Jan. 27, 2025
United States of Care and 100 Weeks of Maternal Support with Natalie Davis
Natalie Davis, a passionate advocate for maternal healthcare reform, joins us to share her journey and groundbreaking work with the 100 Weeks initiative. Natalie’s personal experiences, from navigating the challenges of preterm labor to working in healthcare policy at the forefront of the Obama administration, offer a compelling narrative. Through candid storytelling, she reflects on how these experiences shaped her commitment to extending postpartum support for mothers beyond the standard timeline.
Listeners are invited to explore the highs and lows of pregnancy and childbirth, including Natalie's frank discussion on the emotional and physical demands faced by mothers. She opens up about the profound learnings from her own unconventional birthing experiences, which included navigating labor pains using natural techniques and the unexpected need for epidural assistance during placenta delivery. Natalie’s story of her child’s en caul birth serves as a powerful metaphor for new beginnings and the awe-inspiring journey of motherhood.
We also spotlight Natalie’s professional dedication to healthcare policy reform. Her leadership at the United States of Care and the 100 Weeks Project highlights the urgent need for comprehensive postpartum care. This episode underscores the crucial role of effective patient-provider communication and the transformative impact of accessible maternal health services. Join us as we explore how personal passion and professional pr
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Medical Disclaimer:
This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman’s medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.
Chapters
00:00 - Maternal Health Advocate Natalie Davis
11:35 - Experience With Pregnancy and Birth
21:09 - Unconventional Birth Experience
28:19 - Maternal Health and Policy Initiatives
31:34 - Advocacy for Maternal Health Reform
42:58 - Navigating Patient-Provider Communication
Transcript
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Hello, today I have with me Natalie Davis.
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Natalie has worked for nearly two decades shaping and implementing American healthcare policies to improve the lives of all people.
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In 2018, she and fellow national healthcare leader, andy Slavitt, launched United States of Care to ensure that everyone in the country has access to quality, affordable healthcare, regardless of health status, social need or income.
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She is relentless in her person-centered approach to building health care solutions and has a history of building partnerships with organizations, patient advocacy groups and everyday people that work to create positive change in our country's health care system.
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From 2010 to 2016, natalie served at the Centers for Medicare and Medicaid Services, with the final two years as senior advisor to former CMS administrator, andy Slavitt.
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In 2017, natalie served as the director of strategic engagement at the Bipartisan Policy Center.
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A social entrepreneur, natalie also helped found Town Hall Ventures and the Medicaid Transformation Project, both of which focus on bringing the best of innovation and care delivery to diverse communities.
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Natalie holds an MA in social policy from George Washington University and is an alumna of Salisbury University Schools of Sociology and Art History.
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Natalie lives in Washington DC with her amazing husband and four children.
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Natalie, welcome and thank you for joining me.
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Thank you so much for having me.
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I'm excited.
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I am so eager to hear all of the things that you have done and the inspiration for your work with the United States of Care and your latest project, 100 Weeks, which my understanding and I want a lot more information on it is.
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It will help moms have access to postpartum care for up to 100 weeks, which is a lot more than what we have now.
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Yeah.
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Yeah, that's right.
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For a year we're really and we can talk a lot more about it really focused on how do we make sure that, after mom is no longer pregnant, does she have the care that she needs and that she needs to be a healthy individual, a healthy mom, a healthy community member and family member.
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For that, one year after postpartum.
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Yeah, and beyond, but let's get her started with that one year.
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Yeah Well, natalie, most of my guests have stories that kind of launched the reason that they've decided to explore more work in the area of maternal health.
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And after talking to you just briefly, I've learned that you are no different.
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And because most of my listeners love hearing juicy birth stories, if you'd like to start with your birth story and then kind of the inspiration for pivoting your work to more of the maternal aspect of care, I would love to hear it.
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Great, well, my son.
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Like you said, I have four kids.
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My one and only son was my first pregnancy and first child.
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He's our oldest, I should say, and it was.
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It really was happening at the beginning of my career, working in Washington DC on health policy and, kind of coincidentally, I was pregnant while I was working on a project.
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That happened right after CHIPRA was passed legislation out of the Hill that really focused on mom and child health, and I was working on a project that was looking at how do you measure good quality care for pregnancy and labor and delivery and afterwards.
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And so I was super excited to be pregnant, to be able to use time at work to understand what does that good care look like, and found for me that I was so interested in Ina May just became like the goddess for me of all things and just and even actually for all four pregnancies.
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I read that book over and over and over again, especially the birth stories part at the beginning, half.
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I send that to everybody that I know that gets pregnant, and actually just met someone recently whose good friend grew up on the farm and was like, oh, if you ever want to go, I'll take you.
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I'm like my gosh Graceland Anyway.
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So I hope I can do that.
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So I was really learning about what the female body can do during labor, pregnancy, and labor and delivery, and really excited about trying to turn my hand at.
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What I wanted at that time was a natural birth.
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I wanted a home birth.
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I was going to midwifery center in Virginia and really loving being pregnant, honestly loving everything about it, and while I was definitely very scared and nervous about labor and delivery, I was also really excited to enter into that phase and see what that was like.
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And then during that time, I went and started working for the Obama administration, working on building healthcaregov, and so I vividly remember being on a work call, at work with the National Association of Insurance Commissioners, as we were talking about rolling out you know, standard benefits and coverage of you guys although you get those bills now and I was under my desk on all fours.
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I was 32 weeks and I was like man, I don't feel well, it just feels better to be under my desk.
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And then I was like texting friends who were also pregnant and like my back hurts, and I was like man, I don't feel well, it just feels better to be under my desk and then I was like texting friends who were also pregnant and like my back hurts and they were like I think you should call your midwife, like this doesn't seem good.
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And so I did and they were like you need to come in right now.
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So my husband left his job early, came and got me, I told my boss and later when I came back to work, she was like when I looked at you I was like she is not coming back tomorrow and so we got in the car.
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We drove all the way to Alexandria during rush hour and I got there and I guess they're able to do I didn't know this they're able to do a swab to home because you are in labor and maybe let's hope for the best.
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And so we drove all the way back through town up to Washington Hospital Center.
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There was like a building on fire and I'm in the backseat like oh my God, it's happening.
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I wasn't even thinking about how the dangers of preterm labor and like I was in it, I was starting to get really into it and I'm like I just go into the zone like get into the animal.
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And my husband was not feeling that way.
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He's like avoiding something.
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Your treasury building was on fire and stuff.
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So, anyway, get to the hospital.
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They're like you're in labor and they kept wanting me to like try not to be in preterm labor, which I know was really very smart and safe of them.
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But I also knew the baby was coming and so I wanted to get into like comfortable positions and I found you probably you and others that are care providers probably won't like this part of the story, but I found out that, like if I went to the bathroom, I could take off the monitors which were like really bothering me while I'm drinking a drink.
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So I'd like go to the bathroom.
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I've never heard of that before.
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No one's ever tried that Okay.
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Yeah we get it.
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I was moved from triage room to delivery and to deliver our son, lauren at 32 weeks and came out very healthy but of course very small and too soon, and he was whisked away to the NICU and put on oxygen and thankfully that in the entire month that he was in the NICU he was very healthy and we just had to wait for all the measures of growth.
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But there were a lot of things then.
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A, I felt very proud of my body for being able to go through labor and delivery and I felt like I was able to listen to my body, even though it was too early.
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It wasn't until later where I started feeling like my body failed me and should have kept the baby in longer.
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But I did feel like I accomplished what I wanted to.
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And we still have this picture that I post every year on his birthday of when I finally got to meet him in the Q and he's in my shirt and he's got the little oxygen you know, oxygen in his nose and the gavage and all that.
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And at that point it still hadn't like hit me.
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You know what we were up against and you know, for that month while he was in the NICU, I guess, and this kind of starts to go.
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What my interest is, then, in maternal health and especially postpartum health.
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You know, my husband and I had all the support we could ever ask for from family and friends, and at that time we were living in an apartment that was across town that didn't have a washer and dryer in it, and so we had friends that would come and pick up our laundry and wash it for us, because we were going back and forth to the NICU many times a day.
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I really wanted to breastfeed and I wanted to be with him and like I remember going home and feeling, like you know, empty in belly and empty in arms and it was just heartbreaking to live like that every day at home.
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And so my husband eventually, of course, had to go back to work after just a couple of days, and those were lonely days and we didn't have a second car, and so I was riding like the shuttle and the bus to get over there.
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I wasn't physically healing, I wasn't emotionally healing, but, you know, wanted to be there and wanted to bring you know.
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I was pumping every three hours, you know, or probably even more often than that, and it just like became so clear that they were doing a great job of taking care of Lauren.
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Nobody was thinking about taking care of me, including myself and loved ones, I'm sure were, but it was very healthcare wise.
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It was very isolating for me during that month.
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I don't even know if anybody, I don't remember if anybody checked up on me.
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Just really realizing like this is such a lonely time.
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And even when I had my girls, my next three births, none of them went to the NICU, but it's lonely right.
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And you are worried you're not doing the right thing, you're not sure if you can handle everything that's coming.
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You've got hormones going on, you've got other people to care for sometimes and we can talk more about our project, our 100 Weeks Project, which really is focused on postpartum health, and it's because it's what we've heard from women and family and caregivers across the country, that women feel alone after they have the baby or they're no longer pregnant for whatever reason, and so I think you know that isn't like why I started United States of Care, it's not why we started 100 Weeks Project, bringing back stories for me of of those feelings and especially when lauren was in the NICU and and just one story to tell there we, after the month that he was in there, he had hit, he was starting to breastfeed, he had hit five pounds so we could take him home in the car seat and I don't remember the other measures, but he had all of them and releasing him.
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I remember having a a meeting with a head doctor in the NICU and I was like we and we and Jimmy and I, my husband, we're like we want to take our son home, like I need him home and he's, and he said all of your measures.
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And the doctor had the nerve to reach across the table and say you know, mom, it's really hard to wake up in the middle of the night to nurse a baby.
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We're taking good care of him and this is easier for you, mom, to have the baby in the hospital.
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I couldn't.
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I was there at 3 am dropping off milk at the hospital and so my husband, you know, kind of held me back because I was so upset and he was like you don't have any other measures that he hasn't hit.
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And I said we're going to take him out against medical advice unless you can give me a good reason why he's staying.
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And they didn't.
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And they released him the next day because he had hit everything.
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But it was just this like complete lack of trust in me as a mom.
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I already started feeling like in that month that I had lost trust in my body because it didn't do the quote-unquote thing a pregnant body is supposed to do, which is keep a healthy baby in for 40 weeks.
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And it was just this moment of the healthcare system that was taking very good care of Lauren but not taking care of me and not listening to what I could do and what I needed and just how often.
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You know we're not able to be heard by care providers at times and that stuck with me, of course, for throughout.
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You know my life and creating the United States of Care and how often we need to be listening to patients and you know using that as a part of how we construct what is good health care and a good health care system yeah, wow.
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That really hits home.
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I would be so infuriated if somebody yeah, what do you know about what I can do?
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Yeah, I'm like I'm literally here at 3 am dropping off milk.
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What else can I do to prove it?
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Oh my gosh, yeah, yeah, it was upsetting.
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Well, I'm glad that you were able to take him home.
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You've touched on a subject that I hear from a lot of people.
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It's that the you know the disappointment in your body.
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So did we find out at all what happened?
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No, no, he was.
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So he was born at 31 or 32 weeks.
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My second kid, ruthie, was born a month early, but able to come home, and I had progesterone shots for her and then progesterone shots for the next two, which I know.
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Now is, you know, up in question?
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I don't know why.
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I mean, I think that if progesterone played a role in it, progesterone is what keeps us pregnant, right, so that makes sense.
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Now it's using the Makina shots, which now are like under question.
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There's like a lot of studies that it's like not only doesn't do anything, but that it's also can be really harmful for BB.
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How interesting, yeah, do you remember how to?
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spell that M-E-K-E-N-A mackenafigastrone.
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They were injections that we did at home oh, it's no longer available.
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A brand name for a hormone injection used to reduce the risk of preterm birth in women who had previously given birth prematurely.
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The FDA withdrew approval of the canine on April 6th oh, very recently of 2023, and it is no longer available in the United States.
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Yeah, I had that for both and I'm like gosh, that could have been bad.
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That was while the shots we chose to do at home because I didn't want to go to the office.
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Yeah because nobody has time for that.
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My husband would do it in my butt cheek and it was like a harpoon.
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I mean the viscous, it was so viscous it was so it's so interesting too and this is kind of off topic and I'm going to edit it out but we do the.
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We've started at our clinic to do the beta methadone, the first shot, and then giving dad the second shot, which is a steroid and that helps speed up the development of the baby's lungs, but it just I mean, I had no idea that dads were giving IM injections in the butt at home.
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That's what we did with McKenna, I don't.
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They were like your husband wants to do it.
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I was like, yeah, I can't come in every like my job, Right, I just couldn't.
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And he was fine with doing it.
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Yeah, it blows my mind what dads will do.
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Okay, so you for your second pregnancy, you had the McKenna Yep and then did you remind me did you need progesterone for the other two?
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Yeah, I did.
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I took McKenna for all three I know which.
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Now, looking at the risks, it's like I can't.
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Is it risks for the fetus or risks for you?
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Because I didn't see I'm not pulling them up.
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Yeah, the fetus, there was some.
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There's a news outlet that did a bunch of in-depth reporting on it.
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It's amazing how, like after 10 years in labor and delivery, there's just so much left to know.
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Oh yeah, so, okay.
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So your second one.
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You delivered a month early and that went smoothly, did you?
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Have an epidural with any of them, mm-mm.
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Oh, you are such a rock star Not that anybody that had an epidural isn't a rock star Like I had two epidurals two epidurals.
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But you really have to do some mental prep for that mental prep, which is why I love that Ina book.
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And you know, for each one, I mean the last, the last two were so fast that I couldn't even like really get into the zone.
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But Ruthie, or my, my second felt classically like what you read about, at least like it was.
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You know, over six hours I've got to the hospital with.
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You know, I don't remember how much I was dilated, but but like at the perfect time, and for me for that one, like it was, I didn't know I was doing this, but my husband told me like every like 15 minutes I was changing position, I was like moving from the bed to and feeling circles, and so like there was a lampshade that had circles on it and I was visualizing that as my dilation, and there was like a thing on the bed that was a circle and I was like tracing it.
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It was kind of crazy.
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It's hypnotic.
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You have to go into kind of what people call labor land.
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Right, you have to get into that hypnotic state.
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And everybody does it differently, like hypnobabies and hypnobirthing is one way to do it, but there's so many different ways and you're just finding what is soothing to you to keep your mind off of what's going on.
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Exactly, and so for me it was circles and that wasn't for all three of them, it was just for Ruthie's, probably, because I just had more time.
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And then, yeah, I was on the toilet when my water broke and they were like you've got like three pushes, natalie, you can do it on the toilet or you can get in bed, and I'm like I'm ready for it on the toilet.
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My husband was like can we just think about that for a second?
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Maybe not have a toilet, baby.
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We went out there.
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My body's doing it.
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Yeah, most of the time, women are just like whatever.
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When they like scoop me up and carry me to the bed.
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That's hysterical.
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Oh my gosh, I love that.
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I was just about to ask you one more thing.
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Oh the, what came up for me when you're talking about being under the desk, knowing nothing else about your births.
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Yeah, what I think of when you say that is that you're just, you said, getting into the, into the animal right.
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They go hide.
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You needed your cave right and then being on all fours, to take that pressure off and get the baby in the right rotation, because you just followed your instincts.
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And I just think that's so impressive because I think we tend to negate our instinct.
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Many people nowadays.
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Well, it's scary, right.
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And then if you get out of that zone, you realize what's happening and it's worked so much and it's so scary and so much buildup.
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And for Ruthieie, I actually birthed on all fours.
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Nice, yeah, did you birth at the same place every time?
00:17:17.054 --> 00:17:18.657
For the last three I was.
00:17:18.657 --> 00:17:21.631
I did, and wonderfully for me, for the way we wanted to do it.
00:17:21.631 --> 00:17:25.665
It's the midwifery center at GW and so it was.
00:17:25.665 --> 00:17:27.431
It had the benefit of being in the hospital in case.
00:17:27.431 --> 00:17:34.837
I went early, surrounded by midwives and nurses and everybody who kind of like let me be the way I wanted to be, and so it was.
00:17:34.837 --> 00:17:36.761
It was a great experience for us, yeah.
00:17:37.026 --> 00:17:43.430
And then so for then I almost had a toilet baby, and then your return.
00:17:43.450 --> 00:17:44.633
Baby a Nikki baby.
00:17:44.633 --> 00:17:48.307
I had a toilet baby almost a baby, my third.
00:17:48.307 --> 00:17:49.993
I almost had a valet parking lot.
00:17:49.993 --> 00:17:50.945
Okay.
00:17:51.326 --> 00:17:51.949
So tell me about.
00:17:51.949 --> 00:17:52.288
Okay.
00:17:52.288 --> 00:17:54.314
So you go into labor with your third.
00:17:54.314 --> 00:17:54.855
Where were you?
00:17:54.855 --> 00:17:55.597
What was going on?
00:17:55.924 --> 00:18:02.551
So on my due date or the day before my due date, we my mom and my brother and sister-in-law came and took our.
00:18:02.551 --> 00:18:05.035
So then we had two toddlers and we all went out.
00:18:05.035 --> 00:18:17.243
We walked up to the National Cathedral, we had ice cream and then they like swept the two kids away just even to give us a break cream, and then they like swept the two kids away just even to give us a break, and Jimmy and I went, walked down to Georgetown, the neighborhood, and like had dinner and walked back home.
00:18:17.243 --> 00:18:22.584
I was feeling so exhausted, my back hurt and stuff, but I just figured that was from so much walking.
00:18:22.584 --> 00:18:46.426
And actually I should say for all of my my pregnancies I had I think there's some term for them now I think them as like not Braxton Hicks, but felt like it, but like I had contractions that were more intense than Braxton Hicks for like a month or month and a half before having constantly feeling like labor, prodromal labor, that one yeah, I didn't know that term then were you dilating before that, like we're?
00:18:47.028 --> 00:19:13.931
okay yeah, but it was like it was doing stuff for sure and so I thought that was what was happening and I was just exhausted from walking all day and being super, super pregnant and we went to bed and I woke up in the middle of the night and was like, oh, these are feeling really intense and my tell for me that I now know is that if I take a shower twice within 20 minutes, that is real labor, because usually the shower helps, laying down helps, water helps, but if I take two in 20 minutes, what can?
00:19:13.951 --> 00:19:14.794
we have through that.
00:19:14.794 --> 00:19:17.833
How does one take two showers in 20 minutes?
00:19:17.833 --> 00:19:18.093
What?
00:19:18.113 --> 00:19:20.026
do you do in between, Like what makes you get?
00:19:20.145 --> 00:19:21.207
out of the shower and get back in.
00:19:21.247 --> 00:19:22.888
Yeah, because usually that would help with those contractions.
00:19:22.909 --> 00:19:23.630
The prodromal huh.
00:19:24.090 --> 00:19:25.913
If they weren't real, it would make them Okay.
00:19:25.913 --> 00:19:29.757
And then if I'm like, oh, it's still, it didn't go away.
00:19:29.797 --> 00:19:33.121
I'm happy you get out of the shower and be like, okay, I'm cool, and you're like nope, not cool.
00:19:40.666 --> 00:19:42.068
Time to get back in.
00:19:42.068 --> 00:19:46.032
Exactly, and for that one, my husband woke up to my second shower and I was mooing out of the window.
00:19:46.032 --> 00:19:46.933
And so he walks in.
00:19:46.933 --> 00:19:48.655
He's like what he was asleep.
00:19:48.655 --> 00:19:50.257
He's like what is going on.
00:19:50.257 --> 00:19:51.278
I'm like, why is's like you?
00:19:51.298 --> 00:19:52.219
know, three.
00:19:52.278 --> 00:20:00.645
I think it was like 3am and he was like I'm calling the midwife and they were like it's her third baby, she's mooing two showers, like get in, you know, get in.
00:20:00.645 --> 00:20:05.337
And so we, we use my mom's car because she took the van and we hop in, we're driving.
00:20:05.337 --> 00:20:10.734
Thankfully it was because it was morning, the streets were emptied in DC and my water breaks in the car.
00:20:10.734 --> 00:20:28.205
You pull up in front of GW and all the lights are off in the hospital and there's yellow tape around that yellow do not enter tape around the entrance and I'm like in labor, like almost crowning, and I get out of the car and I'm like, well, here it is, I'm just going to have a baby on the street.
00:20:28.205 --> 00:20:29.648
And I'm like, well, I'm going to do it.
00:20:29.648 --> 00:20:31.272
And I got on all fours.
00:20:31.272 --> 00:20:32.335
Okay, here we go.
00:20:32.335 --> 00:20:33.056
I've done this before.
00:20:40.964 --> 00:20:43.515
My husband is panicking because he's not in any different mindset, you know, like he's just woke up and his wife's a Libra.
00:20:43.515 --> 00:20:45.181
He's literally was picking up a rock.
00:20:45.181 --> 00:20:46.325
We don't know why he was doing this.
00:20:46.325 --> 00:20:49.349
He was picking up a rock to throw it through the window so we could get it out.
00:20:49.349 --> 00:20:51.473
We're like, how did they close the hospital and not tell us?
00:20:51.473 --> 00:21:01.365
And there's a woman who was sleeping on the bench Again, it's like 3 am and she yells something at us and my husband, who is a very nice, very, very nice person, yells at her.
00:21:01.365 --> 00:21:03.750
He's like if you want to be helpful, go get a nurse.
00:21:04.631 --> 00:21:20.006
And then we didn't think anything of it and I'm like, all right, I'm like crowning, it is happening and all of a sudden we see at the bay near the er and people like look out of, like I got a panic and like grabbed a wheelchair and like ran down and got me.
00:21:20.006 --> 00:21:25.448
The woman went and got the er doctors and she was trying to yell at us like go to the er, not the front door.
00:21:26.349 --> 00:21:27.792
And I have a baby coming out of me.
00:21:27.792 --> 00:21:29.517
I'm a hospital adjacent.
00:21:29.517 --> 00:21:30.965
That's as far as I can get.
00:21:31.326 --> 00:21:41.297
Why the door open or they run down there, down to the valet parking where our car is, and I get on backwards because I'm crowning, so I'm like riding on this, so you don't spit on your baby.
00:21:41.297 --> 00:21:43.728
I don't spit on the baby, I'm sitting on it backwards.
00:21:43.728 --> 00:21:56.451
They go me up, I start pushing in the elevator, they wheel me into the room and they go to the midwife who was actually the same midwife that birthed my second child and they were like your patient in room two is, you know, crowding, and she's like I don't have a patient in room two.
00:21:56.451 --> 00:22:03.852
They're like, yes, you do, and they came in, caught the baby and actually she got there to catch.
00:22:03.852 --> 00:22:16.124
That's amazing, yeah, and it was amazing Sierra, she was great and amazing Sierra, she was great.
00:22:16.124 --> 00:22:17.352
And then I like so the baby was born, it went great.
00:22:17.316 --> 00:22:18.690
I did this for my fourth kid, but I would have for the other ones.
00:22:18.690 --> 00:22:21.406
I asked for an epidural for my placenta because I hate passing the placenta.
00:22:21.406 --> 00:22:22.150
I hate it.
00:22:22.150 --> 00:22:23.674
I hate when they like help it come out.
00:22:23.674 --> 00:22:31.289
It's so painful to me and I'm like so overstimulated, my body's done and I'm like don't want to get this out and I was like can I have an epidural?
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