161 Brittany Sharpe McCollum + Pelvic Dynamics

What if tiny, subtle movements during labor could give your baby extra centimeters of space in your pelvis? Those centimeters just might make all the difference in getting your VBAC.   Brittany Sharpe McCollum is an expert on educating women about pelvic biomechanics. This episode is packed with valuable, mind-blowing information that will put you, the laboring woman, back in control of your labor and ready to have an exhilarating birth.     “It doesn’t matter if somebody is birthing with an epidural or without an epidural. They should come out of their experience feeling like they did something amazing. It doesn’t matter if somebody has a Cesarean or vaginal birth. They should come out of it feeling like they did something awesome rather than feeling like something happened to them.”   Today’s topics include:  - Your pelvis shape and optimal fetal positioning - Subtle movements during labor - Closed knee pushing - 5/4/3 Rule of Movement Additional links How to VBAC: The Ultimate Preparation Course for Parents Brittany Sharpe McCollum’s website: Blossoming Bellies Birth Blossoming Bellies Birth Instagram Baby Got VBAC Free Webinars The VBAC Link T-Shirt Shop Episode sponsor This episode is sponsored by our signature course, How to VBAC: The Ultimate Preparation Course for Parents. It is the most comprehensive VBAC preparation course in the world, perfectly packaged in an online, self-paced, video course. Together, Meagan and Julie have helped over 800 parents get the birth that they wanted, and we are ready to help you too. Head over to thevbaclink.com to find out more and sign up today.   Sponsorship inquiries Interested in sponsoring a The VBAC Link podcast? Find out more information here at advertisecast.com/TheVBACLink or email us at [email protected].   Full transcript Note: All transcripts are edited to correct grammar and to eliminate false starts and filler words.    Julie: Welcome to The VBAC Link podcast. This is Julie and Megan with you today and we are really thrilled about the guest that we have today. We have Brittany Sharpe McCollum who is a pelvic dynamics specialist. We first learned about Brittany when we were at the Evidence Based Birth® conference. Meagan attended one of her workshops there and instantly fell in love.   Meagan: Like, madly in love.   Julie: Don’t tell Meagan this, but she is kind of obsessed.   We are really excited to have her on today because a lot of Cesareans happen because of big babies, small pelvis. We have all heard it. If we had a quarter for every time we heard that excuse for a Cesarean, we would be rich women. We are going to talk about that. We are going to talk about that today with Brittany.    Brittany is a childbirth educator. She is a doula and a pelvic biomechanics educator. Her work with expectant families centers around supporting people and exploring their options, developing their preferences, and navigating the tools and information necessary to make them a reality. In her trainings for birth professionals, she takes a research-based, multidisciplinary approach to exploring pelvic dynamics in relation to labor and facilitating the understanding of movement as a benefit to medicated and unmedicated labors.   Guys, the things that she does can help you whether you have an epidural, whether you are unmedicated, home birth, hospital birth, birth center-- anywhere and everywhere you give birth. We are going to have some really, really awesome tips for you by the end of this episode, so get your pen and paper out. This is going to be one you want to take notes on. Review of the Week   Julie: But before we do that, Meagan has a review of the week for us.   Meagan: Yes, I do. This one is going to be one of those episodes that you likely listen to and then have to go relisten to it and relisten to it. You are going to learn things every single time you listen. I am so excited for this review, too. It is from drFL0W and the subject is “Phenomenal.” So, thank you.   It says, “Meagan and Julie are amazing! I love the knowledge they share on their podcast and their enthusiasm for helping women have amazing VBACs.”   Thank you, drFL0W.   Julie: Do you know what? Dr. Flow, Flow Chiropractic.   Meagan: Flow Chiropractic!   Julie: Steven Roushar. I wonder. I bet.   Meagan: Dr. Flow. That makes sense.   Julie: I may have kind of made him write this review at a chiropractor appointment. I asked him to and he said he did it on Google and Apple Podcasts.   Meagan: Well, then that’s his one. Thank you. Thank you, thank you. We love him.   Julie: Thanks, Steven.   Meagan: But yeah, seriously, this podcast is going to be filled with tons of knowledge. So, gear up. Buckle in and get ready to roll.   Episode sponsor   Julie: Do you want a VBAC but don’t know where to start? It’s easy to feel like we need to figure it all out on our own. That’s what we used to do, and it was the loneliest and most ineffective thing we have ever done. That’s why Meagan and I created our signature course, How to VBAC: The Ultimate Preparation Course for Parents, which you can find at thevbaclink.com. It is the most comprehensive VBAC preparation course in the world, perfectly packaged in an online, self-paced, video course.    Together, Meagan and I have helped over 800 parents get the birth that they wanted, and we are ready to help you too. Head on over to thevbaclink.com to find out more and sign up today. That’s thevbaclink.com. See you there.   Pelvic dynamics with Brittany Sharpe McCollum   Julie: Alrighty. I absolutely love what Meagan said before our intro. Buckle up. It’s going to be a bumpy ride. But do you know what? It’s the best woman to take a bumpy ride with because Brittany is going to help us get our pelvises ready for the bumpy ride of childbirth. How was that? Was that a little bit too corny?   Meagan: There you go. See, and in my head, I am looking at it as we are going to be going full speed and your mind is going to be like, “Whoa!”   Julie: Alright. Well, Meagan, you set this up. So, I want to let you drive the car. Is that okay? I am going to pop in with oogly-ness wherever it is appropriate.   Meagan: Sure. Well, I just love Brittany. I loved her the second that I technically met her in Lexington. You guys should have seen this room. It was this little conference-type classroom in a hotel. We were shoulder to shoulder. It never would’ve happened during COVID because we were definitely not social distancing. We were packed. Everybody wanted to come and learn what she had to say. We only got one tiny little hour and, of course, she had this big line of people to ask her questions after. As soon as I left, I told Julie, I said, “I need more. I need more.”   Julie: Yes, she was. Even now when I am at a birth I’m like, “Hold on. Remind me. Is it knees in or knees out? Is it asymmetrical movement or symmetrical movement for this stage?”   Meagan: We are going to learn so much. I was so fortunate even during to COVID to be able to attend one of her workshops live this year in 2020. She just continues to amaze me and when Julie says I am obsessed, I really am obsessed with her. I love her. I can’t get enough of her and I’m so excited that she is here with us today.   Pelvis shape and optimal fetal positioning   Meagan: First of all, I have this one thing that I would like to talk about because this is something that I personally get stuck on myself, even as a doula. As a doula, I was trained this. So when I learned about this, I was like, what? If you have ever heard that your baby has to be in a LOA position, then you really want to turn the volume up right now because you are going to learn some stuff.   Julie: Lightbulb. Lightbulb.   Meagan: During my pregnancy with Webster, I did not sit on a couch or a chair other than my actual car literally the entire time. So, all the way up until 40 weeks and 5 days, I did not sit on a chair, a couch, nothing. I sat on the ground. I didn’t even sit on the birthing ball. I sat on the ground and was tipping my pelvis up, and sitting so uncomfortably that it hurt my stomach and my back. I killed myself. And guess what? My baby was OP. He was posterior. I was doing all the things to get this baby in LOA because we had to have this baby in LOA and he was posterior.   After taking Brittany‘s course, I realized that’s how he needed to be. Then we worked through labor, worked with my pelvis and him, and got him where he needed to be. So, my first topic of discussion that I would love Brittany to touch on is position of the baby and how yes it matters, but how there is so much that we can work with.   Brittany: Thank you so much. That introduction, oh my gosh. I would love for you to introduce me everywhere I go like that.   Julie: We will come with you.   Meagan: I will totally come with you. If I could be a fly on the wall in your life, that would be a dream come true.   Brittany: My goodness. That was crazy. I want you in my back pocket to boost my self-esteem every day.   Julie: We’re there. We’re there. Just tell us.   Brittany: I am so honored that you feel this way. We have only met in person twice and I am just incredibly honored that you feel that way and that I have had such an impact on your excitement about positioning in the pelvis.   Meagan: But not even just me. You have had an impact on my clients' births.   Brittany: Well that I think is where the real importance of this information comes into play is that once you have these seeds planted, then we go out and share this information. We use it and we share it with providers. We share it with nurses. We share it with clients and then it spreads, and it starts to infiltrate the entire childbearing reproductive care system and hopefully make some serious change.   That’s why, like you were talking about the workshops that I teach-- that’s why I love them so much because even if you have a workshop with 20 or 30 people in it, there’s a potential to impact hundreds of births. I think that’s really amazing.   Oh my gosh. That Evidence Based Birth® conference was incredible. That conference was phenomenal. That room, when you said-- we wouldn’t have been able to do that in COVID. Absolutely. We would not have been able to pack in there if it was COVID time. I am happy that we are able to get that workshop in before COVID.   Meagan: Me too.   Brittany: Yeah, yeah. So, you had mentioned LOA. Let me talk a little bit about that. Maybe I should give a little bit of a background on what I do first. When you introduced me-- I am a pelvic biomechanics educator, a child educator, a birth doula, and when I am talking about pelvic biomechanics, what I am really referring to are the laws that govern the push and pull that occurs within the body to change the bonds of the pelvis and change the space between the bones of the pelvis, particularly during labor and birth. So, that’s what biomechanics are-- these biological laws that govern the effects of movement in the body.   Then, I take these ideas and incorporate them into understanding how we can change space for the baby in the pelvis and encourage a baby to continue to descend and rotate. The goal in everything that I do is, of course, to decrease unnecessary intervention because when we have unnecessary intervention, we tend to have a whole lot more risk than benefit. As anyone knows who does childbirth education and works with pregnant people, it is a constant weighing out of benefit and risk with every choice that is made.   But anyway, that’s really important to me, is decreasing unnecessary intervention. But another really important part of what I do is restoring the autonomy of the birth process back to the person giving birth. It doesn’t matter how that person is giving birth. It doesn’t matter if it is a medicated birth.   Julie: Yeah, absolutely.   Brittany: Well that could be a whole other hour-long podcast. But it doesn’t matter if somebody is birthing with an epidural or without an epidural. They should come out of their experience feeling like they did something amazing. It doesn’t matter if somebody has a Cesarean or a vaginal birth. They should come out of it feeling like they did something awesome rather than feeling like something happened to them.    Yeah, so it makes no difference how someone is giving birth. They should feel like they have done something awesome in that experience. And then, I feel like that then translates into how they parent and how confident they feel moving forward through their entire parenting journey. That impacts the relationships that they have within their family dynamic. I mean, we carry our births with us for the rest of our lives. So, if we can help people to feel more empowered in their experience, that’s a really amazing thing.   So, that’s my goal. A lot of what I do focuses on really two things: the importance of movement in all births and the importance, the opportunity for informed consent and refusal. To actually answer your question or provide some insight into your question about positioning of the baby, I can offer a little bit of background first.   I definitely talk with my clients in pregnancy about the importance of aligning their bodies. So, Meagan, you had mentioned you didn’t sit on the couch your entire pregnancy and for a lot of people, I think particularly people who maybe have had a past certain experience that they want to have differently the next time, they’ll do extreme things like not sit on a couch at all.   What I love to do is offer people modifications for their everyday things that can help them to be better aligned when they are preparing for labor rather than giving someone a to-do and not-to-do list. I try really hard to encourage people to be aware of how they are holding their body and how they are balancing the weight of their body and whether they are getting up to move frequently or getting stuck in positions for a long period of time. The things that I talk about with my clients prenatally to encourage alignment are not geared towards getting a baby positioned a specific way, which kind of ties into what you were saying about, “Oh no. What if my baby is not LOA?”   What the most current anthropological research tells us is that most people have variations of four basic pelvic shapes. What is so interesting is that according to the research that we have, which we could question this research to an extent because, how good could this research be? But, according to the research that we have, about two of the four pelvic shapes-- again, we are thinking about variations of pelvic shape. But, two of the four pelvic shapes actually favor a baby moving into the pelvis in a right side-lying, posterior position. Meaning that, for those people that have pelvic shapes similar to the pelvises that favor those positions, their babies need to be positioned that way in order for them to start their journey descending and rotating through the pelvis. So, when we encourage babies to be positioned one specific way, we discount a significant number of people‘s pelvises that will not favor a baby being positioned a specific way.   Julie: Yes. Well, and I see that so many times where my clients, or maybe they are even looking transverse, but that is just the way that the baby has to enter their specific pelvis shape. And I know that maybe we will touch on this a little bit sooner, but the more we interbreed with each other, the less distinct the pelvis shapes are becoming. So, there are not necessarily four distinct pelvic types anymore, but there are many variations of those.   That is why after Meagan came back and told me all the things that she learned from your workshop, I have been focusing more on helping my clients create space in their pelvis, loosening up those pelvic ligaments, their connective tissues, the tuberosacral ligament or is it sacrotuberal? I don’t remember.   Brittany: Sacrotuberous.   Julie: Yeah, and just creating looseness, and freedom of movement, and flexibility rather than focusing on a specific position for baby to be in. Right?   Brittany: Yeah, yeah. Absolutely. I am a non-clinical provider. I am a doula and a childbirth educator. I don’t do soft tissue releases or things like that. That is not my wheelhouse. Everything that I do in classes and workshops is all non-clinical information, education-based stuff that then people can continue to share. So all of that stuff, that soft tissue release-- that is amazing stuff also. That is complementary to everything that I do and that is definitely something that people should be exploring and seeking out resources for in pregnancy.   A lot of the things that I like to suggest are simple bodily movements or changes in ways that they do everyday things, which I think of more as alignment. I think it is a complement to soft tissue release work, and chiropractic care, and all of that. We want to utilize as many resources available to us as possible so that we can best prepare our bodies to give birth in a way that is healthy, and may be efficient and really positive too.   So yeah, all of that stuff is really important. It is so much less about getting the baby positioned a specific way because no one knows what pelvic shape they have unless they have had x-ray pelvimetry, which most people haven’t. Even if they have had x-ray pelvimetry, it is unlikely that they would have looked at anthropological research to compare that to variations of pelvic shape. I have had experience with clients who have had x-ray pelvimetry in the past and still they don’t know what variation of pelvic shape they have.    My goal is to really take information that is more tangible and usable rather than saying, “Theoretically, I think your pelvis might be like this, so your baby should be like this.” No way. I don’t know what pelvic shape someone has. They don’t know what pelvic shape they have. Their provider does not know what pelvic shape they have. So, rather than focus on getting a baby specifically positioned a certain way, I like to give people the tools to allow their body, like you said, to create space as much as possible, so that then their baby can find the most ideal position to move through the pelvis that the baby is working with.   Meagan: Exactly. I feel like that is so powerful. To me, anyway. I was like, “What? Wait, whoa. Okay, I love it.”   Brittany: Yeah. One thing that is so interesting is that posterior babies get a really bad rap. In the longer workshops that I teach, we go into a lot of the history of this with obstetrical bias and things like that, but I think it’s really important to recognize that as soon as a provider-- and this has to do with really honestly, in my opinion, inadequate training when it comes to understanding bodily mechanics. I’m not saying that for all providers. Many providers seek out this information on their own, but conventional training does not include an anthropological look at pelvic shape or anything. But anyway, I am digressing.   My point was that we have all, especially as birth professionals, probably been in the same situation, or maybe someone as a birthing person has been, where a provider comes in and maybe does an internal exam or does a quick palpation of the belly and they say, “Oh. This baby is posterior. Well, we will give it a little more time and see if we can get the baby to turn.” And what happens then? The energy in the room deflates. I think of that as such loaded words. Like, yeah. Sure. The provider is saying they will give it a bit more time. But really, what the provider is saying is that “I already don’t think you can have a vaginal birth.”   Meagan: Yes, and something is wrong. They are saying, “Oh. Your baby is posterior.”   Julie: And what does that do for hormone levels? Right?   Brittany: Totally.   Julie: Adrenaline levels rise, oxytocin levels crash, and then what happens? A need for interventions like Pitocin to get contractions stronger and all of those things. Oh my gosh, yes.   Brittany: Yep. And then also, that seed is planted in support people that this is not likely to wind up in a vaginal birth and how does that affect the way the support people provide support?   Julie: Because then they try and fix it right?   Brittany: Say that one more time. I didn’t hear you.   Julie: Sorry. Then we try to fix it, so we get our rebozos out and we start doing all these different types of movements that we learn in our doula trainings and everything like that. Our moms are like, “Oh my gosh. I’ve got to do all of this work to get my baby in a better position,” and providers or support people are like, “Okay. Well, something needs to be fixed. Something needs to be fixed,” when it might not necessarily be that something needs to be fixed. It might just be the way that that baby has to move through the pelvis.   Brittany: Yeah, and the focus shifts from being physical and emotional support for the laboring process and, just like you said, focuses on, “Now, we have to fix something. Something is wrong.” For other support people like a partner or a family member that is there, now that seed is planted that this is probably or possibly going to end up in a Cesarean. It is now making that support person “okay” with that idea, which then means they may be less likely to advocate for things like more time.   So, when we have a provider that does not fully understand how babies rotate and descend, why some babies are posterior, and how that is totally okay, and when we have the tools to work with that then it is awesome. When we have a provider that doesn’t have that knowledge, we potentially impact not only the outcome vaginal or cesarean, but we also potentially impact how someone feels about their birth.   We have taken the power away from that laboring person and that is really, I feel like that is really detrimental. I think what we really need to do is continue to restore that power to the laboring person. So, a big part of what I really emphasize is helping people understand not how a baby should or should not be positioned, but instead to understand how they can move their body in a way that works with where their baby is in the pelvis to create space for the baby. Then, trust in that process that the contractions, and the pressure on the pelvic floor, and the movements of the baby are going to work together to help encourage efficient labor progress.   So, yeah. It’s a lot of information.   Meagan: Yes, but powerful. Powerful information. So good.   Julie: Well, and I think if we can change the way we think about birth and think about baby positioning. I think the biggest disrupter of birth is the mindset of the birthing person. If we can just say, “It’s okay. Let’s see how the next couple of hours go because this might just be the way your baby needs to come out.”    If we can set that tone instead of, “Let’s start doing sifting. Shake the apples. This is really fun. It will get you laughing. We can do asymmetrical movements,” although I don’t know if that is good. I still can’t remember which way asymmetrical movements are good for. You know what I mean? If we can step away from fixing things and be like, “Alright, that’s okay. It looks like your baby needs this, this, and that.” If we can change the conversation about that, then it will do so much good for balancing out the hormones that are part of birth.   Brittany: Yeah, and I tell people all of the time that the same positions-- me, personally as a doula, the same positions that I’m going to suggest to work through a potential positioning issue are the things that I’m going to suggest to prevent it in the first place. I don’t have these magic tools to pull out in certain situations. My goal is to help us recognize the wide variation of normal in terms of how babies descend and rotate, and to have a toolbox full of ideas for encouraging that continued descent and rotation and progress.   It’s not so much like, “Let’s have things just keep moving along. Everything is fine. Oh my god, everything is not fine. Now we have to jump in.” It’s more like, “Let’s incorporate movement throughout the entire laboring process so that we can continue to work with descent and rotation.” One of the things, too, that I think is really important-- a lot of times, I’m thinking of a few clients that I have had where they are really into the idea of movement, but they are also like, “I am going to be really tired.” And so, I try to emphasize that when I’m talking about movement, I am not necessarily referring to walking up and down the stairs sideways 20 times, and then doing a whole bunch of lunges, and then doing curb walking. I am not referring to all of those things, although sometimes I am.   Subtle movements during labor   Subtle movements can be really impactful as well. Even something as simple as shifting how far apart the legs are from one another, or standing in a staggered leg position instead of with your feet evenly in line with each other, or something as simple as somebody is sitting in a semi-reclined position with the soles of the feet together, and then sitting in a semi-reclined position with the leg draped over the peanut ball. We can take really simple, subtle little movements and make really big opportunities for descent and rotation.   So, although I do love really big dramatic movements sometimes, I also recognize that labor is exhausting. My goal is not to make people more tired in labor, but instead for them to realize that simple, tiny movements throughout the whole process are what helps to keep things going.   Meagan: Definitely. Just last week, I was at a birth. Second-time mom and starting in a really good position. 3 centimeters, favorable cervix, whatever. She was going in for an induction. The baby was really, really high. She was making progress, but the baby just wasn’t coming down, wasn’t coming down. And so, we started doing these ever so slight movements every five contractions, and seriously, it was dramatic.   Brittany: Yay!   Meagan: The last two positions, the nurses-- in fact, they pulled out their phones and pulled up your Instagram because I was like, “You have to, yeah.” Because they were like, “Where did you learn that?” I was like, “Oh my gosh. I just have to tell you.” I couldn’t even get into it as deep as I wanted to because I needed to respect the space of the room, because she was in labor. She was 10 centimeters.    But anyway, she was hanging out at 9 centimeters. For a second-time birth, you don’t expect to hang out at 9 centimeters, but sometimes that happens. This baby just wasn’t quite low enough and engaged. Anyways, we ended up moving ever so slightly. We did knees together because baby was getting lower, so we were doing both. Alternating, right? Then the last one, I was like, “If you could, even just for three,” I said. “I just want you to lift your foot up and we are just going to do this little lunge thing,” and she was like, “Okay”.   So we did that, and I was like, “Okay. Now I want you to put your knees back together.” She did that and it was two contractions. She was like, “Oh, yeah. He is coming. He is coming!”   Julie: Oh my gosh!   Meagan: I was like, “Boom. Yeah!”   Julie: That’s amazing.   Meagan: The nurses were watching this happen and you could see them. There was one nurse in training. She was like, “I need to learn all of that.” I am like, “Yes, you do.” One nurse was like, “So, is this just a Spinning Babies®?” And I was like, “No. You need to come here. Give me your phone. This is it.”   Julie: You know that is exactly how it went down because I can see Meagan doing that.   Meagan: It is legitimately how it went down. But then they were like, “We can’t let you touch our phone because of COVID.” I’m like, “Okay. Here it is.” I pulled out my phone and I set it aside on the bed as I continued to support. I said, “Go like her right now.”    Seriously, you guys. It was dramatic. Yeah, it took a minute. Because it was seriously like, every five contractions we were changing it up ever so slightly, and then she was like, “Boom. He is coming.” Sure enough, he did. She pushed this cute little baby out so well in such control. Even the doctor was like, “Whoa. This control is incredible.” I think it was just because the baby was set up to come out in the perfect position for that baby.   Brittany: Yeah. It sounds like you did a lot of restoring that power back to the person who was laboring, which gives her that confidence to be like, “Yeah. I can totally birth this baby.”   Meagan: Yeah. She was questioning. She was like, “I don’t think I can do this anymore.” She got an epidural at 8 centimeters last time and I was like, “No. You are doing this and you can do this. It’s amazing, and you are going to do great.”   Julie: That’s awesome.   Meagan: She just kept doing that. And I said, “Okay. We are going to take it one at a time. I don’t want you to think about the next one after this.” It was beautiful and I loved it. I was like, “Yeah. That is Brittany for you.” She was with me.   Brittany: Aw, that’s awesome.   Meagan: I just love you. I love what you were saying. It doesn’t have to be dramatic. It is hard. Labor can be exhausting. Standing up or moving your whole body over to the other side can just seem daunting and so sometimes we are like, “No. I would rather just stay here,” which isn’t bad. It’s not bad.   Brittany: Yeah, absolutely. Right. I mean, it can be something like-- let’s say somebody is in a side-lying position. They could be lying with the peanut ball between their knees and then there are five contractions in that position, and then we take the peanut ball out and they straighten out their top leg. That’s a position change. That makes space in the pelvis. It changes space. It’s not always about creating the space where the baby needs it, although the majority of the time that is what I am thinking about, but it is also just about changing the space in general.   Movement is more important than any specific position. So again, when I am telling people if there is something to allow to guide your labor, movement is so important. It doesn’t have to be crazy movement. It doesn’t have to be remembering all of the specific positions to do at different points depending on where the baby is. It can be as simple as remembering to move.   It doesn’t have to be only in unmedicated births. That is such a myth that is out there. Once someone gets an epidural, they are limited to lying on their back or lying on their side. There are a million things that you can do in the bed. Pretty much any position you can do standing or on the floor, you can modify in some way to do on the bed.   Meagan: Really though, yeah.   Brittany: It is really important to recognize that movement is an optimal part of all births. The reason I say that is because movement helps to encourage progress in labor. This is all research-based. Movement helps to encourage progress in labor. Movement helps with comfort in labor. That’s mainly people that are birthing unmedicated. But comfort in labor, progress in labor, and then also, it helps with oxygenation of the baby. It helps to keep everybody healthy and happy. That is a really important part of it too.   That’s why movement is something that I really feel like clinical providers can, may, should jump on board with because not only is it about progress in labor and comfort, but it’s also about optimizing outcomes for the laboring person and the baby. I think that’s a really important goal for clinical providers is to make sure the process is safe. When we encourage movement, we give the baby more opportunity to make subtle shifts and changes which allows the umbilical cord to move around more freely and helps to oxygenate the baby.   I also love to say this too because I think this is often an overlooked part about the importance of movement, but prenatal education about movement and labor can help support people to be more invested in the process. It gives them something to do as support people. It gives them something they can offer and suggest throughout the process, and it helps support people to feel more useful in labor which is important for them feeling positive about the birth experience. When they are more invested and they feel more positive, then it decreases anxiety and allows for that great hormonal release in labor for the laboring person too.   It’s about everyone in the laboring room. Movement is just such an important part.   Meagan: It really is. When you talk about prenatally too, I feel the familiarity. If they have been in that position before labor has begun, they are more comfortable trying that position in labor.   Julie: It will be something that they go to by default, too. It will be something that they naturally go to.   Meagan: Birth workers out there, if you teach this in your prenatal courses or your meetings and things like that-- I don’t know if you realize that there is so much power behind that because it is going to help that couple. It is going to help that birthing couple to be okay and comfortable in trying new things.   Closed knee pushing   Okay, I am going into the “knees all the way back, spread open-wide in your armpits” thing. We have always seen in all the movies. Literally, where are your knees? When you see someone pushing in Friends or a movie-- I’m thinking of Rachel in Friends. Your feet are up in the sky. Your knees are in your armpits. Your head is trying to touch your belly button. Seriously, this is the position, right? And so, when we are like, “Hey, so I actually need you to close your knees.” They’re like, “What? You want me to do what?”   Then their provider is like, “No, no, no, no. We don’t want to do that. Why would we do that?” But there is so much to it. And so, if you can, educate them before, and show them, and teach them. Do the dot trick from lovely Gina who we just love from mamastefit. Do the dot trick and show them in their prenatals. “Look at what your pelvis is doing,” and they are like, “Oh, okay.”    So, when you are like, “I want you to put your knees together and your feet out,” they are not thinking we are smoking something. They’re like, “Do you want me to keep my baby in or get my baby out?” You’re like, “Actually, we want you to get your baby out. We are going to help you do that by putting your knees together.”   Can we talk a little bit about that too? Maybe segue a little bit into closed knee pushing.   Brittany: Yes, that is one of my favorite topics. I actually did a webinar for ICEA for their virtual conference all on closed knee pushing. It was straight up, a half-hour just on closed knee pushing. It was so awesome.   Closed knee pushing is when we push with the knees closed. Honestly, it is less about the knees being closed, but more about the internal rotation of the thighs that happens when our knees are closer than our hips. This internal thigh rotation actually pulls out on the hips which opens up space side to side at the bottom of the pelvis, or at the pelvic outlet, which is where the baby is coming out. The way that I love to share this with especially pregnant people is to actually think about late pregnancy.   When you are 36, 38, 42 weeks pregnant, you are sitting on your birth ball. Maybe you are sitting on your couch or a chair. You’re sitting with your knees really far apart because that is what feels better. Our bodies are telling us in late pregnancy it feels better to sit with the knees far apart. Internally, what is happening when we sit with our knees far apart is external thigh rotation which opens the top of the pelvis, the inlet of the pelvis, which is what the baby is settling into in the last few weeks, or sometimes the last few days of pregnancy. And so, when we sit in late pregnancy with our knees really wide, not only does it feel better, but also inside, it’s giving the baby space at the top of the pelvis to settle in.   Now, if that is working at the end of pregnancy to help the babies settle into the top of the pelvis, why would we do the same position when the baby is at the bottom of the pelvis? It wouldn’t make sense to do the same thing when we are pushing a baby out versus when we are in late pregnancy encouraging baby to descend into the pelvis.   So, in late pregnancy, our bodies instinctually get into this wide-legged position. But also what I have found, especially when we have been in situations with really supportive providers, is that instinctually, when people are pushing their babies out, they do bring their knees together or they get into an asymmetrical position. People do not typically-- and this is my experience. People do not typically get into really wide-legged positions when they are pushing their babies out. They bring their needs together.    Think about going to the bathroom. The next time you go to the bathroom, you’re sitting on the toilet. Think about how you’re positioning yourself. Probably knees together, maybe a little bit of asymmetry there. You’re just trying to allow that space for your bowel movement to come out. Same thing is happening.   Meagan: It might be the easiest poop you ever took. Just saying.   Julie: Alright, who is going to play around with new positioning next time she is sitting on the toilet? I don’t know about you. I totally am.   Meagan: I’m telling you.   Brittany: It is so important to connect this stuff to everyday life and to what our bodies are instinctually doing because when we do that, it restores that confidence. When we feel more confident then, even though every single image we have ever seen of birth in the movies has the knees far apart, even though a provider is like, “Oh, no. You have got to pull those knees far apart,” what we start to realize is from a biomechanical standpoint, pulling the knees apart actually doesn’t make sense. So, we need to tie this stuff into everyday life and into the end of pregnancy so that we start to see, “Oh. Well actually, our bodies know exactly what to do in labor.” We just have to be willing to tap into that and work with that.   Closed knee pushing is pretty awesome. It is something that you can do no matter what position you are in, whether you are in a standing position or side-lying position. You can even do it in a reclined position, all fours, and it is really instinctual. Again, going back to what I said earlier about how movement is more important than any specific position, I don’t think that we should be in one closed knee position for three hours. Then, it loses its benefit. But when we incorporate that into the different positions that we adapt to during the pushing part of labor, when we recognize that bringing the knees closer together and internally rotating the thighs creates space at the outlet, then we can put that into our toolbox of positions for pushing. Yeah, so closed knee pushing is all the rage right now.   Meagan: It really is. I really have witnessed it for a recent VBAC client of mine. She was pushing great. She was totally pushing great and baby was making good progress. You know how it is natural for them to come back in a little bit and come back out. He stopped coming out further. He would come out, go back in, come out, but never go that one step further. I love this midwife so much. I felt very, very comfortable saying, “Close your knees. Close your knees.” And that baby-- next push, boom. Way further, and then the next push was out.   Julie: Holy cow.   Meagan: It is just so cool to see. That was easy for me as a provider with someone that I had a good relationship with. I work with this midwife often and I could be like, “Close your knees.” But in a hospital setting with many providers and nurses who are unfamiliar, or even birth centers, or just in general, when we are with providers who are unfamiliar with this technique and the reason behind it, what would you say is a way-- because I would love for us-- obviously what you’re doing. You’re getting out there. You’re in the community. You’re educating. It is only going to spread.    But how can we as people and as birth workers try to facilitate this even more in a position where the doctor is like, “Nope. Get those knees opened wide. Butt in the air!” What suggestions or advice would you give? Because as birthing people, we have the right to say, “This isn’t working for me. I want to try this.” But many times, we have a provider say, “Well now, if you really want me to be able to support your perineum and avoid tearing, then you need to be on this back. Or you need to be in this position so I can get to your perineum.” Well, but the thing is, guess what? If I close my knees and open my legs, I am pretty sure you could still get to my perineum if you really wanted to, and I don’t think you need to be up in my perineum. I am just saying here. What would you suggest as birth workers?   Julie: Wait. Can we just wait a minute? Hold on. I think we need to make a shirt that says, “Don’t be all up in my perineum.” For real.   Meagan: I love that.   Brittany: I would wear it. I would wear that shirt.   There are so many things that I want to touch on with what you said there. First, I will start with what you last said and then I will go back to the beginning. In terms of preserving the perineum, which I think is probably a goal for most people that are birthing vaginally, what we actually know about perineal tearing, and increasing or decreasing the likelihood of tearing, is that when the thighs are internally rotated, it actually can decrease the likelihood of tearing because the skin, the perineal area, is not stretched side to side. Instead, it’s given the opportunity to stretch more front to back.    Although many babies do move into the pelvis posteriorly, most babies do wind up eventually rotating around to come out facing backwards. The crown of their head is right underneath the pubic bone there and they are facing backwards, which means the bigger area of their head is front to back, which means the perineum needs to be able to have more give front to back rather than being stretched side to side.   So, when we pull the knees closer together, we actually allow the skin to be stretched less side to side, which gives us the opportunity to stretch more front to back. Closing the knees or internally rotating the thighs helps to decrease the likelihood of tearing as well which is huge for people planning a vaginal birth.   Meagan: It really is.   Brittany: It really is.   Going back to what you said about providers that are maybe not so familiar with the idea or the concept of bringing their knees together for pushing, I think it really comes back to prenatal education. It is not just about educating about the biomechanics, but like you said, it is about educating people about their rights. It’s about educating. If they have a partner or a support person there with them that is not their doula, it’s also important to educate that person because that person is going to become a really big part of the advocacy in the laboring room.   So, when people realize they have the right to birth in whatever position that they choose and when they have the information to understand how to create more space within their pelvises--   Julie: --and have a supportive partner or doula that will advocate for them because when you are in the pushing stage, you are not always able to speak for yourself.   Brittany: Absolutely. If they have somebody else in their court there as well saying, “No, she is comfortable like this,” or, “No, she is not going to get into that position.” That can really help. It also provides a buffer for that laboring person to stay in the zone which is right where they need to be when they are pushing a baby out. I think prenatal education is a really, really important part of that.   Also, this might sound really silly but practice the conversation surrounding informed consent and refusal, and advocacy for your rights. Literally, have practice conversations with partners or with friends about what you would do in that moment. What words are you going to use in that moment? As a birthing person, what words are you going to use in that moment to let your provider know that you are not going to be on your back with your legs hiked far apart, or maybe you’ll be on your back with your legs hiked closer together, or whatever.   But practice those conversations ahead of time because it’s much easier when you have the language easily available than it is in the moment to try to come up with that. I think a lot of people in the moment wind up being in a situation mentally when they’re pushing their baby out where if they are faced with being encouraged to do something that does not feel right to them, they have to choose where they’re going to put their energy. Are they going to put their energy into pushing their baby out or are they going to put their energy into debating with a provider about what they want to do?   Unfortunately, I think that position puts people in a place where they have to focus on pushing their baby out, so they will do what their provider suggests. This is when partner support or friend support, whoever is there in addition to a doula can absolutely step in and be like, “Actually, she has thought a lot about pushing positions and this is how she would like to be.” If a provider is like, “Well, she is going to tear.” “This is how she would like to be.”   Julie: Then let her tear. Let her tear.   Brittany: Right. Yeah. I think prenatal education, practicing how you’re going to actually word things-- and that is a partner activity too, not just the person who is giving birth-- and really being willing to stand up and speak up. But then, a huge part of it too, and this is a given, is to find a provider that you can have open conversations with prenatally and you can really either help them figure out what your priorities are or maybe you have a provider already that is open to pushing positions that are not the stranded beetle position. But finding a provider that truly is on the same page with you and respectful of your rights as a laboring person is really important.   Meagan: Yes. Yeah. In the birth that I was telling you about, the provider was like, “So, I was really trying to get in there to help you support, but if this is the approach you want to take, I mean, I guess we will just sit here and wait.”   Julie: Whoa. Oh my gosh.   Meagan: That made the birthing parent feel like, “Okay. Am I doing this wrong?” I just looked at her and winked and said, “You’ve got this. Keep on going.” Sure enough, she did. But, it is so hard. We fall in love with these providers, but we need them to be there for us 110% until the very end. The very end meaning you are done, six weeks postpartum, plus. To the very end.    As a birthing professional, I feel like we need to educate prenatally and give questions to these parents so they can find the right provider. Obviously, we can’t go and pick them, but if we can get questions. Don’t be scared as a birthing parent to ask questions and say, “This is how I want to do it. Do you support that?” or “Hey, what have you seen in the past? Have you ever seen this happen?” If they are like, “Oh, no. That would never work.” Well then, maybe you’ve got a provider that is maybe not right for you if that is what you’re wanting to do.   Brittany: Right.   Julie: It reminds me of the time I had this provider come into the room and we were trying some less traditional methods to get labor to progress on its own. There were flyers up all over the labor and delivery floor. “This provider has delivered 5000 babies.” “5000 babies” all over the floor. You can’t walk outside the door into the bathroom without getting slapped in the face with this celebratory flyer about this provider delivering 5000 babies.   She walks in the room and she’s like, “I have delivered 5000 babies and I’ve never seen this work before. I’ve never seen this happen,” and I’m like, “Well.” That was my birth trauma provider and the first literal birth obstetric violence I’ve seen. That was that birth. I’m like, “Well, have you ever seen anyone try this before?” and she’s like, “This is ridiculous. This is not going to work.” I am like, “But 5000 babies, huh?” That’s all I could think in my mind.   I feel like it’s easy for providers to get set in their ways and a routine. Ideally, we would like providers to be open and understand that parents can have their intuition and that they can adjust as needed, and they can try different things, but a lot of providers see birth one way and one way only. Whenever anything deviates from that way, it feels uncomfortable for them.   I can relate to that. I have really bad anxiety. Ask Meagan. Anytime we try and do something different than we normally do, I’m like, “No, no, no, no, no. We can’t do it that way because we’ve always done it this way,” and Meagan is like, “Well, let’s just go with the flow on this one.” I’m like, “No, no, no, no, no, no, no.” But, you know what? I can see a provider kind of reacting like that too. And so, figuring out how to overcome those things, like you said, prenatally is really, really important especially when we have providers that have been doing things their way for a really, really long time.   Brittany: Yeah, and I think exactly like you said, providers have been doing something and seen some things work the majority of the time for potentially a really long time. The training that providers are getting is somewhat limited in terms of the different alternatives that are explored. It’s really easy to very, very strongly believe in the way that you were trained and the way that you have practiced for many years. But, I also think there’s a lot of opportunity to plant little seeds.   As a doula, I love to say things like, “Actually, I learned this new technique. Do you think we could give it a try just for maybe a couple of contractions?” And in my experience--   Julie: How does that go?   Brittany: Yeah, a couple of contractions-- actually, Meagan was hinting towards this, the five contraction thing. A couple of contractions is usually all that you need in one position. I developed this rule that I call the Blossoming Bellies 5/4/3 Rule and it is literally like a guideline for movement. Change position every five contractions. Choose one of four basic positions and change them up in three different ways.   When I say to a provider, “I learned this really cool thing. Do you think we could try it just for a couple of contractions?” Usually, they’re like, “Okay, fine. We will give it a try.” And really, all I want is a couple of contractions because then I would want someone to get into a different position anyway. So, I think planting that seed of change for a provider, and then when they see it work-- that’s when now they are going to put it into the next birth that they go to. But if we don’t stand up, and if we don’t offer, and if we don’t suggest and ask, then we lose that opportunity to plant a seed. Even if that provider is not on board with it in that birth, maybe the next time they hear that they’ll be like, “Oh, this is now the second time I am hearing this. Maybe we should just give it a try.”   I have seen that happen with doula colleagues of mine. I have seen things happen where I have suggested something at a birth and there was a hard “no” from the provider and then actually-- a friend of mine who is a doula. We were talking about this birth and she had the same provider there, and that provider suggested that they do the thing that I just suggested a week before that she was like, “No. Absolutely not.”   I am not going to take the credit for that, but I do like to think that maybe a little seed was planted. I think there is opportunity for change especially with providers that are really interested in again helping to restore that power back to the laboring person. When we remind providers how beautiful of a thing that can be for someone to come out of their birth just feeling amazing about it, we can help providers to become excited about what they are doing rather than just feel like they are tired, and that they are exhausted, and they’re on call, which is all true, but they’re also really lucky to be part of such an amazing experience like birth.   Meagan: Absolutely. I love it. Oh, you give me chills. You make me so happy. You make me happy.   Julie: I have a lot of questions, but I’m just going to ask one since we are kind of running short on time. Going back to closed knee pushing, is it closed knee, ankles out? Or does it matter where the ankles are?   Brittany: In order for the thighs to internally rotate, generally the ankles have to come out. The knees come closer than the hips and the ankles come wider than the hips. But, there are different degrees of variation. I would even encourage everybody to experiment with this on themselves. You could just sit in a chair, bring your knees together and get a sense as to where your ankles are, then bring your ankles farther apart and you’ll get a sense of how even more deeply internally rotated the thighs are.   But, you could also have your feet hip-distance apart, your ankles hip-distance apart, and bring your knees together, and we get internal rotation. So, the knees come in closer than the hips and closer than the ankles, and that is what causes that internal thigh rotation. That’s what pulls on the hips and allows for more space side to side at the outlet of the pelvis.   Julie: That’s what I was figuring. I just wanted to double-check because-- and well, now that I am sitting here on my chair-- if you can hear my creaky chair in the background, that’s why. If you move forward and sit on your sitz bones, sitting on the edge, you can feel that even more. Your sitz bones moving around and your pelvis opening and closing as you move your ankles and knees. We can’t really widen your hips on purpose, but you can do those things. You can feel the adjustment just by sitting on your sitz bones. It’s really cool.   Brittany: Yeah, absolutely. It’s a couple of centimeters of space change, but when you’re pushing out a baby’s head, you want every bit of space that you can get.   Julie: Yes. You need it. I had a midwife tell me once at a home birth-- I am like, “What station is baby at?” Because we know that what we need to do with the pelvis depends on where the baby is and I was like, “Is she zero or plus one?” The midwife was like, “Well, it is really only a 1-centimeter difference.” And I’m like, “Okay, so we are generally mid pelvis, right?” She was like, “Yeah, I would say mid pelvis.” I’m like, “Well, centimeters matter.”    Oh my gosh, we should make another shirt. “Centimeters matter.” “Get all up out of my perineum.” But really though, even the smallest amount. That’s why I-- sorry, I am just connecting all the dots right now in my mind.   When you’re talking about-- it doesn’t matter what kind of movement, just move. That movement creates those little shifts that help the baby move because the baby is working with your body, and as your body and baby work together, those little minute spaces of movement can make the biggest difference in how the baby descends.   Brittany: Yeah, absolutely. Absolutely. Generally, we think of it as pelvic inlet, mid pelvis, and pelvic outlet. Providers can’t always tell exactly what centimeter station the baby is at, but I think it is really important also, especially like you were mentioning in a home birth, that as birth support people, we are able to watch someone laboring, observe someone laboring and recognize where they might be. When you even just said that you said to the midwife, “Is the baby at a zero, or a plus one?” you already knew that baby was at mid pelvis, probably by what you were seeing. Then, we can use that information from an internal exam to further hone in on what positions we may suggest.   I hate to overwhelm people too with all these specific positions that are great at certain points. I don’t like to set people up to think that they could do anything “wrong” in labor. I always like to tell people the first level is just recognizing that movement is really important. The next level would be getting comfortable and familiar with different movements that help when the baby is at different stations.   But really again, even if that feels like way too much to remember, especially as a partner, or a friend, or something supporting someone labor, just remember movement because even the process of getting out of one position and into another-- it’s just like you said. Creating these incremental space changes that give the baby more wiggle room.   Meagan: Absolutely.   Julie: We don’t have to over-complicate it, just like you said, because I am the one that would get overwhelmed. Like Meagan said earlier, she did not sit down at all during her pregnancy. I feel like that in some sense was a certain type of overwhelm, right? And so, if you just say, “Hey, just move, and if you are pushing and it’s not going well, try putting your knees together.” Tada! That’s all you’ve got to remember. I feel like those two things alone can make big shifts in a labor that is not progressing as you normally would like to see it progress.   Brittany: Yeah, definitely. And remember not to stay in any position for too long. I think that’s another thing. I think too, just along the lines like you were saying, getting overwhelmed with things. Sometimes we also get so set on specific things, like how great the all-fours position is, and the all-fours position is great, but not if you’re in it for three hours.   Meagan: Exactly.   Brittany: It is so much about remembering that we don’t want to get hung up on one thing. Labor requires so many different variations, and different suggestions, and a lot of intuitive listening to what the body needs if that is possible-- particularly, like again, an unmedicated birth. But then, if somebody is birthing medicated, we can take those same principles or concepts and apply them to medicated birth too. Again, it doesn’t have to be something that is just for unmedicated labors.   Meagan: Absolutely. We talked about it a little bit earlier, with an epidural. I have actually had a mom squat her baby, deliver squatting with an epidural. We put a rebozo underneath her thighs to hold her up and give her some support and then gave her a squatting bar. Remember, if you are birthing with an epidural, you really, really are not limited to just side, side, back. You are really not. It might take some effort from your support people, but it is okay. You can do it.   Brittany: Yeah. On the other end of the spectrum too, if somebody is birthing without an epidural, side-lying positions can be really awesome for them too, just like they could be for someone with an epidural. I wouldn’t want people to think like, “Well, if I am committed to giving birth without an epidural, I also have to be committed to being upright and in a million different positions.” Upright positions are awesome. I am a big fan of upright positions. But also, sometimes at the end of labor, people need to rest in between pushing contractions.   Meagan: Yes.   Brittany: We can take some of the things that we do with people who have epidurals and also apply that to people who are birthing without epidurals, but remembering the dynamics piece of it, which is how we allow the body to shift and move so that we can create the space where the baby needs it.   5/4/3 Rule of Movement   Meagan: Definitely. So, I know we are running out of time. I have a really quick question for you. I was at a birth one time and the birthing parent kept going to her hands and knees all the time. Her knees were bruised. She would not get off her hands and knees no matter what. Anything we did-- I was like, “Let’s do this. Let’s do that.” She would not get off her hands and knees.    The midwife was like, “I don’t know what it is,” and she is a first-time mom. “I don’t know what it is with first-time moms.” She was like, “But I see this pattern.” She was like, “I see that everyone always goes to their hands and knees.”    Do you think because this is instinctually what our bodies are telling us to do and our babies are speaking to us and saying, “Hey, mom. You need to get on your hands and knees position to help me come down,” or do you think this is something-- because again, it’s more like the movies where you see people laboring on their hands and knees. Do you feel like hands and knees during the entire course of labor is effective? Even slight movement with hip to hip-- do you feel like it should be more? I don’t know. What do you think about hands and knees all the time?   Brittany: That’s a really good question. The first part of your question was, why do I think people tend to assume that position? I think that position, first of all, from an emotional standpoint, you’re focusing on just what is directly in front of you, so it gets rid of all that stimulation that is happening around you. I think it can help people stay in the zone. I also think that it tends to take some pressure off the low back, which most people, even if the baby is not posterior, or there are not tight uterosacral ligaments, people still tend to feel some pressure in their back with contractions. So, that can decrease that pressure.   Also, it may, because it is not a direct upright position, it may decrease the intensity of pelvic floor sensation too. So, I think it can be a little bit of a protective position, but it is also a really great position for progress because it still allows for a little bit of gravity. It still opens up space in the pelvis. Although it may be a protective position in terms of allowing someone to manage sensations more easily, I think it’s also a really great progressive position too.   But, I think you’ll know my answer to the second part which is, what about people staying in that position the whole time they’re in labor? I would say no.   Meagan: Move, yeah. No.   Brittany: Move. But here’s the thing. So, let’s say someone loves that position. Well, if they’re getting up to go to the bathroom once every hour, then there is a movement. That’s great. Then they can go back into their all-fours position. But also, if we remember-- and you hinted at this with the swing of the hips. If we remember that there’s a million different positions within that all fours position, that’s really important.   For example, when I was talking about the 5/4/3 rule with the four basic positions that I use as my starting points-- there is standing, seated, all fours, and reclined. The three variations that we suggest for those for basic positions are thigh rotation and how we rock the lower back, whether we do sacral nutation or counternutation, iliac nutation or counternutation-- basically like pelvic tilts-- and then also whether we are creating asymmetry.   So, if we have this all-fours position, and we cycle through different degrees of variation within those three things-- the thigh rotation, the pelvic tilt in the asymmetry-- we can still stay in all fours, and changeup that position every five contractions, and do a modification of all fours, and then remember to get up once every hour and go to the bathroom.    And then, if that’s the position the person wants to stay in, great. But they are not staying in a stagnant all fours the entire time. They are still changing it up, staggering their legs, bringing their knees farther apart, bringing them closer together, elevating one leg up on a yoga block, elevating one leg up more dramatically on a peanut ball, putting your upper body at a 45-degree angle then doing a flat tabletop back, rocking the lower back to do some pelvic tilts. We’ve done all those things for five contractions. It’s definitely time to get up and use the bathroom now, and then you can come back in that position and do it all again.   Don’t forget to pee!   Meagan: Yes, and the bathroom. While we were chatting, I was like, “Oh. The ‘use the bathroom’ thing.” It just gets me. It is such a perfect thing because one, it is good to empty our bladder and we sometimes forget about it. Two, it changes things up, really gets our pelvis moving and changing. It opens with gravity as we are sitting on the toilet, which, I like to sit on the toilet backwards when I’m in the bathroom even though people think that is kind of crazy, but it is really good.   But, yes. Don’t forget to go to the bathroom and I love the “every hour.” Just try. Yeah, you may not have been drinking a lot, but you may have had IV fluids or your body is making urine. So, don’t forget to pee.   Brittany: That needs to be a T-shirt too. “Your body is making urine. Don’t forget to pee.”   Julie: A doula shirt! “Don’t forget to pee.” There are so many benefits though because an empty bladder helps baby descend properly too because the bladder is underneath the baby’s head. I tell my clients that every time a nurse asks if they can check your cervix, then just ask if you can go pee first because then it gets you up and moving. It gets you on the toilet which helps open up the pelvis. It empties your bladder and it gives you a little more time, right? Just a little more time. But, still. I am going to make a shirt. Oh my gosh, I have got to make a list.   “Do you have to pee? Don’t forget to pee!”   Meagan: I keep referencing back to this awesome birth because it was literally a week ago, but that was something that happened. She hadn’t peed in forever. I had been with her for 4.5 hours at this point and she had not peed. We are looking at this 9 centimeters thing, right? We are sitting here at 9 centimeters. We are working on things. I had her pee, but she couldn’t. She couldn’t pee because the baby was blocking things a little bit. Then the providers were like, “She doesn’t need anything. She hasn’t even gotten that many fluids.” I’m like, “Yeah, but she has been drinking.” Anyway, she was like, “I don’t really feel like I have to pee.” I’m like, “That doesn’t mean you don’t have to.”    So, anyway. We talked about straight cath. She was unmedicated, and so that can be sometimes uncomfortable, but you should have seen the amount of pee that came out of this straight rubber red cath. I do think that had a lot to do with helping as well because it created space for the baby in there in a different way.   That is an option if you can’t pee and you haven’t peed for a while and you are unmedicated, because usually if you are medicated, you’ve got a catheter and it’s easy peasy. But, it’s okay. I asked her, “So, how was that?” She was like, “That was nothing. That was nothing.”   Don’t be scared of that. The providers were like, “We don’t want to put her through that” and she was like, “No. I am glad we did.” So, know that that is an option if you feel like you cannot go to the bathroom because your baby is blocking or too low in that sense. You can do that and it did. It worked and it helped.   Baby Got VBAC   Meagan: There is something that can’t go untold about you. It’s a really exciting thing. It’s really exciting, and guess what? It is November 30th as of this day. By the time this is being released soon, this is already going to happen. Brittany actually has a chapter-- is it a chapter technically that you have written?-- in a book that is getting released in December. I’m so excited about this. Do you want to talk a little bit about that and maybe tell them where they can find it?   Brittany: Yeah, sure. Absolutely. I am really honored to be a part of this book. It is a multi-author book. Each chapter is written by somebody different. The book focuses specifically on VBAC and inspiring stories, confidence-building stories, and also tips, and techniques, and suggestions, and insights from birth professionals to help people feel really empowered in moving forward with a VBAC or also feel empowered by a repeat Cesarean birth.   It’s called Baby Got VBAC and I do have a chapter in the book. My chapter is on pelvic dynamics because it is a really important part of labor progress which can help to decrease the need for intervention. My chapter is all about the importance of movement, but also, it is filled with some anecdotal stories that I have gotten permission to share from clients whose births I have attended, and just an insight into my perspective on birth and movement, and birth, and empowering birth experiences. I even get into a little bit of informed consent because that is another really important part of what I do. So, it is really awesome. It is coming out mid-December.   It is called Baby Got VBAC. The link to purchase it will be available on my website, which is at blossomingbelliesbirth.com. It will be available on Amazon for only one dollar for the first 30 days or so. It will be a digital download that you can put on your Kindle, or whatever you use to read stuff on your phone, or whatever. So very limited time, it will be available for one dollar and then after that, it will be available on the website at regular price and we will have print additions coming out as well. We are looking at mid-December for that to be released. You’ll be able to find a link to that on my website.   I am really excited to share that platform with expectant parents, not expectant parents, although expectant parents can read it, but people who have given birth, parents sharing their stories, which I think is really awesome, but also I think what makes this book really unique is that it incorporates stories from birth professionals too, including clinical providers also. It is a really interesting mix of empowering stories coming from a lot of different areas. It is intended for birth professionals to read. It is intended for expectant parents, and I think also, even people who are maybe done having children may still find the book to be really fun and inspiring. So, yeah. Baby Got VBAC coming out in mid-December.   Meagan: Yay!   Julie: That is so exciting. By the time this episode airs, it will be-- let me look at my schedule, February. It is live now! Go buy it.   Brittany: Thank you.   Meagan: I want you to put a pause on this episode right now, but don’t forget to come back and listen. I want you to go to Instagram and go to @blossomingbelliesbirth  and you will see her Instagram. Trust me, you want to go join it. Girl, you do so many things. You do webinars and trainings, and just so much stuff that is so awesome. So, go check her out. Don’t miss what she has got going on, because it’s amazing.   Free birth webinars   Brittany: Thank you. Just to let people know, that although a lot of the services that I offer are services that people pay for, I do also think it is so important for people to have access to free, usable information. There are also one-hour webinars available on the website that are totally free. Physical and postpartum recovery from both vaginal and Cesarean birth, prenatal nutrition, pregnancy Q&A, pumping and storing human milk-- all sorts of options on there for free, one-hour webinars too. I don’t think people should be limited to having money to get information. I think it should be accessible to everyone.   Julie: I’m so glad you said that because we agree, too. That’s why we have this podcast. We have our blogs so people can find a lot of information for free, but we also have our paid course, which is like the deluxe, more in-depth. You don’t have to go searching all of our podcasts and websites for information. It’s all right there in a condensed version for you with lots more, really cool stuff to do. Yes. I love that. I love that you offer that. Meagan, we should do a one-hour webinar on our website.   Meagan: You are inspiring us in all the ways.   Brittany: Oh good! I am so glad. That is awesome.   Meagan: Yes. You know, I haven’t really ever done a webinar, but y’all are doing it. Gina does it too. I am late. Maybe we need to do a webinar.   Julie: We have done webinars. It’s just Facebook Live or Zoom.   Meagan: Yeah, Facebook Lives. I guess that is true. But Brittany is there anything you would like to add that we-- I mean, I’m sure there is tons of stuff that you could add.   Brittany: Oh my gosh, right? Do we have another 10 hours? No, I mean, just maybe in parting, I would encourage people to remember that this is your birth experience and it is something that you carry with you for the rest of your life. Your provider may or may not remember your birth a week from now or a year from now, but you carry that experience with you every day moving forward.    Do the research. Get the education. Get comfortable using your voice. Really expect the same respect that you would in any other aspect of your life in birth. I feel like birth is one of those times where for some reason we may allow ourselves to be treated in a way that we wouldn’t in other aspects of our lives, and recognizing that it is a client and professional relationship. You are paying somebody to be there with you. You have every right to use your voice, and speak up, and make your wishes heard and respected. I think that’s everything.   Meagan: Thank you so much. Julie, is there anything you want to say?   Julie: Amen. And find our T-shirt shop, thevbaclink.com/bonfire because there will be additions.   Meagan: There will be additional T-shirts. She is probably really not kidding because she loves T-shirts.   Julie: No, I am not kidding. Creating and designing things and so, when we get inspired, let’s do it.   Meagan: Right? We should do another T-shirt that says, “Closed knees, say what?”   Julie: Okay, hold on. Hold on. I have got to add it to my list. I really have a list going on. Oh my gosh. Yes, this will be fun.   Meagan: Thank you so much, seriously.   Brittany: Thank you for having me. This has been super fun and it has been an honor to be here.   Meagan: Well, it is an honor to have you here. Like I said, I just adore you and love you, and I am always scrolling your Instagram. I can’t wait to read that book. I can’t wait. I will definitely be picking it up for a dollar, that’s for sure. I would pay more than a dollar too.   Julie: Well, thank you so much.   Brittany: Thank you very much, guys.   Closing   Would you like to be a guest on the podcast? Head over to thevbaclink.com/share and submit your story. For all things VBAC, including online and in-person VBAC classes, The VBAC Link blog, and Julie and Meagan’s bios, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.   Support this podcast at — https://redcircle.com/the-vbac-link/donations Advertising Inquiries: https://redcircle.com/brands