Pregnancy Loss and Miscarriage (Episode 446)

Full Transcript: Episode 446

Lisa: Welcome to the Fertility Friday podcast, your source for information about the fertility awareness method and all things fertility. I’m your host Lisa Hendrickson Jack. I’m the author of the fifth Vital sign and the fertility awareness Mastery trading workbook. I’m a certified fertility awareness educator and holistic reproductive Health practitioner with over 20 years of experience teaching women to connect to their fifth Vital sign through menstrual cycle charting, balancing Hormone Health and optimizing the menstrual cycle without hormones.

Lisa: I have been consistently outspoken about hormonal birth control over the past two decades and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I teach women’s health professionals how to utilize the menstrual cycle as a Vital sign in their practices and I host live coaching programs to help you achieve optimal fertility in health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies.

Lisa: I’m also a wife and mother of two beautiful boys and a brand new baby girl. This podcast is designed to empower you to take full control of your Cycles your fertility and your overall health and I’m so excited that you’re here with me today. Today’s episode is a heavy one. Today I invited one of my fan practitioners Rebekah Mustaleski on the show to talk about pregnancy loss at the various stages of pregnancy from early loss to later term loss. This episode came about after we had a class together in the fam program and for one reason or another this topic came up and Rebekah started to share her experiences as a midwife supporting women through loss at various stages.

Lisa: In today’s episode this is important information. That’s really why we decided to release this in this episode because in this episode you’ll hear details that we don’t often get to hear and certain specific characteristics of different stages of loss and what to do in certain situations. Things that people don’t really talk about because it’s hard to talk about, but details frankly that we should all be aware of. Rates of miscarriage and pregnancy loss are far higher than we anticipate. It’s much more common than we talk about and my hope for today’s episode is to raise awareness and just to have that difficult conversation.

Lisa: Just as a warning for you, this episode is certainly triggering and take any time you need throughout the episode or after the episode to take care of yourself because like I said it’s a heavy one and we really get into it in today’s call. Before I jump in I’ll share a little bit about Rebekah. Rebekah Mustaleski is a certified professional midwife with Roots & Wings Midwifery in Knoxville, Tennessee where Rebekah promotes evidence-based maternity care for families seeking an out-of-hospital delivery. She is working to improve maternal outcomes during the childbearing years and to promote a sustainable business model for midwifery practices across the country. Rebekah is owner and woman-in-charge of Roots & Wings Midwifery and the maternal compression director for Motif Medical. Outside of work she loves to read, drink coffee, and have all sorts of adventures with her four kids, three cats, two dogs, and ten chickens. So without further ado let’s go ahead and jump into today’s episode with Rebekah.

Lisa: I’m excited to be here today with Rebekah Mustaleski and she is a member of the class of 2022 FAM program. In today’s episode I had actually chatted with her a little bit about talking about her specialization, but talking about one is kind of a more difficult topic, which is pregnancy loss. This came about because we were having one of our regular classes and we had kind of got into it and Rebekah started just sharing a lot of important information that we should all really be aware of if we ever experience a loss. Things that were not necessarily told and it was such a detailed, powerful conversation that I was like, I think we should do this on the podcast as well because there’s so many women that need to hear this information. Thank you so much for being here with us today, Rebekah.

Rebekah: Yeah, thanks for having me.

Lisa: Well I’m so glad that we have this opportunity. Before we get into the topic of the day though, I thought I would ask the same question I’m asking everyone in this year series, which is if you wanted to share a little bit about what brought you to fertility awareness. How old were you when you had your first periods, how did that all go, and maybe share with us a little bit about your experiences leading up to wanting to incorporate fertility awareness into your midwifery practice.

Rebekah: My menstrual history, I feel like it’s been very regular. I haven’t had any significant period pain or issues before I had babies or after I’ve had babies. I am 40 something now, I can never remember how old I am. I’m 40 something now and so I expected that they’ll start changing soon but they haven’t yet. They’re still coming regularly and it’s all very predictable. My own personal history isn’t what brought me to your FAM class. I came here because I am a midwife and I work with all sorts of people that have all sorts of other things going on with their cycles and I do work with a population that is not a big fan of hormonal birth control. Often after they have their babies we have a conversation about what their plan is for family planning and I’ve found that there is a lot of people out there that want to know more about tracking their cycles and being able to either prevent or achieve a pregnancy if that’s what they want to do right away after they have a baby.

Rebekah: But I didn’t learn this information in midwifery school to be able to share with them so I found myself at a loss. I’ve read lots of books, I’ve listened to your podcast for a long time, and that’s actually where I heard about this class was on your podcast and really felt like that was something I needed to do to be able to share this information with more people. The more I’ve learned about it, the more I feel like we are doing a disservice to women all over the place by not sharing this information right from the start. I’m excited to be teaching this to my daughters and get them started off on the right foot and I hope that there will eventually be a point in time where everybody who menstruates has this information and can track their cycles and know about their bodies and know about the information that their body is giving them every single month if they just know what to look for and what to pay attention to.

Lisa: I love that and I’m right there with you. It’s so interesting. When you first kind of dive into it, it feels like there’s so much information, but a couple months in you realize it’s really not that complicated. I hope, just along with you, that we get to that stage. I just think it’s up to us. It’s the grassroots kind of stuff. I’m not waiting for some bureaucrat to decide it’s important. Similarly, when we were having our conversation about pregnancy loss, this topic came up. It could have come up with someone sharing their own personal experience because this is one of the things that gets us into how common it is. I’ve often shared on the podcast that I’ve had a miscarriage. It was quite early on. Before I had my first son, I was charting my cycle. Fifteen days into my luteal I was like, okay I’m pregnant. I waited about a week after my period was supposed to come to pee on a stick. My husband and I had this lovely celebratory evening and then the following day I started to bleed.

Lisa: It was very painful. To this day it was the most painful period I’ve ever had. It was emotionally not great. It was intense. For whatever reason, I had done something to my knee, so my knee was also an issue. It was this whole thing of having the knee issue and going through the painful miscarriage. After I had that experience and I started sharing it with my friends, all of a sudden I realized that so many of the people around me had also had miscarriages and I had no idea until I had had my own and shared about it. It was like I was welcomed into the club. Pregnancy loss can feel so isolating and you don’t know how common it is until you do. We’ve talked about some of the stats in class. Generally speaking, overall miscarriage rate is about 15% of all pregnancies end in miscarriage. If we break it down by age, it’s lower in the 20s, higher in the 30s, and by the time we get to our 40s it’s quite high, up to 50. That’s something that’s not talked about. That leads us into our topic today. I’ll throw it over to you on the prevalence and what you found in your practice.

Rebekah: I’ll give you another statistic and that is that about one in four women will have experienced a pregnancy loss in their lifetime. This is not a rare event. If you’re standing with four friends, one of you has probably lost a pregnancy. It happens much more often than I think a lot of people realize. It is a very isolating thing because for some reason it is not talked about very often. I think in part that is because it is such a painful thing for somebody to go through, especially if it is a wanted and planned pregnancy. It doesn’t really matter if you knew about it for a day or if you knew about it for a month or if you knew about it for three months. That baby was wanted and loved and it is extremely devastating to have this thing happening in your body that you don’t want to have happen and you have no control over it happening. Part of the reason I think it’s not talked about is because it is such a raw, hurtful thing that doesn’t ever seem to get easier to remember or recall. Then I think in part, too, because if you talk to somebody who hasn’t been through that, I find a lot of people don’t know how to respond to that.

Rebekah: Responding to really big emotions in others is difficult and uncomfortable and we don’t quite know how to appropriately respond. Interactions like that can make you go into your shell even more and not want to share. It is not uncommon for somebody to feel like they did something that caused this to happen. If they had eaten better, or if they had not stayed up so late, or not exercised so much, that there was something they did that caused their body to pass the pregnancy. That’s not the truth of it. Most pregnancy losses are not anything that you did or didn’t do. It’s typically more often a genetic issue that something didn’t develop right with the baby and her body recognizes that. It recognizes that this is not a viable pregnancy that’s going to continue to a live healthy baby. Your body knows that this is the best way to take care of that. Your body is smart. I just want to put this out there for anybody who’s listening: if you’ve had a loss, it wasn’t you. There wasn’t anything that you did or didn’t do that would have given you a different outcome. It does need to be talked about because too many women go through a pregnancy loss alone and they don’t know what to expect and that’s not okay. I hope that the information we’re going to cover today is not something you ever need to have, but also if you did need to have this information, I want you to have it and know what is normal and what is not and what to expect.

Lisa: This is not a topic either of us are excited about discussing. It’s a difficult topic. It can come up at any point, and it comes up in almost all of my classes. The pain is often right at the surface because there are very few spaces where we can actually talk about it. We hope you don’t need this information, but we’re going to provide it because you might. We live in a world that’s always telling us you can get pregnant at any time, on any day of your cycle. That’s incorrect, but that’s what we’re taught. It sets us up to assume pregnancy is automatic, and then when loss happens, it can be even more confusing. I’d love to hear your comments on that. Maybe we can go through from earlier pregnancy losses all the way through.

Rebekah: There is so much development that happens from when you conceive to when a baby is born. The more I have learned about birth and fetal development, the more amazing it is to me that so many babies are born healthy and with an uncomplicated pregnancy because the opportunity for things to go even just a little bit wrong is there. There are so many opportunities. Pregnancy is an incredible miracle and babies being born is amazing. This downside of pregnancy loss and miscarriage is more common than I think we realize, but it is not how things go the majority of the time. It is a possibility. We’ll talk about early pregnancy loss and what that looks like. Early losses can happen before you even know that you’re pregnant all the way up until about 12 weeks is still considered an early pregnancy loss. If you were to lose your baby during this first trimester, you may know that you’re pregnant, you may not know that you’re pregnant. It doesn’t matter. It is not uncommon to have some really intense cramping.

Rebekah: Your body has been preparing for the pregnancy. Once the egg is fertilized, the hormones your body creates start forming a fertile environment in your uterus for the baby to implant and grow and develop. If something disrupts the development of the baby, all of that tissue now has to pass from your uterus. You can have really intense cramping. Your bleeding can be much more heavy than you typically have with a period. In general, you should not be soaking more than one pad in an hour when you have a miscarriage. If you are bleeding heavily and you’re soaking through more than a pad in an hour, you need to contact your health care provider or go to the ER. You also shouldn’t feel light-headed or dizzy from the amount of blood that you’re losing. That would be another sign that you would want to go to the ER. You can have clots even early on in a pregnancy loss. The heavy part of your bleeding should be pretty short-lived. It shouldn’t last for more than 24 hours that you have this heavy part. Depending on where you are in that first trimester, the closer you get to 12 weeks, the more likely you are to be able to identify when you pass your baby.

Rebekah: Once your baby and the other products of conception, like placenta or anything like that, are passed from the uterus, then your bleeding should lighten. Once you get to be beyond eight weeks, you can usually identify the amniotic sac. You may be able to see your baby in there around eight weeks. They’re still pretty small, but you can usually see them. If you are going through a miscarriage, it’s okay to be unsure about what you do with your baby when you pass your baby, but it is something to think about. Whether your baby comes out in a pad or while you’re sitting on the toilet, know what you want to do with your baby. I do recommend that you find a place that you want to maybe bury your baby, that you could have a place to go to think about your baby and connect with your baby if that’s something that’s helpful for you. Do something that is honoring to that baby. One of the hardest things to go through is to not know what to do. In that panicked moment of “I don’t know what I’m supposed to do,” is to not do anything and then feel guilty about not doing anything honoring or respectful. Think about that before you find yourself in that moment, if you can, to know what you would want to do.

Lisa: This was one of the topics we were talking about. The natural physical feelings, the urges to push or to empty, typically you end up on the toilet. What can happen is that during this event, the baby can fall into the toilet. In a moment of panic, you don’t want to flush. This conversation is way easier than going through the event.

Rebekah: That actually comes from a personal story. I have had two miscarriages and my first pregnancy ended in a loss around nine weeks and I was the person sitting on the toilet that my baby fell into the toilet and I panicked. I hate to say it, but I flushed my baby down the toilet and that was terrible and I still think about that. I did have another miscarriage later on and after that first experience, I knew I did not want to do that again because I regretted it so much. I was able to know ahead of time that I wanted, if I was able to identify the baby, to take the baby in and bury it in a place in my yard. I did and that felt so much better to me. What I’ve learned through my practice and in talking with other women who have had losses is that I am not the only one who did that or felt that way. I know when I had that first loss and I had that experience on the toilet, I thought I was such a terrible person that I would do that and not even process really what I was doing in the moment.

Rebekah: But I know from talking with other women who have had losses, I’m not the only one who’s done that. I’m not the only one who’s had that experience and I’m not the only one that has that regret. For all of us, a common theme was that nobody told us to expect that or watch for that or to think about that. It was just like, yep, you’re having a miscarriage, call us if you need anything. Nobody wants to talk about these details of the bleeding and the passing of the baby, and that yes, you can identify it. It is a sack and sometimes you can see the baby. Sometimes you’re like, that’s my imagination, that’s not really the baby, this is just tissue, but that’s not always the case. I wish I had had that information and I definitely want to help other women have that information and know what to expect.

Lisa: Well I’m so sorry for your losses, Rebekah, and I really appreciate you sharing that personal story. Years ago on the podcast, I did have a conversation about loss. One of the things that I learned was that unless you work in a field like this, the only experience you have is your own, so you don’t necessarily know the different ways that a first trimester miscarriage can present. My experience of extreme pain and heavy bleeding is one of the ways it can go. Some women may not perceive a baby at that stage, and it can all be bleeding and tissue without a way to distinguish. Other women may have an experience more like passing the amniotic sac clearly. I’m not sure if you wanted to speak to the different ways it can show up.

Rebekah: There is definitely a wide variety in that. It can be easier to think about it in terms of how different people experience their periods. Some people have really painful periods and a lot of cramping, and then there are others that are totally fine. A miscarriage is not dissimilar from that. Even the same person could have one miscarriage that is not a lot of cramping. Yes you’re bleeding and yes it’s an emotional experience, but overall your body takes care of it and there’s no complications from it. It’s also possible for that same person to have a very painful, lots of cramping, lots of clotting, lots of bleeding miscarriage. There’s not necessarily one way that this happens all the time.

Rebekah: The important things to remember are vital signs and warning signs. If you started to run a fever, if your discharge had a foul odor, if you were soaking more than one pad in an hour, if you had clots bigger than a golf ball or especially bigger than a lemon, you want to go to the ER or call your doctor. It can be helpful to have somebody there with you. Some people don’t struggle too much emotionally. Other people put their grieving process off. Other people are grieving and miscarrying at the same time. If you’re going through the grieving while you’re having the miscarriage, it can be helpful to have somebody there who helps you keep track of these other things. It can be really hard to process how much you’re bleeding and what else is going on if you’re okay while you’re also trying to process the emotions of losing your baby. Having somebody there with you can help make sure you’re doing okay and that your body is passing everything in a normal way.

Lisa: Having someone there, present, so that if you did have a difficult issue emotionally or physically, there would be someone there. I did have a couple thoughts around practical scenarios. The body can take care of it in a lot of cases in the sense that when it’s time, the miscarriage takes place and it has a beginning, middle, and an end and then it’s over. But there are other times when someone goes through a loss and the bleeding doesn’t stop. I’ve had many conversations where someone says there’s still spotting and bleeding and it’s been three weeks. I’m like, no, they should go to the hospital, they should go to the doctor, they should get checked. Maybe share some of those complications.

Rebekah: If you have heavier bleeding at the beginning and then the bleeding will decrease significantly once the baby has passed and if there were any placental tissue, once that’s passed, then yes you could bleed for about two weeks. That bleeding should continue to get lighter every day. You shouldn’t maintain heavy bleeding for two weeks. If you had heavy bleeding at the beginning and then it tapered off over the next couple of weeks, that would be considered normal. Sometimes you can have a pregnancy loss and your body doesn’t recognize it. I’ve worked with several clients who go to the doctor for an ultrasound and find out their baby has passed and their body has not yet recognized it. You have options. You can wait for your body to recognize the loss and pass the baby on its own. You should expect that to happen within three to four weeks. If it’s been more than three to four weeks and you have not passed the baby on your own, you might want to consider options your doctor or healthcare provider can give you to help your body pass. The longer your baby stays in there not alive, it increases the risk of infection for you.

Rebekah: There are medications that can cause your uterus to contract and pass all the tissues and the baby to get you on the path to recovering. There’s not a right way or a wrong way. Neither way is easy. After a first trimester miscarriage, it should take only about two weeks for your bleeding to go away and your bleeding should continue to lighten for that whole time. If you are two weeks out and you’re still experiencing bright red flow of blood every day, that would be a reason to contact your health care provider and go in to be checked out. You should be down to really just spotting by two weeks. That’s the normal bleeding time after a first trimester miscarriage. It is longer than a regular period. Don’t expect it to just be a five or six day flow of blood like we typically experience when we have our period because it is usually more than that. It’s okay as long as it’s continuing to lighten throughout that time.

Lisa: This can be very serious. If you’re still bleeding significantly at three weeks, or even still spotting, eventually it should stop. If you’re still bleeding and it’s been several weeks, you could have retained tissue and that can cause an infection and you can get very sick or die.

Rebekah: That’s another good point. Cramping should lighten up after the majority of those tissues have passed. If you’re far enough along that you can identify the baby, when the baby comes out your cramping should lighten up after that. If you’re continuing to have intense cramping for 24 hours beyond that, you would want to contact your health care provider because that’s not considered normal for a miscarriage.

Lisa: I’ve spoken to women who have had miscarriages and continued bleeding and have been told that it’s fine. I’m the one saying no, go in, get an ultrasound. Only to find out they had retained tissue and needed medical intervention. It’s important for women to know what’s normal and abnormal to advocate for themselves. You can even get the incorrect recommendation from a healthcare provider. It happens.

Rebekah: A lot of providers are not familiar enough with women’s cycles to know what’s normal and what’s not normal. It can be helpful for you to know that it’s not considered normal so that you can advocate for yourself and help yourself get the care that you need.

Lisa: If you do have a fairly uncomplicated miscarriage, do we need to go to a doctor?

Rebekah: I don’t think so. That’s my personal opinion. If you’re meeting all of those normal parameters, then I don’t think you need to go to the doctor to be checked out. That’s everybody’s personal preference though. Some people do want to go to the doctor and have reassurance. There’s nothing wrong with that. I don’t know that you need to if your body is doing things on its own and nothing is outside of normal.

Lisa: For myself, even though I had an early loss, I still went and had the ultrasound. I chart my cycles, so I knew when I ovulated. In that cycle I had ovulated around three weeks after my period, not cycle day 14. I remember listening to him explain the baby looked too small. If I hadn’t charted, that would have concerned me. I wanted confirmation that everything was okay. Another time, if everything went as normal, bleeding stopped, pain stopped, I may have taken care of it on my own. I think of it like regular cycles: there is a normal pattern, and if you’re staying in that pattern, it’s fine. It’s important to know the signs that things are outside of normal and you need to seek help. We’ve delved into first trimester. Let’s move into second trimester loss. My understanding is that a second trimester loss is typically between week 16 and 26. What are the main differences?

Rebekah: Once you get into the second trimester, a loss feels more like birth. You’re more likely to have contractions that you notice that come and go just like you do when you give birth to a full-term baby. Around 12 weeks, the placenta has formed and has taken over hormone production. The first trimester loss has a lot more bleeding and tissue that is unidentifiable. A second trimester loss, especially between 16 and 26 weeks, resembles birth. You can feel your water break and have a release of fluid. You typically have contractions that you feel and you will definitely be able to notice and identify your baby when you give birth to your baby. Around 12 weeks your baby is about the size of the palm of your hands. The baby keeps growing and you will definitely be able to identify and notice when you give birth to your baby.

Rebekah: You will also pass placenta. You can usually identify the umbilical cord. Later in the second trimester is even more like giving birth to a full-term baby. Your water will release, you’ll have regular contractions, you will deliver your baby. Babies are more likely to be born breech because their head is not heavier yet and they have so much space. You may have baby’s feet come out first and that’s okay. You will deliver your baby and then you will still have to wait for the placenta to deliver. This is an important time to have somebody with you if you’re having a loss in the second trimester and you’re choosing to stay at home. Definitely have somebody with you. The placenta is functioning but it is not developmentally at a point where it always detaches from the uterus very easily. Sometimes the placenta does not release like it should even after you deliver your baby, which can lead to heavy blood loss. Many families choose to be in the hospital for that reason, to have access to health interventions if they were to need that. None of the women that I’ve worked with in this situation have needed that and their bodies have always been able to deliver the placenta and not have heavy bleeding, but that is a consideration.

Rebekah: Another thing to consider is that you are definitely going to be able to see your baby. Your baby will be an identifiable little baby. It looks just like any other baby, it’s just much smaller. Some women want to hold their baby and some women don’t. There is not a right or a wrong answer. It is whatever you need and whatever you want to do. I do always recommend to my clients that they have somebody take pictures even if you don’t want them right now. Have somebody take pictures and hang on to them for you. You may decide a month or a year later that you want to have those or you may not ever want them, but you can’t take them later. It’s best to have somebody there who will take some pictures for you. Especially if you choose to hold your baby, have them take pictures. There have been some moms that I’ve worked with that have really loved having those mementos of the time that they had together.

Lisa: That brought tears to my eyes. It’s hard to hear that because it would be the last thing you would think to do. This is why we have to say it. If I was going through something like that, it wouldn’t even have occurred to me to take a picture. Two months down the line, when you’re not in that active stage of unrelenting grief, you might regret not doing that. There’s so much value in having access to wise women who’ve been through these things. We don’t really talk about miscarriage at all as a culture. It’s this thing that happens in private. All of these details matter.

Rebekah: I thought of two more things to mention about second trimester losses. The first one is hard to say, but your baby does not get a birth certificate when you give birth in the second trimester to a stillborn baby. Birth certificate is called a certificate of live birth and because your baby is not born living, they do not issue a birth certificate for your baby. Most hospitals will still do some sort of a certificate. It’s not an official birth certificate, but that you gave birth to your baby if you want that. They can do footprints for you for your baby. That can be the mementos that you have from that. The other thing is that if you have a loss after 16 weeks of pregnancy, your milk will come in in the postpartum. Once you get to 16 weeks, your body starts making colostrum. When your baby is born, your body will recognize that your baby has been born and it will create milk. Some women will donate the milk. They’ll pump and donate milk and that helps them through the grieving process. Other women will take herbs or other medications to dry up the milk because they don’t want to be reminded of that they don’t have a baby to give their milk to. Again there’s no right or wrong, but it is something to be aware of and be expecting if you have a loss after 16 weeks.

Lisa: In the second trimester, depending on how far along you go, you start to feel the baby. Having movement stop would prompt you to look deeper into it. How can that work?

Rebekah: I’ve found three most common things. One, your water breaks. For some people that is the first sign that something’s not right. The second is that you stop feeling movement. The third is that sometimes you start bleeding. Usually one of those things happens before you start feeling contractions. I have had a situation where contractions were the first thing that somebody felt. In my experience, that has been more uncommon than having water break or stopping feeling movement or having some bleeding.

Lisa: Moving into third trimester, stillbirth. This is not a fun conversation. Stillbirth happens. There are several reasons that can lead to a stillbirth. When you have a loss in the third trimester, it is often found from lack of movements.

Rebekah: You will have been feeling your baby move regularly and then those movements stop. You should feel your baby move every day. Your baby should have regular movement patterns. When those patterns change, especially when they’re changing significantly, you need to get in touch with your health care provider. I hope your health care provider has talked to you about doing kick counts when you get into the third trimester. That’s a wonderful and easy way to keep track of your baby’s wellness. If you notice those movements are slowing down, you’ll want to contact them. Typically, third trimester losses are found because baby hasn’t moved in 24 hours and they come in to be assessed and there is no cardiac activity found. That is a really devastating thing. I’m a midwife and it’s hard for me too. It’s hard for doctors and labor and delivery nurses because what we often deal with are happy births. It is not easy for us to know what to say. We all wish we could change it, but we can’t.

Rebekah: All I really know to do as a provider is to hold space for whatever you need. I’ve had families that have gone home and needed some time. She wasn’t in labor, there was nothing going on, and they needed some time to wrap their brain around it and do some grieving and prepare for a birth. It’s hard to realize that you’re going to go through labor just like you planned and you’re going to give birth to your baby just like you planned, but you’re not going to hear that cry that we all wait for when the baby comes out. The third trimester is really hard too because there’s so much that you’ve done at home to prepare. Most families have a nursery set up, clothes washed and hanging in the closet. It can be helpful to have somebody take care of that for you so that you don’t have to be the one to go through that and pack it up. If you find yourself in this situation, it is okay to ask for help. Grieving is a process. It’s not going to happen all at once and it’s not ever going to be over. Nobody gets over the loss of their baby.

Lisa: This is why we were not looking forward to this conversation. If it’s this hard for us to talk about and we’re both crying right now, just imagine how hard it is to go through it. For someone who’s listening who has gone through it, our deepest sympathies. It’s just wrong. We’re supposed to have full lives and die when we’re old. One other thing: hospitals may have cuddle cots, cooling cots. If you do want to have more time with your baby, ask about that. Hospitals are usually good at having resources, but you may need to ask about memorial options if you want that. Rebekah, although this was a really difficult conversation, I appreciate that we had it. I’ll include a warning at the top of the episode and, as difficult as it is to hear, this is why we’re doing it. It’s hard enough to go through something like this in a world where we don’t really talk about it. Having midwives or doctors explain these things and take women through it is important. Your clients are blessed to have you as support for the possibilities. Anything to add before we wrap up?

Rebekah: I just want to add one thing. If you are a healthcare provider, whether you’re a midwife or a doula or a doctor, there’s a really wonderful book called Companioning at a Time of Perinatal Loss that gives a lot of helpful information or ways that you can help your families and talk them through and be supportive through that time. I wish I could remember the author’s name, but I don’t remember it off the top of my head. It’s a wonderful resource for somebody who’s in this profession because if you do birth work long enough, you will eventually work with families who have losses.

Lisa: I’ll make sure to link that in the show notes page and we’ll figure out who the author is. Let’s shift gears before we wrap up. Share where you are in the world, the name of your practice, website, socials, for anyone who’s listening if it happens to be in your area.

Rebekah: Perfect. I am Rebekah Mustaleski. I own Roots & Wings Midwifery. We are located in Knoxville, Tennessee and we do home birth and we’re a midwifery group that provides prenatal, labor and delivery, and postpartum care. You can find us on social media. On Instagram we are Roots underscore Wings underscore Midwifery. We’re also on Facebook at Roots and Wings Midwifery. Online you can look us up on our website at www.rootsandwingsmidwifery.com.

Lisa: Awesome. In a future episode we can talk about a happier topic, home birth. One last question: as we’re recording this, today is our last official FAM class. You’ve been in the program an active participant. How has it changed the way you practice or your outlook?

Rebekah: Personally the program has definitely helped me understand my cycle in depth far more than I ever did before. I not only know that my cycle is normal and I’m very thankful for that, but I also know signs to watch out for just in case that were to ever change. Now I know what is a normal variation and what is something that I would want to contact my healthcare provider about and I value that information because I don’t feel like I knew that before. As a practitioner, I feel so much more capable and confident in helping my clients with the variations that they have in their cycle. I have a very boring cycle and I’m thankful for that, but that meant that there are all these people that have an experience outside of what I do and I did not have the information to be able to help them create healthy habits and lifestyles to regulate and bring their cycles back into what would be a more normal pattern. I didn’t know how to help people that wanted to use fertility awareness postpartum if that was what they wanted to do for family planning and now I know how to do that. If you choose to do this program, you will learn so much not only for yourself but also for all of the clients that you work with. It is definitely worthwhile and I am so glad that I have been able to be part of this program.

Lisa: Thank you so much, Rebekah. I’ve been thrilled to get to know you over the past year. I really appreciate you for coming on and tackling this difficult topic with me. Thank you again and I will see you again soon.

Rebekah: All right, sounds good. Thank you.