Skype Call w/ Dr Eden Fromberg
Welcome dr eden eden, we're here with uh there's actually three of us are pregnant. Three of us are not some of us some our mommies we also have to moderator's one whose mommy of too so and in the worldwide audience there are many people expecting hoping or post natal and so lovely it introduce who you are, what you dio and just let's start the dialogue. Okay? I'm dr eaten from bird and I am an osteopathic physician and I'm board certified in obstetrics and gynecology and I'm also board certified in holistic and integrative medicine and my practice is in new york city at soho beach. Julian and I also have a yoga and meditation and movement studio called leela yoga dharma and wellness that's not far from my office and I see a lot of people right now who are either pregnant or who have gynecological problems involving off involve our public and sexual pain actually and I do work in bali. I work with robin lim I've been going there since nineteen ninety seven and it's wonderful to have se...
en that project grown it's called yayasan bumi saha can you slow down and say that last thing again so uso so and explain it robin lim is and then say the project really slowly because it just flew by my ears okay, so I also work in bali with robin lim she's, a midwife who won the cnn hero award in two thousand eleven, and she runs a clinic, and the foundation is called yayasan bumi za hot yayasan just means foundation in indonesian, and she also has a clinic up in aci where that tsunami happened, and people are still really struggling there. Wow, and so can you tell me a little bit about the work you do with? I'm really curious, personally, but the work you do with midwives, and the type of what you see culturally in birthing practices in indonesia versus birthing practices that you see in hospitals or home births in new york city, they couldn't be more different, it seems to me, it's, it's, extremely different and what's really striking is how much culture does influence childbirth, and I first became aware of this when I was in my residency and I was working in an inner city philadelphia neighborhood, and so people of all ethnicities, we're coming in, and it was clear to me that somebody from vietnam, even if she was making no sounds, didn't look like she was uncomfortable. You better check really quick, the baby's head might already be out versus on american woman who would verbalize and vocalize quite a bit more, and the other aspect is how we manage birth or you know, support birth because it's not quite the same thing in in american and western culture there's a lot of giving up the power of birth to experts and the experts don't seem to really remember a lot of the important things about birth that the midwives are remembering so there is a god we're free in the us but made with frickin bali is quite different in fact robin began her midwifery practice more at the encouragement of the community they had lost some of their traditional healers and the women were going to the hospital and when they got there they were discovering that they were mistreated in childbirth and there were me till I flat on their backs which they did not want to do they were separated from their families and they were I'm treated plea they were given no anaesthetic he just and um it was a big problem to the hospital and wait for them in labour and the way she started her midwifery career is essentially that the doctors were busy watching the world cup and they want eighty doughnuts and watch so they said go deliver babies and she started career that way and the project tone and blossomed and what it is is that when women are in labor there is a very important cascade of neurotransmitters and hormones and one important hormone is oxytocin and that's, the hormone of love and attachment and in western obstetrics all culture this is not really valued way just give chitosan in obstetrics we just overwhelmed the whole process and there are a lot of problems and implications when that happens you were speaking before about this so as muscle will the soas muscle is so important when it comes to labor and delivering the baby because the pso has muscles are very bio intelligent they're almost like the barometers of our entire neurological and hormonal state and if we are afraid and way feel that there is danger are so as muscles will tense up and they will become like almost wiry and they won't really participate and so one reason that a woman may not goingto labor or have a slowing of labor is because of ten so as muscles wow isn't for this is in part but she's not cripple in her surroundings but it's all because when a woman's lying flat on her back his muscles become non participatory and the other thing that makes the soas muscles in on participatory is epidural anil jesu which most american women received now during childbirth wow just stopping at the so his bomb is it's so um I'm sure all of you you're so is theirs you know because now we've seen it on the skeleton we've palpate it from the inner fi if you're able to get it up that high just to recognize that of course there is a an intimate structural relationship with your ability to function well during childbirth and just just actually even just hearing her say oh yeah so is this could just be a massive inhibition for you being able to have a peaceful rest for labour and then there are, um implications when overmedication happens into your tissues that you lose that function we got a little bit cut off when you were talking about the soa is and I think all of us and here our minds just started going like racing about you know, just the implications of how uh how certain labor and delivery practices discount that natural the natural function of being able to have commandment of your own soft tissues yeah, I mean it's it's really it's really very a huge because the way that a woman is supported in labor makes all the difference the middle I find to make asking talks about sphincter law in which essentially if ah woman or even a wild animal is afraid the sphincters will shut down. That includes the sphincters that need toe open for birthing and this is normal it felt animal was behind a bush trying to give birth and a scary predator came along the birth process for survival purposes with stop so that the animal could move to a location of safety and then continue with the process and so what happens is weii known now that cat a colon ease the stress hormones, the fight or flight hormones, the ones that turn on this so as muscle, they really don't come into play during a normal labor until the very end, when the mother really has toe push ini jack there's, a fetal ejection reflex even that kicks in and that's when the soe s muscles need to kind of clamp down. But until then, the sores muscles really must be in a very bio intelligent state of perceptive if men in which they're participating in the birth process very much so the baby spirals out and this is actually very important and setting up the baby's own neurology for a lifetime. So the so as muscles are spending the baby, the baby smiting within the birth canal there's a dialogue between the baby and pelvic floor going on, and all of this contributes to the birth process the hormone oxy toast in which is released in a pulse. A tile fashion from the woman's pituitary gland participates in this process, and we know that when the so his muscles are open there's a lot of oxy toasted in the body in a sense of safety, and that sense of safety is very, very important during the birth process, but what happens in many labours, especially in a western culture or in models such as what we find in bali, where there is a traditional culture of birthing butt in the hospitals. They're trying to adopt more of a western cultural birthday, so I always say, don't discount those first world problems they're getting exp ported elsewhere, we really have to deal with them and so putting a woman flat on her back and what we call a dorsal academy position. It's not supportive of birth because it shuts down the activity of the so as muscles, and it also shuts down the diameter of the pelvis by up to a centimeter versus squatting. And the other thing is that epidural anil jesus, which most american women opt for nowadays, it stops the so as mussels from beating participatory it renders them flashing and nonpartisan. Torrey and so all of a sudden, labor may slow. Labor may stop at vigils are known for causing this and the other thing they can cause his fetal distress because all the innovation to the uterus through the soe s muscles. A lot of those nerves penetrate it's, not the same message anymore. And so the birth process often installed there's pick tosa and there's, an artificial hormone. Actually that can be used, but it doesn't have the same effect as the oxytocin and the endorphin rush, those of the sort of narcotic like hormones that come after birth. And the rush of oxy toasting the highest amount of oxytocin the hormone eleven attachment that a woman will ever have in her entire life is after she gives birth and she's listening out enjoying I'm in love with her baby and I think that there are definite consequences to robbing our families of these processes. What we're finding is that instead of babies coming into the world and the neurologically relaxed state, they're coming in startle, they're coming and startle and its implications for this this is not how being should be starting out their lives. Dr eden, this is sally I'm one of the hosts I have a question from me I had my first baby fourteen years ago um and you mentioned mentioned oxidize and we're talking about oxytocin within the context of love and attachment and I have a question during birth I was told it brought on contractions and the doctor said I had to have it in the midwives were really unimpressed and ended up bringing on ly that completely but I didn't die light addle so I ended up, you know, two days later emergency sees a baby and intensive care for three days so you saying that they is a place for oxy tyson in that inducing labor section or do you think that that actually helped shut down my body's ability to pop out? Said child well the difference is natural lexie toast and produced by a woman's own pituitary gland versus in federic katsuhito sin, which is called chitosan, which is usually given with an intravenous drip or sometimes bye intra muscular injection or by other means they're different. When the woman's brain is producing, it is being produced in very calibrated amounts based on conditions at hand, so as labor progresses, it's calibrated, exactly tow what's needed, whereas when it's given through an I v human being has to go and do side to punch in a few numbers on an I v pole and think, well, we'll double it in this amount of time, and then we'll double it again and we'll see where it goes. And actually, the half life of synthetic potosi is about forty five minutes, but they're usually upping it every ten or fifteen in my experience, so the contractions can become quite strong, even too tannic where they really won't let go. And this leads to a lot of fetal distress and cesarean section. So it's not that you didn't need oxytocin, the hormone it's, that they felt that they wanted to give it to you through an exogenous route from the route outside of your own body in a different model of birth, such as what we call the midwife's model of care, they might get you up rock your body there are actually hands on techniques to release the so as muscle I work with a teacher named liz cook out of santa cruz, california who she's taught me techniques that I can you use with my hands to help release so as mussels and that helps induce labor actually quite well, so there are other ways too stimulate oxytocin and released the pso has muscles without trying to overwhelm the process with artificial synthetic drug that doesn't work the same anyway and has a lot of potential risks way had a question coming dr fromberg, this is evelyn and I'm another one of the hosts hear we had another question come in about how epidurals if they are bad, would that be the next best thing for um painkillers refer to relieve that pain what you're what you're explaining right now or is there anything else? Yes, well, there have been some studies done actually, and they show that epidurals or approximately seventy eight percent effective in relieving pain to the extent that the woman wishes, meaning that there are still a lot of room for needing to have other coping scales and not only coping skills but there are other things that you could do for example, hydrotherapy, which means just getting in a tub of water we are fluid bees, we emerge from the water, our bodies or bio intelligent and when we're in water it actually helps the tissues relax and release and a lot of women and the studies have shown over ninety percent of women who do use hydrotherapy or birthing tubs and labor have significant relief and feel much better and more empowered in relation to their pain are discomfort and having supported people on hand they're different acupressure points in massage points that people can really massage getting into different positions squatting there are many different things that people khun dio before resorting to something like an epidural which is essentially a drug derived from cocaine injected into the back which is hardly safe and labor everyone wants labour to be safe and is concerned about safety but it is not safe to put these drugs into ah laboring woman's body by any means um thank you and wall where because I'm sure the studio audience have a lot of questions so I while you're working out your questions I'm gonna put one more out there that this question actually came in yesterday and it was deferred to write your opinion so thank you n e w said that she had a c section for a failure to progress she had issues with her aside joint and the muscles in that area she's pregnant again and she wants a vaginal birth so what if some basic things that would help her go from a c section history to the possibility of a vaginal birth yes um knowing very little about her history other than what you mentioned about her hip I would say that that may be something to focus on in western culture we often don't squat very much in our daily lives and some prenatal yoga programs that are actually discouraging squatting is something that I've discovered but sweating is very important so you know she may want to analyze what the issue is whether hip joint and work with a hands on therapist or some therapy balls or something to help the hit but you know that would be something that I would focus on is getting into squatting which really expands the pelvic floor like nothing else and you know working on the hip in that regard I mean there's so much to be said depending on the individual circumstance great thank you thank you do you guys have any questions for dr absolutely their forms of pain relief lesson basic an epidural such as nitrous or there's nothing with the letters e that I'm thinking of zepa dolor ste something that you may recall it's like it's kind of it's a kind of sedative all right well there are definitely different um drugs and techniques and so since I discussed the lesson drug oriented ways I'll discuss more the drug or in two ways but there are various narcotics you know they there are issues with all of these things you have to remember that there is this very specific neural hormonal physiological cascade that's going on when a woman's in labor and it's very finely tuned and once you throw something else into the mix it doesn't work the same after that it's almost like this cascade of slippery slope of interventions that's often talked about in obstetrics because one thing will lead to another so although there are other methods nitrous which I really don't have that much experience with inhalation anil geez, I don't have too much experience with but I have used a lot of narcotics and labor yeah, they make women throw up, they take them out of their bodies their disassociative um so they're not my favorite but I guess if I was going to give any drug and labor the one that I used to give um was vis toral mistral it's not a narcotic drug so it doesn't have that same effect um so that was one that I used to use that I felt a little bit better about less side effects. Amazing. Well, thank you very much, todo we have another okay? And I'm just starting to try and get into figuring out, you know, all the all the information says oh, you have to decide what you want so you can communicate it to your doctors and the people there and it's sometimes I feel like I don't even know oh where to start you know I know I know I want to try and have a natural childbirth whatever that means but I don't even know what questions to ask you know what my pro or con this but I don't even know what this is to figure out if I'm going to be pro or con against it so I was wondering if you had any sort of kind of general ideas or you know somewhere to start that I could try and figure out you know what questions do I what questions do you wish me well what before they get into that situation well every room no it is important well, you know, I should just mention there is something called a birth plan that sometimes people show up with and this is something that generates a lot of eye rolling and many hospitals because you know the idea that there is a rigid plan and that all of your you know wishes will be fulfilled maybe unrealistic but that being said it's important to have providers meaning doctors midwives who will support what your wishes are so it's kind of important to figure out what they are because otherwise you get whatever the default is and an american obstetrics that default is often highly inter vented birthday experiences that the two high rates of caesarian section and surgical delivery and there are definitely risks in consequence to that so my thought is definitely you should consider avoiding surgical birth unless it's necessary and what is necessary. Meanwhile, this is also something to khun sitter. There are some really good books out. I really like the aina me gaskin books like birth matters, is one of her latest books very well documented. Lots of great info. And the title of the next book on mentioned is great thinking. Woman's guide to a better birth by hence ee gor tio, we are out of canada, but just the idea that we can think about these things and, you know, make different decisions about it. So what are some of the things that you want to think about? Um, are you going to be staying home if your water breaks? Or will you be asked to come to the hospital immediately? Well, they induce your labor immediately. Or will you be given some time to hang out and see what happens? What are their thoughts about inducing labor when you come to full term, what do they consider too late or post states? Um, do you want them to not cut the court immediately? I mean, that's, a really important question. Because a lot of obstetrics providers, contrary to scientific evidence, are still cutting the court immediately at the time of birth, whereas we now know that neonatal anemia and associate id deficits and brain function and learning issues can occur from doing that I mean, why would you want to cut off the blood supply to the baby that's helping to feed iron to the baby's brain? It makes no sense and the scientific literature or supports this so you know you want to know what what are their thoughts about cutting will they were until the court stopped don't that may have consequences. What are some of their policies regarding on cutting of the pz autumn e do they have you strapped to a fetal monitor? Do they allow youto have mobility in labor? Are they opened having you squat and getting down on the floor on their hands and knees to deliver the baby? Or do they have an alternative position where they will feel comfortable delivering the baby? You know, options to move changing position is there a tub? Um you know will you be the one who will be there? Will there be, you know, changing of shifts and then what happens afterwards? You know, some hospitals will whisk the baby away and you don't get to even see your baby for an hour or two sometimes and that makes no sense you really need to bond with your baby afterwards and all of the resuscitation procedures can be done in the room where the baby is born even in the caesarean section if the team of providers is willing to do it they can drop the dream during a cesarean and hand the baby to u s so that you can hold the baby after the court is cut they couldn't do the resuscitation on the belly um a lot of policies and procedures that happened in obstetrics I came about much for the convenience of the people working in the field I mean think about it american medicine and you know, think about the nineteen fifties where if it was essentially knocked out and unconscious during labor it's not like that's completely gone now I mean just there's been a lot of consumer demand and we want you know, to be awake and see our babies and be treated nicely, but there is still this disconnect and it's been written about in the medical literature about how when it comes to women in labor they're it's like it's kind of a human rights issue there where people are not respected and so I realized that the people who are very nice to you while you're you know, seeing them in the office sometimes change a bit during labor I've definitely seen obstetricians bully women say very disparaging things to them um say things like well, you know, of course you need an a p ziana me because how can you squeeze all those potatoes in the sack and not expected to burst at the seams I mean, if people are going to be making a lot of dis empowering statements to a woman in labor, that's going to affect her psychology and it's going to affect her emotions, and it's going to affect that whole neural hormonal cascade that we were just discussing just to feel like crap, so that is definitely not, you know, okay, so you want to feel comfortable of the person who is going to be there at your birth and bring supportive providers, bring, you know, your husband or partner, you may want to hire a doula. Doulas are actually shown to reduce caesarean section rates and have a high degree of satisfaction on what a doula is. A person who joins the mother and labor to exclusively provide her with support and do a made me know different birth positions that a woman can get into and support her with rocking vocalization, undulating movements, different things, and also somewhat run interference between the providers and the family who's giving birth, meaning that if there's an intervention that might be suggested, they can help translate the medical language and helped the woman consider that from maybe an alternate of perspective than the completely medical model, and so, I think, a duel it would be good and, I guess, last but not least. If you're twenty two weeks childbirth classes, they're probably coming up and that's a great place to explore all of that because hopefully in a good childbirth class they will roll out all of the different possibilities that could occur whether it's a home birth or a hospital birth different interventions that may or may not happen and really give you ground in which to consider these things and ask questions of somebody knowledgeable great great way have been getting more and more questions in the chat rooms as we've all been talking and everybody is very enthusiastic look so actually we had a question for you when you were doing some of the stretches sure, since I'd asked you to maybe further explain the external rotation and standing shouldn't quite catch it and you want to make sure that she was following along. So this is something that we started talking about yesterday is to be able teo create some tone iss in the buttocks that also helps to draw that helps too add some tone iss in the pelvic floor when we're about to take action so in terms of that stand position that you're most stable when you're creating a little bit of activity of external rotation and so that action is attempting to turn your feet out like a duck but actually not doing so and this is a great way to stabilize the entire pelvis at once there are obviously there's there's more nuance is teo all of this and there are other tissues that that I could call out but as a very, very simplistic you set this a really great way to establish and re established and effective stand position sure and as we've a cz we've heard also from esther also the you know, the the gloomiest maximus that goody all muscles they need to be super strong they are they are your pelvic girdle support kelly reiterated this katie reiterated this this is this is the this is the basement when you squat the basement when you squad is not your knees and it's not your quads it's your hiney and so this is just a way to keep reinforcing the power of the push from the tush. Great! We thought we might try to squeeze one more question and just while we have dr fromberg with us really appreciate that britney yoga nurture asks if if you would explain to her what you what your thoughts are on antibiotics for those who have been tested positive for group b strep in terms of group b strep group b strep is it's ah very common bacteria that lives a za colonizing flora on women's skin it's on our hands so one niner five women around the time of birth will test positive for group b strep and the main consequences if the water is broken for any length of time and the baby may acquire the infection so antibiotics are given the protocol is to give anna ivy antibiotics during the labor to prevent any transmission of groupie struck to the baby. Um, I feel that it's it's hard to really dispute that, but there are alternative protocols the alternative protocols don't have to do with testing everybody they have more to do with treating with antibiotics and more selective manners, such as when the water has been broken for over eighteen hours, is often in number that I've heard quoted. But people do have different protocols on this and some midwives that I know they do give clear sin, which is on an intra vaginal antibiotic in an attempt to decrease the colonization, even though supposedly it should be given during the time of labor they're awesome alternative protocols being used and, you know, so those air, some different options you might consider great? Well, we all wanted to really thank you for taking the time to join us today, everyone in our chat rooms and here I live really, really appreciates your insights and your knowledge, and you sharing that with us. Thank you so much for taking the time you're an encyclopedia, and I think all of us want a private consultation, and we will all get on the plane and fly to new york. And go to soho, o b, g y end and make an appointment before we have our children that's. Wonderful to see you. Thank you so much for taking this time. Everyone take a really deep breath, a cleansing abdominal, jurassic breath, it's, a lot to take in and and I'm feeling you at, you know that I met twenty four week mark, and just at that point, we're about to tow, take a, you know, birthing class as well, and, um, found a doula to help us out, and you're obviously, I'm sure you've got your team all set up and ready to go. I don't mean work has been so awesome. This is the great book that I'd recommend. Ninety means guides a child birth. I've heard this again and again. She has the whole questionnaire at the back of the book, things to ask providers, which is wonderful, too.