Even after of years practicing and teaching mindfulness and self care, Sarah Olin’s preparedness for the emotional and physical demands of motherhood was challenged in many ways.
Grow with us on IP+! Informed Pregnancy Media presents two all new intimate short-form video series following Garrett and HeHe’s real-time pregnancy journeys as they prepare for an empowered birth and postpartum experience. Each episode features weekly updates with personal photos and videos to help bring these raw stories to life, a visually dynamic guide through each mother’s emotional and physical experiences.
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Sarah Olin in orange.
Dr. Elliot Berlin, DC[0:00] Today's guest spent years practicing and teaching mindfulness, meditation, and self-care. So, you might think, she was unusually well-prepared for the emotional and physical demands of becoming a mother. And then she actually became one. A baby who stayed breech changed the birth she had envisioned, a difficult recovery challenged some of her expectations about motherhood, and trying to balance a new baby with her own needs and ambitions eventually forced her to reconsider an idea so many parents struggle with, that somehow, if we're doing it all right, we should be able to do it all. I'm pregnancy-focused chiropractor Dr. Elliott Berlin, and you are listening to
[0:41] the Informed Pregnancy Podcast. Sarah Olin, welcome to the podcast.
Sarah Olin[1:00] Oh my gosh, Dr. Elliott, thank you.
Dr. Elliot Berlin, DC[1:03] I'm thrilled to be here with you. I'm thrilled to be with you.
Sarah Olin[1:06] You're like a dynamo of energy and information. I've got some.
Dr. Elliot Berlin, DC[1:09] You've got lots of both, and I want to tap into both of them. Before we talk about motherhood, take me back to the beginning. Where did you grow up, and what was your childhood like?
Sarah Olin[1:20] Oh my gosh, I grew up in a small town called North Smithfield, Rhode Island. It was a beautiful, idyllic New England town. There were a hundred kids in my graduating class, great parents. They split up when I was 11, but they were so fabulous about it. They never said a bad word about the other. Amazing, I'm the oldest of three. Grew up with a lot of family around me.
Dr. Elliot Berlin, DC[1:46] Wait, so you already had two kids.
Sarah Olin[1:50] I already had two kids, and my sister is 18 months younger than I am. Oh, wow. Yeah, so we're-
Dr. Elliot Berlin, DC[1:56] I mean, I sort of say that a little jokingly, but a little seriously, and then especially if your parents split when you're 11 and they're younger, does that put you in a little bit of like a support role for them?
Sarah Olin[2:08] You know, it was really interesting because my mom was a stay-at-home mom until my parents split up. And when they did split up, that definitely put me more into, I remember she went to work and it was okay, put the meatloaf in the oven, set the table, get everybody ready, that sort of thing. But she, I feel like I won the lottery with both of my parents, and they're very different people, very fun and interesting. So yeah, they're great and very human.
Dr. Elliot Berlin, DC[2:39] Okay. We're allowed to be human. It sounds wonderful and also like maybe you just had a, at a slightly younger age than other people become more independent and look out for yourself.
Sarah Olin[2:51] Yeah, I think I did grow up fast and I think I always had, I remember my grandmother when I was a kid, I was serious, I was a very serious child, and she'd sing a song called Be a Kid that she made up only that one line, be a kid, be a kid. She'd be like, Grandma, I'm going to be the teacher and you're going to be my student. I'm going to teach you some math. And she's like, oh, my God, this child. So be a student or whatever else I feel like, you know, today.
Dr. Elliot Berlin, DC[3:21] Yeah.
Sarah Olin[3:22] Okay. And you started working pretty young. Tell me about that. I did. I mean, you know, it's funny. I was thinking about my teenage summers compared to my daughter, who's now 14. We went on a three week trip to Europe this summer. I didn't get on a plane till I was in college. And I remember I had my first nannying job when I was 12 or 13. There was a family up the street that owned an HVAC company and I was taking care of three kids from eight to five. I mean, it was just normal. People worked and did stuff. And then I worked in a restaurant and it was just part of what you did. And I was, you know, expected to perform all over.
Dr. Elliot Berlin, DC[4:04] Really performing. You were studying communications at some point, and then you moved to New York to pursue acting.
Sarah Olin[4:12] I did. I did. And, you know, it's funny because I got a great transition. It's a fabulous transition. I am my own horn. There you go toot toot. I studied communications and women's studies in college, and I always wanted to be an actress. And I remember talking to a professor that I trusted and loved so much. And she said, don't do it. It's a terrible life. And I said, okay, I want to make a lot of money and have a real job. And then I eventually got back to acting and I wasn't, you know, it's funny, I look back at my time when I was acting and I was finding yoga meditation, all of that world. And I was teaching and I was started training teachers and I was very
[4:56] committed to that practice. And it brought me so much joy where I found acting just didn't bring as much joy. It wasn't as good at it or whatever it was, but I did do a fabulous hummus commercial that shot in Greece.
Dr. Elliot Berlin, DC[5:11] Now that was a real thrill.
Sarah Olin[5:12] Oh, wow. Yeah, that was kind of receiving a lot of hummus. No. No, I didn't, but it was a fabulous trip.
Dr. Elliot Berlin, DC[5:22] I will say that. That's nice. What about yoga and meditation was like fulfilling for you? What did, what did you get out of it?
Sarah Olin[5:32] It's a cousin to the work I do now where it really helped me just access the parts of myself that I liked the most. I could be less reactive. I could be calmer and more joyful, have a better experience. If I meditated and took care of myself.
Dr. Elliot Berlin, DC[5:52] And it's something that you were seemingly using successfully for yourself,
Sarah Olin[5:57] but then also teaching other people. Yeah, I'm very entrepreneurial and I had a business in New York called relax already. There's nothing more New York than that relax already. And we went into big companies and we taught people meditation around a conference room table.
Dr. Elliot Berlin, DC[6:17] I love the name, but it's also like, it kind of gives insight into how we think and work because I do chiropractic adjustments for a living. Sometimes people get nervous and I sometimes feel like when I say, okay, take a deep breath and relax. As soon as I say the word relax, they just tense up every little muscle in their body. And I'm like, okay, it's not as easy as just saying relax or relax already, you kind of have to work at it and you had the tools to be able to do it and you shared it with other people and taught them how to do it and teach others how to do it, which is kind of a wonderful thing. I feel like if that's spread across the planet, you know, cable news
[6:53] might go out of business. People would just be nice to each other. Yeah.
Sarah Olin[6:57] There's some data to support that too. So yeah, shark tank.
Dr. Elliot Berlin, DC[7:02] Okay. Now back to you. Um, how did you and meet your husband and where,
Sarah Olin[7:08] Oh my gosh. So this is a great story. So I had just been in India for a month doing a big meditation course and I came home and I used to work Sunday afternoons at a bar in Brooklyn to accommodate all my acting and yoga teaching lifestyle. I would work at Sunday afternoons at this bar in Brooklyn. And he walked in one day and said, I'd, he wanted to watch the tar heels. He went to UNC undergrad and he wanted to watch the tar heels. And I said, I just put on NASCAR for this guy, but if you come back later, I'll put on a show for you. I don't even know what made me say it, but he came back. He said, I think we have a lot in common. I said, Oh my God.
[7:52] Yeah. So I said, listen, if you want to go on quick, well, I mean, yeah, we chatted the attraction, just the initial connection. Yeah. He just, you know, and this was a great confusing thing for many a sweet man back in that time. I was literally paid to be nice to people that it was my job to be friendly and I'm giving them drinks. So it's like, it can be a very confusing experience for people, but I was in a very happy place. I had just meditated for a month straight basically. And we started chatting and he said, I'd love to take you out. And I said, okay, if you really want to take me out, because obviously as a bartender, I've been to this
[8:32] party before I said, call me three weeks from today at three o'clock on the dot. If you do that, I'll go out with you. And he did.
Dr. Elliot Berlin, DC[8:39] Wow. This is exciting. Okay. Do you remember where you went on our first day?
Sarah Olin[8:45] I do because we're supposed to go out to dinner and I had shot a commercial and crazy enough in Rhode Island that day. So I'd gone from New York to Rhode Island and I was coming back and I was exhausted. And I said, why don't we just do takeout at my place? And he was like, wow. I'm like, no, it's not that kind of party. It's literally just takeout literally, but we did and we hit it off and we had a nice little smooch and that was it. And then the next week was another dinner out and you know, from there onward. And I remember I was covering my friend's yoga class that was at 10 30 in the morning and you're only getting the elderly or the unemployed that
[9:25] come to a yoga class at 10 30 in the morning. And he showed up with his little yoga mat. I said, this guy is going to do anything for me. And he did and he still does to this day.
Dr. Elliot Berlin, DC[9:36] That's amazing. Yeah. What a great story. No, you got married and at some point you were like, let's have a kid.
Sarah Olin[9:44] Well, yeah, we were, we found out I was pregnant the day I got home from my honeymoon and yeah, I remember my best friend calling me saying, how was it? And I said, lady, we got big a fish to fry. I'm pregnant.
Dr. Elliot Berlin, DC[10:03] Is it something you had talked about or?
Sarah Olin[10:05] Yes, totally for sure.
Dr. Elliot Berlin, DC[10:07] So you're both on board.
Sarah Olin[10:08] Oh, totally on board. What was pregnancy for you? Uh, it was trimester. One was brutal and I just felt like trash every day. So nauseous, exhausted 24 seven never got sick once by the grace of some greater being never got to me.
Dr. Elliot Berlin, DC[10:30] You didn't throw up. You were just never nauseous the whole
Sarah Olin[10:32] time.
Dr. Elliot Berlin, DC[10:33] Exactly. Oh, I don't know which is better.
Sarah Olin[10:36] I know. And I was just dead dog. I mean, I would sleep 12 hours and just, I could, I felt like I had just run three marathons and then the second trimester started. I'm like, Hey, Hey, I got a little energy going. Yeah. I mean, and then in the third trimester, my daughter went heads up and that was tricky because, you know, having a really big yogic background. I mean, I was a geriatric pregnancy at a mean 36, just over the border, just over the border. And I really, exactly. I mean, the youngest of the old people. Uh, and I was very committed to, you know, I wanted a natural, but, and this was the most important and all the things. And I mean, I've heard a lot of people
[11:29] reference on the show, the business of being born that documentary, Sandy Woods was my midwife. Dr.
Dr. Elliot Berlin, DC[11:36] Marietz delivered my daughter.
Sarah Olin[11:37] Oh, wow.
Dr. Elliot Berlin, DC[11:38] I mean, wait, so that was your mindset? Like when you thought about birth, when you thought about labor and delivery, you were thinking in, like in bathtub or you're thinking hospital with a doctor because you're over 35 or what's
Sarah Olin[11:53] our plan was the birthing center at Roosevelt hospital, Dr. Woods. Everybody's on board and she was breech. And Sandy said, we don't deliver breech babies here. All right.
Dr. Elliot Berlin, DC[12:06] We're going to get to that in segment number two, see what happened, but during the first trimester out of curiosity, were the sort of mindfulness things, yoga things helpful at all for coping?
Sarah Olin[12:21] Oh, for sure. Absolutely. You know, I remember, you know, being in New York for 10 years and my teacher was fabulous. And we were so close and, you know, she was very practical and down to earth. And she said, sorry, you just have to rest. You're tired. You rest. That's what you do. And it really gave me permission to rest. I did my best. And, you know, I was really fortunate because again, kind of running my own show.
Dr. Elliot Berlin, DC[12:46] And what was your plan for the future career wise? Were you planning to continue the things that you were doing?
Sarah Olin[12:56] That's a great question. I was pregnant with Mira. I'm still doing the meditation and big companies situation. And I said, I know there's more. I know there's something bigger. I'm going to be a therapist or guidance counselor, some kind of helper. So my plan was, and I was researching graduate schools to go back to school. Okay.
Dr. Elliot Berlin, DC[13:17] Let's take a little break here. When we come back, we'll talk about the fact that your daughter settled into a breach presentation and see how that impacted your birth and maybe eventually your career. We'll be right back. Okay.
Dr. Elliot Berlin, DC[13:43] Welcome back to the informed pregnancy podcast. We are talking with Sarah Olin. Okay. So yoga, meditation, this great energy, this natural birth mindset in a birth center attached to a hospital, just on your own steam, on your own power, it's going to be great. And then the baby's breach. And by this point, very few doctors and midwives are delivering breach babies. And so you have, I guess, two choices, get your baby into a head to home position or have a C-section, which is the other side of the birth plan, like total opposite spectrum. Did you do things to try to encourage head down positioning?
Sarah Olin[14:21] Um, Dr. Elliott, I did literally everything. You name it. I did it. Everything. Frozen peas on the belly. I laid on an ironing board upside down. I mean, even has an ironing board anymore. Literally. I mean, we probably bought it for that.
Dr. Elliot Berlin, DC[14:38] I think it should be the breach board. That is how they market it now.
Sarah Olin[14:42] I did acupuncture, moxibustion. I worked with the chiropractor, one of the top three in New York City. I did everything. Earphones on the baby, prayed, baby, move, you know, I mean, I went to the YMCA. I was like a beach ball and my husband's trying to hold my legs up and I'm crying. It's not, I mean, you know, I did everything. And ultimately it wasn't and I remember Sandy saying, do you want to do the external version? The external version. And the day before it was scheduled, I was at my sisters in Rhode Island and I was meditating and praying and I said, what should I do? I don't know. And I didn't think I was, they had hinted at, I wouldn't be a great candidate
[15:28] for that external rotation because there wasn't a lot of fluid and I was small and this, that, and the other one. And I said, okay. And I meditated and asked the baby, what should I do? And I heard, don't move me. And I called and canceled. And I said, we're, unless she moves, we're going to have a C-section. Yeah.
Dr. Elliot Berlin, DC[15:48] I mean, I, in a first time mom, your odds of the baby turning or less than 50% to begin with, and then certain things will make it even lower, like having low fluid or your placenta in the front or other things like that. And so I think there's no right answer. There's no wrong answer really on whether to do it or not. It's just your own gut feeling. And your baby was telling you, no, I don't want to turn. So that really changes your birth plan to the total opposite end of the spectrum. Instead of being super present and active, you know, you're, it's more of a passive birth and someone does it for you and their surgery involved. What was that decision like
[16:24] when you realized that's, I'm shifting from A to Z on the birth plan. And then how did it actually go down?
Sarah Olin[16:31] You know, it's funny because before I made the decision, I remember being in my birthing class and they asked, you know, what's the worst thing that could happen to you here? And I said, having a caesarian birth would be the worst thing. And, um, first of all, I was wrong. And second of all, it wasn't true, but in my mind, because of, you know, where I was coming from and my orientation towards it, when I found out she was breach and I even remember when it happened because I remember being in the shower and feeling this crazy movement. I was like, Whoa, that was so groovy and it was very, you know, sort of interesting and thinking something big just happened.
[17:12] And, um, yeah, when I found out officially that she was, I said, okay, I'm going to do everything I can. And what's most, you realize really quick, what's most important. And it was that this child is delivered in a safe and healthy way and that I am safe also because, you know, I'm 36. I've never done this. It's important.
Dr. Elliot Berlin, DC[17:35] Yeah. It's a shift in paradigm. When you understand what's most important. Um, did you know her name
Sarah Olin[17:41] was going to be Mira?
Dr. Elliot Berlin, DC[17:42] No, no. Cause then you could have said Mira Mira on the wall. Tell us how you'd like to be born.
Sarah Olin[17:52] Exactly. I just said it without the name, but it was my pelvis. Will your head fall?
Dr. Elliot Berlin, DC[17:59] Please go south child. What was the cesarean
Sarah Olin[18:03] birth like for you? I remember the day perfectly because it was, we had to be at the hospital, maybe around 11. It was scheduled for the afternoon and we went to my teacher's studio. My husband and I meditated for a couple of hours. I couldn't eat. We went over and I remember being in a holding area and there were all women in active labor, you know, and I'm sitting there. I'm like, oh my gosh, this is so wild. And then I had to go and get all prepared without my husband. Because, you know, when they're giving you the
Dr. Elliot Berlin, DC[18:36] epidural, it's a weird
Sarah Olin[18:38] custom to kick out your support person, but very strange, but I'm also exceptionally good at getting support. So I'm like, Hey nurse, come stand here and hold my hand.
Dr. Elliot Berlin, DC[18:48] Oh, good for you.
Sarah Olin[18:49] Oh yeah. Oh, and the dentist. I'm like, all right, everybody, this is how it's going to go. Yeah. Action. Yeah. You hold my hand. You say one, two, three, and try this hummus. You're going to love it. Yeah. Y'all says it's delicious.
Dr. Elliot Berlin, DC[19:09] Okay.
Sarah Olin[19:09] So, and then what about
Dr. Elliot Berlin, DC[19:11] the actual procedure?
Sarah Olin[19:13] So the procedure we go in and I was so lucky because a friend of mine from yoga was a nurse. She was my nurse that day. I knew Dr. Moritz. I thought he was great. They were playing soft music. They had dimmed some lights. I mean, I really got the best sort of experience. It was the best it could be versus I wanted to be chanting the whole time, you know, the whole meditation situation. So they had the music. They had the lights and my husband was supposed to come around to this one side. And that was the side with the IV in my hand. I wanted him to be on the other side. So he comes over and he knocks down all this stuff. So, you know, it was a whole thing.
[19:57] And two minutes later, you know, he pulls the baby. He says, baby, baby, baby. I do remember bouncing around a little bit because they were tugging so hard. And I was so lucky because he's a very talented doctor. And I had no problems. And then Matt came over and I said, go over to the baby, go over to the baby. And they brought her over to me. And then we were off to the races. But it was my sister had had a cesarean birth. My niece is six or seven months older than Mira. And I remember asking her, how is it? She's like, it's not that bad. I'm like, OK. And then a few weeks later, I'm like, why did you tell me that? And she said, I didn't want to scare you.
[20:43] I'm like, OK, well,
Dr. Elliot Berlin, DC[20:45] no points for honesty. OK, a couple of questions here. Number one, did you learn why the baby had been breached?
Sarah Olin[20:53] Well, I don't know, but I do know Dr. Mariette said the cord was wrapped all around her neck.
Dr. Elliot Berlin, DC[20:59] So if it's more than once, especially, you know, makes the cord short and very hard to move around. Yeah, so likely that. Number two, what was physical recovery like from your cesarean birth? And what view did you have of postpartum? Have you given it any thought what it might be like? And then how was actuality compared to that?
Sarah Olin[21:22] No, thank you, God. I didn't think of it. I think I was just so, you know, in the moment and I had bigger fish to fry with like in my how is this baby coming out? I was very focused on turning her, but it was a surprise and I had some. It was just so intense. You know, you're cutting this major abdominal muscle and it was really painful. The first few days were brutal. I mean, we paid for a private room and this was 14 years ago. It was a thousand dollars
Dr. Elliot Berlin, DC[21:58] a night back then.
Sarah Olin[21:59] Wow. Out of pocket, right? Because they're not, you know, go stay with someone else. They're not putting you in a private room unless you're paying for it. So it was tough. My mom came. She was incredible when we went home. And I remember, you know, being on medication, I was having so much trouble breastfeeding like so many women. It was rough. It was hard. I was exhausted, of course, and sore and all the things. And I had this. And I don't know if a lot of women have this. I would shake, shake, shake, shake, shake and get really cold. And my husband would have to lay down on top of me and just try to settle, you know, settle me down. It was really strange.
[22:45] And I I was spoiled. My acupuncturist came to the house the next day and every other day for a week or two, you know, to try and help things move from a healing perspective. But it was tough. But after a week and a half, two weeks, I was feeling much better a month. I'm feeling like a million bucks.
Dr. Elliot Berlin, DC[23:07] Well, I mean, that's like a reasonable trajectory, probably what a lot of people experience.
Sarah Olin[23:13] Yeah.
Dr. Elliot Berlin, DC[23:14] What did you think would happen after, you know, four or six weeks? Just in general, Cesarean or not, like, what was the plan for juggling motherhood and all the other things you were already juggling?
Sarah Olin[23:27] Yeah, because my my husband's work was flexible, we had a friend who was a babysitter and we were just piecing it all together. Now, when I decided that I was going to go into a pretty intensive coaching program in New York and we were moving to Charlotte, that's when, you know, we moved to Charlotte nine months after my daughter was born, North Carolina from Brooklyn. And my in-laws are here, my sister-in-law, niece and nephew. So we had a lot of family and support here. And it was very intentional and we're like Rhode Island, North Carolina, Rhode Island, North Carolina. And the weather went out because we had just been, you know, battling New York winters for 10 years.
[24:12] And we've been in North Carolina ever since. And it's just been really, really good to us.
Dr. Elliot Berlin, DC[24:17] So you're moving away from family.
Sarah Olin[24:21] My family, yeah. Oh, moving away from family. And closer to my husband's family.
Dr. Elliot Berlin, DC[24:26] OK, and you're traveling for coaching. Is that coaching that you're on the receiving end or you're becoming a coach?
Sarah Olin[24:35] I was becoming a coach. And this was, you know, way before COVID. So it was all in person. And I was flying back to New York once a month. I did that for a year. And I fell in love and I became an apprentice with that group and then eventually a trainer. So I did that travel for six or seven years.
Dr. Elliot Berlin, DC[24:54] Well, that's intense with the little one. How was that juggle for you? Just taking care of a baby and taking care of your other baby. The career.
Sarah Olin[25:03] Oh, my gosh, it was a lot. You know, it's funny. If I did not have the husband that I have, who is so supportive and just a true, true partner in parenting, I wouldn't have been able to do it. And my in-laws who I mean, every weekend that I left, my husband packed up Mira and they headed straight to my in-laws. He had it made. He's got his mom cooking. I mean, taking care of the baby. I mean, it was wonderful. They were all so close. My husband and my daughter are so close because of it, I believe. But it was hard. There was a moment. She was she was probably 10 months old. I came home one night and she woke up in the middle of the night and she wouldn't come to me.
[25:48] She wanted my husband and that about killed me.
Dr. Elliot Berlin, DC[25:52] That's always hard, especially, I guess, if you feel like you're under delivering. And I think by the time we had our second kid, I realized that the kids go back and forth. Yeah. With who they want to be held by and who they don't want to have anything to do with. And you just kind of learn to enjoy the time off when they want the other person. But when that first starts happening, it really tugs at your heartstrings. And so how did you react to that? What did you do?
Sarah Olin[26:23] Oh, I cried. I was so sad. And, you know, fortunately, I had a great coach and she supported me and said, let's talk about it instead of just, you know, pretending it didn't happen or I'll be OK or operating on top of it. I got supported. And, you know, I had to really be thoughtful about, you know, what am I committed to? What are my highest commitments? And one of my beliefs is that in order for our kids to have a great life, we need to have a great life. And that means relationships, friendships, career, being a fully expressed human being.
Dr. Elliot Berlin, DC[27:02] Right.
Sarah Olin[27:02] If I want that for Mirabel, which I do more than anything in the world, I want her to have work that she loves so much that she just can't believe how lucky she is to be able to do it every day. That's what I dream for her someday, you know, in addition to many, many things. But, you know, it was important to me to do this and I loved it and I was good at it and I found something that where I could really make a difference.
Dr. Elliot Berlin, DC[27:26] How did these motherhood experiences affect your coaching?
Sarah Olin[27:32] I think I've always been a pretty compassionate person, but it just cracked open my heart at the next level. And even now, with a teenager, I'm learning and growing all the time because of her. And it does. It really challenges you and makes you grow. And it's informed everything because, you know, it's funny in the coaching industry, for sure. I was attracting so many moms, so many new moms, moms further down the road, moms really successful and crushing it in their career, but totally overwhelmed. And like, is this it? I've checked all the boxes and this is what I got. You know, so it was really cool to be able to work with these incredible women
[28:15] doing huge things and support them.
Dr. Elliot Berlin, DC[28:17] So many moms. You could have been… I said so many moms. Your practice could have been mom.com. Mom.com. Or .mom. OK, let's take a little break. But you start working with more and more moms coaching and you notice that moms have like similar problems showing up again and again, like the similar challenges. And you come up with this idea totally, I love to relax already. But now you come up with a different idea, a term that when we come back, we're gonna need you to explain, which is the luscious mother. We'll be right back. Welcome back. We're talking to Sarah Olin. OK, tell me about luscious mother. What is this about?
Sarah Olin[29:14] OK, so it's the coolest thing. I had been coaching for a while and my coach at the time asked me, you know, I was saying, I had this opportunity to coach leaders at the United Nations. And then I wanted to write a book and I wanted, you know, the first big milestone in your practice when your coach is, you know, yeah, I wanna make the six figures, the all the things, right? And she said, who would you need to be to create all that in your life? And I said, luscious mother. And it became my moniker. It became what people knew me for. I started doing, I had my buttoned up Sarah Olin coaching practice, but I'd hold these luscious mother retreats for moms to come and have something for them,
[30:03] to have a weekend to slow down and get some tools and get supported and connect with other women. It was so fabulous and joyful.
Dr. Elliot Berlin, DC[30:13] What are some of the concepts and really solutions for, look, I have this theory that's semi-popular and semi-unpopular. I think that men and women are wired a little bit differently traditionally. And when it comes to procreating, I think that after a new baby comes into the family, there's this hard wiring in women to be around the baby, be around the nest and wanna give. It's not universal, but I think it's a general trend. And men have this general animalistic feeling like I need to go out and hunt and gather more and supply and provide more for the growing family. In today's society, both men and women are kind of encouraged to go out and hunt and gather.
[31:07] And so he fulfills his internal animalistic instinct and gets rewarded from it. Oh, good job. But she gets pulled in two directions much harder typically to be around the nest and to be hunting and gathering at the same time. And my observation comes from working with so many women for two decades now plus, and watching them struggle with that and try to do everything and try to do it really well and feel like I can't do it, like I'm not giving enough to this and I'm not giving enough to that and I'm failing on all fronts and it's a miserable feeling. I imagine a lot of your coaching clients have these problems. And I just wonder what kind of advice,
[31:53] coaching, observation, relief is there for them?
Sarah Olin[31:58] Yeah, I think there's a few different places I look, but one thing that we beat the drum of all the time is wellbeing, wellbeing, wellbeing, wellbeing. And there's the great debate, can women really have it all? Can mothers really have it all? That whole thing. I say, I don't know. And when I am taking care of my body, mind and spirit, when I am taking care of, I have the experience of having it all, do I? I don't know. It's a very personal conversation. So number one, I wanna know how's your wellbeing and likely it's a trash, right? So we've got to do something about that because your experience is gonna get exponentially better as your wellbeing improves.
[32:49] The other thing is what's most important to you? Pick three things. It can't be everything.
Dr. Elliot Berlin, DC[32:56] Oh, that's nice.
Sarah Olin[32:58] It cannot be like, you want me to have the perfect house, be a gourmet chef, sex goddess in the bedroom, fit as a fiddle, make a half a million dollars and be mom of the year, pick two. Like what is most important? And if you say everything, that's your problem. Like you have to be willing and especially for high performing women, near I say perfectionist, it can be incredibly painful to give up your winning strategy of creating success in your life, which is usually outworking everybody. It's not gonna work once you have a baby.
Dr. Elliot Berlin, DC[33:35] Yeah, it's got a major pitfall. Even if, I think even without having a baby, that doesn't work forever.
Sarah Olin[33:41] It doesn't, exactly.
Dr. Elliot Berlin, DC[33:43] But then you throw a baby on top of it and that accelerates the burnout. And I just wonder, cause I hear you saying something pretty smart and what you would think is intuitive, which is prioritize yourself, give yourself, like how is your health? Take care of yourself. But then I also see a lot of people have guilt around taking care of themselves.
Sarah Olin[34:06] Yeah, and I think that I believe one of the antidotes to guilt is curiosity, is really being curious. Like people feel guilty and then they just sit in that versus getting really curious, like what is actually going on here? What's happening? Because if we just accept, like when we think about guilt and what it is, it's like, did you commit a crime? No. Maybe your crime is being amazing or wanting to do too much, I don't know. But people have to challenge it because we're inside of, if you're in the US, you grew up in a particular way, right? I was taught like you work hard, you do all the things, right? And it can't be, it can't be everything.
[34:58] It just can't be. And I'm not saying lower your standards. I'm not saying, you've got to do what's most important for you and your family, but you have to be thoughtful and live in reality. I've never baked a birthday cake for my daughter. I've never baked a birthday cake. In fact, I met my business partner in my daughter's preschool classroom because she emailed the parents saying, hey, I'm the class mom. And does anyone want to donate to this teacher's present or whatever? And I said, lady, if you're buying, I'm doing what, I'm going to send that money. Like you got it, lady. You're my hero. And she was like, who is this crazy woman? We became fast friends
[35:43] and now we run a business together, but it takes a lot. It takes a lot.
Dr. Elliot Berlin, DC[35:49] But it's like in the airplane, they always tell you put on your oxygen mask first right before you put on the kid. Because if you pass out, you're useless to everybody.
Sarah Olin[36:02] 100%.
Dr. Elliot Berlin, DC[36:03] Sometimes if you zoom out, you realize that anything you do to take care of yourself as a mom is taking care of all the people that you're responsible for.
Sarah Olin[36:13] I mean, I feel like moms are the thermometer, the thermostat of the home, right? You know, when I come home and I'm in a great mood, my family is the benefactor of that. When I've, you know, eaten well and I've moved my body and I've sat down to meditate, you know, when I come out and I'm right and connected to them and I can be present for them, we're having a whole new experience. Their lives are better because I've taken care of myself. I care about my life and I care about their life. And if I want them to have a great life, I need to have a great life too.
Dr. Elliot Berlin, DC[36:55] Everything you just said resonates so powerfully and it's so important I think for a mom to be happy and healthy and well-fulfilled and everybody else in the house. You're right, she's the thermostat.
Sarah Olin[37:06] We all get to be, we all get to have a great life, but it's not a guarantee, right? It takes something, you know, and I've worked my butt off for it. Like with her, with my husband, you know, I mean, it wasn't just like, Shangri-La, it's wonderful. Like, you know.
Dr. Elliot Berlin, DC[37:24] What are some of the other common things
Sarah Olin[37:26] that people struggle with in this phase of life? They stop being in a romantic relationship
Dr. Elliot Berlin, DC[37:34] with their partner.
Sarah Olin[37:36] And roommates don't last very long. Yeah, right. That roommate situation, I mean, it's real tough. For so many women, they're just radically under supported. They're doing three jobs. I mean, easily. And they don't have the infrastructure to do it.
Dr. Elliot Berlin, DC[37:54] Right, and I think that if,
Sarah Olin[37:56] do you work with both partners or? Sometimes, I mean, we ask organizations to foot the bill for the work that we do. So we do, our work is more inside of organizations, giving parents the tools there, but yeah, we work with everybody.
Dr. Elliot Berlin, DC[38:11] I mean, I think that sometimes, just going back to what you said previously, if you explain to a guy like, hey, if you provide these basic needs, you know, like make sure she's well-fed and well-rested and other things like that, your life is going to be amazing. Like, you know, the romance and intimacy will just come back naturally in a very gratifying way for everybody. It's like, what guy wouldn't wanna go make sure that his partner is well-fed and well-rested.
Sarah Olin[38:41] Right, and I think that guilt that you talked about leads women to do too much, like over function. So then dad's kind of hanging out over here, but she's actually trained him that she's gonna do everything or has to be the one to do this, that, and the other. So.
Dr. Elliot Berlin, DC[38:58] I mean, your daughter, Mira, is growing up in a different world than you grew up in, and you've learned a lot from life experience. What kind of lessons would you want her to take out of these as she sort of embarks on adulthood, which is not that far away?
Sarah Olin[39:14] Oh my gosh. I want her to learn that her happiness is her responsibility, that no one outside of herself can make her happy. Right, I want her to learn how to have hard conversations with people and tell the truth, even when it's uncomfortable. I want her to learn that creating things in life takes something.
Dr. Elliot Berlin, DC[39:38] Powerful messages for adults and children alike. I've learned a lot from you today, and I'm gonna listen back to this episode at least once or twice to pick up on some of the nuggets that I know you dropped that I missed. Um, because there's a lot, a lot of powerful stuff. I mean, I'm really grateful that you came on and shared in this way.
Sarah Olin[40:00] It's my pleasure, you're a lamb chop.
Dr. Elliot Berlin, DC[40:02] Oh, well that's the first time
Sarah Olin[40:04] I've gotten that feedback.
Dr. Elliot Berlin, DC[40:06] Well, not gonna be the last, I can tell you that. Um, Sarah, where can we find you online?
Sarah Olin[40:13] Oh, I'm on LinkedIn, LumoLeadership.com. If you Google Lumo or Sarah Olin, I'm around. People, you can find me, I'm available.
Dr. Elliot Berlin, DC[40:24] Tell me about Lumo.
Sarah Olin[40:25] We do human-centric leadership for parents and caregivers and everyone in between. We've really expanded beyond that, but we believe that the transition from working professional to working parent is a great unlocking of leadership and it should be treated as such and it is incumbent on organizations if they want to keep this extraordinary talent pool of working parents that they need to invest in them and take care of them.
Dr. Elliot Berlin, DC[40:51] How'd you come up with the name?
Sarah Olin[40:53] Lumo. Lumo. Luscious Mother, baby.
Dr. Elliot Berlin, DC[40:57] Oh, Lumo, Luscious Mother. Oh my goodness.
Sarah Olin[41:01] See, I knew I dropped some nuggets.
Dr. Elliot Berlin, DC[41:04] I'm gonna have to go see.
Sarah Olin[41:04] Well, I didn't say it, but it was actually my husband's idea because we knew that Luscious Mother wasn't gonna get through a firewall at a big, you know, a fortune fan. So he said, what about Lumo for Luscious Mother? And I said, let's do it.
Dr. Elliot Berlin, DC[41:20] Brilliant. All right, I'm gonna check out those resources online and listen to this at least twice. Thank you again for joining me. And at home, thanks for listening to the Informed Pregnancy podcast. For more pregnancy, parenting, and working mom information just like this, visit us online at informedpregnancy.com.
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“The VBAC did make me go, oh, you can do this. Not only can you do this, you can do this without medication.”
“I decided that I probably would never regret having another child and I would never regret bringing life into the world one more time.”
“So I think it's going to be wild, but I think I thrive in chaos.”
“My ideal birth situation would be that I start labor at night and I have a quick and calm and empowering delivery at home and have a baby by morning time.”
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Kara Sutton in orange.
Dr. Elliot Berlin, DC[0:00] Today's guest joined me five years ago, while preparing for the birth of her third baby after two caesarian births. We followed that story before the birth, in episode 388, and after, in episode 389. Since then, life has changed dramatically. She successfully welcomed her third daughter, learned what life is really like with three little ones, and now she's preparing for perhaps her boldest birth yet, planning to welcome baby number four, at home. I'm pregnancy-focused chiropractor, Dr. Elliott Berlin, and you're listening to the Informed Pregnancy podcast. Kara Sutton, welcome back to the podcast.
Kara Sutton[0:52] Thank you for having me. I'm so excited to be back.
Dr. Elliot Berlin, DC[0:55] I'm excited to, well, chiropractors always say we're glad to see you're back, but I'm excited that you're back as well. And also, it's crazy that you move further away, and when we link up on Zoom, it feels like you're in the room with me. That's your energy. So people at home, Kara is going to be in your room today for the next 45 minutes.
Kara Sutton[1:14] Thank you. I have big energy.
Dr. Elliot Berlin, DC[1:16] I have a lot of questions for you and your big energy. First of all, let's talk about after baby number three came. So you had a successful VBAC, now that you've had a few years to process it. What does the trilogy of your first three births look like in the rearview mirror?
Kara Sutton[1:33] Yeah. I mean, when we last spoke, we went in detail, but to give everyone a quick synopsis, I did an emergency C-section in a hospital. I did a planned C-section in the middle of COVID. I did a VBAC medicated with an epidural right before I pushed. And now I'm just preparing for my fourth, which I plan to have be a home birth.
Dr. Elliot Berlin, DC[1:58] Did the VBAC change at all your relationship with yourself, how you see yourself, your body?
Kara Sutton[2:05] Yes. I think that, well, I skipped over one part. I had a miscarriage in between the planned C-section and the VBAC. And that was, I think I mentioned before, but alone in my bathtub and was weirdly like a moment that made me realize, oh, I can do vaginal birth, maybe even more than the VBAC. That's kind of what inspired it. And I don't know why, but it just was very incredible to me that my body knows what to do and knows how to get rid of like what maybe isn't a viable fetus. And so that was incredible. The VBAC did make me go, oh, you can do this. Not only can you do this, you can do this without medication. You can do this without a hospital system telling you when to
[2:46] push or how to do things. So I do think it was incredibly empowering and made me really go. The female body is incredible and so strong, right?
Dr. Elliot Berlin, DC[2:56] So, I mean, just incredible and strong. And it's just like a Marvel that never gets old when you see like every day I see and think about what really happens and all of it and conceiving and growing through the various stages of the pregnancy and building this human being from two cells into a full-size human in your body and delivering the baby through your body into the world and making the perfect food for the baby with your body. Like all of that is mind blowing. And over 20 years later never gets old. It's still incredibly fascinating every day. I wonder what life was like once you had three little girls in tow.
Kara Sutton[3:36] It was so fun. I think that motherhood is a gift and really incredible and one of the most fun things I've ever done and the most fulfilling and purpose driven things I've ever done. And I feel like sometimes a lot of people complain about how hard it is. And it is hard. I don't want to pretend it's easy at all, but it is a blast. I have fun with it every day and I really enjoyed bringing home a third baby and I thought it was my last. If you go back and listen to our previous podcasts, you make a joke about a fourth. And I was like, yeah, right. Like would never, I'm not making any jokes today. And now I'm like, okay, a fourth, which, you know, for west side of LA
[4:19] is like ballerina farm status for everyone's like, whoa, are you like Mormons independently wealthy. What's happening is something, you know, but no, I just really enjoy it. And I enjoy having three small kids at home. I have seven, five, and two, and, you know, 30, almost 39 weeks pregnant about to welcome a fourth. So I think it's going to be wild, but I think I thrive in chaos. And I think that it's incredibly fun and fulfilling and hard and challenging, but amazing.
Dr. Elliot Berlin, DC[4:50] I mean, fun and fulfilling is great. Cause if it wasn't, that would be a big problem, but it is hard. And I wonder having three, which is already a lot for some people, for many people, do you feel like it became a little easier because you're more experienced or harder because you're outnumbered or both?
Kara Sutton[5:09] I think easier because I'm more experienced and you learn to let go of the things that don't matter that much, you know, you just make more room in your life. And I don't think I've experienced any anxiety, which is weird. I had way more anxiety in my twenties and about things that ultimately were kind of silly, but it seems like I'm able to handle even more and be even more steady with the more children that I have. So I've found it to be, to get busier for sure. You have less hands, you're outnumbered, but also easier cause you have experienced, you know, what you're doing and nothing rattles you the way it did with maybe the first child and even the second.
Dr. Elliot Berlin, DC[5:45] I've heard a lot of people describe women in particular describe the first baby as being kind of exciting and challenging because everything's a learning curve. There's nothing new, but then a lot of women describe the second baby as the hardest because it's the first time you really have to learn how to juggle two needy customers at the same time. And for me, it kind of made sense. The third was my hardest because it's really the first time I had to juggle two needy customers at the same time. So if I was home and we just had one baby, we would just kind of alternate two babies. I would usually take the toddler and my wife would take care of the newborn.
[6:24] And then it was really three babies when I had to kind of juggle two toddlers at the same time. And I think whatever was left of my hair probably started to come out at that time. All this to say, I don't know if that's how you felt about it or not, but was there like a marked sign of the transition to three?
Kara Sutton[6:45] Honestly, no, not to three. I think my husband took the other two a lot more and I had the baby strapped to me kind of at all times and was breastfeeding for well over a year. And so I found it relaxing to just be with one and to have breastfeeding as my excuse to sort of get some quiet time. I agree with you though, that the second felt the hardest going from one to two was challenging for me. They say like having one is like a hobby, like parents being like, it's more of like a hobby. And then when you get the second one in there, that was like, okay, this is like a full, this is like my life, you know, this is, this is not a joke. So very needy people are depending on you all the
[7:25] time.
Dr. Elliot Berlin, DC[7:26] Yeah, it's a struggle. It's a juggle. So at what point did you and Freddie realize
Kara Sutton[7:31] let's have another one?
Dr. Elliot Berlin, DC[7:33] The third or the fourth, fourth now, cause you said you were pretty much done.
Kara Sutton[7:37] Yeah, I did think I was done. I just never felt like I, I just thought this can't be it. I don't know. Both of us were 50 50. We kept calling it the maybe baby. Like maybe we'll do it. Maybe we won't. I thought on it for a long time and then I decided that I probably would never regret having another child and I would never regret bringing life into the world one more time. And I kind of felt like if I was going to do it, you know, that it was a little bit in God's hands. Like if I get pregnant fast, then it's meant to be. And if not, I have three beautiful sort of healthy children already, and I'm not going to fixate on what I don't have and sit
[8:18] there with sort of like a missing tile syndrome. But I did, you know, think, okay, if this happens fast, it's a viable pregnancy. It'll all work out. And I got pregnant super fast, luckily. And, um, I gave myself like a very small three month window where I was like, okay, let's see how this goes.
Dr. Elliot Berlin, DC[8:34] You challenged the universe and the universe has responded.
Kara Sutton[8:37] Loudly.
Dr. Elliot Berlin, DC[8:39] Yeah. Do you know what you're having?
Kara Sutton[8:41] No.
Dr. Elliot Berlin, DC[8:42] Okay.
Kara Sutton[8:43] This is my first time doing a home birth and my first time not finding out the gender at like 10 weeks on the dot. I'm just kind of for this fourth one, I just told you, I feel like, I think it's a boy, but I asked you what you thought when you were like cracking my back and you're like, I think it's a girl.
Dr. Elliot Berlin, DC[8:59] Yeah. But I also told you I'm right only about 20% of the time. So there you go. We both basically made the same guess on what it will actually be. All right. Let's take a little break. When we come back, we'll talk about this pregnancy and the decision that's changing everything, a planned home birth. We'll be right back.
Dr. Elliot Berlin, DC[9:29] Welcome back to the informed pregnancy podcast. We're catching up with Kara Sutton as she prepares to welcome her fourth baby, like you said, 39 weeks and change. So any day now.
Kara Sutton[9:39] Yes.
Dr. Elliot Berlin, DC[9:39] All right. You're planning to have this baby at home and you talked a little bit about how at the last birth and maybe even with the miscarriage, that combination gave you a lot more trust in your body and made you feel like not only can you do this, you can do it without any medications, any interventions and without an institution. What are the pros and cons of having the institution available to you or having the baby there versus at home?
Kara Sutton[10:08] It's a really good question and one that I thought about pretty heavily right before making this decision. I think that the pros, I'll start with the pros of the institution. I think a lot of women, maybe myself included, feel safe there. You have a lot of medical experts. You have doctors, you have nurses, you have a staff and the entire point of it that, you know, whole floor is designed to make sure you have a baby safely. You also have things available to you if something is to go wrong, right? And if something does go wrong and you need a cesarean, you know, you have hemorrhaging, whatever it may be, shoulder dystocia. There's so many things that can
[10:44] go wrong in labor. You have people there who can help you. So I'd say that's the pro and probably the only like pro in my opinion. The cons, I think, are that it's an unnatural environment to give birth. Everything from the lighting to the need to maybe make birth pretty uniform for each person and have it be on a timeline or have it be a certain way is kind of, I would say, in contrast to a lot of what natural birth looks like. For me, for an example, is birthing on my back didn't feel right. I think it's like a weird position to even be in when you think about maybe even bearing down to go to the bathroom. Like, I wouldn't want to do that on my back.
Dr. Elliot Berlin, DC[11:28] Nobody's ever said that before, but that makes sense. I think we can all relate.
Kara Sutton[11:32] Yeah. I'm sorry to be like graphic about it, but when you're having contractions, it feels not too dissimilar to that urge to want to sort of push, right? And I think that, so for me, that is a uniform way for a doctor to be able to see, you know, what's going on down there and have access to all of that. And so that's like a great position for a hospital to make pretty standardized, right? So it's just very natural in any system, in any business that you're going to want to standardize a lot of things to make it as uniform as possible and feel as controlled as possible. And I just think birth is one of those things that is not that and is so different for
[12:08] each woman and each body and each pregnancy, even each instance of all of that. So that's challenging in a hospital setting. I think also just the act of even getting to the hospital is an intervention in your birth that you don't even think about, right? Just the knowing you need to leave where you are and get somewhere else, at least for me, and my last one was a big stopping, it stopped my contractions completely, so.
Dr. Elliot Berlin, DC[12:30] So it's interesting that you say that because in my mind I'm thinking that when I would attend birth, so many times you would see that exact thing that at home, the labor pattern is building at a steady pace, becoming more productive, and she's handling it really, really well. And then somehow we decided it's time to go to the hospital and by the time we get there, everything's stalled, like the contractions are weaker, they're spaced out further and the pain tolerance goes down, everything feels worse. And, you know, I give a lot of thought about, too, what happened from 20 minutes ago when I was going beautifully to here and, you know, we are
[13:12] animals and we respond to stimuli around us and certain stimuli make us feel safe and relaxed and that's conducive to labor and certain stimuli make us feel like we're in danger and that's not conducive to labor, that stops labor. I've talked about on the podcast before, I saw a video from the 1980s of a very enthusiastic pet owner and his cat was giving birth in the closet and he was so excited and he got out his video camera, which at the time was that big giant thing with a big light at the end of it, and he was so excited to capture the birth on camera and the second that light hits the cat's eyes, she stops her, like, paced meowing, gets up with a
[13:53] kitten pretty much half out of her and starts pacing around and then she goes underneath the bed where it's dark and the light can't get to her and all of a sudden you hear the meowing come back, the pacing come back and she delivers the rest of her litter. So it kind of, to me, looks like that for some women when they get to the hospital, all those stimuli are like the bright light in their face, literally bright light, this smell of germicide here, put on this hospital moo moo, we're going to poke you with some needles and put these straps and bands around you, you lose your autonomy, it's no longer like I want this or I want that, I'm just going to have it,
[14:28] it's like, can I go pee now, can I have this trail mix?
Kara Sutton[14:32] Can I have this trail mix? It's scary, you know? It's a scary feeling.
Dr. Elliot Berlin, DC[14:37] It's just, none of those are naturally conducive, whether you love hospital or home, none of those are naturally conducive to calming your autonomic nervous system, saying I'm in a very safe place, I'm in control, this is a comfortable space for me to deliver now and kind of fire off all the hormones that would make that happen smoothly, it's the opposite, you release adrenaline and that slows everything down. Now I think that all the merits that you said about hospital birth are there and for some people they feel very safe at the hospital and not safe at home and some people feel very safe at home and not safe at the hospital and today in America, especially
[15:14] since we have such diverse training for practitioners, really robust diverse training for midwives and doctors and other practitioners, you could really have whatever birth you want to, it's like there's no wrong way to do it if you're healthy and you have a good responsible team with you. However, I think different people, if you feel safe at home you might be better off giving birth at home and if you feel safe you might be better off giving birth at the hospital and a home birth always includes the hospital as a possibility, it's like we're going to start at home and see how things are going.
Kara Sutton[15:46] Right.
Dr. Elliot Berlin, DC[15:46] And you know, pink flags come up, we don't just stay there and wait to see if
Kara Sutton[15:50] they become red flags.
Dr. Elliot Berlin, DC[15:51] Totally. We transport. So oftentimes a woman will say, I really feel like I want to have this baby at home and then her partner is really not that comfortable with it. How was Freddie about home birth?
Kara Sutton[16:04] Gosh, you know, he has been incredible now, but he's been through a lot of trauma, like he's experienced some traumatic births. And so when I knew in my heart and mind that I wanted to do a home birth and that was absolutely like what I wanted to do. I told him I want to have this baby at home and he was like, oh, my gosh. And I was like, but I'm going to get us, you know, the best team. It's not going to be all on you at all to make sure that this is a safe environment or that I'm doing well. So I think that made him feel good once he met the doula that I selected, met the midwife that I selected, the midwife's assistant. And as I became very,
[16:44] very educated on home birth and read so much and talked to so many people, he became really comfortable and supportive. And I think he's very excited about it now and looking forward to it and thinks it makes a ton of sense as well.
Dr. Elliot Berlin, DC[16:59] So that's much more comforting when you're on the same page. Was there a favorite book or media that you liked for home birth, for you or for him?
Kara Sutton[17:10] I read, is it Iname? Is Iname? I know I'm going to. I think it's Iname Gaskin.
Dr. Elliot Berlin, DC[17:16] Yes.
Kara Sutton[17:17] I mean, I think everyone reads her books, but I read Spiritual Midwifery, which is a wild book, because I feel like a lot of those people were on drugs having babies, but they're all like, really, it's interesting. Like people are like, I'm seeing colors and seeing auras, but it was an interesting book for sure. Made you realize you can have birth in a lot of places and a lot of ways with all sorts of things. So that one was a new one that I read. And then the transformed by birth was a good one as well. Yeah, by Verita Bush now.
Dr. Elliot Berlin, DC[17:49] Yep.
Kara Sutton[17:49] She was really good. And then just like a couple of midwives that I follow on Instagram had some interesting things to say and interesting videos and quotes. I obviously listen to your podcast and I think it's a great, you know, podcast.
Dr. Elliot Berlin, DC[18:04] It's my mother's second favorite podcast. I don't even know
Kara Sutton[18:08] if my mother knows this podcast exists. I mean, yeah, those were some of the things I listened to. And then I just read a few other books as well. A lot of reading, so.
Dr. Elliot Berlin, DC[18:18] I don't think there is such thing as unmedicated birth, meaning I think those people are on drugs, but it's drugs that you make. Right. And they're very powerful drugs. I always think if we could somehow get them in pill form, people would go for these drugs that you make.
Kara Sutton[18:34] I think you're right. Yeah, I think they refer to being high a lot. And I think it's a term that's used in spiritual midwifery in a very different way than we think of it today. You know, so it's more of like a natural high, a spiritual high. Yeah, like a high of endorphins and oxytocin and all of these things. And so it's just funny because the terminology of that book is very like far out, you know? Yeah, just very 70s. And so it's fun to read it because you're like, oh, my gosh, this is a throwback, you know?
Dr. Elliot Berlin, DC[19:06] But when you see it, it is a mind, body and spirit high. There's no other way to describe it. And the cool thing is whatever drugs you're making, they somehow permeate to the other people in the room that are there supporting your first and foremost, your partner. It's very cool because you kind of see the couple get high.
Kara Sutton[19:22] I'm looking forward to that. And I honestly really am hoping that that's what I experienced.
Dr. Elliot Berlin, DC[19:27] So want to make a baby number five joke here, but I'm not going to. I'll leave it up to you guys.
Kara Sutton[19:34] Oh, God, no.
Dr. Elliot Berlin, DC[19:35] OK, so you mentioned like, OK, hospitals great because what about X, Y and Z happening? Do you have a plan for that?
Kara Sutton[19:44] Absolutely, yes. I saw an OB up until I was like 20 weeks, maybe 25 weeks or so. And I really like her a lot. She's incredible. And we have a hospital up the street that's two minutes away. So it's not that I'm anti hospital or anti, you know, and this birth for me is not about ego and not about trying to accomplish some goal. So if we need to go to the hospital, that's what we're going to be doing.
Dr. Elliot Berlin, DC[20:10] You know, does the fact that you had two cesarean births play a role in your mind or the mind of your birth
Kara Sutton[20:17] team? You know, I don't think so because of a successful feedback and just my health level in general. I don't think so.
Dr. Elliot Berlin, DC[20:27] How have you prepared
Kara Sutton[20:28] your home for home birth? I have cleared out a bedroom, basically, that is, you know, the nursery where the baby will be be there. I have a birth tub that is ready. I've got all the things, I would say, that are just shoved into a closet right now, but they're ready for when it's go time.
Dr. Elliot Berlin, DC[20:47] So, yeah, let's take a little break. When we come back, we'll paint the picture of what Kara hopes birthday looks like from who's on the birth theme to what she hopes those first moments with her baby will be like. We'll be right back. Welcome back. We're talking to Kara Sutton, who is preparing for something she's never experienced before, having a baby at home. OK, Kara, walk us through your ideal birthday from the moment labor begins. Like, if you could pick any way you'd like it to go down and also based on how it went down last time, what would you choose?
Kara Sutton[21:33] My ideal birth situation would be that I start labor at night and I have a quick and calm and empowering delivery at home and have a baby by morning time. I would love for birth to be in or around the water. I would love to not feel a huge sense of fear and I would love to not hemorrhage after delivering, which happened to me in my last delivery. So that is kind of all I'm hoping for is just a powerful and calm experience that is ideal, so.
Dr. Elliot Berlin, DC[22:16] Who are the people that will be there with you? You mentioned them briefly in the last segment, but who's going to be around you and what role does each one have?
Kara Sutton[22:25] My husband will be there, Freddy. He helped make the baby, so he's going to help have the baby come out. My doula, Elizabeth, from Luma Birth and my midwife, Jesse, who's from Gold Soul Midwifery and her midwife assistant. So it'll be four other humans besides myself. And eventually the baby.
Dr. Elliot Berlin, DC[22:47] And eventually the baby. What about your other kids?
Kara Sutton[22:51] I actually am hoping that they, the plan is for them to go to my parents' house. My parents live about 20 minutes away and I would love for them to be not in the house in the event that there is, I just want to be able to make the noises that I want to make. I want to be able, sometimes birth is bloody and-
Dr. Elliot Berlin, DC[23:12] Primal.
Kara Sutton[23:13] Primal, right? And I don't want them to mistake that primalness level for pain or something going wrong or trauma. Like I just, it's really for me, I'm sure they'd be fine. But for me, it's like I want to protect them from that and be able to not have anything holding me back and not feeling like I need to sort of quiet myself for any thing.
Dr. Elliot Berlin, DC[23:34] It's funny, I come from a more conservative background, more medical background. And when I even started attending Home Birth, at first I was like, what? Like I think my first Home Birth I went to was a lawyer. I'm like, that's weird. You're not like a tree-hugging, tree-drugging, vegan hippie. And it was so cool. And it just like, it clicked at that moment why people do it. And it was just such a natural, smooth birth in her own environment. And I think that the first time I was told, okay, yeah, and my two kids are gonna come, I was like, that's crazy. And that time and every time since then that toddlers attend birth, it actually looks so natural
[24:16] and so normal. And everyone who does it leaves an option for them to, you know, a caregiver standing by to take them and if they're not reacting well to it. But I honestly always seems to go really well. Like for them, it seems a lot more natural, maybe because they're not too far removed from when they were going on the slide, but they always seem to be okay with it. And moms actually have an interesting reaction to it. It reminds me of like, my wife hates roller coasters and I very much dislike roller coasters, but we don't want our kids to like not like roller coasters.
Kara Sutton[24:48] Right.
Dr. Elliot Berlin, DC[24:49] So since I was the one who was less terrified of them, I would take the kids because I didn't want them to hate it. I would just throw up my hands and scream woo. And actually I started to really like them like, wow, this is fun when you're not trying to control it that much. And sometimes that's what it looks like for a mom who's in labor. And maybe there is some fear and then all of a sudden the toddler comes by and you jump into mommy mode where you're like a caregiver for the toddler and want them to feel safe and comfortable. So you just throw up your hands and go woo. And then all of a sudden you're loving it.
Kara Sutton[25:22] I never really thought about it like that. And now you're making me think, oh, it wouldn't be the worst thing if they were around, which is good because this might happen fast and they might be around, right? And so yeah, there is an element of like faking it a little bit and then you can embody that.
Dr. Elliot Berlin, DC[25:36] Yeah, and then you all of a sudden realize, wait a second, I don't have to fake it. I'm actually really liking this. And I don't see, like originally I thought the kids would be traumatized by it, but they actually seem to handle it really well. They get it, like it's a natural process. I'm sure there are exceptions to that. Okay, as we're 39 weeks plus and that's your vision that labor starts at nighttime and just progresses smoothly. Are you doing things pre-birth that people sometimes do right before they go into labor to get yourself ready for it?
Kara Sutton[26:06] I'm doing all the things. I'm walking every day. I'm doing raspberry tea at night. I'm on a lot of different supplements. I'm still doing a really high protein intake. I'm going to be getting acupuncture. I'm doing deep tissue massage. What else am I doing? I'm still working. I think that it's up to anyone what they wanna do, but I like to stay moving and sort of, I don't wanna say distracted, but busy a bit, just cause I think movement will help get things going for me.
Dr. Elliot Berlin, DC[26:36] So mind distracted sometimes is a great thing. Otherwise you're sitting around watching the pot not boil.
Kara Sutton[26:41] Yeah, it can't. It's a very good way of putting it. I think I'm someone who would just like, will go kind of crazy if I just sit here and be like, what is this gonna happen? So I'm staying busy and I'm doing spinning babies or trying to do some of those poses. I'm still working out, like doing yoga and every time I step into a yoga class,
Dr. Elliot Berlin, DC[27:01] there's just a lot of comments,
Kara Sutton[27:02] which happens I think in general
Dr. Elliot Berlin, DC[27:04] when a pregnant person does anything.
Kara Sutton[27:06] It's weird when you're this pregnant and you look this pregnant because people treat you like public property a little bit
Dr. Elliot Berlin, DC[27:10] like where everyone has a thought
Kara Sutton[27:13] on what you should be doing. And I think it is funny. I kind of, the rebel in me enjoys going to a workout class just to see people's faces. Yeah, I just feel bad about myself. I'm like, oh, she's working out. And I'm in the front row. I'm like, I'm not, I'm not being coy about this. Are you a water person or are you a land person for birth? You know, I don't know because it's my first time really having that option a little bit. In general and in life, I'm a water person. I was raised on the beach. My dad was owned a yacht company growing up. We spent a lot of time in and around water. So I'm glad to have the option of water. I could see myself wanting to be in the water
[27:58] but then maybe not wanting to deliver in the water. I just don't know if I want to like slip around, but we'll see. It's one of those things where it's going to be a game time decision.
Dr. Elliot Berlin, DC[28:06] I may sound like a jerk, but one of the cool things about home birth is great snacks. Have you thought about what kind of snacks you'll have available for your birth support team?
Kara Sutton[28:15] No, but should I have like a charcuterie? Like, what do we think? Like I think- Yeah, people put out really cool stuff like the whole Air 1 spread.
Dr. Elliot Berlin, DC[28:23] You just made this birth so much more expensive.
Kara Sutton[28:25] I'm so sorry. Yeah, it could be more of a spread. Okay, this is my fourth kid. This is going to be like a cold spread, okay? Like we are- Impossible sponsor. Impossible sponsor. That's a good idea. I should do that today and I'm going to do that actually after we get off this podcast. I'm going to go snack up the house and I'm going to put it in an area where my kids won't eat it because if they are from Air 1, like they can't touch it. It's just too expensive. Too rich.
Dr. Elliot Berlin, DC[28:52] Too rich for them. Yeah, in my house, I'd have to give it to my wife and be like, hide these from me.
Kara Sutton[28:58] Hide them from me? I'm going to have to hide them from Freddie too. So that's not a bad play.
Dr. Elliot Berlin, DC[29:02] I really am honored that you're sharing this element of your journey, that you've shared the whole journey with us from the beginning. I mean, every single pregnancy and birth of yours is a story. I mean, everyone's is, but yours are like out of the box stories. And this is no different choosing to have your fourth baby at home. Sounds like you have a really beautiful vision and a great team around you and you're fantastic. So I'm looking forward to the next episode when you come back and share your birth story with little gurgling noises in the background.
Kara Sutton[29:36] Oh, I'm so hoping when I share that story with you, it's a really positive one because I would love for this last one to not be traumatic. So I'm really, really hoping and praying for that birth to happen for me. So we'll see.
Dr. Elliot Berlin, DC[29:51] I am as well and I'm sure the audiences too. Kara, thank you so much for coming on. Where can we find you online?
Kara Sutton[29:57] You can find me on Instagram at I care about you. You can find me on my website. My run of business called Always Friday. So you can find me at alwaysfriday.com or you can find me on LinkedIn where I have a much more serious headshot under Kara Sutton. But yeah, I'm around.
Dr. Elliot Berlin, DC[30:13] So many ways to consume Kara. Thank you. And I'm looking forward to talking to you again soon 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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Board certified obstetrician and maternal fetal medicine specialist Dr. Nathan Fox has made a career helping women navigate routine and high risk pregnancies, delivering thousands of babies and tackling the most complicated situations in obstetrics. He returns to the podcast to discuss cesarean section births including how and when the decision is made, common reasons for this type of birth, what happens in the operating room, and what recovery should look like.
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“At the end of the day, what I tell people is the important thing is not what the C-section rate is, but are you under the care of someone or a group of people who are good doctors or midwives? Are they wise? Are they patient? Do they explain things well? And if that's the situation, if you need a C-section, you will feel confident that it was recommended for the right reasons and you're doing it, that it's an overall good decision.”
“it's major abdominal surgery, it's a bigger surgery than having your gallbladder out, it's a bigger surgery than having your appendix out, it's a bigger surgery than donating a kidney.”
“But a gentle c-section is, it's almost the default now where you're trying to make it as it's surgery, right? It's surgery, you can't get around it, like it's a major abdominal surgery, but to try to make the experience either as pleasant or as less unpleasant as possible.”
“And so what that means is I'll usually, you know, if she's okay with it, hold her hand, put my hand on her shoulder, talk to her, keep her focused, say, here's what's happening. Here's what's gonna happen.”
“So it has to be individualized to the person, just sort of the facts on the ground, but also people's wishes and their attitudes and their understanding is going to be different.”
AI-generated transcript with speaker labels — may contain errors, especially names and medical terms. Dr. Elliot Berlin, DC appears in blue; Dr. Nathan Fox in orange.
Dr. Elliot Berlin, DC[0:00] My guest today is a board-certified obstetrician and maternal fetal medicine specialist who has spent decades caring for women through both routine and high-risk pregnancies. He's delivered thousands of babies, helped families navigate some of the most complicated situations in obstetrics, and is also the host of one of the most respected women's health podcasts in the country. Many of our listeners have heard him on our show before, where we've discussed topics like prenatal genetic testing, preeclampsia, thrombophilias, external cephalic version, and more. He has a unique ability to explain complex medical topics in a way that's practical, reassuring, and easy to understand.
[0:38] Today we're talking about cesarean birth. Nearly one out of every three babies in America is born by C-section, yet most parents don't learn much about them until they're suddenly facing one themselves. Sometimes that conversation happens weeks before delivery, sometimes it happens during labor, and sometimes it comes completely out of nowhere. What are the most common reasons someone needs a cesarean section? What choices can still be made once that decision is reached? What actually happens in the operating room? And perhaps, most importantly, what should recovery look like in the hours, days, weeks, and months afterwards? I'm pregnancy-focused chiropractor Dr. Elliott Berlin,
[1:19] and you're listening to the Informed Pregnancy Podcast. Dr. Nathan Fox, welcome back to the podcast.
Dr. Nathan Fox[1:40] It's great to be here. It's great to see you. You look terrific,
Dr. Elliot Berlin, DC[1:43] my friend. Welcome back. Thank you so much. You're welcome back anytime. Let's do another one tomorrow. My pleasure. What's going on? Nothing. It's always great to talk to you. You're one of the most refreshing guests because you're so knowledgeable and so calm. And as I said in the introduction, you have a really wonderful way of explaining things that will make a listener or a patient feel confident, heard, understood, and give them all the information they need to move forward in whatever choice they're trying to make in the best way. So today we're talking about C-sections. My understanding is you've done a few. I have, and I appreciate the intro. And
Dr. Nathan Fox[2:24] let's see how well I make people feel reassured when we're done. Maybe you're going to have a C-section. We talked about a VBAC,
Dr. Elliot Berlin, DC[2:32] vaginal birth after coronary artery surgery. We can do it. Thank you. So I'm extra interested in hearing what you have to say today. Okay. Before we talk about the surgery itself, let's talk about some reasons why someone would be recommended to have a cesarean versus vaginal birth. Yeah. So there's probably two buckets
Dr. Nathan Fox[2:53] of why someone would get recommended to have a C-section. And the second bucket has two buckets within it. So it's like one and then two A and two B. The first bucket is it's known before the due date or before labor or before the end of pregnancy that a C-section is preferred compared to even trying a vaginal delivery. So for example, something like a placenta previa where the placenta is blocking the cervix. And we know that that is life-threatening. If a woman were to labor with that, then so we recommend the C-section. Or for example, sometimes with breech babies, and we discussed this, that in the past we would deliver them vaginally and now most people deliver them by C-section. But that would be,
[3:41] for example, a reason why someone would recommend a cesarean without even laboring or trying to labor. There are other reasons on that list, but basically that's the first bucket where during the course of prenatal care or even going into pregnancy, it's known that for this particular person, for you, it's safer, we think, for you and the baby to have a C-section than it is to try to labor. And that's sort of like high-level bucket number one. Even if we don't talk them through in detail, what are a couple of the other things on that list? So there are certain prior surgeries one might have had, like certain fibroid removals like myomectomy or certain kinds of C-section, like a classical
[4:24] C-section or something like that, where it's not safe to be back. So those would be reasons. One of the controversial ones is if the baby's measuring very large, are you better off having a C-section or better off trying to deliver vaginally? So that itself is a complicated discussion, but it is possible that someone might recommend it. Sometimes if someone's having twins or triplets and they're not in the right position, they'll recommend a C-section for that reason. Those would probably be the main reasons.
Dr. Elliot Berlin, DC[4:52] Like STD, cord issues?
Dr. Nathan Fox[4:55] Cord issues, not so much unless there's something called the vasoprevia, which is pretty rare. That could be one reason. STDs, I mean, if someone has an STD, then they're probably going to recommend a C-section or a C-section or a C-section. herpes, we'll usually recommend a C-section to prevent the baby from getting it. It's unusual So that's one of the reasons. because, I mean, a lot of people have been exposed to genital herpes, but they have an active one at the time that you're in labor. And also, typically for those women, the plan is to deliver vaginally, but if at that time they coincidentally have an active herpes lesion, then we will, you know, recommend the C-section instead. But over the course of pregnancy,
[5:33] you wouldn't say to someone going into pregnancy, for example, who has a history of herpes, oh, you can't try to labor. We would say as long as you don't have an active lesion, you can labor. It's a different bucket. And then also a funic presentation. So that's where the cord is in front of the head. It's also pretty rare, and you wouldn't verify that again until the very end of pregnancy, because it can move out of the way, even in early labor can move out of the way. So again, that wouldn't be one where we would necessarily be talking about it for weeks and weeks, but maybe that's between the
Dr. Elliot Berlin, DC[6:05] buckets, I would say. Okay. Maybe three more between the buckets would be, because I guess depends where and to the degree, but is C-section on the table as an option for early preeclampsia, for colostasis, for IUGR? So, you know, generally it depends on the
Dr. Nathan Fox[6:24] circumstances, meaning if someone needs to be delivered early for a medical reason, and then there's a decision, is it better to induce your labor or do a C-section? There might be a reason where you would say a C-section is better, although generally, for all those reasons, you could induce labor. Sometimes if there is growth restriction and the baby's in real dire straits, and we don't think the baby's going to tolerate labor, then we might say it's not worth trying. But again, if someone has colostasis, it's not like the plan is, oh, therefore you need a C-section. It might turn into a situation where you need one, but I would say that's the exception. Okay. More buckets. So the other big
[7:02] bucket is someone who is in the process of trying to deliver vaginally, where we say, hey, we need to change plans, and now the better plan is to do a C-section. The reason I said there's two A and two B is because there's sort of two general reasons why for someone in labor we might say, hey, I think we should switch plans. The first one, and both of them have a lot of gray to them, right? And there's a lot of art in determining if it's happening or not. And the first one is related to concerns over the baby. For example, things like with fetal heart rate monitoring, or we're concerned that somehow the baby's not going to tolerate the labor and is going to somehow get harmed during labor. So that's a
[7:43] reason why it might be recommended. Part of the reason it's very complex is because interpreting fetal heart rate monitoring and making that determination is difficult and notorious that we're going to recommend more C-sections than are necessary because we don't always know which of these, let's say I'm making these numbers up, but let's say for every 10 C-sections I recommend in labor for that reason, only one of the babies truly, truly needed it. Meaning had we let them all labor, nine would have been fine and one would not have been. Again, I'm making these numbers up, but it's hard to know which one of those 10. So sort of what's your threshold? At what point of concern do I need to be in order
[8:27] to recommend the C-section is a complicated topic, varies from doctor to doctor, and this is part of the reason we spend years training to do it in a way where we are recommending it enough that babies don't get harmed, but not recommending it too much that we're doing C-sections and everybody. And that is a very tough balance. And that's sort of like the first of those two buckets. And the second of those two buckets is related to a concept where if the labor is taking too long, one of the words is protracted, one of the words is stalled, one of the words is arrested. Like some sort of labor dystocia is another word for it, where basically the labor is taking so long and is moving so slowly or hasn't progressed
[9:10] that at a certain point we're like, hey, maybe it's safer not to proceed indefinitely and to do a C-section instead. And again, that's also very great because what is that? What is the number for that? How much time do you wait? It depends on a lot of factors. There's a lot of different interpretation to that. I mean, if you wait forever, all the babies are going to come out vaginally, but if it's going to take four to five days, it may not be the safest thing for the mother and the baby. And how do you make that determination? When do you make that determination? Sort of where are the areas we can give back and forth? And that again, takes years and years of training and
[9:45] experience to do it in a way where you're trying to recommend it enough that you're keeping everyone well, but not recommending it too much that you're doing a C-section for everyone. I can see that being a very difficult balance and also very different from patient to
Dr. Elliot Berlin, DC[10:01] patient, taking into account their input as well.
Dr. Nathan Fox[10:05] Yeah. All of those situations require input because different people have different, number one, they themselves are situations different. Every fetal heart rate monitor tracing is different. Every labor curve is different. Every human body is different. Every baby is different. Like all of these things are different. So it has to be individualized to the person, just sort of the facts on the ground, but also people's wishes and their attitudes and their understanding is going to be different. And some people might have a very low threshold and say, Hey, I don't want to take any risk whatsoever. If there's any blip in the radar, let's just do a C-section.
[10:41] And other people are like, Hey, I really want to push it as far to the line as you can go because I really, really want that vaginal birth. And maybe I'm willing to take a little bit of extra risk compared to the woman next door. And that's fair, right? And so you have to sort of work with people, you know, try not to let them make decisions that are going to get them harmed, but there's definitely leeway in both of those decisions to try to talk to people and come to an understanding that everyone's comfortable with.
Dr. Elliot Berlin, DC[11:07] During my doula days, I've had more than one occasion where I had a client in labor and things would take taking a while, but you could see on the monitor the other two tracings of patients that that nurse was caring for so that she can see, you know, her other clients when she's in another room. And I've had people be like, you know, turn it competitive. Wow, look at those contractions. I'm going to pull ahead. I'm going to get this baby out for you. Yeah, I don't know what sparked me to think that, but okay, one in three is roughly the cesarean rate currently in the United States. Do you think that is a healthy number? Should we strive for higher or lower,
[11:50] or is that a good place to be?
Dr. Nathan Fox[11:53] So I don't know is the right answer. And I think that there's a lot of talk about how many C-sections are being done. A lot of people say it's too many. The problem is that may or may not be true. The problem is no one knows what the right number is. I mean, if you look at places around the world that have very, very low C-section rates, they have actually high infant morbidity and mortality. Meaning there is some number of C-sections you should be doing in order to maximize health for the newborns, right? That's at the expense of doing C-section on the mother, obviously, which is a trade-off. But what is the upper limit of normal? Like what should it be?
[12:38] We don't know. People give all these numbers out and they say this is good, this is good, but it's not based on solid science. That's number one. Number two, you have to be very particular what you're talking about. So the overall C-section rate in a population is also gonna be related to the risks of that population. So for example, people ask me like in my practice, what's my C-section rate? First of all, I don't know. Second of all, it might be different because I take care of maybe women who are on average older and there's a higher risk of C-section as you get older or maybe they're more likely to have prior C-sections or medical problems or issues with the baby
[13:14] as compared to someone who takes care of only young, healthy, multiparous patients where their C-section rate is gonna be very, very low. So does that mean that I practice differently from the other doctor? No, we just have different groups of patients who come to see us and so C-section rates will vary a lot based on the population being looked at. So one of the things that has been sort of created to try to level the playing field is something called an NTSV, which is an acronym for Noliparis, first baby. T is for terms, so full term. S is for singletons, so not twins. And V is for vertex, meaning head down. So you take what is your C-section rate
[13:56] in first time moms who are full term with a head down baby. And to say, okay, that's sort of like trying to compare apples to apples. And people have talked about what the C-section rate should be in that population. And people say the goal is somewhere in the 20 to 25% range, but again, I don't know, is that the right number? Should it be lower? Should it be higher? I'm not really sure. At the end of the day, what I tell people is the important thing is not what the C-section rate is, but are you under the care of someone or a group of people who are good doctors or midwives? Are they wise? Are they patient? Do they explain things well? And if that's the situation,
[14:40] if you need a C-section, you will feel confident that it was recommended for the right reasons and you're doing it, that it's an overall good decision. Versus if you're under the care of someone who you don't feel as wise or don't feel as patient or don't feel they really know what they're doing, then no matter what happens when they recommend a C-section, you're always gonna second guess, was it the right reason? Was it appropriate? Did I not need it? on an individual level, that's the more important thing, that if people end up needing a C-section, they feel that it was done for the right reason, and they were comfortable with it, and they were part of that decision. And so there's no regret over it. They feel like this
Dr. Elliot Berlin, DC[15:19] was the right thing for me personally. I think that's a really smart way to look at it. And I might add one piece, which is, are they on the same page with you in terms of important things? So you could have a very wise doctor, but a doctor is a person too, and they also have decisions to make, and there are certain things that are in their comfort zone and feel like doing that is going to be giving good care, and doing something else is not going to be giving their best care. And also certain things liability-wise that they may be comfortable or not comfortable doing. And that doesn't make them a better or worse doctor, but it might make them a better
[15:53] or worse fit for you. So all the things that you said, plus that. I'm going to take a little Welcome back. We're talking to Dr. Nathan Fox and getting great information about cesarean birth. Okay, so someone is going to have a c-section. Maybe they have months of warning and notice and time to think about it. Maybe it's happening in the moment. Are there specific decisions they can still make as to how the cesarean is done? Are there choices and options or is it one size fits all? Yeah, there are choices and options
Dr. Nathan Fox[18:07] potentially. A lot of this is going to vary based on who's the doctor doing the c-section, what hospital. Is it scheduled versus emergent in nature? And there's a whole wider range of things in between that. So some of those things will depend. If you know you're going to be having a c-section, if you're in that bucket number one, these are things you can discuss in advance, obviously. Or even if not, because you might end up in bucket number two because you don't know, these are things you can discuss in advance. And just to touch on something you said at the end of the last segment about being on the same page as the person taking care of you, I think the conversations like this are best had earlier
[18:51] in pregnancy. I mean, finding a doctor, I tell people it's like dating, right? Like you could be a good person, the other one could be a good person, and you sit at dinner together and you talk and you're like, we're not a good fit for each other, right? God bless, good luck to you. You'll find someone and do well. The same is true with doctors, right? You could have a great person who's a patient and a great person who's a doctor, and they're not a good fit for each other. Or you may be surprised that someone is a good fit for you. And these are things you sort of find out just the same way you'd find out in dating. You talk to the person, you listen to the person, you get a good sense, are we a good
[19:23] fit? And assuming you think they're a good fit, you can ask questions about this. Hey, what does happen for C-section with you? Do I have choices? Things like that. So if you know you have a scheduled C-section, one of the choices might be, when am I doing it? What day of the week am I doing it on? Am I doing it in the morning, in the afternoon, the evening? Who is the doctor? Who's going to operate on me? Sometimes these are options that are available to you. Who's going to come in the operating room with me? Right? Do I want it to be my spouse, my partner? Do I not want it to be that person? Are they going to pass out and I'd rather have my sister come in with me or my doula come in with me or whoever it
[20:00] is? Is there an option for how many people can come in with you? Are you limited to one person? Can you have two? Can I play music? So can I play my own? Can I wear headphones? Do I have to wear a hospital gown? I mean, there's all these types of things that you can ask about sort of going into the room. Once you're in the room, typically things go pretty, for the most part, according to protocol, because we're trying to do it in a way that's safe, that's sterile, minimizes the risk of bleeding and infection. And that's why you sort of limit certain variation in how we operate. There are some things that might be available, like in our hospital, there's an option for like, they can drop the drape, or there's like a
[20:46] clear drape, so that if you want to see the baby coming out of your belly, you can. Other people don't want to do that. And there's an option for sometimes the anesthesiologist to put the heart monitor stickers on your back instead of on your front if you want, you know, less wires on your front. There are some cool, I've never heard of that. Yeah, there's a concept, I don't know, something called the gentle c-section. Have you heard of this? Yes. Yeah. So in our practice, I say if you want, you can have certain doctors deliver you the non-Jewish ones, and then it'll be a Gentile c-section. But a gentle c-section is, it's almost the default now where you're trying to make it as
[21:24] it's surgery, right? It's surgery, you can't get around it, like it's a major abdominal surgery, but to try to make the experience either as pleasant or as less unpleasant as possible. And so giving people some of the experience of a vaginal birth, seeing the baby, trying to get the baby on them like you would in a vaginal birth, maybe even if their arms are available to have them hold the baby a little bit. Certainly, if they're not up to holding a baby while they're having surgery on them to just have the baby nestled up against them, or if the partner's there, the partner can hold the baby. And these are generally available to people unless obviously there's a concern with the baby and the pediatricians are
[22:03] working with the baby, but generally those things are available. For the majority of people having a c-section, the anesthesia is going to be such that you're awake, right? It's a spinal or epidural. And so being awake gives you the opportunity to ask questions while it's happening. Is everything okay? What are you doing right now? What step are you on? And most of the surgeons are very comfortable talking to the patients during the operation. Obviously, if I have to focus on something and concentrate, I'll say, hey, listen, I need a couple of minutes. I'm, you know, I'm very focused here, but otherwise we're happy to talk and answer questions that people have. It also gives people an opportunity to hear the
[22:37] baby, to hear the cry and to see the baby, right? Whereas if you're under general anesthesia, you're put to sleep. You don't have those memories and experiences, which most people
Dr. Elliot Berlin, DC[22:46] obviously really cherish afterwards. It's a weird surgery because you're generally awake for it. And so it's got to be a surreal feeling to have your belly cut open and have your baby pulled out while you're awake. It's also surreal for the doctor because we
Dr. Nathan Fox[23:03] don't normally operate on people who are awake, right? That's true. It's one of the things where I always, when I'm outside and I'm scrubbing, if there's a med student, I'll always say to them, like, have you been in a C-section before? And I'll feel like, remember, they're awake, right? Like the things we say, they hear. So you don't say things like, whoa, never seen that before. Or like, oops, like there's things you just don't say, you know, during a C-section, you have to be very, very careful because they're there with you, right? They're present in the room and fully alert and awake and have a partner with them. And so it's just a different tone in the room. It's nice,
Dr. Elliot Berlin, DC[23:40] actually. It's quite pleasant. I want to spend the rest of this segment talking about what actually happens during a cesarean to better prepare someone who might go through it. First of all, the people in the room, who's in the room from the medical side?
Dr. Nathan Fox[23:56] The way we do it is there's two surgeons, at least sometimes a third person. If maybe there's a learner, like a med student or a resident or something like that, someone like that, excuse me. So there's at least two surgeons. There's at least one anesthesiologist, sometimes two. There is someone called a scrub tech, who is the person who scrubs it on the operation and helps us like hands us the instruments and takes them back from us. There's usually someone called a circulator nurse. That's a nurse who is in the room, not scrub, that like helps get things and sets things up and helps with the suction and sort of manning the room, so to speak. Then there's frequently another person
[24:36] or set of people there for the baby, whether that's a nurse, a pediatrician, or a combination of the two depends on the circumstances. That tends to be it on a routine basis. In the operating room, there may be more people if more people are needed, but there's more than one baby coming out. There might be more people for the babies, obviously. So those are the people in the room, plus obviously the patient herself, plus the person who's with her and if they allow two people, maybe two people with her. And possibly allow one person with you.
Dr. Elliot Berlin, DC[25:06] separate the patient from their partner for prep. Is that something you do too?
Dr. Nathan Fox[25:11] We wait until we're ready to start. And the reason is, number one, we don't like someone in the room when they're placing the spine over a epidural because that's the time where people can get loosey and pass out and we don't want two patients, we just want one. And then number two, when we're getting people prepped, it's very disconcerting to see a loved one lying on an operating room table. You know, they're not fully clothed, they're lying there, the room is kind of scary. And so we like to get everything set up and prepped with all the drapes on. And so basically the patient is completely covered except, I don't know, from her chest and up
[25:45] and her arms. And so it's not as frightening to see a loved one in that circumstance. Similarly, if someone's having general anesthesia and they're asleep, we usually don't let someone in the room with them and that is very scary to see, to see a loved one with a tube in their throat and, you know, on a machine, it's just understandably freaks people out. And so that's not really the best situation to have someone in the room with you. And so we wait until everything's ready to go and then we usually bring a partner in before we start.
Dr. Elliot Berlin, DC[26:12] From feedback from our patients on the other side of that coin, some of them don't want their partner in the room during that time where they are, you know, maybe vulnerable and comfortable. And other ones actually would much more prefer to have their partner with them during that time just to have support during what is the precursor to their potentially, you know, scary event, all the prep that's happening. Oftentimes we do get that feedback. Man, I don't know why they kicked my partner out. That's when I needed them the most.
Dr. Nathan Fox[26:44] Yeah, I think that's fair. There are logistical reasons also because we're trying to get the field to a sterile field and they'd have to sort of sit in the corner and this and so I think that's a fair feedback and criticism, but there are legitimate reasons for it. What I try to do personally to mitigate that is, you know, while all the people are doing the setup, usually I assign one person to sort of act as the surrogate partner, so to speak. Frequently it's just me, right? I'll let everyone else do all the work. And so what that means is I'll usually, you know, if she's okay with it, hold her hand, put my hand on her shoulder, talk to her, keep her focused, say, here's what's happening.
[27:22] Here's what's gonna happen. When she's getting her spinal epidural if it wasn't in place, I'm usually the one who she leans on, you know, and I hold her while she's having it done just so no one feels alone during that time period. Again, I'm a lousy substitute for someone's loved one, but I'm better than nobody, I would say. And so just to keep people, you know, calm and comfortable and I think they appreciate that it's one of the surgeons and I can answer questions for them and always reassure them, we're taking good care of you, everything's going fine, your baby's good, you're good. And so to try to mitigate that so people don't feel A, alone,
[27:57] or B, that they're just being sort of manhandled, you know, like they don't count or anything like that, which is an understandable feeling people could get.
Dr. Elliot Berlin, DC[28:04] First person perspective on my surgery three months ago, the team in there was incredible at helping me feel calm and relaxed going into surgery. Of course, I got to go to sleep, which is one of my favorite things anyway, so.
Dr. Nathan Fox[28:20] Now, you know, my experience, the kindest thing and most effective thing you could do to someone before they go to sleep is right before they go to sleep, you hold their hand and you say, we're gonna take really good care of you, you're gonna be okay. That is a very reassuring thing for people rather than just you're awake, you're asleep.
Dr. Elliot Berlin, DC[28:35] It's very comforting and just very human and very helpful. Okay, you mentioned two different kinds of anesthesia, the spinal and the epidural, what's the difference?
Dr. Nathan Fox[28:46] From the patient end, very little. In both situations, you're sort of hunched over and they're putting a needle in your back first to numb up the skin and then they, after that's numbed up, they sort of push a longer needle into your back. That part doesn't hurt like sharp pain, it's just pressure and then in the spinal, it goes directly into the spinal cord, they inject medicine and then they pull everything out. Gives you a very dense block for two to four hours or something like that and it's enough to do surgery. We do C-sections with it. An epidural is what people get in labor where they sort of stop the needle before the spinal cord and then they thread a catheter in
[29:23] and so the catheter sits just outside the spinal cord and sort of bathes the spinal cord in numbing medicine. That takes a little bit more time to gear up and to get very numb but it can last for much longer. You can leave that in for days. So that's why we use it in labor because it can last for a very, very long time. For a C-section, usually people would choose an epidural either because they already had one in labor so they use that or if we think the C-section might take a longer time than an hour or two. The anesthesiologists will usually leave in an epidural and if someone's having a very complicated C-section they think it's gonna take three or four hours,
[29:59] usually they'll leave an epidural in. But from the patient's side, you wouldn't be able to tell which one.
Dr. Elliot Berlin, DC[30:05] getting. They feel the same experience-wise. Right. I guess seemingly with the epidural, you also have more choices if you want to increase or decrease? In labor, yes. For a C-section, you don't want to decrease. You want to be fully numb. Full stop. Okay. Yeah. Which is
Dr. Nathan Fox[30:19] interesting though, because when I say fully numb, you don't feel pain. One of the weird things people experience during a C-section is you still feel us touching you. You feel touching, you feel pulling, you feel pressure, as if someone's pinching your skin and pulling it left and right and up and down, but you don't feel sharp pains. People describe a very strange experience. If anyone's ever had a cut on their arm and they get stitches, it's the same thing. You see them sticking a needle in your skin and sewing up your skin, and it's weird, and you feel it, but it doesn't hurt. I've never had a C-section done to me, but that's what people describe to me, how I would describe it back. It's that concept.
[31:00] You still feel touch. You know something's happening, but it doesn't hurt.
Dr. Elliot Berlin, DC[31:04] Right. That's how they describe it to me as well. Tugging and pulling, but the mind can run away with that because you know what's really happening. They sometimes feel like, I'm going to feel like I'm getting cut open, but they never do. Speaking of which, they're all numb and ready to go. What is happening mechanically? What do you do?
Dr. Nathan Fox[31:27] Basically, we're making an incision in the belly and the skin. Most often, that incision is low down and what we call transverse, which is side to side. Usually, it's around just under where the top of someone's underwear would sit, like their bikini line, we call it, maybe the top of the hairline. That incision, we make with a knife or what we call a scalpel. Then from there, there's several layers in one's body in order to get to the uterus. There's always fat under the skin. Even if you're skinny, there's fat under the skin. Then we get to something what we call a fascia, which is basically like a canvas, like a rough canvas that holds everyone's belly in place. We cut
[32:07] through that. Then underneath that are the muscles, like your belly muscles, your abs that we have to separate. Then once we do that- You said separate, but not cut? You do to separate them. If they're not already separated, a lot of people have that in pregnancy, you will cut them to separate them. That cut on the muscles is made up and down so that the muscles fall apart to your left and to your right. Are these the rectus muscles? Correct, that's correct. Okay, so my six pack. Yeah, your six pack becomes two, three packs basically. Then underneath that is something called the peritoneum, which is a very fine saran wrap layer around your belly. Then we open
[32:44] that and then we're looking at your uterus. How long would you say that takes? Five to 10 minutes if it's your first C-section, pretty quick. If it's not your first C-section, it could be longer, could be much longer in theory, but usually five to 10 minutes. Because of scar tissue? Yeah, because of scar tissue. Then once we see the uterus, we're going to make an incision on the uterus. Again, most often that incision is also going to be low down on the uterus side to side. We call that a low transverse incision. That's the kind of incision where one could potentially V back afterwards versus if for some reason we had to make an incision up down on the uterus, what we call a classical incision. That is something,
[33:26] the type of incision where someone could not V back afterwards. Again, that's a rare type of incision, but occasionally it has to be done. And then the incision on the uterus, and then right after that, we basically make it wide enough and deliver the baby through that incision.
Dr. Elliot Berlin, DC[33:40] Do you break the water with your scope?
Dr. Nathan Fox[33:42] Yeah. So after you go through the uterus, there's another bag of water inside the uterus that we break that water bag. And then the baby comes out, we clamp and cut the cord. And then the baby usually goes to the nurse or pediatricians first, and then hopefully soon thereafter to the parents. And then after that, the patient, they're usually focused on the baby. And then that's when we start working quickly. We have to take the placenta out, stop the bleeding, close the uterus up. Once the uterus is closed up, then we can more take our time again, because the bleeding is usually stopped or slowed down significantly by that point.
Dr. Elliot Berlin, DC[34:15] How do you not accidentally cut the baby?
Dr. Nathan Fox[34:19] We do not accidentally cut the baby. It does happen from time to time that the baby will get a cut. It's rare. It does happen. It's more common in emergency C-sections, or if the uterus is very, very thin. It's obviously something we try to avoid 100% of the time. When it does happen, the babies tend to be fine. They either get a little bandaid or rarely, I mean, rarely they would need stitches, but that's extremely, extremely rare. Usually it's just a very like scratch. Again, it's always rare, but when it happens, it's usually not such a horrible thing for the baby. And then for us, then we just have to go backwards steps and close either all of the layers we opened, and different people do it
[34:58] differently. Some people just close some of the layers they opened and let others close on their own. I'm a little bit more old school over. close you mean with stitches? Yeah so like I sew the peritoneum, not everyone does that. I sew the muscles back together, not everybody does that. And those stitches dissolve? All the stitches internally dissolve, correct. And then when we get back to the skin layer, different people do it differently. Some people close the skin with these surgical staples that stay in for like four to five days and then get removed in the office. A lot of people, myself included, close the skin with absorbable sutures that don't need to be removed and they just stay in and dissolve on their own. Start to
[35:42] finish I tell people c-section is 30 to 60 minutes. It'll feel a lot longer because there's prep time in the room there's cleaning up afterwards so for loved ones in a waiting room somewhere I tell them expect it to be two plus hours but the actual surgical time is probably 30 to 60 minutes. I have a couple more questions for this segment. Number one, do you take the uterus out? So there is something to call exteriorize the uterus where after the baby is born in order to close the uterus you can just leave it inside the body and close it. Sometimes you can pull out the top of the uterus so it sits on the mom's belly and then close it that way. I've done it both ways it sort of depends on the anatomy
[36:23] which way's easier. That is something that people do not want to see themselves, the uterus sitting on their belly, but for the med students it's pretty cool to see to see an organ sitting outside someone's body. As long as they don't comment on it. Yeah we do put it back in. That would be a big miss not to do that.
Dr. Elliot Berlin, DC[36:41] Are there different types of stitching for the uterus and is one or the other better for future pregnancies or the hope of a vaginal birth?
Dr. Nathan Fox[36:51] The main thing that people talk about is doing one layer or two layers where you either close the uterus in sort of one running stitch or you do it in one and then a second. The data on that is weak. I think some of the data suggests that if you do a two layer closure it sort of heals a little bit stronger and makes the chance of V-back or a safe V-back better. Whether that's actually true probably depends a lot on how people do their one layer closure and how people do their two layer closure. It's hard to study surgical technique in a real comprehensive way because each surgeon is going to do it slightly different and may have different skills and so you can compare people who had one layer to two layer but
[37:33] it's hard to control for who their surgeon was. So I typically close with two layers not 100% of the time but that's sort of my default. I don't know if that's what most people do in the country. I think yes but I don't know that to be a true fact.
Dr. Elliot Berlin, DC[37:45] You're pretty thorough with the stitching. Old people tend to sew more but even when I was
Dr. Nathan Fox[37:52] young that's how I was trained to do it also. I was trained by old people I guess.
Dr. Elliot Berlin, DC[37:56] All right two more quick questions on this segment. They're both about choice. One is some people want delayed cord clamping. They kind of want as much of the blood from the placenta to get into the baby before you clamp the cord. Is that an option for c-section?
Dr. Nathan Fox[38:12] Generally yes. It depends on how the baby's doing, how much bleeding is going on and things like that. Delayed cord clamping, there's good data that it's helpful in pre-term babies and full-term babies the data is not as strong meaning for most full-term babies it doesn't really matter and so it's just sort of what I found is for most people it's just something that someone told them they should do or they found online but is it-
Dr. Elliot Berlin, DC[38:35] Some podcast.
Dr. Nathan Fox[38:37] Yeah whatever. I mean for pre-term babies there's good data to support that it helps them it lowers the chance of anemia things like that for full-term babies it's fine like whatever but it's it's probably not as as valuable in that sense but we do it if people want it and we try to do it as sort of a routine at c-section again there's other variables compared to vaginal delivery like how much bleeding is she having how's the baby doing that sometimes limits our ability to do it for a long time but we try to do it as long as we can if that's what the parents want.
Dr. Elliot Berlin, DC[39:05] Last procedural question. Do you strap down arms and legs and if so is it all of them or is there a choice there as well?
Dr. Nathan Fox[39:14] For legs we do strap them down because people have no control over their legs they're completely numb and we don't want them sort of falling off the table like slipping and so the legs we definitely strap down the arms for c-sections at least in our situation we do not strap the arms down that's really meant for people who are asleep the reason people's arms get strapped down in surgery is mostly because they're asleep and you don't want their arm just like slipping off the board and like dangling off the side of the table so you sort of secure them but for people who are awake that's obviously a pretty scary thing to be tied down for surgery obviously so we don't do that
[39:51] in our hospital people's arms are free they do lie them out like out to the side like in t-position just because you know there's an ivy in there and there's a thing and we need access but they can move their arms freely typically during a c-section when they're awake if they were
Dr. Elliot Berlin, DC[40:08] Makes sense. All right, let's take a quick break. When we come back, we'll talk about recovery from a cesarean birth. Welcome back. We're talking to Dr. Nathan Fox, very valuable, helpful information doc. I think one of the things that I hear feedback wise is I have the C-section and then my doctor is like, I'll see you in six weeks and there's not a ton of information about how to recover from this surgery. It's a very common surgery. It's a very safe surgery but it's also like an abdominal surgery and I think for some reason when you have other types of abdominal surgery, there's a lot more instruction on how to take care of yourself and a lot of people rally around you but in this case everybody's like
[40:59] focused on the baby. What is recovery like? What should someone expect to feel? What restrictions are there in the few days after the cesarean and the weeks and months to follow?
Dr. Nathan Fox[41:12] Yeah, so a few things. The reason we don't normally see people for six weeks is not because it's more convenient for us, it's because it's more convenient for the patients. Meaning most people would prefer not to have to schlep into their doctor's office, particularly if they have a newborn unless they have to. So we usually, we want to see everyone in six weeks and what I tell people is if you need to be seen between zero and six weeks, we'll see you the same day. We used to see everyone in two weeks and we realized that was a waste of time because they'd come in, they'd schlep in, they're in pain or come to our office and would say, you're good, go home and they'd
[41:43] be like, what the hell, why did I come in for this? So that's why we see people six weeks. You know, recovery from a c-section, again full disclosure, I've never had a c-section. I have a wife who's had a c-section, I have a daughter who's had a c-section, I have many patients who've had c-section, so I have some understanding of it although I won't say I've experienced it. It is a balance between on the one hand, it is a common operation, it is a safe operation and people typically recover well and do perfectly fine on the one hand and on the other hand, it's like you got hit by a truck and I think that you're correct that sometimes that part is not properly advertised to people. Having a c-section is no joke,
[42:23] it's major abdominal surgery, it's a bigger surgery than having your gallbladder out, it's a bigger surgery than having your appendix out, it's a bigger surgery than donating a kidney. It is a major abdominal surgery and it hurts afterwards and so I think that for most people, the recovery, what I tell them is the first two weeks are rough, predominantly for pain and after two weeks, you'll usually feel around 80-ish percent of who you were beforehand, 80, 90, 70, somewhere in that range. Maybe you feel pretty good, you could get out of the house, you could go somewhere but you don't feel normal. It takes two months to feel normal. Some people are blessed and they feel normal at five weeks, other people it takes 12 weeks but
[43:10] I tell people expect it to be two months till you feel normal and during those first two weeks, again, the primary issue is pain and as you said, not only recovering from surgery, you have a newborn. Most people who have surgery aren't saying, oh, by the way, take care of this newborn, feed this kid every three hours, don't sleep, don't eat. It's very, very hard. Because of that, people will often require more help than they might otherwise, whether that's family, friends, whether that's hired help, whether that's professional help, lactation consultants or whoever it might be but people, there's no shame in needing help after a C-section for yourself or for taking care of your baby.
[43:52] People should take the pain medicines that they need in order to be as functional as possible. By functional, get out of bed, take a shower, go to the bathroom, be able to feed yourself, stuff like that. It's hard to take enough pain medicine that you have no pain but you want to do that and you're balancing because the stronger pain medicines like narcotics, people are worried that they're going to get addicted which doesn't happen much after C-section fortunately but also they have side effects. They make people drowsy, they make people constipated, they make people nauseous so we try to get people off narcotics as soon as we can without them suffering and then focus a lot on things like NSAIDs like ibuprofen which is
[44:31] Motrin or Advil and Tylenol and so that happens. People are off narcotics somewhere between two and seven days after a C-section I would say and then they're on the Tylenol, Motrin for usually a couple of weeks, give or take. It increases with time, people can usually shower after a day or two which feels delightful for Motrin.
Dr. Elliot Berlin, DC[44:53] Yeah, let's go back because the first few days are usually in the hospital after a C-section.
Dr. Nathan Fox[44:57] Yeah, two to four days, yeah.
Dr. Elliot Berlin, DC[44:59] Two to four days. How soon till they can get up and start walking around?
Dr. Nathan Fox[45:03] Either the same day or the next day.
Dr. Elliot Berlin, DC[45:06] Okay. And then shower, you say, maybe a day or two later as well?
Dr. Nathan Fox[45:11] Yeah, we usually let people shower the next day. They have to be able to stand, obviously, unless there's a seat in the shower, and then there's some issues with the wound. But usually after 24 hours, we're okay with the wound getting wet.
Dr. Elliot Berlin, DC[45:22] What do they do, instructions for when they get home, for the wound itself, but also limitations, like you talked about taking care of a newborn, can they bend, lift, hold, and feed the newborn, or are there modifications?
Dr. Nathan Fox[45:34] For the wound, we generally, there are fortunately not a lot of instructions. By the time they go home, there's usually nothing covering the wound except for maybe these little pieces of tape we call starry strips. Some people use glue. Again, if you had staples, the surgeon's gonna wanna take them out at some point, but if you went home with stitches, like we do it, you don't have to do anything. I tell people you can shower, it can get wet, soap can get on it. Don't scrub it, not like anyone would, and then just pat dry it with a towel. It does not need to be covered. I tell people New York City Air has all you need to heal this thing. Maybe where you are, California air is good.
[46:10] And then after about two weeks, we tell people they could pull the little pieces of tape off, and again, everything else is out. So there's no, I say no potions, no lotions. There's nothing you need on the wound afterwards.
Dr. Elliot Berlin, DC[46:20] So not a fan of silicone?
Dr. Nathan Fox[46:22] It's not that I'm not a fan. I don't recommend it routinely. Someone wants to do it, they can, but I don't know if it makes it any better. They usually heal pretty good. The wound, they're low down in the belly, they're across. They tend to heal nicely. Some people keloid in general, but the wound usually looks pretty good afterwards. In terms of restrictions, we tell people after all births, not just the C-section, usually don't have sex for X amount of time. Not like most people after C-section are clamoring to have sex sooner after. In terms of activities, we tell them not to lift anything too heavy. They can lift their baby, their baby bag,
[46:55] things like that, but nothing crazy. Not to do anything that hurts, right? And I tell them for activity to start slow, like they could start with walking, and as long as what they're doing doesn't hurt them that much, then it's generally safe. So people start with walking, and once they can do walks, they do long walks, and then they do longer walks. Most people are not hitting the gym in the first four to six weeks after a C-section. That's pretty unusual.
Dr. Elliot Berlin, DC[47:19] What about picking up the baby?
Dr. Nathan Fox[47:22] Picking up the baby's fine. Nothing's gonna happen if they pick up the baby. And the concern is not that the wound is gonna blow open if they lift something. It's just, it's gonna hurt, and this, and we don't want people to suffer. And so we tell them to try to increase their activities slowly.
Dr. Elliot Berlin, DC[47:38] Right, but sometimes they also have a toddler who's gonna be one to pick up the baby.
Dr. Nathan Fox[47:42] Yeah, you have to sort of see how you feel. Sometimes you don't have a choice. Sometimes you can sit and let the toddler sit on your lap, but you have to be careful they're not kicking you in the belly because it'll just hurt. Again, they're not gonna do anything to you that's gonna harm you. It can be very painful, and you don't want to do something that's gonna end up causing a lot of pain.
Dr. Elliot Berlin, DC[47:58] Okay, is there anything specific to do if they're hoping to have a vaginal birth in the future, or does it really matter?
Dr. Nathan Fox[48:05] There's some evidence that they should wait a certain amount of time to let the uterus heal. Exactly how much time that is is debatable. For most people, as long as you wait like nine to 12 months before getting pregnant again, that's usually fine. Most people are not timing their kids closer than that, but if they were thinking of it, it's something they want to talk to their doctors about particularly if they had a C-section because sometimes doctors will let them be back if it's after X amount of time, but not let them if it's within a certain amount of time. So again, on average, I would say most people are not getting pregnant within the first nine months of their baby being born,
[48:40] in which case that timing is fine, in my opinion. If you're thinking about doing it earlier than that and you're planning on being back, I would definitely speak to your doctor first.
Dr. Elliot Berlin, DC[48:48] Are there any restrictions on driving
Dr. Nathan Fox[48:50] right after they get home? I usually tell people if you're on narcotics, you shouldn't be driving. I usually tell people it's not wise to drive for the first couple of weeks, just because if you get like a bout of pain, it can affect, you know, you're driving, maybe you're gonna turn the wheel, or sometimes your reaction time is slow after surgery. So I tell people usually the first two weeks, it's better to have someone drive you. That's not a hard rule. There's probably someone who's okay to drive it 13 days and someone who's not okay to drive it three weeks, but that's sort of like as my baseline, it's probably not wise to drive in the first two weeks.
Dr. Elliot Berlin, DC[49:21] Do you recommend an abdominal binder?
Dr. Nathan Fox[49:24] Only if it makes someone feel better. It doesn't always. Not necessarily, it doesn't always. Some people, they feel better with it. Some people, they feel worse with it, but it's enough. One day.
Dr. Elliot Berlin, DC[49:31] I will have a long conversation with you about all the work we do for cesarean scar remediation and low level laser therapy and also manual work. But I don't wanna take up any more of your time today. You've been very generous with both your time and as I said at the beginning, you're really explaining things in a wonderful way. Certainly people who listen to this episode all the way to this point are gonna want more. Dr. Nathan Fox, where can we find you online? And tell me just very briefly about your podcast.
Dr. Nathan Fox[50:02] Yes, so you can find me on… I guess my practice website, mfmnyc.com. Probably the better place to go is our podcast, which is called The Healthful Woman, W-O-M-A-N. We also have a website, healthfullwoman.com. We've done hundreds of podcasts, like you were in the same space, and I think there's a lot of overlap in our philosophies, and I think a lot of people who enjoy your podcast will probably enjoy mine, and vice versa. And yeah, or otherwise just, you know, walk around the upper east side of Manhattan and look for the guy with the Cubs' backpack, and you'll find me.
Dr. Elliot Berlin, DC[50:39] And you also just recently co-wrote a book.
Dr. Nathan Fox[50:42] Yes, Emily Ostroni co-wrote a book called The Unexpected. It's about a pregnancy after a pregnancy. We have a whole chapter on V-back and pregnancy after C-section and after other various complications of pregnancy. And so yeah, thank you for a plug on that,
Dr. Elliot Berlin, DC[50:56] appreciate it. Thank you so much for joining me in 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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