C-Section recovery, with Clare Bourne

C-section recovery is one of those subjects that is rarely mentioned before you experience it. So this week, I’ve got together with Clare Bourne, a pelvic health physiotherapist, to talk you through what you need to know to recover well. We cover everything from how to get out of bed in those first few hours, to exercise, to long term recovery and scar massage. 

For more information on Caesarean Sections, see Season 2 Episode 6 - Caesarean Birth with Consultant Obstetrician, Florence Wilcock

Find out more about Clare and her services at www.clare-bourne.com

Please subscribe, rate and review, so we can get this vital info to as many parents-to-be as we can!

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Transcript

Megan Rossiter 00:00

Ad - This episode is brought to you in partnership with iCandy. I've been using our iCandy peach pushchair almost daily for the last seven years and counting. And I've really put their five year warranty to the test using it for both my boys on muddy walks in aeroplane holes in and out of my car boot and aside from being completely filthy, my fault not theirs. It's still going strong. I can't wait to tell you more about my experience with eye candy later in the show.  

00:24

Ad - This episode is brought to you in partnership with the bump plan which is honestly the best pre and postnatal exercise programme that I've come across in a decade of supporting families through pregnancy and the early years of parenting. For 20% off and access to a free pregnancy or postnatal safe workout. Follow the link in the show notes.

00:49

You're listening to the Birth-ed podcast. I'm your host and founder of Birth-ed, Megan Rossiter. If you're looking for the evidence, the nuance the detail that's missing from your antenatal appointment, then I've got your back. The Birth-ed podcast is here to help you sort the facts from the advertising the instinct from the influences and the information you're looking for from the white noise of the internet. I hope you've got a cup of tea in hand and a notepad at the ready. Let's dive in. 

Megan Rossiter  01:14

Welcome back to the Birth-ed podcast. In today's episode, we are going to be talking about all things Caesarean birth recovery and I am delighted to be joined by my guest today Clare Bourne. Clare is a specialist pelvic health physiotherapist and author based in London with a passion to support women and men through their lives. She believes in talking openly about taboo topics and ensuring everyone feels comfortable to get support for problems that may feel embarrassing to talk about. She worked extensively in the NHS before starting up her own private practice. She's also a mom of two and has learned firsthand the importance of care and support during the perinatal period. Clare is also the author of a fantastic new book strong foundations why pelvic health matters, as well as founder of all about mum, which provides postnatal education cards, webinars and ebooks to support women with all the information they deserve at this time of their lives. She is also co founder of the pelvic health practice a specialist team of pelvic health physiotherapist providing home visits across London. Clare, thank you so much for joining me and welcome to the podcast. 

Clare Bourne  02:24

Oh, thank you for having me. So lovely to chat.

Megan Rossiter 02:27

So we have another podcast episode if you're if you haven't already listened to this one that is about Caesarean birth itself, with Florence Wilcock an obstetrician, talking about actually making decisions around how to birth your baby and what to actually expect from a caesarean birth. And we chat in such detail that we managed to fill an entire hour and sort of basically just got to the few moments after Caesarean birth has finished so I wanted to kind of dedicate an entire podcast episode to Caesarean birth recovery, which I think is like a really overlooked part of birth preparation, and really isn't even given that much. You're not given that much information about it that much support were there even literally after you've just had a Caesarean birth, you might get care for the kind of first day or two but nothing really kind of long term except for you know, maybe a leaflet or two. So I want in this episode to really explore both the kind of short term and longer term physical recovery but I suppose a probably a helpful place to start would be I suppose, what we can expect from that kind of very, very immediate postnatal period. So this is area and birth has happened. Somebody has moved into the recovery area, I suppose, of the labour ward at this point, usually, and they're being kind of cared for one to one, by midwife. It's still got a catheter in, they're still fairly numb. What are we sort of looking at in terms of the next few hours up to the kind of first 24 hours after the baby has been born? 

Clare Bourne  04:03

Yeah, great question. I always like to start when I talk about Caesarean birth being like, it's so easy I think in the birth world and I'm sure you see this too. We go like it's this is Caesarean birth, or it's a vaginal birth. But then when you subcategorize within each of those, it's actually such a vast extreme. So you can you know, if you have an elective section and you know, having that 6am, your experience is probably likely to be different, someone who's laboured for three days, and then ended up with an emergency caesarean at 10pm. So I always say to I guess, whenever I talk about these things, I'm like all of this is very general, but Your experience may be different and please don't panic if you feel like your experience has been very different to the lady lying next to you, or, you know, or your other friends because it is a very, very different overall physical experience when you've laboured when you've not laboured, and the time of the day, also now and in some hospitals, so when I was used to be in the NHS, we worked on an enhanced recovery programme. So we actually educated the women prices areas they came in kind of optimising nutrition and fluid and everything. And we took feedback and their response for their recovery was very different to everybody else. So I think this is where there is a huge spectrum. But generally speaking, once you're in that, 

Megan Rossiter 05:12

well, while we're there, can we actually jump back a step further then? So if somebody is planning a caesarean birth, what are the considerations that they should have before they've even given birth? Yeah, in terms of promoting their recovery? 

Clare Bourne  05:26

Yeah. So a lot of the work that we did was actually, again, probably what you've done in a lot on your other episode of education about what's actually involved in this area. And so you actually know kind of what's ahead, we talk about kind of like, because you're not meant to eat before, so kind of what to eat and the day's running up. So you feel like you've had really good nutrition, like your protein, making sure you're really well hydrated, and all that sort of kind of, I guess, kind of normal, everyday stuff, but stuff that you don't really think about, because if you're waiting for quite a few hours, and you're not able to eat or drink that much that has a big knock on effect. So we've done as much as we can in the days ahead. That's really important. I also talk a lot about kind of preparing for the initial days. So even thinking about, can I have enough for the baby upstairs and downstairs, if you live in a house and not in a flat? You know, really think about the initial six weeks of recovery? So if maybe your partner has got two weeks off, but what about the month after Have you got family or friends around that you could start talking to them? The beauty of an elective is that you know, the date, so it's very easy to plan, which we'll see like for a lot of other things we don't know in birth. So you can start thinking, Okay, well, after two weeks, I'm gonna have that support, but actually, I'm still recovering. And I think this is a huge part of expectations for women, which we are not very good at talking about, you know, saying that actually, your body is still very much healing and recovering. You know, what, what are going to be your limitations that you won't be as flexible to be able to drive, you know, you might still need to go to appointments. And I think just being very practical, and how you think about the first six weeks can make a huge difference to your recovery in the shock. So that's sort of kind of what we would cover and what we were talking about. 

Megan Rossiter 06:55

Yeah, amazing. So let's, let's jump ahead to them. So birth has happened first few hours to first kind of 24 hours, I suppose, after the birth. 

Clare Bourne  07:04

So yes, you're gonna know, as you've mentioned, you're going to be quite numb, and then obviously, we allow the kind of epidural or spinal block to wear off sensation starts to come back. Now, it's always a bit of a fine line between obviously when you're numb, you don't have the sensation of any pain or discomfort. And then also, we need to make sure that you're an adequate pain relief to maybe have sensation that you've had surgery, but not be in so much agony that you can't move, as well. So what will generally happen if you've had a caesarean in the morning, by later on that day, they will check your sensation and your legs and your control and how you can move your move yourself. But you will be encouraged to get out of bed on the day. And I think that can be like a humongous mind shift where women are like, so sorry, what you have just opened me up, and now you're gonna go to the toilet. And there's reasons and there's there's reasons behind that. And that is very much because actually, movement is important for many things, medical stuffs on the side of clots in our legs, we want to prevent any blood clots. And that's why you generally run a blood thinning injection as well. But movement is so vastly important. So we want to get you what from a very much like a circulation point of view. Equally though, we want to start encouraging you and give you the support and start looking after your baby yourself. Now, that can feel very difficult. But when you're on a ward, where you've only got a few medical team, we need you to start feeling capable to get up and out because you know, partners aren't there overnight. But just for other things like your bowels, we want your bowels to start kicking in and moving now movement is really important for that. Now, we wouldn't get you up if it wasn't safe. So that's something I think to have an expectation if you're going into this to say you know what to expect if it's early in the morning, and obviously, as I mentioned, if you've had a caesarean at 10pm at night, we're not going to be like well, it's still the same day. That doesn't happen. So we'd give you the break of the night and sort of be like your day, probably start things to start wearing off. And then generally what happens first is they take your catheter out. And again, this is not always what women expect. But anytime we're doing a neurological block or changing a sensation, obviously you can also don't feel when you need a week. So we put a catheter into drain urine because we want to make sure there's no bladder injury, which is when what can happen is essentially even if you can't feel that you need a way your bladder will just keep filling and it is a balloon. So it will just then overstretch and at that point, it can then be very hard to get it back from that point and can live longer term can like conditions with problems with our bladder. So that's why we use the catheter. The catheter comes out and then we want to encourage you to able to go to the toilet. They will get you to measure your first week. So you get like a bedpan. None of this is glam. None. And I remember working on the postnatal ward and women coming out the toilet holding a pan of weeding like Who do I give this book on my life but don't worry, it's all very normal. And what the team on the ward will do is they'll take it they'll just measure it and make sure that they feel that your bladder is passing good volumes of urine. So that will generally be your first kind of adventure out to the toilet and then you might sit in a chair for a bit or back to bed, 

Megan Rossiter 10:00

and it can sometimes be quite hard to go for a way the first time when he just had a catheter taken out can't it?

Clare Bourne  10:07

Absolutely. And so things I sometimes say to him, like if you don't necessarily have the sensation, but they're like, you really should try and go for a week. Now, things like turning on taps having the audible, you know, water is can really help a little bit of rocking for us, what we do not want to do is start straining to push away out, that's not what we want to do. Now, if basically the ruling is that we need you to do away within six hours of the catheter coming out, so you have a window of opportunity. Now, what I wouldn't recommend is you just be like, I'm gonna glug down like a litre and a half and make myself go. Keep your fluid intake regular. So kind of 300 400 miles an hour if that works for you. Generally, the postnatal wards are like a sauna, and women are thirsty. So do drink what you need, but just don't overdo it all in an hour. Because we want the filtration into your bladder to be gradually as well. And then generally, if you're struggling and nothing is coming out within that six hours, despite us trying everything, they may need to put a catheter back in and give you a bladder a little bit longer. Now, in this area, and I'm sure you discussed before, it's all very close to your bladder and your bowels. So there can be a point where your bladder in your bowels become a bit sleepy. And actually, everything becomes just that they're just not ready yet. They're kind of like just give me another six hours, I need a bit more time. And that's why they put a catheter in. And then the next day, they will try what we call a twerk, which is a trial without catheter that take it out again and give you another six hour window to try and go. Most people it's not an issue. But I think what's important is that we identify if we are struggling, because it's not one of the things we're like, oh, well, I'll just go tomorrow when the sensation comes back it as I say it can lead to an injury that we definitely want to prevent.

Megan Rossiter 11:40

Yeah. Okay, so you've potentially come back to your chair or your bed, and we sort of didn't talk about the get getting out of bed, or the chair or whatever you're in, that's gonna prove potentially tricky. 

Clare Bourne  11:55

It is. And I already know what this is having worked with women like immediate officers there and they sort of lie there and they're like, Okay, I can see myself here and I can see myself there. But this process of getting there, I just can't what my it's almost like we become very disconnected with our body. There's no judgement here, that's a completely normal thing after us is it like after any surgery, especially women in our abdomen, and I'll trunk is so vital in our movement. Now what I generally say is the beauty at a hospital is you've got better go up and down, legs go up and down, we can tilt it in all directions, and you should have your control. So you can do that, well I don't really recommend is that you bring the head section up. So you're kind of sitting up at a kind of a 45 degree angle, but your legs are straight, so you don't want your knees bent, then what we're going to do is you often have bars on the bed, you have a bar by your head and a bar by your legs, we put the bar by your legs down, but you keep the one up by your head, because we're going to use that and with our arms, then we want to bend the knees to bring one leg up at a time. So you're like basically sitting up with your knees bent, look in the direction you want to roll and take your hand across to use that bar. And basically, if you then let your knees just gradually fade out. And often what happens is we freeze and we go incredibly tense, because we're anticipating what's going to hurt. Unfortunately, when that happens, and again, this isn't from judgement. So I've been there, it's a scary thing. But what happens is, then we're more tense, and arguably, that often often leads to pain. So I'd say if you've got someone with you ask them just to support the weight of your legs, so you feel a bit more confident like you're not needing to control those legs. So they hold your legs, you pull with your arm and you roll over onto your side. So we just break it down. Once you're on your side. Again, if someone's there to support you, they can take the weight of your legs, you're going to take your legs off the side of the bed. Now once your legs go down with gravity in the way of your legs, generally, you start to sit up anyway. So if you've got someone on your legs that are going off the bed and you just do one push with your arms, you will come into a sitting position with actually minimal use of your core. Now I'm not pretending that there won't be any core muscles all whenever we move our core muscles activated. I think what's really important is that actually women do not understand that because we no one tells them is that when they're doing a service area, and they are not just cutting through all of your abdominal muscles, which I think naturally is what we think about. Now there are very rare occurrences where they would potentially need to in an emergency if things are struggling to get the baby out. But it's having spoken to a number of obstetricians, they're like we're not doing that as a routine we're going between the muscles. So I think psychologically, that really helps because you're like, why would I want to get out of bed when a muscle has been cut? Now I'm not again, I'm not trying to downplay the experience because it's so big surgery, but just when you know that you're like, Okay, well actually rolling and using these muscles is not bad. But what you're feeling is because you've got swelling now around a wound, and you know, there's other tissues in your abdomen that have been impacted. Once you're on your side, then you can stand up and then you just do the reverse of that to get back in is almost what you're probably doing at the end of pregnancy when you've got a big bump because you can't pull yourself up anyway. But I would encourage what's natural as you want someone to pull you up and get you out. But actually when someone comes into our personal space and sort of pulling on us generally, we brace quite a lot. And that bracing can actually make again, the discomfort worse. So I always just recommend, try and do as much of yourself but have someone there for support as you need? 

Megan Rossiter 15:11

And what about if you were then doing that same thing at home? And you didn't have your thought? Yes. Oh, yeah. Your moveable bed? I know. There's all these adverts and you're like, Oh, that's my Yeah, my grandma had one of those at one point.

Clare Bourne  15:29

So what could what could help I mean, you could always ask your, if you've got someone at home with you in the early days for them to put their kind of elbow on the bed and almost that arm to be like a poll that you can kind of push on that can help. Or you just push on the bed, so you'll just be flatter, but you're just push on the bed. And as your legs come down, you will naturally come up. And that might be when you want a little bit of help from someone just to support you up. So basically repeat the same thing. But you'll get more confident as you go home. And often the hospital say varies, doesn't it you know, what, on this enhanced programme that was part of women were there for 24 hours, and they went home, but they actually felt very ready to and they've been up and walking for almost 12 hours, by the time they went home, Casper was out and they were like I'm keen to get out of here I want to go home. Because again, if it's an emergency there, and there's complications for the baby, you might be in for a bit longer and have those beds. So depending on your experience, you may feel like you need a bit more support. And again, that's discussion with the medical team at the time, ultimately, your pain should be well enough controlled, that movement is possible. That's what's so important. So as they say to him, and if we are not, if you're not able to get out of bed, we are not controlling your pain well enough. And I think sometimes because we come from pregnancy where we're like, we don't want to take any medication, it's quite hard to lean into this aspect of like, I need to be taking analgesia every four to six hours like this doesn't feel natural to me. But I always say to women in those early days is it's totally Well, it's totally fine at any point. But please do take your regular energy. So the worst thing you want you don't want to happen is you want to stop chasing pain, you want to keep on top of the pain, you don't want to pick it so high. And then you're like trying to manage it from there to keep on that regular painkillers for as long as you feel that you need to allow your function to be what it needs to be just to like survive in the house and look after your baby.

Megan Rossiter 17:07

Yeah, and I think there's I think one of the big concerns with that and taking kind of medication. postnatally is often if somebody is hoping to breastfeed or they're giving their baby breast milk. And you know, we know that the the analgesia that you are being given is safe. Or certainly the benefits of taking it outweigh the risks of taking it, even if you're breastfeeding. And one of the things, we've got a really good episode that's on preparing to breastfeed, and we talked about this Aryan birth in there, but one of the things that can disrupt that is the really struggling to move and struggling to find a comfortable position to hold your baby in. And actually, if the taking painkillers enables you to find yourself a comfortable position to be able to hold your baby. And then that is more important to establishing breastfeeding than having zero trace of any medication and your breast milk. So it's it's that kind of weighing things up, isn't it?

Clare Bourne  18:05

It's like risk benefit analysis. There's so many things. But yeah, we should not be expecting ourselves be able to get up after I mean, any birth. You know, I knew I had two vaginal deliveries and felt really sore. And I definitely needed painkillers. I remember my husband like writing out like a drug chart to be like take this, then take this and take this. And I think that was really helpful. And I think that's where again, partners can really help. Because Are you sure you remember this? You're not really sure what time of the day night where you are in time or space? And I was like, when did I take it? I don't even remember when I took it last. And so that's what can feel quite scary. So I think sometimes partners being responsible for medication and being someone they can practically support with makes a huge, huge difference. 

Megan Rossiter 18:44

Yeah, absolutely. So we were talking about picking up baby to feed them to breastfeed them. And the other thing as well as getting up out of bed that is quite tricky, I suppose for some people is any sort of twisting motion. So usually when you're in hospital, babies and their little what looks a bit like a fish tank next next to the bed, and that's where they'll kind of be put. So twisting to pick them up and bring them back again can be really difficult and certainly in the first couple of weeks it feels kind of easy enough for somebody to be there to pass the baby to you. Sometimes people have an issue of in some hospitals, you're not allowed artless to stay overnight and who is picking up this baby when you're four hours postnatal having a caesarean is completely insane. And in some hospitals, certainly our local hospital they're allowed to stay overnight, but they're kind of strongly encouraged to go home. Yeah, yeah, but but so I think it's like if somebody can be there. That's going to do would you say that's going to be the most helpful thing?

Clare Bourne  19:52

Definitely. I just think it is barbaric that we expect women like no other point in like, you know, having worked across multiple wards in multiple specialisms and we've done surgery and then expect that person to stay on all night and also look after something else is mad or it's better to have women. So yes, if someone can stay in they're happy to I appreciate the setup is generally an ideal they're trying to sleep in a chair. And it doesn't always work. But I think most women stories that they just felt like when you get one midwife or maybe six women, they cannot be there constantly, as well as doing a medication and everything else that they're meant to be doing to pick up your child. So I always say to have an ultimate, what I would recommend is if you can get yourself into that sitting position, and lift from there and then sort of pivot yourself back, that's going to be better than sort of just like the yank and rotate. Because that will genuinely hurt a bit more. And I think it's so hard because then we're being told, you know, like safe sleep and don't keep them with you. But then you're like, yes, but it's actually feels really unsafe for me to like, lift this baby over there, because it's really painful for me as well. So ideal, you know, gold standard, if we can for women, it would be for them to have like some support. After that, you know, I think it's trying to sit up before you then left. So you're not having to rotate, not the rotation is bad, it's just going to be generally more uncomfortable because you're having to use more of the abdominal muscles. And it's not it's not necessarily muscles themselves at the issue, but obviously they're connected to the connective tissue that has been cut. And it's that sort of pulling sensation that can cause a lot of discomfort.

Megan Rossiter 21:17

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Megan Rossiter  22:31

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Megan Rossiter  23:47

So we're 24 hours in they've got us up out of bed we've been hopefully been for a week and a catheter hopefully hasn't gone back in it might have done and you can go home with a catheter in if there was any need for you to you potentially have had a little Potter around the postnatal ward so you're feeling a little bit steadier on your feet. Is there anything else that you would need to be aware of in that kind of immediate 24 hours, which was is almost always going to be in the hospital environment

Clare Bourne  24:27

Things like if you're going to cough, sneeze or laugh like someone say to him and have a little blanket just over your tummy or use your hand to apply some external pressure, you're not going to open your wound if you cough season off, but that increased pressure can cause pain. So that's just another nice little tip that we do. Bows. I think bows are like terrifying actually. My friend had his own recently she messaged me being like Why did no one tell me about the first poo like oh my gosh, I was not prepared. And I think you just because you've not birth vaginally you kind of imagine everything down there like it's got to just be like working as clockwork, but as I say your bowels can become quite sleepy so it can take a few days. So I think again, focusing on that, keeping the fibre intake high water hydration really important. And don't put off if you get the urge to go again, because it can feel like oh, it's really hard to get to the toilet, I can't be bothered, I'll just wait. But when we actually wait and don't do a poo, when we get the urge to poo, basically, the pool is gonna get bigger and harder and make it even harder to pass. And often, what we don't want to do is have a very bloated, uncomfortable stomach when your wounds healing, because that's just going to pull a lot of pressure and discomfort. So that's my tips, I think, who's one of the biggest things and that may or may not happen in hospital, it might happen once you're home. But that's the I think the only other things that I generally be thinking of 

Megan Rossiter 25:41

and do you find women take things like stool softeners to help or is that just only if they were, if you know, they'd gone several days with no sign of passing their bowels, or?

Clare Bourne  25:53

 some do some do and some places will just give women like latch pillows to help to make sure they do keep going. So I'd say that that definitely is a thing, and they will definitely use that. Otherwise it is generally if you've not gone for three days at that point where like we vary it but please don't feel embarrassed to say that as well. Because medical professionals talk about pee all the time. Like we're totally down with that chat. And it's really important that you don't feel like anxious to talk to us about this at all. Like you're you're at home and you're then like stuck really struggling. You're struggling to get in with your GP maybe it's the day your midwives not visiting and then you feel very alone. Things you can you can do this yourself or like add flax seeds to yoghurt when you get home. You know, I'm not just nailing biscuits in those early days to be completely honest with you. Yeah, I wasn't like Oh, give me flaxseed yoghurt. But like my second time round, I was very much more aware of it. And I was like, actually, I need to be very much like on even if you have homemade bread and sort of white or you know you're having cereal anyways, add a bit of flaxseed. Like there's so many ways that you can add it in without feeling like you've got to have some kind of like full unhealthy diet that when all you are is exhausted and wants to just eat sugar. I'm not saying I promote that, but equally, it's what I did. Yeah. survival expert, I think rails or something else, I'm just gonna survive. But yeah, you can, you know, I think there's ways that you can bring it in to help, which will help. Yeah, but you might want to take a gentle laxatives, there's so many options, but something like lateralis, or fibre gel can be a nice place to start, rather than like your centre cots or stuff like that, that are going to stimulate the bow, which might be needed, but it wouldn't be our first line choice.

Megan Rossiter 27:24

Yeah, and the other one that's just come to mind that I know is sometimes kind of treated in hospital and certainly relevant for like any kind of major surgery that sometimes women experience is the shoulder tip pain. 

Clare Bourne  27:37

Yes. So the trapped wind can often give referred pain to the shoulder, I remember treating me like what did they do to my shoulder and nothing, nothing. You're awake, you know, nothing happened up here. But the referral that often like that pain can be worse. So that's where again, keeping our bowels happy. And getting moving can actually help with a when some people will talk about using like peppermint teas or gums or stuff like that to kind of help with digestion as well. But don't be alarmed, it can be very uncomfortable. Again, painkillers should help with that. But generally, once your bowels start going, you start passing wind, which again, none of this is glam but necessary. That does settle it some it's to do with like the diaphragm and kind of points of pressure that kind of refer. Yeah, fascinating. But so don't be don't totally panic if you're like a special that develop some kind of tendinopathy. And it's just a pain,

Megan Rossiter 28:31

you have actually just reminded me of a really good bit of research that I read. That was about chewing gum, and it said if you chew gum three times for 30 minutes, in the first couple of days after a caesarean birth, that aids the bowels. 

Clare Bourne  28:46

I mean, it makes sense from kind of if you think about our whole digestive tract, it starts with our mouth. And that's why they talk about chewing being really important. If we don't chew our food, it doesn't actually aid digestion. So again, if you eat too quickly, that can cause a lot of bowel disease problems as well. So it makes sense. I'm not I'm not read that research, but I'll see if I can find it.

Megan Rossiter  29:04

I mean, it feels like a very harmless intervention. 

Clare Bourne  29:07

So good breath. Yeah, great. Healthy bowels. Worth a go, but I think that's the whole thing of like, again, eating regularly again, that whole like no idea what time you're busy feeding you don't eat and that's again, my partner's come in, or family come in to be like, here's a meal. I'm gonna hold the baby, we're going to eat it. It was the only one a little bit we're going to eat some proper food, because that the bow needs regular input and actually for them forgetting to eat for six hours and then we're eating, but we're not chewing because we're rushing because we're anxious about the memory like do I really do I poo? Do I have a shower? Do I eat like those priority? It can be very hard but I'd say little and often bits of food can be really helpful as well.

Megan Rossiter 29:46

Yeah, so you've got You mentioned having a shower. There's one that's another thing I suppose that people often ask about. So you've got usually it's quite it's like a waterproof dressing, isn't it that goes over the the wound and what What point genuinely is that removed? 

Clare Bourne  30:02

Hmm, good question. I mean, in the first couple of days, you know, depending on your surgery, if there's been oozing all that sort of stuff, but generally in that first couple of days, they will remove the dressing, and then your stitches come out later. You know, once you see the midwives, again, like there's such variety that stitches, there's glue, you know, there's different options as well. But yeah, within the first, you know, couple of days, the dressing,

Megan Rossiter 30:27

it often feels surprisingly early does like, like people are like, what? Oh, you want to take this off already? It feels like a layer of tection. And you haven't seen the sky yet? And that can be a feel like quite a big deal, I suppose. 

Clare Bourne  30:42

Well, what I will say to him is actually it's remembering that that's really helpful for them the initial initial bit, but actually, for wound healing, we need it to have air, we need to keep dry, wet. And that's why it's waterproof initially. But ultimately, we want there to be that exposure. But it does feel a bit of a shock as you say, Yeah. Especially if you're not mentally prepared for this area. And as well, you weren't expecting to have this area, and then to have this whole process. It feels very, like, you know, step by step. 

Megan Rossiter 31:11

Yeah. So going back to then the shower, at what point? Can you should you would you have a shower or a bath? Healing from a scenario? 

Clare Bourne  31:23

Yeah. So again, once you're up, you know, whether that's the first day or the second day, I think most women generally leave it to that second day, because they're like, you know, it's enough just to go for a week and come back to bed. But generally, that second day, women, like I had a shower, and it was the best year of my life, you know, just feel like a bit grubby. So you just clean yourself. So you can, you know, the next day is absolutely fine, too. I think the hardest thing is, is standing up for that long, you know, making sure you've had enough hydration, depending on if you've lost how much blood you've lost, you know, you can feel a bit woozy or a bit faint for some people, not everybody, but some people. So I think it's always making that judgement call of again, do you want to have someone else in the shower with you, if you've got your partner there can they be with you, because a lot of the time in the NHS, they're kind of in these big toilet shower room places. So you could have someone in there so with you, I know, even not officers there and I wanted someone there just because I was just you feel a little bit vulnerable. So you can share if that's what you want. And you might just want to spend a few minutes just generally, but washing your body. And then just you know, tap dry if you've got the dressing on, it's waterproof anyway. But just make sure you draw around the area. And then once the dressings often say you're home and you're having some showers, what we just recommend is that you, you know, tap the area dry with your towel. And I always recommend trying if you can get two or three minutes just to lie on your bed and allow some air to it. Because depending on our tummy and our anatomy, sometimes the scars actually very much like underneath some skin and tissues. And so actually getting air to that is quite hard, especially in the winter as well when we're trying to get all our layers back on. So if you can find a time to lay there, kind of lift your tummy, because you're still gonna have a rounded tummy, we you know, we don't bounce back, our tummy takes time. And so just lifting the tummy away from the scar, allowing some air to it in those early days can can really just aid the whole healing because I think we often think oh, we need to keep it clean with like soaps and stuff. But actually, we just need to keep it clean with water, dry it and allow it to have some air. And if we're doing those three things, we're doing as much as we can to sort of keep it clean and prevent infection. 

Megan Rossiter  33:21

Yeah, oh, I've got two things that you that have come up when you've spoken I want to touch on both of them. I'm going to come back to the scar in a second. We were talking about the shower, I just realised something that often people don't realise after Caesarean birth, is that you're still still going to be bleeding vaginally, after a caesarean birth, even though you haven't had a vaginal birth, just worth pointing out. And the same kind of care, in terms of what you're looking for what you're checking for would be exactly the same as new to however you've given birth.

Clare Bourne  33:50

Yeah, yeah, new, like, I've got a pad now in my pants, I've got this pad on my belly, it just can all feel an awful lot. But you quickly just get into the rhythm of it. I remember those first days just thinking crikey, this is like a full time job like looking after myself. But there isn't time to but you do find your rhythm you react.

Megan Rossiter  34:07

And so going back to the scar, then what is normal? And what is a sign that at potentially sign of infection sign that something's not quite right. And at what point? Are we kind of looking for things? extra support? 

Clare Bourne  34:22

Yeah. So the good thing with the early days is that often you do have midwife appointments now that there is whether they're coming to your house or whether you're going to an appointment. So we should have some medical eyes on that wound in the early days. Because as I say, it's quite hard to sometimes see it on yourself but looking in the mirror or asking your partner so look, it's also quite a good idea. Essentially, it's going to look like scabby is going to look like a kind of if you think about cutting any other part of your body if you fall and over. What the body is doing is it's bringing platelets to the air it's bringing blood to the area to help with that healing and with that clotting and then the tissue remodelling and forming collagen and making new tissue. So that's why we have the stitches to hold it together while it's doing that process and then those two taken out as and when appropriate, essentially what you're looking for, the area will look swollen, and it will look really bruised. What we're looking for to monitor because our main concern generally is infection. So what we're looking for is kind of really red areas that look really angry, feel particularly hot. You may also feel unwell or have a temperature as well. Essentially, if you're not sure if that is normal or not, are someone to check it? Because you're never going to regret being a bit overcautious. But you might be like, Oh, well, I think it's meant to look like that. Why I'd say infections look alike generally, because obviously, you have that generalised overall swelling, infections often look, one area looks very different, very red, very angry, you may see kind of pus around the wound as well, which is, again, a real sign that there's something else going on there. There'll be a variety of management, if that say that did turn up for you, you know, again, if you're still under midwife care, then your midwives would be the first people to call and they might do an extra visit or ask you to come in. And they may recommend some oral antibiotics. In some cases, you know, maybe later on, they might recommend a cream to put on the area as well. So depending on how it looks and how you're feeling or how unwell you are, then they might recommend different management, but you can get antibiotic creams and you can get antibiotic tablets. If it's got really bad, then they might recommend that you go back into hospital. But I say I really heard that on such a minimal, but I always want to be honest about these things. So that is not as such a shock for women, if they're like, Oh, I was told to get back into hospital and have it checked. But most of these things can be managed in the community. And we're also talking that this is not a common occurrence is quite rare. But the reason we need to be mindful of infection is not just, you know, your overall wellness. But sometimes, again, in rare occurrences, if there is an infection, that's the only time it might open a little bit at the wound. And we want to obviously prevent that happening.

Megan Rossiter  36:53

So that's all in regards to the kind of than the longer term healing of the scar itself. So maybe we can kind of we've looked at the first 24 hours, and then that kind of period that you might be at home postnatally. Hopefully, you've got kind of support considering the kind of wider support that you might have for those first few weeks. And it does very much depend doesn't it and how it from individual to individual in terms of when they feel like they can go for a walk when they feel like they can drive a car, like those kinds of things. 

Clare Bourne  37:27

Totally. It's often people like when Am I allowed? And I'm like, I'm not the one who's going to tell you what you should and shouldn't do, you know, what I want you to do is really understand what your body's been through and what feels right for you. I think getting out in some fresh air, whatever the weather, or however, you know, whatever time of year is, is really important because I think it makes such a difference to our mental health. And with that whole, like circadian rhythm when you're up a lot at night, it's very important for our body to get out into daylight and see that good for our babies as well. But sometimes, you know, depending on where you live, whether you have a house or you're in an apartment, getting into a communal garden or into your garden might be enough, you know, just walking down, I'm just standing in the sunlight and both of my winter babies, but that just felt like enough for the first few days of just being that was almost enough of a journey out into the garden, walk around the garden for a bit and come back in the house. But I still felt lots of benefits from that. And I think sometimes it's easy to be like, well, if I'm not going out for a walk, what's the point, but that just being in and out can make a big difference. And then I would say to women, always underestimate first, you know, be like, I'm just going to try and walk to the end of the road and come back, I reassess how I feel if I think I could do that again, then I'll do it again. But what I always recommend women don't do is be like, I'm just gonna go for a lap around the block, and you get halfway around the block. And you're like, oh, no, I want to go home and you still got to make it back. So small targets. And that will look different for everybody. And I meet someone else's area. And they're like, oh, yeah, I felt great after a few days. And I did do a loop around the block or a couple of loops around the blocks and some of them light off. It took me two weeks to feel like I really felt up to that. And that's totally fine. So pacing is the key. 

Megan Rossiter  38:57

Yeah, and sometimes we have this focus on say in the UK, we have this six week check with our GP. And I think sometimes I don't have an episode on this, but we should probably do one, there's a kind of expectation that you'll go to this and they'll do this like really thorough holistic check of your star and your abdominal muscles and your pelvic floor. And they'll tell you that you can go and do this, that or the other. And in reality that is very, very rarely, I mean, you're lucky if they even check the scar without you asking them to. And so it can be that you have to kind of and that goes for whether it's a if it was vaginal tasca or Caesarean scar. So if you want it to be looked at or checked, sometimes you even have to go as far as outright asking them to do it. It isn't always kind of offered. And so there's sometimes this sort of a sort of mythical feeling around six weeks. It's like right we have six weeks now that's it off you go to your join your exercise class. That's it. Everything's like you're back to normal and And actually, regardless of how you've given birth after pregnancy, there can be so much more consideration, can't they? So should we move into chatting a little bit more about the kind of long term physical recovery from a caesarean birth. So both in terms of the scar and one of Claire's various specialist subjects is the is your kind of pelvic floor health as well. So start me wherever, wherever you would start if someone had come to chat postnatally six weeks where one hour?

Clare Bourne  40:30

Absolutely, I think that hallway I love what you've just said that you know about this kind of like expectation that it's six weeks, I still think naively felt like for this kind of like turning point. I'm just the same as every other day I it took a lot longer Mr. Feel like me again. And I think that's an important conversation to have. Because I think we do we do set up women to be like, this is magical experience that six weeks, and then you're just gonna be like, Oh, this is a whole door open to the next stage of my life. The way I like to break it down. It's what I talk about in my book, I will say the first six weeks is recovery. And this is however you birth your baby, you really need to just put in your mindset, this is a recovery period, the next six weeks or more like your minimum, but we you know, we all love a timescale, so around six weeks rehab, and then after that sort of reintroduction to the things that maybe you loved and did before. The other thing that is often a bit of a myth that's out there is that women shouldn't do any exercise for 12 weeks after this area for six weeks after a vaginal delivery and 12 weeks after zero. I have hunted and hunted as to where this comes from. I have spoken to multiple people and we can't find it anywhere. So I think what's really important is again, that we don't generalise into how we birth, but this individual that's experienced birth, which will vary. And as a some women, you know we again, and we always think that Suzanne recovery is way harder than vaginal birth recovery. However, I've met women after Caesarean who found their recovery a lot easier than a vaginal delivery. So I think it's really important that we never box people in and we say they're actually for you, the most important thing is you don't live under the name of your birth, but your personal experience and how you're feeling. And obviously, we all come into the birth in a very different place. Maybe we've exercised during the pregnancy, maybe we haven't. Maybe we're really unwell and we were being sick for nine months. It's a very different experience for someone who has had no nausea or sickness and has kept a complete training programme for nine months. So what I'd always say is that six week mark is there as a general rule, because that takes soft tissue healing is around six weeks, that's where that comes from. If you've had an infection, this kind of the healing kind of starts again. So if you are someone who's had an infection, don't worry if it looks like your wounds taking longer to heal 810 12 weeks, because actually, you're just slightly delayed because of that infection that needed to be treated. What are we expecting, I guess it's six weeks. So the first six weeks, I say that walking is important. Another thing I hear a lot is you can't walk too much in the first six weeks walking is amazing. Walk as much as you want. I actually disagree, which I probably slightly controversial, but actually, I've met a number of women who've done SOS messages to maybe like at four weeks, oh my gosh, I thought I was better. I went out for a two hour walk. And I'm like in agony, or my vagina doesn't feel right, or my wound feels horrendous. And I'm like, You know what, at any point, you need to pace it. So even if it four weeks you like I do feel it's better. And suddenly, like I'm gonna do the bins, I'm gonna take that stuff outside, I'm gonna move that piece of furniture. And I'm gonna have a two hour walk, your body is still recovering. And actually, we know that the remodelling of a scar actually takes a lot longer than we think, you know, there's there's changes potentially going on, and we still need more research for a year to 18 months. Now, that doesn't mean it's the acute healing. But I think this is where we have to understand that healing and remodelling is a huge, long process. And when we're talking about the six weeks, it's just that initial initial phase. So that walk in Yes. But you know, I think in the first six weeks as well, what I often encourage women offices Aryan or vaginal delivery, is to do some deep breathing, do some diaphragmatic breathing, do you think about your pelvic floor exercises, it can be so easy to sit there and think I don't need to do that got off scot free. let's scrub that one off the list. But pregnancy alone has a lot of impact on our pelvic floor. So I always encourage all women to do pelvic floor exercises as well in pregnancy, but also as rehab and really a lifelong thing. But that's a whole nother topic. But definitely think about as being part of your life. However you feed your baby when you're feeding them once feeding as established poets wrestlers are a great thing to do when you're feeding them is a nice kind of connection point means we're more likely to do them. We don't need anything added on to everything else we're trying to do in that newborn phase to do it at the same time that can really really help after that six week mark. So you may see a GP who may not you might have a check, you may not and so it can be very hospital. Where do I go from here? Again, I like to think about it as layers and also thinking about well, what are my goals? You know, what am I wanting to get back to? Acknowledging that? Yes, I've had a big experience of caesarean birth, but I've also been pregnant for nine months running up to that. So things like a Postnatal Pilates class or postnatal yoga also an online programme that's very much designed for postnatal. For most women that six weeks is appropriate to start because most of these programmes aren't going into heavy exercise initially, the ones I always recommend, keep it very easy, very simple, connecting with our bodies, again, creating a bit of time for ourselves, movement, helping with aches and pains and things like that before we kind of then grade up and it's all very, very graded. So users loads of YouTube videos as well that you know, if finances are not something that you can then easily go out and pay for a programme or a PT or anything like that. loads of great stuff on YouTube or ebooks or things like that. So you might want to start with that and then slowly increase the walking as well. You might want to start doing some bodyweight movements like squats and lunges, I think what's really important is to compare is we often putting this exercise on a pedestal and be like, well, I can't exercise from day one. When you stand out of a chair with the baby on your shoulder, you are doing a squat. So yes, you may not be doing a workout programme, but you're doing these functional movements. And I'm a real believer that we need women to be supported to train for motherhood. Rather than viewing that like the exercises in addition to being a mom, they're very much connected, and we need to be strong to lug kids and car seats again, heavier, I swear. It's back breaking work and buggies that like Land Rover. Yeah. I remember lifting my other boots thinking, I don't think I'm smart enough to do this right now. So think about your I would say to a man, like reframe it as like, really what the, in the UK the government recommends is activity. We don't necessarily think about it as exercise. I've actually mentally we're not there yet. But how can I be active in my day? And what does that look like? Because you can do some gentle squats or while your babies maybe in the bounce or on the play mat, or do some pelvic floor exercises or some gentle Pilates movements. Obviously, if your goals are things like running brilliant, you know, but I would be putting it in your mindset that really the earliest we should be doing that sort of thing, on average is 12 weeks high impact or lifting weights. And so what you need to then use that first 12 weeks is for recovery, but also rehab, that includes your pelvic floor, your abdominal muscles, your glute muscles, your leg muscles, there's so many changes that occur. And we can support you to do that. And I guess that's where physiotherapy really comes in. And we try and bridge the gap. Now, the problem is accessibility, isn't it with all of these things. And there will be a huge variety. Also, if you've got symptoms, so you have got incontinence, or you're struggling with your bladder or your bowels in any way. Or you notice something that we call diastasis recti, which is the abdominal separation of the muscles, the six pack muscles that it's completely natural. So it's been shown to be present in 100% of women by 35 weeks of pregnancy. So obviously, if you go to that, you know, appreciate some babies are born pre 35 weeks, but if your baby is born after 35 weeks, it's totally expected that you will have an element of abdominal separation. We need to monitor for that. And there's general healing in the first six to eight weeks anyway, but some women do have ongoing separation. And again, that might need specific rehab. If you've got specific problems, the NHS is absolutely there and provides that. If you're looking for more like a generalised assessment, something you might hear about the mummy mot or postnatal check, they are available privately. And what we would do as physios, if we will work in that context, is just do an oval, even if you're not like I've got major issues, but I just want to know how to get back to exercise. That's something that we can provide.

Megan Rossiter  48:12

I think just a helpful sort of tidbit to chip in from from the perspective of somebody who threw out there certainly late 20s and 30s. It has not been a big exercise. If you get to six weeks and exercises, probably like apps not even to be honest. It's not even on your to do. It's not even on there. It's never too late is it like I'm now through my youngest is not about to turn three. And only now have I just got like the motivation to actually start rebuilding I kind of physical strength. So it's never, ever too late.

Clare Bourne  48:48

I mean, I've got into lifting heavy weights after both of my kids, I never did it before. And actually I've as I've gone I've got old and I realised that my kids are really heavy. And actually I'm thinking about my older self and bone density and all these other things. I was like, actually, I'm going to start doing that. Whereas I think most people think we've got to do everything that we did before kid, you know, you couldn't start something new, but your body is really not broken. And it's absolutely capable. Again, I didn't do that until two years after my second and running. I didn't go back until six years after my first I just didn't have I didn't have the desire, I was knackered I was busy. Whereas now I'm at a bit of a run by a bit of headspace feels really good. So absolutely. There is no I think we talked about these frameworks. But you're right, you're six weeks or six months, you know, sorry, 12 week frame, it might be two years and that's fine. Never too late or to have assessment as well. 

Megan Rossiter  49:36

Okay, so then the final thing that I wanted to kind of touch on that, I suppose is a concern for people that have had a caesarean birth is the kind of long term healing from bear scar. People might have heard about scar massage, but that might be as much as they've heard. See, can you share like a little bit about the difficulties that somebody might experience with their scar kind of Longer term, and if there is anything that can be kind of done for that? 

Clare Bourne  50:03

Absolutely. I think this is such an important conversation. And I think what's really sad is that women can feel so criticised that if they're not happy with this guy, it's because they're like, aesthetically driven. And I think, well, first of all, if you are bothered about how you look is totally okay. That is really fine. If you do worry about it, there's nothing wrong with that, it's totally not fine that we expect women to just have a baby and then be like, Well, I don't care about myself anymore. Because I've got a baby, that's just a completely unhelpful mentality. It's always about balance. So isn't it but if we just look at kind of physical sensations, so often what people report what numbness around their scar, and that can go on for months, and sometimes doesn't always fully come back, but it will definitely improve, someone will have more the other end hypersensitivity, almost like a cooling sensation, or this kind of like funny electric shock sensation, where they're like, it's almost like I'm hyper aware of that area or parts of the area, they might feel it pulling or dragging. So when they go back into more rotation, especially like, say, exercise, if they wanting to do more rotation, or just like life, like you know, picking up a baby and putting onto your shoulder, they can like I feel this pulling sensation, since you if you think about it, a scar is always a bit tighter than other tissues around it. And that's why we can have a very classic overhang because you've got a tight line, and then you've got looser tissues, because Tommy's have to stretch in order to grow baby, and then it's that tissue that overhangs over the scar, I think it's very easy for them to think, Oh, it's just because I've got weight to lose. And I'm like, it's not that simple. If you know, I mean, women who are on their perfect BMI or under, they still can have an overhang because it's the tissue to tightness ratio. In essence, it's really normal to have this pocket of swelling in the early weeks and months. And that's a lot of women come to me like when is that gonna go. And actually, that's where massage can make a big difference. So if we talk about massage, it can help with kind of all of these things overhang since oversensitivity numbness, connection with your body and the journey this is there and as we've already mentioned, can be very different between you really wanting it and being like that is my birth preference. And my birth choice to this was really not what I wanted. But this has been the safe thing for me and my baby and, and emotionally and mentally, those are very different things so reconnecting, but even if you wanted it, the reality of having a scar in your abdomen and your body looking different can actually be very disconnecting as well. So I will say to women, massaging and engaging is really important, but it can come with emotional or mental barriers, it can some for some women, it can have very traumatic flashbacks. And I know our mutual friend Ely Morrison mixing up motherhood, you know, I recommend a lot of women to her for her debriefs because I think it's very important to bring that mind body connection where we are one, and we absolutely cannot separate that. But massage can be great. But if you're feeling like it's too much of a barrier at the minute, don't worry if you want to delay or get some emotional mental support on board before you do any of these techniques. But initially, working above the scar is really nice. So we wouldn't generally recommend this until around six weeks. And the reason for that is we want the scab to have completely gone, we don't want you putting anything on the air that could risk infection. And obviously our hands, though we might wash them, they there's bacteria everywhere, isn't it so we don't be rubbing that into an area that's healing. So once it's healed, scabs gone, we can start applying an oil. And there's lots of different ones that you can use. But you want some of that space basically as natural as possible without any kind of chemicals or products. Start by sweeping up that area above the scar can be really nice. And as I say it might feel a bit swollen. So think about just gently kind of moving through the tissues before you then move on to the scar. And generally just starting off by sweeping side to side is enough. And then we might do some circles all along and rubbing. And maybe we can share some videos in the notes. If people are wanting kind of more practical videos to help with that. I think there's something that I'd like women to look out for. So there's kind of scars can heal differently. So you can have a very flat scar, you can have one that's slightly raised, which we would call a hypertrophic scar. Now if that is the case, we wouldn't encourage you to start rubbing over the scar, we just want to keep it with the nice sweeps along the scar. And we can get key loading, which is where the scar kind of grows out of its borders as well. So if you're looking and thinking my scar just definitely doesn't look again speak to a medical professional who might be able to advise, there is some research that silicone can help with scars that are again a bit more hypertrophic bit sicker, you can get silicone in many forms, but these kinds of bandages that you can put over them and stick on can be a really nice thing again, kind of after that scab has gone to help with that. So often it's a combination of the massage the silicone, that can really, really help to connect with and help with any of those symptoms and that kind of just like remodelling process. Again, we need more research to be as conclusive about what we feel we see. But the work that I do with women, you know, immediate, they're like, Wow, my tissues feel more mobile, it looks less swollen, my overhang is less visible. And there are now some therapists in the UK there's lots of I mean, this is very much in the private world. But some women are kind of wanting to kind of explore more options for themselves. There are different kinds of machines that we can use to help loosen up scar tissue as well. So there's a whole spectrum but don't underestimate what you can do with your own hands. It's very, very powerful mentally, physically, emotionally, but Yeah, it's just getting into the habit. And you're like, oh, how do I like how often, you know, every day every other day for five minutes, you know, if you're applying some body cream anyway, literally, you don't need to spend an hour on this. It's very small, practical, do pulverise the sizes when you're feeding, after your shower, apply your moisturiser, little bit of massage, you're done. And if you don't do it every day, that's okay. Okay, totally fine. I did not do everything every day. It doesn't have any,

Megan Rossiter  55:26

no, no, some days you can, all you can do is lay in bed, and also very, very important. 

Clare Bourne  55:32

I wish I could do that, again, to be honest!

Megan Rossiter  55:35

I think that's a really helpful place to finish particularly because, you know, that just isn't something that we see talked about in NHS Care, really, and they're, you know, it's not really going to cost anybody anything and can have, like a really, really positive impact to their kind of long term recovery and feelings and emotions around the way that they've given birth. So you, thank you so, so much for joining me if people want to buy your book, if they want to follow along, if they want to find out more from you. Where can they find you? 

Clare Bourne  56:08

Yeah, so I mean, my website is clare-bourne.com. And that's kind of all about me and my services. I've got some recovery ebooks, actually, there's a certain ebook that has videos that kind of like lots of that walks you through Week by week, if that's something that you want, my book can be bought on Amazon or kind of Waterstones or anywhere. It's called Strong Foundations: why pelvic health matters, but it has a whole section on kind of postnatal recovery, and including all the massage techniques with images if that's what you prefer. But yeah, you know, reach out ask me questions. I've got a little team, some people will like rather have an appointment at home. I think what's really important to know about physios is not like if you're asking for a physio appointment, we're expecting you to come for five to 10 sessions privately. That's absolutely not I do a lot of one offs just to give women the empowerment to be like this is how your body's recovering. And this is how I do the next few months. And it can be life transforming. Sometimes you're like, you know what, I can invest that amount of money in one appointment, that's fine. Or we might even support you to how to get in more NHS support. So I'll very much say to women like what is available to you. If you'd like I can write to your GP and ask them to do X, Y and Zed. So there's lots of ways I believe and we can weave care to optimise it for women, whether that's a virtual console or something else. So I very much believe that there is something there for everyone from the price of an ebook all the way up to a consultation, one to whatever we can make it work but just know if you're struggling, please do reach out because there's so many of us that would just love to support you. 

Megan Rossiter  57:28

Amazing. Thank you so much.

Megan Rossiter  57:35

Thank you so much for listening to today's episode of the Birth-ed podcast. It's my actual life mission to get these conversations in front of as many expensive families as possible and you can be a part of this mission. Don't worry, I'm not recruiting you into my cult. But if you leave a five star rating and review of the podcast then we creep up the charts getting more ears, change more births, change more lives and come on, you know you want to be a part of that change.