Courtney Collen (Host): Hello and welcome to Her Kind of Healthy, a health podcast series brought to you by Sanford Women’s. I’m your host, Courtney Collen with Sanford Health News. We want to start new conversations about age-old topics from fertility and postpartum depression to managing stress, healthy living and so much more. Her Kind of Healthy is designed to bring you honest conversations about self-care, happiness and your overall wellbeing with our Sanford Health Experts.
In this episode, we are focusing on what to look for when choosing where to have your baby. It’s a really special conversation. I have Elizabeth Miller, M.D., joining me now. She is a Sanford Women’s specialist in obstetrics and gynecology, and I want to welcome Dr. Miller to the podcast. Welcome!
Dr. Elizabeth Miller: Thank you, Courtney, for having me. This is such an important topic, and I think people get really excited because this is one of the first big decisions that they’re making as parents.
Host: Yeah, let’s talk about that for a moment. How special is this time? And some big decisions to make for a new mom or parents-to-be.
Dr. Elizabeth Miller: Absolutely. This is a very exciting time. They’re thinking about who’s going to be taking care of them throughout their pregnancy, where they’re going to deliver, who’s going to take care of their baby afterwards and all of the care that they’re going to receive during that time. So, I see pregnant patients even from a preconception visit when they’re thinking about getting pregnant and all of the things that go into that. And then I see women throughout their entire prenatal journey. I deliver babies here in the hospital and I also see them for their postpartum care.
Host: How much do you love what you do?
Dr. Elizabeth Miller: It’s a pretty special job. I don’t think that a lot of people can say that they’re a part of that.
Host: Yeah, let’s dive right in. What should patients or parents look for in a facility or hospital system when selecting their birthplace?
Dr. Elizabeth Miller: It’s really important to look for a place that’s going to provide safe evidence-based care and also a place that can support women in the decisions that they want through the whole birthing process.
Host: Let’s talk through some of those things that Sanford offers. First, who is here to provide that care?
Dr. Elizabeth Miller: So patients here have a decision to make about the provider they would like to see during their prenatal care and for delivery. We have a group of OB/GYN physicians, and we work really closely with midwives that are part of our group too. And then there are also family medicine doctors who will do deliveries.
Host: Can we talk quickly about the difference between an OB/GYN and a midwife?
Dr. Elizabeth Miller: Yes. So an OB/GYN is a physician who has completed medical school and a residency specific in OB/GYN training. All our midwives who are with our group are certified nurse midwives, which means that they have extra training and our advanced practitioners before they get their midwife training. So they have a very high level of care with a nursing background as well.
Host: What are some of those important things women should consider when planning the birth process?
Dr. Elizabeth Miller: One thing that I think is really important for women to consider is what type of birth they would like to have and here at Sanford, we can support women, whether they want a low intervention birth all the way to, if they need a C-section delivery for any reason. So what a low intervention birth could look like is different ways that we can support women who might not want to use things for pain medication who might want to labor in the tub, be able to move around during labor. And we have water birth suites which is kind of unique in this area. And some of our midwives do water births, but even if patients aren’t interested in a water birth, they can still labor in the tub and water can be very therapeutic, especially in the early labor process.
We then have wireless monitors. So while women are in the early phases of labor, or even later on, we can still watch mom and baby and they can move around freely.
So traditionally all of our fetal monitoring would have to be connected to a wall and you would have maybe three or four feet to be able to move around with these wires and you’re always getting kind of hooked up in them as you’re trying to move around. And if people want to try different positions beyond the birthing ball, we can support that with these wireless monitors. They can also go in the tub, which is pretty incredible.
Host: Yes, amazing. But women don’t have to have a low intervention birth, right?
Dr. Elizabeth Miller: Absolutely. Women don’t have to have a low intervention birth. We have women who really want their epidural and we have great anesthesiologists who can help provide excellent pain relief during labor with epidurals.
We also have other options for pain management here at the hospital with IV pain medications, nitrous oxide, which is gas that you can breathe in during contractions to help take away some of that pain during contractions and women can choose any of those options while they’re here having a safe delivery.
So we are watching mom and baby, we have nurses who are trained to be looking for anything that would be outside of the norm with that so that we can intervene or help at any point. And that’s the other really important thing when looking for a hospital: it’s great to have all this support for low intervention, but you also want a place that has a safety net for anything that goes wrong.
So one important thing that we offer here at Sanford are VBAC deliveries, which stands for a vaginal birth after cesarean. So this is for moms who have had a C-section before, and usually it is one or two prior C-sections and there’s, you know, other criteria that makes in the candidate for this or not. But for women who are interested in trying for a vaginal delivery after a C-section. And this is a little bit unique because there are increased risks associated with that. And so we perform continuous monitoring of mom and baby throughout the process. And we have anesthesia and OB available at any time if there was an emergency.
So, frequently, we will see people who are referred to our clinic to discuss TOLAC, which is trial of labor after C-section for patients who are wanting to try for a VBAC delivery. And we meet with them in clinic, we talk about why they had the C-section in the first place, what things make them a good candidate for trying for a vaginal delivery and how we support them through that process.
We also talk to women if we think that it would be safer for them to have a repeat C-section and talk about the risks and benefits of both. Not all hospitals are able to provide a VBAC for patients, but this can be really important, especially if patients want the vaginal birth experience or if they’re planning on having a lot of other pregnancies to be able to have a vaginal birth and then set them up for other vaginal deliveries in the future is really important.
I like to share with my patients that I’m a VBAC mom and I had my VBAC here at Sanford with my son, and it was such a great experience. And I knew that I was in good hands. And if anything were to change during the labor process, I knew that my team would be ready to step in and help my son.
Host: How old is your son now?
Dr. Elizabeth Miller: He’s 15 months old.
Host: Oh, congratulations!
Dr. Elizabeth Miller: Thank you.
Host: When do women start to make those decisions as part of what their labor and delivery might look like?
Dr. Elizabeth Miller: I highly encourage patients to talk with their OB provider, who is giving their prenatal care, about their options during the prenatal visits. The OB provider is the one who knows the patient the best. And usually patients will fill out a birth preference or birth wish sheet for us so that we know some of the things that they’re looking for and then we can talk about those in more detail with them.
Host: Talk about the importance of having pediatricians rounding in the hospital labor and delivery units to check on baby and maybe perform procedures that might be needed.
Dr. Elizabeth Miller: Sure. So the pediatricians that come to see the babies are getting to know their newest patients and they get to know them from the very beginning. And they can identify if there are any extra needs that the babies have and start to address those right away in the hospital. They can also help the parents kind of understand some of those early cares if there’s any procedures that are needed such as a circumcision that that’s desired, those can be performed at that time too.
Host: It sounds like a pretty seamless transition from prenatal care or care with an OB GYN to a new baby. And now it’s time for baby’s care journey to begin.
Dr. Elizabeth Miller: Yeah. That’s our goal.
Host: That care will continue between mom and her OB/GYN. Is that right?
Dr. Elizabeth Miller: We still see our patients in the hospital for their postpartum cares and also for their postpartum visits too.
Host: We expand more on that transition from postpartum to parenting and add additional expertise and insights from Dr. Jennifer Haggar as Sanford Health pediatrician, joining Dr. Miller in another episode of this podcast series as well.
Dr. Miller, what types of pregnancy parenting newborn education options are there here at Sanford? And, and why is it important to have those options available?
Dr. Elizabeth Miller: We’ve already talked about this being a really exciting time. It is also such a huge transition. You are preparing to take home a baby and learning about the actual care of the infant, but there’s also so much learning that goes into the birthing process. And I feel like if patients take the time to do some of these classes, they’re going to feel more comfortable and more confident with that. Here in our clinic, we have birth navigators who are nurses that are specifically trained in OB care and helping women kind of through the prenatal process and connecting them in with classes. They also give tours of our labor and delivery.
And I think this is a really important opportunity for patients to take advantage of because when you can see where you’re going to be giving birth, I feel like that takes away a lot of the unknown and can make you feel a little bit better when you’re able to visualize them.
The classes that we have are all available on the Mom2Be website. And there are online courses and in-person courses, and then also a combo of the two. So they really try and work with people’s schedules to make this an easy thing to do. There’s a Birthing with Confidence course that has both online and in-person parts. And they talk about things like positioning during labor, massage from your partner, different comfort me measures, how to relax and how to support people in labor.
There is also an Understanding Birth online course, and they share birth stories and go through what is labor because a lot of people don’t really understand that. And that’s understandable that they don’t know if they haven’t been through this before.
There’s a WebEx course called Birth Basics. They teach people what the signs are for labor, how to time your contractions at home, when to call or when to come in for evaluation. And when I see patients in clinic, that’s one of their biggest concerns. When do I come into the hospital? And how do I know if I’m in labor? So that’s a great course to kind of go over those basics and also reiterate that patients can just call us with any questions or concerns. And they don’t have to make that decision to come in, in a vacuum. We will help them with that process.
One thing that’s kind of unique here is that we have a Spinning Babies parent course, and this really works with optimal positioning and using balance, gravity and movement throughout labor to help babies kind of come down the right way in the birth canal and to ease the birthing process. And that’s a really fun class.
And then for patients that are looking for extra support and relaxation during labor, our midwives teach a hypnobirthing (now Hypnobabies) course. This is a longer course that does have some practice that they need to do outside of the course, too, to get the full experience. But it uses guided imagery, visualization, and breathing to help during labor.
One of the most underutilized visits is what I consider a preconception counseling visit. And this is for patients who are considering pregnancy and they can come and talk with us about ways to optimize pregnancy, optimize fertility, starting a prenatal vitamin. We talk about any labs that are needed beforehand. And it’s a really great way for them to get to know what type of care we provide during pregnancy then, and answer some really important questions that people have about that. So I encourage anyone who’s considering pregnancy to schedule a visit with us. We love to chat with people even before pregnancy to go over all this stuff.
Host: A lot of questions I’m sure women have before the process. There’s so much great information. Dr. Miller, thank you for giving us an overview. It’s a lot to think about. How important is planning for the unexpected and what are some of those options at Sanford?
Dr. Elizabeth Miller: This is one of the things that I like to talk to my patients about during their prenatal visits, because birth can be unpredictable. Our favorite thing is when we can have a healthy vaginal delivery for mom and baby, but there are times when things change, and our plans change and you want to be in a place that can change those plans quickly and support mom and baby.
When something happens during birth, minutes count for delivery.
So here at Sanford, we have OB/GYN doctors in house 24/7. We have anesthesia here 24/7, and we have operating rooms that are right in our labor and delivery suite. So that we don’t have to move down a floor or across the hospital to deliver baby. We can just go right across the hallway to deliver baby quickly.
The other important thing is we have an excellent NICU team. So they come to any of our deliveries for preterm babies when we are expecting babies are going to need extra care, and they also come to our C-section deliveries and they are there to provide extra support if needed. They can also come immediately after delivery if there’s anything that we notice with baby, where baby is going to need extra care.
Last night, I was on night call on labor and delivery. And I knew that I was going to be doing this podcast in the morning.
So I went straight to the source and surveyed a couple of our night labor and delivery nurses. And these are an awesome crew of people. They are so great at taking care of their patients. They provide a lot of one-on-one support during labor. And I said, why would you recommend for someone to come and deliver at Sanford?
And the biggest things that they were emphasizing were our support of lower, low intervention births. They talked extensively about using water, using water births, and also their support of different positions and movements during pregnancy. And again, I want to emphasize the wireless monitoring that we have available for patients and they were saying that that makes their job so much easier too, because they have the confidence that they still know what’s going on with mom and baby, but people can move around. People can walk around and that’s awesome.
The other thing that they talked about was how quickly our team assembles when needed if there is any type of emergency, whether with a vaginal delivery or with a C-section delivery, we are ready. We practice this with drills. We have excellent communication as a team and we are set to help take care of mom and baby.
Host: It sounds like the care journey is really tailored to each woman. It could be as hands on or hands off right here in the hospital. Dr. Miller, thank you so much for your insight and expertise in this space and all that you do here at Sanford.
Dr. Elizabeth Miller: Thank you, Courtney.
Before we go, I want to mention that many of the services and care options mentioned during my conversation with Dr. Miller are available at the Sanford USD Medical Center in Sioux Falls. For information or to find what options are available near you, call your provider, clinic or visit sanfordhealth.org.
I’m Courtney Collen. Thanks for being here.