Know Your Birthing Options


Know Your Birthing Options

In today’s episode, I’m talking with doula and co-founder of Carriage House Birth, Lindsey Bliss, about natural birthing options. She shares what a doula is and does, what it’s like to work with one, and why it’s important to understand your options and rights around birthing.

We also discuss the challenges around reproductive injustice, the common myths about giving birth, and how mothers can prepare for pregnancy, labor and, postpartum in a way that is safe, comfortable, and low stress and fear.
Lindsey Bliss

Lindsey Bliss


Lindsey Bliss is a co-founder of Carriage House Birth, a seasoned birth doula, a childbirth educator, and a mother of seven. Lindsey is considered to be a multiples expert after giving birth to two consecutive sets of twins. She is the author of The Doula’s Guide to Empowering Your Birth. Lindsey has been practicing since 2009 and has supported first-time parents, multiparas, single parents, LGBTQIA+ families, twin births, medicated and non-medicated vaginal births, cesarean births, and VBACs.


Maria Marlowe: [00:00:34] On today’s episode of the Happier and Healthier podcast, we’re talking all things pre, during, and post-pregnancy with doula, Lindsey Bliss. Lindsey Bliss is the co-founder of Carriage House Birth, a seasoned birth doula who’s helped deliver over 400 babies in the New York City area, a childbirth educator, and a mother of seven. I invited Lindsey on the show today to share a perspective about birth that is not commonly or typically portrayed in the media. I think often or not I think. I know. In the media, birth is often portrayed as something that’s painful. It looks quite unpleasant, to be frank, and doesn’t really look like something that I’d voluntarily sign up for. But Lindsey is going to paint a different picture of birth and a picture where pregnancy and birth can actually be a more pleasant process, a more calm process, and one that doesn’t even have to include pain. In fact, she even touches on orgasmic birth, which is, again, in very stark contrast to what we typically see portrayed in the media.

Maria Marlowe: [00:01:54] So if you’re someone who has never been pregnant before, I think this episode will be super beneficial because you’ll get a little bit of an insider’s view into what actually goes on in the birthing process. I know for me and just amongst my friends, it seems they don’t tell you about pregnancy until after you’re pregnant. So there’s a lot of unknowns. And I think with the unknowns comes fear. So hopefully this episode will shed a little bit more light on the whole process and lessen some of those fears. And that’s for anyone who has already had a baby, I think this episode is also interesting for you because it provides an option or a path for birth that is not so mainstream and it’s not the typical medical hospital birth. Lindsey is going to share about what a doula is and how a doula can help the birthing process and what your options are for having a baby outside of the hospital if that’s something that you want to do and what those options are. I think most people don’t even realize there are other options.

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Maria Marlowe: [00:03:43] So you’re a doula, and I feel like using a doula and using a midwife have become a little bit more popular recently, but still, it’s not something… I think people have no idea what a doula is or midwife is or what’s the difference. So to start, can you explain what is a doula? What does a doula do and what is the difference between a doula and a midwife?

Lindsey Bliss: [00:04:05] Yeah, I’m in New York City, so people in the coastal areas tend to know what doulas are. New York City, Los Angeles, very familiar with doulas. A lot of places in between are just becoming familiarized with doulas. Doulas give informational, educational, and physical support. We highlight choice during the birthing process or that’s what I do as a birth worker. I really want my clients to know what they’re going to get from the experience and also help manage expectations. I have clients that are like I want a water birth. I’m like, okay, well, the hospital you chose does not have water birth, so that’s highly unlikely. Or I want to have an unmedicated delivery. Okay, well, the epidural rate there’s ninety-five percent. So the likelihood of you having an unmedicated delivery is going to be lower because the hospital’s culture is not in alignment.

Lindsey Bliss: [00:05:00] So doulas can also be advocates. We’re there to be a witness, to bear witness to things as they unfold, and the difference between a midwife and doulas – Doulas are nonclinical. We do not perform internal exams. We do not. Midwives are trained. They’re skilled professionals to help support birthing people and babies. Some of them work in hospitals. Some of them work in the home birth setting, but they are trained professionals. Birth doulas are as well but we are nonclinical. So that’s the big difference. I do not catch babies. I will not do an internal exam. You know, I won’t take your blood pressure, but I’m going to tell you to go by a blood pressure cuff and know what your baseline is. So I will advocate for people to have bodily autonomy and kind of know body literacy so they know how to navigate their experience, being a little bit more informed.

Maria Marlowe: [00:06:01] So it sounds like a doula is an educator first and foremost, and she’s there to be the guide through pregnancy. I think especially for a first-time mom who has really nothing, has no idea what to expect because that is something I want to talk about. I feel again, things are kind of changing now in 2021. But for the most part, we don’t really talk about pregnancy and birth. And as a woman, you really have no idea what you’re going in for until you actually get there. And I remember, I forget who posted this, but maybe it was Chrissy Teigen. But after the birth of her baby, she’s like, they tell you that your baby’s going home in diapers, but they don’t tell you that you’re going home in a diaper, too.

Maria Marlowe: [00:06:46] So I think there’s a lot that’s just not talked about. But okay so a midwife could also be a nurse, right? So she’s more medically trained, more clinically whereas a doula is more an educator and guide. And especially if you do want to have more of a natural birth, she’ll be the one to kind of help you know what your options are and just give you other alternatives that you probably wouldn’t learn about in a more traditional medical setting. Okay, cool. So why did you decide to become a doula? And I know you are the mother of seven children and two sets of twins. So, oh, my goodness. How did you do it? Tell us a little bit about your experience.

Lindsey Bliss: [00:07:29] Well, before I became a doula, I worked as a rape crisis advocate. So I had worked in an advocacy role supporting survivors through the hospital intake and it was really intense work. And so I had always been passionate about supporting people through things. And my first child was born in a birthing center. I had a doula. I had a midwife. It was an unmedicated delivery. I felt well educated about the process. Fast forward to my second pregnancy, which was twins – a completely different experience. A lot of fear-based care, like if you don’t do this, your babies could die. I shifted from a midwifery model of care into an obstetrics model of care, which was vastly different from my previous… Looks like it was a high-risk pregnancy and all these labels were put on the pregnancy.

Lindsey Bliss: [00:08:21] So I gave birth and during labor, I had an OB who I had never met because there were eight doctors in the practice come and say, why don’t you just do a C-section? It would be so much easier. For who? For you? The babies are fine. They’re both head down. I had a previous vaginal birth. Why are you fucking with me? So I had a vaginal birth. I had to fight for it and at the end, I’m like, you know, if I had spoken a different language, if my skin was black or brown, I would have had a very different outcome. And it was the first time that I realized and I felt very disempowered after that experience. I wasn’t allowed to have a doula. I had to have an epidural. I had to deliver by a certain date.

Lindsey Bliss: [00:09:08] There were so many parameters put on the pregnancy, which was otherwise uncomplicated. And really I felt like the care was somewhat restrictive. And I’m like, I wish that I had known more. Like you were mentioning before, I knew the baby would go home in diapers. I didn’t know I would go home in diapers. I wanted to share with other people who are giving birth all the what-ifs so that they were fully informed and they knew the culture of the place in which they were giving birth. I didn’t know the hospital I was in is a more conservative hospital. The practices are very risk-averse, defensive medicine very centered on minimizing risk. So I didn’t know that at the time or maybe I would have chosen differently. And I did for my second set of twins.

Maria Marlowe: [00:09:54] It’s interesting to learn about the history of childbirth because now childbirth is a medical event. It typically happens in a hospital and we’ve all seen it in the movies. We know what it looks like. And typically it looks like the woman is in agony and she’s screaming and it’s painful and she’s laying down and she’s getting the epidural and all that. So that is our vision of birth but that’s not necessarily, well, it’s definitely not how births have been happening for thousands of years. So can you just share a little bit about the history of birthing and what were women doing before we were birthing in a hospital? Because that’s relatively recent, correct?

Lindsey Bliss: [00:10:39] Yeah, it’s relatively recent. I mean, in the South, there were the grand midwives who delivered mostly all of the community’s babies. And then from the colonization of midwifery, and the midwives were then forced to have to go to nursing school. And they were lay midwives who delivered the babies of the community of people around them. And then once we just got more medicalized and, you know, really, white men took over… I mean, this is probably a conversation that would require a few episodes. There was a lot more midwifery, but then it was wiped out and put into a hospital, and it was made into a system that I think put profit over people.

Lindsey Bliss: [00:11:30] So the history of midwifery is that in all different indigenous cultures, people gave birth where they were. They didn’t need all of this support and this help from the medical system. And it’s wild to me because, you know, the maternal mortality rate for our country isn’t great, especially compared to very modernized countries. We are at a really, really bad place as far as our maternal mortality rates for the US.

Maria Marlowe: [00:12:05] I just looked it up because I’m curious, so it turns out up until the year or around the 1900s, all births were home births and around that time that’s when we started switching towards hospital births. So by 1938, the number of home births fell to 50 percent and by 1955 that number fell again to less than one percent. Now in the 1970s, there was a revival of midwifery and because of that there was an increased interest in home births or births outside of the hospital. But still, the number of home births to this day has remained at or below that one percent rate. So still, a very insignificant number of women are performing home births at this time. And I think part of the reason is very well because most people don’t even know that’s an option. And I do think that there is now this idea that a home birth is maybe not safe or maybe not as clean and sterile as doing it in a hospital. So that’s an interesting statistic or interesting fact.

Maria Marlowe: [00:13:22] Now about the maternal mortality rate, this is, quite frankly, unacceptable for a country like the United States, which is supposed to be at the forefront of Western medicine. We spend more on medical care than any country in the world, and yet we have a maternal mortality rate – this is based on 2017 data – of 19 deaths per 100,000 births. Now, to put that in perspective, the United Kingdom has about 7 deaths per 100,000 births. So that means we have more than double the amount of maternal births in the UK. And to maybe put this even more into perspective, countries that have a better maternal outcome and a lower maternal mortality rate than the US include countries like Iran, Oman, Turkey, Saudi Arabia, Tajikistan, Russia, Bahrain, Kuwait, Serbia, Bosnia, Bulgaria, Qatar, a whole list of countries. A number of European countries, a number of Middle Eastern countries, and when we look at some of these European, and even Middle Eastern countries, we have 3 deaths per 100,000 births.

Maria Marlowe: [00:14:44] Whereas in places like Israel, Greece, Finland, and the United Arab Emirates and places like Belarus, Italy, Norway, and Poland only have 2 deaths per 100,000 births. So the fact that our maternal birth rate is so high is, quite frankly, completely unacceptable and is alarming. Why do we fare so poorly in that department? And one thing that I’ve learned from following pages like yours and other pages about doulas and midwifery and birthing and pregnancy and all of this stuff is that the number of maternal deaths for black and brown women is significantly higher than white women, which again, completely unacceptable. So what’s going on here? What are we doing wrong? Why do we have these kinds of statistics?

Lindsey Bliss: [00:15:35] I mean, New York is 12 times higher than the rest of the country, like 12 times higher than their white counterparts.

Maria Marlowe: [00:15:43] And this is the maternal death rate?

Lindsey Bliss: [00:15:48] Maternal mortality, and morbidity rate. And it’s due to systemic racism. It’s something that… The system wasn’t built for black and brown bodies and so it’s working as it was designed. So new systems need to be built. There are all of these wonderful birthing centers that are opening. The birth sanctuary is one shouting out doctor midwife who’s doing a birthing center in Gainesville, Alabama. It’s a black-led birthing center. The narrative is being shifted, but it’s happening on a very grassroots level. There’s a lot of crowdsourcing for fundraising and it’s shifting. The narrative is shifting. But, you know, I don’t think big systemic change is going to happen any time soon.

Lindsey Bliss: [00:16:41] I think what’s happening is that people are building their own systems, their own networks of support. So funding black midwives, making sure, like we talked. You said something about midwives earlier and the midwives being nurses. Some are and some aren’t. Some are CPM, certified professional midwives or lay midwives, or indigenous midwives. So there are all different types of midwives. Like New York City, you can be a CNM and deliver in a hospital and a home birth setting. That’s a certified nurse-midwife. If you’re a CPM, it is illegal for you to practice in New York City. So there are so many restrictions, even in New York City on midwifery care. And I do believe one of the solutions to the maternal mortality rate for blackbirding people is there being more midwives and specifically more black midwives.

Lindsey Bliss: [00:17:38] So one way I feel people can uplift and support this movement is like funding a black midwife on their journey through their education, boosting their campaign. I have friends who are doing a stoop sale for one of our friends who is a midwife, who’s a student midwife who’s been going through the process and doing a stupe sale to try to raise funds. And Instagram has been a great way to raise funds. But yeah, it’s supporting the systems, these grassroots systems that people are creating outside of the bigger system, which is rooted in racism.

Maria Marlowe: [00:18:12] What do you wish new moms knew about pregnancy and birth, that you think that most people don’t know?

Lindsey Bliss: [00:18:20] That’s a hard question because I think there are so many things, but let’s see. I think there’s one thing I talk about with a lot of people, and a friend of mine always uses this analogy: It feels like a hurricane in a teacup. So most moments feel really, really big while you’re in that moment. And that’s not to minimize the moment that you’re in. Like a hurricane is a really big deal but it’s a teacup. And you’re going to move past this moment to another moment. And, you know, I thought of this just through my own experience with my first baby. I had postpartum anxiety. I had some postpartum depression. The journey was really hard because I was mourning my former life.

Lindsey Bliss: [00:19:03] And with my second pregnancy and delivery, I was a little bit more accepting of everything as it unfolded because I knew the sleepless nights were temporary. I knew that figuring out how to feed these kids was going to get situated, whether it was with my breast, the bottle, donor milk, formula, whatever. I knew the second time that I was going to figure it out. The first time I didn’t believe it. I was like, how am I going to figure this shit out? This is way too much. And I didn’t think that I would ever get through those little hurricane-in-a-teacup moments, but I did.

Lindsey Bliss: [00:19:41] So I try to encourage people to surrender and embrace chaos a little bit. Draw a really loose circle around the chaos and know that you’re going to be okay. I think the emotional space holding is the biggest part of what I do. Because you can go to a childbirth ed class. You have your care provider who can inform you of all the things. But nobody holds space for that emotional processing that happens during pregnancy, childbirth, and the new postpartum space. And then, you’re postpartum forever. I’m still postpartum, you know. Who holds emotional space for the things, the big things that come up? I’m not a therapist. But I am somebody that can guide you to resources. I can listen to you. I can witness you or help you to feel like you have the resources to do what you need to do to get through it.

Maria Marlowe: [00:20:32] Kind of like a coach in a way.

Lindsey Bliss: [00:20:35] Right.

Maria Marlowe: [00:20:35] The cheerleader and the support system and the guide just to kind of help make that journey a little easier and a little less fearful. So that’s what that sounds like.

Lindsey Bliss: [00:20:49] And I don’t empower people. They choose to empower themselves. I’m not doing it. I’m laying out some tools and you can choose to use the tools or not.

Maria Marlowe: [00:21:00] We’re all familiar with a birth in a hospital, but I think we’re not so familiar in general with the other options of home births, for example, and water birth, like you mentioned. So if someone did want to have more of a natural birth, not in a hospital setting, what are the options for that?

Lindsey Bliss: [00:21:21] So there are birthing centers. Some of them are in hospital. There might be a birthing center within a hospital setting, there could be an out-of-hospital birthing center, which is an independent facility. Then there’s also a home birth option which can be supported by midwives. There are some OBs that attend home birth. It’s a lot more rare. In California, there’s an OB and midwifery team that supports twin deliveries and all sorts of different types of births in the home birth setting.

Lindsey Bliss: [00:21:51] And then there are unassisted deliveries. So it’s a very wide range of options. The one thing that’s limiting is sometimes home birth is not covered by people’s insurance. So there’s an access issue for a lot of people. So I try to be fully informed of what facilities take certain types of insurance or Medicaid or what facilities so I know when I’m guiding a client, what resources they have and that are available to them. Because not everybody has the same access.

Maria Marlowe: [00:22:26] And so in a birthing center, what would a birth look like compared to, again, say, a traditional, you know, laying in a hospital bed type of birth?

Lindsey Bliss: [00:22:37] Typically birthing centers want you to come in pretty active labor. So they’re probably hoping your six or seven centimeters when you come into the place of birth, to the birthing center. The hope is that you’re doing a lot of laboring in your home setting as long as everything… Baby’s moving, maybe the water is broken, but there’s no meconium present in the water. Birthing centers and home births are for only low-risk birthing people. They are not for people that have any type of high risk or something, but also different care providers determine what high risk is. I had a set of twins at home and many health care providers would not agree that that’s a low-risk scenario. But my pregnancy was low-risk. It was a very uncomplicated pregnancy and delivery. So different care providers might label something.  Thirty-five and up, some care providers might say is high risk.

Maria Marlowe: [00:23:29] They call that advanced maternal age, which I just hate. But that’s what it’s called. Correct?

Lindsey Bliss: [00:23:35] Geriatric pregnancy.

Maria Marlowe: [00:23:38] Do they actually call it that?

Lindsey Bliss: [00:23:39] Yeah, geriatric pregnancy or AMA. Yeah, I really don’t like geriatric pregnancy. Most of my clients, they’re over thirty-five. I’m in New York. A lot of people have babies in their thirties and forties and have healthy pregnancies.

Maria Marlowe: [00:23:53] I know. Which is something…

Lindsey Bliss: [00:23:55] I got off track. Sorry.

Maria Marlowe: [00:23:57] No, it’s something I hate also as being in my thirties and in New York and these major cities. Yeah, I have some friends who have had their babies earlier and in their twenties and things. But, you know, a lot of people are in their thirties and their mid-thirties and they want to have kids. But it’ll be in their late thirties, even for myself. So, yeah, I think there’s definitely fear around pregnancy, to begin with. But then once you hit thirty-five, it’s like you’re going off the deep end. Your geriatric now. So I love also hearing stories of healthy easy pregnancies, thirty-five plus. Because I feel like we don’t care about those and where we’re led to believe, first of all, that the baby will have birth defects or is at a higher risk of birth defects and the pregnancy is more complicated and all of that. So, yeah, I’d love for you to share your experience, particularly on the geriatric. Actually, I hate that. Let’s not call it that. On women over thirty-five.

Lindsey Bliss: [00:24:55] I think the bulk of my clients are over the age of thirty-five. I don’t know, maybe it’s just what I attract. I’m forty-two, so maybe I attract people that are closer to my age. I don’t know. I find that most of my clients have really healthy pregnancies and deliveries. Some of them have required assistance in getting pregnant through IVF or IUI. Some of them have spontaneous pregnancies. The one thing that seems to be the common thread is a lot of testing early on in the pregnancy to make sure because there is an increased risk of Down’s syndrome and Trisomy 18. There’s a lot of different things that you are at a higher risk for but once you pass that screening…

Lindsey Bliss: [00:25:38] You know, I’ve had really healthy people have babies well into their forties. I even had a client who was fifty-two who had a very healthy pregnancy. Blood pressure went up. But when you’re 50 and you’re having babies, your blood pressure is probably likely to go up, right? I know mine does in a 40-year-old body and I’m not pregnant. But yeah, I find my first baby, I was twenty-five when I got pregnant, had her close to twenty-six, and my last baby I was thirty-seven, thirty-eight when I had her. And I see most of my clients having their first baby at thirty-seven, thirty-eight and they’re already planning multiple babies well into their forties.

Lindsey Bliss: [00:26:18] Again every single person is different. It’s individual. How many eggs you got on reserve and all that is very individual. You can’t always compare yourself to statistics. Oh the percentage of you getting pregnant at thirty-five is only 20 percent. And then if you’re forty years old, it’s 13 percent. And if you get lost in all of those numbers and statistics and averages, you’re going to lose your mind. You need to really focus on your own health and get yourself checked out and don’t get lost in Doctor Google and some of these stats. Yeah, I see a lot of healthy pregnancies, thirty-five plus. And the ones that aren’t, are managed by beautiful care providers and they have the information they need to manage a higher-risk pregnancy. But it’s usually not related to their age, it’s usually related to pre-existing conditions.

Maria Marlowe: [00:27:16] Which brings me to my next question. So if someone is thinking about getting pregnant, what are some of the things that they can do to physically and mentally prepare for this?

Lindsey Bliss: [00:27:28] Nutrition? Huge, which I’m sure you can probably echo those sentiments. Really supporting your system with whole foods. I’m a big fan of Nettles. I love using different plants to help support the system. It’s also so much more than just nutrition, though. There’s a mindfulness element that needs to happen, connecting the mind and the body to prepare. Working through trauma that sits and lives in your body because I often think we can’t let babies in when we’ve got a whole bunch of stuff blocking us. So clients that make space for a new baby to come in, which might mean therapy, might mean meditation, might mean just processing through trauma that lives in the body, you can then create space for a new soul to come in. I do find that the mind and the body are so connected and with a foundation of nutrition, really feeding your body in a way that supports your entire system is really, really helpful for people that are on a pregnancy journey.

Maria Marlowe: [00:28:41] A hundred percent. And of course, I’m a huge proponent of healthy eating and nutrition, but something I’ve definitely learned over the years, and obviously all my listeners are well aware because I’ve had so many great guests on things like breathwork and mindfulness of meditation and healing through trauma and all these sorts of things. Because nutrition is incredibly, incredibly powerful but yes, our brain in our mind is still attached to our body. So it’s all connected. And if we want optimal health, we have to focus on the whole picture and not just one part of it. Are there any sort of common ideas or thoughts about birth that you feel are not true, sort of urban myths, or just popular sentiments that you feel need to be dispelled?

Lindsey Bliss: [00:29:35] I like that question. That birth has to be painful, that’s a big one. I didn’t believe that myself until I had a birth that wasn’t painful. There’s Debra Pascali-Bonaro who has a video called Orgasmic Birth and talks about how birth could be filled with ecstasy. And I’m like, no way. There’s no way. There’s no possible way. Birth is painful. Birth is suffering. And in my own journey as a birth worker, in my own personal lived experiences, I’ve learned that it doesn’t have to be. My twin home birth, the one that was supposed to be so high-risk and all that, I had this beautiful home birth that wasn’t painful. It was intense. I pushed two large babies out of my body. It was intense, but I didn’t process it as pain because the environment that I was in felt fully supported. My anxiety was almost non-existent due to the location that I chose.

Lindsey Bliss: [00:30:36] So for me, home birth lowers my anxiety. For others, maybe a hospital will lower their anxiety. To each their own. But for me, feeling held, supported by my care providers, my partner, processed pain. It was just intense and it felt, I don’t know, the closest thing to orgasmic that a birth could be. I had my orgasmic birth. Not all of them were like that. Only that one birth was but now I believe that birth doesn’t have to be painful. And I do believe it’s in the way that we surrender to the process. We choose how we respond to it. You may not want that cesarean birth, it might not be what you chose, but if you choose to respond to it in a way that is like, okay, I’m going to accept that this is happening and surround yourself with, I don’t know, focusing on the fact that this is the moment you’re meeting your children instead of this isn’t a birth that I wanted. There’s a way to empower yourself by choosing how you respond to what unfolds.

Maria Marlowe: [00:31:39] Well, it all comes back to mindset, right? And our mind is really the most powerful thing. It’s how we see things that’s going to determine how we feel. And that changes a lot of things. Our perception of things physically changes what’s going on in our body. So I love that you brought that up. It sounds like in order to have what could be as close to an orgasmic birth as possible, it really starts with mindset and like you said, surrendering and being comfortable and ready for the whole process.

Lindsey Bliss: [00:32:14] Absolutely. I always say labor is between your ears and not between your legs. It happens between your ears. All here.

Maria Marlowe: [00:32:22] Yeah. Which is why I think it’s so important… Even for you, having your Instagram account and sharing a little bit of what’s going on in the process and all that. I think if there’s just this cloud of secrecy around a lot of it and a lot of people don’t talk about it. I remember when I was in my early 20s, one of my friends, she was the first one in the friend group to have a baby. And afterward, she’s like guys, there’s so much they don’t tell you. She’s like, you know, there are so many things they don’t tell you. I’m like, what? What do you mean? So,

Maria Marlowe: [00:32:58] I love what you’re doing and how you’re really helping people again, just kind of guide people through the process so they can be in that mental space where they’re like, okay, I’m ready. I’m not scared. I’m sure there’s always a little bit of apprehension, but in a place where you’re not so fearful and scared of the whole process. Are there any dos and don’ts of pregnancy?

Lindsey Bliss: [00:33:24] Stay away from Dr Google is one of them. That’s a big one. People go on spirals searching things like every little symptom that comes up. They search things and they end up self-diagnosing with something really awful when really it’s just a common thing that happens during pregnancy. Another big do that I really want to highlight is choosing your care provider. Choose a care provider that you are really in alignment with. Don’t just kind of like them. Yeah, they’re okay. Or use a care provider your best friend used. Really vet your care providers. You are hiring them, right? Even if you are on Medicaid and you only have certain options, you still have options. It’s just making sure somebody is illuminating these options for you. So care provider and prioritize the care provider.

Lindsey Bliss: [00:34:14] We spend all this money on weddings but when it comes to giving birth, we’re like, I’m just going to go to the hospital that’s near my house or where my friend went instead of vetting these care providers, the same way we chose flowers for our wedding or the dress. We should be doing that. And not everybody gets married. But, you know, it’s an event that people put a lot of energy into. I wish that same energy was put into planning a birth. So choosing a care provider is a big do, one that you really feel good about. Get a support team, whether it’s a doula or a family member or a friend, hopefully, somebody that’s not going to be super judgmental in this space. That’s my one caveat to that. Get a support member who’s not going to judge you for your choices.

Lindsey Bliss: [00:35:02] So what was my don’t? My don’t was don’t Dr. Google stay. Away from Dr. Google. Know the culture of the hospital where you’re giving birth or birthing center. Know the culture, know the stats. Ask what the C-section rate is. If you’re hoping for a vaginal birth, ask what their C-section rate is. Really interview your care provider.

Maria Marlowe: [00:35:22] Are there any specific questions besides that? That was a great question about the C-section. Any other questions you think would be beneficial to ask?

Lindsey Bliss: [00:35:32] During covid and this current climate, I’ve seen so many inductions, so I would ask immediately, what are your thoughts on inductions? When would you typically want to induce somebody? What are the reasons why? I would talk about that because I feel in New York City, probably in California, too, everybody was being induced so care providers could manage their patient load and minimize exposure. It was really medically managed for a period of time. So the likelihood of clients being induced was very high. So asking right off the gate, when do you typically induce? What are your philosophies on birth? See if they’re in alignment with your philosophies on birth. If they’re not, maybe that’s a sign that you should explore somewhere else.

Lindsey Bliss: [00:36:21] I do have a printout somewhere that has a whole list of questions that I send to my clients. Provider questions that you can ask. But those are the top ones that I can think of off the top of my head. And an episiotomy rate. People are also really concerned of a tearing, for good reason. So what’s your episiotomy rate? What are your thoughts on episiotomies? That’s another question and concern that many, many clients have.

Maria Marlowe: [00:36:47] So I’ve heard that eating dates before your pregnancy is supposed to be very helpful at softening things downstairs so you don’t tear. Have you heard of that? Is there any truth to that?

Lindsey Bliss: [00:37:01] I don’t know about minimizing, tearing. I do know it can shorten labor. So they say… But eight dates, and you can probably attest to this is a lot of sugar. So I think a couple of dates is probably okay, but consuming eight dates seems like a whole lot of dates to me.

Maria Marlowe: [00:37:23] Yeah, well, actually, interestingly, there have been some studies on dates, particularly around diabetes, because obviously, diabetics manage their blood sugar. But even consuming seven dates didn’t seem to significantly raise their blood sugar likely because it’s not just refined sugar. There’s obviously fiber and nutrients and other components to the date. But, yeah, something to consider. But I will say so a friend of mine who swears by it because she’s had, three kids. She said it’s fine and she told me that she told her sister to do it and her sister was like yeah, yeah, whatever. And she didn’t do it and she did tear. So she’s like, you know…

Lindsey Bliss: [00:38:03] You should have done the dates.

Maria Marlowe: [00:38:06] And what about also… I’ve heard that typically an older mother, like, again, thirty-five and above, has a higher chance of having twins. Is there any truth to that? I don’t know where I heard that from. So that’s why I’m asking. Is there any truth to that?

Lindsey Bliss: [00:38:24] Yes, there is. You hyper ovulate the older you get because it’s your body’s last-ditch effort to make babies. And so after thirty-five, your chance of having twins increases and you start to hyper ovulate. So yes, that is true. And also if you’ve had a set of twins, especially if they’re spontaneous twins, fraternal, spontaneous twins, your likelihood of having them again increases significantly. I wish I had known that since I’m somebody who had back-to-back twins.

Maria Marlowe: [00:38:59] Oh, wow. So you have seven kids. So what was the what was kind of the order?

Lindsey Bliss: [00:39:06] So number one is my stepdaughter, and she is twenty-five, so I did not birth her with my body, but she’s number one. My first that came out of my body is my daughter, Mia. She’s fifteen. Then I had a set of twins Birdie and Hazel. They are now twelve. Then I had a set of twins again, Luke and Rocco. They are just about ten and then Olympia is five. And I have bookends of singletons between the twins and that’s the crew.

Maria Marlowe: [00:39:39] Okay. All right. Wow. You have been busy but you’ve survived it all. So it gives us hope, for the ones that are still a little scared about the process. What about postpartum? Postpartum, there’s a lot of emotions going on. Obviously a lot of changes going on. And postpartum depression is a very real thing. So how could we prepare for postpartum and any tips and advice in having the most pleasant or positive postpartum?

Lindsey Bliss: [00:40:14] That’s a great question. I like to plan with my clients just as much as I plan. Well, I don’t like using the word plan, because not everything goes as planned. But I like to have my clients have birth preferences, postpartum preferences, or a bit of a plan. Like what’s your lying in plan once this baby comes? I also like to have them talk about intimacy if they have a partner. What’s your intimacy plan with your partner? Because once a baby comes, stuff changes. But we’ll focus on postpartum here. But I talk a lot with my clients about postpartum.

Lindsey Bliss: [00:40:46] Again, using marriage as a reference, I don’t know why I keep doing this, but it’s almost like the birth is the wedding day and postpartum is your marriage. Being married and all the things that you didn’t realize, we’re going to be hard, nobody talks about that part. With postpartum, I don’t think people plan as much as they should. Think about support. Who can help you, really help you? Who are the family members or friends that can show up for you fully that you’re not having to take care of? Nourishment. Nourishment is huge. I send my clients some recipes. I have them making bone broth. Some of them are vegetarian or vegan. So I have a seaweed mushroom broth that they can make. Lasagnas, frozen foods that are really nourishing in the postpartum space.

Lindsey Bliss: [00:41:36] I feel nourishment is one of the biggest things because you’re going to be sleep-deprived. That’s just a given. You’re feeding a child, whether it’s with your body or a bottle every two to three hours. So you’re having to wake up no matter what. What can you do with this sleep-deprived body that can fill you back up and that’s nourishment. I love the first 40 days book. It has wonderful recipes that I have clients put a little post-it on and have them care for them. But food is probably the biggest thing I focus on in the postpartum space. My clients, that have mental health struggles already before they give birth, we talk about what support do you have in place? Postpartum. Do you have a therapist? Do you have access to a support group? What resources do you have set up for your mental health and wellbeing in the postpartum space?

Lindsey Bliss: [00:42:28] Sleep is a huge thing. Sleep deprivation, I feel, leads to postpartum depression and all of these other perinatal mood disorders. So figuring out do you need someone to come and help you over the nighttime with the nighttime feeds? Do you need a family member to stay with you and help you protect your sleep? Postpartum doulas can come and do that. They take your little one and soothe the baby while you are getting protected sleep. That’s a big thing that postpartum doulas do and family members that are actually helpful. But I really think nourishment is number one. I have all my clients do a meal train. And they’re like, well, isn’t that like food charity? I’m like, no, it’s not at all. It’s like having your postpartum registry of a baby registry. Here’s your postpartum registry. Bringing nourishing foods. So I’m really, really big on that.

Lindsey Bliss: [00:43:18] And I talk a lot about the pelvic floor because the care provider doesn’t really talk about it. It’s something that isn’t prioritized in our country. I interviewed somebody from Sweden and they’re like, oh, well, we have this package there where you get however many months of postpartum pelvic floor support. And I’m just like, oh, yeah, here, we don’t get that.

Maria Marlowe: [00:43:41] What is that? What are they even doing for all those months? So what would that mean exactly? Like just doing the exercises?

Lindsey Bliss: [00:43:47] Just being aware of your pelvic floor prenatally and postpartum will help you to learn how to strengthen the pelvic floor. People have light bladder leakage and are so embarrassed by it that they’re even afraid to tell their care providers because we’ve attached so much shame to our postpartum bodies that we don’t even talk about the things that can happen. You can have painful penetrative sex. There are different things like hemorrhoids, varicose veins in the vulva, all sorts of things that are connected to the pelvic floor and pelvic floor health.

Lindsey Bliss: [00:44:22] I have L4, L5 herniation in my spine. I guarantee you it’s due to my diastasis which is the separation of the abdominal muscles. I also have a herniation of my belly button. I spent years like this, breastfeeding babies. I leaned over and so my posture is directly related to my core and my pelvic floor. And we just don’t talk about that. We don’t talk about what. So now the babies here, you can ignore it a little bit to like, oh, bring me the baby. Where’s the baby? Nobody gives a shit about you. They want to see your kid and the body gets neglected. You build resentment like it’s this vicious cycle.

Maria Marlowe: [00:45:02] I’m glad you said that because that’s something I was reading,  a natural pregnancy book by Dr. Aviva Romm. And she said the same thing that you did. Is that…

Lindsey Bliss: [00:45:12] Aviva’s great.

Maria Marlowe: [00:45:12] I love her. She’s a midwife, turned MD. But she talks about the same thing that you said, which is, yeah, everybody wants to see the baby and everyone forgets about the mom. And the mom needs just as much attention to make sure she’s getting nourishment, to make sure she’s getting sleep, to make sure she’s okay. So that’s really important to have that support system around you that’s also going to take care of mom.

Lindsey Bliss: [00:45:38] Absolutely.

Maria Marlowe: [00:45:40] So is there anything else? I feel like for me because I have not went through childbirth yet there are so many things that I just don’t know. So I turn to people like you to learn. I turn to books to learn. I’ve only read half of this Aviva Romm book so far. What are the questions I’m not asking or what are some things that you think are important for anyone thinking about pregnancy?

Lindsey Bliss: [00:46:04] Do your research, read some books, ask your friends, but also be very careful about the stories they’re sharing and that they’re not just trying to unload their trauma on you. I think storytelling is so powerful, but make sure that the people that are offering their stories, like I said, aren’t just unloading their trauma. But ask your parents if they’re still with us or if you are connected with them, what their birth story was with you. Get connected to birth in a way that is intimate instead of… What do we know of birth? Have you ever been to a birth before?

Maria Marlowe: [00:46:47] No.

Lindsey Bliss: [00:46:48] And most people haven’t. What do we know of birth? What we see on the movies like your water breaking in a very public place, people screaming, and then a three-month-old baby comes out. We don’t see birth, we don’t know birth. I mean, but the thing is, we have a cellular memory of our own births. So we’ve been there. We’ve done it. We’ve just been desensitized in thinking that we don’t know anything and we don’t normalize births. So my goal for people that are wanting to learn more, ask around like what was my birth like? Start sharing stories with people that are not just trying to unload their trauma and really hear and witness them would be a great way to prep.

Lindsey Bliss: [00:47:33] Read some books like Aviva Romm’s a wonderful resource. There are some really great books out there. Nurture by Erica Chidi is an amazing book. There are wonderful resources that are out there. Start listening to some birth podcasts. There’s a couple out there I’ve shared. Probably most of them I’ve been on and shared my birth stories. Many people, when they’re newly pregnant, want to hear all the stories. But I think that’s a really great way to prepare yourself. And if you are looking to have a birth, consider getting the support of a doula. I’m not just being biased because I am a doula. My births have been very different when I’ve had the support of a doula through the process. And I felt like it was a very important decision for me. And I believe it was the reason I had the positive outcomes that I did have for most of my birthing experiences.

Maria Marlowe: [00:48:24] Yeah, I do. From what I have been reading, I think it is very important to choose your birthing team and it is a team. You know, there are multiple people involved like a doula. Even you said you had a doula and a midwife when you delivered one of your babies. And then obviously, if you are using a doctor and Ob-gyn make sure you get along with that person and make sure you do have a similar philosophy because you definitely don’t want someone you’re kind of butting heads with. What about after the birth? I’ve been reading about lately the clamping of the umbilical cord, which was traditionally in the hospital setting, done very quickly. But now, people are waiting a little while, I think, I don’t know, it was ten minutes. And then some people are leaving it on until it falls off. So anything that you can share on that topic?

Lindsey Bliss: [00:49:15] Yeah, delayed cord clamping. So what it does is allow for the blood volume from the placenta to go back to the baby so the baby receives the blood volume back in their body. Many care providers will do two minutes. So they used to not do any. They used to be cut right away. They’ve done some studies. They believe that two minutes, I think, ACOG had a study that said two minutes is it because if you wait longer, there is an increased risk of jaundice for the baby, which is true, but it’s only a very slight risk. So in hospitals, you’ll see about two minutes, some care providers will do a little bit longer. But you’re going to have to kind of push with them, you know, and really advocate for yourself.

Lindsey Bliss: [00:49:58] In the home birth setting, they’ll leave the placenta attached 15, 20 minutes. They’ll sometimes even do the newborn exam with the placenta still attached. And then some people do a cord burning to separate the birthing person and the baby. Sometimes a partner will cut the cord. Sometimes the person that gave birth cuts the cord. But there seems to be a benefit because the baby receives more of its blood volume back. I did an experiment with my twins. Baby A came out and they had to cut Baby A very quickly because the risk is more with baby B because there could be a cord prolapse and the baby could change positions. The cervix, they could just get more… They want baby A out of the way so they could birth baby B.

Lindsey Bliss: [00:50:40] So baby A had no delayed cord clamping. Baby B, once baby B was out safely I was able to have, I think got about five minutes and I was able to compare them. This is just anecdotally. This is my study that I performed. Baby A was really pale and it took her a little while to come into her body. Baby B was so pink. Her color, everything just looked better. So that was my one little personal experiment that I did. And then with my home birth, it was delayed probably fifteen to twenty minutes before I cut the cord. And there are also people that do lotus births and there are more spiritual reasons and why that’s done. And for folks that are interested, you can Google it. Robin Lim wrote a book on it. I forget what it’s called. The title. But Robin Lim is a midwife who wrote a book on the placenta.

Maria Marlowe: [00:51:35] If you can leave our listeners with just one piece of advice on how they can live a happier and healthier life, what would that be?

Lindsey Bliss: [00:51:44] Embrace chaos. Surrender and embrace chaos.

Maria Marlowe: [00:51:52] For more from Lindsey, you can find her on Instagram at @carriagehousebirth or @doulabliss. She also wrote a book called The Doula’s Guide To Empowering Your Birth, which I will link to in the show notes.

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