EBB 222 – Navigating Induction and Pregnancy at 35+ with EBB Instructor and Birth Fusion Founder, Jennifer Anderson

Learn more about Jennifer Anderson and Birth Fusion here.

Learn more about the ARRIVAL trial on EBB episode 10 here.

Listen to EBB episode 176 here. 

Listen to EBB episode 177 here.

Listen to EBB episode 178 here.

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Birth Fusion founder and Evidence Based Birth® instructor, Jennifer Anderson, about her work as a childbirth educator and doula, serving families who get pregnant via in vitro fertilization and those over the age of 35.

Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker. I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. My name is Dr. Rebecca Dekker, pronouns she/her, and I will be your host for today’s episode. Today we are so excited to welcome Jennifer Anderson to the podcast. But before I read Jen’s introduction, I want to let you know that we will mention the COVID pandemic, stillbirth, and miscarriage related to being 35 and older. If there are any other detailed content or trigger warnings, we always post them in the description or show notes that go along with this episode. And now I’d like to introduce our honored guest. 

Jennifer Anderson, pronouns she/her, is an RN, doula, childbirth educator, birth photographer, and Evidence Based Birth® Instructor. Jen provides labor support to couples in the Sacramento, California region and she also teaches the Evidence Based Birth® Childbirth Class online to families everywhere.

Jen graduated from the University of Pittsburgh School of Nursing in 1990. She spent the first half of her career in the NICU and pediatric OR nursing in Philadelphia and Seattle. In 2004, she moved to Davis, California, and she found her way into labor and delivery nursing in 2006, after giving birth to her first child. Jennifer trained at a hospital where midwives attend most of the births. Recognized by the California Department of Health and Human Services, this facility has the lowest cesarean rate in California at 12%. Jen also coordinated their volunteer doula program for four years, and that program provided free labor support to couples requesting this care and labor. The volunteer doula program remained active throughout the COVID pandemic.

In 2011, Jen started Birth Fusion to provide labor support and childbirth classes to couples in Northern California. Today, she has supported more than 225 births in the Sacramento and Bay Area. In 2019, Jen was one of the first instructors to begin teaching the EBB Childbirth Class, and she’s taught more than 45 classes in three short years. While keeping her license active in nursing, Jen likes to say she practices community nursing. She thrives in mentoring families through all aspects of their childbirth journey. Jennifer’s core demographics include IVF couples and those over the age of 35. And she guides couples in understanding their risks through the lens of their values. Jen’s superpower is educating and supporting families and navigating labor inductions by taking away the element of surprise while thinking outside the box to help her clients gain agency and autonomy in this process. We are so thrilled to have Jen Anderson with us, welcome to the Evidence Based Birth® Podcast.

Jennifer Anderson:

Hi, Rebecca. It’s a pleasure to be here and an honor to be on your podcast. Thanks for having me.

Rebecca Dekker:

So Jen, you have had probably more clients or students from your childbirth class on the podcast than any other instructor, and it’s probably because you teach so prolifically. But I want to go back earlier in your career, I talked a lot in your bio about how you’re a nurse, can you share what led to your career in labor and delivery nursing?

Jennifer Anderson:

Yeah, it’s actually a really interesting story. I was pretty much working in pediatric nursing in the operating room, in NICU nursing, prior to becoming a labor and delivery nurse. I always say, that kind of nursing is really warm and fuzzy, high touch. You’re dealing with children and children’s families there. You can’t be super clinical there. So I really kind of love that warm, fuzzy type of nursing. And when I moved down here to Northern California, there wasn’t a free standing pediatric facility here. So I was managing an OR in Sacramento and discovered quickly that management is not my thing.

And during a case, I became pregnant while I was a manager in the OR, and I had pretty much planned on having my birth at the facility where I worked, which was in Sacramento, but where I live is about 20 minutes outside of there. And we have a great hospital here in our backyard, but I decided I was like, “No, I know all the docs, I’m just going to have my baby here. Yeah, let’s do this. Epidurals? Of course, I don’t want to be hero.” And I really didn’t know that much about childbirth despite being a nurse, that was 16 years behind me. So I was circulating on a case, I was relieving somebody for lunch once, and was in the OR. And at that point in time, I started to investigate other birth options, as I started reading more, reading amazing books and other books that were just really kind of inspiring me to go, “Wait a minute, there might be more than just a medical kind of birth here?”

I was mentioning amusing about that during a case. And I had mentioned that I was thinking about transferring my care from that facility over to the facility in my hometown. Same system, same hospital was owned by the same major corporation. And one of the anesthesiologists had popped up from behind the screen in the OR and just kind of hearing this, and his immediate reaction was shocker. He was like, “Why would you want to go to Davis and deliver in a dirty filthy tub with a bunch of granola heads?” And I was like, “Whoa, wait, what? Where did that come from?” It felt so hostile and at me, and this person was a casual acquaintance. It made me start thinking more like, what caused that person to say that? Why was their knee-jerk reaction so negative to unmedicated births, to using the water, to midwifery-led care? And it pretty much compelled me to keep digging deeper.

And so fast forward, I ended up taking multiple classes, including hypnobirthing. And while I was in another class for the community, actually, one of the nurses from this hospital was teaching the class, and I was like, “You know what? I’m starting to kind of get interested in this labor and delivery thing. And I’m thinking I might want to make a career transfer.” I’m like, “Do you guys ever hire nurses without experience?” And they were like, “Well, yeah, we actually have a position open right now.” I was like, “Really?”

And so I showed up for an interview on my due date, 40 weeks pregnant, I always say, sat there in that interview, and I love to say, got the job, because who’s not going to give that per… I would’ve crumbled into a ball of guilt. I wanted this so badly. So I got that position and then promptly gave birth to my daughter two weeks later. So I always say, I did that post dates March. I was also 37 and 39 with my two children, so over the age of 35. And while that was a pretty interventive birth that needed to happen, everything happened for a reason and I felt very held and informed throughout the entire process. And it just-

Rebecca Dekker:

Now, did you give birth at the place where you had just gotten the job?

Jennifer Anderson:

I did. I did.

Rebecca Dekker:

Okay.

Jennifer Anderson:

So yeah, there was a lot of things going on. My water broke, there was very thick meconium, I was 42 weeks, baby needed to come out. And I always say, there but for the grace, did I have a vaginal birth. I know for a fact, had I given birth anywhere else, my birth would’ve absolutely been a cesarean birth. Baby didn’t look good, I was older. Fortunately, my body labored fast and the baby came out, and we were all well and good. I went on to have a home birth with my son and got that water birth that I didn’t get the first time at my facility. So after that, I started doing labor and delivery nursing. It was really kind of my pregnancy and my reading up on how to do this thing that really kind of sparked my interest and helped me decide that this was a career shift that I was ready to make.

Rebecca Dekker:

And at this facility where you were practicing as labor delivery nurse, you’re saying that water birth was actually an option in the hospital?

Jennifer Anderson:

Yep.

Rebecca Dekker:

Or just labor?

Jennifer Anderson:

No, the whole-

Rebecca Dekker:

They don’t make you get out?

Jennifer Anderson:

They do not make you get out. No. In fact, this hospital as well as San Francisco General are really the only two birthing hospitals in Northern California that follow it all the way through with the water birth. There are plenty of hospitals in our region that do have tubs, but as you mentioned, most hospital facilities do not promote hospital water births. They do make you get out once you’re 10 centimeters, or whenever but before pushing. This hospital, no. I’ve done hundreds of water births myself, both as a nurse, as well as witnessing them as a doula. So it’s one of their really awesome claim to fames.

Rebecca Dekker:

And what else do they offer at this facility that is not common in the rest of California or even the rest of the United States?

Jennifer Anderson:

Definitely both. The midwifery program there is probably the most active. They do catch the majority of babies. Right now, on the Cal Hospital Compare site, where they do rank and show the number of births that are caught by midwives, for this hospital, it states that it’s at 60%. But in talking with some of my colleagues that still work there, you have to think about the fact that midwives are not involved in catching babies that are cesarean births, whether planned or ending up that way. So take the cesarean birth population off of there, where those midwives could have never caught those babies anyway, then they kind of suspect that number is kind of closer to about 80%.

Rebecca Dekker:

Mm-hmm (affirmative).

Jennifer Anderson:

So, that midwifery model of care, it’s not that true midwifery-led model because it is a collaborative practice. We do have OBs, there’s an OB on call and a midwife on call at all times. And in California, midwives do have to work underneath the description of an OB in the hospital. We do have some new laws coming through that they can practice independently outside in the community. But within the hospital, they practice together. So this really isn’t that true midwifery-led model, but it’s about as close as you can possibly get. So, that is one huge aspect. These midwives are on call. They’re not in the OR. They’re not in the office. They don’t go home. There is no clock. And that is a really, really big aspect of how people are treated and how labors are supported at this facility.

Probably, the other one that is a really kind of bubbles up to the top is their volunteer doula program that I used to coordinate. And recently during COVID, I rejoined the program to help out a little bit. So, that is another one that really helps these families have the support that they need. Their nurses are very well trained in labor support. These nurses know how to do a hip squeeze. These nurses know how to hold up a chair and sit by the bed and hold their hand. They really do have that high-touch care that is so lacking in so many other facilities that I go to. So, that and just a lot of the comfort measure stuff.

In addition to tubs, they have TENS units. We do sterile water injections on a regular basis. Being allowed to walk around. Intermittent auscultation with a Doppler is another really, really big one. These families, when they get there, we make sure that their babies look okay. And then 20 minutes, we’re looking at our watch, let’s get in there, let’s get her off the monitor, and let’s get her up and moving around and doing what we need to do. So those are just a few of the things that really kind of help that caesarian birth rate be at that 12% level, which is unseen anywhere else. And this-

Rebecca Dekker:

So lots of upright positioning and mobility. Can people birth in the position of their choice?

Jennifer Anderson:

Always, always. I don’t know… The stirrups rarely make an appearance until it’s time to kind of clean things up at the end. But very rarely is somebody… They don’t even go up. I always say just the way I kind of learn it, when I’m a doula, I always look at the nurse and say, “Me and the partner, we’re the human stirrups.” We’re going to kind of help her pull her legs back and down, but just keeping those things out of the way really makes the birth feel human again, just like you would have in any outside of the hospital facility. As soon as those stirrups go up, I kind of even get a little bit of a knee-jerk, “Ugh.” I don’t like it when I see it at other facilities, so it’s kind of one of my big advocacy things when I’m working with births elsewhere, is, “Can we keep the stirrups down? Me and the partner, we’re going to be human stirrups.”

Rebecca Dekker:

Yeah.

Jennifer Anderson:

So yeah, any position, rarely is somebody on their back. Let’s put it that way.

Rebecca Dekker:

Mm-hmm (affirmative).

Jennifer Anderson:

Yeah.

Rebecca Dekker:

Yeah. That’s incredible. So with the volunteer doula program, anybody who wants a doula just asks for one when they get there?

Jennifer Anderson:

That’s it. Show up and say you want one, and they’ll go out to the call list. We usually manage expectations a little bit with this, and that really probably has not changed, where we cannot guarantee that we can provide you a doula. This is a volunteer program.

Rebecca Dekker:

Okay.

Jennifer Anderson:

So the people that train to be doulas in this program donate their time out of the goodness of their heart. They come in at three o’clock in the morning to sit and labor, sit with somebody they’ve never met before. They are truly some of the most giving volunteers you can possibly imagine. It’s a 24/7 job and they do an amazing job. But there are gaps. There are times when they don’t have a doula on call, or the single doula that they do have on call is with somebody else. And that part is practiced like doula care. It’s continuous. That doula isn’t going from room to room and holding everyone’s hand. If that person has a doula, then we have to find another doula for the second person or third one who might be asking. So they do that pretty well. They’ll put call blasts out and see if somebody will show up.

But as far as there’s no forms to fill out, no nothing, usually the nurse ask, “Would you like a doula? Do you have one? Are you interested in one?” And at that time, a lot of people just learn for the first time what a doula is. So it’s really an important aspect of that because so many people go into the facility, not even knowing what a doula is and would never even think to ask for it. So the fact that the midwives and nurses also offer it is an also a huge, important aspect of that program. Make sure people know what they are and how they serve us.

Rebecca Dekker:

And then are the doulas respected? Because I know a lot of doulas feel like, when they walk into hospitals, they’re not wanted there. But they feel like they’re part of a team and valued?

Jennifer Anderson:

Yeah. I mean, you can only imagine. This hospital welcomes doulas with open arms, even during the pandemic while they… The big system said, all hospitals have to shut their doors to doulas, this hospital really didn’t want to, but they were able to at least keep their doula program alive and active, where families at least had access to that at very least because those doulas are health screened. They do have to abide by certain policies that visiting doulas do not. So they could control that a little bit better, and that was a safety aspect that the facility and the region was allowed, able to kind of swallow.

But otherwise, there is a number of doula programs in our area now. They’ve kind of sprouted up everywhere. And this one is definitely different in that, we’re already operating from a place where the standards of care at this facility are very evidence based. So the advocacy piece that is so crucial and important in doula care and the one that is probably the most difficult to navigate with hospital-based doula programs simply doesn’t exist. In all honesty, usually the care that’s being recommended at this facility is evidence based and appropriate. May not match that person’s values, and we do have to dive into that a little bit more, but they are very much supported in the decisions they need to make. So doulas in this program really get to focus on the parts of our job that we absolutely love, the labor support, the hand touch, the communication, the keeping the family together as a unit, helping the partners and their support team kind of relax and get into it.

So, there’s not that heavy advocacy piece that is part of doula care. That is a little bit a conflict of interest in hospital-based programs because most of everything that’s being recommended kind of makes sense. So we don’t see this at our hospital. There are probably isolated incidences where a doula was recommending something that the provider didn’t really buy into, but those are usually the exceptions to the rule and it’s not a rate limiting stuff for this doula program here at this facility.

Rebecca Dekker:

So a hospital-based doula program where there’s volunteer doulas or staff doulas could be more difficult in an institution where they’re forcing care on people that’s unwanted or unnecessary. And this situation’s different because there’s so much respect for the patient autonomy.

Jennifer Anderson:

Mm-hmm (affirmative).

Rebecca Dekker:

And for the evidence that you don’t have to go in with your guard up, worrying about your clients.

Jennifer Anderson:

No.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

I don’t know that I could work at a program that does limit that. My partner and I run a mentoring program for new doulas, and a couple of them that we have in our program volunteer for another program in our region, another hospital. And one of the things that they learned in their training and that they are kind of trained to operate and ask and part of their training is, as a volunteer doula, you do not speak when the doctor enters the room. That was what they were told. You cannot not allowed to open your mouth.

Rebecca Dekker:

Not allowed to talk.

Jennifer Anderson:

Yes.

Rebecca Dekker:

Uh-huh (affirmative).

Jennifer Anderson:

We don’t want to hear you. And that’s fine, the conversation does need to happen between the provider and the patient, but at the same time, I will interject questions that I think my client needs to hear the answer to in order to make an informed decision if it was something they didn’t think to ask.

Rebecca Dekker:

Mm-hmm (affirmative).

Jennifer Anderson:

And in certain programs, I like to say they’re kind of putting lipstick on a pig. They’re putting this program out here as a little bit of a, “Hey, look at us. We do all these wonderful things. We’ve got this volunteer doula program,” but how these doulas are trained, they’re trained in a manner where they’re kind of hamstrung in some of the most important roles that a doula has with regards to helping their families get the information they need to make informed choices in birth. So it’s a very delicate line to walk. And I understand the hospital’s conflict of interest as well as the doula’s conflict of interest being on both sides of those labor room doors in my career. And all I can say is that, this facility really manages that beautifully. The doulas are very well supported. The nurses love them, want them around. And when I go there, it’s just a plain old doula to my clients. Same thing, doulas are just welcome with open arms, and it really is an enjoyable experience.

Rebecca Dekker:

And so a lot of the people who use the hospital volunteer doulas, it’s usually because they never thought to hire one but now they realize they would like one, or they didn’t have the funds to hire one. But some people bring their own doulas that they hire independently and privately. What are the advantages of that, if you’re able to hire a doula ahead of time?

Jennifer Anderson:

First off, you build that relationship with this person who’s going to be supporting you. When we think about birth, we think about who do we want around us that is going to hold us up and help us achieve our vision of what our birth should look like. And that’s somewhat hard to do when you don’t know the person that you’re going in to serve. Nurses kind of are automatically in that category, “I’m meeting you at five centimeters. I don’t know what your values are. I don’t know what your childhood experiences were. I don’t know what this relationship with your partner looks like. That mother-in-law that’s sitting in the corner, what is her role and how is she playing into all of this?” And as a nurse or a volunteer doula, you don’t have that in depth knowledge that you do end up getting when you are working with your clients over a continuum of time.

I’m booking out until October, November right now. So some of these clients get to know me and we have a relationship together for quite a long time. So I know how they tick. I know how they think. I know what’s important to them. And I also have a really strong handle on both their pregnancy risk factors, as well as their general health risk factors, and how that might affect some of the decisions that we may need to make in labor.

Then the other side of the spectrum is, that volunteer doula program, labor only, that’s it. As soon as that baby comes out, those doulas are usually gone. If you end up getting an epidural and choosing that for some reason, usually those doulas leave, where private doulas, me, I just break up my yoga mat, it’s a nap time for everybody, and I’m sleeping on the floor. I don’t leave my client even when they get regional or any kind of medical pain relief. That’s when we really need to amp up our advocacy because that’s when risks start to rise for things and interventions can start to snowball.

So, our need for a doula, really we’re kind of thinking about the birth process itself when we’re talking about volunteer doula programs, where privately hired programs are community-based volunteer doula programs that do set up care throughout the continuum of pregnancy are far more comprehensive in the experience that the birthing person receives. You also get that postpartum care that a volunteer doula program simply does not offer, which also includes checking in with families at home afterwards. Let’s practice breastfeeding on that sofa with those pillows or in that bed with that supportive back. What furniture do you have at home to make this happen? Let’s get you into a sideline breastfeeding position, something that maybe you did not learn how to do in the hospital. So, these are things that private doulas can really kind of carry that care a little bit more forward.

The other thing I’ll also add too is that, a lot of people decide, “Well, I’m not going to get a doula because I’m going to be induced. I’m just going to have medical intervention, and doulas are only for people that want natural births,” or, “I’m not going to get a doula because I know I want a epidural. So why would I do that?” And that I often say is where volunteer doula programs can be very useful, that “Okay, let’s help you cope with labor until that epidural is safe for you to get.” I always say labor hurts until you get to that point. So that aspect of it, a lot of people know what a doula is, but decide that they don’t need one because they’re going to have an interventive birth. That’s a perception that needs to change for sure.

Rebecca Dekker:

Mm-hmm (affirmative). For sure. Tell me about becoming an EBB instructor. So, you are labor and delivery nurse, you became a doula, you ran this volunteer doula program. What inspired you to join the Evidence Based Birth® Instructor Program fairly early on?

Jennifer Anderson:

Yeah, I think your program started in 2015, I believe, and I joined you in 2016. I was teaching childbirth classes in the community both as a nurse. I’ve been doing that since 2007. So I was kind of a dual career as a RN and educator. And then when I started my own business, the RN part just turned into the doula part, but I still continued to teach classes. And I kind of clued into you very early on with some of your earliest blog articles and things that you were discussing as far as perfect tools and topics for me to discuss in my childbirth classes. And I did not teach for any national organization. I kind of taught my own homegrown class based on my nursing experience at a very forward thinking facility. So I kind of got to make it up and do whatever I want. And I would have a whole desk full of just your single page PDFs on my thing back to 2000 probably ’14, was when I finally started starting finding your things and using your single-page articles as supplemental material for my classes.

So I really kind of say, my process of finding you happened through teaching childbirth classes and just kind of learning a little bit more, and going, “This stuff makes sense.” And it also spoke to me. The more I started to read these articles, I’m thinking, at the facility where I worked, I’m like, “Oh we do that. Yeah, we do that too. Yeah, we do that. We do that.” And some of these articles, I didn’t realize until I left nursing at that facility that I was like, “Oh my gosh, we really are different.” I start walking into facilities that have a 95% epidural rate and a 30% first time cesarean birth rate. And it threw me and I really didn’t realize how much of a Nirvana I trained under. And that really motivated me to get this evidence-based information into my classes because not everybody I was teaching was delivering at this hospital, and I knew that these clients needed this information to help them navigate their birth experiences.

Rebecca Dekker:

Mm-hmm (affirmative). And then you started teaching the EBB childbirth class in 2019, and what was that experience like?

Jennifer Anderson:

Oh, it was freaking awesome. I just taught my class until nine o’clock last night. I absolutely loved teaching the Evidence Based Birth® Class. Probably the thing that I love the most about it, is how the curriculum includes advocacy. And I always say in the start out of teaching this class that it’s the one piece that I never really taught well prior to the EEB Childbirth Class. We taught you the evidence. We taught you how to move in labor or the birthing positions, how to breathe, all those common things.

But what we didn’t realize is, okay, here’s the evidence, and what do you do when you go, “Hey doc, what do you think about this research paper or this evidence on this? I think I want to eat and drink in labor.” “Oh, well, hospital policy says we can’t do it.” You chuck it over your shoulder. Now, what do we do? I taught you to say, this is what you want, but what do you do when the provider says no? Or the hospital or the nurse says no? It’s not no. And I think that is the biggest probably third leg to use kind of the Evidence Based Birth® mantra of the three-legged stool. It’s probably the most important third leg of this class, of really focusing on advocacy and comfort measures. So I love teaching it.

Jennifer Anderson:

When COVID hit, this class, I love to say, was the one class in the nation that did not miss a beat because it was a hybrid class, because part of it was already on Zoom before most people knew Zoom. My intro emails were exactly how to log into Zoom. And then COVID hit and I don’t have to send that email anymore. And because it is online and accessible to everybody, it really is a joy to see because I get to be in people’s living rooms. Last night, I was kind of laughing because a cat was walking along the top of the sofa behind this birthing person. And I was just like, “Christina, someone’s watching you.” And everybody kind of looked at her and everyone started laughing. And I just did a really fun picture at the end of everybody holding their animals up before the end of our last class.

So the convenience of this now being 100% on Zoom, the pandemic kind of made us have to pivot that way. As things wane, there are instructors that are teaching locally in their community. I chose to stay on Zoom because, one, I love the intimacy and the convenience of learning in our own homes, teaching in our own homes. But I also love the opportunity to meet people from all over California, from all over the West Coast, sea area. And I do get couples every once in a while from the East Coast that pop in because the dates worked, or I’m a night owl. And if you’re on the East Coast, then you’re taking my class close to 11 o’clock at night, but that works for your schedule. So the flexibility and the intimacy of this class, as well as the curriculum itself are probably my favorite aspects of it. And I also have my favorite topics within the class too.

Rebecca Dekker:

Yeah. And I know you get to incorporate some of your nursing background and your doula work. One of the things that I love about the class is that, each instructor also serves as a mentor because they bring their own personal experiences and stories to the class. And all the class you said is a hundred percent on Zoom. Actually, a lot of it’s self-paced, and it’s just the kind of check-in meetings once a week where you get to talk with your instructor and get mentorship that are on Zoom.

Jennifer Anderson:

Yeah. So it really does fit busy lifestyles because as you said, yes, there is the online component where you are watching videos ahead of each week’s class. You’re reading articles ahead of each week’s class. You’re finding playlists. You’re doing relaxation practices. A lot of these things are done during your time between our live Zooms, but it’s not an online class with respect to, “Here you go. Here’s a curriculum. See you later.”

Rebecca Dekker:

Yeah.

Jennifer Anderson:

You have that weekly-

Rebecca Dekker:

You’re not just watching a presentation on Zoom.

Jennifer Anderson:

Yeah.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

So that accountability piece is great. I have to check… Well, you don’t have to, but everybody wants to check in. And then, two, that time for us together really allows the individual EBB instructors to bring their perspective, their knowledge base to the class. And there are many niches that a lot of our instructors focus on, like BIPOC families or first time families or rainbow babies. And these kind of niches are really special aspects of the class where that instructor has that solid core of knowledge base in that certain little niche, that maybe the bend to a childbirth class that you’re really looking for.

Rebecca Dekker:

Yeah. So let’s go into your niche or your expertise in supporting IVF families and people who are giving birth over the age of 35. Can you tell us a little bit about some of the challenges that they face, what do you talk about in your classes with them?

Jennifer Anderson:

Yeah. Over the age of 35 and IVF, or assisted reproductive technology is sometimes how we will talk about it, they tend to walk hand in hand with each other. IVF pregnancies, in general, tend to wade naturally into that over the 35-year age group because it takes a while to become pregnant. By the time you finally do, you’re over that age. And then there’s just plenty of people that this is when they finally found their soulmate, or this is when they finally decided it was a right time to give birth. And while I did not have… I had spontaneous pregnancies with both of my pregnancies and births. I was, as I said, 37 and 39. So I had very much that mindset of the older pregnant person that I knew, in my own experience, handicapped me in some ways with regards to how I thought. Or my life experiences were a little bit more global and so I kind of really dug in to what I knew I wanted with my birth.

And as I mentioned with my first birth, it did not go the way I wanted. I had manifested a beautiful tub birth. I labored in the room with the tub that I was not allowed to get into for very, very good reasons because my baby was not doing well and it wouldn’t have been appropriate. And I always kind of say, I looked at that tub with devil horns. It was just staring at me like, “You’re not going to get in.” And in the end, I kind of had to process a lot of that. Was it my age? What was it that had me wait into that 42-week period? What was it that caused that meconium that necessitated an induction when my water broke? And I really threw a lot of self-reflection, realized that a lot of it was how I dug in my heels to the birth that I wanted and was not able to get. And the fact that I couldn’t get the thing that I wanted, I struggled on how to recover from that.

Even though I had a very lovely birth, healthy mom, healthy baby doesn’t necessarily always mean healthy mind. And when I kind of sat back and finally examined it, I realized I’m like, “No, that birth, while it was wonderful, I struggled with it.” And I think part of it was just where I was in my stage of life. I was a little bit more dug in and unable to kind of flex with things. I had the time to do the research and I did too much research on all the things that I really wanted without really looking at the things that I may not want but may need. And that oftentimes, in this age group, does tend to be an issue.

The other scenario is that, we do have increased risks of poorer outcomes sometimes with older families that just comes naturally with the age. We do see stillbirth more often as we age. While it’s still extremely low, 100% low, each birth person has to look at their actual rates and make that decision for themselves. What kind of risk can they tolerate? And the older we get, the harder it is to become pregnant. In IVF, how much money we threw at this pregnancy to get here changes our values and it changes how we look at the evidence.

And one of the things that I love that you always mention in your podcast and with us in general is that, the evidence is just one piece of it, but if we only look at the evidence, it can become a very bad dictator. And I take that statement with me all the time because we can look at the evidence that says, “Yes, we see, as you get older, that your chance of the stillbirth increases ever so slightly,” but still, what does that mean to you? Just because the numbers go up, does that mean that we have to induce?

Perceived risk versus actual risk are two very different things. And people in these two categories get a lot of, “Well, you have this risk so we’re going to do this.” And that should not be the end of the conversation. How does the birthing person and the couple feel about that actual risk that they have? Is that a risk that they’re willing to take and tolerate? And those conversations between the couple and the provider are also very important. It’s something I really infuse into the class, like how to have those conversations about what is important to you.

Rebecca Dekker:

So, you mentioned your own induction. Can you talk a little bit about how often, when the birthing person is 35 and older, they’re faced with an induction and how you help them prepare for that or decide if they’re going to have one or not? And why is it offered so frequently?

Jennifer Anderson:

Enter the ARRIVE trial. We all know and love this well. You have a podcast on it. We do discuss it in the EBB Childbirth Class. I bring that article to the class and we really discuss in a little bit more detail because it is something that my clients over the age of 35 and with IVF pregnancies tend to see more often, that recommendation to induce at 39 weeks to reduce the chance of having a cesarean birth, which the ARRIVE trial in its truest form did demonstrate, that we did see a decrease in the caesarian birth rate when we were induced at 39 weeks. This study looked at only first time parents with a single head down baby. So it doesn’t look at repeat families or anything like that.

So when that study came out, and it really kind of hit with a true force when COVID hit, I started seeing my clients being offered this 39-week induction pretty much across the board everywhere, except at more evidence-based facilities. And so you’re told, “Hey, I can have a better chance of having a vaginal birth if we induce at 39 weeks.” Without digging into that anymore, most people are going to go, “Yeah, sure. I’ll do that.” And my clients that are over the age of 35 and those with IVF, get that all the time. And so looking at what the evidence actually supports for a 39-week induction, as well as what does an induction look like? It’s not just a word, it’s a process and it’s an interventive process. And it takes a lot of advantages of vaginal births off of the table, such as laboring at home, or being able to move around freely, going for walks, just getting outside. Hospitals lock you in now, can’t walk around outside. So inductions and my patient population tend to really go together a lot more. I see I have about a 30% induction rate and-

Rebecca Dekker:

For people who are in your classes?

Jennifer Anderson:

No, for my own clients. About 30% of them required induction because, while you kind of talk about the fact that about 20% of total births are over the age of 35 at this point in time, I’m seeing almost 40% of my population is over the age of 35. So I see a much higher demographic than that. And it naturally brings up that induction rate too. Why? Sometimes it’s just because of age, but other times there’s other comorbidities that kind of marry themselves to age, such as hypertensive disorders of pregnancy, such as gestational diabetes. So when those co-diagnoses come up and marry themselves to an AMA diagnosis, then the desire to induce becomes a little bit more strong. And so we have to navigate this more often in the older that we get. And I always say, “It’s my will. It’s my jam. It’s my superpower,” is to take that induction and still make it human, to take that induction and help our clients still make choices every step of the way and not a let induction happen to them.

Rebecca Dekker:

So the families that you’re teaching, many of them are 35 and older when they get pregnant and had to go through very expensive lengthy invasive process with assisted reproductive technology to get pregnant, often with IVF, then they confront perhaps medical conditions because of their age, and then there’s also the desire to lower the risk of stillbirth with pregnancies that go on past your due date or even trying to induce before your due date. And there’s also this heightened awareness that this pregnancy was very difficult to come by because of the IVF. So, people find themselves frequently in the situation where an induction is being recommended. So if a family decides, “Yes, I’m going to accept the induction,” because their values and the evidence or their personal preference is to have that, what are some of the things you do as the EBB childbirth class instructor? They’ve had a lot of content about inductions. How do you customize some of that content? And what are some of the tips you give them? You mentioned humanizing the induction.

Jennifer Anderson:

Yeah. So first off, kind of really understanding what goes into induction, what kind of things are we not going to be able to kind of wave off. If we’re using medications, for example, to induce you, then monitoring has to be a part of that. We can’t say, “Yes, I want to be induced, but no, I don’t want to be monitored,” simply because these medications can cause too many contractions, which can be stressful to the baby, and we have to make sure that we’re managing that carefully. So understanding that there are some things that have to go together, how can we make that useful?

So, perfect example using that one of monitoring is that, we have many different ways that we can monitor you if you are on Pitocin, for example, which is, I also say not how we started an induction. And I am emphatically clear because everyone thinks induction, “Oh, I don’t want Pitocin.” I’m like, “You might not need it. We can get your labor started with things that are not Pitocin.” And in fact, it’s usually the right way to do things, using tools and using more cervical ripening methods to get us there. And I really kind of spell that out and spend a great deal of time in the childbirth class of how all of these methods actually work and what their approaches are.

And then once you do decide what your method of choice is, if there is monitoring that has to play into it, there’s different ways that we can monitor you that will allow you better freedom of movement. There is a certain type of monitor that operates on Bluetooth technology, a fetal monitoring device called “the Monica”. It picks up contraction frequency as well as fetal at rate in a different manner than our traditional monitors do. This monitor is a sticker that goes on your belly with a little Bluetooth box that kind of sits in the middle. And that’s it. There’s no heavy bands that are strapping you down. There’s no wires that go back to a monitor. And because it operates, it looks at contraction frequency and heart rate differently. It also really picks up both in any position. And for anybody who has been through a monitored birth, which is the majority of this country, will recognize, “Oh my gosh, if that nurse came in and adjusted my monitor one more time.” They’re constantly putting more straps on. They were tightening it. They were putting wash cloths under it to try to get it.

Rebecca Dekker:

I remember having marks from where the discs they indent into your abdomen, and it hurts.

Jennifer Anderson:

Mm-hmm (affirmative) Yeah.

Rebecca Dekker:

It hurts.

Jennifer Anderson:

Yeah.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

And some people just have really tender areas down in our lower quadrants where we tend to pick up baby’s heart rate. And so just the mild touch is really disturbing to a parent. And as they’re laboring, the last thing we want to do is cause them more pain. That is something that I teach my clients is out there and some hospitals have it, but the nurse doesn’t like it. So I’m not going to go ahead and get it. I’m not going to hook it up because she doesn’t know any better.

So when my clients go in and say, “Well, I’m having an induction. Do you have the Monica available? Is that something I can offer?” At least that patient now, that client is demonstrating that they’ve done their homework. They kind of know what options they have out there. And for a labor where we have to monitor you the entire time, which can happen. I was monitored the entire time, very appropriate. Having something else on my belly to do that, where it would allow me to move around a little bit more and not have that impedance, would’ve been really, really helpful. So that’s just one example of many kind of tips and tricks.

I got another story that I think is kind of apropo here. I had a client recently who was 42. She was at just one of her typical prenatal visits. I think it was around 38, 39 weeks. They had already been talking about an induction because of her age, and she had decided that she was going to wait at least until 40 weeks before deciding to do that. As it was, when she went in for that prenatal visit, her blood pressure was high. And so she got sent over to the labor and delivery unit. It remained high. The labs came back conclusive and diagnostic for pre-eclampsia and the recommendation was to induce. And so we were talking on the phone and this was all within four hours of each other, “Hey, want to meet your baby today?” Nobody ever really wants to hear that after a prenatal visit. So she was kind of really wrapping her head around it.

She was a researcher. She was a scientist at our… I live in a college town. So she had done her homework and knew everything. She knew that this was real, that this was probably an appropriate recommendation. And I reinforced that, yes, it was, but that doesn’t mean that we’re just going to railroad you. It was nine o’clock at night. She had worked all day long, and I could hear it in her voice, she was just shaky. And before I was even going to come to her, I was trying to help her decide kind of accept this diagnosis.

As we were doing that, and she really was there, I was like, “Well, we’ve got a couple of options.” I’m like, “This induction doesn’t have to happen tonight. It can wait a little bit if you don’t think your right head space for it.” We talked about why, while it wouldn’t be supported, you’d probably have to sign an AMA form. I’m like, “You could go home and sleep on it and come back tomorrow.” I told her that’s not what I would recommend based on her lab values, but if that makes you too nervous, and she admitted that it did, then I said, “Why don’t we ask them about maybe just taking a sleeping pill, having them monitor you overnight at the hospital and monitor your blood pressures at the same time? If anything looks kind of concerning, then we can start the induction at that point. Otherwise, why don’t we see if we can get you a good night’s sleep in the hospital and we can start this induction at 6:00 AM?”

And that was something that was suitable for her and so she floated it to the providers. And that would’ve never been an offer that they would’ve been offered. “No, recommendation is to induce, we’re going to do this tonight.” And when she brought it up, they were like, “Well, yeah. Yeah, we could do that. That sounds perfectly appropriate and acceptable.” And the providers were totally on board with letting her stay, be monitored, but holding off the induction so that she can get some better sleep. In the end, when we talked about her birth afterwards, she did have a spontaneous vaginal birth, no epidural, no pain medications, 12 hours, beautiful, beautiful birth experience.

And afterwards she’s like, “I don’t think that would’ve been the birth experience had I not gotten some rest that night.” By the time she woke up in the morning, she was less anxious. She had her head wrapped around this process. She was like, “Okay, let’s do it.” And when we’re going into an induction that we know has to happen, that “Okay, let’s do this” kind of has to be there. It really can improve our outcomes and our memory, I should say more importantly, our memory of our birth experience when you go into it ready for bear. So that’s a lot of trying to think outside the box like, “All right, let’s be safe. But within the realm of being safe, we can still get creative.” And that was just one example of how that creativity helped her have the birth experience that she’s fairly sure as am I. Probably would not have happened if we would’ve started that induction at nine o’clock at night and she would’ve never gotten any sleep.

Rebecca Dekker:

Yeah. And I think that is something that people don’t think about ahead of time, is that, although she had a 12-hour induction, many inductions can take two or three days and can be very exhausting. And if you start them when you’re already sleep deprived, that can make it even harder. I know some hospitals ask you to come in at midnight, 12:01, because that’s when the clock starts for billing or whatever purposes.

Jennifer Anderson:

Mm-hmm (affirmative).

Rebecca Dekker:

But then, you’re starting the induction already without sleep.

Jennifer Anderson:

Yeah.

Rebecca Dekker:

They haven’t slept in 18 hours and then you’re starting a two or three-day process. So what do you tell people when they’re recommended that?

Jennifer Anderson:

Yeah, I will absolutely support and endorse your observation. I would say, probably in the last two or three years, the nighttime induction start has become all the range. And what my clients tend to hear a lot from their providers is, “Well, yeah, let’s get you going so you can have this baby by lunchtime. And so we’re going to start at seven o’clock at night so that you can have this baby by lunchtime,” where I ask, “And so you won’t be up all night.” You’re like, “We’ll get this going and you can sleep, and you’ll have your baby by lunch.” And what I always like to remind my clients is, I’m like, “Got news for you. You are not going to sleep. Okay, it’s a hospital. It’s not your own bed. It’s not comfortable. It’s a labor bed. It’s not meant to sleep in. It’s meant to labor in and break down. And with the Monica monitor on, if you’re trying to sleep and you change over positions, here comes that nurse. You roll over again, here comes that nurse. Baby change positions, here comes that nurse.”

Rebecca Dekker:

And how many times are they going to ask you for a cervical check while you’re trying to sleep?

Jennifer Anderson:

Exactly, yep.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

“Okay, the doctor’s on the floor. They kind of want to… Oh, the doctor’s calling in at three o’clock in the morning. How’s she doing? I got to come in and check you.” Even if you say no, that you woke me up, tell me that. So you don’t sleep. And in my world, I really do think it’s the provider… Because if we start in the morning, the provider’s probably going to come in at 3:00 AM to catch a baby. They don’t want to do that. So I really do believe billing is absolutely one of the aspects of it. But I also believe it’s kind of a passive aggressive way of the provider getting a full night’s sleep and not having to come in at three o’clock in the morning because we started an induction at 7:00 AM.

So I do help my clients try to advocate for daytime inductions. We don’t always get that. But when that does come into play, I really help them, encourage them to take a nap. I do talk about some sleep aids that the hospital can offer, that can kind of… It’s not a narcotic, it’s a cousin to Benadryl. It can work quite well yet. If labor comes, you’re not going to sleep through it. You’re not groggy when you wake up from it. So there are, “Bring your own blanket, bring your own pillow.” As I said, ask for that Monica monitor that can be worn on you and will pick up your baby in any position so that they really can let you sleep. And if labor does kind of in a gear, then, hey, it’s a win-win, we wanted that anyway. But most of the time with inductions, as you said, the first 12 hours are kind of watching paint dry. And doing that overnight sounds like a logical thing, but it doesn’t really work out that way well in practice.

Rebecca Dekker:

Yeah. And exhaustion can make you much more likely, if the induction is taking a long time, to agree to just have a surgery, get it over with, to get the baby out.

Jennifer Anderson:

Yep. Or navigate from your plan. I wanted a water birth, I wanted an unmedicated birth. And I talk about the three biggest deal breakers to the best birth plan: induction, back labor, exhaustion. Let’s keep our eye on that prize. But when I’m looking at these three things, I am much more in tune to my clients’ needs as far as when plans need to shift. Because when I talk about the best birth plan, I talk about whatever your ideal birth plan is, especially if it’s to avoid intervention or keep birth as low intervention as possible.

So when we’re looking at exhaustion, when your body gets tired, it doesn’t work as well. Who runs a marathon well after doing a bender the night before? Nobody. Who can cope with pain well when we’re exhausted? Nobody. So the contractions hurt more as we get more exhausted? Back labor can happen in any type of labor. Induction doesn’t necessarily cause it, but it can contribute to it. And with an induction, you’re not laboring at home at all. We took that all out of the process, and we added fear-based language and a concern about my own health or my baby’s health to this process. And then as I said, back labor is a whole other beast that doesn’t just claim the space of people over the age of 35. That’s everybody.

Rebecca Dekker:

Mm-hmm (affirmative).

Jennifer Anderson:

So when we’re grappling with these things, especially exhaustion, our plans change, or at least, we have to be open and prepared for the possibility that this could be long and I may need some medicinal help to stay comfortable through it and also have a good memory of it. We shouldn’t be suffering just because we’re being induced.

Rebecca Dekker:

This is all really great advice. I’m sure, for some parents listening who are concerned about having an induction, just knowing that there’s all these options and that you can agree to things, some things, but say no to other things, and kind of customize your induction made me think about birth plans because you mentioned the ideal birth plan. And can you explain to our listeners a little bit about the EBB philosophy when we teach our classes about the backup plan philosophy?

Jennifer Anderson:

Yeah. Creating a couple of plans. My clients, I usually have them have access to… I like visual birth plans for one. I can talk about birth plans in general, as far as how they are received by hospitals, because I’m a nurse. And even though we worked at a very forward-thinking facility, we would still get the birth plan. And some of the times we would go out to the desk and we’d be looking at this four-page birth plan. And I always like to say, “Thank you for being part of our birth experience. We really are so happy that you can be taking care of us.” Now don’t do this, don’t do this, don’t do this, don’t do this, don’t do this. And the wording in birth plans can set your care team on their heels like, “Who does she think she is?”

And really, once I started to see visual birth plans come up, and what I mean by a visual birth plan is something where you have a sticker or an icon that demonstrates, “I only want a saline lock. I want the freedom to move. I would like to labor in the water.” Instead of saying that, it’s a little image that kind of demonstrates that. Not a little pregnant person in the shower, a little cartoon. And it communicates your desires without the use of words because words can be viewed through many different lenses. And as we know all so well. Use a picture, and now I know that laboring in the water is important to you. Now I know that you would like to avoid an induction. Now I know that if you do need an induction, that you would like to talk about a cervical balloon, as opposed to going straight to Pitocin or using medications.

The philosophy with Evidence Based Birth® as far as having multiple plans is that reality that I was going to have an unmedicated birth. I didn’t have a cesarean birth plan. I didn’t have an induction birth plan because that happens to other people. Over hell or high water was I going to be induced. When my water broke, I was going to go into the hospital, I was going to get checked out, and I was going to go back home again and wait for labor to begin.

My baby had other plans. And I didn’t plan on the fact that there were things about that process I couldn’t control. And so I didn’t have that induction birth plan. Not having that and not really investigating those options left me wondering whether I was making all the right choices. Fortunately, for me, giving birth at this facility where I eventually worked, I was offered all the right stuff right off the bat, but that’s an exception to the rule. Most people are not. And so if you don’t how you want your induction to look or what options you would like to be discussed and considered in your birth experience, then we’re not going to get what we don’t ask for.

The EBB class really kind of helps put out on the table, “Not that you have to do this, but hey, let’s have the menu of options here, kind of that A La Carte menu and say, ‘This is important to me. This is important to me. And if I need to be induced, this is something that’s important to me. I would like to use a Monica monitor if I need to be induced as opposed to a wired monitor. If I have to have a cesarean birth, skin to skin in the OR is so important to me.'” So having all three of those birth plans to kind of learn about the three different ways that a baby could come out, spontaneous, induction, cesarean birth. And really, kind of saying all three of these things, “I don’t know what’s going to happen, so here’s the things that are important to me because of that,” in all of those situations.

Rebecca Dekker:

Yeah. And then for people planning a home birth or a free standing birth in their birth, we also encourage a transfer plan.

Jennifer Anderson:

Mm-hmm (affirmative).

Rebecca Dekker:

But if your home birth turned into needing to transport to the hospital, which hospital do you want to get to? What pain management options would you want at that point? And that sort of thing.

Jennifer Anderson:

Mm-hmm (affirmative). Yeah.

Rebecca Dekker:

So I think it’s been really interesting because I feel like we haven’t had a lot of people who take the class, who tell us, “I was really disappointed because my birth didn’t live up to my expectations.” Instead, they go into it, knowing no matter which path this process goes, I know my options and I’ve got these backup plans in place. And so they feel more confident and secure.

Jennifer Anderson:

Mm-hmm (affirmative).

Rebecca Dekker:

I love that method of having backup plans. And especially, if you’re 35 and older and it seems like induction or cesarean are things that happen more often in those age groups, having those plans would be especially important.

Jennifer Anderson:

Yeah. You see it in the evaluations that students return and I see it in the lovely emails or the birth announcements that are sent to me from couples in our class, where it was like, “Well, that didn’t go as I planned. Nothing on my first birth plan ended up working out. And you know what, Jen, it was still amazing. Why? Because I knew exactly what to expect around every corner. I knew they were going to come in and suggest X, Y, or Z. And so while I didn’t like it, that a little bit of a window of forethought was something that really kind of helped me wrap my head around this decision when they came in and said exactly what I knew they were going to come in and say because you told me if this happens, they’re going to come in and say this.”

So I always kind of like to say, hashtag no surprises, take the surprise element out of childbirth. Positive memories are more achievable. The moment that we’re blindsided by something, even if we have a healthy baby, healthy mom, I understand that statement, but it really glosses over… It simplifies the process too much. The experience can create an unhealthy mom, whether it’s mentally or physically. The experience can create the potential for poor outcomes for our babies. So really, kind of backing away from that healthy baby, healthy mom to agency in the process. I know that I’m going to have the tools to make every decision at every crossroads in my labor.

To me, that’s what the EBB classroom really helps couples prepare for. Even if you are 28 years old and 100% healthy and planning a home birth, great, that’s going to be amazing. And if you achieve it, then this class really just said, “Woo, woo.” But if things go sideways, we do need to transfer. This did go on for 36 hours and I just need some sleep, and an epidural is the only way we’re going to get that, then those families are also prepared to transfer over to the hospital. You just did a recent podcast with one of my students about that exact thing, a transfer from a hospital, a home birth to a hospital birth, and how the class really kind of helped her advocate every step of the way.

Rebecca Dekker:

Yeah. And that was-

Jennifer Anderson:

Cheyanne.

Rebecca Dekker:

Cheyenne Saenz, episode 208, advocating for your rights in birth.

Jennifer Anderson:

I loved her story.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

And when she wrote it, it was amazing when I listened to it. Probably the takeaway that I got from that was our discussion that I really dive in deeply to in this class, this is one of the live Zooms that I really kind of say, “Okay, my patients, my clients tend to see inductions in medical intervention more often. So let’s talk about both informed consent as well as informed refusal.” And she talked about how when she was leaving the hospital, she had a binder full of against medical advice forms that she had signed like, “I’m not going to do this. I’m not going to do this. Nope, I’m still going to sign it.”

And she knew from the class that that was just documenting her no. And just like an informed consent, documents here, yes. And the hospital has a right to say, “This is our concern. This is our risk. If you choose not to do this, we want you to sign this form.” It’s just saying, “Yep. You told me everything. I got it. I still am going to say no.”

Rebecca Dekker:

Mm-hmm (affirmative).

Jennifer Anderson:

And Cheyanne was somebody who really kind of took that empowerment. And I just, I love that girl. I was so proud of her. We instructors become proud mamas when you see your clients really take what you’re passionate about and put it into practice. And she did exactly that.

Rebecca Dekker:

Yeah. And speaking of other episodes, I wanted to call a couple other episodes that relate to what we’ve talked about today. Episode 176, we talked about the evidence on pregnancy at 35 and older, and then 177 and 178 go at more in depth into that topic with a birth story. And then also an appearance from Dr. Shannon Clark, maternal-fetal medicine physician. You mentioned the ARRIVE study. That’s episode 10. That’s one of the first podcast episodes we published.

Jennifer Anderson:

Wow. That goes back far.

Rebecca Dekker:

And it’s hard to find some of the older episodes on podcasting apps, but you can always go to evidencebasedbirth.com, I believe, slash podcast.

Jennifer Anderson:

Yeah. I go to that all the time. 

Rebecca Dekker:

And that will take you to a page with the entire library so you can get to any of them from there. And then episode 117, we talk about the updated evidence on being induced for reaching your due dates. And then we talk about 39, 40 and 41 weeks. And then of course we have our induction pocket guide, just kind of very handy to have if you are bringing-

Jennifer Anderson:

I just received one myself. Even though there’s nothing on there that I haven’t really heard or said before, I absolutely loved looking at that. It is in my birth bag because it will be something that will be very easy to whip out. Actually, since I’ve gotten it, I haven’t had a birth. So I kind of can’t wait until we do need to have this discussion because instead of pulling out your one page article, now it’s just a small little card. And it really kind of can drive that point home on both induction tools and tricks as well as comfort measures and still staying comfortable and coping with a labor. Induction is still a labor. In the end, we still have to cope with the intensity of the contractions that are coming. And that pocket guide’s a great way to do that.

Rebecca Dekker:

Yeah. And my brother and sister-in-law, when they had an induction, they brought it with them, and they said the nurses were ooing and awing over and so impressed. It was really interesting how the nurses loved it so much. I think it actually affected the quality of care my brother and his wife received.

Jennifer Anderson:

That’s awesome.

Rebecca Dekker:

Yeah.

Jennifer Anderson:

It’s very well done. I can’t recommend people grabbing that more.

Rebecca Dekker:

So Jen, how can people follow you in your work and get to know you?

Jennifer Anderson:

Yeah. So my business is Birth Fusion. I came up with the name Birth Fusion when I was trying to think of my business because of all the different roles that I hold around birth. And I throw mother in there as well. So between mother, nurse, childbirth, educator, doula, birth photographer, I’m like, “Total package.” I’m like, “Ugh, that doesn’t fit right.” And then I kind of came up with a fusion of services and that kind of really stuck. So my business is Birth Fusion. You can find me at birthfusion.com. I am on social media channels, @birthfusion on Facebook, Instagram. And I’m just starting a Pinterest account now because I do do birth photography, and realizing that that is a really great aspect to get more real non iStock photos out there.

Jennifer Anderson:

Somebody screaming and sweating being handed a baby wrapped up in a towel, looking three months old, just doesn’t mix. And so much of the imagery we have in childbirth on the internet and our social media channels are so kind of created. And so I love using my birth photography because it’s real people doing this real thing. And eventually, that will be you too. And people can see themselves in those photographs. So Pinterest is something I’m really excited to start getting a little bit more into now.

Rebecca Dekker:

Yes. And Jen has amazing photography skills and is really one of our top instructors in terms of the number of students you’ve mentored. So thank you so much-

Jennifer Anderson:

Thank you. Thank you.

Rebecca Dekker:

… for mentoring so many families through that process and getting that education. I know they go on to tell their friends and to educate their friends and family members. So it’s really fun to see that ripple effect of all the families’ lives you’ve touched and how they go on to impact other nurses and doulas and other parents. So thank you, Jen, for all your work.

Jennifer Anderson:

You’re very welcome. It’s truly an honor to be part of this organization for so long and to have really developed some amazing friends and colleagues through this program. And one of my, I call, birth bestie I met because she started teaching the EBB class in my community, and I decided, you know what, if one person knows, then two people know, then more people know. So the more she’s successful, the more I’m successful. And so I started mentoring her and realizing that kind of helping all of us achieve these goals really betters all of us. And there is not enough of all of us to go around. So I always come from a place of abundance in sharing my knowledge and wisdom because I want everybody to succeed. Making the world a better place one birth at a time.

Rebecca Dekker:

That’s a great way to end today’s podcast, making the world a better place one birth at a time.

Jennifer Anderson:

One birth at a time. Yep.

Rebecca Dekker:

Thank you, Jen.

Jennifer Anderson:

It was my honor, Rebecca. Thank you. Nice to be here.

Rebecca Dekker:

Today’s podcast episode was brought to you by the online workshops for birth professionals taught by Evidence Based Birth® Instructors. We have an amazing group of EBB instructors from around the world who can provide you with live interactive continuing education workshops that are fully online. We designed Savvy Birth Pro workshops to help birth professionals who are feeling stressed by the limitations of the healthcare system. Our instructors also teach the popular comfort measures for birth professionals and labor and delivery nurses workshop. If you are a nurse or birth professional who wants instruction and massage upright birthing positions, acupressure for pain relief and more, you’ll love the Comfort Measures workshop. Visit ebbirth.com/events to find a list of upcoming online workshops.