it’s really a handful of times that I can think of where I needed to transfer mom to the hospital, like call 911, because I’m the 911, right? I’m a provider that if the mom starts to bleed too much, for example, postpartum, I’ve got all the same equipment that a birth center has to give her. If the herbs and the natural remedies aren’t working, I have Pitocin and the hemorrhage medications. I can start IV fluids at home. And I’ve never lost a mom, thankfully.
So it’s not like we just let everything happen and go away. We’re watching. But people have this fear that there’s like a sudden thing that happens, a sudden crisis that happens with good prenatal care and good midwifery or obstetrical care, you can pick these up in plenty of time, that it’s not a crisis. It won’t become emergency caesarean.
DrMR: Yeah. I’m really glad you said that because, you’re right, I think people are fearful of that sudden thing happening. And I think that’s understandable. But I also have come to find that the less you know about something, the easier it is to be paralyzed by fear. And of course, the more you know about something, the more you can go into a situation confident. And so what you said makes absolute sense, which is the proper screening will help you know, okay, there is a risk for this and because of that we want to be in the hospital or we’re very low risk or what-have-you. And just like you said, you’ll see the path kind of unfold or the best path unfold before you as you go through the appropriate prenatal screening. That makes a lot of sense.
AM: The vast majority of times, yes. And that’s why I don’t support unattended birth because, yeah, I’ve had to deal with emergencies. But thankfully midwives are skilled to deal with emergencies, right? So yeah, the most common emergency is sometimes the baby just needs to get a little assistance breathing. And the most common emergency for a mom is postpartum hemorrhage, which I’ve treated every single one in my practice with the interventions that I have, right? So these are all treatable problems.
DrMR: Sure, sure. Well, I think that’s fantastic. And I know that you have materials to kind of walk people through some of this. So, for the audience, we’re working to that. But thankfully, there’s some documentation that kind of gives this all to you in a linear kind of format.
Dr. Ruscio Resources
Hey, everyone, this is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients both via telemedicine, via Skype, and also at my physical practice in Walnut Creek, California.
There is of course my book, Healthy Gut, Healthy You, which gives you what I think is one of the best self-help protocols for optimizing you gut health and of course understanding why your gut is so important and so massively impactful on your overall health.
And then finally, if you are a clinician trying to learn more about my functional medicine approach, there is The Future of Functional Medicine Review, which is a monthly newsletter. Which is a training tool to help sharpen clinical skills. All of the information for all three of these is available at the URL drruscio.com/resources. And in case you are on the go, that link is available in the description on all of your podcast players. Okay, back to the show.
DrMR: I want to ask you first about what about the postpartum period? And of course, I think our audience understands that probiotics can be helpful, so I’d be curious to get your thoughts or even disagreements on probiotics, breastfeeding to be health promoting. So maybe touch on those and then I’m curious about any thoughts you have on vaccination and also some of the antibiotics that are used very early on in the process?
AM: Oh yeah, my gosh. Yeah, so that brings me back to—so, all pregnant women in the United States were given the flu vaccine and pertussis, DTaP, but it’s mostly for pertussis. And that is concerning, the flu vaccine. And so I would urge you, I wrote a blog on it, on all the evidence of the pros and the cons, urging women to know that you have a choice whether you take that flu vaccine or not because we’re exposing all unborn babies in a big scientific experiment and if it’s safe or not to give the flu vaccine in pregnancy.
But antibiotics, that’s another good point that you’re talking about because of the Group B Strep. And also every, like, given that there’s about 4.3 million births per year in the United States and we’re having about, let’s say, over 30% caesarean rates, some hospitals it’s 40 to 50%, every baby that’s born by caesarean, the mother is given IV antibiotics.
So just think of how many, just to prevent infections, and that like disrupts the normal flora, the microbiome, right. That’s not to be taken lightly. How many babies are being exposed to antibiotics? This is not even talking about the issue of Strep, which is a whole other discussion. So I would definitely say that if a woman does need a caesarean birth, I like to call it caesarean birth, because it’s still a birth—it is major abdominal surgery, but it’s still a birth to be celebrated and it’s a birth of the parents and the baby—we’re now saying that the mom is to take a swab of her vaginal canal before the birth and then after the birth to swab the baby so that the baby gets a little bit of that flora on the skin and to have immediate skin to skin contact and breastfeeding to build the antibodies and the immune system. But yeah, I think probiotics, especially in that case, is important to restore the disruption of the flora.
But postpartum—so here’s another thing, when baby is born, what they’re doing in the hospital immediately after the baby’s birth is they clamp and cut the umbilical cord, which is a hugely harmful and dangerous intervention that is not backed by evidence. No other animal, since the beginning of time, have we cut cords. And it’s only when birth was moved to the hospital that we’re cutting the cord. So what happens is a third of the baby’s blood supply, which has stem cells, iron, oxygen, and blood volume and nutrients to help the baby transition to life outside the womb, the cord is breathing for the baby. The baby doesn’t breathe using lungs in the womb.
So a third of that blood supply backs up into the placenta as the baby is being birthed. And that baby needs that third of its blood supply back. A third of the baby’s blood supply is equivalent to a hemorrhage nobody sees when that cord is clamped right away. So then we have to resuscitate more babies. Babies become anemic and problems with immunity because they’re not getting the stem cells and the antibodies. So a huge thing postpartum for moms, I implore everybody to research and ask their doctor or midwife, hopefully the midwife is doing this, anyway, don’t cut my baby’s cord. Let the baby have the cord blood. That’s number one postpartum.
Number two, I would say, don’t suction my baby. My baby can—as soon as the baby’s born, a lot of times they stick suctions down the baby’s pipes to suction fluid. But babies can clear their own fluid. And that’s not scientifically based and that can cause more problems. And it’s traumatic. It’s traumatic for the baby. And then have immediate skin to skin. That baby was heart to heart, skin to skin—in the womb, 24-hour womb service, we call it inside. And then when born, exposed to the world, that baby needs to be with mom and breastfeeding. Putting the baby in a nursery is—I urge you to reconsider that and to keep the baby with you. That’s where baby needs to be, that’s where you need to have your baby with you and to get to breastfeeding. That’s the most important thing postpartum for the mom’s health and the baby’s health.
And then I say, in the pregnancy—you’re asking about postpartum, I encourage women to make sure they’re well supported so that they have nothing to do other than heal, rest, and breastfeed and be taken care of. They’re not like being responsible for like errands and cleaning and cooking and childcare of other children so that they heal and they don’t have risk of postpartum depression and postpartum infections and illnesses from being overwhelmed and alone without support. So those would be my big take homes.
DrMR: Yeah, some great ones there. So with the postpartum kind of relaxation period, roughly how long would you recommend someone to take it easy?
AM: Well, I would say, in other countries, it’s like four to six weeks that the mom’s responsibilities are taken over by everybody else in the community. So I would say at least four to six weeks, because she needs to recover and get to breastfeeding. And this little baby is coming into the world, not sleeping in the middle of the night, they get up every few hours, and always go back to sleep so there’s this lack of sleep and hormonal change. And it’s a huge, major life change to become a new mom. So I would say four to six weeks at least from a vaginal birth. And they’re discharging you two days postpartum and you’re on your own. I mean, that’s dangerous.
DrMR: Right, right. And the cord piece was actually something I hadn’t heard before. So can you elaborate a little bit on that? How quickly do they typically clamp and then cut the cord? And what specifically—and I’m sure if someone found a good midwife, they would get the specifics on this. But just to fill in my own knowledge base here and for the audience, how long do they stay attached and then to clamping and to cutting is the more ideal way to approach this?
AM: So the hospitals are like in a rush. As soon as the baby is birthed in most hospitals, unless they’re practicing evidence-based care, the cord is cut. It’s called immediate cord clamping. It’s like the baby’s born, cord is clamped and cut. And so that’s like suffocating the baby and taking a third of the baby’s blood supply and oxygen away. I don’t cut cords at all. I wait until the placenta is birthed or until the cord stops pulsing. The cord varies how long it’s going to pulse the blood back to the baby.
So after the baby’s born, the placenta that is still attached inside to the mom getting all the oxygen and blood and nutrients is going to the baby. And usually that can be 10 minutes, 20 minutes, a half an hour, 40 minutes, and it gradually stops pulsing. And it can be cut then if mom wants, if the family wants. Who says we have to cut it? There’s no evidence to support that we have to cut it. We can just leave it the way it is and then the placenta is birthed and then we can cut it. But there are those people who do what is called lotus birth and they don’t cut the cord at all. And it naturally falls off eight to 10 days later. But at least let the baby have the blood and the gold that’s in the blood from the cord. Yeah.
DrMR: Got you. All right, well, that’s most of what I wanted to get through. Was there anything else that you think is important to mention? I mean, I’m sure there’s a lot, but anything else in particular that you wanted to leave people with?
AM: Yeah, just that every day a woman is birthing, 300,000 women are birthing around the world and billions and billions of women have given birth before you and that it works. And to trust that your body can birth like you can breathe. I like women to really, really understand that just like they breathe, when we get our mind out of the way, our bodies are breathing. We don’t have to think about it, right?
So when we get our mind out of the way and we can relax and trust the process, our bodies know how to birth. And I like women to know that they are stronger than they realize. That they can—I’m the biggest wuss and wimp when it comes to intense sensations and pain but I did it. And I have never, not once, in all my 22 years have had to attend a normal, healthy pregnancy where a woman in labor needed an epidural. If it wasn’t a normal labor, that’s different. But I’m saying that’s a lot of women in my practice having babies without pain medication.
So these women are doing it and it has a lot to do with the preparation in advance and the care that they’re given. But these are women from all ranges of backgrounds and education and incomes and professions and they’re doing it. So you can do it too is my message.
DrMR: And tell people a little bit more about the program that you have where they can get more information on this?
AM: Well, my website is homesweethomebirth.com, so home-sweet-home-birth dot com. And again, it’s not about home birth. It’s the home birth model of care even in the operating room, even if a caesarean is needed. How can we restore the humanity and the evidence-based care and the celebration and the respect and the compassion and sensitive, kind support, loving support? How can we restore that and have that for all women no matter where they’re giving birth, right? So that’s my website. But my work has gone global in the last several years. I just exploded on social media, so that sort of birth on a lot of women from all over the world are consulting me having to do with—their baby’s breach and the doctor wants to give them a caesarean, what should they do? And what would I recommend, right? So that kind of birth online consulting, right.
And then I was interviewed on many podcasts. And one podcast, a woman said, do you have a course, like how do you bring people through your pregnancy and postpartum, birth and postpartum? And she offered to me to come out to California and we filmed the course. It’s 10 modules and it’s really how I prepare women in the pregnancy for really rocking, having the most optimal healthy mind, body, heart, and soul. Pregnancy, birth, postpartum, and newborn. And that’s on my website as well.
And I just made a webinar because I’m very passionate about preventing birth trauma for moms and babies. So that is free and you can go to bit.ly/preventbirthtrauma. And it’s all about preventing the—because our country, especially modern medicine, does not really recognize the profound psychological impact of having a baby on mother and on baby. And a third of women who have given birth in our country, at least, described their birth as traumatic, which is really pretty unacceptable.
And babies now, speaking about babies, 80% of children with autism and sensory deficits and ADHD and developmental delays have a history of birth traumas. So something traumatic that happened. It’s usually around the care that was given at the birth. So the mind and body is very connected and I’m all about preventing it and then healing it if it happens.
DrMR: Sure. Well, I think what you’re doing is terrific and I’m hoping a lot of women look into this and take action. Because, like I said at the start of the podcast, one of the things that became clearly evident to me when I was researching the book that I recently wrote was how profoundly important pregnancy and early life is for the healthy development of a child’s gut and immune system and that really the immune system has far-reaching effects as does the gut. And so if we can get this right, then you really will set the next generations up for a lot more success. So I think this is a hugely important issue and I’m really happy that you’re doing the work that you’re doing. And thank you for taking the time to speak with us today.
AM: And it’s been a pleasure. I actually want to tell your audience also my book, Natural Birth Secrets, became a bestseller and it was on the prelaunch and it’s being released tomorrow. And it’s on Amazon. And it goes into detail about a lot of this. So just educate, prepare yourselves is what I want to tell everybody.
DrMR: Awesome, great. Well, Anne, thank you again for taking the time. This has been a great conversation, and we’ll make sure to get all those links put into the transcript.
DrMR: All right. Take care.
AM: Thank you.