Supporting natural birth through low intervention

Podcast: Megan Burgers, nurse-midwife, empowers women on their birth plan options

Supporting natural birth through low intervention

Episode Transcript

Courtney Collen (Host): Hello and welcome to Her Kind of Healthy, a brand new health podcast series brought to you by Sanford Women’s. I’m your host, Courtney Collen with Sanford Health News. We want to start a brand new conversation 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 well-being with our Sanford Health experts.

Today, we’re talking with Megan Burgers, a certified nurse-midwife, about low intervention birth options and how Sanford Women’s supports expecting mothers through that natural birth process. Megan, it’s so good to have you here with us.

Megan Burgers, CNM (Guest): Thank you for having me.

Host: Tell us first, a little bit about yourself and what brought you here to Sanford Women’s?

Burgers: Sure. Well I’m a California native. What brought me here is the primary question is why did you come here from California. My husband is from the are and his whole family is here. And so, when I got this opportunity at Sanford, we jumped at the opportunity to come to live close to family.

Host: What about your role as a Sanford Women’s nurse-midwife do you enjoy the most?

Burgers: The personal interaction with each particular woman. Pregnancy and birth is a very personal and vulnerable season in life, and I love the opportunity to be allowed to come into that space. It feels very sacred. And I keep it in the highest regard. And that just feels like a privilege.

Host: Define low intervention when it comes to planning for a baby’s arrival.

Burgers: Sure. So, interventions are things that we do to the process involve instead of observe. So, the majority of women who are experiencing pregnancy and birth, are generally going to have normal low risk healthy births. And so, our job as providers, is to observe alongside. We check baby’s heartbeat at every visit. We’re doing lab work to make sure that we’re catching any abnormalities, anemia, gestational diabetes, etc.

And when it comes to birth, us as nurse midwives, we highly encourage spontaneous labor. So, again, we’re not doing anything and so, labor – we’re designed to conceive, grow babies and birth babies. Our bodies were designed to do that. So, observing the process is low intervention. So, when it would be appropriate to intervene, would be is when we did see the normal natural process veer off to the side. And that would be things that I had mentioned already or a myriad of things. And we are trained as health care providers to notice when things veer off to the side. Because ultimately, we’d love to maintain the possibility of a vaginal birth versus a surgical birth. And keep it as low risk as possible.

And so, if there is something that does come up, we do notice it and there are things that are appropriate to do in the meantime.

Host: So, talk about some of the options that Sanford Women’s provides expecting moms to support that natural birth experience.

Burgers: Part of the big core base is education. And so, if you understand how your body works, if you understand the normal physiologic process; then there is a trust aspect of that. We do have the Mom-to-Be Center which has educators. We have childbirth classes, breastfeeding classes. We have dad classes, baby basics classes available to add onto what we’re talking about in clinic as well. And so starting off with a basic understanding is what I think is the building blocks to understanding the initial steps of having a low intervention birth.

So, if you know already that you can help your body foster a healthy spontaneous labor; then that’s step one. Other options would be we have wireless monitors so that you don’t have to be attached to one of the heart rate monitors once you are in labor. We do have whirlpool tubs in most of the rooms to allow for what we call hydrotherapy. Getting in and out of a hot tub during labor sounds terrific. We as nurse midwives, also offer water birth too and so if a woman is interested in having — to actually birth their baby underwater, we do offer that as well and so that allows for the benefits of the hydrotherapy, decreased pain sensation, increased overall satisfaction with that. We also offer nitrous. So, nitrous oxide is what we think of as laughing gas at the dentist office. But it is used worldwide, much more so than the US, but it is catching on. And it is a really terrific option in place as either if a woman is planning on an epidural, it might be the first step. It might be the only thing that’s necessary for her to be able to cope with labor at the time.

So, it is a less concentrated amount of it. So, it takes the edge off and many women really, really love it to be able to do that.

Host: So, women don’t have to deliver lying flat on their backs.

Burgers: Oh no. No, and so sometimes that is an option, or a common position just related to having an epidural, not being able to leave the bed. But if the woman wants to deliver in a different position, mobility is really important to assisting in the birth process. I’ve even caught babies with moms standing at the side of the bed or sometimes moms have babies in the bathroom and so it can be — yeah, as long as the situation is deemed appropriate and safe and the provider is supportive and comfortable with that. Movement is awesome. So, different positions, hands and knees, laying on their side, anything like that. We got birth chairs that are more — facilitate kind of a squatting position. And so some women find that they feel more powerful in that position. Yeah, so lots of options.

Host: What are some of the most common that women tend to gravitate toward when it comes to these low intervention options?

Burgers: We encourage walking. So, we’ll see a lot of women walking in the halls. The tubs. The tubs are really highly used. And so, that’s a really great option for women in all stages of labor but I would say many, many women use it kind of in the early stages of labor, get in and out. We can reheat it and —

Host: So, expand on the benefits then of this type of experience for both mom and baby and then of course that support person that might be in the room as well.

Burgers: Absolutely. So, when we foster a physiologic birth, it’s just the normal body process. And so, if there — it’s that old adage of if it’s not broke, don’t fix it. And so, if we can be vigilant observers of normal, then our body is designed to work that way. And so, women can have a — feel maybe more empowered that her body was able to do what it’s designed to do with close observation from us and feel safe.

Labor can progress normally. Babies do well. If it’s necessary to intervene, then by all means. Safety is of utmost priority. Yeah, having a low intervention birth just fosters so many normal body processes. So, for instance, when we allow for the brain to create the hormone called oxytocin, that send signals down to the uterus to cause contractions. What it also does in the brain is release endorphins. So, these are those natural brain opiates. So, if you can imagine we’re having the contractions but also the natural opiates at the same time, that is natural pain killers. And so, if we’re using a synthetic version of that oxytocin, through an IV; it’s called pitocin. Now it is widely used in the hospital and there are very, very appropriate times to use pitocin.

But if we use it in a situation where maybe it didn’t necessarily have to be used, we’re bypassing that normal opiate process. Does that make sense?

Host: Yeah it does. Do all women have the opportunity for this type of care during labor and like what would make a woman a candidate for a more holistic birth experience?

Burgers: So, to a degree, I think every woman is an appropriate candidate for personalized, tailored experience. So, all the way from normal, healthy, spontaneous, no problems, one baby, from that gamut, from that end of the spectrum to the woman who is having a particularly high risk pregnancy. Now we can talk about minimizing interventions. Do we have to use all of them? Not necessarily can that woman who is having a high risk pregnancy still have a vaginal birth? We don’t have to necessarily do a C-section unless it’s medically necessary. And then plus also having conversations of how can we tailor this experience? What are some options involved in the process? How can we involve the woman and her family and their preferences or how they’d like to see it go. I think there’s always room for conversation of that.

Host: Talk about the advantage of choosing a low intervention birth in a hospital setting like Sanford versus at home.

Burgers: Sure. The benefits of having a hospital birth is that should things go sideways, we have all of the available resources. So, at Sanford, which makes us different in the local community is that us, Certified Nurse Midwives, and OB/GYN physician, there is one of each of us in the hospital 24/7. And so for women who choose to have one of those two care providers; we are always available. And for women who choose one of us Certified Nurse Midwives, is there’s the question of okay well if you are not a surgeon, and if I need surgery; what happens then?

We work very closely with our OB/GYN physician colleagues and so, it is a seamless transition to go from a midwife caring for you. We’re recognizing when something goes sideways. And if a C-section is urgently necessary; the OB comes right in, we’re having that conversation right there, it’s happening right away. We’re down the hall from the OR and so, we’re maintaining all of those levels of safety. And so, having that low intervention birth can feel like you’re at home with the knowledge that you can have a physician if necessary, for their expertise as surgeons as well as the NICU down the hall too. So, if everything goes swimmingly and baby is born and then baby is needing resuscitation, we have seconds in between, a highly specialized care team in the door.

Host: Are you seeing an increase? Is your team seeing an increase in requests for these low intervention options and if so, why do you think that’s the case?

Burgers: Yes, we are. And so, for example, us midwives, we offer water birth like I said before and so, a couple of years ago, we actually had two of the labor and delivery rooms converted into low intervention rooms. And both of them have really beautiful built-in, in the room, jacuzzi tubs that are designed to birth in. And the room was, had, was renovated. It’s tiled. It’s very beautiful. And so, it can give a woman a feeling of not being hospitalized. Does that make sense? You’re not necessarily in the hospital. And so, we are seeing an increase in interest and desire for using these rooms, asking for — we also teach hypnobirthing (now Hypnobabies) which is kind of a way to approach birth and labor and think about that and how to use relaxation to maximize their coping during labor. And so, we’re seeing a significant increase in those numbers of women who are seeking out that kind of class.

And the reason why it is I think is because women are now, I think more and more understanding that they want to know more. They’re learning how their bodies are working and they are seeing maybe that there is a difference between decades ago when it was just you did what your doctor or your provider said. Because that’s what they knew. Now, it’s like well, do I — I’m hearing stories of other people having different experiences and that actually sounds like something I like.

Host: Because the physiologic birth process can happen on its own, right, and so, to support women in this journey, and provide these low intervention options; what does it mean as a nurse-midwife to you to be able to do that, to be a part of something like that?

Burgers: It is beautiful to see a woman feel like she’s heard, like she is safe, she’s trusting the process, trusting her care team and feeling empowered during that process and I don’t have to do anything. If I’m involved in the process where part of my job is, what I love, is educating women about their bodies. Knowledge is power. And if you don’t know how something works, you’re not going to know how to ask or how to tailor this for yourself. So, to observe something that can be lifelong empowering, I just know that it affects the family for their entire future. We’ve had many, many women come to us and say, gosh my first birth, I know now what I know, and I didn’t know then and I want this to go different. And to hear them speak afterwards, of an entirely different empowering process; is just so rewarding. And that doesn’t mean to say that that first birth was spontaneous and ended in a vaginal birth and the last one didn’t go sideways and have a C-section, but more intervention doesn’t necessarily mean less powerful, less listening, less trust, less — you know that type of thing.

Host: So, I want to shift for just a moment before we wrap up to bring in COVID-19. I’m wondering how this pandemic has impacted the way you deliver care and the labor experience in general. What are you hearing from women?

Burgers: Well what I think was the most surprising thing for women is on a hospital level, we are decreasing numbers of visitors. What we have heard time and time again, is gosh I had no idea that it would be so peaceful and quiet to not have all the visitors. I can rest, I can breastfeed, I can just have this bonding time with my partner and my baby and that has been I think one of the most surprising things for families. Because initially it’s like oh well, decreasing visitors, gosh that sounds like a really big negative thing. I mean you’re really only here for a day or two afterwards, maybe three. And then go home and have visitors as appropriate or however you deem that to be. But that is —that’s been one of the most surprising things. But in terms of, caring for women, it just is the same. We are just all wear masks now. And doing tests as appropriate. And so it really hasn’t changed a lot besides again, less people, less visitors. It’s more of an intimate environment and I think it kinds of lends itself a little bit more towards this privacy, feeling more comfortable, kind of an environment.

Host:  So, if women are feeling anxious about the labor and delivery experience amid this pandemic, how would you ease that fear, that worry?

Burgers: Yeah, well good news is that the overall experience really isn’t that different. And I think coming out of this, we’re seeing a lot of positive things from it including we have implemented quickly telehealth, telemedicine visits and so, where appropriate, women are able to just video chat with us. I’ll sit in my office a couple of times a day and have a video chat, a video visit with some women that I’m seeing for their pregnancy or whatnot. That’s a nice option especially if women are coming from farther away or finding it a little more difficult to get away and into the clinic. Yes, that is. And then, just feeling anxious about it — safety is our utmost priority. And so how we’re helping to elevate safety is not necessarily having babies sleep in the nursery. Babies are staying in the rooms. We’re encouraging moms and babies to go home as soon as it’s appropriate, it’s safe. And so that sometimes is a little bit shorter than typical. So, maybe 24 hours instead of 48 hours. And so I would say that it’s not very different. Honestly, it’s not very different. And we are being very cautious about safety with COVID and mask wearing and staff and hand hygiene and all of that. And so, some people are afraid to come to the hospital because they are afraid that maybe they might get it here or — but people at the door are screened, our unit is closed. Yeah, we’re taking all the precautions necessary and it doesn’t feel really that much different.

Host: OK, so, now I want to know how early can a woman start to develop this birth plan and when can she start to explore all of these options?

Burgers: Today. And it doesn’t even have to be anything that is hard in stone or anything like that. It can just be exploring options. Here at Sanford, we have options of care providers that range from OB/GYN physicians, family practice physicians, certified nurse midwives. So, that process can start right away. You don’t even have to think that you even might even get pregnant in the next year or two or five but can go see your provider and start having these conversations. How can I start now to prepare my mind and my body to have the healthiest start to whenever that season may come? So, and preconception visits are always welcome. And so, yeah, that conversation can start right now.

Host: So, where can a woman find more information as she starts to plan and really think about these things?

Burgers: Yes. So, definitely our website. We have most of — all of this information on our website at Sanford Women’s but then also we have Before Baby events and so, we have these periodically throughout the year and what’s great about this is that some women come with their partners who are planning to get pregnant in the near future, who are already pregnant, and we have information there that ranges from here are the different types of prenatal care providers, and here’s pediatricians, and here’s prenatal yoga teachers, all the way to finances, all the way to tours and things like that. So, it’s a really wonderful evening, a snapshot of learning more. And then also just talking with your provider. And so, just make an appointment, wherever you are and see what they have to say. But I do work in the OB/GYN clinic here at the main campus in Sioux Falls. And everyone is welcome to make an appointment and start having these conversations. And I know they happen across the Sanford footprint and at different clinics across the city, but anyone is welcome to make these appointments and start that conversation.

Host: Wonderful. I learned a lot today. Megan Burgers is a certified nurse-midwife with Sanford Women’s. We’re grateful for your time. Thank you so much for all of your insight and information on these low intervention birth options.

Burgers: Absolutely. Thank you.

Host: Thank you for joining us today. I’m Courtney Collen with Sanford Health News. Be on the lookout for our next episode of Her Kind of Healthy coming your way soon. Stay well and have a great day.

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