Pregnancy prep: Are you ready to give birth?

Giving birth is one experience in your life you will never forget. There are so many emotions in the mix, both leading up to the birth, and on display during the birth! 

Host Jessica Rolph met Leslie Schrock when she was in the process of publishing her book Bumpin’: The Modern Guide to Pregnancy, which she wrote while she was pregnant with her first baby. Leslie does not consider herself a pregnancy guru, but instead a curious person who found trustworthy resources for pregnant women in short supply. She talked with all variety of experts in the process of writing her book and shares her findings on this episode.  

Key Takeaways:

[1:34] What inspired Leslie to write her book about pregnancy?

[3:10] Leslie shares how it felt to be her own health advocate.

[5:58] What is the technical difference between a doula and a midwife? Why would you want one over the other? Does it make sense to have both? 

[7:55] Does the participation of a doula or midwife preclude you from having a medicated birth? 

[10:32] Where does a doctor fit into all of this? 

[11:59] What goes into the decision to have an epidural or not? How to build a supportive birthing team and what to consider if you want to plan for an un-medicated birth.

[16:07] Leslie shares tools for feeling positive when going into labor.

[18:40] Leslie gives advice on how to best involve your birth partner. 

[20:23] What is going on with the pelvic floor during pregnancy and birth? What can women do to make sure that it’s healthy after birth?

[21:18] What is pelvic floor dysfunction?

Mentioned in this episode:

Bumpin’: The Modern Guide to Pregnancy, Leslie Schrock

Bumpin.com

Transcript:

Inspiration behind Bumpin’, The Modern Guide to Pregnancy

Jessica: I knew you before you launched your book, and I can’t wait to hear a little bit more about why… What did inspire you to write this book about pregnancy? 

Leslie: Yeah, I always kind of thought I would write a book but I kind of assumed it would be fiction actually, ’cause I’m a lifelong reader. But truly my own personal experience inspired the writing of this book. So when I decided to get pregnant, I was 35, I had spent… I’ve been in health and tech for about a decade now, and I thought to myself, “Oh, well, this is going to be easy, I’ll just get pregnant and that’ll be that and things will be smooth and, yeah, because I’m a healthy person.” I thought I knew what I was getting into, and turns out I just really didn’t.

So I had a miscarriage around five, six weeks, that was the first pregnancy. The second pregnancy, we had a fatal chromosomal abnormality that we found out about and the baby wasn’t growing and we knew that it was going to end on its own, but it was still technically a termination, which was one of the most… I can’t even describe what it was like going through that, having to terminate a wanted pregnancy because it was going to end on its own in a few weeks was just something I didn’t even know was a thing. And so, really, it was that second pregnancy that inspired me to start learning, and learning everything I could about all of it and realizing that a lot of the literature and a lot of the conversations we have about pregnancy don’t really reflect the needs of diverse working families. They’re written kind of in this binary way.

Considerations before conception

Jessica: And let’s start with conception. What tips do you have for us who are trying to conceive? 

Leslie: One thing I think that’s interesting about conception is that we don’t really talk about getting your whole life in order. So there are easy tips, like start taking a prenatal vitamin three months before you plan to try to conceive. That’s actually the best timeline if you can do it, because the levels of folate build up in your system. But then, also, really preparing families for the financial realities of having children, especially in the United States where there is not a lot of support for parents, even leave, Pre and post-pregnancy is not something that we are privileged to have much of. So, for me, it was also thinking about, yes, morning sickness is a thing to prepare for but you also should start looking at your finances, you should start talking to your partner, if you have one, if this is a planned pregnancy, really taking the time to have those meaningful, purposeful conversations. And then, yes, getting your body in shape.

So one interesting thing that I learned that I had no idea was an actual problem, was that, although it’s going to sound really obvious when I say it, is that one-third of fertility issues are actually due to sperm. And so for a lot of couples that run into fertility problems, most of the time, women get tested, men don’t get tested. And it’s much more invasive to get your eggs tested and everything else. And so another goal of mine is just to bring some illumination to the fact that, “Listen, if you’re running into some issues with conception, both partners need to be tested,” even though it’s something that is not very popular in the male community yet, but I think it’s really important that we know that.

Be your own birth advocate

Jessica: Oh, that’s so important to know. I actually didn’t know that statistic. I didn’t know that, so thank you for sharing. You learned how to be your own medical and birth advocate through this process you had…Tell me about this advocacy and this importance of being your own medical and birth advocate.

Leslie: So this was something that I had to grow comfortable with, because I don’t think it’s the most intuitive thing to go into your doctor’s office and, I wouldn’t say pushback, but really make sure that you understand exactly what’s going on. So, I think there’s a stat, it’s something like 80% of what your doctor tells you, you forget immediately after you leave the doctor’s office. And I knew that from my work in health, my longtime work in health. But I was surprised when it started happening to me, and I had to make sure that my husband and I were taking notes when we would go to appointments if it was anything important. But really it started small. When things started to not go so well for us, I realized I didn’t understand why things weren’t going well. And I had to ask my doctor, “Why did I have this miscarriage? How did this chromosomal abnormality happen?” I had conversations with the genetic counselor about, “Could this technology possibly be wrong, because I can’t believe this would happen to me, an otherwise healthy 35-year-old.” And so, really, it started small. Asking questions in appointments, making sure that I understood the decisions that were being made. This was really useful during birth.

So, I had a doula team that worked with us both before birth, they taught our birth class, they were with us through those hours at home trying to figure out when to go to the hospital because, as anyone who’s given birth before knows, a lot of people end up having to go home, they’re sent home by the hospital because it’s just too soon. And so we…

Jessica: That happened with my third. So embarrassing.

Leslie: You know what…

Jessica: She was 10 days late and I just kept… I was like, “It’s happening, it’s going to happen, right now.” And it was like… So it is kind of… It’s a little… I don’t know the feeling when you go to the hospital and you feel like you’re gearing up and this is the moment and then it’s not. It’s hard.

Leslie: Yeah. But see, you were on your third time and it still wasn’t like a perfect… You had to go home. I think that that’s such a great lesson for birth is that you can do all of the preparation in the world that you want, but sometimes it just doesn’t go exactly the way that you want it to or that you plan. It’s not an event that can be totally controlled. But really, I think birth is a great time. This is why I’m a real advocate of learning to have these conversations with your physician and other medical professionals far before birth, because when you’re in the throes of birth, there’s a lot happening, you’re not exactly yourself. But I think that’s another reason that it’s so powerful to work with a doula. For actual medical care, you’re going to have either an OB or a midwife. Midwives are not in every state… Yeah.

Differences between a doula and midwife

Jessica: Okay. So break this down for me. I’ve always really… I’ve always wanted to know. What is the true difference or the technical difference between a doula and midwife, and why… Could you have both? Would you want to have one or the other? How does this work? 

Leslie: Yeah. So think of a doula as a supporter, a cheerleader, who’s there for you from the waist up. So they are not there to perform medical procedures, although some do perineal massage and apply perineal heating pads, which helps with tearing, it’s a very fascinating… I think we’re going to talk about the pelvic floor, so I’ll save it, but their job is not to make medical decisions for you. Doulas are there to emotionally support you, they are your coach during birth, they provide education before birth, they do check-ins after birth, they can help with breastfeeding, but, really, you should think of them as an emotional supporter. Midwives, on the other hand, most of the time they’re trained nurses. So they are there specifically for birth, and they are there as medical professionals, many can prescribe medications, but they’re going to be the medical side of the house.

So that’s really the big difference, is that doulas cannot prescribe medication. Most are not trained medical professionals, but they are invaluable advocates for you. They will help you understand what’s coming, when to go to the hospital, what’s going to happen in each step. Our doulas knew exactly what the doctors were going to do before they came back in the room during my birth, which really helped us make decisions. And it also made me feel really confident in asking, “Why are we continuing to labor right now when there’s been no progress? What can we do?” So I think even though I had a very complicated birth, personally, it was so incredible to have them there.

Defining natural birth

Jessica: And I always associate I guess these words, doula and midwife, with a natural birth. And I know natural birth is kind of alluded description because it can mean everything from a vaginal birth to an un-medicated vaginal birth. Can you tell me about where the doula and midwife fit? Do you have to be intentionally having a natural birth in order to incorporate a doula and midwife or a midwife? 

Leslie: Yeah. Well, you touched on something that I felt personally very strongly about when I was writing the book and also just as someone who had birth kind of go sideways is that, to me, natural birth just means there was a baby that you birthed from your body, whether it was through your belly or through your vagina, one of the two. But this whole idea that there is somehow unnatural birth I think brings a lot of shame on people who don’t have birth go precisely the way that they want. So the way that I like to talk about it is vaginal birth versus C-sections. And then you can have an un-medicated vaginal birth, or you can have a medicated vaginal birth. And, really, that decision is yours to make.

There are definitely positives to waiting on an epidural. There’s lots of research that shows labor can go longer if you get an epidural. However, as someone who was in un-medicated labor for a long time, my whole birth experience was 65 hours and I was un-medicated for a big chunk of it, and then finally just nothing was happening so I had to get a break. I’ve never had pain relief that… I mean, it was amazing. I’m thinking about it right now and just like, I can’t even believe how it worked. So, I think if that’s your goal, it’s a wonderful goal to have an un-medicated vaginal birth, but I think having any sense of shame about getting medication, there are lots of people who have pre-existing conditions, emotional or mental health conditions where it’s actually much better for them to be medicated. So I think we’ve got to get away from the judgmental language around this.

But doulas are appropriate, actually, for both medicated and un-medicated birth. They do teach you many methods that help with un-medicated births. So they’ll teach you massage, they teach your partner or your birth supporter how to be involved in birth. And then with midwives, they’re really appropriate for any kind of birth, as well. They are also probably more geared toward un-medicated birth, but they’re also great when… They also birth plenty of babies with moms who get epidurals. And I would say the only situation, if you know that you have a pre-planned C-section, you probably don’t need a doula. Although, having a doula around in the hours after birth can be quite useful, especially if your hospital doesn’t have lactation consultants. They can be very helpful with breastfeeding. Many of them are trained lactation consultants, as well.

Do you need both a midwife and a doctor?

Jessica: And so would you ever have a midwife and a doctor, both? 

Leslie: I had a midwife and a doctor at my birth. So because of my kind of history, having somewhat complicated pregnancies and having three of them, I, unfortunately, couldn’t see a midwife for my care right out of the gate. My doctor actually released me into the midwifery program at about 32 weeks. She was like, “Your pregnancy is boring, you can go see the midwives now.” But when there’s any threat, like if you have technically a high risk pregnancy, most of the time you need to, at least, start your care with an obstetrician. But if you have a low risk pregnancy, there is no reason in the world you should not get your prenatal care from a midwife.

One of the things that I loved about my midwife appointments was that we were a little more focused on my emotional well-being. The appointments were a bit longer than they typically were with an obstetrician. So I think midwifery is a practice that I am so thrilled to see become more popularized again because I think that birth outcomes are better, it is appropriate for many women who do not have high risk pregnancies, and everyone kind of leaves the birth experience feeling a little more positive, generally. There’s a lot of really promising, really great research that shows that adding midwives back to prenatal care is a win for everybody.

Choosing your birth preferences

Jessica: And so, let’s talk about this kind of setting an intention for a birth. How do you think about, like truly the preparation process? How does one make a decision whether to have an epidural or not, whether they want to have that intention, right, knowing that things might change in the moment. And then, also, kind of how do you get a support system and what kind of preparation do you need If you want to plan for an un-medicated birth? 

Leslie: Yeah. So this is, again, I think, where just becoming a student of birth and really understanding all of the different stages of birth, there are different stages of labor, the weeks leading up to birth, things you can do to prepare. There are a lot of different ideologies when it comes to preparing your body for an un-medicated birth. This is, again, I think, why doulas are so powerful is because they can teach you, you and your partner or birth supporter, how to do things like massage, acupressure points. And then I think there are also lots and lots of great frameworks for preparing mentally, which I think is the real thing to do. You got the Bradley method, you have Lamaze, you have HypnoBirthing, meditation, and what you choose is really specific to you. There is no one right way to give birth, and there is no one right way to prepare your mind for dealing with what can be pretty intense labor pain.

So, for me, the way that I like to think about it is birth preferences. So I think the word, plan, can be pretty dangerous for people because if it doesn’t go according to plan, as anyone will tell you, who’s given birth, like something inevitably will not go exactly the way you thought it would, it can be really, really hard afterwards. I had a birth where everything possible could have… I ended up with a C-section, I wanted an un-medicated vaginal birth, but guess what, my son got stuck ’cause he was giant and I am not particularly giant, all kinds of other things happened during my birth that were not planned. And so I really like to think of it as birth preferences. And so, actually, I created a template for people to use as part of supplemental materials for my book because I get this question a lot, like, “What goes in birth preferences?” And the answer is, it can kind of be whatever you want.

So there are very basic things to understand, like whether or not… What are the pros and cons to epidurals, do you want that or not, and that can be as simple as like, do you go into the hospital and just not sign the paperwork and sign it later if you want it, or do you just say, “Absolutely, no, I’m not going to get it,” but also what do you want to happen with your baby right after birth. And for most hospitals these days, you get immediate skin to skin time, rooming in is more and more common. But all of these things are kind of the standard-issue “birth preferences.” But I’ll tell you, the other thing I think people miss out on a lot is that you can really have some fun with your birth preferences. You can have a labor play-list, I had music going the entire time I labored. All 12 hours, I was un-medicated. I had a really crazy play-list going and it really kept me going. We actually took our speaker, we had a little portable speaker, which was totally okay with our hospital, and we actually took it into the C-section.

And so I was listening to music the entire time when my son was born, and I think he still recognizes that play-list sometimes. It’s really interesting to kind of watch him when I put on the songs that were on when he was born, so… Aromatherapy, I think, is another really great way to make birth feel a little more like home. Because, let’s be honest, hospitals can often feel very cold, they don’t always feel like home. If you can labor at home for as long as you can, that’s always the best thing to do, especially since they’ll send you home if you’re not dilated enough. But I think we’ve got to feel more free to bring ourselves into that hospital room, both during labor and during birth and then also in the postpartum period.

Make sure you feel prepared

Jessica: What insights do you have for pregnant women who are… To not have the fear of the birth? I think that, for me, I really try to work on that but there was a piece of me that was just really worried about it, like it’s such a big deal, and how is this going to go, and just… Can you give me some tips for mindfulness tips or what tools do you recommend for feeling positive going into that moment? 

Leslie: Well when it was getting close to birth for me… So I was writing a book as I was pregnant, my book was written in real-time page by page, every moment that I went through was reflected in those pages, but also lots and lots of information and questions from forums and people I knew and I interviewed, over 20 different people for the book who all contributed across all kinds of different practices, but, really, I found that the most helpful thing for me was learning about how birth actually worked. So what are all the phases my body is going to go through, physiologically, what happens, where is the baby, what does labor pain feel like, there are all of these things that we don’t really talk about, that are so mysterious, and then I think we, unfortunately, largely because of social media, have a kind of culture of reading about really gnarly births and thinking that those are… That’s the way it works, thinking that births with a lot of stuff is not textbook, it’s how it’s going to happen for you. Because think about it, you’re not… People aren’t going to write about their totally vanilla textbook births, it’s like, “Yeah, I had a baby, things went well for me.” Those are not the stories we hear in the media, those are not the stories that are posted on social media. It’s always the really intense, intense births that we read about.

So my advice would be, number one, learn about birth, read about it, read about what happens at each phase, read about what labor pain feels like. TLDR, it’s kind of like really intense menstrual cramps for most people, and it can be lower back pain, but there are different kinds of pain as it relates to birth. And then, also… Just maybe don’t go into every single forum and read every single birth, and what goes wrong. Really, understand that your birth is going to be your birth, it’s not going to be like anyone else’s. And the best thing you can do is prepare your mind, prepare your body, prepare your partner, or birth supporter to be there for you. The emotional support that you will get during birth is really important, whether it comes from a doula or your friend or your partner. Those are the ways, I think, that are really productive, and then just be willing to forgive yourself if all does not go the way that you would like because, as we said before, not everything is going to be perfect. There is no such thing as a perfect birth.

Empower your partner 

Jessica: How did you involve your partner in the birth, and what kind of advice do you have to best involve the birth support person? 

Leslie: So, we got a doula team, mostly because I had heard from friends that having a doula at birth, yes, it’s for the birth parent but, in some cases, can be even more so for the partner. So in our case, we took birth classes with our doula. My husband learned how to apply pressure to acupressure points, he learned how to do massage. But really, I think the thing that was most helpful is just walking us through what happens in a normal labor. And so he was kind of empowered… My husband’s biggest fear is just not knowing what to do, like standing by and just being helpless and like… And when you watch your partner in pain, which for many people it is pretty painful, he wanted to know what he could do to help. And so the doula was there for him to say like, “Now, maybe you can try this. Now, maybe you can try that… ” And I think Bradley method and some others don’t necessarily involve a doula and they can actually help you really… Your partner, in many ways, becomes fully in that role.

So I think it’s really teaching your partner kind of, “Here’s some things that we know work,” making that person feel empowered, and then also accepting help. I think this is another area where it’s really useful to learn it while you’re pregnant because when you become a parent, when that baby shows up, learning how to accept help is so important. You cannot do it all yourself.

Understanding pelvic floor dysfunction 

Jessica: You have a real interest in pelvic floor support, pelvic floor help, tell us about that, what is going on with the pelvic floor during pregnancy and birth and what can we do to make sure that it’s healthy afterwards? And I’ll just be really real here, like, I’m talking about… I think what I’m talking about is like leaking pee that I have sometimes when I’m on a trampoline or like that… The kegels and the whole thing, we want to hear.

Leslie: Oh, yeah. Well, so, while researching this book, there were a few things I just couldn’t unsee. And the fact that over half of women experience pelvic floor dysfunction at some point in their lives was one of the most shocking things that I learned. And as I’ve promoted the book and been talking to a lot of people, I realized that most people don’t even really know what the pelvic floor is. They kind of think they know but they don’t necessarily know. So let’s talk about what pelvic floor dysfunction is, first.

Jessica: Exactly. I’m like, “Let’s define this, like is this my leaky… Is that mean in layman’s term’s leaking pee? 

Leslie: It’s leaky pee. Some… Yes, it’s incontinence. Post-birth incontinence is very, very common even if you don’t have long-term pelvic floor dysfunction. Most people are leaky for the first six weeks. It’s just a thing. Everything has… You’ve been carrying a bowling ball in your abdomen, you’ve been putting all this pressure on your pelvic floor. So what is the pelvic floor? The pelvic floor is the… Think of it as a sling holding up your uterus, your bladder and your internal organs.

And so, we know pelvic floor dysfunction, which is mostly incontinence or pelvic organ prolapse, happens in over half of women but it turns out there’s actually a lot of work you can do both while you’re pregnant and also afterwards. If you handle this in the six months postpartum, your outcomes are improved quite a lot. So, everyone knows about kegels, everyone kind of thinks they know how to do kegels… Jess, what do you think kegels are? 

Kegels 

Jessica: I mean, it’s when you squeeze that part inside you and it’s supposed to build the muscle? I don’t know. I don’t know if I do it right.

Leslie: Yup. See? But you know what? So it turns out over a third of women do not do them properly without instruction. If you’re doing a kegel and you feel your butt squeeze, you’re not doing it right. That’s probably the easiest test. So, you can think of it as kind of… Some people think of it as pulling a tampon into your body. There are lots of different frameworks for it but kegels are not always the right movement for everybody, just like every pregnancy is different. Every pelvic floor is different. One of the things I really encourage pregnant women to do is to go see a pelvic floor specialist, a pelvic floor PT. You can actually do this via telemedicine if it’s hard to access someone locally. You can also go see someone and they can actually perform a test and see kind of what’s going on down there before birth and after birth. So I started working with a pelvic floor PT in the third trimester. I learned a bunch of really great ways to strengthen. I’ve been doing kegels because I knew it was a thing. But I didn’t understand there’s a whole network of muscles that works together to really support the pelvic floor, your transverse abdominis is important, and these exercises are not rocket science.

I actually have a whole chapter in my book about this because I realized that most people don’t know what the pelvic floor is. Most people don’t understand everything’s connected, and then everyone thinks kegels are just the right way. So there are actually a whole host of other exercises. I have a bunch in my book, I actually have some on my website too, if people want to just get a taste of that.

Jessica: Leslie, thank you. This has been so wonderful talking to you. Thank you.

Leslie: This has been so fun. We have to do this again.

Three episode takeaways

For help finding pre- and post-natal care, visit Leslie’s website at bumpin.com. There you’ll find a link to Maven, a service that provides virtual access to lots of different practitioner types. Other online resources can also be found on her site, broken down by trimester.  

Set your birth intentions

It’s wise to release expectations around your birthing experience – rarely do they go as planned. But do consider setting intentions for what you hope to happen, including who you want to be at your side and ways to work through the pain. Think of it as birth preferences, rather than a birthing plan.

Understanding doulas and midwives

You can think of a doula as a supporter and cheerleader from the waist up. Some do perineal massage that can help with tearing. While a doula is not a medical professional, a midwife is a trained nurse and also offers support. Both can help navigate the medical system and advocate for those elements of your birthing experience that you feel are most important. 

Prepare yourself

Learning about how the birth works, the phases the mother’s body passes through, can help diminish nerves or fears you might have. Make sure your sources are reliable – forums have a way of focusing on all the ways in which a birth can go sideways. Leslie’s book is a great place to start! 

You can find more information on Lovevery’s blog, “Here With You.”