Sarah Lavonne discusses her work as a registered nurse, childbirth educator, and the founder of BundleBirth , a global education company training nurses in physiological birth.
Informed Pregnancy Media and Mahmee present an all new podcast! One Way or a Mother is a new narrative podcast from Dr. Elliot Berlin, DC. Each season is an intimate story of one woman, one pregnancy, and all of the preparations, emotions, and personal history leading up to the birth. Episodes feature the expectant mother along with her family, doctors, and birth work team.
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Sarah Lavonne in orange.
Dr. Elliot Berlin, DC[0:00] My guest today is a registered nurse childbirth educator and founder of bundle birth a global education company training thousands of nurses in physiological birth She's been on the podcast before but now there's so much more going on. I can't wait to share it with you all I'm pregnancy focused chiropractor. Dr. Elliott Berlin and you're listening to the informed pregnancy podcast Sarah LaVon, welcome back to the podcast. Thank you so much for having me. I'm so excited to be back I'm honored. Well, I haven't seen you in forever which kind of sucks. I know you have crazy energy I can feel it coming through the zoom over here as always and you are sort of an earth mover game changer in general
[0:56] But when it comes to the world of childbirth Empowerment and childbirth education and childbirth You are like top of the mountain and so you have a lot of new stuff going on since the last time we talked To you and I want to get into all of it But let's start at the beginning where you from originally how'd you get into this stuff? Well, thank you for that compliment
Sarah Lavonne[1:16] I have been working now for seven years I'll get to that and it's just so so fun to be back with you and just to see where the world can take Us my life now is very different from what I ever Could have possibly dreamt it to be and my journey in birth really started. I'm living in Los Angeles Right now I've been in Los Angeles my entire adult life and it started in birth here in LA and so I moved here from Ecuador when I graduated high school and Came to nursing school here in Los Angeles really never thinking that I would stay but a few years later Many many years later now. I'm like very much an LA person and I don't see myself leaving. I love Los Angeles
[1:59] I love it here. I love the culture even the birth culture and everything that I get to do because I'm in the city So currently in Los Angeles been in Los Angeles and that is now my home
Dr. Elliot Berlin, DC[2:09] But your original experience with birth was in Minnesota
Sarah Lavonne[2:14] So how'd you end up in Ecuador? Yeah, so my very first experience with birth was with my mother when I was five years old She let me be present at my sister's birth She had a very progressive doctor at the time and I remember I did like little sibling classes and they talked me through The whole process they brought me in when my sister was crowning and I was there for her birth at five years old and so I blame my mom actually for my like fascination and obsession with birth because she Stuck it in there at a very young age. What is your memory of that? Like that's a great question I remember it very clearly actually I remember Knowing that my mom was gonna be in pain and that being just like, okay
[2:57] they've told me this is the way that it is and it's normal and natural and I remember that I was with my mom's best friend outside the room and I could hear my mom making loud primal birth noises and The friend was like, yeah, that's normal and I was like, okay Okay, and like this is what you're gonna see when you walk in and sure enough My mom did have a hospital birth. It was unmedicated meaning no epidural but she was you know in a hospital bed on her back and all that and Felt everything and so they brought me in as they could start to see my sister's head and I remember standing right next to her and My mom turning to me at a moment after she had pushed and was very vocal with her pushes
[3:40] And looked straight at me in the eye and was like Sarah I'm okay, and I looked at her dead face back and was like I know mom Like so serious just so calm. That's always kind of how I've been with people's discomfort and labor So I blame my mom for really setting me up with a perspective on birth that I think was really unique especially at that time that was in the 90s and It was just very rare that people Especially children were allowed in the room Remember we like went from like husbands not being in the room to then being in the room and then let alone a child
Dr. Elliot Berlin, DC[4:14] So I think it's even rare now husbands and partners not allowed in the room to all of a sudden No, are you in the room? But you're the coach? I think that's incredibly cool. I know that when I started to attend birth I come from more of a conservative background I come from more of a medical background and got into more of a holistic lifestyle later in life and You know the idea I would be present at a birth invited to attend a birth and then they've like oh Yeah, the toddlers are gonna come down when I'm ready to push. I'm like, that's crazy. Are you sure? That's okay Do we need a psychologist and then right every single time? I've seen it happen
[4:53] It's just so natural like the kids come down and they're not afraid of it We just think they're gonna be afraid of it and they're not traumatized by it. They're educated by it and they have exposure That's really important I think that's missing for most women because you get to birth now and it's like your first time ever being around it is When you're going through it and I don't think that's the way it was meant to be so you went to Your parents went to Ecuador
Sarah Lavonne[5:16] Yeah My parents went to Ecuador when I was in sixth grade and then I was there went through middle school and high school in Ecuador I went to an international school there So there were kids from 53 different countries in my little K through 12 school And which was the most incredible experience and actually I've had family in Ecuador up until last August So for the last goodness like 25 years, there's been someone in Ecuador. I know I know So that's also home for me It's my like sneaky sauce because if you saw my picture you'd be like, I'm sorry. What you grew up in South America I'm like, mm-hmm It's my secret that I definitely hold back because you learn a lot about people when you can fully understand them and they think you
Dr. Elliot Berlin, DC[5:57] Can't so it's fine. Yes, you do. I know several examples of this Undercover speaker languages. Okay. So then you left Ecuador and then when did you Realize nursing is your calling. I
Sarah Lavonne[6:15] Realized nursing was my calling although not fully understanding what nursing was to be honest. I knew I wanted to help people I knew I didn't want to be behind a computer Although now ironically that is where I spend a lot of my time But I knew that I also really loved babies and I really loved working with women and so it sort of naturally was like Interesting. I've also always had a full-on obsession with pregnant people I think they're the most beautiful human beings on the planet I still after 5,000 births later I still think at every single birth like how is that just inside like this is Nuts still to this day and so that started at a very young age
[6:57] But I decided and I had like a gut feeling to be honest about nursing and about 10th grade That's when I started looking at schools and was looking for specifically nursing schools and good nursing schools I went to Azusa Pacific University here in Los Angeles is where I ended up They have a very very good nursing program. It was number one in the country Actually when I went to it, I did not have a social life. It sort of traumatized me to be honest Now I'm like I'll never go back to school again, but it prepared me to be a very good nurse and I had a lot of experience. It was four years of clinical I walked out with a public health nurse license on top of it. And so it was just amazing
[7:35] So I knew nursing in about 10th. Yeah, and then I came here and
Dr. Elliot Berlin, DC[7:39] Graduated okay, so after graduation, what kind of jobs did you want? Did you get?
Sarah Lavonne[7:45] So I was throughout nursing school working at Children's Hospital of Los Angeles so I was a like a CNA basically there and that gave me incredible experience and I loved peeds and I loved working with the kids and not but and It was also not for the faint of heart and just like grueling Emotionally for me and I remember I had a 13 year old Passaway in my arms and I remember holding her as I felt her body go limp and was like This is the last time I want to do this And so I had a job in peeds and I love that and if you are a peeds nurse out there You know anybody, please give them extra love because that is like the most amazing job And also the one of the most challenging but I also always knew I loved labor and birth in nursing school
[8:34] My labor and delivery rotation my professor sort of I think she knew that like I'd probably end up I had like the personality for a labor and delivery nurse And so she'd pull me from the postpartum shifts and put me in labor I saw like 26 births when I was in nursing school, which is insane You're lucky if you see one or two on the huge and so that was just amazing I just remember loving it and really wanting labor and delivery Having a job in peeds and then it was also in the era where nursing jobs were extremely Competitive extremely to the point where I had people in my nursing cohort Which again like one of the top schools in the country that didn't get a job in nursing
[9:13] No matter what specialty for like a year and a half after they graduated. It was wild But I got hired directly into labor and delivery Yeah, yeah, it was amazing and I really think like it set me up because I feel like I've been on this like Expedited trajectory through my career. I've also never considered myself an ambitious person Which if you knew me now, you'd be like, I'm so confused by that But really I just wanted to help people and I remember My first day of nursing and going in and crying like bawling to my mother who was still in Ecuador who I had To call on like Skype and being like I will never be able to do this. This is terrible
[9:57] It's so hard. They're doing so many things at once I will never be able to do it and I love it and it really being like I remember saying within the first couple of Months like I will do this the rest of my life Like people go through multiple careers and stuff and like I was like I will never get tired of this This is the most amazing job in the entire world. I mean, I still feel that way. My career has shifted
Dr. Elliot Berlin, DC[10:23] Yeah, but I think that even me like it's incredible to be connected with your passion for what you do But I think the audience can already feel the drive from the nuclear energy behind you that has led to what you're doing right now We are gonna take a break But I will say a few things that you mentioned that I can relate to number one birth never gets old I never thought I'd be in the birth world ever but 20 years later. It just never had the magic of it the Miraculousness of it everything about it just never gets old and number two nurses run the world Save the world make the world go round. I knew that from work that I've done in emergency rooms and hospitals from when I was 18 years old working in emergency medicine all the way up until
[11:09] Working in pregnancy labor and delivery And then when I got kovat and I was trying not to die from the alpha Kovat and doctors wouldn't come in the room But the nurses were there putting their life on the line for me and for everyone else who had it Nurses are insane and then pediatric nurses in general even in like healthy settings are insane and in hospital settings I mean just the biggest angels and you know as in my emergency medicine if someone would die in my arms in there in Their 90s, it's Devastatingly sad but when you lose a peed and they make that transition with somebody loving nurturing caring It just makes all the difference. So those are a few things. We'll recap
[11:49] I want to know where your nuclear energy took you next, but we're gonna take a quick break and we'll be right back with Sarah Levan
Dr. Elliot Berlin, DC[12:06] Welcome back to our nuclear submarine Sarah Levan. Okay, so nursing now big change So you get into labor and delivery? Mm-hmm. And what's that transition like for you?
Sarah Lavonne[12:18] It was amazing. It was very hard and I learned a lot in my downtown Hospital that I saw literally every major obstetric emergency within the first about year Which they say usually takes about five and so I was just like ushered into a whole lot of learning Really quickly and lucky for me. I do learn very quickly. I love a challenge. I love the adrenaline I love the interpersonal and yet that was the only vantage point on birth that I had and again It was like at an inner city hospital in downtown Los Angeles I only spoke Spanish my Spanish was better there than it ever was living in Ecuador to be honest And I learned all the OB Spanish too, which is like a whole nother language in and of itself in English
[13:02] Let alone Spanish. So it was really amazing and I realized what honestly the motivation was I looked at my student loans and was like, oh I'm gonna be broke and in these loans forever if I don't actually start doing something about it And then I had a nursing friend or nurse friend who had started at a very different Demographic hospital here in Los Angeles out in Beverly Hills and she was like come and got there's per diems available so I technically got a second job one to pay off my student loans and Two because but specifically looking for an environment that would provide me with a complete opposite perspective And often in nursing this is true in many specialties
[13:42] but I'll speak only to labor and delivery because that's all I've ever done and That each hospital has its own culture and its own way of doing birth and we know this as birth workers Now having gone all over that like they have like it's a process, right? And until you get out of that and you start seeing and learning from one another Whether that be in the same city or the country or even the world now that I get to learn from these nurses All over the place you start to realize like wow, there's a lot the same but there's a lot different And so I started at the second hospital per diem paid off my loans loved it there, too And as I was working those two jobs
[14:16] They were looking for eight nurses to pull and help develop their childbirth education program In Beverly Hills, yes, and so I was one of those eight chosen to help develop their childbirth education program and We did that and then I started teaching I started developing and teaching a bunch of their specialty classes and really started seeing what was happening in like the community Prior to birth my only exposure to pregnant people really was like unless I was at Target or something At the bedside when they were in labor or when they were having a medical issue that hopefully we discharge them home or take care of them throughout their pregnancy and so my
[14:54] experience of seeing the process of like early pregnancy to like middle pregnancy to Labor was non-existent. And so that was really helpful for me. I never really thought about that Mm-hmm. Yeah as labor and delivery your labor and delivery Yes, and our vantage point on pregnancy birth sort of like even the like perinatal period is very much labor centric and So it really helped sort of bring my vantage point just like one step outward to go Oh wait, like community health and like public health stuff and like prevention all of that And so I realized too that like which I knew for a while because I'd been doing it on the floor as a peer Mentor I had sort of like created jobs for myself
[15:39] I just like see a need and fill it and then they'd be like you should do that the whole time We'll give you a promotion. So I moved my way through various roles on the floor very quickly in a like short amount of time and everything related to education empowerment supporting nurses, but then now I was also getting to support the community and see how specifically childbirth education Completely transformed their experience and I to the end I could tell like a family would show up in labor And I'd be like, you know observe them for a while ask them a few questions and I'd be like you did our classes Huh, and they'd be like, yeah, we did I'm like I can totally tell and it would make a difference
[16:20] And so that was really exciting to me And I was also seeing a lot of gaps and a lot of issues and a lot of concerns and I Was seeing and hearing the stats that up to 78% of people would use the word traumatic to describe their birth and I'm thinking Wait a second. That is so Unacceptable, and then I went into this whole like trauma thing with trauma informed care and all of that And it just really got all of those vantage points I started working with doulas in the community Training doulas in the community and really just hearing a lot more stories that were a lot more varied than my own Only patient care as a nurse with nurse, which is very valid and helpful, but it just sort of expanded my mindset
[17:06] And so I had lots of ideas. I am an idea girly. I am a problem solver I want to help I realize I can't save the world but I know that I can show up with myself wherever I am and help make a difference and So I pitched that to that hospital at some point in there I quit my other job and I went full-time at the Beverly Hills hospital So I was not doing both jobs the whole time and working like six days a week forever Thank goodness, but when I was there, I pitched these ideas and was like I I I have some ideas and I have some thoughts I had just done a presentation for CMQCC, which is a Multidisciplinary collaborative in California that sort of sets some standards pools the research and says here's how we're better as
[17:50] a medical world and So that had sort of gotten me on the map There were some calls coming in from managers across the country asking me to train their staff they didn't like that and I had a very pivotal conversation with my manager at the time and Was pitching like we could do this and dreams and what about this and we can do so much better We could be on the map and like change the world, you know, I'm exaggerating but not really I was very naive Especially looking back. I'm like, what was I thinking? Did I not know where I was? I did not I was just like, you know the starry-eyed young kid that like just wanted to help I still feel that way but you know in a different way and so I looked at her gave her those thoughts and she
[18:32] laughed at me and I said so basically what I'm hearing you say is you want me to come to work and go to some meetings and She's laughed and said well that and like answer some emails. Oh And I was like, oh Because at that point I was up in management so I had worked my way into an assistant nurse manager role was running the childbirth education program at that hospital and I walked out of that called my friend and was like my soul will die here and I remember saying that I know exactly Where I was and I was like, oh You're not gonna be able to stand being in this place for very long And it was about six weeks later that I officially quit my job
[19:13] And I just said if they don't want me then I'm just gonna try it on my own and that was also very dumb I Well that started with I knew so honestly how it really started was I googled like I was like, okay So I'm pregnant. I have a question. I would Google it, right? This is seven and a half almost eight years ago and you Google it and the first bar that came up on the screen For Google was a bunch of YouTube videos. And so I was like, okay, what's out there? And I remember this video still is out there. It had millions of views and it was this Woman with sort of a bowl cut that was at the front of a classroom with an easel and talked like this about
[19:56] pregnancy and your uterus and and I was like, oh I got this one down at that point. There really wasn't birth influencers. There really wasn't people on Instagram There definitely wasn't really anyone on YouTube and I was like I have a few things I knew I was gonna take clients as a doula So I knew I was going that direction as well and was gonna do private childbirth ed But I was like if I put a few of those videos on YouTube one I could send them to my clients so I don't have to answer the same question again 7,000 times again Yes, when do I know that I'm in labor? What is the cervix? What do they do for a vaginally all those things? so I was just like I'm gonna do these videos put them out there so I can use them for my clients and
[20:40] if people watch them great and Slowly, but surely my youtube channel grew and it continued to grow and for about four and a half years I put out a video a week on YouTube while building up a client base. Yeah, they're well done Well, and they've gotten even better well done So I took a break because YouTube if you're thinking about doing any kind of social I will say YouTube is the most strenuous. It is the most Expensive it requires the most and I do all of them now So I would say that like I just sort of my business took off and so I took a break for about almost three years And just this last April we are back and I am put back to posting a video a week
[21:20] and what's fun about it now is that all of our production has increased like Exponentially, and so it's so fun to get to go a little shorter Give a fresh take and be back on YouTube and continuing to Nurture that audience. Thank you. It's so fun. So I did that I started taking doula clients I did some private classes. I taught childbirth class in the community and then Sort of got to a place where I was maxed out and then kovat happened Somewhere in there and so but mind you I know that also took place I'm sure it's like, you know, it's a distant memory now But I remember that FaceTime call from you actually when you were in the hospital was so sweet
[22:04] So it was actually prior to kovat where I was all of a sudden It took my nursing brain where like when you're a nurse and you're at the bedside I really only saw how I Practiced as a nurse and I knew how I was and I had ownership over that but you don't really get to see What other nurses do all the time? But now as a doula I did and I started to get to go to all the hospitals all over LA and was Observing the nursing culture nursing environment nursing care all over the city at the same time I was developing my own practice as a nurse which I can offer my patients my nursing education My nursing brain all of that and also couldn't up the pit Increase the pitocin on the pump. I couldn't call the doctor. I couldn't advocate in the same way
[22:53] I couldn't use the medical stuff to help my patient along which that was how I was trained
Dr. Elliot Berlin, DC[23:00] It sounds like a neutered nurse It was my hands were tied with my normal like anatomy that I was used to my hand must be so hard because even as A doula you kind of want to jump Yes. Oh my gosh, that was your environment. That's what you were running and doing and then managing Yeah, now you're just kind of there like hands tied observing. Yeah Well, and like imagine there being emergencies and you watching people's response and being like get over there What are you doing or like resuscitating a baby? Like I was just like I always will tell people you want Sarah LaVon She's gonna be the best doula ever because like doulas don't have medical training medical experience for other kinds of support
[23:47] You had everything and then I never thought about the fact that you're in there and just have to like zip it and yeah
Sarah Lavonne[23:53] Well, it's it's like an art. I will say that like it's a practice I feel like I've developed to and I will say that now having rapport with the nurses because now I show up to a Hospital and they know me and they're like you do whatever you tell us what to do and I'm like no No, no, no. No, that is not what I'm here to do. I'm here to support you But they're a little bit more Easier to work with but I will say secret sauce is that I had never obviously been on the doula side But I'd been working with doulas in the community and like hearing complaints and hearing the challenges. I Never got it until I was on that side and I was like, whoa This is very different and I have all this expertise
[24:35] I am like, you know board certified and obstetrics like I know my ish and I wasn't always Like that at the bedside or seen that way. Let me recap before we take our next break
Dr. Elliot Berlin, DC[24:48] Five years old you watch your mom give birth and it's like wow, that was cool Then ten years old you're like, I want to be a nurse whatever that means then you become a nurse get a job right out of it and Pediatric experience and then working at an LA Hospital trauma hospital Where you see a lot it must have been taking on experience like drinking from a fire hose Yeah, and then the Beverly Hills version of labor and delivery quite different Then getting involved in education then management and then realizing your hands are very tied at the hospital So you leave that system to have a better impact on a problem, which is people are having crappy childbirth experiences
[25:30] And you're not able to solve the problem the way you want to from within so you go outside the system And you're supporting people one at a time, but making videos for the rest of us And then you're doing childbirth education, which is a great effort at solving the problem Like the more information people have the more empowered they are. That's what we're all good information. They have Yes, okay catch there important clarification and That's what you and we have in common so much as an informed pregnancy basically empowered pregnancy But then as the doula you have this other problem Which is you're in the hospital setting now, and you can't do anything, but you're a nuclear submarine
[26:15] So you don't stop there, and that's gonna bring us to what you're doing now when we get back. We'll be right back Well, this is the moment you've been waiting for we're back with Sarah LaVon And how do you solve the key issue which is people are still having crappy traumatic birth experiences? In the hospital setting and what do you do? How do you make a difference? I know that you go home at night and scratch your head wondering what you could be doing different to influence the system So what you come up with?
Sarah Lavonne[26:55] Well, I also realize that like I can train people through YouTube or my online classes And I'm not there and like they're at the will of the nurse And so knowing that I had the background that I did that I've always really believed in nurses I am a nurse at my core. I will always be a nurse at my core. I Thought to myself the way I'm gonna make a difference and an exponential difference is through nursing education and really what the phrase that we use is changing the game in obstetrics and flipping the switch on the various Statistics that I've been hearing be the same for like the last five ten years And so I really thought to myself like if we're gonna make a difference these nurses
[27:38] They are the ones that are preventing issues they're recognizing they're assessing they're having those one-on-one interactions they're showing up providing support or not and I could train them till I'm blue in the face and you show up to the hospital and your nurse either gets right on board and empowers you and amplifies your experience and supports you all the way or disempowers you in Potentially even just like one sentence and again I was seeing all the variations of the way that nursing care was being provided not only all over LA but at that point I had also began to build a social media presence in the nursing side as well and began to
[28:18] nurture that community and Just was seeing what was going on more And so I said if I can't make a difference from the outside in let's go back to inside out But from the outside which is the innovation side of things
Dr. Elliot Berlin, DC[28:32] I'll believe that makes a lot of sense
Sarah Lavonne[28:35] I hope so and so I had been brewing a training in my brain at every single birth Testing it out. I was in like massive study mode and had been sort of obsessing about the concept surrounding physiologic birth I read PT books I read Chiropractic books I read like all sorts of specialties I was like kind of really pushing into the more holistic side of medicine, which I always was inclined to I was always given the patience without an epidural, you know, like that was always very comfortable for me but I also knew that like the more holistic side and particularly the physiology of birth was not Included in any of my nursing education not in nursing school or on the floor
[29:27] We are not being trained in the core of what birth is and So I had been putting together this class in my head that I was calling physiologic birth that I was like if everybody knew this stuff One we decrease medical interventions, but we decrease these section rates We'd increase patient satisfaction and they'd have better birth experiences But again, there's like this enormous gap in our nursing education related to the concepts around physiologic birth and so I put together a class alongside Justine who was my partner at the time partner meaning professional partner at the time and She eventually got pregnant and needed to take a leave So I ended up doing it by myself
[30:08] But I needed her to like expedite the process and like help me do it and commit to it And so in January of 2020 we launched our first nursing training I rented a space in Los Angeles that had room for 46 people. We sold it out I like basically asked for favors from all of my nursing friends and like invite everybody and it sold it out added a second day Sold it out and the buzz was there and I was like we're gonna take this ish on the road We're gonna change the whole world of OB families are gonna have way better births. Their nurses are gonna be trained in physiologic birth we're gonna start with like Activating the body and helping set the body up to work on its own
[30:48] before we go to medical interventions and that was in January of 2020 and As we all know the whole world shut down in that March And so that training went really good and I kind of sat on it for a year as I pivoted to virtual support and did A lot of online stuff. That was when my YouTube channel really blew up as you can imagine, right? But I was sitting on this and just was like, oh my gosh I have to get this out and it was Justine who actually just kept pushing me like we can put it online We can put it online. I was like it's like a positioning class and it's like hands on you got to practice and sure enough by that time I'd done enough YouTube videos that me being on camera was very comfortable and we had multiple cameras to do multiple camera angles and
[31:27] My assistant at the time had a broadcast degree Long story short we put it online and to date I have trained over 6,000 labor and delivery nurses
Dr. Elliot Berlin, DC[31:35] Sarah congratulations. It's amazing. Isn't that crazy? You know when I was building my practice I would be tempted to go to these marketing events these Pregnancy expos where all these people are running around and be able to expose them and say oh I know you're achy and you're stiff or your breach or look at what we can do We can help you feel better We can help you function better and you would bring in like three or four people from the event though You know all day on your feet and have four great new clients from the event, which is okay. That's worthwhile Yeah, when you go to an event of childbirth professionals Same amount of time on your feet and then make really deep relationships with three or four childbirth professionals
[32:19] They're going to be sending clients to you Yeah till the end of time and so the difference between being able to help an individual which is very powerful But to be able to help an individual who is then gonna go help many many many individuals is so Exponential and six thousand nurses just means nobody knows how many people's lives you're affecting impacting How many births you're improving and then you double it or more because it's not just that mom that's giving birth It's the child that was birth and their birth experience and there's that nuclear energy There's that person that never stopped thinking about the problem and about solutions and putting in the hard work to make it happen
[33:04] And then seeing success so all right at the end of the day first of all just major kudos to you You're just thank you Inspiration you always have been but even more so now so as an Individual as a person who might be pregnant or thinking about a pregnancy What do you have for us for them and then as a nurse or a childbirth professional? What do you have for them and where do we find it all?
Sarah Lavonne[33:34] Yeah, so for pregnant people if you want more from me I encourage you to take the bundle birth class Which is a childbirth class combined with everything that I teach our nurses And so it really is this like easy touch point where then if your nurse has taken our class and now you've taken The bundle birth class you're off to the races You're speaking the same language you're on the same page And it is so fun to hear those stories of like I took your class Was really hoping for a bundle birth nurse and sure enough they came in with their team underwear pin or their starfish pin or they had your position guide at the bedside because now it's Turned into products and mentorships and all sorts of things
[34:10] We have a learning retreat in Mexico for nurses that like it's just exploded and so then you're off to the races You're speaking the same language, and so we have that coping with labor class etc Mind you what I will say to those pregnant people is that I think and I was thinking about this moment with you Dr. Belin and I just was like I think so much of the information out there about hospital birth is really scary People love to tell their horror stories Which your story is so valid and there is a lot that the hospital still has to improve if anybody knows I know trust me, you know, and I'm hearing those stories every day and There's so much good also happening in the hospital and there are so many
[34:51] Incredible Human beings and I say nurses because that's really my community but also doctors midwives other birth professionals Dulas out there that genuinely care to be the best they can be for you These nurses are investing their own personal money to be better for you. And I think for me as a pregnant person I'm not pregnant But if I was a pregnant person, you know I think to know that it's not all bad that there are Especially ask for your bundle birth nurses and they might be like, what's that and then be like, oh well You should know bundle birth because what's happening is that units are not only decreasing their c-section rate by like 1015 percent
[35:33] Okay, which is astronomical if you read any of those studies like a 1% decrease is considered significant But these families are walking out feeling whole feeling like they were heard that they were seen safe and soothed as we teach That like they've had nurses who came alongside them and maybe it didn't go as planned But also they had that support that they were never alone. They felt autonomy over their body their experience That's been one of our big pushes. And in fact, if you are being asked, can I touch you here? Can I do this? Are you ready? Now you tell me when that movement is a bundle birth nurses movement and these nurses have latched on
[36:10] Because they've just needed the tools to be better and that's exactly what I get to do now on that Exponential level which just feels like what am I doing with my life? It's just like again I was fully happy just being a bedside nurse and helping every patient and I still miss that to be honest because I'm not There at the bedside right now, but you know, it's like a million bedsides Yeah, yeah, which is why I still take private clients occasionally because I'm just like desperate to be at births People are like I'm sorry. I'm like no there's no place I'd rather be than at a birth until I've been up for three days and then I might want to be in my bed for like a second, but
[36:46] I digress So if you want to find us bundle birth calm bundle birth on Instagram bundle birth on tik-tok Sarah LaVon on YouTube But if you put in the search bundle birth, you'll find me There's so many free and paid resources out there for you. We just want to support you and a
Dr. Elliot Berlin, DC[37:03] Smattering of gifts on informed pregnancy plus. Oh, yeah shared with us. That's right Taste you can always check it out if you subscribe to informed pregnancy plus
Sarah Lavonne[37:14] Sarah you're amazing. So are you I really am honored to be in this work with you to be honest I actually talk about you and physiologic birth by the way, not by name I keep it anonymous unless you don't want to be anonymous But I talk about the work that you've done and how you had to sensitize your fingertips To be able to feel and all of that So you've influenced my practice and I appreciate that I can come to you with questions and that we're in this work doing Like very different work, but also very similar work. It's mutual
Dr. Elliot Berlin, DC[37:43] There's you know, a bunch of puzzle pieces that together make the full picture Yeah, and super honored to be in that puzzle with you. Thank you for sharing everything that you're doing now And thank you for doing it. Yeah, and if you're listening, I would definitely recommend going to check out bundle birth and Sarah LaVon You're gonna be glad you did. All right Thanks for listening to the informed pregnancy podcast for more pregnancy and parenting information just like this Visit us online at informed pregnancy
Want more pregnancy + parenting? Start your FREE TRIAL of Informed Pregnancy+ and get access to all our curated pregnancy and parenting content — original series, iconic birth films like The Business of Being Born, prenatal workouts and more.
Nurse practitioner Emilie McLain joins the podcast to discuss her path to practicing midlife gynecology including how to understand and navigate the hormone shifts of perimenopause and beyond.
Informed Pregnancy Media and Mahmee present an all new podcast! One Way or a Mother is a new narrative podcast from Dr. Elliot Berlin, DC. Each season is an intimate story of one woman, one pregnancy, and all of the preparations, emotions, and personal history leading up to the birth. Episodes feature the expectant mother along with her family, doctors, and birth work team.
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Emilie McLain in orange.
Dr. Elliot Berlin, DC[0:00] My guest today is a nurse practitioner with a doctorate in nursing practice whose work has spanned both ends of the reproductive spectrum from labor and delivery to menopause care. After years of supporting women through childbirth in a hospital setting, she transitioned into midlife gynecology where she now helps patients understand and navigate the hormone shifts of perimenopause and beyond. She'll share what everyone needs to know about postpartum and early menopause, as well as her own birth experiences, which she approached with a blend of professional knowledge and some natural anxiety. I'm pregnancy-focused chiropractor, Dr. Elliott Berlin, and you're listening to the Informed Pregnancy Podcast.
[0:54] Emily McClain, welcome to the podcast. Hi, Dr. Berlin. Thank you so much for having me. My pleasure. I was telling you just earlier, my wife and I got into this field through our infertility journey, and we really had a passion for helping people who were on that journey. And after they started to get pregnant, our practice kind of shifted into pregnancy. And then after that birth and postpartum, and now as that population is aging, we're getting into perimenopause and menopause, and I don't know much about it. So I'm really honored and thrilled that you're here to educate us all. I'm happy to be here. Tell me about the beginning. Where are you from originally, and what kind of work do you do?
Emilie McLain[1:37] Yeah, so I am from the suburbs of Chicago. I relocated to central Illinois for school, worked as a labor and delivery nurse in that community, and I have since transplanted myself back into the suburbs, where I now work as a women's health nurse practitioner in the gynecology space with a special focus in menopause. What led you into birth work originally? So I entered nursing school, and I knew I wanted to be a nurse practitioner, and so that was kind of my driving goal. We had a pediatric nurse practitioner growing up, and me and my family really loved her. And so that was what piqued my interest in nursing school. And then as I was in clinicals, being in the birth space was, I mean, as you know,
[2:29] it's invigorating. It's amazing. It's just incredible to be a part of that. And so I really wanted to focus on that once I graduated nursing school. However, it was at least hard to get a job in labor and delivery as a new grad. So I started in MedSurg first, just on a regular medical surgical unit, which was really useful anyways, because I got to hone in on some basic nursing skills before I was thrown into the world of labor and delivery and postpartum. And then, yeah, my love for women's health just grew and expanded from there. So I knew I wanted to focus on women's health once I started NP school, and that's what I do now. I would say to me, anyway, it's invigorating and draining at the same time.
Dr. Elliot Berlin, DC[3:19] Yeah, that's possible. That is a good way to put it. Yes. Like being thirsty and having to pay. I mean, you finally got into labor and delivery and also postpartum care units.
Emilie McLain[3:34] What was it like when you got there? It's a lot to take in at first, which is why I was really grateful that, like I said, I had those basic nursing schools going into it. There's so much to learn. And as excited you are to be there and just in awe of everything going around, there was a lot to learn. Absolutely. And as many good experiences there are with birth, being in a hospital setting, you see more medically complex cases. And so that can be a really scary thing to be a part of, especially as a nurse who's just kind of learning the ropes. For example, preeclampsia, eclampsia, cesarean sections, fetal intolerance to labor, hemorrhages. That's when you realize that there are lots of things that
[4:27] are life and death about labor and delivery for both the mom and the baby. So it was sort of a shock to get started in it. Did you not see those kind of things during your clinicals? Not really. I don't think in nursing and clinicals, you're not spending a ton of time in those deliveries. And so yes, you do see deliveries, but you don't see a huge range of them. And so a lot of my exposure was honestly when I was on orientation as a labor and delivery nurse. And then even as a labor and delivery nurse, when you have experience, you're always seeing new things and learning from new experiences. And so that's just kind of how the medical field is in general, that you're always learning and expanding your
[5:14] horizons. And so yeah, it's a lot to take in, but I also felt such a passion for wanting to help these moms get the experience that they want, but also have the education to where they can make these informed decisions. And so the more I kind of was in that space, the more research and education I was doing for myself so that I could be a better
Dr. Elliot Berlin, DC[5:41] nurse for my patients. I mean, that's pretty cool. I think nurses in hospitals are the jam. They make everything tick and do all the work, you know, the line share of the work in general, and especially in labor and delivery. And there is so much responsibility. I always have mad respect for the nurses. And also when I had COVID and I was in the ICU, the nurses were just insanely supportive and helpful more than anybody else. So I have a great appreciation for you and all of your colleagues. But at this point, you didn't have
Emilie McLain[6:16] any kids yet, right? I did not know. And so I think that I wouldn't say it was hard to relate to my patients, but it is different when you haven't gone through something personally. But as you get that experience, you definitely form your own ideals and the care that you want to give your patients. You definitely develop that as you go, even if you haven't personally been through it before. I mean, you become a nurse because you care deeply for other people and you want to help them through their healthcare goals. And so the basics of that, you know, are the same whether or not you've experienced it personally. But as someone who might go through it down the road when you're going through those
[7:00] experiences, especially the scarier ones, getting pregnant, it didn't affect you right away. How did it have more of an effect on you? Yeah. So when I initially got pregnant, I really felt good about the whole thing. I felt like I, you know, had all this education. I knew what I wanted in my birth. I knew I wanted a low intervention, you know, delivery experience. And I really felt like I had the tools to accomplish that. And so I felt really good about being pregnant initially. And I really had a pretty uncomplicated pregnancy. I felt really good throughout the whole thing. I was active, I was exercising. But then I turned 38 weeks and my blood pressure started creeping up.
[7:52] And so that was very scary for me. Very, very, very scary for me because seeing how this has played out in the hospital for previous patients of mine, it was hard to stop myself from going down that rabbit hole and thinking, okay, now I'm going to be induced and it's my first pregnancy. And so I have a higher risk of failure to progress and then end up in a C-section and then have a NICU admission and then have difficulty breastfeeding. The whole cascade. Yes, exactly. That cascade of interventions. And not that it always plays out like that, but now suddenly I'm sitting in that chair and that is all I can think of. And so my anxiety was truly through the roof, truly through the roof. So I ended up
[8:45] being induced, which was not- Because of the high blood pressure? Yes, because of my high blood pressure. Where's there other labs along with it that were concerning? So I had my first high blood pressure reading at an appointment and both me and the midwife were kind of like, oh, I just took four flights of stairs. Like, of course my blood pressure is going to be elevated. Let me check my blood pressure at home for the next couple of days. And so I was doing that. It was normal at home. But then when I went back a couple of days later for my appointment, it was elevated again. So then we decided to do some labs and I had protein in my urine, which is one of the most common signs of
[9:26] pre-eclampsia. So that earned me an induction. So I sent to labor and delivery, started the induction process. I was, I'm not even sure if I was one centimeter dilated yet. So again, that just added to my fear of how this whole thing was going to go. So I ended up getting two doses of Cytotec, which actually put me into a pretty regular contraction pattern. Did the Foley balloon, incredibly painful. Did you just do it on yourself or did you let? No, the midwife did it for me. Thank goodness.
Dr. Elliot Berlin, DC[10:01] But that's also, that's got to be something that once you've experienced you,
Emilie McLain[10:05] you have a much different perspective on doing it to other people. Yeah, I was kind of shocked. I felt so bad for, you know, not realizing how painful this could truly be. I mean, some people do fine with it. Other people are in a lot of pain with it. And I was one of those people that I was like, holy cow, this is super, super painful.
Dr. Elliot Berlin, DC[10:28] In my doula work. I noticed that for some people that you could, you might have to tell them that you're doing it because otherwise now it's just like a cervical exam for them. And for other people, the tissue seems to be so incredibly painful and sensitive that very, very tough people are screaming.
Emilie McLain[10:45] I'll never do this again. Yeah. So that was basically my experience. It was so painful. And of course, I was not tolerating the pain very well. And I remember them, they kept telling me I could get the epidural and I was like, I'm not getting the epidural yet. I need to be active during my labor. Like, I know how important this is. So anyways, the Foley balloon ended up coming out. It was still ambulatory the whole time. That was something really great. I think about my midwifery lead induction was they didn't hook me up to oral IV fluids. They let me drink water. They encouraged me to eat. They let me walk around the unit. And those were all things that were very, very important to me.
[11:30] So after the Foley came out, I did get the epidural. They broke my water. Two hours later, my son was born. So it happened very, very fast after that.
Dr. Elliot Berlin, DC[11:44] I know it was a while back, but congratulations.
Emilie McLain[11:47] Thank you. Thank you. Thank you. It was a beautiful story. It was a really, really, really positive induction. It still was hard to sort of wrap my mind around it because I was still grieving the process of not going into natural labor, which I think is very fair. But my experience itself was so positive. I had such wonderful nurses. I had great midwifery care. I had a beautiful delivery. So it went about as good as it could be. And then my blood pressure was fine.
Dr. Elliot Berlin, DC[12:19] So is it in? Yeah, I don't know if you know,
Emilie McLain[12:22] there's a test called the encompass test, but one of our sponsors, that predicts with incredible accuracy, who's going to get preeclampsia. Yeah, yes, I have heard of that. And I was actually listening to that episode. I think it was shortly after I delivered my second son. And I was thinking, I wonder if that would have been a good thing or a bad thing for me to know. If I was going to get preeclampsia again, because that really weighed on me a lot when I was thinking about getting pregnant the second time was now, even though I did have a great delivery, but I just felt like the stakes are higher now the second time, right? I already have a baby at home. I don't want to have to have a C-section and be recovering
[13:12] for that while I'm caring for a toddler. And knowing that I had preeclampsia the first time, my chances of getting it, you know, are pretty good. I mean, not good, but, you know, greater than the average. Yeah. So then I'm kind of thinking, oh, gosh, what if I end up delivering earlier, you know, next time, even earlier? So even though I had a good experience, I was already starting to go down that rabbit hole before I even got pregnant for the second time. And so that is when I decided I really need to work on this before I get pregnant and go see a therapist. And so that's what I did.
Dr. Elliot Berlin, DC[13:51] Oh, I want to hear all about that and see how it impacted your second pregnancy experience after a quick break. We'll be right back.
Dr. Elliot Berlin, DC[14:11] Okay. Welcome back. We are, I mean, this is a packed episode. We're going to have labor and delivery from the perspective of a labor and delivery nurse who did it twice. And then also talk about postpartum and the midlife hormone changes with Emily McClain. Okay. So the anxiety of your first labor and delivery, even though it went well, made you think I should see a therapist before I do this again. How did that go?
Emilie McLain[14:39] It went really, really well. I mean, I started a couple months before we were planning to get pregnant. And so I established with a therapist whose focus is pregnancy, delivery, postpartum depression. Like that's really her focus. And so we just kind of talked through how that experience went. And for me, it wasn't even necessarily my experience, right? I didn't have a bad experience, but I did have something scary that could have been a different outcome. And it just brought me back to those other experiences that I had been a part of. So it's sort of like, you know, PTSD by proxy, essentially. And so I was talking through things with my therapist and I think a great
[15:31] lesson that we really drove home every single session was I can be an advocate for myself and I know how to say what I want and say what my goals are and understand what's happening to me. And I have a great support system around me. And she taught me good grounding techniques too, because I realized kind of being in that office was a bit of a trigger for me brought me back to that last appointment that I had that I was sent right to the hospital. And so focusing on things that would make me feel grounded in the moment, reminding myself that I had no reason to think that I was unsafe or my baby was unsafe and really just staying in the moment, which is easier said than done.
[16:18] For all of us.
Dr. Elliot Berlin, DC[16:19] Yes. Yes. Yes. So you still went ahead and did it again.
Emilie McLain[16:26] I did do it again. Yes. I got pregnant very quickly and so didn't really have time to be like, Oh, maybe I'm not ready yet. You know, ready or not here we come. Yeah, exactly. Exactly. So got pregnant quickly. I had spotting, which I had actually had the first trimester of my first pregnancy as well. And so that was, you know, scary, but I felt like I was able to sort of rationalize that. And again, just trusting my body, like my body knows things that I don't know. If this is a good pregnancy, I can trust that my body knows that. And so I actually did okay with that sort of anxiety, but as we got closer to the due date, I felt my anxiety building a little bit more.
[17:15] And so I still kept up with my therapy appointments and my midwives knew that I did have anxiety about all of this and I was tracking my blood pressure at home. And I just had a really good support system too, with my husband who is constantly checking in on me and seeing how I was doing with everything. And so because of my previous induction, I was talking to my midwife at one of my later appointments, I think it was about 37 weeks for my second pregnancy. And she offered scheduling an induction because she knew I was really anxious about getting preeclampsia again. And so she had actually suggested scheduling an induction around my due date to hopefully prevent me from getting
[18:06] preeclampsia again, if I went later on in the pregnancy. And so never in a million years would I think that I would be okay with doing another induction. Choosing induction, right? Yes, but here I was thinking, huh, okay, well that does make sense. If I can do something to prevent, I mean, really there's not a whole lot you can do to prevent preeclampsia, besides staying active, eating well, taking a baby aspirin, that was something that maternal fetal medicine had recommended to me. But besides that, it really was sort of out of my hands. And so we decided to schedule an induction and she promised a very slow induction and that's exactly what I got. It was as low of an intervention induction as you could get. So
[18:58] I went in a day after my due date. So I was 40 and one, my blood pressures had been normal the whole time. And I was already three centimeters. They had did a membrane sweep on me in the office a couple of days prior that did start contractions, but then didn't end up going anywhere. So I still ended up being induced with pitocin. So they turned it up very, very, very slowly. I was ambulatory the whole time, changing positions on my ball. I started to get uncomfortable and asked for the epidural. And after my epidural was placed, they broke my water. And this time it was only an hour until delivery. So ended up being a really, really fast delivery. And I was just so grateful that it all worked out. And even though it was
[19:52] an induction, you know, this was sort of my way of, I guess, taking back my birth experience, because I didn't feel so threatened by an induction for preeclampsia anymore, if I already knew that I was planning on an induction. And so being able to kind of process that before my actual delivery, I think really helped me stay in the moment. And I was able to enjoy the process, honestly. I love that. Yeah. I love that. What would you say?
Dr. Elliot Berlin, DC[20:24] Because I sort of heard undertones of you feeling like you had to make sure that you had your autonomy and that your voice could be heard while you're in labor. And I've had OB-GYNs on the podcast who say that during their pregnancy or during their birth, there are certain things that they wanted that they just couldn't either find a way to say or couldn't find a way for themselves to be heard and for those wishes to be carried out. And so, I mean, for someone who's been through it from both sides, the personal and the professional, is there a tip? Because a lot of people listening right now are pregnant, and they have visions on what they want their birth to be like. Is there any kind of tip or
[21:07] thought or advice on how to either find the voice or make sure that the voice is heard
Emilie McLain[21:13] and respected? Yeah. I think being aware of how a typical birth in the setting that you're planning to give birth in, how those policies typically go and what a birth and delivery typically look like, because then I think you can have more of an idea of what to expect and then advocate for yourself on things that maybe would be a little bit different so that you're not in the spot in the moment because you're really overwhelmed when you're going through that experience, when you are the patient, that a lot of times, it's easier just to say, okay, okay, go along with things, even though that's not really what you feel. I think being prepared and knowing what to expect before you get to that
[22:04] situation helps a lot. Then you can think about what kind of conversation you want to have about these things. Another thing I think that's really helpful is having those conversations with your birth team. For me, it was having that conversation with the midwife at my prenatal appointments saying, even if I go through with an injection, I really want it to be slow pace. I want to be able to move around. I want to be able to eat. I want those things, and that's important to me so that, again, everyone can be on the same page before you actually get to that event and emotions are heightened. What was your postpartum experience like each time? The first time, it was really hard. It was really hard, I'm not going to lie.
[22:55] I knew what to expect as far as how newborns act and the needs that they have and the frequent feedings. I was very educated on how to help other moms breastfeed. When it was me, I really struggled with it. My baby didn't have a good latch and it went on for far too long where I was in so much pain. I kept seeing different lactation consultants that all told me that it was normal. That is not a good feeling when you have this goal that you want to accomplish and know in your gut that things are not right and you can't find people to help you meet those goals. That's a terrible feeling. Plus, you're sleep deprived and emotional because you're postpartum and all of the things. Postpartum was really tough from a feeding
[23:51] perspective, but also just an identity shift and everything about your life changes. Now, all of a sudden, you have to really plan out exactly what 20 minutes you can use to brush your teeth and take a shower. That's a really big change from when you don't have any kids. Right. Massive change. How did you get the breastfeeding worked out? I ended up finding a lactation consultant in my area who did home visits and I didn't end up seeing her until my son was I think about six weeks and I just knew this was not right. It was not getting better. I was in so much pain all the time and pumping was not helping and so she came to our house and confirmed that he had a tongue tie, which is why his
[24:46] latch was so shallow, which is why I was in so much pain, which is why he was so spitty because he was taking in too much air with all these feeds and so we got that released. It's a little startling. Other lactation consultants missed that. Yeah, I think at the time it wasn't as well known and I still think that it's not a large part of the lactation education that you get and so now I think that there is more awareness about it because with my second son, about 36 hours after he was born, I started having those same feelings of that nipple pain and I was like, oh, but see, I know that this is not normal. I know that it doesn't have to hurt and some of
[25:36] that is just of course getting used to things, but I said that to the in-hospital lactation consultants that I had concerns with this baby having a tongue tie too and they were way more open regarding the tie than they were with my first son. So I think that there's just more awareness and more education surrounding it and so we ended up getting that corrected really quickly with my second son, which honestly made a world of difference with our feeding experience and postpartum and everything. Well, 36 hours is a lot better than six weeks. Yeah, exactly. So you had a better postpartum transition the second time? Definitely, definitely. Yeah, I think the first is always harder because there's a massive
[26:21] learning curve too and the whole sleep deprivation is really foreign to you the first time or the second time. It's like, well, we kind of already figured out how to get through this and how to manage and so that's less of a shock. Plus we're just more confident as parents and so you have your toolbox of things that you know you can try, even if it didn't work for our first son. Well, this is something that we remember looking up, so we'll try it for the second. And you know, you're just more confident, you have more education, you have more experience. There's just less moving pieces, it seems like, the second time when you're already in parenthood. You moved away from labor delivery and postpartum to sort of
[27:06] midlife gynecology. What led to that transition? I sort of fell into it. There was a job opening very close to my house and the focus was menopause. So I had dabbled a little bit into menopause with a previous position. But with this one, I had so much guidance from a really wonderful provider who is a menopause expert. And so she was really inspiring to learn from, but also just work with these women who have been brushed off from doctor to doctor to doctor about all these symptoms that they're having. And your heart goes out to them and you want to help them. And there are lots of things that you can do to help their quality of life. And so I know it seems weird to switch from one side of
[28:00] women's health to another, but it really is so intertwined that your hormones affect everything about your life, every aspect of your life. So it was actually a really
Dr. Elliot Berlin, DC[28:12] natural transition. I sometimes think it's not that big of a gap from going through, especially as women are having babies older, going through postpartum to all of a sudden going through the onset of menopause, the beginnings of menopause. And also it's the same hormones that play. So do you see similarities in sometimes those postpartum
Emilie McLain[28:34] hormone swings that then come again later? Absolutely. Absolutely. A lot of the symptoms can present very similarly. So for example, night sweats, hot flashes. I mean, I think every mom I've known, we all experience waking up in the middle of the night just covered in sweat. That's the menopausal symptom. Absolutely. The brain fog, fatigue. I mean, some of this is due to lack of sleep and caring for a newborn, but also the lack of sleep too. Sometimes when you even have a moment to sleep, it's really hard to sleep. And that's something that I actually experienced this second time around. And I was like, Oh yeah, this is a menopause symptom for sure. Like my baby's sleeping just fine. And yet I cannot fall asleep and it's 3 a.m.
[29:24] And now I'm going to be up all night. So sleep trouble, decreased libido, urinary symptoms, like urgency, frequency, feeling like a UTI sort of, that kind of goes along with vaginal dryness. That's really common in breastfeeding women especially is that they have this drop of estrogen and they now have all these vaginal and bladder symptoms. And so that is a very common symptom that menopausal women experience as well. So many systems of the body are estrogen
Dr. Elliot Berlin, DC[29:59] dependent. And so I think you're sometimes not aware of how widespread the symptoms can be and how many different systems it affects. And I imagine oftentimes those symptoms, nobody's really putting it together. The individual is not putting together. Sometimes when you have a symptom, you see a specialist and the specialist is zoned in on just that symptom, not looking at the bigger picture. And I am sure that the more information somebody has, just like pregnancy, birth and postpartum, as an individual, the more information somebody has, the better their care is going to be managed because they're going to be an active part of the care team. I want to take another break and when I come back, learn everything we can
[30:46] about what to look for, what the different signs and symptoms are, the scope of the effects that it can have on the body and things that we can do to be proactive in terms of taking care of oneself. We'll be right back. Welcome back. We're about to drop some knowledge bombs with Emily McLean, all about perimenopause, menopause. Okay. When should someone start to look out for symptoms and what are some of the things they might start to see that would set off like a boom, here's a light. I'm starting to enter this chapter.
Emilie McLain[31:30] Yeah. So menopause, we'll start with some definitions. So menopause is the moment in time when you go one full year since your last period. So that would be menopause and the average age for menopause for women in the US is between 51 and 52 years old. We use the term perimenopause to explain the hormonal shifts that happen leading up to menopause and then menopause happens. That's that point in time and then post-menopause is everything that happens after that. And so a woman then is considered to be post-menopausal for the rest of her life. We usually use the term menopausal interchangeably, but that is once they go one full year since their last period, then they're a menopausal or post-menopausal for
[32:20] the rest of their life. So perimenopause on average lasts about four to five years before women stop having a period, but for some women it can last seven to 10 years even. And so it is a very wide range of ages, which also makes it sort of tricky to diagnose and treat and can lead to, like you explained before, kind of going to different specialists to kind of try to pinpoint treating one symptom at a time rather than looking at the whole thing. So the first thing that usually happens in perimenopause is your cycles start to change just a little bit. And so you're not ovulating regularly. And so your periods will start to vary first by a couple of days, then maybe five days, then a week,
[33:10] then over a week. And then they can kind of become really erratic. Your flow could also change. So they could get lighter and lighter. Sometimes they get heavier. Sometimes they get heavy, then light, then heavy, then light. And all of that has to do with the fact that your menstrual cycle is no longer following that nice curve of hormones and that nice peak for ovulation and then progesterone being made by the corpus luteum after ovulation. And so there's just less of a coordination between these different phases of the menstrual cycle when you enter perimenopause. And so you still have enough estrogen where you're having a cycle, but you start to have these really big dips in your estrogen and also just
[33:58] kind of these erratic points of highs and lows, a roller coaster essentially, where that is leading to a lot of those same symptoms that I just described that you can have
Dr. Elliot Berlin, DC[34:10] in postpartum. Yeah, I see people that come into the office in a couple of different ways. Sometimes I think it affects bone density. And so they'll all of a sudden be losing bone density, but also really more the nerves. I'll see all these peripheral nerve symptoms like tingling or burning or numbness, sometimes like restless leg type symptoms, sometimes muscle cramping. And if you don't have your eye out for hormones playing a role here, you just start to treat it on a very muscular skeletal level. Oh, there must be a pinch of the nerve. And my job as a massage person is to release the soft tissues and take pressure off the nerve. My job as a carpark to release restricted joints, take pressure off the nerve.
[34:58] But I think in general, I kind of have a rule that I'll treat something four times. And if it doesn't make any change, I'm not going to keep barking up that tree without investigating further. That might be doing lab testing, that might be doing imaging. But as I mentioned at the onset of the episode, as my population of my patients is getting older and older in their 40s and close to 50s, they're starting to see these types of symptoms. And I'm realizing that oftentimes it's the changes in estrogen. Yeah. I mean, estrogen really
Emilie McLain[35:32] affects every aspect of our bodies. And to be honest, the research is ongoing. The more and more we research estrogen's role, the more we're finding out more about all of these symptoms. And I have seen that tingling or itchy skin, that sort of thing, all over joint pain. The bone density is a very real concern for women who are entering menopause. We know that the first two years, actually, after your last period is when you lose the most of your bone density. And so to try to be proactive, to prevent that from happening is crucial for setting women up for quality of life beyond 50 years old.
Dr. Elliot Berlin, DC[36:21] There's a million things going through my mind. First of all, I know for a fact, because these are my patients, that not unlike you in your breastfeeding journey, when you felt like something was totally wrong, but people were telling you, no, it's totally normal. I know people are starting to feel these menopausal symptoms and talking to providers about it and being dismissed sometimes. No, no, no. You had a baby and things like that. So on that level, it's sort of like when someone has a gut feeling like that, what do you recommend that they do in terms of trying to figure it out and get
Emilie McLain[36:58] some answers? The Menopause Society is a wonderful resource for really everyone to know about. So it used to be called the North American Menopause Society. And they're the ones that kind of come up with all of these position statements and education for the general public, but also providers. And they have a great resource list that you can actually look up your zip code and find a practitioner who is menopause certified. And so to be menopause certified, you actually have to take a test, you have to continue with continuing education to show that you're keeping up to date with the menopause guidelines. And so I think if you really have that gut feeling or you're trying
[37:46] to be proactive about your health, you just want to learn more, you want to establish a relationship with someone who can help you in this next phase of life, that is a wonderful place to start where you know you're going to be getting the most up-to-date evidence-based
Dr. Elliot Berlin, DC[38:00] care. Okay. Well, that's a great resource. And then there are screenings people can do. When
Emilie McLain[38:06] do you suggest that they do them and what are the screenings? Yeah. So as far as screening for menopause itself, unfortunately, there's not really an easy task that you can do. Your hormones fluctuate so much throughout perimenopause that it's really hard to capture what's going on in a single moment. And so as far as screening for menopause, usually we're just kind of looking at symptoms going on, what your periods look like, how old you are, and we'll have to kind of put the pieces together to figure out exactly what's going on because it can be hard to tease out what symptoms are exactly menopause and hormone related and what symptoms may just be the stress of life
[38:51] and your dog's sleeping with you and so you can't get sleep. You know, like there are other factors at play here. So as far as additional screening, screening for heart disease, metabolic disease, bone density, those things are all very important to do. So for screening for heart disease, something that I always like to look at is if a woman has a history of preeclampsia, we know that that increases their risk for heart attack, for stroke, for high blood pressure later in their life. So those women in particular need to be really conscientious about their heart health as they're entering menopause. So screenings that I would consider for them would be a lipid panel. There's advanced lipid panels that you
[39:40] could get drawn to see if you have genetic risk factors for having a cardiovascular event. You can consider doing a coronary calcium score which looks for plaque buildup on your arteries and also then just screening for thyroid disorder, diabetes, just metabolic disorder in general. The other thing I like to think about too talking about pregnancy disorders is gestational diabetes increases your risk for developing type 2 diabetes later in life. So for those women, we should really be screening them early for insulin resistance. We can do that by getting fasting insulin, fasting glucose levels, a hemoglobin A1c looks at their average blood sugar over the past three months. And then having that information can help us come up with a plan
[40:30] on how to be proactive about their life, the future. So tips that I like to give all my patients is following a Mediterranean diet can really help to decrease the risk for heart disease, for metabolic disease, getting 10,000 steps a day, doing heavy lifting, making sure you're getting enough protein in your diet, making sure you're getting enough fiber in your diet. Those things are just kind of general tokens I like to give to everyone. But as far as those screenings, those are readily available. You should be doing them about yearly as you approach menopause, as you're in menopause. And then the last thing, like I mentioned before, is that bone density screening. So I really like to do that about
[41:16] two years after someone's last period, because then we have an opportunity to sort of catch that osteoporosis from forming before we get to osteoporosis.
Dr. Elliot Berlin, DC[41:27] What do you say as you approach menopause? Is that going to be different from person to
Emilie McLain[41:31] person, or is there an age where it's like, I've reached this age, I should do these screenings? There's not necessarily a hard and fast rule as far as age. I think it really depends on the person. Someone who is 42, who is skipping her periods, who has a family history of heart disease, we probably want to be looking at her heart health sooner rather than later. And so I think it really depends on your personal history or family history. And so that's a great conversation to have with a menopause specialist, someone who understands that risk a little bit
Dr. Elliot Berlin, DC[42:09] more. I think you talked about lifestyle changes, which is super important for maintaining health, especially during this period of life. But also, as the symptoms start to come on, what kind of therapeutic tools are available to help out?
Emilie McLain[42:23] So as far as therapeutic tools, we have a couple of different options. We can use non-hormonal treatment options or just lifestyle changes too, depending on exactly how that person presents, what their history is, what their goals are too. But most commonly, I do utilize hormone therapy for a vast majority of my patients, because that allows us to get to the root cause of their symptoms and it helps them feel more like themselves. Plus it gives them bone protection and it just helps to give them quality of life so that they can be more proactive, have the energy to be more proactive and follow those healthy lifestyle recommendations.
Dr. Elliot Berlin, DC[43:10] I think also, especially during the time, people have little kids and you've got to be energetic just to keep up with them. And especially if you're splitting your time between that and a career, it's a time when you want to feel good and you
Emilie McLain[43:25] need the energy. Yeah. And some women are also even dealing with now grandkids. I mean, it's such a wide range of life events that happen when you're midlife. You might have little kids yourself. Your kids might have kids now. You might be taking care of your aging parents. And so there's so much going on in that period of your life that we really can't have your body giving out on you too.
Dr. Elliot Berlin, DC[43:53] There's the health and then there's everything, all the practical consequences of that. Emily, I really am learning a lot from you today and I really appreciate you coming and sharing both your personal stories and your professional journey and some tips from all the different stages of pregnancy, birth, postpartum and now menopause. Is there anything on your mind that I didn't ask that you think would be important that we share before we wind
Emilie McLain[44:18] down? I think in my personal and professional experience, I really want women to know that they can trust their bodies and they can trust their gut. And if they feel that something is wrong, that something's off, that there are people that can help them achieve their goals and help them improve their quality of life. And so I think, unfortunately, you do kind of have to do a little bit of your own research to find those people to keep in your circle, but they are out there and we really do want to be able to live out the rest of your years
Dr. Elliot Berlin, DC[45:00] in good health. Very well said. Thank you.
Emilie McLain[45:04] And thank you again for sharing. Where can we find you online? You can find me on my personal LinkedIn, Emily McLean, or on my professional website, mymenopauseRx.com. What kind of things can we find there? On mymenopauseRx.com, you have the ability to book appointments with myself or my colleagues. We also have lots of resources regarding perimenopause education, menopause education symptoms, just things to experience, things to expect. We also have sort of a social media type platform too that you can ask your questions and we give generalized medical advice or medical tips for women who are experiencing these changes. Amazing. We'll check it out and
Dr. Elliot Berlin, DC[45:57] you know, if there are things we'll add that to our show notes, but if there are the things that you'd like us to add, we'll add those as well. Thank you again for the incredible work that you're doing and for joining me today. And at home, thanks for listening to the Informed Pregnancy podcast. For more pregnancy parenting and now perimenopause and menopause information just like this, visit us online at informedpregnancy.com.
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Double board certified OBGYN and medical geneticist Dr. Dallas Reed joins the podcast to discuss a deeply personal family experience, how she’s bridging obstetrics, pediatrics, and genetics, and what every parent to be should know.
Informed Pregnancy Media and Mahmee present an all new podcast! One Way or a Mother is a new narrative podcast from Dr. Elliot Berlin, DC. Each season is an intimate story of one woman, one pregnancy, and all of the preparations, emotions, and personal history leading up to the birth. Episodes feature the expectant mother along with her family, doctors, and birth work team.
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Dr. Dallas Reed in orange.
Dr. Elliot Berlin, DC[0:00] This episode is made possible in part by support from our guest, helping us to bring you quality content that is both entertaining and informative. My guest today is a double board certified OBGYN and medical geneticist at a leading academic hospital in Boston. Inspired by a deeply personal family experience, she now bridges obstetrics, pediatrics, and genetics to support families navigating complex diagnoses. From teaching medical students to comforting patients, she brings heart and science to every interaction. And today, she's here to share how genetic insights are transforming pregnancy care and what every parent-to-be should know. I'm pregnancy-focused chiropractor, Dr. Elliott Brevin, and you're listening to the Informed Pregnancy Podcast.
[0:48] Dr. Dallas Reed, welcome to the podcast.
Dr. Dallas Reed[1:04] Thank you for having me.
Dr. Elliot Berlin, DC[1:06] My pleasure, especially with little kids at home. Thank you for making time for us. And I'm really excited to sort of pick your brain and dive deep into all the things that you are an expert at. And some of them that we've not really ever talked about on the podcast before. Well, let's get started at the beginning. You were born and upstate and raised in Texas. Is your name, Dallas, inspired by that at all?
Dr. Dallas Reed[1:29] It is not just a weird coincidence that we ended up moving to Plano, Texas, which is the biggest suburb of Dallas, Texas, when I was like four. So I did all of my elementary and high schooling in Plano, and I think it was a very formative part of my personality being named Dallas and growing up in Texas. So it's followed me everywhere I go.
Dr. Elliot Berlin, DC[1:50] Well, you've gone to a lot of places, and you've come a lot since high school. You have two specialties, and you're certified in a unique combination of specialties. What led you into a path of medicine?
Dr. Dallas Reed[2:03] So it's a great question. I always thought that the reason that I got into this field was because of a personal experience. As you alluded to earlier, my mom had a baby with a genetic condition when I was in first grade. It was very unexpected. There was no clues to it during her pregnancy, and she had an essentially emergency C-section. Afterwards, it was obvious that something was different about my brother, and we weren't really sure what it was for a little while. He ended up getting diagnosed with a genetic condition a little bit into his life, and he lived for two months in the NICU and then at home with us for two months before he passed away,
[2:45] which was an expected outcome with what his diagnosis was. Actually, we expected him to pass away sooner than he did, so that was really a blessing. That very clearly put me on the path to become an OB-GYN geneticist, but actually when I was moving from my fellowship to Boston where I live now, my mom sent me a whole bunch of stuff because she moved houses. In there was something from preschool where your teacher asks you, what do you want to be when you grow up? I told her I wanted to be a doctor, and I was four. I didn't really know that I knew that early. Again, my brother was born when I was in first grade, so that was well after being four.
[3:25] I don't know where that desire to be a doctor came from. I think kids say that a lot. How many actually end up becoming a doctor, I don't know. I didn't have any doctors in my family. I still don't have any doctors in my family. I think just being a first born, motivated child with this life experience really led me to where I am now.
Dr. Elliot Berlin, DC[3:44] I guess you probably had seen doctors, though. Maybe someone left a mark on you.
Dr. Dallas Reed[3:49] Maybe.
Dr. Elliot Berlin, DC[3:50] I mean, that's a really challenging situation for anyone in your family, but first grade is a very hard time to go through that kind of experience, that kind of really trauma, and to watch your parents go through it must have been challenging.
Dr. Dallas Reed[4:07] I think being that young is a good thing, actually, because you only know as much as you know. You know that this is your brother. You know that he has some special needs. We got to meet other families that had children with his diagnosis or similar diagnoses, so I remember going to people's houses and meeting up with other kids whose siblings had a special need. I think it's a really important time in your neurodevelopmental development, really, because I actually really remember after he was born in elementary school, there were some kids in our school that had special needs that were in sort of like a subseparate classroom, and you can volunteer to kind of go to that classroom for part of the day and interact with those children,
[4:50] and I was like one of the people that did that, and I think that people who have people in their family that have special needs, you know, they learn to be a little bit more accepting, a little bit more compassionate, a little bit more open to difference, which being a doctor is super important, as you can imagine, but facing a person in the world is probably a good thing to have. It was, of course, hard. I think, you know, we knew that he wasn't going to live a long, normal life, and so that wasn't like hidden from us as kids. We knew that that was true, and we went to school one day and he was alive, and we came home and he had passed away, and that was just the reality of it,
[5:29] but I don't feel any like negative feelings about it or anything. I think my parents did a really good job in normalizing what was happening as much as they could, and this was in the early 90s, so there was like no Google, there was no internet. It was a very different time to find support and find information, which I think is also what kind of sparked me to do this job that I'm doing, because families who are in that situation, they really just need information. They need experts to know what it is that they're dealing with and how to connect them with the other resources, and so I really wanted to kind of be what our family probably needed at that time,
[6:06] and I feel very honored to be able to do this type of work.
Dr. Elliot Berlin, DC[6:10] Did you pursue OB-GYN first or medical genetics or both at the same time?
Dr. Dallas Reed[6:15] So the training pathway, you essentially have to do OB-GYN before genetics for the most part, but I really came into medical school thinking I wanted to do the combination and really figuring out how to do that combination was part of what I was figuring out at the beginning of medical school, but just the way the training is set up, you typically do OB-GYN before genetics.
Dr. Elliot Berlin, DC[6:38] And does that add a significant amount to the time of school training?
Dr. Dallas Reed[6:43] I mean, when you're thinking about medicine and a career to medicine, what's another year or two? But, you know, medical school is usually about four years. OB-GYN residency is four years, and then genetics fellowship was two years.
Dr. Elliot Berlin, DC[6:58] And the things that you learned in genetics, because, I mean, I really don't know too many people who are certified in it, and I just wonder, the things that you learned there, as a practicing OB-GYN, just everyone must come up with cases, and how do they handle them? Do they always refer them out, or how do they handle them without that training?
Dr. Dallas Reed[7:22] Yeah, so that's a great question. Typically, OB-GYN practices are, you know, one thing about OB-GYN is that to do the work that we do, you have to be affiliated with a hospital, because to do deliveries, you know, most OB-GYNs are doing deliveries in a hospital setting. To do gynecologic surgery, that is obviously in a hospital setting. And so you're usually affiliated with a hospital that has some other sort of specialists attached to it. So most OB-GYNs will have a high-risk of obstetricians. Sometimes it's also called a perinatologist or a maternal fetal medicine specialist, that they refer a lot of their high-risk patients to, or patients who have fetuses with birth anomalies
[8:06] or differences seen on ultrasound. And oftentimes, maternal fetal medicine specialists have prenatal genetic counselors, who are masters-trained individuals who also learn about genetics. They're not physicians, but they learn about genetics and how to talk to people about genetic testing and genetic conditions. They're very skilled in sort of the counseling aspects of those conversations, so helping people understand their values and how to apply that to the situation that they're in and how to sort of anticipate how they may feel about this result over that result or what they would do with the information. And so usually, an OB-GYN has at least a genetic counselor
[8:46] or a maternal fetal medicine specialist that is accessible to them. And then, you know, certainly tertiary care centers will have a geneticist, even if they're not in obstetrics, that they can refer patients to or have consultation with. I think it's very unique to have the OB-GYN and the genetics piece. And the work that I do, you know, every geneticist kind of does something a little bit differently, but in the hospital that I work at, I am literally the only person who ever has had the ability to sort of talk to a family before they get pregnant in a preconception setting, potentially take care of them during their pregnancy or counsel them during their pregnancy about something genetically related.
[9:28] I might be able to deliver their baby. I may see their baby in the NICU from a genetic perspective, and then I may follow their baby afterwards in the outpatient setting if there's a concern about a genetic condition. So no one at my hospital has ever gotten to do that, and I've been able to do that for the last nine years, which is like a very special thing. And we've certainly had geneticists at our hospital before, but they don't also deliver babies kind of the other way around. So it provides us like very nice continuity that I think patients really appreciate.
Dr. Elliot Berlin, DC[9:58] The continuity of care. I mean, it must be special for you to be able to do that, but incredibly special for them to have that continuity. It's really hard to find, you know, everybody's a specialist. And so I oftentimes end up in a situation, both in my own family and I see my patients, where there's a lot of hands in the pie, and they're not always talking to each other and communicating. Well, so in your case, it's just you talking to you.
Dr. Dallas Reed[10:23] Exactly. Or my genetic counselors. Like we're all a team, and so it's nice to be like knowing what's going on, like before, during, and after. And then the nice thing about my job is maybe I'll see a couple in a family for their one child that has a genetic condition, but then it's family building. So they have another baby and there may be, you know, nothing different at all about that pregnancy, but they want to still see me just for the obstetrics care part. So I get to continue to like be involved with that family. I like my repeat customers. So when somebody comes back to me the next time when they're pregnant, it's just nice. You get to really know people.
Dr. Elliot Berlin, DC[11:00] That's very cool. I want to take a break. When we come back, I want to get more into the details of genetics and what role you play and what our listeners might think about when they're planning to have a baby or during a pregnancy when genetic issues come up. We'll take a quick break and we'll be right back.
Dr. Elliot Berlin, DC[11:29] Welcome back. We are talking to Dr. Dallas Reed, OB-GYN and medical genetics specialist. So someone's thinking about having a baby. What information would you like them to know?
Dr. Dallas Reed[11:42] Great question. So in pregnancy, there are a couple of genetic tests that we offer patients to help give them more information about their pregnancy. And hopefully at the end of the day, help reassure them that things are going well. So one of the tests actually can be offered prior to pregnancy. And it's what I really strongly recommend people do the testing, although it can be done early in pregnancy too. And that testing is called carrier screening. So there are some genetic conditions in which we need both parents to be what we call carriers of the condition in order for there to be a chance that their fetus could have the condition. And so there's some genetic testing available that allows us to test one
[12:26] or both partners. It doesn't have to be at the same time. You can do one at a time if you need to, to look for some of these recessive conditions to see if, usually it's the female partner seeing us in OB-GYN, see if they are a carrier. If they are, then we want their partner to get testing to see if the partner is also a carrier for the same genetic condition. And if both are carriers, there's a 25% chance each pregnancy that that pregnancy could have the genetic condition. And so many people that are looking for as much information as possible would want to know this. These are rare conditions. They're also conditions that don't typically run in your family.
[13:06] And so sometimes I talk to patients about this carrier screening and they say, I'm fine. There's nobody in my family that has anything like that. And what I say to them is like, exactly. You wouldn't know it because if anybody in your family is a carrier, carriers don't have any symptoms at all of the condition. Two carriers have to come together to have a baby in order for that condition to make itself known in a family. And so what we expect is that you don't have any family history of that condition. And so therefore you wouldn't know. Some of the conditions can be quite significant. They can be life limiting. They can cause intellectual disability or birth differences or
[13:42] multiple medical problems. And so sometimes it's something that people would want to know beforehand. Again, ideally before pregnancy, but many times we don't have planned pregnancies often in our country. And so oftentimes we're offering this testing early in pregnancy, which is also an option. It just gives you less options as far as what to do with the information for that particular pregnancy.
Dr. Elliot Berlin, DC[14:03] Okay. So it's called a carrier screening to tell if you are a carrier, to tell if your partner is a carrier. Once you're pregnant, what point can it be done?
Dr. Dallas Reed[14:12] It's typically if it wasn't already done prenatally, I should say it actually only has to happen once. We don't need to continue to look at the same conditions year after year after year or pregnancy after pregnancy, because it's looking at your DNA. And so we're just looking at your status. If it wasn't done prior to pregnancy, then typically it's offered at the very first appointment. And the idea is to do it as early as possible because if both parts of the couple are carriers for the same conditions, we want to be able to give you as much information about that condition as possible so that you have as many choices available to you as possible and you can sort of get things lined up,
[14:50] however they need to be lined up in order to go forward. So as early as possible in the pregnancy is typically when it's offered.
Dr. Elliot Berlin, DC[14:57] How many conditions are we talking about that you can test for?
Dr. Dallas Reed[15:01] Great question. There are some guidelines as to how many conditions should be tested. And things have changed over time with carrier screening. We sort of started initially when genetic testing was very expensive and hard to do with just a few conditions. And those conditions were really based on the ancestry of the patient. So there were certain conditions that were very common in Ashkenazi Jewish individuals or African-American individuals or Asian individuals. But over time, especially in the United States, we've recognized that some people don't know their ethnic background or ancestral background. Stories that families pass down are not always accurate about that kind
[15:42] of information. And actually that's not the most equitable way to approach carrier screening. And so depends on the guidelines you look at. The American College of OB-GYN really recommends that people are only screened for really three conditions. The American College of Medical Genetics recommends essentially everybody gets screened for about 115 conditions. And there are other options available that are bigger than that. I think the biggest one available is about 780-something conditions. It kind of depends on the laboratory that you're using. And each laboratory has multiple options. How you pick between 700 and 300, you know, I think really hard for the average person to just decide between them.
[16:28] And oftentimes practices will kind of have the standard one that they offer. But you have to think 700 conditions and there's 20,000 genes. So there's thousands and thousands of genetic conditions that we know about. And the testing is only looking at three or 115 or 700, depending on what you get done.
Dr. Elliot Berlin, DC[16:48] Was it done ancestrally because it was cost prohibitive to do all the tests for all the people? And if so, has that changed?
Dr. Dallas Reed[16:58] Yes. So it has changed over time. Once the human genome was sequenced 25 years ago, that was $3 billion it took to sequence the human genome. And over time that price has come down, come down, come down, come down. And so what happened is that not only is the now we know sort of what the sequence of the DNA is, but also the technology has changed. And so before it was very cumbersome to do a lot of genes at one time or a lot of conditions at one time. Now it's very easy to do that. And therefore it has become less expensive. So we wouldn't do this in a carrier screening setting, but to sequence somebody's whole genome, which is like all of their 20,000 genes can be done as rapidly as
[17:47] three days in very urgent cases, and can be done as inexpensively as a couple thousand dollars.
Dr. Elliot Berlin, DC[17:55] That's pretty incredible. It is. It's totally changing. And I imagine technology is only improving, and those numbers will get even more astonishing. So you're a geneticist, but I mean, most people just go to an OBGYN and they do some genetic testing, but it doesn't sound like it's this caliber.
Dr. Dallas Reed[18:14] Offering carrier screening. What size of carrier screening is, I think, really inhibited by the fact that the American College of OBGYN only have guidelines for three conditions, and they have yet to come out with guidelines for more. So OBGYNs tend to follow the American College of OBGYN guidelines, whereas genetic people like genetic counselors and geneticists tend to, you know, look to other genetic societies also for guidance. I should mention that the other genetic test that should be offered to every pregnancy, if only offered in pregnancy, should be offered every pregnancy. It's called non-invasive prenatal testing.
Dr. Elliot Berlin, DC[18:58] Oh, NIPT.
Dr. Dallas Reed[19:00] NIPT, yes. So you're familiar. So that's a blood test that happens as early, depending on the laboratory, as early as eight weeks of pregnancy, although most labs do it at nine or 10. And it's looking for markers for Down syndrome, Trisomy 13, Trisomy 18, and it can also look at the sex chromosomes, which can tell you if there are two or less than two or more than two. It also is now, you know, growing and growing and growing in the number of things that we can do from NIPT, but those are sort of the standard ones that are offered to pregnant people.
Dr. Elliot Berlin, DC[19:37] What if we're later in the pregnancy and we haven't done carrier screening? We don't have that much data. So what does a couple do in that situation? Yeah. I mean, let's say they're listening to this podcast right now and they're 24 weeks pregnant.
Dr. Dallas Reed[19:53] Yeah. So they may have been offered and may have had the testing done. At that very first OB-GYN appointment, someone who's 24 weeks will know they get, you know, so many tubes of blood, they're testing many, many things, and there's lots of things to talk about at that appointment. So I find that sometimes it's discussed, but patients don't really remember because there's so many things that are being talked about. It's a long appointment, and also if it comes back normal, there's oftentimes not a lot of conversation about it. So one question I would say is, confirm that you didn't have that testing. And then I think the second question is, you know,
[20:29] is that information important to me right now, now that I'm 24 weeks in pregnancy, or is it something that I'm going to, you know, keep in the back of my mind and talk to my doctor about, you know, to be done after I deliver or before my next pregnancy, if it really wasn't done? NITT is, I think, more standardly offered across the board, and that can really be done after, you know, eight or nine or 10 weeks at any point in the pregnancy. But again, I think this is where sometimes genetic counselors can be really helpful because the test is important, but it's also about what are you going to do with that information? And as you get farther along in the pregnancy,
[21:06] I think that conversation becomes even more relevant. Like, what if it did show something? What would we do with that information? You know, how would you want to proceed?
Dr. Elliot Berlin, DC[21:14] Those are the questions that are racing across my mind at lightning speed. As you talk about doing all this testing, you know, what do you do with the information that you get? Yeah. Let's take a little break, and when we come back, we'll talk about that practical application. Don't go anywhere. Welcome back. I am learning a lot with Dr. Dallas Reid, and I'm sure you are too. And I have a lot of questions, and I bet you do too. So I'm going to hopefully ask the questions that are on your mind at home. Okay, so you do all this testing ahead of time. Let's say you do a carrier test, and you're testing for hundreds of things. First of all, that sounds a little scary,
[22:00] like that there are hundreds of things that my partner and I could both be carriers for, and then our kids each have a 25% chance of actually developing. But also, what do you do when you have that information? I'm already with my partner, and now we both turn out to be carriers for these genetic conditions. What do you do with that information?
Dr. Dallas Reed[22:19] Yeah, I think that's a very common concern that patients have, and I first try to reassure them that this is one way for you to get information that you really wouldn't know otherwise. And also, it's the most likely scenario is that it will come back normal or that it will come back as you being a carrier for one thing, but your partner not being a carrier for that thing. So that's the most likely outcome, so keep that in mind. Sometimes as you get into the bigger panels, people come back as carriers for multiple things, but still, as long as the partner is not a carrier, you know, we have very low concern that the baby will have any of those conditions,
[22:55] and so for a lot of people, this is very reassuring. But in the case that you do both come back as a carrier for the same condition, one of the reasons that there's a big benefit in doing this prior to pregnancy is because it gives you the most options. So one thing we know is that sometimes people who are carriers of the same condition choose to build their family using in-vitro fertilization and genetic testing of embryos. So if we know that there's a genetic condition that runs in the family, we can create embryos and test them genetically and determine, you know, which ones have the genetic conditions and which ones do not have the genetic conditions,
[23:34] freeze those embryos, and then use them for pregnancies as you build your family. So that is one of the huge benefits of doing it prior to pregnancy. You also can make other choices, like, for example, you could do donor gametes, like donor egg or donor sperm, and use IVF. You could decide that you are going to do adoption instead of having biological children. You could decide to not have any children, you know, depending on the results. But for people that are either going forward with a pregnancy knowing this information, you can also test early in pregnancy to see if the fetus has the condition or not. For a lot of people, what they really are wanting
[24:13] is to know what to be prepared for. So, you know, what kind of specialist will this baby need to see? What kind of support are we going to need around us? What kind of hospital do I need to deliver at to make sure that my baby has the best start as they can have? Are there therapies available? I mean, we're talking about changes that are happening in genetics. Gene therapies and therapies for rare genetic conditions are becoming more and more prevalent. And so there are many genetic conditions that are tested for, even in the three conditions that we talked about, are kind of the ACOP standard, even ones that are done on newborn screening, which is a blood test that all newborn babies get
[24:52] that looks at genetic conditions. There are now treatments and cures available. And so, you know, I try to reassure patients that this information doesn't have to be doom and gloom. You know, first of all, we're trying to reassure you that things are all okay, but if it turns out that you both are carriers, let's talk about all of it. Let's talk about what all of the options are. Let's talk about what all of the treatments are. Let's talk about all of it so that, again, you and your partner can, like, discover what your values are and what matters to you. And I will say there are some things on these carrier screening panels that are life-limiting,
[25:25] but there are other things that are not, like hearing loss genes, for example. We know that half of hearing loss can be genetic, and, you know, that may be something that a couple is like, that's totally fine. I have no concerns about that. I don't think I need to do IVF. I don't think I need to do anything special. You know, we'll just test the baby's hearing when they're born, and we'll discover if they have hearing loss or not. And, you know, they sort of go on with their life. So, you know, we don't want it to be scary. It can be very serious, of course, but we want it to be more, like, empowering so people have information and can be proactive with that information
[26:01] versus just being so scared that they just don't want to know.
Dr. Elliot Berlin, DC[26:05] Yeah, the technology on all fronts is developing rapidly, so, you know, someone with hearing loss today already is so much more accessible to them than someone who had hearing loss 15 or 20 years ago, and what will happen in another 15 or 20 years, one can only imagine. When you talk about gene therapy, that's curious. Are you actually talking about changing the genetics? How does that work?
Dr. Dallas Reed[26:30] Sure. So, it really depends on the condition, but there are more and more conditions in which there are therapies directed at the very specific genetic change that is present in that individual, and doing something to modify how those proteins in the body work in order to minimize some of the symptoms. So, for example, spinal muscular atrophy, SMA is the acronym for it, is a very common genetic condition that is screened for in carrier screening, the three recommended by ACOG, as well as in newborn screening in many states, maybe all states, but definitely in my state. And there is… SMA is a condition where we have to make sure that an individual has two copies of the SMA gene.
[27:16] If they have no copies of the gene, then that's when they have SMA. And there is a gene therapy that essentially tricks the body into using another gene to create almost a similar protein that the SMA gene creates, and so the muscles can work similarly to how they would work if the SMA gene was working properly. So, it's very specific to the genetic condition and the type of genetic change that's present, but it's basically like tricking the body into using the genes in a different way or trying to find a protein that works similarly and kind of boosts the effectiveness of that particular protein.
Dr. Elliot Berlin, DC[27:59] Very cool. Very, very incredible. I just remember when I read about three parent IVF to overcome mitochondrial disease and the idea that we can take an egg from a person who has mitochondrial disease, who has disease mitochondria, and an egg from a person who doesn't, who has healthy mitochondria, from a person from the intended father, and take out the disease mitochondria from the intended mother's egg and then replace it with the healthy mitochondria from the donor egg and then put them together and make a healthy baby out of that. It was just like science fiction, but it's real.
Dr. Dallas Reed[28:42] It is crazy. That doesn't use CRISPR technology, but you might have heard of CRISPR technology, which is a technology that, you know, helps with this sort of gene editing. And really, that's kind of what helps to spur a lot of these, you know, types of therapies. But there are definitely some genetic eye conditions that can cause blindness, for example, where there are gene therapies where you get one injection one time in your life and it cures you of that vision issue. I mean, it's so cool. That's where we're going, and it's really exciting to be in the field where we're, you know, I talk to medical students and they're sort of like, well, why would you want to be a geneticist?
[29:19] It's like you're just giving people bad news all the time. And I say, well, number one, especially if you're dealing with a child or not a fetus, a child or an adult that has been in the world and is experiencing the world, that family already knows that their family member has something. And it actually is helpful to give a name to it and really put some parameters around what it is and what it isn't. And so having an answer is actually very therapeutic, I think, for families. But also, there's so much changing. Like, we're actually learning a lot and we're actually able to treat a lot, and it's very cutting edge. And so genetics is a very young field in medicine.
[29:54] Like, some of the pioneers of genetics are still alive. Like, they're at the conferences, the things, the conditions named after them or the technologies that were discovered. These people are still like walking around, you know, the world, which is, you know, I think so cool. So there's just so much more that we're going to be able to do, and that is exciting.
Dr. Elliot Berlin, DC[30:15] Yeah, my wife is a psychologist, and I remember going to conferences with her when she was in graduate school, and you would literally see the people who came up with these groundbreaking techniques, and they're right there, not just in the textbook. A couple more questions. One is, you know, I think several people, especially if you find a genetic condition mid-pregnancy, I think different people will probably take that information and do different things with it. As someone who counsels them, how are you able to take into account different backgrounds and the different choices people would make? I think sometimes just as a human, you want to see someone make a specific choice,
[30:58] but they have a different set of what's important to them or ethical considerations may be different. How do you balance that?
Dr. Dallas Reed[31:07] Yeah, I would say it's one of the things that I really treasured about doing the genetics training because I trained alongside genetic counseling students, and that is really a tenant of genetic counseling, and I think it is in medicine as physicians as well, but we're not as good at it, and we're much more directive with our counseling sometimes, but the idea of genetic counseling is really this non-directed counseling. It's helping people identify their values and what matters to them and, you know, giving them a set of information, essentially, and kind of talking through with them, like, how do you feel about this? Like, what would you say if this was the case,
[31:46] or how would you react to that, or how would you handle that? And so, you know, of course I have patients that have a fetus with a condition, and I should say that sometimes we have a lot of information about what these conditions are on the carrier screening ones, for example, but let's say we see an ultrasound and a fetus has a heart defect and a brain difference. You know, there's other genetic testing that we can offer in pregnancy to help figure that out, and we may come back with a result that isn't exactly clear about what that's going to look like for the future of that child. And so, definitely there are situations where couples are asking me, what would you do, right?
[32:23] And that, it's not my job to say what I would do. It's my job to figure out what they think the best choice is for them, and so I actually find that very liberating. I mean, I don't need to make the decision for them. I just need to make sure that they have the information and they understand the information and their questions are answered and that I anticipate what their questions may be, and then we can kind of talk through, like, well, how does this sound? I do think that sometimes people come into these consultations with fearing the worst, and once we actually give them the information that's out there in the literature or what I know from my own experience
[33:00] in taking care of people with these conditions, there's varying reactions to that information, but a lot of times people feel really relieved to just have really accurate information and be able to feel like they can make a decision about what to do next.
Dr. Elliot Berlin, DC[33:14] And we're just talking about prenatal screenings right now, but the field of genetics is exploding in a lot of different ways with many different applications, with oncology screenings, even the way mental health drugs are prescribed based on how you absorb them and process them. You know, the same drug could have a totally different effect on you than it has on somebody else, and so we're able to sort of fine-tune some of the therapeutics. You work with Myriad Genetics. Tell me about that company.
Dr. Dallas Reed[33:45] Yeah, so Myriad Genetics is a great company. They are a genetic testing company that, in the Women's Health Division, focus on carrier screening. The testing that they have is called foresight carrier screening. They also do an IPT. That test is called Prequel, and they are the only lab that allows you to do Prequel at eight weeks of gestation. That's the earliest of any tests that's available. There's also other things you can do besides the Down syndrome, trisomy 13 and trisomy 18 testing. You can also look at deletions of parts of the DNA and other things. And then they also, you talked about the way, you know, the genetics, how it's applicable across different disciplines.
[34:28] They also do hereditary cancer genetic testing, which I know this is not often on the mind of prospective parents, but we also know that if there is a strong family history of cancer, that there could be a genetic component to that. And even if you yourself have not had cancer, you could be at risk of developing a cancer if there's a genetic cause in the family. So Myriad's product is called MyRisk, and I would also, you know, suggest that people consider talking to their doctor about cancer genetic testing if they have a strong family history, because very similar to the choices about like IVF and reproductive decision-making, if you knew that you were a carrier
[35:09] of a cancer genetic condition, there are similar options available to you to do like IVF, for example, so that that doesn't continue to be passed down in the family and you've sort of, you know, lifted that weight of a possible, you know, adult onset cancer genetic diagnosis for your child. So yeah.
Dr. Elliot Berlin, DC[35:27] I think in some ways scary to have this conversation, but also I think the take-home message is that knowledge is power. The more you know, the more you can do about it.
Dr. Dallas Reed[35:38] I agree with that. I would say the other thing that I'm always reminded of in genetics, which I think is very different than other parts of medicine, is that genetics is very much about you as an individual, like your potential children, but your other family members too, right? And so if you're a carrier for a genetic condition, your sibling could also be a carrier. And if they're a carrier, we want their partner to be screened also. If you are at risk of a hereditary cancer condition, your partner could be, I mean, not your partner, but your sibling could be as well, or your parent could be as well. So genetics is very much a family-oriented specialty
[36:14] where we're constantly thinking about family members. And it goes the other way, like we need you to get information from your family members. Is there autism that runs in the family? Is there brain loss that runs in the family? Is there cancer that runs in the family? That can help us as your OB-GYN team or your genetics team in guiding you to the right place for what kind of screening you should be offered and what kinds of information we could give you prior to pregnancy or early in pregnancy.
Dr. Elliot Berlin, DC[36:41] I came into this episode hoping I would learn a lot, and I did. You definitely, as you often do, you delivered.
Dr. Dallas Reed[36:49] Thank you.
Dr. Elliot Berlin, DC[36:51] As we're winding down, is there anything on your mind that I didn't ask about that you think would be important for us to know?
Dr. Dallas Reed[36:58] I think one resource that I want to make your audience aware of is Myriad Genetics put a website together called NoMoreSooner.com. No is spelled K-N-O-W. MoreSooner.com. And it talks about the foresight carrier screening and the prequel and IPT testing, and just what kind of information you can get from that. It also has some stories of real patients and what information they gleaned from that and how they use that to feel empowered. And I think that's really the take-home point I want people to know, like you mentioned before. This information should be empowering. And your OB-GYN, even if they're not a geneticist like me, they have people around them to help them help you
[37:46] through these kinds of conversations. So your doctor is always a good resource. This website, NoMoreSooner, is a great resource. And you can always go to MyriadGenetics.com, too, if you have questions about what they offer. But know that these are not things we've never seen before. Even your OB-GYN has seen these kinds of things before, and they're here to support you.
Dr. Elliot Berlin, DC[38:08] Dr. Dallas Reed, thank you so much for joining me and for sharing so much valuable information and for the incredible work that you're doing. And at home, thanks for listening to the Informed Pregnancy Podcast. For more pregnancy and parenting information just like this, visit us online at informedpregnancy.com.
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Neonatologist and Chief Medical Officer of Prolacta Bioscience Dr. Melinda Elliott discusses nutritional care in the NICU, the high stakes decisions parents have to face, the differences between potential outcomes for fragile babies, and her own personal high risk pregnancy experiences.
Prolacta Bioscience is a privately held life sciences company that has touched the lives of more than 100,000 premature infants globally and is dedicated to advancing the science of human milk.
Informed Pregnancy Media and Mahmee present an all new podcast! One Way or a Mother is a new narrative podcast from Dr. Elliot Berlin, DC. Each season is an intimate story of one woman, one pregnancy, and all of the preparations, emotions, and personal history leading up to the birth. Episodes feature the expectant mother along with her family, doctors, and birth work team.
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Dr. Melinda Elliott in orange.
Dr. Elliot Berlin, DC[0:00] This episode is made possible in part by support from our guest, helping us to bring you quality content that is both entertaining and informative. Nobody ever plans to spend time in the NICU, but when you do, every detail of your baby's care becomes high-stakes decisions. The choices you face there can shape your child's future in ways most parents never imagine. This episode will address one of the most important elements of NICU care that every patient should know about – nutrition. What fragile babies are fed can make the difference between devastating complications and thriving outcomes. My guest today is a neonatologist and chief medical officer at Prolacta Bioscience,
[0:41] with decades of experience in NICUs across the country. She's also walked her own path through high-risk pregnancies, giving her a unique perspective on the fears and resilience that families face. From the patient who changed everything to the science behind human milk-based nutrition, we'll explore her story, her work, and the breathtaking, transforming outcomes for premature infants. I'm pregnancy-focused chiropractor Dr. Elliott Berlin, and you're listening to the Informed Pregnancy Podcast. Dr. Melinda Elliott, welcome to the podcast.
Dr. Melinda Elliott[1:28] Thanks so much, Dr. Berlin. I'm very happy to be here.
Dr. Elliot Berlin, DC[1:31] I'm so happy to have you here, and it's kind of weird. I don't know why a lot of chiropractors go by doctor first names, so Dr. Ron, Dr. Katie, and so both of us often
Dr. Melinda Elliott[1:42] probably get called Dr. Elliott. That's funny, yes, but you're missing a T.
Dr. Elliot Berlin, DC[1:46] I know. I know. Leave off the last T for something. All right. I want to learn from you. NICU is not something anybody wants to talk about unless you're there, and then it's probably all you want to talk about. But it happens. Sometimes babies end up in the NICU, and I think that doing a little research and learning a little bit about NICU could make the journey a lot better for people who end up having to spend time there. So with all your experience and expertise in NICU, I'm looking forward to learning from you, especially about nutrition. But let's start at the beginning with your roots. Where did you grow up, and what first sparked your interest in pediatrics and eventually in neonatology?
Dr. Melinda Elliott[2:29] I love that question, mostly just because I'm from West Virginia, and we West Virginians are looked down upon by maybe 49 other states. I'm not sure. But I have yet to meet a West Virginian who wasn't proud to be from West Virginia. And I was lucky to grow up there. I had a best friend, as many of us do when we're kids, and she's still one of my best friends. And we told everyone from about the time we were three years old that I was going to grow up and be a baby doctor, and she was going to grow up and be a baby nurse. And we actually did those things. We did not do them together, but we did do them. Just retired this year as a pediatric nurse. I have not yet retired as a neonatologist. But I thought
[3:20] I was just going to be a pediatrician. And I shouldn't say just because pediatricians are very important. But when I was in med school, you do various rotations your last year of med school. And I walked into a big NICU, my fourth year of med school, and felt at home. And I was just like, here it is. This is it. This is where I belong. I had an amazing experience in that NICU and went into residency with that plan. I knew that I wanted to do neonatology because it's a special place. I love it. I love the babies, the families. I love everything about it. And so yeah, for me, it was always going to be children. And then I was able to focus pretty early in my career. I feel lucky to just know I was
Dr. Elliot Berlin, DC[4:06] home. It's such a stressful and challenging time for people to have somebody who's so passionate about it, especially after doing it for so long, because you see a lot of doctors get burnt out and whatever they're doing. You just seem even more passionate about it
Dr. Melinda Elliott[4:22] after having done it for a long time. I am. I look at it as a chance to make a difference. You know, every patient I've ever had has their entire life ahead of them. And when we're talking about their lives, we're talking about decades, and I think what the median survival now for girls is in the 80 years and for men, it's getting close to 80. And that's a long time to make a difference.
Dr. Elliot Berlin, DC[4:47] I also wonder at the time that you got excited about neonatology, did you have any kids yet?
Dr. Melinda Elliott[4:55] No, I did not. I mean, to me, I wonder if it would be scary studying all those things before you have your own first pregnancy. I think it's scarier to be pregnant once you've learned all those things. You know, I have not at all afraid to tell people about myself. And I went on bed rest at 24 weeks with my daughter when preterm labor. And at the time I went on bed rest, I was scared to death because I knew a lot that could happen. And when she was born, 24 weeks wasn't even viable babies weren't being resuscitated. So at the time I went on bed rest, all I could think of was not today, just not today. And, you know, now we are resuscitating 24-weekers regularly as we should,
[5:42] because we do so much better now.
Dr. Elliot Berlin, DC[5:44] I mean, out of all the fields of medicine, which many of them are making leaps and bounds in advancement, I think neonatology is probably in many ways the leader of the pack. We did an episode, our episode 244 with Dr. Seth Langston about neonatal cooling. And we got a lot of feedback about how incredible that technology is. And who even sits around thinking, I wonder if we do this, what kind of impact that'll have?
Dr. Melinda Elliott[6:11] I've always wondered about those people that they come up with, you know, what if we did this? But I remember even like you said, I've been doing neonatology for many years now. And I remember very clearly when I started and what we had as tools in our toolbox at the time just don't even match at all to what I have available today. Like I have so many more things to do to help babies than I did back when I started my career.
Dr. Elliot Berlin, DC[6:40] It's really cool. I was talking to an OB yesterday who's probably at the end of his career. He said this year he's retiring. I think it's the eighth year in a row that he said he's retiring and he does ultrasound all the time. So more ultrasounds than any other doctor I can think of as an OB. And one day I asked him about it and he's like, well, I got to make up for lost time. We didn't have this for the first half of my career.
Dr. Melinda Elliott[7:05] I understand that. I remember very early on the types of ultrasounds I had at my disposal and they were very different from what we have now. And yeah, and you know, I think, and I know we're going to talk about this in a little bit, but the same thing goes for nutrition for these babies. Like we weren't even saving these babies, like I said, when I started. And now we do regularly and they do well. And we need to give them everything we can
Dr. Elliot Berlin, DC[7:33] to allow them to succeed. I sort of think before you like proceed in forward that to me, I mean, I'm done having kids, but that to me is sort of like a deep breath of fresh air, knowing that should my baby end up in the NICU, that there is so much advancement and there's so much that can be done and that they can get really great care and have really great outcomes. In terms of your personal story, it sounds like everything turned
Dr. Melinda Elliott[8:00] out okay. Yes, I was on bed rest for quite a long time. That's the good news. And yes, my daughter's fine. She's married and all grown and you know, and then I went on bed rest the second time at 30 weeks with my son, but he too ended up full term. I got quite lucky. My daughter literally was born on the day I turned 37 weeks. So she escaped being a preemie
Dr. Elliot Berlin, DC[8:22] by a day. By hours. Did that experience, I mean, it sounds like you were towards the end of your training or the beginning of your career at that time. Did that experience shape at all? Like I can imagine that you can relate to parents going through scary times just before and after having a baby better than let's say I could.
Dr. Melinda Elliott[8:42] Yeah, I can certainly relate to the fear. I can't relate and I'll never pretend to be able to relate to what it's actually like to have a baby in the NICU. I try my best. You know, I try to put myself in the parent's place because I think as a healthcare provider, whether you're the doctor, the nurse, the therapist or whatever, you have to do that. Like these parents are going through what is likely the most stressful time of their lives and you have to be there to support them. You don't have just one patient, the baby. You have the patient, the baby, the family, the extended family, like whoever's there. They are all sort of your patients and you have to remember that.
Dr. Elliot Berlin, DC[9:21] Yeah. I mean, just your energy even comes through here on Zoom and I think the people that get to be around you during those times are just so lucky. Let's take a little break. When we come back, we'll talk more about nutrition and advancements in neonatal nutrition and how they can improve outcomes. We'll be right back.
Dr. Elliot Berlin, DC[9:43] Welcome back. We're talking to neonatologist Dr. Melinda Elliott. All right. So we keep talking about nutrition. Babies come really early. They need a lot of nutrition. What are generally the options for them?
Dr. Melinda Elliott[10:07] So I think the first thing to understand is not all premature babies are the same, right? And prematurity is a big problem here in the US. About 10% of babies are born prematurely and that's a lot of kids. However, only about 10% of them are the babies that I serve with my company that I work for. We're talking about babies born three or more months early, kids who weigh less than three pounds at birth. And those children, all babies, full term, premature, very premature. The absolute best thing to feed them is their mother's milk. If mom can provide milk, first and foremost, that is without a doubt the best thing. Full term babies, mom's milk is perfect. It's enough. It's all they need.
[10:55] Healthy full term babies, mom's milk, done. Premature babies often need more than mom's milk. They need extra calories, extra protein, extra minerals in order for them to grow and develop appropriately. And it's even more critical for those born three months or more early. So the way to provide more protein, minerals, all that to babies is to add fortifier to mother's milk. Now, there are two kinds of fortifiers available. One is made from cow milk, one is made from human milk. And for the very small babies, again, less than three pounds at birth, human milk actually saves lives. We know that if you use a human milk based fortifier rather than a cow milk based fortifier, that the risk of problems like
[11:46] necrotizing enterocolitis in the premature baby are much reduced. It's never totally eliminated. We do not know everything about neck or necrotizing enterocolitis, but we do know that you can dramatically reduce the incidence of neck by using only human milk in the first critical weeks, which then sets that baby up for success long term. You already said so much and I have so many questions. Okay. So is prematurity defined as before 37 weeks? That's correct. So there's degrees of prematurity. There's prematurity less than 37 weeks. There's very premature and that's less than 32 weeks. And then there's extremely premature, which is less than 29 or 28 weeks.
[12:34] So it's the extremely premature babies that are the highest risk to have trouble. What is the current week of viability? That's an excellent question. Generally, I would say babies born at 24 weeks, most people agree we should try very hard to
Dr. Elliot Berlin, DC[12:55] save those children. It used to be a much higher, when I started my career,
Dr. Melinda Elliott[12:59] 28 weeks was the limit. Right. The goalpost is moving. Yeah, the goalpost has moved quite a bit. So 24 weeks is close to the limit, but, and this is a really big, but they're being successful. We are being successful saving babies at 23 weeks or even 22 weeks. Not all of them. And they are at risk for problems. The younger you are, the higher the risk. So that ideally is a conversation the neonatologist can have with the family before the child is born.
Dr. Elliot Berlin, DC[13:32] Okay. Then you mentioned fortifier, which sounds to me like the protein powder I add to my
Dr. Melinda Elliott[13:37] smoothie. Yeah, it's not all that different.
Dr. Elliot Berlin, DC[13:41] My smoothie has a lot of good nutrition in it, but sometimes- So it's more than protein, right? Yeah.
Dr. Melinda Elliott[13:46] It's a liquid, first of all, that we use only liquids in the NICU. That is something that is required by the joint commission of hospital accreditation. And that's for infectious issues, not because there's anything wrong with the powder. So there are liquid fortifiers, two or so made from cow milk, one made from human milk. They contain protein. First and foremost, that's one thing they need. These little babies need much more protein than a full-term baby would need, but they also need a large amount of calories more than just mom's milk or even donor human milk alone can provide. And then there's minerals, calcium and phosphorus to build strong bones.
[14:27] They need like three and four times what is in plain human milk in order to build strong bones. Mom, you can't feed a baby a volume of mother's milk that's going to hit the numbers they need. Right. So you mix it in with the
Dr. Elliot Berlin, DC[14:41] mother's milk or you just supplement it? Yep.
Dr. Melinda Elliott[14:43] You add it to the mother's milk or you add mother's milk to the fortifier, depending on which one you're using. And there's different ratios and ways to add it to give the proper
Dr. Elliot Berlin, DC[14:52] amount of nutrition based on how the baby's growing. Okay. Then you mentioned NAC, N-E-C, Necrotizing Anerocolitis. If I break that down in my head, necrotizing is tissue death. Anerocolitis is gastrointestinal inflammation. And so babies who are born very premature are at risk for, it sounds like some pretty gnarly gut issue.
Dr. Melinda Elliott[15:19] Yes. It's actually, it's a horrific disease. We don't know who will get NAC and who will not. What we do know is the smaller the baby, the higher the risk. The earlier they're born, the higher the risk. The use of cow milk products, the higher the risk. And that human milk is protective. So we know all those things. And so what it, for instance, in my unit, the reason I even got into this is that we brought these products into my unit and we saw a dramatic reduction. In fact, we saw a 90% reduction in NAC in my unit. It was incredible, the difference. And it was incredible. Yeah. It's actually why I work for Prolacta Bioscience now is that I saw firsthand how important it is to feed the right thing at
[16:10] the right time. And parents are told, oh, their baby's getting HMF or human milk fortifier. That's actually just the name of the fortifier. And up until Prolacta came around, the human milk fortifiers were all made from cow milk. Now there's two kinds. There's one made from cow milk and one made from human milk. And parents need to kind of be prepared for that when they have a very premature baby that, you know, the baby's going to do better
Dr. Elliot Berlin, DC[16:37] if you get the human milk based one. Is that the same like if mom can't produce milk or doesn't want to, is that the same that the babies will do better with donor human milk and then cow formula? Absolutely. A hundred percent for the very
Dr. Melinda Elliott[16:52] small babies. Bigger babies will do okay with cow milk based formula. And you know, the other thing is it's hard to have a baby in the NICU and moms struggle. Remember that baby's not nursing, not able to go to breast and nurse. So mom has to pump. It's critical that mom gets support in pumping. We need to help that mom all we can, but not every mom can produce enough milk for her baby. And that's where donor human milk comes in. And you know, we use donor milk as a supplement to mom. If mom doesn't have any or doesn't have enough, we use donor milk to supplement that. And then we still have to fortify either way.
Dr. Elliot Berlin, DC[17:31] Got it. Now I know how to get the milk from cows. How do you get a supply of human milk?
Dr. Melinda Elliott[17:38] Amazing women doing the work. They donate it and they work hard because you need to have high quality milk. If you're feeding a baby that weighs one pound, the risks are huge. And so, you know, our donors, the donors that send to prolacta, they go undergo extensive screening. They undergo extensive testing. Their milk is tested extensively because we cannot allow anything in that milk that could harm a baby. And so it's really important. And those women work hard. Now all of them are over producers, something I personally am not familiar with, but a lot of women out there are over producers. They're amazing and they're feeding their own babies and then they have extra. They're filling up their freezers and potentially
[18:28] their spouses are saying, what's with the milk? And so a great place for all that extra milk to go is to a human milk bank and where it can be used for just these very premature babies
Dr. Elliot Berlin, DC[18:40] who are sick whose moms can't make enough. I mean, I know that there are amazing women who listen to this podcast that might be thinking, wait a second, I produce a lot of milk. Maybe I can donate. How would they get involved? Well, there's two places really to
Dr. Melinda Elliott[18:55] donate your milk on the prolacta website, which is www.prolacta.com. There's all donor page and you can go there and look into what it takes to be a donor. And there's also the Human Milk Banking Association of North America or Himbana. They also take milk. So if you've got a lot of milk and your baby is fully fed and everything is fine and you need to clean out the freezer, those are two places to look. Your milk will be used. You know, you have to pass all the screening, but it's a great thing for people to do.
Dr. Elliot Berlin, DC[19:28] I had a friend who was also a patient, but she had triplets. And unfortunately, after she gave birth to the triplets, she ended up very, very sick and could not feed her babies. And she just had this incredible wish for them to have human milk. And we kind of put out the word in the local community. And once a week, I'd kind of drive around with a cooler on my front seat, picking up bags of milk from incredible women who were donating. Sometimes not an oversupply, just pumping for these babies and giving away what seemed to be, you know, liquid platinum to them. Well, at Prolacta, we will not take milk from a
Dr. Melinda Elliott[20:10] baby. So the mom has to have an oversupply. We have to actually have certification from her baby's doctor that the baby is fully breastfed if less than six months old or still breastfeeding if more than six months old. We can't take it out of the mouth of that baby. But our women, our moms are all, they're amazing. Like they're all, you know, super women. They really are. Like, yeah, just to say they were, they're just incredibly generous and wanted these babies to have the best. I will say for a baby in the NICU and I laud, you are helping your friend with the triplets. That's a tough story. But for a baby in the NICU, you do not want to bring
[20:49] in milk that hasn't been tested and pasteurized. Yeah. I'm just going to throw that in because
Dr. Elliot Berlin, DC[20:55] I just want to make sure people know. Completely different scenario. But the heart, the heart and soul is likely the same. So before we go to break, if somebody is, you know, finds himself in a NICU situation, you're saying there's cow-based and there's human-based
Dr. Melinda Elliott[21:11] fortifiers. Do all NICUs have both? No, but all NICUs could have both. You don't need to have a contract with prolacta to give a baby human milk-based fortifiers from prolacta. Over 50% of the NICUs in the U.S. use prolacta fortifiers, but that means not quite 50% don't. And so I think that moms and dads and families need to understand that if you do have a tiny preemie, try to put my voice in the back of your brain. And when you walk into that NICU, once you feel like you can ask the question, ask what your baby's going to be fed. You know, tell me, doctor or nurse or dietitian, tell me what you plan on feeding the baby. Can I give my milk? I want to give my milk.
[21:58] And if I don't have enough milk, I want my baby to receive human milk. And I only want my baby to receive exclusive human milk. I want human milk-based fortifiers. They can ask for it. You don't need a contract. And parents don't pay. It's part of the hospital bill.
Dr. Elliot Berlin, DC[22:12] That's really helpful information. Let's take a little break. And when we come back, we'll wind down and get even more information for NICU parents. We'll be right back. Welcome back. We're talking to Dr. Melinda Elliott, neonatologist, extensive career, and a lot of passion. And in our last segment, we talked a lot about nutrition and especially for very early preemies, how the difference might be for human milk fortifiers versus cow milk fortifiers. And I know you're super passionate about it. And I know that you shared with me with us that there was a patient who kind of ignited
Dr. Melinda Elliott[23:03] your passion. Can you share that story? Yeah, this is a tough story, but I will never forget this little boy. So this now has been 15 years ago, probably. And I had a patient, a little boy, who was born at 28 weeks. So he was 12 weeks early. He weighed just about two pounds, maybe a little more, not much more. And he was doing great. He was doing great. He needed no breathing help. He was fine. He was on his mother's milk. He was getting that milk fortified, like we mentioned, with a cow milk based fortifier, because that's what I had about 15 years ago. And I went home from the NICU one night. He was doing great. In fact, he was in, we had two sections to our NICU. We had the front area that was the acutely ill
[23:56] babies. And we had the back area where the babies were stable and doing well and where they were cared for. But they were basically back there just growing and getting big enough to go home. And he was about three weeks old at this point. And I went home. I came back the next morning. And overnight, he had developed necrotizing enterocolitis, that disease we talked about, where his intestines got very inflamed, and he was horrifically ill. He had gone from not needing any breathing support to being on a breathing machine, on a ventilator. He had low blood pressure. His belly was just very distended and swollen, and he was clearly very, very ill. And his bowel had what we called
[24:42] perforated. He had air in his belly that was outside of his intestine, which unfortunately happens sometimes in babies with neck. And when that happens, they usually have to go to the operating room for surgery, which he did. Sometimes children do not survive that surgery because they are so sick, but this little guy did survive. He lost a large amount of his small intestine, a very large amount of his small intestine. So we spent the next few weeks nursing him back to health from the surgery and he recovered from the surgery. But he had what we call short gut syndrome. In other words, his intestines were now too short for him to absorb food. Yeah. And so we had to nourish him by vein. We could feed him small
[25:32] amounts of his mother's milk, but he couldn't tolerate anymore because he didn't have enough intestine. So our whole goal now at that point was to help him grow and develop and get big enough to eventually perhaps have a small bowel transplant. And we were working on that. He was growing, he was developing and he was smiling. He was laughing. He was cooing. He was eight months old, still in our nursery. And he, unfortunately got another infection and liver failure and died at eight and a half months of age. It was horrible. It was absolutely horrible. And all I could think of was there's got to be a better way. You know, there's got to be something I can do. And I just happened to be attending a conference
[26:26] and I walked past this booth that said human milk based fortifiers. And it was the proactive bioscience booth. And all I could think of was, well, that makes sense. So much sense. Human milk for human babies. So I went back to my hospital and I talked with my colleagues, my nurse manager, our blood bank person, because in Maryland, where I am from, human milk is a tissue. It's regulated like blood. And we got together and we brought in this exclusive human milk diet to our nursery. And we did it very thoughtfully as a team. We followed our outcomes. I mentioned earlier, the difference in the babies was seen within about three weeks. We used to worry when we fortified. We stopped worrying. The babies
[27:14] had no problem. And long story short, we gathered our data and we wrote a paper. We saw our necrotizing and our colitis rate drop 90%. We also saw other things get better, like the lung disease of prematurity and the eye disease of prematurity. It all got better. And babies went home earlier. And we saw that we actually saved money because they went home earlier and did better. I mean, for me, it was just this incredible epiphany about this is so much better for babies. And Prolacta found me after we published our paper. And that's how I ended up working for them is that, you know, I just had this opportunity and I took it. This little boy changed my life. I could not save
[27:57] his. And for that, I am forever unhappy. But he changed my life. And I'd like to think he changed the lives of many babies because he started us on a path to really get more and more babies that chance to have this product. Sure. Sounds like he has helped
Dr. Elliot Berlin, DC[28:14] many babies. I'm so sorry for that loss. And I don't know how any of you neonatologists do what you do. It's such an emotional roller coaster. And, you know, you have to walk into every patient with your a game. You know, you do. But they deserve it, right? Yeah. But you're human, too. And so, you know, but we win. And by win, I mean,
Dr. Melinda Elliott[28:38] we send these little babies home with their families way more often than not. Like, you know, yeah, sometimes we don't win, but every baby deserves a chance. Every family deserves a chance. And it's why I work and do what I do. I love it. Is there any data on long term outcomes, long term improvements after using human fortifier? That is a great question. I mean, first of all, there's a ton of data on the short term outcomes. There's over 30 published papers. There have been a few randomized trials. We know that babies have less necrotizing enterocolitis, less lung disease, less eye disease. Those are the short term outcomes. But there was recently just this year
[29:19] published a paper on outcomes at age three. It was from the Kaiser Permanente Group in California, which I know you're familiar with a very big health care group. And one of the neonatologists there looked at the Kaiser database in Southern California and wrote a paper looking at three year outcomes for motor disability, things like cerebral palsy and other things like that. And what they found is that in babies who received the human milk based fortifiers from prolacta, they had better three year outcomes and less motor disability than in children who did not receive the exclusive human milk diet from prolacta. And that even included the fact that the kids who didn't get the human milk based
[30:04] fortifiers, that those the ones that got cow milk based fortifiers, they were actually a little more mature and a little bigger and they still didn't do as well. So yeah. It leaves me wondering why anyone still uses cow milk fortifiers. Well, you know, there's a lot of controversy. There's never been a perfect study. One of the things people will say is that they don't see enough data. I respectfully disagree with them. I think more than 30 published papers and both RCTs and cohort trials. There's plenty of data out there that shows it's better. There is a price tag associated with these human milk based products. It costs a lot of money to make them and keep the
[30:45] quality very high. Having said that, when we looked at my hospital, we saved money because the kids did better and they went home earlier. So for my hospital, it was a very easy decision to keep going. Right. I mean, that sometimes happens with a premium product. You pay more upfront and save in the long run. Exactly. And that's exactly it. You know, in US with our healthcare system, as you know, the way it works with insurance and all that, it's harder for the hospitals to see paying upfront, reaping it in the end because of the way things are billed and paid. But, you know, when you really dig in, there was another study published out of USC at LA County hospital. They saw the same thing,
Dr. Elliot Berlin, DC[31:26] better outcomes and they saved money. So again, anybody listening who is struggling with a NICU stay or finds themselves in the NICU. We said in that second segment, even if your hospital doesn't offer human fortifier, you can always ask for it. It sounds like any hospital can get it. Yeah, any hospital in the country can get it.
Dr. Melinda Elliott[31:49] There's no contract required. You know, it's hard as a parent. There's so many things happening in the NICU and you have a very tiny sick baby, but I always encourage parents to ask questions. If you don't understand the answer, ask again, ask someone else. Like it's your baby. There's nothing more important. And I think you really should advocate for your baby. And you have every right to do that. You will not make enemies. You will not make people mad. Sometimes it does make people take a step back when a parent comes in and said, I really want this for my baby. But most times the doctor and the nurses will talk with you and find out more information. And, you know, you come in and you say, this is why I don't
[32:29] want to take any chances. Most of the time you'll be able to get what you need for your baby.
Dr. Elliot Berlin, DC[32:34] Is there a source of information? Because, you know, if there's cost involved, I imagine some parents will get pushback from the hospital. Is there sources of information we can bring or arm ourselves with to sort of push back against the pushback?
Dr. Melinda Elliott[32:52] Yes, there are. So on the same ProLacta website, www.prolacta.com, there's a page for parents. And on that page is all the scientific data. They can take that to their baby's doctors. We also have an entire team of health economists who are more than happy to help the hospital understand if they can bill separately for these products, help them look at their own data and see where they might be able to make some impact by using the products and really help that hospital understand that they can potentially save money. So we have teams that are dedicated to do that. All we need is the parents asking and the clinicians and hospitals willing to talk.
Dr. Elliot Berlin, DC[33:34] Thank you so much for your passion and for the work that you do and for sharing your
Dr. Melinda Elliott[33:40] expertise with us today. I learned a lot and I know our audience did too. Dr. Elliot, where can we find you online? So I am mostly found through ProLacta.com. I am on social media, but probably not enough professionally, but I am always available. I can be emailed. If you send an email to meded at ProLacta.com, you will get me. It's one of my favorite ads, meded at ProLacta.com. You're probably not on social
Dr. Elliot Berlin, DC[34:13] media because you're out saving the world. I'm a little bit on social media, but I am not really not what parents might want to see. You might see pictures of my kids. Not the med ed stuff. Thank you again. And at home, thanks for listening to our podcast. For more pregnancy and parenting information just like this, visit us online at informedpregnancy.com.
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