Hey, Hillary, how are you today? Good. I'm so excited to talk about this. This is one of my favorite things. Yeah. Yeah. I'm, I'm super excited about it too. So I'm really appreciative. Like I've done, I had a birth with an epidural. I had a birth where like I planned to get the epidural, but also we got there about 40 minutes before the baby came, so that just like didn't happen. And then after. I had a birth where like I planned to, like I did, you know, make it through without getting an epidural. Like that was the plan. And then the fourth one, like I also planned not to get the epidural and I started freaking out and like begging for one. But by that time, obviously it was transition and like that one also didn't so. three out of four of my kids were born without an epidural, but it was still like very different each time. So I would love to hear tips from an actual labor and delivery nurse about if that's something you wanna do to go unmedicated, how you go about that. Yeah, there are a lot of good tips, but I have to caution people that the number one tip is to not be in labor very long. And there. All that much you can do about that. Because if you need to be induced at 37 weeks and it's a two day induction you know, the chances of you going natural are pretty slow. So, and also if you were just like a slow laborer, like some people just labor a really long time. So I see people on social media saying, this is the reason I didn't end up with an epidural. And I'm like, no, girl. The reason you didn't end up with an epidural is your labor was five hours. Like, that's very different than somebody who labors for 24. That just is, yeah. Yeah, that's true. Yeah. I think my second one was like three hours, so I could totally see that. Yeah. So beyond the, the things that you can have some control over, which is all we can do, which obviously the first one is to take a prenatal class so that you know what to expect and all these different kinds of things. I would love it if people join me in mine, the online prenatal, classwork, couples. But the first one is to wait to go to the hospital. I think. Think of the hospital as a safe place, you know that they and their baby are gonna be safer. And I'm actually not a hundred percent sure that that's true because in early labor the studies have shown that all that monitoring that we do for. All the time. Once you come into the hospital, it doesn't really improve outcomes all that much in the beginning of labor. Of course, a lot of people come to the hospital cuz they want pain management and that is a whole different bag of chips. But if you're looking to avoid an epidural, you're gonna wanna wait and you're gonna wanna have a conversation with your provider about they when they really think that you need to come to the hospital. That makes sense. So, you know, again, like I said, every labor was different. So my fourth child, I got up at like two in the morning with like real contractions, you know, like I said, I did this three times before, so I was like, these are real contractions. So like I got my husband up. We got the other three kids, God bless my in-laws, you know, we got the other three kids and bundled them up and took them to my in-laws who they were just like on the way to the hospital and they were literally like maybe five minutes away from the hospital. So we took them over there, got them back in bed at my in-laws place and then I just like hung out for a little while. Cuz like you said, you don't need to get there like immediately. And as I hung. My contractions got less intense and spaced out and just stopped. And it was very frustrating. So like we called the hospital and we were like, Hey, so this is what's happening. And I, they were like, well just come anyways. So we came in. and they hooked me up to like the monitor. I was exhausted, you know, cuz like I didn't sleep all night cuz I was like laboring. Right? Yeah. And they don't let you eat at the hospital and they have you hooked up to this thing for a while and anyways, I was like sleepy and hungry and mad But the doctor eventually he came in. and he was like, well, you know, it looks like it did stop. And he, you mentioned about having a plan and talking to your provider. I had a birth plan I had given him and he was like, you said you wanted to go natural, so why don't you just go home? And so he let me go home. I got to have my food, have a nap. And then like I said, you know, once I went back in there, I think that one was like 17 minutes from when we hit the door to when the child was born, It was intense. Yeah. And a lot of people have that fear of a quick delivery. It's unlikely on your first, they get more likely as you roll along, but some people do have quick deliveries. The good news is if you do have a quick delivery in general, they're very safe. This is what I tell myself when a doctor's not there and we're delivering the baby for them. But it's also important to know that if you call the hospital, they're gonna give you the same response that they gave you. Well come in because there's so much liability for the hospital for just like, just stay at home girl. You got this. Like, if you just called Hillary, Hillary, your friend, like I can tell if people are on. over the phone pretty much. Yeah. And I'll, I give that advice to my actual friends who I'm, I'm hopeful they won't sue me, but I'll be like, you really sound like you're not in labor yet, so I know you're miserable. Just keep being miserable at home where you have brownies and your bed and shower, all the things that you love. Yes. Yes, keep doing that because it's so much more comfortable to labor at home than it is at the hospital. But, and anytime you go to sleep, you know, they come like you're supposed to do, like you come in every 20 minutes to check on us and check a monitor and all that. Yeah, yeah. But I'm saying, you know, once you hit active labor, when they think you should go, then you should go to the hospital because you really don't wanna deliver your baby in your. That's true. Yeah. I don't know how a car comes back from that. That's all I ever think. Love it. Yeah. And I think it's really important to have that conversation with your provider because I worked at one hospital that was really close to a very popular mall and a downtown district. Like I don't. When they put the hospital there, obviously none of that was there, but it was difficult to get to at certain times of the day. And so the provider needed to have a conversation about traffic times in addition to Like when your contractions are three to five minutes, you know that kind of a thing too. Or if you live in a very rural and you have to drive an hour into the hospital, yes. Then you're gonna need to have that conversation with your provider. So everybody online is like, oh, I have the perfect equation as to when you should come into the hospital. And there are great guidelines for that that you can discuss with your provider. But you also need to have, you know, the hospital parking conversation because some hospitals, it's. unbearable to even find a spot or are you gonna valet are like, you know, there's all these different kinds of things that your provider needs to come to you with your specific needs and circumstances and say, this is probably the time you wanna show up to the hospital. So that's my best advice. And you probably wanna do the thing where like they show you the hospital beforehand and show you the layout so like you know where to go. Although since Covid, a lot of hospitals have stopped doing tours, which is kind of dumb. Oh yeah. So the fourth one was born in January of 2020, so right before it all changed. So thank you for updating that for me. Yeah. So, but either way you can always ask the hospital, you can call the, the unit. We want you to know where to park. We don't want people having their baby in their car because they literally couldn't find a parking spot. Like, that would be the worst for me. Or like in the hallway, you're, yeah, no, none of that So, you know, and at some hospitals you show up to the emergency room, some hospitals you throw up, show up directly to labor and delivery. You have to be aware that every unit has these differences and you should discuss it with your provider and write it down and discuss it with. Your partner because you know, he's gonna think, well, we should just go to labor and delivery. And even though your doctor has said, please show up to the emergency room. Ooh. So that they can get you directly to, you know, some who knows, some labor and delivery units have locked units and so they have to have an RN to get them into the locked unit. You just have to talk with your provider. So yeah, that's my number one advice. Wait to come in, but also don't wait too long. Right. Maybe even like, let. Partner, be the one having that part of the conversation, because that's probably not gonna be at the forefront of your mind, like when you're in labor, right? No. They should be the one that's remembering that kind of stuff. Yes. Or you got it written down in your phone and it's like a notes app that you're sharing with them. Yes. Okay, so my number two is to move when you're at home, move when you're in the hospital also. But movement is so important and the real bummer is that when we're in pain, like when I have kidney stones, I'm not like, you know, I would love to do jumping jacks right now, right? Mm-hmm. no. I'm like curled up in a ball, sometimes vomiting, just, I don't wanna move at all. I don't, I'm like breathing very shallowly cuz I don't want them breathing to affect it. Like it is not our natural instinct to be like, let's move while we're in pain. That sounds like fun. So it isn't our natural instinct, which is why I always, in my prenatal class, I encourage partners to every 30 minutes encourage their laboring person to move. So that means except unless they're asleep. So if you're asleep, don't wake you up. But if you're actually asleep, not like resting your eyes, like my mom used to always say So, If you're, if you're awake, try and move positions every 30 minutes. And I'm not saying that you need to like, you know, go into a fully different position. It literally could just be turning on your side or if you're pretty darn uncomfortable shifting your hips in some way because that's gonna help the baby find their best way out. Cuz at some point they gotta spiral down into your pelvis and vacate the premises. Yeah, I had, so the third one, like I said, that was actually my longest labor, which is weird and different. My third one had his head like tucked behind my left hip weirdly. So I was laying on, I think I was on my side, you know, cause I had heard side lying is really good for like trying to stay unmedicated and I was pretty comfortable and stuff. And I had a younger, like a resident doctor who was kind of keeping tabs on me and he was at the point where he was like, I don't know why this isn't happening. Cause you've been here for a while. So he got an ultrasound. and he was like, I can't find the baby's head. And I was like, it has to have it So a more experienced nurse, you know, who actually she used to work at, like a birth center that was more, you know, natural and stuff before they shut it down, came in and found, you know, like I said, baby's head was like stuck there at my hip bone. So she had me get up on like my knees, like stand on my knees and I felt that, I felt that kid turn and. Lock in the right way and then like 10 minutes later he was out. So somebody, yeah. But it's, it's so important and it's so not natural, so that just sucks. Yes. And especially, you know, cuz. I, because y'all mostly see people getting epidurals, right? Like that's what most people choose, which is fine. It depends on the hospital. My first hospital, because it was a lot of Hispanic, younger Hispanics that were getting pregnant no, like 50%. So when I started labor and delivery, most of my patients did not get an epidural. So, oh, it just really depends. Yeah. So some places it's like that. Some places it's very rare. Like it just depends on where you are, like you said. But you know, you're, it kind of feels like. you're sort of stuck to the bed. Like if you're, if you're on all those machines and stuff and strapped down, it's harder to get to move because like you're stuck there. Which again is why you said wait till later. Yes. To go to the hospital. Yeah. But I, I wanna encourage people. So first off, there are wireless monitors, but I don't Oh, cool. I don't love to get people's hopes up for the wireless monitors because just the, like, it depends on the hospital. Bluetooth headphones, sometimes they don't connect. Sometimes they're real staticy. Sometimes it just doesn't work and we can troubleshoot, like, all the things, but we all know that sometimes you have that device that you're like, well, this is just not happening today. You know? Yeah. Like us trying to get on Zoom earlier. yes. Yes. But also I think people, I think, first off, I think people really like to be in the bed. I, I know everybody likes to be on social media and be like, they chained me to that bed, but I'm the one that's like, Hey, can we get up? Do you wanna sit at the bedside? How if we, how if we bring the doctor's stool over. and they're like, oh, like the exercise, I'm really like laying down, roll the ground on. Yeah. So I could see, you know, I, I like my bed too. I, I'm not against beds, but there are, even with the wired monitors, cuz they make'em with pretty long cords. Mm-hmm. you can stand at the bedside. You, I love using the doctor stool. I like it better than the birthing balls because I, I feel like the hospital birthing balls are always so short. If you had a great, nice, tall, but I swear either we don't pump ours up enough or whatever. Nobody's super uncomfortable when you're like in a full squat. It just makes it hard and it's hard to get up, especially if you're in pain. So I love using the doctor's stool which is like a rolly, a rolly stool that you can use very similarly at the bedside. Oh, you can even just sit in the chair. You can lunge at the bedside. You can. Stretch your body at the bedside. You can go on hands and knees at the bedside. Now, this isn't to say that your baby can be monitored in all of those positions, cuz that really depends on where your baby's at and your body type and all these stupid different things. But they're, you can. You know, if I couldn't get it one way, I always had an idea of one way, another way that I could get the baby on the monitor. Like nurses are idea people, but we also really wanna keep eyes on that baby cuz you know, we love our license. Yeah, and once again it's, that's one of the nice things about having someone with 20 years of experience is you know how to find the baby. Cuz you've had to in all sorts of different. Yeah, you know, and you can also offer to hold the monitor cuz sometimes if you're in a certain position, we have to hold the monitor a certain way and the nurse may have two patients and I can't, I can't literally hold the monitor. So if you offer or your partner offers, Hey, we are happy to push on the monitor to get this baby on. We can hear it when the baby's on the monitor. It's not like you have to have an RN degree to hold the monitor. The, the thing on the monitor, and I can tell if it comes off cuz we can see the monitors in all the different rooms. So you can say, you know, I'm happy to hold the monitor. You don't have to stand here and hold the monitor. Or I'm gonna make my husband hold the monitor cuz he's doing nothing over there. Cause I will, I love this position. Right, right. And that can help out as well. And it gives your partner something to do cuz a lot of times they're bored and. Feel uninvolved, and if you can get'em involved and if they're closer to you, it might help your oxytocin flow. Who knows? Yeah. But I love getting partners involved. Either board or like what do I do? Like? Yes. Any number of. Feelings Yeah. So, and then my third tip is to pick the right doctor and the right hospital, because some doctors everybody gets an epidural, everybody delivers on their back. Everybody, like, they just have, this is the way things happen and. You, you know, I would just make your first appointment with somebody that somebody recommends, but at that appointment, you can ask'em what percentage of your patients do you think get an epidural if you're considering not getting an epidural? And you can continue to have this conversation with them, you know, into your, through your second trimester. But once you start into your third trimester, you really need to lock down a doctor because it's hard to change doctors once you hit about 30 weeks. So I have a question about that. With where I went, I think. all of them really. It was like we're gonna introduce you to all the doctors and whoever happens to be on call. When you go into labor, that's who you get. Sorry. So like two of'em, honest to goodness, I don't even know if I had met them. Like these people that I'd never met before came in and delivered my baby. So, what about that? So usually doctors have somebody, their group tends to have a similar approach to things. Now that is not always the case. And if you, you're in a big enough group, they usually don't even care because, you know, they're only taking call like three times a. So they're not like, I need you to have your baby by 8:00 AM because I have office hours. Because they're just like there. So it really depends on how doctors take call. Very rare. We're gonna find Dr. Brown, who is his own doctor. He does all of his deliveries unless he's on vacation, and then he gets Dr. Smith to cover him. Right. The, that just, it's just not the standard of care anymore. Like it was probably when I had my first baby in the two thousands. It's e it was even starting to shift back then because doctors need to have lives, Yes. They, they do. They, a lot of them are females, so they're having babies of their own. They want to be to the school plays they want, and we want them to have that. We want doctors that have a life that care about things that, all those different kinds of things. So of course most doctors are turning into larger practices where they, they just don't care as much because they're seeing a wired, a variety of patients, and they're just on call for 24 hours. They're just like, I'm here to do whatever happens in the next 24 hours and then I'm going home. You. Okay, so if you end up with another doctor, A, you've probably already met them anyways. It was just kind of weird for me. I think it is weird. Okay. But also, did you see that doctor for very long? Really? It's your labor message. No, I didn't like so much. She, like I said, I had the resident who, of course I hadn't met the resident before, like the resident hung with me like the whole time until like I was pushing and the nurse was like, stop pushing, we gotta go get the doctor. And I just yelled no at her it's like, That's not possible. Well, what is the resident, it says behind their name, doctor Right? Well, he, under their name, he didn't count anymore. I guess they wanted like the grown up doctor, I guess. The real doctor, yeah. Yes. Anyways, the whoever was in charge and more experienced ob like, came in literally like delivered the baby. and the next day came in, you know how they come in like the very next day and talk to you about birth control. She had that conversation with me and that was all that I ever saw her. Yeah. So I mean, if you didn't have the resident, you might have seen'em a little bit more, but really you don't see them. The thing is, is you know, those doctors who want everyone to have an epidural, want everyone to do X, Y, Z tend to deliver at hospitals that they understand their routine, and that's kind of how the hospital does it. So I know that when I see a doc, a patient of Dr. X, Y, Z, that most likely they're going to go. They're gonna want an epidural. They're gonna come in in early labor. He's gonna try and do some at 39 weeks. I just know because I know this doctor, like, so then when they have a patient that come in that doesn't want an epidural, I'm like, I'm so sorry. Who was your doctor again? like, I'm like, Did I hear it wrong? Cuz you all are not matching. I mean, every once in a while it happens. But picking the doctor and then also picking the hospital because some hospitals are just more like the one I delivered at most recently. They have the jet, the jetted tubs. So usually if they're having jetted tubs, they have special lighting, stuff like that, they're usually a little bit more accommodating to patients who want to deliver natural versus Right? Because if you're gonna put in the effort to do all that, then clearly that's something you're trying to go for. Yeah. And if you have a friend who delivered naturally, you could ask'em what hospital they delivered at. And there's a good number of people who pick their doctor baked based on the hospital that they go to. Because you have to remember that not every doctor goes to every hospital in a major metropolitan area. They usually pick one or two that they deliver at. Okay. And even so, if you're in a rural area where it's like, this is the hospital we have. Then you're gonna deliver at that hospital. Yes. And just have the conversation with your provider beforehand. Like communication, I think is probably the biggest thing here. It seems like. Yes. Bringing it up early. You know, I'm planning on not having an epidural. I'm adamant that I like because. I would say that a good number of people come in saying, I don't think I want an epidural. And like when I survey my course members at the beginning of my course, the majority say they don't plan on having an epidural. And I'm like, that's awesome. We have a natural birth management thing, and then the majority end up getting an epidural. Yeah. And there's no shame in that, like, no. So that's fine. You kind of have to know like how adamant you are. Cuz I think a lot of people are like, well, I'm just gonna see how I take the pain, but I'd rather not get an epidural if I don't need one. I think that's what most, you're pretty much definitely, yeah. In that case, yeah. Versus. You know, and if those people come in and they have their baby in four hours, then there's a good chance they're not gonna need an epidural. They just won't have time to get one. That's true. Versus the gal who is miserable for 24 hours has been contracting for a day and a half at home, comes in as just bone tired. Oh yeah. You know, she's gonna be like, yeah, I'm gonna want that. Right. Yeah. So, yeah, absolutely. Unless, you know, she's just like adamant that she doesn't want the epidural. I think that's something you want to tell your provider that you're at like level 10, don't want an epi. Right. That's something to be really honest, instead of just like, I don't think I want an epidural because that's what most people say and we, that doesn't really convey the fact that you are like dead dissected. You don't want an epidural. That isn't to me that you aren't gonna get an epidural or want an epidural when you're in labor. Just what you're thinking at that point in time, be very communicative about that. And you mentioned movement earlier and you kind of like alluded to breathing. I think that's the biggest, like especially. For me with the third and fourth kids, like take, you talked about taking really shallow breaths if it's hard, but if you will take deep breaths like, you know, deep inhale, hold it for a little bit and then blow out through your mouth. Yeah, like, and you can do like counting, breathing, where you breathe in four and you breathe out five. And personally I think it's all about concentrating on something else that's not the contraction. You can do like where you take short breaths in and then you blow out all at once or you can do five breaths out. And so I really think that most of that is about concentrating on something else and also getting oxygenated, which is so important because. We need our oxygen to survive, and it just helps, you know, try and clench your lady parts while you're doing really deep breathing. That's hard. It takes a lot of effort, right? So if you'll relax, breathing, that's it. Breathing helps you relax. And mentally too, because I found with my second one, Like I said, that was the one, that was the first one that like, you know, came into the hospital and she was born so quickly, like there was no shot of an epidural, but I was panicking, like screaming, freaking out, panicking. And a lot of it, if I had been taking those super breaths, if I had known like this is as bad as it gets and it's only gonna last for like 10 more minutes or something. Right. I feel. The fear was almost worse than the pain, if that makes sense. Yeah. And a lot of times when patients start to just freak out, they're out of control. That's the point where we're like, let's check her. You know, she's nine centimeters. We can freak out for a little bit. But if you're at eight centimeters, you have absolute lack of control. You're just screaming like we're pulling your arms off. that you might wanna consider an epidural at that point? Oh yeah, for sure. You're pumping adrenaline through your system and a lot of that's getting to your baby. And then the baby comes out and they're just like, I need an nap like this. I've been running a marathon inside this womb And so, and we're like, no, we need you to cry and get that fluid out of their lungs. And they're just like, no, not really in the mood And that's not what I want. Okay. Yeah, that makes sense. Yeah. So there is a point at which your, your partner needs to be honest with you. Like, Hey, girl, you, you need some help, right? Mm-hmm. like, we're not in control of ourselves, and you're just over your head, and that's fine. Yeah. That's, that's the beauty of modern medicine. When we get over our head in lots of different ways, we use medicine to fix it. Absolutely. Yes. Yeah, so those are my best tips. Talk with your provider. Definitely talk with your provider, whatever you're thinking. Even at your, probably not your first appointment cuz there's just like so much in it's information overload at your first appointment. But once you start getting into those second, third appointments, there's nothing wrong with being like, Hey, I'm thinking I don't want an IV delivery. You know, starting to bring up like things that you're real serious about so that you can ha start to have those conversations early on. That would be great. And I could, I, I won't, but I could ask more questions. I have so many things in my head but I appreciate it. One thing you mentioned at the very beginning was taking a prenatal class. So with my first baby, they. Prenatal class at the hospital, and it was actually more like horrifying than helpful. But you said you have one that's actually. Helpful. Oh yeah. I founding, found myself in the bathroom with my head between my legs in my prenatal class that I took in 2000 with my first baby because I was like freaking out. I called my mom like on my flip phone, you know, 2000. Yeah. And I was like, I don't know what's wrong with me, mom. I'm feeling really sick. She was like, where are you? What were you doing? And I was like, I was a prenatal class and we were talking about having a baby. And she was like, you're coming to terms with the fact that you're gonna have a baby and it's coming out your lady parts, that's why you're sick. You idiot I had seen babies be born, I had done like three months in labor and delivery. Just the idea, the fact that it was coming outta my, between my legs was a lot. So yes, I teach an online prenatal class and I've actually had a couple reviews that said I found myself laughing at things that I thought that I used to think were. So, right, because I think when you simplify it Yeah. Taking the cue for people, they just really like, oh, okay. Yeah. Yeah. Because I think we think we're making decisions forever. We can change our mind in labor just like we can anywhere else. You know? It's just, yeah. It's easy. It's just, okay, great. It just sounds hard.