Born Free Method: The Podcast

In this solo cast, I am not looking at data and reviewing journal articles. I’m pontificating on how we might reimagine the birth of children through the lens of “safety”. The nervous system responds to our environment, so the environment - including external inputs like sound and internal inputs like thoughts - will lead to physiologic changes throughout our bodies depending on whether our nervous systems are sensing safety. Ideally, we would all feel safe when the environment is safe, but this is unfortunately not the case for all adults, even in the “wealthy” United States. This is even more important when we consider a baby’s need to feel safe…To understand this in a more comprehensive way than we learn in medical school, I will be drawing on Polyvagal Theroy and the Perinatal Matrix Theory. If you’re unfamiliar, here is a synopsis of each:Polyvagal Theory, developed by Stephen Porges, PhD, explains how our autonomic nervous system regulates safety, connection, and defense. It describes three states: social engagement (ventral vagal), fight-or-flight (sympathetic), and shutdown (dorsal vagal). Understanding these helps explain trauma responses and how co-regulation and safety cues restore calm and connection.Stan Grof’s (MD) perinatal matrix theory links stages of birth to deep layers of the unconscious. He describes four Basic Perinatal Matrices (BPM I–IV): blissful womb, constriction, struggle through the birth canal, and birth/release. These stages shape emotional patterns, trauma, and spiritual experiences throughout life.The environment within which a baby develops is critical. We know this. So why wouldn’t the environment after birth matter just as much? And if we were to prioritize the optimization of the birth experience - for both the baby and his parents - would this lead to widespread changes in our world?It’s a lofty claim, but I think it’s possible. Enjoy this exploration. If you like this conversation, you’ll love the Born Free Method, as this solo-cast elaborates the cornerstone of my approach to childbirth alongside my best friend (and a badass midwife) Sara Rosser, CPM. You can access over 60 hrs of pre-recorded lessons (w/ slides) spread out over 180+ lessons when you enroll. You will also be invited to a Zoom call (recorded) every other week hosted by me, Sara, and both. We also often have guest speakers, and you will have access to recordings for all 100+ of our past calls/interviews. 12-month access is $750Lifetime access is $3997 (plus you get direct support from me and Sara for life by phone/text/email/whatever)We also offer a Fertility Deep Dive ($499) if you just want to focus on pre-conception planning and fertility, but this content is included in both of our other offerings above. We have payment plans available for the lifetime package, and we have discounts available for any of our programs for students and birthworkers. Just shoot us an email: support@bornfreemethod.comNotes for this episode are found on SubstackWork with Nathan:Support for Midwives | Private Consultation | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Trigger warning: This conversation exploring the depths of stillbirth. I met MaKayla Wonder a year or so ago, soon after she and her husband, Adam, experienced the devastation of a stillbirth. If the news of realizing their baby, Declan, had died in-utero wasn’t bad enough, their treatment in the hospital left them shattered, which brought them to the Born Free Method community. In this powerful conversation, MaKayla and Adam share the layered story of her journey to motherhood—one marked by the heartbreaking stillbirth of her son, Declan, and the redemptive birth of her daughter, Heidi. With honesty and grace, she recounts how fear, cultural conditioning, and a chaotic hospital experience left her feeling abandoned in her first birth journey. Seeking a different path, MaKayla turned inward, trusting her intuition and embracing the Born Free Method, which helped her heal and reclaim her power. Her story is not one of simple tragedy or triumph but of integration—holding space for both sorrow and joy, death and life, within one sacred womb. Through vulnerability and courage, MaKayla reminds us that birth is not just a medical event, but a profoundly spiritual and emotional rite of passage. This episode offers a tender and transformative look into the resilience of the human spirit and the wisdom of mothers. Here are some main topics we covered:* The Duality of Birth and Loss: The emotional complexity of holding space for both the grief of losing a baby and the joy of welcoming another.* The Impact of Medicalized Maternity Care: Reflections on the impersonal and disempowering aspects of her hospital experience, including a lack of support and clarity during her stillbirth.* Intuition vs. Intervention: MaKayla’s growing mistrust of the conventional birth system and her shift toward a more intuitive, personalized approach to pregnancy and birth.* The Born Free Method’s Role in Healing: How the support of the Born Free Method community helped her process her trauma, rebuild trust in her body, and approach her second birth with intention and support.* Honoring Both Stories: How mothers can integrate seemingly opposing birth experiences into a unified narrative—one that honors the child who died and celebrates the child who lives.This interview was a follow-up to an anonymous conversation with Makayla prior to her conceiving and birthing Heidi. That first conversation is available in our FREE Pregnancy Loss program also available at www.BornFreeMethod.com. If you’re interested in enrolling as a midwife or a student or if you’re a birthing family looking for support, head to www.BornFreeMethod.com. Code STUDENT50 gets you 50% if you enroll in the month of June!For our comprehensive digital playground, live calls, and lifetime, direct support), we also offer payment plans! (3-month and 12-month options)If you aren’t ready for the full investment, we offer a less-pricey but more limited Fertility Deep Dive. You can also pay a monthly subscription to simply attend our twice monthly live calls (and view past recordings).www.BornFreeMethod.comNotes for this episode are found on SubstackWork with Nathan:Support for Midwives | Private Consultation | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Born Free Method has undergone a makeover…a massive makeover. Our pet project is now the most comprehensive pregnancy support program on the planet, including 60+ hours of lessons, twice monthly recorded group calls (and access to the recordings of all past calls), a private community forum, and direct access to Nathan and Sara for life. After we had a moment to decompress from this massive undertaking, Sara and I sat down to reflect on the journey of launching Born Free Method back in May, 2023, and then rebuilding the whole program based on the feedback of our community and new insights from births that we have attended since the launch. The Born Free Method can best be described as a digital playground for seekers—students, midwives, birthing families, and misfits alike. Through our thriving community at the Born Free Method, we honor imperfection, speak to love and surrender to the current of childbirth. Through it all, one thread has emerged above all: community matters. The “data” or any curriculum proposed by a childbirth support program pales in comparison to the connections forged from direct support by an OBGYN and a midwife to birthing families, where stories are medicine, and transformation begins with telling the truth. This conversation dances between birth and belief, method and mystery. We explored public perception of birth choices, breastfeeding, and the brave work of reimagining maternity care. Amid reflections on family, mentorship, and fractured systems, a deeper current ran through this conversation: our ongoing courage to question, to hold space, to show up. And as a bridge between worlds…we are bound to get stepped on, which we discuss as well.Here is a sampling of what we cover in this conversation:* New updates to the Born Free Method, now redesigned as an interactive, self-guided platform with comprehensive explanation of low- and high-risk pregnancy and birth scenarios.* Reflections on the program’s evolution, emphasizing the importance of community feedback, personalization, and ongoing learning.* The importance of the supportive environment that we've built, where mentorship, vulnerability, and experiential learning are prioritized over rigid dogma.* Broader themes around faith, family dynamics, and control, linking personal stories to societal patterns of power and belief.If you’re interested in enrolling as a midwife or a student or if you’re a birthing family looking for support, head to www.bornfreemethod.com. Code STUDENT50 gets you 50% if you enroll in the month of June!For our comprehensive digital playground, live calls, and lifetime, direct support), we also offer payment plans! (3-month and 12-month options)If you aren’t ready for the full investment, we offer a less-pricey but more limited Fertility Deep Dive. You can also pay a monthly subscription to simply attend our twice monthly live calls (and view past recordings). www.BornFreeMethod.comMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Dr. Sarah Pederson is founder of Vera Fertility where she uses Naprotechnology and a restorative reproductive health approach to find and treat the root cause of hormone imbalances and infertility. Rose MacKenzie is the Clinical Manager at MiraCare.com, where she assists healthcare professionals in effectively integrating Mira's hormone monitoring tools into their practices. Rose is well-equipped to provide education and support to providers and fertility awareness educators. Additionally, Rose brings nearly a decade of experience as a natural family planning instructor, specializing in the Marquette and Sympto-Thermal Methods. For more information about Mira: 1. Introduction to Mira video (produced for practitioners but also valuable for non-practitioner) 2. Book a meeting with Mira staff (for providers) 3. 20% discount code: BELOVED20 Episode is available for listening on all podcast platforms AND you can watch our interview and walk through the case studies presented if you check out the episode on Youtube.Notes for this episode are found on SubstackWork with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

I recently completed a 3-part essay series on Oxytocin versus Pitocin®. In Part 1, I focused on oxytocin and its activities throughout the conception and childbirth continuum. Part 2 focused on the increased use of synthetic oxytocin (Pitocin®) in the conventional, hospital-based maternity care model. Part 3 focused on the potential detrimental effects of the nearly ubiquitous use of Pitocin® in U.S.-based childbirth, considering that 98% or more of birth are happening within hospitals.Well, my guest in this interview is the world’s expert on Oxytocin. Sue Carter, PhD, has a laundry list of accolades. She spent most of her career as a professor of medicine at the Universities of Virginia and Indiana. A quick Pubmed search is very revealing…Dr. Carter is the real deal. And her research into Oxytocin was extremely helpful to this series of essays and my own appreciation for this magical molecule. This interview was also conducted as a community call with the Born Free Method community members. So there is also some live Q&A action. (If you aren’t familiar with the Born Free Method, it’s the most comprehensive childbirth education program on the planet. In fact, it’s so unique that it’s not fair to even categorize is “childbirth education”. It’s a part of a childbirth revolution.)Notes for this episode are found on SubstackWork with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

My mother started nursing at age 20, and she was fired more than once for standing up to physicians who strayed from the path. She and I were often at odds during my formative years, during which she verifies what many already know about me: I was a pain in the ass for my teachers and preceptors over the years. I was curious and often demanded deeper reasoning behind the answers I was expected to give in my many years of education. When I was fired for blowing whistles after completing my training, she wasn’t surprised. She was also concerned for me, but not because of my disruptive tendencies but rather as a consequence of her own ordeals as a health care professional who put her own job in jeopardy innumerable times over the course of her illustrious career. In this beautiful conversation with my mother, the original disruptor by the same name, we cover:Her direct experience with the corruption of informed consent and coercion (and the consequences of calling it out)Her Pediatric ICU experience and how it informed her fears around parenthoodMy birth story (and my sister’s) and the challenges of giving birth without the support of a partnerCorruption in clinical trials and the consequences of whistleblowingHer reflections on the COVID moment through the lens of her years of experience in every facet of healthcareHow her influence and integrity as a health care professional ultimately influenced my own experience as a physician and general pain-in-the-ass Born Free Method: The Podcast is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Notes for this episode are found on SubstackWork with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

This summary covers:- Prediction and Prevention of Spontaneous Preterm Birth - Practice Bulletin #234 - Published August 2021- Management of Preterm Labor - Practice Bulletin #171 - Published October 2016Prediction and PreventionFive Pearls* PTD at <34 wga carries higher mortality and morbidity risk to newborn in delivery and long-term morbidity* History of PTD is the greatest risk factor for PTD in a current pregnancy* Progesterone supplementation can be considered regardless of history of PTD* In patients w/ singleton pregnancy and history of PTD, cerclage should be offered if CL <25 mm is detected on TVUS at 16-24 wga* Omega 3s, low-dose aspirin, lifestyle modification, and smoking cessation are also important considerations in decreasing our national PTD rateBackground* rates of preterm delivery in the U.S. has been pretty stable* "Although risks are greatest for neonates born before 34 weeks of gestation, infants born after 34 weeks of gestation but before 37 weeks of gestation are still more likely to experience delivery complications, long-term impairment, and early death than those born later in pregnancy"* risk factors for PTD: prior PTD (1-2x ↑ risk), short cervical length (<20mm if no history of PTD; <25mm if prior history), vaginal infection in pregnancy, vaginal bleeding in pregnancy, UTI in pregnancy, or periodontal disease in pregnancy (treatment of any of these won't normalize risk, though), low maternal BMI, smoking, substance abuse, and short inter-pregnancy interval* in case you were wondering, history of LEEP of CKC for cervical dysplasia has not been found to be a risk factor after all according to ACOG but there are studies that support this (and my own direct clinical experience reflects the alternative)* White women have the lowest rate (9.3%), Hispanic women (10%), American Indian and Alaskan native (11.5%), Native Hawaiian and Pacific Islander (11.8%), with highest rates seen among black women (14%)Who should be screened and how?* the purpose of screening is to identify patients in whom intervention will be helpful* really the only patients who qualify for screening are those with a history of prior PTD, PPROM, multiple gestations, but ACOG feels it’s reasonable to screen universally as 5% of all women could potentially give birth preterm* a systematic review looked at 14 studies and found that:“a cervical length less than 25 mm before 16-24 weeks of gestation had a sensitivity of 65.4% for preterm birth before 35 weeks of gestation, with a positive predictive value of 33.0% and a negative predictive value of 92.0%. Sub-analysis of the studies that included only women whose risk factor was prior spontaneous preterm birth found a similar sensitivity and a positive predictive value of 41.4%”* get a baseline transvaginal ultrasound (TVUS) and repeat this evaluation every 1-2 weeks to assess for change (limited data on time interval)* measure three times, and go with the average* "fetal fibronectin screening, bacterial vaginosis screening, and home uterine activity monitoring have been proposed to assess a woman’s risk of preterm delivery" and none of them have panned out as useful predictors of PTD in asymptomatic women* recent data suggests that it might actually be cost-effective to universally screen for shortened cervix in patients without history of PTD (study 1, study 2), but, for now, ACOG states it's reasonable to offer but not necessarily recommended universallyWhen and how to prevent PTD?No history of PTD* Extensively studied as a means to reduce the risk of preterm birth in asymptomatic women with a singleton pregnancy, short cervix, and no prior preterm birth.* a meta-analysis of five randomized trials of vaginal progesterone versus placebo in patients with a singleton pregnancy, a short cervix, and no prior preterm birth was performed, including patients from the 2019 OPTIMUM (Does Progesterone Prophylaxis to Prevent Preterm Labour Improve Outcome?) trial who did not have other risk factors, and standardizing the threshold definition of shortened cervix at 25 mm or less for their analysis. Patients treated with vaginal progesterone had a significantly reduced risk of any preterm birth before 34 0/7 weeks of gestation (14.5% versus 24.6%; RR, 0.60; 95% CI, 0.44–0.82), spontaneous preterm birth before 34 0/7 weeks of gestation (RR, 0.63; 95% CI, 0.44–0.88), neonatal respiratory distress, and neonatal intensive care unit admission. The meta-analysis authors calculated that 14 patients would need to be treated to prevent one spontaneous preterm birth before 34 0/7 weeks of gestation.* Vaginal progesterone is recommended for asymptomatic individuals without a history of preterm birth with a singleton pregnancy and a short cervix. 200 mg per vagina nightly is the best studied regimenHistory of PTD:* Before the PROLONG trial (2020), a metaanalysis was published in 1990 that showed demonstrable evidence of the benefits of 17-OH-P in preventing recurrent PTD, which led to a large multicenter RCT of 463 patients. They were randomized to receive either 250 mg 17-OHPC IM or placebo, starting between 16 0/7 and 20 6/7 weeks of gestation. Administration of 17-OHPC reduced the rate of preterm birth before 35 weeks of gestation by one third, leading ACOG and SMFM to recommend this intervention universally to women with history of PTD.* Then came the PROLONG trial, which evaluated the efficacy of 17-OHPC 250 mg intramuscular injection weekly compared with placebo on preterm birth and neonatal morbidity among women with a singleton pregnancy and prior spontaneous preterm birth. Large, international, multicenter double-blind RCT. 1740 women randomized (of 1877 eligible). No statistical difference found in the two primary outcomes of preterm birth before 35 0/7 weeks of gestation or maternal/neonatal outcomes.* On April 5, 2023, the FDA withdrew its approval of 17-OHP for prevention of preterm birth as a result of the PROLONG trial* Data comparing vaginal to IM progesterone supplementation continues to roll in, so no definitive conclusions can be made yet* In the meantime, SMFM discourages clinicians from using IM 17-OHP off-label* Recommended to screen cervical length every week from 16-24 weeks and to offer cerclage if it measures <25 mm, though this intervention was best studied for women with history of PTD <34 weeks* it may be more cost effective to forego cervical shortening screening altogether in those without this historyCerclage* Short cervix found on ultrasound: uncertain effectiveness in patients with a short cervix and no history of preterm birth. However, there is evidence of potential benefit in patients with a very short cervical length (<10 mm)* Open cervix on physical exam: Individuals with cervical insufficiency based on a dilated cervix on a digital or speculum examination at 16 0/7–23 6/7 weeks of gestation are candidates for a physical examination-indicated cerclage (but data is mixed)* unclear if 17-OH-P plus cerclage are additionally helpful together compared to either intervention alone* An interesting side note: there’s no evidence, per say, that suggests that it’s a terrible idea to place an US-indicated cerclage after 23 6/7 weeks; this is merely “expert opinion”* Because cervical insufficiency traditionally is defined as painless cervical dilation in the 2nd trimester, this restriction presented no issue when viability did not begin until the 3rd trimester and indeed may have arisen to discourage the treatment of patients with threatened preterm labor with cerclage* But now that we have better means of keeping 23+ weekers alive in the NICU, it seems that little investment has been made to prevent babies from coming super early* What if a specific institution doesn’t have the full capacities for keeping these very preterm babies alive? Should we not then consider an early 3rd trimester cerclage? Why not? Very little data to continue this conversation…(much of this is paraphrased from a bada$$ article that was recently published in the Green Journal)Notes on cerclages...There are three indications:* Ultrasound-indicated: what we've already described* History-indicated: cerclage placed at conclusion of first trimester and after prenatal screening has been completed in patients with cervical insufficiency* Physical exam-indicated (e.g. rescue cerclage): option if cervical dilation >2cm is visualized on speculum exam or ultrasound <24 wgaThere are three techniques (all call for Mersilene suture):* McDonald: performed vaginally under regional anesthesia using the purse-string technique at the cervicovaginal junction; bladder emptying is recommended, but mobilization is not required* Shirodkar: performed vaginally under regional anesthesia using purse string technique after emptying and mobilizing the bladder* Transabdominal: performed laparoscopically or open, placing the suture in purse-string fashion at the cervicoisthmic jxn (**will require c-section); recommended if vaginal placement is determined not possible or if cervix is too short that vaginal effort is unlikely to be successfulIf a patient has a cerclage in place and presents in active labor, you must remove the cerclage to avoid cervical laceration, which can lead to outrageous brisk bleeding (you can't stop active labor)Other options* if birth was preterm due to other comorbidities, low-dose aspirin has been demonstrated in some studies to prevent preclampsia and thus prevent indication for iatrogenic preterm birth* tighter control over BPs in cHTN may also decrease our PTD rates* presence of funneling hasn't been found to significantly influence the risk of PTD* "indomethacin or antibiotics, activity restriction, or supplementation with omega-3 fatty acids have not been evaluated in the context of randomized trials for women with short cervical length, and are not recommended as clinical interventions for women with an incidentally diagnosed short cervical length."* stop smoking* omega 3 fatty acids show some promise (2018 Cochrane review)* decreasing allostatic load (think: improve our racist, inegalitarian society)* treat UTIs and vaginal infections when they arise* avoid licorice root?* false unicorn root* wild yam* uva ursi (indirectly through flushing urinary tract)* history of PROM: check electrolytes or hair mineral analysisManagement of Preterm LaborFive Pearls* Preterm labor carries significant risks to the newborn: the more premature, the worse the outcomes* Given high risk for long-term morbidity in extremely premature infants, focusing on comfort as opposed to aggressive resuscitation at time of delivery is reasonable through a shared medical decision-making process* Corticosteroids can improve outcomes for newborns at risk of preterm birth at <34 wga (and some as late as 36w5d) if delivery anticipated within the next 7 days* Latency antibiotics can improve outcomes for newborns in the setting of PPROM at <34 wga* Magnesium sulfate can improve outcomes for newborns at risk of preterm birth at <32 wgaBackground* around 10% of babies are born before 37 wga* why are we concerned? higher risk of neonatal mortality, respiratory distress, sepsis, intracranial bleeding, and long-term issues like neurodevelopmental challenges* preterm labor definition: regular uterine contractions + cervical dilation ≥ 2 cm between 20 wga and 36w6d ga* <10% of women who present that meet these criteria actually deliver within 7 daysSo a patient presents with contractions preterm...* you could look with a speculum exam, collect fetal fibronectin, and/or get an endovaginal ultrasound* utility of ultrasound and FFN haven't been validated through RCTs, though observational data suggests they may be helpful in identifying patients truly at risk for preterm birth; FFN alone has poor predictive value (CONSIDER THE WHOLE CLINICAL PICTURE)* if she looks like she's in labor, especially if >32 wga, digital exam of the cervix may be warranted - we will review prevention of preterm labor in a future episode...When should we be worried about preterm delivery?* consistent regular contractions and evidence of cervical dilation are good sign that preterm delivery may be happening* in 30% of patients presenting w/ preterm prodromal labor, the process will cease spontaneously; only 50% of patients admitted for preterm labor concerns will end up delivering at term (SO BE JUDICIOUS AND THOUGHTFUL)Pearl: ~20% of patients who present with preterm contractions without cervical dilation will deliver before 37 wga; <5% will deliver within 2 weeks of presentationCan we stop preterm labor?* Sometimes, but tocolytic therapy is only thought to be effective for 48 hrs (just so happens to buy you enough time to get corticosteroids on board if indicated)* tocolysis is generally not recommended after 34 wga* since 30% of preterm labor will resolve without any intervention, even patients with advanced cervical dilation (2 cm) at <34 can generally be observed without tocolytics, and particularly so if no cervical dilation is found* b-adrenergics don't tocolyze well and carry significant maternal cardiovascular risks (but OK for antepartum uterine tachysystole)What's the cut off for viability?* <20 weeks is considered previable (no intervention indicated)* 23 wga to ~26 wga can be considered periviable* this NICHD calculator can be used in your counseling to guide delivery/management planPearl: Just because we can resuscitate a baby doesn't mean that we should. Delivery of a peri-viable newborn must include risks and benefits of delivery methods to mom and risk and benefits of preterm delivery and resuscitation to the newborn.What's the role of corticosteroids?* stimulates the development of alveoli in premature fetal lungs in order to optimize transition to external environment* can significantly improve outcomes* recommend a single course if patient presents with preterm labor (or need for delivery due to maternal health concerns like early-onset severe preeclampsia) between 23 wga and 33w6d if you anticipate delivery within 7 days* can repeat the course if greater than 2 weeks have passed after first course* can recommend single course between 34 wga and 36w5d if i) no prior steroids, ii) membranes intact, iii) patient not diabetic (and don't delay delivery to complete course)Regimens:a. betamethasone 12-mg IM q24 hrs for 2 dosesb. dexamethasone 6-mg IM q12 hrs for 4 dosesShould I mag or should i not?* if <32 wga, start mag for fetal neuroprotection* mag isn't a reliable tocolytic agent* if patient is on mag for fetal neuroprotection, adding on a tocolytic agent can still be considered, but be careful with b-agonists and Ca-channel blockers (synergistic w/ mag sulfate, so may cause hypotension); go with indomethacinShould I recommend antibiotics?* intrauterine infection is a well known cause of preterm labor and delivery* antibiotics haven't been found to be helpful outside of PPROM at <34 wga ("latency" abx)* latency antibiotics have been found to improve interval from time of PPROM to delivery, ↓ risk of chorio, neonatal infection, and need for neonatal oxygen therapy (Cochrane Review) in patients who present w/ PPROM at <34 wgaThe regimen:2x days ampicillin 2 g IV q6hr PLUS erythromycin 250 mg IV q6hr THEN 5x days amoxicillin 250 mg PO q8hr PLUS erythromycin 333 mg PO q8hr* erythromycin and azithromycin are equally efficacious, but the latter is cheaper and better tolerated from GI standpoint* amoxicillin-clavulanic acid (augmentin) associated with higher risk of neonatal necrotizing enterocolitis (NEC) in some studies, therefore not recommendedIf PCN allergic:Azithromycin 1 g PO x1 at time of admission PLUS 2x days cefazolin 1g IV q8hr THEN 5x days cephalexin 500 mg PO four times daily* if severe PCN allergy, substitute cephalosporins for gentamicin/clindamycin* at 34 wga, it's prudent to recommend IOL (risks versus benefits)What can be done to prevent preterm delivery?* hydration, bed rest, nor tocolytics in asymptomatic women have been found to be helpful prophylaxis against preterm delivery* plus there's potential harm from decreased activity: ↑ risk VTE, ↑ bone demineralization, and general de-conditioning* Atosiban is a maintenance tocolytic that isn't FDA approved for use in the USWhat about preterm delivery in multiple gestations?* no clear data to support the benefit of steroids or mag sulfate for fetal neuroprotection in multiple gestations* many experts extrapolate that benefits outweighs risk, though* tocolytics: risks outweigh benefits in multiple gestationsBorn Free Method: The Podcast is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Notes for this episode are found on SubstackWork with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by RealMovieScores / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Dr. Powell is a naturopathic physician with her master’s degree in public health. She’s a doula, as well, as she has a wealth of knowledge when it comes to interpreting stool analyses and supporting the gut in pregnancy and postpartum. We met when I called Genova Diagnostics for support in interpreting a client’s GI Effects stool analysis. Now we’re friends, and I wanted to share her with the world.Speaking of stool analyses, the reason that I prefer GI Effects is because I have run all of the major stool analyses (GI-Map, GI360, etc.), and GI Effects found several problem areas that were missed by the others. GI Effects gives you an impression of the degree of inflammation in the gut, pancreatic function, gut flora, presence of parasites, and digestion and absorption of proteins/fats/carbs. Plus, when I started running these analyses on clients, I loved that I was able to arrange for consults with Genova consultants to go deep into the results. In this conversation, Dr. Powell teaches me about:* What can a stool analysis tell you about your health?* What is the optimal frequency and consistency of poop? (We say poop a lot in this episode…try to get over it)* What might reflux or bloating tell you about your gut function?* How do you select a probiotic?* What role does diet play in gut health?* What role does the gut play in hormone health?* How can you optimize gut function in pregnancy and postpartum?* Chiropractics and gut function* Calcium D-Glucarate, vitamins, fermented foods, milk thistle, and more…We go deep in this one. Enjoy.Find Lahnor Powell, ND, MPH on Instagram. Her practice is called Okana Care.Notes for this episodeWork with Nathan: Beloved Holistics | Born Free Method | Clear & Free | Twins-Breech TrainingMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by AudioKraken / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe