In the first home birth episode of High Risk Birth Stories, OB-GYN Dr. Amber Warmsley talks about her experience choosing home birth for her second child. After delivering her first baby at the hospital, an experience she says she treated “almost like a science experiment,” Dr. Warmsley began shadowing a home birth midwife. She explains why she ultimately chose home birth, how the experience met her emotional needs, and more.
“The OBGYN Who Chose a Home Birth” -with Dr. Amber Warmsley
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Dr. Fox: Welcome to “High Risk Birth Stories,” the home birth edition. So, for a long time now, I’ve been thinking about if and how I want to present the topic of home births. On the one hand, home births are absolutely a part of birth stories. Maybe not so often in my neck of the woods, but certainly in many communities around the world. On the other hand, I have very little personal or professional experience with home births and I don’t want to present them in a way that is, or even appears to be biased in one direction or another. It’s a real risk because home births in the U.S. can be a very heated and divisive topic, and discussions about them tend to be quite passionate, sometimes even aggressive. So if we’re gonna cover them, I want it to be very deliberate in how we kick off this conversation to keep the discussion as unbiased and thoughtful as possible.
So I’m really excited about today’s and next week’s “High Risk Birth Stories.” Today, I am joined by Dr. Amber Warmsley, who is a friend of mine and an OB-GYN herself, who chose a home birth for her second child, Olivia. Her experience was very positive. Next week, I’m gonna be joined by certified nurse-midwife, Athena Antal, who chose a home birth for her first child, Linden. At the time of the birth, she wasn’t yet a midwife, but she was a labor and delivery nurse. Her experience was not as positive. I think that by presenting both sides of the coin and also having guests who themselves are and were absolutely well-informed about home versus hospital birth will give us the best chance of having an honest and educated discussion about this topic.
All right. That was a really long intro. So sit back and enjoy today’s High Risk Birth Story, the OB-GYN who chose a home birth with Amber Warmsley. Next week’s High Risk Birth story will be Rethinking My Attempted Home Birth with Athena Antal. Thanks for listening. Have a great day and have a great weekend. Welcome to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman Podcast.” I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you the listener a window into life-changing experiences of pregnancy, fertility, and childbirth. All right, Dr. Amber Warmsley. Amber, welcome to the podcast. It’s so nice to talk to you. I miss you.
Dr. Warmsley: Same here.
Dr. Fox: Wow. So, Amber, as you know, but our listeners might not, you were an OB-GYN resident at Mount Sinai in the famous class of 2012, famous for many reasons. But I would say mostly because four of you now, as of this podcast, have been on my podcast, right? Melka, of course, who was your roommate, and then [inaudible 00:02:53] and Gazelka. It’s unbelievable.
Dr. Warmsley: Well, that’s because…I mean, I’m not biased or anything, but we are the best class that Sinai has ever put out.
Dr. Fox: Since 2005.
Dr. Warmsley: I’ll give you that. Since 2005, we are hands down the best class. So I’m not surprised, in the least.
Dr. Fox: Right. And you’re not coming today specifically as an OB-GYN expert, although you are. That’s not the reason you’re on the podcast. You’re here to tell your own birth story. We’re gonna be talking mostly about your birth of Olivia. She’s a little bit over a year now, right?
Dr. Warmsley: Yes, yes. She just turned a year in June.
Dr. Fox: But you do have another, you have SJ, who is, I guess, a four and a half.
Dr. Warmsley: He’s four and a half now. Yes. He just started pre-K today, actually. I just dropped him off this morning at pre-K.
Dr. Fox: Oh my God, did he make it through the full day?
Dr. Warmsley: Oh, yeah, he loves it.
Dr. Fox: Did they make him wear two masks and a helmet and body shields.
Dr. Warmsley: Everything and above.
Dr. Fox: He’s in hazmat suit for pre-K.
Dr. Warmsley: Exactly.
Dr. Fox: That’s good. Less T, in fact, another pre-K. So just as a little bit of background, tell us who you are, where you’re from, how you got into OB-GYN and then we’ll talk about your births after that.
Dr. Warmsley: Sure. So I’m actually originally from Southern California, but we kind of just moved around a lot as a family and winds up on the East Coast. My mom was a nurse in the NICU. So I actually kind of grew up being in the NICU, being around babies. My dad was in computer science and IT field, but was always super supportive of my interest in biology and sending me to science camps and things like that. Actually…yes, I am true nerd to the core. I make no apologies. I’m such a nerd. And I actually always thought I wanted to do pediatrics. I just assumed I would actually be a neonatologist because I was always around the NICU.
And during medical school, I just quickly realized that that isn’t really what interested me and I started volunteering on the labor and delivery floor just because I thought it would be cool to see a birth. I still thought I was gonna be a pediatrician and I kept taking shifts, volunteering, and actually volunteering to stay overnight. And all of a sudden, the residents were like, “You’re here all the time and this is not your rotation. Are you going into OB?” And I was like, “No, no, I’m just volunteering.” And then all of a sudden, one day it hit me like, “Oh, this is what I love.” So that’s actually how I came into OB.
Dr. Fox: Yeah, and you were in med school in Buffalo, right?
Dr. Warmsley: Correct.
Dr. Fox: And that’s a far cry from Southern California.
Dr. Warmsley: It is. We had actually already moved to Maryland at that point. So we had already been to the East Coast and then my senior year of high school wound up moving to upstate New York. And so because of that, I kind of got into the New York school system for both college and then just stayed for medical school as well.
Dr. Fox: Right, and you got a heavy winter coat.
Dr. Warmsley: Exactly. And that’s exactly why for residency, I was like, “Absolutely not.” And I only entertained D.C. and New York, and that’s how I wound up with Sinai.
Dr. Fox: So you did your residency at Mount Sinai obviously for OB-GYN, you were roommates with the great Dr. Melka?
Dr. Warmsley: Yes, forever and ever.
Dr. Fox: What was that like? This is great. We get to talk about Melka without her being here to interject and, you know, debate.
Dr. Warmsley: We always joke that she was kind of like either a parent or like my personal assistant because she was so much more grown up than I was. She would remind me to eat dinner because we always joke now about how I’ll just make myself a bowl of cereal, and she was…
Dr. Fox: That’s dinner. That counts.
Dr. Warmsley: She comes from this awesome Italian family, would like make me from scratch meatballs and all of these amazing sausages and meals and would remind me things and send emails on my behalf. So we always joked. We got to be chairs together, our coachees together for our last year. It was just awesome. So we have a special bond.
Dr. Fox: And you’ve also done a lot of international work, OB-GYN-wise. So tell us about that.
Dr. Warmsley: Yeah, so it started in medical school. I actually went on my own and did a lot of work in Ecuador, both to learn the language and just learn about other health systems and wound up falling in love with international medicine. At the time, started my own nonprofit to actually bring medical students down to expose them and would do kind of like six-week programs with them. And so I would lead that out down there in Ecuador. And then actually after finishing residency, I was able to go down there, both in terms of working with some residents on some projects and also working as an attending down there at a hospital that had no OBs in the middle of the jungle. So that was awesome.
And even throughout my residency, I piggybacked on some of the other trips that were there. So I did some cervical cancer screening in El Salvador, I did some GYN surgeries in Nicaragua. So that’s always been near and dear to my heart. The hospital that I’m at now actually, pretty much 90% of the women are from Central America and recent immigrants. So I kind of still feel that connection, even though I’m based here in the D.C. Metro area.
Dr. Fox: Wow. And then when did you decide to start your family?
Dr. Warmsley: My husband and I met in New York, actually. I had come back from Ecuador and was there back at Sinai in private practice as well as working for the hospital and I met my husband there. And we were married in 2015. And about a year later is when we decided to start now. I was old AMA, whatever you want to call it.
You know, it’s that tension of like, “Well, we want some time together, but we also don’t want to wait too long.” So we’d been together a year and we were like, “All right, well, I kind of feel if I don’t do it now, I might just decide not to do it. So let’s just do it before I change my mind.”
Dr. Fox: Right. So SJ was born in February 2017, but he was born in Maryland. Correct?
Dr. Warmsley: Yes. So after being married, we had kind of talked about our long-term plans and I kind of known that I didn’t want to stay in New York long-term. Discussing kind of the different options, Maryland was always a second home to me because I had actually come here when I was in junior high school. My dad was here. My mom is here now and not at the time, but my dad was here, I had cousins here. And I thought it would kind of a nice bridge from my husband being a lawyer, that there’d be a lot of opportunities in D.C., but I would still get more of the suburb life in Maryland. So we agreed to move down here. So we actually moved here in the middle of my pregnancy, which was…my OCD, like being in control brain was kind of annoyed because then I had to go through the whole process of finding doctors with, you know…and I didn’t know anyone at Sinai. I had my doctors picked, I had my nurse picked, I probably had my L&D room picked out, you know.
Dr. Fox: “I want that pillow. That’s the pillow I want.”
Dr. Warmsley: Exactly. “This is the nurse. This is how it’s gonna happen. This is exactly what’s gonna happen.” So, you know, being a control freak, I came down here and I was like, “Oh my goodness, like, what do I do now?”
Dr. Fox: Tell me about that birth briefly. We’ll talk about, you know, SJ briefly, and then we’ll spend a lot more time on Olivia’s pregnancy and delivery.
Dr. Warmsley: Yeah, so I had a very uncomplicated, easy pregnancy, I’d have to say. I was very lucky without complications, besides some annoying heartburn. I was pretty uncomplicated besides being AMA. I was 36 at the time and everything was going smoothly. I had my 39-week checkup and absolutely nothing was going on. I had been going on for my weekly ultrasounds. And so it was funny because all of the women on my immediate family have very quick first births. My mom had me very quickly within a few hours. My aunt did, their mother did, but I always joked with them that, you know, your birth story is not genetic per se. And they were all like 19 years old.
So I was like, “All right, your 19-year-old body, you know, knew exactly what to do. I’m 36 and this could be a whole new ballgame.” And, you know, in my mind now, I’m the wise OB, so I know better than my mother. Right?
Dr. Fox: Right, yeah, good luck with that.
Dr. Warmsley: So nothing was going on at all. I was actually three days before my due date. I talked potentially about a possible induction. I was kind of on the fence with when…I didn’t really have any specific ideas of what I wanted to happen, but I was like, “Eh, if things could just happen by themselves, I would prefer that.” So it was funny. Nothing was going on at all. I kind of woke up feeling a little…just couldn’t sleep around 2:00 in the morning, went down to watching TV around 4:00 a.m. I was like, “Oh, maybe it’s the first time ever that I’m getting Braxton Hicks maybe that I was just watching TV.”
My husband came down and around 5:00 a.m, I remember I couldn’t even make it through like five minutes left of a show. Contractions just came out of nowhere and I got in the shower and I remember he was timing them. And he was like, “Another one? It hasn’t even been a minute yet.” And I was like, “What?” And, you know, the whole idea when you tell people, “Oh, it’ll be like maybe every 20 minutes or 15 minutes and then 5 minutes and call us when it’s been more than a few hours of 5 minutes apart,” I literally went from nothing, feeling nothing, to severe contractions every minute on top of each other. Like they wouldn’t even finish sometimes before another one would come. And so he was like, “Should I call the doctor?” I was like, “Absolutely not. It’s been 20 minutes,” like that’s crazy.
Dr. Fox: Right. “I’m an OB. It’s so embarrassing.”
Dr. Warmsley: “I’m an OB. I can’t call them and tell them I’ve had contractions for 20 minutes.” And so finally, he didn’t know what to do. He went to go get my mom and my mom walks in the room. This was like at 6:00 in the morning. She walks in and sees me. And she’s like, “Unless you want to have this baby here, get in the car.” And I was like, “Mom, you don’t know what you’re talking about.” You know, I’m the wise OB. In-between my contractions, now mind you, I couldn’t even get up to get my shoes on. My mom…
Dr. Fox: Yeah, you’re like, “Mom, you don’t know…”
Dr. Warmsley: Exactly.
Dr. Fox: “…what you’re talking about.”
Dr. Warmsley: She had to literally like help me put shoes on. And she’s like, “This is what I looked like. This is what my labor looked like. And you are in labor.” And I’m like, “I’m gonna get there and they’re gonna send me home.” You know, in my mind, I just was so focused on, you know, “This can’t be real.” And sure enough, I got there and, I mean, everything happened really quickly. But the nurse initially checked me and said I was 5 centimeters. And shortly after that, my MD came in and she was gonna check me herself because I actually was kind of showing signs that maybe I was already kind of getting ready to push. And she was about to check me and then got called. I could actually hear it over the intercom, got called for some emergency to another room.
So she ran out and was kind of like, “All right, well, it’s her first baby. She’s five. You know, she has time. Go ahead. She can get an epidural if she wants.” And in my mind, I was like, “5 centimeters for first time. Mom, this could still be hours and I can’t do this for hours.” And so I was like, “Yes, epidural.” And I got the epidural and literally when she came back to check me, I was nine and a half centimeters. So I think we got to the hospital at like 7-something. Unfortunately, after the epidural, just he did not like it. My blood pressure dropped. I just kind of had those classic issues with my blood pressure dropping, his heart rate dropping, slipping me all around different positions and kind of being a little concerned about that at the end. So I labored down for about an hour and then began pushing and literally pushed within five minutes. It was very, very hectic because, you know, I’m half watching the tracing too and he was definitely just still not really tolerating everything with the epidural. But luckily, I pushed really quickly. He was born at like 10 in the morning after we got there at like 7-something in the morning.
Dr. Fox: You were looking at your own tracing?
Dr. Warmsley: Yes, I was.
Dr. Fox: Oh, man, I would have been so mad at you.
Dr. Warmsley: I remember at one point looking at my husband being like, “They’re gonna section me.” I would like see a big dip and I was flipping myself over, I was holding the monitor. So my whole first pregnancy, I was very much an OB. It was almost like a science experiment, like, “Let me see if what I tell everyone is actually real. Let me see if this is what it’s actually like.” And I really felt like an OB that was kind of just second-handedly experiencing the pregnancy, which we’ll talk about was very different with my second experience.
But, you know, even the appointments for my whole first half of the pregnancy when I was in New York, I didn’t really go to any appointments. I was like, you know, while I was at work, I would have them check my blood pressure and I would do the labs that I needed, you know. So a very much kind of that mentality of like, “Well, they have nothing to tell me that I don’t already know.” And I had to go to, you know, my prenatal appointments when I came here to Maryland, but it was very much like, “All right, well, I’ll go and then my husband can ask questions, but I don’t need to know anything.” Right? Very much that mentality of like, “What can you tell me? I do this for a living.”
So it was just very kind of rushed and hectic and very much like, “Oh my gosh, I’m gonna get sectioned.” And then at that moment feeling like, “Oh, is this what people feel like?” I was crying. And my husband’s like, “It’s gonna be okay.” And my mom, you know, my mom is like, “You’re gonna push the baby out like two seconds. Stop worrying.” And I’m like, “You don’t know that mom.” It turns out she was right the whole time.
Dr. Fox: Yeah, lesson number one, listen to your mother.
Dr. Warmsley: Always, always. I’m gonna have her listen to this. And she’s gonna say, “Absolutely, listen to your mother.”
Dr. Fox: Listen to your mother, especially if I’m the mother. Yeah.
Dr. Warmsley: Yes, yes.
Dr. Fox: So after that second time around, for Olivia, how was it different? Obviously, you’re in Maryland the whole time. Was it the same doctors?
Dr. Warmsley: It wasn’t. The condensed version, it’s so hard to find a condensed version. But I had actually been kind of on my own, even outside of pregnancy. I had been on my own kind of professional and personal journey, just about my philosophy of births and just learning more about my field and understanding more about history and its country. And it kind of what led me down a path of wanting to learn more information about midwifery care in this country and home birth. I had actually already met up and I had been shadowing a home birth midwife for about two years, just professionally. And she had invited me in and I would come into her sessions and I was even invited to some of the births. So I’d actually developed a relationship with her and professionally was just amazed at the quality of care she gave and really her expertise.
I always would joke. I was like, “Well, if I decide to have a second one, you know, who knows? Maybe I’ll go to you.” But I actually I think deep down didn’t really think I would do that. Just I think being an OB and just intrinsically always being trained that that’s so “dangerous,” I just kind of said it jokingly. So what happened actually was I found out I was pregnant right before the funeral of my brother. He suddenly passed away without warning. And it was obviously a huge shock and very difficult for our family and just kind of came out of nowhere. He was my only biological brother. He was eight years younger than me. So I was kind of like his second mom.
So it was obviously extremely traumatizing. And I literally found out I was pregnant a couple of weeks before the funeral. With everything I had learned, feeling very comfortable from a safety standpoint, knowing how my first birth went, I immediately called up the midwife I was working with, Mari, and I was like, “All right, I am pregnant and I’m gonna come see you.” I just knew that I needed a different type of care, a different level of care. I knew that emotionally I would need to be supported differently, and I wanted to feel like a mom this time. It was very hard to simultaneously kind of grieve my sibling and then also celebrate that I was giving my child a sibling. It was just very taxing. And so I just wanted something different.
The last time I was in a hospital was, you know, saying goodbye to my brother. And so I had just kind of decided, you know, as long as things are safe and things are going well, I want to be here in the comfort of my own home and just have supported loved ones with me here. That was before COVID. So I was actually had already been planning this. It took my husband a little bit more time to get on board because he’s, just by nature, a little bit more risk-conscious. So it was a little bit harder for him to really feel comfortable and get on board, but he did. One of the things that I struggled with actually was how was I gonna tell my family? How was I gonna tell my friends and peers? What will they think of me? You know, there’s a lot of that judgment that you feel.
And so it was kind of funny because I was kind of wrestling with how I was gonna tell family members and then COVID hit. And I actually remember my dad asking me like…you know, when everyone was concerned about being in the hospital, he was like, “Well, do you have a backup plan if it’s really bad? And, you know, at the time, you couldn’t have potentially a partner with you.” And it was just kind of funny because when I told them that I was gonna have a home birth, everyone was relieved. It was almost like, “Oh, thank God, like you don’t have to go to the hospital unless you need to,” you know.
Dr. Fox: Wow, do you think if your brother had not passed away, if you didn’t have that experience, you would not have considered a home birth? I mean, because you were saying that you were sort of in the back of your mind maybe, but you probably wouldn’t have pulled the trigger and that was sort of the event that maybe put you over into that. But what do you think would have happened otherwise, again, knowing that COVID, you know, happened and all that? I’m just curious.
Dr. Warmsley: Yeah, I don’t know. You know, I definitely on paper really believed in the safety of it and in a select group of people. And so I kind of already had time to do the research and look into the numbers. And so from a head perspective, I totally was on board. But sometimes it’s still hard to get over that what you’ve been taught and what you’ve been ingrained with and culture and what other people are going to think. And I don’t know if I would have been able to pull the trigger or if it would have been easier to just kind of go with the flow.
You know, I didn’t have some traumatic first birth experience. I really appreciate my OBs. I don’t think it compares at all to home birth. I just think that if it’s possible being at home, it was just amazing. But that being said, I really did love my OBs and my husband really likes them. And I think it might’ve been easier to just stay with the status quo. And I think having that emotional need that really pushed things over was what made it easier to make the decision for myself and also for my husband to get on board. And I think that it would have been a little bit harder to get over that hump outside of that. So I don’t know. I honestly don’t know if I would have definitively done that. I would like to say that I hope I would have, although I think it would have been a tougher call.
Dr. Fox: When you had made the decision and that was your plan, did you have any times throughout the pregnancy where you would just be like, “Oh my God, what am I doing? What if A happens? What if B happens?” Because listen, you’re an OB, you know…
Dr. Warmsley: Yeah, absolutely.
Dr. Fox: …all the crazy things that can happen. Did they happen a lot or was it sort of not something you thought about so much? You know, what was going on in your head?
Dr. Warmsley: Part of it is just gonna be your baseline personality. So I actually live five minutes from my hospital. So I felt comfortable. You know, when you look at the literature, the number one reason for transfer is for just the stalled out long labor, or…
Dr. Fox: Right, that’s not happening into my family.
Dr. Warmsley: Yeah, or even if it does, it’s not emergent like postpartum hemorrhages or those things that you have time, right? Even in an emergency, sometimes when a non-reassuring tracing, like when you actually look at the time elapse of doing something, it’s a fair amount of time through emergencies, you know, cord prolapses. Yes, you have these isolated events, but that can also happen even…you know, I’ve heard of cases of, you know, someone wakes up, they break their water and they have a cord prolapse at home, right? So you’d have to hospitalize someone for their entire pregnancy to really ensure zero bad outcomes. And that’s not even true because in a hospital, I think we have this misperception that the hospital is some magical place that prevents any bad outcomes.
And one of the things that helped me, it’s strange that I say it this way, but I actually had a unexpected, very bad outcome with a baby that I was taking care of that I delivered about two or three years back. And it was very devastating for me emotionally to come back from that. And, you know, playing it over and over and over again, there was nothing that I would have done differently. It’s just one of those things that are unexpected, and they were in this safe place, right? They were in this hospital, they were in the right place and doing everything. And yet it didn’t protect you from having one of those rare, bad outcomes.
And so for me, I kind of lumped it in that same boat, that there’s no perfect place to prevent that. It is what it is. And when you actually think about it, you know, the U.S. has one of the highest mortality rates, unfortunately, of moms and babies in the developed world, and yet 99% of our births happen in the hospital. So, obviously, the hospital is not some magical place that prevents all bad outcomes. Right? So I think that that really allowed me to just look at it differently and knowing that I was in very trusted hands that I had observed for…you know, this wasn’t just I was going to some random person. This is someone that I felt extremely comfortable with because from an OB perspective, I had actually spent the last two years seeing her in action, as well as knowing that I was around the corner from my hospital, as well as knowing that I had a very uncomplicated first time birth really made me feel very comfortable.
I never, ever worried about something bad happening actually. I felt more stressed about something bad happening with my first when I was in the hospital because it’s just this layer of stress that something bad could happen, because you’re there to prevent bad things from happening. So, by definition, that means something bad can happen. So it’s really weird. It never once crossed my mind. What did cross my mind was that if something were to happen, everyone would judge you, right? If something bad happens in a hospital, “Oh, that’s so horrible. Poor you.” But if something happens at home, it’s all your fault.
Dr. Fox: It definitely helps that you’re so close to the hospital and the first baby came so fast and so easy that you’re not expecting this to be a drawn out process. Absolutely. Did you get a lot of crap from your colleagues, let’s say? Forget about family and friends or whatever, I mean, because, you know, you’re an OB. So people are gonna say like, “What? Like, you work in a hospital, like, why wouldn’t you deliver there?”
Dr. Warmsley: Yes. So that was actually what I was worried about. I think even more so than my family because I feel like with my family I can pull the, “Well, I’m the expert in the field. So, obviously, I know what I’m doing. So back off.”
Dr. Fox: Yeah. “Either I or my mom is the expert in the field. The rest of you keep quiet.” Okay.
Dr. Warmsley: Exactly. So I was less worried about my family. I was actually more kind of just from a judgment standpoint worried about like, “Oh my gosh, what are my colleagues gonna think about me?” And I remember that I texted a couple of people that I felt closer to and was really surprised and impressed by the response. Like one person was like, “Oh, that’s awesome. You’re an awesome candidate for it. Like tell me about it.” And, you know, I talked about like what some of my own research and things that I had learned over the last two years. And they were like, “That’s awesome.” And some people were even like, “Oh, that’s great. Wish I could do it.” And, you know, even the people that were more hesitant were like, “Wow,” you know. I could tell they weren’t necessarily on board, but they were like, “Well, obviously, we feel that you’re a good OB and you know what you’re doing and, you know, we have to, on some level, trust that judgment.” And so it was actually way more positive than I was expecting.
But one of my colleagues where I work now trained in Europe and she was like, “Oh, yeah, you should do that. That’s great.” You know, for her, it was par for the course, like, “Why not? You know, all of our data shows there’s no difference at all in outcomes, moms or babies.” So she was like, “Absolutely, you should do that.” So that just gave me even more like, “Okay, I’m not crazy.” One of the things that actually shifted my mindset a lot is that it’s very much ingrained that it is not safe for anybody. And I think in schooling and residency here in the U.S., we kind of have that mentality that no one should ever do that unless it’s by accident. And obviously, many other countries in the world do not take that stance and, you know, Scandinavia, some other places. And it’s very much part of the system integrated into the system with no difference in outcomes.
And you know, when you watch documentaries or things, it’s very easy to say, “They don’t know what they’re talking about. It’s a bunch of people that want experience over safety and don’t know the real risks.” Just like you said, I’m an OB, I know the risks. And there was a documentary that I came across actually called “Why Not Home?” And it was specifically about OBs, family medicine doctors that do deliveries and labor and delivery nurses, all of whom work in hospital settings, and they all chose home births for themselves. So that really piqued my interest because I was like, “Okay, all these other, you know, documentaries, or what have you, you can say they don’t know what they’re talking about. But these are a group of “my peers” that see it every day, do it every day. What do they know or think or see that I don’t? And I think after that documentary, plus my own research and investigation, it just really changed my perspective of it’s a conversation about risk and benefits, and I think we underplay the risks that can be associated with hospital birth as well. One of the examples that came to my mind was, I’m a big proponent of VBACs. I know for a fact you offer VBACs and do many of VBAC.
Dr. Fox: In fact, you have an inside source at Melka.
Dr. Warmsley: And, you know, we have to counsel about risk of uterine rupture. And by definition, if you have an increased risk of uterine rupture, potentially you can have an increased risk of fetal death, correct? That’s just a factual statement, that if you looked at the population level, you are going to probably have potentially more fetal harm outcomes with a VBAC versus a repeat section. But there’s a whole host on the other side of potential gains. When we counsel someone and someone wants to VBAC, even if they’re increasing potential risks of certain complications, we’re not berating them about how they’re potentially putting themselves in a situation where they can have a uterine rupture in a decade.
We don’t say that to them. But why? Because that’s a factual statement. Why? Right, I mean, I’ve been in uterine rupturing cases, I’ve been in really horrible neonatal outcome cases. But we don’t look at it from that perspective. We look at it at a perspective of two things, risk and benefits. What’s the harm and benefit on both sides? And number two, absolute versus relative risk. And that’s one of the things that I learned with you in our weekly, you know…
Dr. Fox: Torture sessions?
Dr. Warmsley: Exactly. Our lovely rounds of learning how to read through literature. And, you know, you can say something, “Oh, there’s two to three times more likely of this bad event.” But if you’re talking about, you know, one in a million versus two in a million, is that worth everything else that you’re giving up? And so I think those two things, kind of the idea of risk benefit counseling and absolute relative risk, for me, changed the conversation and changed the dialogue.
Dr. Fox: Yeah, I think…I mean, obviously, listen, you’re super-duper smart and you know what’s going on. I think what’s interesting is, you know, if you look at the data on home births and, you know, all the countries, you know, you mentioned that they do it and they do it really well and outcomes are the same, I think most people would agree that it’s appropriate there because they have a good system set up. And I think that part of the reason there’s a lot of debate in this country, there is debate on sort of a philosophical level, like you said, some people like, you know, experience over, you know, a health or whatever it is. There’s that level. That exists.
But I think even on let’s call a pure level of just looking at it from a data perspective, so you had an option to do it in your home, which is five minutes from a hospital with a midwife that you know knows what she’s doing. Right? You know, like you’ve seen her, and you know what to look for. So you’re informed, she’s informed, she’s good. You’re close to the hospital. You’re “low-risk.” I think the data would show that in that setting outcomes are not worse because of everything you said. And I think what happens sort of on a higher level when people argue is people argue with extrapolating that to, “Okay, I’m gonna do my VBAC at home with someone who’s only delivered four babies and I live an hour from the hospital and I don’t have a working automobile.” Okay, so both of those are home births, right? But there’s, you know, you have a home birth [crosstalk 00:31:23].
Dr. Warmsley: Right, a totally different.
Dr. Fox: Those are totally different in terms of what is the risk to the mother and baby and what are the options that things go south. And I think that that’s where a lot of this gets confusing because I think many of the people who are not so in favor of home births, it’s circumstantial because they don’t have the option for what you had, which is sort of like the ideal setup for a home birth. And that’s a lot in the U.S. at least. I think that’s where a lot of the arguments lie.
Dr. Warmsley: Well, I think the answer to that is then working on systems-based issues, right? And so not just saying that home birth is bad and continuing to teach that and not having this polarization of, you know, kind of more philosophy of physiological supported, whether it be at home or what have you and more intervention. I think that we are just very polarized in this country. And I think that is what creates harm on both levels because I think…
Dr. Fox: Right. Wait, we’re polarized in this country? Are you sure?
Dr. Warmsley: I know. [crosstalk 00:32:20].
Dr. Fox: And that’s the first time I’m hearing of this. Yeah, I never heard about polarization country. I thought it was all unified. Oh, all right.
Dr. Warmsley: No, but you can draw those lines. And I think that it hurts both camps because then what happens is, you know, a home birth community and midwives and practitioners feel less and less able to want to transfer, to want to do those things because of the both perceived and real judgments and treatments and things like that. And so then they began to do potentially more and more riskier things, which then confirms, you know, the OB minds impressions of, “Look how dangerous this is.” So I think the solution really comes down to integrative care, building good relationships, standardizations of things, making those systems-based work so that it can be a safe option for some women, and not all, right? But for some women and not ostracizing or vilifying the location versus understanding the needs and desires that go into that. And if someone is appropriate, then having systems that support that and make it safe.
And that’s what we are lacking in the U.S. But the answer then isn’t just to throw the baby out with the bath water and say that that’s bad. The answer is then to maybe look into fixing some of our structures that make that bad because some of those structures are making outcomes bad for everyone, regardless of where you deliver. Right? I mean, the U.S. just has a lot of work to do in terms of our outcomes for moms and babies.
Dr. Fox: So interesting. I’m curious, are there any issues with like healthcare coverage? Do like insurance companies say, “We’re not covering home births”?
Dr. Warmsley: Yes.
Dr. Fox: I didn’t even think about this before the podcast, so it just came up. So what were those? I’m curious.
Dr. Warmsley: So that’s another huge issue, which unfortunately for those women, that could be good candidates. The system, again, works against them. So, as a comparison, my son’s birth in the hospital that I was affiliated with, so my insurance completely covered it. I don’t remember looking at the bills, but probably it was maybe a $20,000 bill. I paid $100 and that was everything I paid. And that was my insurance copay for my hospitalization.
Dr. Fox: And the insurance probably paid the hospital, you know, the $20,000 bill, but they probably paid them, you know, 5 or 7 or whatever it is. They negotiate something.
Dr. Warmsley: Exactly. For our birth with my daughter, it was roughly $6,000, but insurance paid none of it. Some insurances you can get some reimbursement after the fact. It depends on the language and the particular insurance. So some women will maybe be able to like use their out-of-network benefits. So some women will get reimbursed. Ours did not allow that. And so we paid all of that out of pocket.
Dr. Fox: Wow. That’s so interesting.
Dr. Warmsley: Yeah, so it’s a huge difference and obviously curtails who is able to access that, just unfortunately like many aspects of our healthcare, you know, people that have the means have more options.
Dr. Fox: You made this decision and you’re plowing forward. How did it go? I mean, listen, COVID broke out in the middle of your pregnancy, so that’s always fascinating. But in terms of the pregnancy and the birth, how’d that go?
Dr. Warmsley: So the pregnancy was pretty similar. I had that heartburn again, but outside of that, it was pretty uncomplicated again, very lucky. I was 39 this time.
Dr. Fox: Oh my God.
Dr. Warmsley: So even more AMA.
Dr. Fox: You’re so old. All right. Yeah.
Dr. Warmsley: So old. But very healthy and, you know, it was funny I was exercising all throughout my pregnancy and doing all of these things and then COVID hits, right? So that was a stressor. I think that was actually a little bit of a challenge for me, working in the hospital with COVID patients when all of this broke out and no one knows anything, you know. And so are pregnant women at increased risk? We don’t know. But with the flu, they are. Maybe with this, they are. Who knows? So that was a little distressing, just not knowing. Risk doesn’t usually bother me too much. I mean, I flew to Liberia during the Ebola crisis and worked in the hospitals there, so that gives you a little bit of background about my sense of risk. But now, you know, being a mom, that’s different and wanting to protect my child and not knowing what a potential exposure could mean for me or the baby.
So that actually was a little stressful because I was due in June. And so working, especially April, kind of March everything closed down. So March, April, beginning of May was stressful. And then also just being in all of your full protective gear in my last trimester pregnancy was physically not an easy feat as well. So the end of pregnancy was tough. And then on top of it, even though we were planning a home birth because of COVID, you know, normally one of the good things about home birth is that you can have whoever you want there. There’s no rules, there’s no regulations, but that actually did change.
With our particular group, doulas were not allowed in the home. And they actually only wanted people in the home that lived in the home. So they didn’t want, you know, grandma coming, this person coming, this person coming if they live outside of the home because they were a small group and they needed to protect themselves to make sure that they weren’t exposed for their patients, which I totally got. So what we had to actually do is have everyone who we had planned to be there. So my mom, my dad, they’re divorced. So they live in separate households. So my mom, my dad, my sister, all basically kind of moved in so that they could be here quarantined for the last two weeks before my birth.
Dr. Fox: Wow, you’re a brave woman. You’re a brave, brave woman.
Dr. Warmsley: Oh, Lord. So I went out of work, and so I was literally sitting at home with all of these people who are staring and looking at me like, “Okay, when are you going to give birth?” Like every morning, my mom would just come there and she’s like, “You look too comfortable.” I was like, “I’m trying everything. I’m going for walks, I’m doing this. I even like drink a little castor oil.” I was like, “I don’t know, anything it takes.” Let me have some of the…whatever tea they say brings on contractions, sure, let me try it. And I just nothing, nothing, nothing. In my mind, I was like, “Oh, I was 39 and 3 with my son. So I could probably do 38 and some things. Sure, sure,” just hoping the baby would come. Because there’s also…you know, nothing, I couldn’t go anywhere, I couldn’t do anything. Everything was on lockdown. It was Friday night and I was just sitting there like, “Of course, nothing’s gonna happen today either.”
My due date was that Sunday. So this was Friday, I was 39 and 5. And now, I was annoyed because I went past when my son was born. Right? So now, I’m like extra annoyed, like, “What is going on?” You know, watching Hot to Boil. And I went to bed, nothing going on. And then at midnight, my midwife had already gotten mad at me because she’s like, “Anytime you feel anything.” I was like, “Oh, you know, I’ve had a couple of maybe some pressure, maybe this.” She’s like, “Call me for anything. Don’t be an OB, just call me for anything.”
Dr. Fox: Right. Don’t use your judgment because you know what happened last time you did that.
Dr. Warmsley: Yes. So she’s like, “[inaudible: 00:39:06], tell me, I want to know everything.” She’s like, “Okay.” I’m like, “Okay, whatever.” So, at midnight, I’m like laying on bed like, “Oh, I smell something like Braxton Hicks.” So, you know, some kind of cramping. So I called her almost to kind of, I think, be a little annoying, I was like, “Well, you wanted to know everything. So I’m having some cramping, like every 10 minutes, but it doesn’t hurt and, you know, I can feel them and I’m conscious of it. So, you know, I don’t think anything’s happening, but just FYI.” And then while I was in the bathroom on the phone with her because my husband was asleep, I was like, “Oh, yeah, like that one kind of twinged a little bit and, you know, that’s the first time that I’ve had that.” She’s like, “All right, well…” She’s like, “Because of your history, just keep an eye on it and the mix, and call me back in like 20, 30 minutes and just let me know. You know, if you fall back asleep, I won’t call you, but just let me know what you think.”
And I actually had to go back to look at the phone records to confirm this. But whatever time I called her, I want to say like 12:30, my husband has an outgoing phone call nine minutes later saying, “She cannot get off the floor. You need to come now.” And I didn’t believe…like looking back, I was like, “Give me your phone. Let me see the exact time you called her back.” And it literally was like nine minutes later.
Dr. Fox: Right, because it’s very clear that your entire sense of time is lost once you go into labor.
Dr. Warmsley: Yes. I was like, “Well, maybe I’m just making it up and it was like, you know, 30 minutes later or something.” No, it was literally nine minutes. I couldn’t even make the phone call. My husband had to call and say, “You should just come.” And so there’s always two midwives that come. So we woke my mom up. My mom was in the room. My dad was pacing outside like in the 1950s commercial. My son was asleep and my sister was there to take pictures actually. So we have like really nice birth pictures. And she got there and it was just really…I mean, the contractions are contractions, but I will say it felt totally different. I think just being comfortable and being in your own surroundings you take for granted without having that stress and cortisol and all of those things, fight or flight kicking in, I was just very comfortable and it was just really nice to be in my own environment. I thought I was going to feel, “I’m so close to the hospital. Just take me to the hospital so I can get an epidural.” That’s what I thought beforehand, right?
Dr. Fox: Right, you felt like you’re gonna tap out.
Dr. Warmsley: I would just be like, “Never mind, what was I thinking? This is dumb. Take me to go get my epidural. Why would anyone want to do this?”
Dr. Fox: What was your plan for the mess?
Dr. Warmsley: Oh, they are amazing with it. They have a whole system set up.
Dr. Fox: They have the pool and the whole thing? The tub?
Dr. Warmsley: No, it wasn’t gonna be the pool. And actually, because of COVID, they had stopped that super early. But they have a hold like double setup that they do on your bed and they basically follow you around with chuck pads everywhere. So we have like a whole painters, like the painter’s tarp, not the slippery one, but like the fabric one kind of down in the whole room. And then they like do a whole double-bed set up and take care of everything and do all your laundry before you leave. So it’s like nothing happens. It’s like nothing happens.
Dr. Fox: Oh my God, that’s amazing.
Dr. Warmsley: It’s pretty amazing. So they give you instructions, like when Greg called and he had instructions of like kind of setting the bed up, he was amazing. I think just being in his own space, he didn’t feel like he was a third party at the hospital. He felt like ownership and was actually so much more involved with helping me through the contractions. But you know, it never even once crossed my mind to think about an epidural. It was almost like they don’t exist. Like it wasn’t even…
Dr. Fox: Right, down on the table.
Dr. Warmsley: …in my brain. It just was like, “Hurry up. I want this to be done.” But it never even entered my mind that knowing an epidural was even something that existed. So it just was, you know, my mom was there. She had actually had my brother’s baby book. My sister-in-law had put together this amazing book for her, all of his pictures and his birth pictures and his baby pictures. So she was actually showing me pictures and telling me her birth story with him and like showing the midwives. And so I have these pictures. Like in-between contractions, I’m like pointing to his picture. And it was really like I felt even through a grieving, we were able to include him, I guess, in a way in that moment and have him there in some way or kind of, you know, thinking about him.
Dr. Fox: Yeah, his presence.
Dr. Warmsley: Yeah, his presence.
Dr. Fox: You felt his presence. There is no question.
Dr. Warmsley: And, you know, one of the biggest differences I would say is in a hospital, the patient kind of has to cater to what the nurse or a physician needs, right? So you have to get into a position that the nurse can then trace the baby or find the baby. It’s kind of all about you need to do things to make it convenient for everyone else. Where at home it’s the opposite. So they followed me, they found the heart rate. Whatever position I was in, they figured it out. And they listened, you know, regularly. They have their standardization of instrument and monitoring. So they did all of that and they just follow your lead and let you go. And then they had some suggestions of positioning and I had like a false alarm because I got to nine pretty quickly, of course.
And in my mind, I was like, “Okay, this is second baby. I don’t feel any pressure, but I’m just gonna push. I just want this to be done.” And five minutes into that, that did not work and I was just irritated and she was a little asynclitic. So the head was just kind of in a funny position and just didn’t want to come down super quick. So that actually was the hardest part for me because I was like, “She should be out.” You know, this should be done and then spent another 45 minutes just kind of literally having to position, get into a better position. And then I set up. Now, I understand the meaning of rectal pressure and urge to push like I never have before. I was like, “Oh, yes, it’s time.” And two pushes later, she was out.
Dr. Fox: Wow, it’s amazing.
Dr. Warmsley: And it was kind of amazing because we didn’t know the sex. I actually thought it was a boy. I was sure we were having another boy. So my mom, the way that I found out was I remember her saying, “I was right. She’s a little brat.” And I was like, “Oh, I guess it’s a girl.” You know, we just used skin-to-skin right away. They do all of the checking, everything on baby right on you and just have this really nice uninterrupted time. And then they do all the weights and measurements. And then when I went to shower, they helped me shower. And then my husband had her while I showered.
And then the other nice thing is that it was a little different with COVID. We included some virtual visits in there. But typically, they’ll see you…you know, they’re there with you for about two to four hours after the birth and they leave once everything looks perfect. They see you the next day. You see your pediatrician the day after that and they’ll see you again on day 3, day 7, day 14, 1 month, and then 6 weeks. So this whole idea of you just disappear from your OB and then you see them six weeks later, it’s so different. My birth was relatively straightforward and quick and I was an OB and it was COVID. So we did half of those or more with virtual visits or phone calls, but that support, you know, it was a lot more than what we typically do in an OB world. So, yeah, it was really, really amazing.
Dr. Fox: Looking back, obviously, we’ve spoken a lot about, you know, how your thoughts have changed over the years about home births, in general, but I’m curious on a professional level, how do you talk to patients about home birth now?
Dr. Warmsley: Yeah, so I’ve had people and it’s really funny. I had one person who she knew I was an OB and when I asked her…she was a relative of a friend. So I didn’t know her. And I saw she was obviously pregnant. I was so excited, you know, “Oh, where are you gonna have your baby?” And I could tell the hesitation. It’s like all of a sudden you can read it on people. And she kind of skirted around it knowing I was gonna be and then said something about home, and I was like, “Oh, that’s great. Who are you gonna be with?” You know, immediately kind of just affirming her, first and foremost. And then I actually found out it was with my same group. So then I was like, “Oh, you’re in amazing hands. That’s awesome.”
But what I do is I say, you know, everything’s about risk and benefits. These are the things that you need to look into. Being a low risk, you know, I do know that there are people that do VBACs and things like that. And again, it’s all about risk and benefits. For myself, I would probably counsel against that or not want that for myself. But again, people have autonomy. And unless we’re gonna say people can’t make their own decisions, the best thing that you can do is really educate, counsel, give your reasons, give your concerns, talk about the evidence and then support people in their decisions instead of shaming them.
So I think that’s one of the biggest takeaways I’ve gotten from is that even if I disagree with someone’s decision, you know, understanding why, first and foremost, or what their motivations are, have they thought through benefits and risks? You know, what is their backup plan because things happen? Who are they gonna be with? Engaging in a conversation instead of just automatically shame and judging and why would you ever do that? Because that just closes the door, right? It just shows that you haven’t even thought about why they might be interested in that. Just like there are women that I don’t necessarily think are the best VBAC candidates, but I love VBAC-ing people, everyone I can, I try to, you know, just personally.
And if I have a patient that I feel might not be a great option, I always start by saying, “I’m a huge proponent of this and I see the benefits. You know, for you, what’s your motivation, or what are the benefits you’re looking at, or what are the reasons that you don’t want a C-section? Talk to me a little bit about that.” And then I’m gonna talk with you about my concerns and then, you know, let’s talk about our plan that, you know, we could be comfortable with. And I had that happen recently with someone who got on board with a repeat section, but not that day and wanting to wait, and we came up with a plan that we were both okay with.
And so saying, you know, I can’t guarantee that, you know, nothing bad will happen, but that’s why you can’t guarantee things. And I just think that showing people respect and understanding beats everything, even if I don’t agree with you and I just think, unfortunately, a little bit in our field, we are a little paternalistic and judgmental and, “Okay, so you just want to kill your baby,” you know? And I even remember some of that in residency, hearing that, you know, someone refused GBS treatment. And I get it and I understand the benefits and why we want to, why we recommend, you know, prophylactic use. But I think that we need to change how we interact with patients. And, you know, we’re really there to support them this whole time and to help create safe births for the families. But safety and respect and empathy and kindness are not mutually respected. Those things need to go hand in hand.
So I think that’s what I’ve learned from it is just engaging and showing them that, “I respect you, I’m not judging you and I understand that you have values and concerns that are gonna go into your decision making. I’m here to bring my evidence and my training and my concerns and what I think, and to hear, to help you make the best decision.” And I think that that is not always taught. You know, we’re kind of taught that, “We’re the doctors, we’re the ones that have the degree. You need to listen to me or don’t even bother coming to me.” And I just think that that’s where we go wrong. I don’t think that everyone needs to have a home birth. And there’s plenty of people that I’m like, “Eh, I wouldn’t do that.” But the answer is not to vilify people or to shame people, it’s to like, “Hey, let’s open the doors of communication.” So that’s like my biggest thing is really respectful, collaborative care, both between professionals and with our families.
Dr. Fox: Yeah, it’s not unique to OB. I mean, this is medicine in general. It’s just about, you know, having that honest and open communication. And I think that it’s hard to learn that as a physician, as a provider, you know, physician, nurse, midwife, whoever you are. You know, if you’re providing care or helping people through care, I think it’s very difficult to get the right balance because on the one hand, there are some people who don’t get enough of what you’re talking about, disability to listen to people and understand them and really try to get at their motivations and try to come to some, you know, understanding, “You know, this is what I think, you know, is the right way to go. This is what you think is the right way to go. Ultimately, it’s your decision, it’s, you know, your health, your family, your body,” and to come to some sort of understanding that’s not a conflict, right? Even if you disagree, like you said, it’s not conflict. And so there’s people who can’t get that. Yeah.
Dr. Warmsley: Or even if you decide that you’re not the right [crosstalk 00:51:24] just say, “You know, I just don’t think that our plans don’t align and I don’t think I’m the right person to take care of you. That doesn’t mean that I think just some horrible person, but maybe I’m just not the right person for you.” I mean, that’s reasonable too, right? Doesn’t mean that you have to just do and cater to what every person wants. So that’s on the table as well.
Dr. Fox: A hundred percent. I think that some people don’t get that. I do think what I sometimes see amongst our younger physicians who are maybe getting that a lot better than we did in training, meaning they’re very open to these ideas, sometimes they have the opposite problem that they have the inability to tell someone what their opinion is. You know, they just won’t be able to say which they think is better like, “Well, you have option A and option B.” But a lot of people are like, “Well, all right, you’re the doctor, which one do you think is better? I may disagree, but I want to know what your opinion is like.” If my plumber says to me…
Dr. Warmsley: If this was your sister, what would you tell her to do?
Dr. Fox: Right, or if my plumber came in and said, “Well, I can use this pipe or this pipe, what do you want?” I’m like, “I don’t know, like, you tell me. You’re the plumber.” Now, obviously, if he said, “Well, this pipe is more expensive, but more durable, and this pipe is cheaper, but, you know, not gonna last as long.” “All right, I have a decision to make, but there’s only one choice. You tell me what it is.” And so I think that there’s really that balance. And it’s hard to train because you’re spending so much time learning the knowledge. This is like a meta level of training of how to use that knowledge in communicating with people, which is very high-level stuff. It’s not easy.
Dr. Warmsley: I think one of the things that I’ve found myself doing, and I don’t know if I learned this per se or just kind of became my style is that I would…you know, because of everything and I would say, “I will let you know if I think that there’s a clear winner or if there’s a reason that I think that this is the clear winner.” And it might be a close call and I might say, “Well, I think this edges this one out.” I might say, “I think this is the clear winner and why.” If it’s not outside of standard of care and you still want option B, you know, I’ll say, “Okay, I think that’s the lesser of the two, but okay.”
I’ll make it very clear if I think it’s outside standard of care. And I’ll also let you know if I’m just…you know, sometimes there are situations where I’m like, “Eh, either’s fine. It’s 50/50. It really comes down to what you think.” And I try to say that. I try to either say, “I think both of these are equal and it really comes down to, like, what’s most important for you in this setting or what’s gonna…you know, what’s the one that kinda you’re going to feel better about trying.” And then I will say, “I will let you know if I think that there’s a clear winner or one that edges it out,” and what I would probably do, again, letting you know if the other option I think is still reasonable or safe versus if something is starting to go into the boundaries, to me, of unsafe. So I try to approach it like that. And I’ve found that’s helpful.
Dr. Fox: I tell people the same thing. I’ll say, “Listen, if it’s a toss up, I’m going to tell you it’s a toss up. You know, choose. If I think one is better, fine.” I said, “I’m not gonna let you do something that’s crazy without me telling you.” I’d be like, “That’s nuts, like don’t do that.” People can do it. It’s a free country. They can choose not to listen to me, but I will voice my opinion. Amber, I love talking to you. You’re the best. I missed you. See, you’re the reason. 2012, what a great year? Vintage, dude, that’s our vintage year.
Dr. Warmsley: We are. We should get like minted or something. We need like jackets. Maybe we’ll talk about in our class. We need to make ourselves like vintage jackets.
Dr. Fox: Awesome. Thank you for coming on and tell your story.
Dr. Warmsley: Well, thank you for being amazing. And, I mean, our four years plus more of being there afterwards of being around you and, you know, seeing the way that you care for patients and continue to do so has never left me and a lot of that stuff I’ve taken, you know, into my own. So I want to thank you for that as well.
Dr. Fox: Wow, what a great way to kick off our discussion about home births. Speaking with Amber definitely made me rethink my own views about home birth. I’ve known Amber for a long time, and I have tremendous respect for her as a doctor and a person. So her opinion holds a lot of weight with me. Next week, we’re going to hear another home birth story from Athena Antal, who is a midwife herself, and at the time of her birth, was a labor and delivery nurse. Athena did not have a bad outcome or anything like that, but she has a different take on home births after her own experience. So be sure to check out that birth story next week to get another perspective. Thank you all for listening. Have a great day, have a great weekend.
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