Ep 173. All About Homebirth Transfers

Let's take a deep dive together and chat about all things home birth transfers. We'll discuss FAQs like the most common reasons for transfers, the midwife's role, and coping emotionally when birth doesn’t go as planned. Whether you’ve transferred in labor before, or are planning a home birth and want to understand transfers better, this episode offers essential insights and support.


01:09 Today's Topic: Home Birth Transfers
02:21 Personal Anecdotes on Disappointment
07:55 Diving into Home Birth Transfers
09:00 Common Reasons for Non-Emergent Transfers
12:26 Handling Emergencies and Complications
18:24 Importance of Communication and Trust
21:52 Questions from Listeners
30:16 Discussing the Role of Midwives in Hospital Transfers
31:02 Coordinating with Hospitals During Transfers
32:10 Navigating Hospital Transfers During COVID-19
33:05 Preparing for Hospital Transfers: What to Expect
34:44 Understanding Hospital Policies and Staff Interactions
36:57 Balancing Birth Plans and Necessary Interventions
39:50 Managing Expectations and Emotional Processing
45:16 Processing Birth Experiences and Moving Forward
50:03 Preparing for Future Births After a Transfer
55:21 Conclusion and Community Support

Links We Chat About:

How Midwives Handle Complications at Homebirths

Processing Birth Disappointment: Ep 74

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Our Childbirth Education Course, use code RADIANT10 for 10% off

Our Monthly Membership

Be sure to subscribe to the podcast to catch every episode. Follow us on Instagram for extra education and antics between episodes at: @beautifulonemidwifery

Episode Transcript

(00:00):
Welcome to at Home with Kellyand Tiffany, where we share
powerful tools, excitingeducation, and relatable views
about holistic health,physiological birth, and
thriving in the female body.
We are home birth midwives insunny San Diego.
Passionate about thealternatives that give women
control and confidence inhealth, in birth and in life.

(00:24):
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value offerings.
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way in.
But this podcast.
We want to bring zero costinformation about health and
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(00:46):
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When you leave a review, sharean episode and join our
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It really helps us keep thisspace open, ad free and full of
honest, valuable conversations.
Now let's dive into today'sshow.

Kelly (01:09):
Welcome back to the podcast ladies.
I am Kelly.

Tiffany (01:14):
And I'm Tiffany.

Kelly (01:15):
And we are here as you can see in the subject of our
podcast today, a reallyimportant, really commonly asked
topic in general.
All about home birth transfers.
So we are home birth midwives inSan Diego.
Who we help women have babies athome, but certainly there are

(01:36):
situations where transfersoccur.
We get a lot of questions,especially on Instagram about
this topic.
So we knew this was one of thetop ones that we wanted to bring
back when we brought back thepodcast to answer a lot of those
questions that we commonly getasked.

Tiffany (01:50):
And I'm excited to bring this information into like
a deeper dive.
So women who are curious aboutthis as they're considering home
birth for themselves, but alsofor women who have experienced
home birth transfers.
That seems to be sometimes oneof the most impactful ways that
we have this discussion isvalidating and processing that.

(02:12):
That peace for women who plan tohave a home birth and had to
transfer for some reason, it canfeel there can be so many
emotions tied up in that.
So before we dive in, ouricebreaker for today, Kelly is
sharing a recent disappointmentof your own.
And how you've been processingthat, because I think that we

(02:35):
often are pointing the fingertowards processing
disappointment in birth,processing, disappointment in
how pregnancy was managed,processing, you know, some, some
piece of.
Pregnancy, birth postpartum.
That just felt overwhelming andI was realizing that actually
that's a muscle processingDisappointment is like a muscle

(02:57):
that we flex throughout ourentire lives and could be so
helpful for women to considerthat even before they get
pregnant, how they processdisappointment and how they move
through something not going asplanned.
Give an example in your life of.
It could be so minuscule too.
It doesn't have to be like somebig dramatic thing, but what's

(03:20):
a, what's a piece ofdisappointment in your own life
that you've processed recently?

Kelly (03:23):
There, it was funny but I feel like there's many that I
could pull from, and that's justlike the way life is sometimes,
right?
Where you're like, oh man, I'vehad to pivot a lot, or, you
know, restructure what I thoughtwas gonna happen a lot.
The most recent one, just I'vebeen on this dive, trying to
sort out what we're doing nextis, I created this landscape
project for our backyard and Iwas like, this is it.

(03:45):
Like we're really trying to redoit.
A lot of it we're doingourselves or as we're able to.
But I created this kind ofvision.
And I was like, this is what'sgonna really like, make such a
sweet backyard space for all ofus to be in and enjoy, you know,
company, all of that.
and it was like, this is thestory of my life.
Also, it was wildly moreexpensive than I anticipated,

(04:06):
including getting quotes frommultiple people, like our go-to
guy who's like below the radaron all the things, all the way
through companies who are like,we'll give you a percentage, you
know, here's our sale.
So it was just wildly moreexpensive than I thought and I
was like.
Okay, well you know what, thenI, we can wait.
I, we don't have to do it rightnow.
How about we wait and we save upfor it?

(04:26):
Like I'm very patient when itcomes to that stuff.
We've lived in our house for awhile.
A lot of stuff still isn't done.
'cause I'm like, I'm just notthere yet, or I haven't found
the right thing for that yet.
Like, I can be patient that'slike kind of added to the list
of things that were like, well,maybe we should wait and save
for that, that my husband waslike, let's put these like in
order of what we actually reallycare about.

(04:47):
So anyway, we started pivotingand like kind of re we threw
away that old plan basically,and we're like, let's start with
something completely differentand what else can we do to make
this what we want it to be?
But actually within a moregrab-able.
You know, nearer timeline forus.
And so, yeah, it was just, itwas a bit of like wanting

(05:09):
something really badly and beinglike, but this is what this is,
this is gonna make it perfect.
And then realizing that's justsort of the vision that I had.
There are other things that aregoing to.
know, take up the space, make itcomfortable for everybody and
beautiful and all of that.
So that's been like the recentthing, just because that's been
on my, like if, I don't know ifyou're on Pinterest, but if you

(05:30):
are and you follow me per mypersonal account somehow it's
all landscaping ideas right now.

Tiffany (05:38):
I, you are giving me PTSD from my landscaping era.

Kelly (05:43):
Yep.

Tiffany (05:43):
I remember the time where I was like, okay, so while
you're saying that, it's makingme realize that sometimes the
hardest piece to process is thevision of what it you thought it
was gonna be.
And my problem sometimes withbeing disappointed with
something is that my, thereality cannot catch up to the

(06:04):
vision.
I cannot make the two piecescome together.
And I did not do the work ittook in order to get my vision
to reality.
Soon enough,

Kelly (06:16):
Mm.

Tiffany (06:17):
didn't do the research.
I needed to affirm my vision isreasonable, and instead I
thought what I was being likekind of modest and rather simple
with the plan.
Turns out I.
It's not reasonable.
I can't afford a$25,000 deck,even though I think that's the

(06:41):
simplest way to fix the frontyard is have this really cutesy
deck.
It's gonna cost$25,000 at bestbecause lumber prices are insane
right now.
Now my entire vision has topivot because.
I didn't budget it right, andnow I'm just, and all I can

(07:03):
think about is the deck thatnever was, I spent too long on
the vision and not enough timeon the planning.
And it reminds me it reminds mea little bit of the time where I
swore I don't know where I wasat mentally.
I swore I was having a boy thesecond time, my second

(07:23):
pregnancy.
And we went to go get the genderreveal ultrasound early, and
it's a girl again, and I, I loveher.
She's wonderful.
There's nothing wrong withhaving two girls, but because I
decided in my head that it wasgonna be a boy this time I cried
at the ultrasound and myhusband's like laughing at me
like, there's a 50 50 chancehere, lady.

(07:44):
Like, what?
I'm not sure how you got sowrapped up in that.
There's another example of thevision got away

Kelly (07:51):
Yep,

Tiffany (07:52):
from reality.
Oh my gosh.
Okay, well let's ju let's jumpinto home birth transfers.
'cause I know there's a lot ofinformation that we wanna share.
On this topic, I askedInstagram, Hey, what are your
questions about this?
And we got some, we got a reallygood spread of them.
But just to start out, just toprovide some context for what

(08:14):
we're talking about here, likethere's, there we would have to
talk about this.
Topic for three or four hours inorder to completely cover the
scope of why would you need totransfer?
What are the nuances oftransfer?
What if you're, what kind ofrecommendations would your
midwife make?
What might be going on in yourlabor, et cetera, et cetera.

(08:35):
So.
I know that we don't have timefor that three hour podcast.
We do have a ton of that levelof information in our childbirth
education course, so women whoare thinking, I need a lot more
of this type of processing.
There's so much more in depththere, but just a general
overview of why women mighttransfer from home to the

(08:58):
hospital.
Hospital.
Can you give some examples,Kelly, of like, I mean, I, I
think I wanna reiterate rightoff the bat that.
90% of our transfers arenon-emergent, maybe even more
than 90% of our transfers.
We have a very small amount ofwomen who transfer to begin
with, so it's a very, very smallnumber of women who are gonna

(09:20):
have an emergent transport.
Most of what we're gonna talkabout today is non-emergent.
There's a couple of differentpieces there of being
cautionary, risking out, andwe'll talk about some of those.
Things and we can get, we cantalk a, we'll talk a little bit
about the emergent transferbecause I know that that's
something that women, you know,wanna hear about.

(09:40):
But let's just assume most ofwhat we're talking about is
non-emergent.
Can you give some examples ofwhat some of those transfer
reasons would be?

Kelly (09:49):
Yeah, so obviously there's, there's transfers that
can happen technically, like atransfer of care while still
pregnant, right?
Like you are no longer in thisumbrella of low risk pregnancy,
low risk mom, low risk babysituation.
And so that can come up.
Even potentially earlier thantowards the end of pregnancy,
right?
Something can flag on anultrasound and that gets more
information where like, hey,actually the safest place for

(10:11):
you to have your baby isactually the hospital, right?
Or as you get closer, like herein California, we have a couple
laws that oversee what we cando, like a planned breach birth
or multiples, right?
And so.
There are some pieces or, youknow, risking out in terms of
timing, having your baby before37 weeks or after 42.
Again, those are Californiathings.
There's other states that kindof follow that.

(10:31):
So there's, there's some ofthose pieces that like we are
very, you know, quick to discussleading up to even at the very
beginning of pregnancy, right?
But in labor itself.
You are correct.
The most common reason that wesee women transfer is for a
very, very long labor.
And so we have been working onit for many hours.

(10:52):
We are doing all of the things,we are sometimes doing nothing
also to like let things just beand rest and you know calm down
the nervous system and all ofthat.
And so all of the many thingsthat we can do at home.
Over those many days.
Mom in particular, we, we don'treally ever make that call
because again, it's nonemergent.
But if mom is like, no, I'm, I'mready.

(11:15):
I need a nap.
I just need an epidural.
I need to go to sleep and wakeup and have like the resolve to
actually have this baby.
That is a great use of resourcefor that particular situation.
Right?
And so that's probably the most,the most common one that we see.
There's obviously some otherthings that can come up during
labor itself.
If there we're dealing withheart tones for the baby that

(11:35):
are just non-res reassuring insome way, particularly high,
particularly low, in aparticular way to contractions
themselves, kind of giving us,like to think of a heartbeat of
a baby as like telling us astory.
That's the way that the baby cancommunicate with us.
And so we use that informationto say, what is the baby telling
us?

(11:55):
And so oftentimes that's not a.
gosh, we listened to this once.
This is a, an emergency, we needto leave right now.
Again, it's a storytelling, Hey,this is what we're hearing with
your baby's heartbeat.
Let's try these things.
Let's see how this, you know,goes over this next chunk of
time.
As of right now, it's not aneem.
You know, we're not concerned.
We don't need to do anythingright now, but we just need to

(12:15):
say like this out loud.
Here's what we're hearing.
Here's the story that's kind ofbeing told.
Those would be like kind of thetop two flagged things of.
More non-emergent situations.
Of course, again, like you said,there's plenty of potential
complications and emergenciesthat arise.
Most of the time those are dealtwith at home really well, right?

(12:35):
And we can manage those at homewithout needing to transfer.
Of course, there are so timeswhere we say, Hey, we're doing
all of the things.
We're keeping things as stableas possible, but just isn't the
right place for you or for baby,for whatever reason.
Mm-hmm.

Tiffany (13:06):
just level of exhaustion is impacting her
pulse or her temperature, or,her blood pressure, right?
We've had a couple situations inpregnancy where the blood
pressure or in labor where theblood pressured is kind of like
a piece of concern.
There's a couple of things thatmidwives do transfer for that we
don't generally, and that ismeconium present at labor.

(13:31):
That is, that by itself is not areason for our pra.
We don't, our practice doesn'ttransfer just for that reason.
We would be looking for othersigns of fetal distress to
accompany that sign.
And then your water broken fortoo long.
Without labor starting orwithout labor progressing.
I mean, of course there can besome other factors in there that
complicate that situation, butwe don't transfer just because x

(13:55):
amount of time has passed.
After your la your water'sbroken, the concern there is
infection.
So then we're looking for signsof infection.
We would transfer for signs ofinfection.
So there's, there's a couple oflike nuances even in what.
What would be recommended, andthere are some questions here
today from our followers aboutagreeing or challenging the

(14:17):
midwife's

Kelly (14:18):
Mm-hmm.

Tiffany (14:19):
for, for transferring you.
So we can get into that a littlebit too.
And some reasons for emergenttransfers.
You know, like Kelly, you said,fetal distress.
Like sometimes the heart rate isdoing a thing and we're like,
Hmm, this could potentially be aproblem for later.
Let's get you into a settingwhere this can be handled
better.

(14:39):
Usually there's other piecesthat are going on with that,
right?
Sometimes there's a reallyobvious, your baby is not okay.
This is not normal.
We need to get you in for moremonitoring.
So that could be a piece of it.
Postpartum hemorrhage is on thelist, except we've not
transferred for postpartumhemorrhage specifically in our
practice.
We've had severe transfers, orwe've had severe hemorrhages,

(15:02):
and we've had we've given theoption to women, Hey, you're
kind of on the, you're on theborderline here.
These are the things that youcan do to recover really well
and will continue to monitoryou.
Or you could go in for bloodproducts if you want to, but I
guess the hemorrhage that wasnot able to be controlled at
home.
You, you, you automaticallywould call 9 1 1 once you

(15:23):
realize that it's not gonna getunder control at home.
So that's a thing.
The internet think shoulderdystocia is a reason for
transfer and it's not number onebecause you do not have time.
For your emergency personnel tocome and not know how to handle
so shoulder dystocia and get youto a hospital shoulder dystocia

(15:46):
always has to be resolved athome.
You need a midwife who istrained in that, those
resolution things, and that'ssomething to talk about.
With your midwife, how does shehandle shoulder dystocia?
The baby always comes out athome.
Sometimes you need to transferbecause the baby was stuck for

(16:06):
too long and needs furthermonitoring or more assessment or
potentially more help, you know,as a result of shoulder
dystocia.
Along with.
Postpartum hemorrhage.
An emergent reason would beplacenta abruption or suspected
uterine rupture.
We have not had that happen inour practice but it is a
possibility.
I think that that's importantfor women to talk about with

(16:28):
their care providers.
Like, hey.
This is a risk.
Do I have extra risk factors?
How would you handle thissituation?
Along with blood pressure wouldbe, you know, other really un
reassuring signs with the mom ifshe keeps passing out, if she
seems like she's potentiallyhaving a seizure, if she you
know, is not okay for any reasonat all, even if she just is like

(16:51):
vomiting so much that she can'tget a grip on.
On labor that would be a reasonto transfer.
And then lastly on my list is asevere tear, which we have
transferred.
We did have one transfer forsevere tearing.
There's just only so much that ahome birth midwife can do with
the equipment and training thatshe has.

(17:12):
There is absolutely a time andplace for a trained surgeon to
put your pelvic floor and vaginaback together.

Kelly (17:20):
That one in particular, I remember being like the, the,
even the provider who wetransferred into was like, oh,
this is, this is extensive.
Right?
And so being like, yes, ourassessment of that was correct.
Right?
We can do a lot at home.
But it was like validating inthat particular way.
I will say, we'll link in ourshow notes also some, some
spaces to go check more intosome of these things, like how

(17:43):
do we manage hemorrhage at home?
All of that.
It's not like we're like, oh,you're just bleeding too much.
Let's call an ambulance and hopethat they get here in time.
Like, we've done all we can do,and we kind of like wipe our
hands and walk away.
We're just continuing to work orcontinuing to breathe for the
baby to help, you know stabilizeyour bleeding.
All of the things.
While we are en route to go dosome of these transfer things.

(18:05):
So I think that's just a helpfulpiece as you consider transfers
in general because it's, it'snot like, oh, just because we
can't finish this at home just'cause we can't re resolve this
completely at home doesn't meanthat your midwife isn't
continuing to keep you safe inthat kind of interim time.

Tiffany (18:23):
Yep.
And how midwives handlecomplications is a completely
different discussion than homebirth transfers.
So go get some education onthose pieces.
We have an excellent blog postfor that.
Midwives are equipped foremergencies, and you need to
know how your midwife isequipped for yours and be on the
same page.
That's also kind of a nod to acouple of episodes ago where,

(18:47):
dads like to be involved in thatconversation too.
So much so that we have safetyconversations, conversations
about safety in birth with ourclients throughout the entire
pregnancy, and we leave thatdiscussion open.
We're really transparent aboutour capabilities and our
background and our comfortlevel, and I think that's

(19:07):
important to understand aboutyour midwife because every
midwife kind of goes aboutassessing risk and their
responsibility with it a littlebit differently.
But we especially discussemergencies that can happen at
birth, at the home visit, that36, 37 week visit where we ask
everyone who's going to be atthe birth to be present because

(19:28):
they need, the whole entire teamneeds to be a part of that
conversation.
We don't have time to explain toyou what we're doing if we're
trying to handle an emergency.
You just need to know, yes, wetalked about this, my midwives.
Have a plan for it.
And I think that's a huge piecefor women to not shy away from,
not feel afraid to talk aboutwith their care provider.

(19:50):
And then Kelly, I'm justthinking right now that like
I've heard you chime in on thisquite a few times, but I.
You should have thesediscussions with your
obstetrician.
Also, I think we assume ifyou're giving birth in a
hospital with all the equipmentand all the lifesaving devices
and stuff, that you're justgoing to be like, well, if
something bad happens, justhandle it and I'll trust you to

(20:13):
handle it.
But if we're giving birth athome with a provider who's
trained in to handle the sameexact types of complications, we
wanna know exactly.
How they're prepared to handleit, what their perspective is,
what the philosophy is forpreserving physiology, how
you're gonna be respected andtreated, what the protocol is.

(20:34):
And those discussions need to behappening with every care
provider in every setting.
I.

Kelly (20:40):
I, I think obviously as midwives we're just like, put
under more scrutiny forwhatever.
I mean, there's like lots ofcultural re there's just that's
again a whole differentconversation, but.
You deserve that informationmatter where you're having your
baby.
And then that is part of makingthat informed decision of are
you the right provider for me?
Is this the right birth locationfor me?
Those two things, provider andbirth location, are going to

(21:02):
impact your birth experience somuch that yes, you absolutely
should be asking, Hey, how doyou guys handle shoulder
dystocia?
Oh, that's interesting.
That sounds completelyphilosophically different than
the midwife I just interviewedwith.
Interesting.
I'm gonna bank that, you know,as I make my decisions.
Kind of thing.
'Cause it, does matter.
And again, you deserve, youdeserve the information and

(21:23):
deserve to be a part of a partof it too.

Tiffany (21:27):
Absolutely, and there's plans that are in place for
transfers.
In fact, it's a part ofCalifornia law that we have a
written plan of.
Where we're going to transfer,who we're gonna transfer to the
types of working relationshipswe may or may not have in our
community.
And that needs to be disclosedto every single client.

(21:49):
So women should be looking forthat too.
Okay.
Let's jump into some of thesequestions because it's gonna
provide a lot of context.
We kind of did just like thisoverview of, of potential
transfer situations.
I wanna start out saying thoseof you who are listening or who
are.
Who are afraid of potentiallyhaving to have a transfer from

(22:12):
home to the hospital?
If you trust your care providerand if you trust the plan that
was made, and if you.
Participated really well inpreventative care in your
pregnancy.
A transfer is a best and wiseuse of resources.
It is not a failure.

(22:33):
It is not plan B necessarily.
It is not everything has to goout the window and everything
that you wanted about your birthis ruined now.
It is just a good.
Use of resources.

Kelly (22:51):
I think that's just such a helpful reminder because we've
had a couple.
Transfer situations where, youknow, we go in and the
discussion of like failed homebirth is, you know, mentioned or
I've seen it charted before,maybe not said out loud and I'm
like, I wanna rip my hair outbecause I'm like, this is.

(23:11):
Part of what keeps home birthsafe is that we are not so dug
in the ground.
All of us that we're saying itis home birth at all costs.
I don't care what the outcomeis, we're staying home.
Right?
That is not the philosophy.
And so understanding whatactually keeps home birth safe
is recognizing a provider andmom, family relationship that is

(23:33):
trustworthy enough to say, Hey,here's.
this collective experience we'rehaving.
Here's the safest place to allowthis to kind of un unfold and,
you know, move forward.
So that is always one of thosethings that just digs under my
skin, that idea of somethingthat's failed because it's
completely not a failure, it'sjust, needing to move forward in

(23:55):
a different way.
Right.

Tiffany (23:58):
Yeah.
And I think another thing thatis worth sharing is the midwife
has her own process of.
Her role in your transfer, andit is something that greatly
pains us even when it'scompletely necessary.
We have spent hours and hoursdiscussing and processing

(24:22):
without you.
It's not your responsibility asthe woman or the client to be a
part of that processing for us.
But I'm thinking of the timesthat we have transferred and my,
my greatest concern, of course,is safety.
I want everybody to be safe whenit comes down to should we
transfer, should we not?
But very, very, very closesecond, because we take.

(24:46):
The, because we take the birthprocess and the experience so
seriously, really close tosafety for me is was it
necessary?
Was it absolutely necessary?
Was there anything else that wecould have done?
Looking back, I'm so critical ofare we sure we needed to

(25:08):
transfer?
Are we certain we needed totransfer because.
I understand that there's a lotof midwives out there who would
just, they always default tobetter safe than, sorry, better
safe than sorry, and are veryquick to transfer any time risk
comes up.
I do not, I don't identify withthat.
I do not want to, I don't wantto be better safe than, sorry, I

(25:30):
mean in the real context ofthings that I do, but I think
it's so, I think there's so.
To the safety discussion, thenget you to higher level care if
anything comes up.

Kelly (25:43):
Yeah, and honestly the you know, everyone's gonna
practice differently.
Understanding, you know, andasking good questions as you're
interviewing midwives is gonnabe important.
But that is a huge sign to me oflike.
In some situations, I'm notgonna blanket everybody who has
that mentality, but like ofburnout also, of just like, oh
man, I did everything.
Okay, let's just like move.

(26:03):
Let's just get this, keep thismoving.
Right?
And that is a huge problem justwith maternity care in general.
Hey, just like, get on this,let's just keep this moving.
Okay.
We've started this thing andjust like, I don't really care
how it finishes, like pleasejust, just go.
And again, I'm not saying thatevery.
Midwife feels that way oranything, but it's just a
helpful piece.
Seeing it from this side as aprovider, but also from the

(26:24):
other side as a mom.
witnessing all of the differentkind of nuances there.
And it really does matter howyour midwife is going to manage
some of these things.
So it matters.
Again, coming back to selectingthe right care provider for you
which.
in with a lot of research andresponsibility and question

(26:44):
asking of your own as well.
But again, that responsibilityis worth it.
It's worth kind of digging intoand, and asking some of those
questions.

Tiffany (26:53):
Totally.
Okay, Kelly, so how far inadvance do we know that a
transfer is happening?
That is our first question.

Kelly (27:02):
I mean, it is, it runs the gamut, right?
There may be, there's veryrarely but could be a situation
where we are saying.
Oh, was so normal or like waswell contained within this
little normal sphere and nowsomething just got chucked out
of it so far that there's no waywe can bring that back into
normal.
It happens so quickly.

(27:22):
We need to go like as quickly aspossible.
Of course that can happen.
The most common thing is that itmight ping in our own brains.
Wow.
She's been at this for a reallylong time.
We're really working.
I'm throwing everything I can afew times at this, you know,
using all of the different toolsthat I have, and you kind of
see.

(27:42):
Well, let's, I'm not gonna putthis out there to her, right?
But like, let's just kinda seewhere this potentially goes.
Right?
And so that idea may be kind ofwormed in there, not in saying,
I think you're gonna transfer soI'm just gonna stop doing stuff.
'cause that's where we'reeventually going.
But we see things kind of playout over time, usually.

(28:02):
And so similar with like vitalsor something, right?
If we can't get things tostabilize, we are thinking.
Hey, probably eventually this isgoing to happen.
So there's no actual timelinethat we have to say like, oh, we
knew it an hour.
We knew for sure an hour ago,and now we're, now we're just
finally talking about it.
We, as midwives and as a team,have resolved to be very

(28:24):
communicative.
So the second we see somethingis sort of out of normal, we
will say, Hey, we're noticingthis thing.
We're telling you now we'regonna work on this thing.
To bring that back into normalit on its own, it's not an
issue.
But we also don't wanna seeother things start to kind of
like follow that thing that'sout of normal.
Right?
And so that conversation maybehad a day before you have your

(28:45):
baby, maybe have the 30 minutesbefore, right?
But we don't, we never shy awayfrom that.
We don't ever wanna keep parentsin the dark about something
that's going on with their laborbecause she may say, Hey, that's
actually, you know, that's aproblem for me.
I wanna go.
And then that's an entirelydifferent conversation than us
clinically deciding to go.

Tiffany (29:04):
Yep.
And I think our clients knowthat they can always make the
decision to go.
They can always say, I want togo, but.
Unless it's a A, unless there'ssomething clinically going on,
we usually tell women, Hey, weare not entertaining the I want
to transfer discussion, or Can'tI just get an epidural or I'm

(29:26):
done until you are getting up,putting pants on, grabbing your
bag.
Telling your husband, no,seriously, I'm getting in the
car right now.
And that's a completelydifferent scenario and situation
than actually talking about doyou need to go in for something?

(29:47):
Therapeutics, I think sometimeswomen think, you know, are
thinking through that too.
And then dads are like we alwaysmake sure to tell dads if we're
acting normal and cool andrelaxed and.
Smiling sometimes and noddingour head and quietly leaving the

(30:08):
room and giving you guys space.
And then everything's normal andfine.
We're not secretly gatheringinformation.
And then going to discuss, isn'tthis absolutely.
Terrible.
What a train wreck this is gonnabe and not tell you.
I think everyone's always like,is everything okay?
Is everything all right?
Yes.

(30:28):
Assume everything's fine andeverything's okay.
Un unless we have some piece ofinformation that we'll share
with you.
And it doesn't always mean, Hey,this is bad.
This just means like, oh, thisis what I'm noticing.
Here's how we're gonna monitorthat.
Here's what this could mean.
Here's what we're gonna do totry to prevent that from
happening, right?
I mean, the communication pieceis huge.

(30:51):
So women wanna know whatmidwife's role in a transfer do
we go with women to thehospital?
How do we work with the staffand that kind of thing.

Kelly (31:02):
Yeah.
I mean, one of our, one of myfavorite things about the setup
that we have doing thistogether, and your midwife will
have somebody there with her,right?
Usually depending on whereyou're at in your labor and all
of that.
Is the fact that we get to kindof like tag team some of the big
issues, right?
And so one of us, whoever's kindof primary that during that
birth will.
Call the hospital, discuss thesituation.

(31:23):
We actually, from our electronichealth records, can download all
of your information, the labor,you know, stuff so far, and fax
that over very quickly so thatthey have it before you even get
there.
They know who you are, they havea grid for it.
They're getting some of yourinformation before you get
there.
They are saying, yes, we areready for this.
Transfer.
We've had some conversationsthat have been beautiful.

(31:45):
Oh gosh, I'm sure she justreally doesn't even wanna be
here.
We're gonna try to make this as,you know, best as possible.
We've had other conversationssaying, I can't believe that
this is happening, and she'sprobably gonna have a c-section
when we get here.
And I'm like is, should, is thiswhere we need to transfer?
Like, what should we do aboutthat?
And so.
Yeah, so there's a, there's a,it's not on the mom to like,
call and say, Hey, this iswhat's going on.

(32:06):
We call, we move forward withthat idea of transfer one of us.
So COVID messed everything up,right?
Where we couldn't go at all andwe didn't really have a ton of
transfers, but that just suckedso bad to be like, okay, good
luck.
Right?
And I don't know what exactly isgonna happen.
And I, and I can't be there tolike, hold your hand and say
that things are gonna be okay.

(32:27):
so, but what we, what we.
Desire to do what the goal is,is that one of us will go right.
Mom and dad usually are justdriving themselves.
If they're in an ambulance,obviously we're coming in a
different car and usually whatwe're doing is gathering stuff
to bring to them, right?
Your clothes, your phonecharger, all of that good stuff.
And then one of us will stayhome and actually clean up,

(32:47):
right?
Because your birth tub may beout.
You probably don't wanna comehome from your hospital birth to
see your blown up birth tubsitting there and think about.
You know, even more just thework you have to do, the what
didn't happen, all of that.
So one of us will stay homeclean up.
One of us usually will go withdepending on the situation,
right?
And so.
We're not the care providerthough when we get there, we are

(33:07):
always your care provider, butwithin that spectrum, we now are
more so like doulas, right?
And so we don't, we can givesome clinical feedback, all of
that, but we then are handingyour clinical care over.
And so that's generally speakingwhat that kind of transition
looks like.

Tiffany (33:25):
And so women wanna know what what's the situation if
they've never had prenatal carewith a hospital-based provider,
or what if their midwife doesn'twork closely with the
transferring ob?
How does that work?

Kelly (33:39):
Yeah, so we ha we've transferred to obs that we have
never met before.
We've transferred in situationswhere I've been like, actually,
I've never even been to thishospital.
You live in a different area oftown that I, you know, am not
super familiar with anymore.
And so again, we can downloadall of your records, all of your
lab work, your ultrasounds.
All of that and be able to sharethat with them basically

(34:00):
instantly so that they have theinformation that they need so
they can see, yes, you have beengetting prenatal care.
Look, your GBS negative, here'swhat your, you know, gestational
diabetes screening tools lookedlike.
All of those things can kind ofget your, your background.
They can also get it if you'vesaid, I've declined everything
in my pregnancy and here I am.
Right.

(34:20):
So they can get that informationjust so they understand.
of who is in front of them.
We like to give context too,right?
So like over the phone can saythe things that we want to, but
really they're just kind ofcoming after some of that
clinical data, which is veryeasy to share.
And then that all of a suddengives you like a history that
they have access to too.

Tiffany (34:41):
Yep.
So it usually goes prettysmoothly.
I mean, in our community,especially with the, some of the
emer emergent pieces and laboractually happening, the hospital
has to receive the transfer.
And so sometimes they like that,sometimes they don't.
And

Kelly (34:58):
Yes.

Tiffany (34:59):
that's just what we're dealing with.

Kelly (35:02):
There are certain hospitals around here that are
kind of known for being, youknow, more willing, more kind,
more gentle with transfers.
And so you can kind of assessthat in your own community.
Ask your doula, ask yourmidwife.
That's mostly just like whatword on the street has been
basically, oh, I had this goodexperience here.
I had this bad experience here,kind of thing.

(35:22):
And granted, we don't know who'son call.
We don't know the nursing staffthat day.
We can't guarantee like, oh, youwill be, you know, received
Well.
Amazingly enough, most of ourtransfers have actually been
received quite well with a, witha sense of.
This wasn't where you wanted tohave your baby, but you're here
now.
So like, let's try to make thisthe best that we can.

(35:42):
But also, you're not hereanymore for this like low risk
completely hands-off experience.
Usually if you're going in, it'sfor, it's for something, right?
And so there's not, not thatyou, you still absolutely have a
say.
You should say yes or no.
You should have informed consentover all the things.
It's just most likely gonna looka little bit different in terms
of what you're desiring becauseyou're going in.

(36:05):
For something usually.

Tiffany (36:09):
Yeah, so you, there's a thing in our community, and I
guess it will vary in manydifferent ones.
Even if you see an OB duringyour entire pregnancy and you're
under their care and you'reunder midwifery care, they will
not accept a transfer in laborfor anything it is against their
malpractice coverage or youknow, something like that.

(36:30):
And so that's important to know.
'cause I think a lot of womenthink, oh, here's my backup
plan.
If this doesn't work out, I'llstill get this great doctor and
try to have this really great.
Experience, but they're notallowed.
Maybe they're the hospitalistthat day, maybe they're already
on rotation on l and d that day,and they end up being there to
receive your care.
But in our community, that isnot something that we can ever

(36:53):
guarantee or promise women.

Kelly (36:56):
Yeah.

Tiffany (36:57):
So once we get to the hospital, Kelly, what does how
do women, you said we're goingin for a reason, right?
I think that's the, I thinkthat's the ticket that.
That need, we need to reframewhat we're doing here because we
had a lot of questions onInstagram about how do we
preserve the birth plan, how dowe try to keep interventions as

(37:18):
little as possible?
How do you know tho those, thosekinds of discussions?
And I don't mean to be little,that concept at all.
We can still have as much, wecan still try to protect
physiology and the experienceand try to have the best
experience ever, but we're goingin for interventions.
That's what we're doing.
There's going to beinterventions.
So how do we work with ourclients on the balance there or

(37:42):
on that spectrum of advocatingfor yourself, still trying to
have the best experience yetgoing for the things that we're
going for.

Kelly (37:52):
Yeah, I, I think you nailed it when we're, we're
trying to preserve physiology asmuch as possible, right?
We're, we're going into a thingthat most likely is going to
disturb that a little bit, butthat doesn't mean like
everything is completelyrailroaded now.
An emphasis on really goingslowly through these things as
much as your safety, you know,situation allows for, right?
Like if you're going in for.

(38:13):
Man, my, my labor is juststalled and the contractions
aren't doing a thing anymore.
And we've done everything andyeah, I am gonna need some
Pitocin.
We can go in and we can slowlystart that.
We don't have to, we don't haveto ramp up just because you've
been in labor for a long time,right?
We can slowly start that andremind your body, this is what
we were doing before, is what wecan do.

(38:33):
We can kind of allow yourhormones a second to kind of
catch up to what we're trying toencourage your body to do.
Then.
Same thing with like an ifyou're going in for an epidural,
right?
Yet, no, that wasn't what youoriginally anticipated, right?
But you can still make that areally connected experience.
Yes.
It's gonna come along with like,okay, well now I'm gonna have a
catheter.
Now I'm gonna have this likemonitoring.

(38:55):
But one of my favorite things toencourage moms to do who have an
epidural, right, is if you'renot, you could be still be
feeling that like tightness.
If you're not feeling anythingand you're like, this is really
disorienting, look over at themonitor.
It'll show you when you'restarting to, and you can hold
your belly and you can do yournice deep breaths, and you can
use that time to just talk toyour baby, right?
Connect with them and then enjoythe rest in between.

(39:17):
Right?
And so there's like some piecesthat you can still say, Hey, I,
I still have some control here.
And just because you say yes toone thing doesn't mean you're
saying yes.
everything.
But again, that reframing ofYeah, yeah.
We're, we're here for a reasonis a really helpful shift.
You are always still in charge,but still recognizing, yeah,

(39:38):
this is this, these are thereasons that this stuff even
exists.
It's not just for every birthand whatever, like this is a
really good usage of these kindsof interventions and tools that
they have.

Tiffany (39:49):
Yeah.
And then for non-emergenttransfers, which is going to be
the huge majority of what we endup dealing with, there's,
there's not, it doesn'tautomatically mean you're gonna
have a C-section or you're goingto have the, this worst case
scenario thing happen.
At your birth.
We usually still have time onour side.

(40:11):
We usually still have stablevitals on our side.
That's why we went when we went.
We usually have still lots ofcapabilities, and so that's an
important part of the discussionis timing the transfer in a way
that still gives you lots ofoptions so that it's not an
emergency, so that it's notsomething where we have to make
decisions quickly and push it.

(40:32):
But what would you say to womenabout.
That C-section rate.
I think the, I think women areafraid that transferring into
the hospital means automaticallythey're gonna end up with a
C-section.

Kelly (40:43):
Yeah, I mean that has happened for a couple clients of
ours.
That's like kind of how thatstory went and we can see how a
very small amount of womenactually.
Really do at the end of the day,really need C-sections versus
how many are actually gettingthem right.
And so to recognize, oh, I'm sothankful for this because this
is the situation where like thiswas actually needed.

(41:05):
Right?
Versus most of our moms aregoing in.
Again, the most common reasonfor transfer is wanting that
epidural, wanting to take a nap.
Not kidding, right?
Going in, getting the epidural,setting yourself up with like a
peanut ball or with a bunch ofpillows, right?
And just sleeping for a littlebit.
Most of our clients are wakingup and saying.

(41:27):
Or, or their provider is sayinglike, oh wow, a lot has changed
while you were sleeping.
It's time to push your baby out.
It's a, a very common, notsaying that's everybody's
experience, but it's reallycommon.
If that is the reason fortransfer, to allow your body
just to be like, man, I neededthat and then I.
To wake up and say, okay, we'relike making progress, we're
moving forward.
We're kind of ready to have ababy, or we need a little bit

(41:49):
more support to do that.
But now I feel revitalized andcan actually be involved in this
conversation and be an activeparticipant.
I think that's a huge part of,of that.
So I'm not exactly sure what thereal stat is in terms of a home
birth transfer turning into acesarean, but for ours it's very
low.
Just because of, you know, I.

(42:09):
A million different situations,but that in particular is a very
common thread that we have,we've seen happen.

Tiffany (42:18):
Yeah, I'm thinking of a transfer that we had where it
was emergent, four heart tones,really unstable heart tones.
We had been in labor for quite awhile and it was taking so long.
And then once I started hearingheart tones become destabilized,
then I was listening a whole lotmore frequently and it was

(42:38):
seemingly.
Getting worse and worse.
And so I called 9 1 1 and I'mtelling everybody in the whole,
during the whole transfer andthe whole team, oh, we're just
going to the hospital for aC-section, that's what we're
doing.
And then we get to the hospitaland the provider's feeling just
like really generous and like wedo have a little bit more time

(43:01):
and they're not rushing her backto a C-section, they're gonna
let her labor for a little bit.
And I'm like.
This is really interesting.
This is the opposite of what Icame here for, but at least.
But at least the ORs down thehall now instead of an ambulance
ride away.
Right.
And so I'm just waiting andwaiting and waiting for the OB

(43:22):
to make the call to go do theC-section and finally they do.
And I'm so relieved as theprovider'cause I'm like, that's
what we needed.
We needed.
We needed to cut this baby outimmediately.
Which of course is never on our,never, never a part of our plan,
right?
Not a part of our repertoire isplease cut the baby out.
And later the mom was havingsuch a hard time processing that

(43:45):
she ended up at the C-section.
It just was mentally more thanshe ever.
She just really didn't thinkthat that could happen to her,
or she felt like it was theworst thing that could happen to
her in her birth.
And she was, just asking overand over again, was it needed,
could I have had more time?
And while I was helping herprocess it, I was like.

(44:08):
Yes.
I thought if I could perform ac-section on you at home before
we even called 9 1 1, if I cando that safely, I would've taken
your baby out then.
So it's, so mostly I'mdemonstrating this, that there
can be what was happeningclinically.
There can be processing theevent as the first person that

(44:29):
that's happening to, and thenthere can be years and years of.
Trying to wrap your head aroundshifting from that vision,
understanding reality, what wasneeded, questioning that, and
even in a situation that to me,looked really appropriate for
that high level of interventionfor the mom, can still feel

(44:51):
really disorienting, reallydisappointing.
Really upsetting and just evenprocessing with someone who was
there and was your care providerand right.
Like there's so many supportivepieces there.
And still, it took a really longtime during our postpartum,
postpartum year together, andI'm not sure if she ever really

(45:12):
finally arrived to, I acceptthat this happened.
But let's talk about that alittle bit.
Kelly.
Let's talk about processing theexperience, processing the
event.
How do women even begin toprocess, no matter what happened
to them, no matter what the,what the situation was with the
transfer?
How do women begin to wrap theirhead around that happening to

(45:35):
them?

Kelly (45:36):
Yeah, I mean it's, it's hard because no matter, no
matter what in birth, there'sgonna be something that happens
where you're like, oh, that wassurprising or potentially
disappointing.
Pointing.
Right?
And so working through, nomatter what your birth looked
like, because for some peoplethey may look from the outside
and say, oh, well you had avaginal birth.
It all went straightforward,except for the fact that like,
you just didn't get to do it athome.
What are you complaining about?

(45:56):
Right?
But again, that idea, even thatwe were talking about the
beginning, right?
This vision that you havecreated, like it, it feels very,
I mean, birth is so personal andso.
Meaningful and impactful thatlike, of course, no matter what,
even if you had your baby verystraightforward and it was at
home, right?
There's still things that you'reunpacking and processing.
And so being able to say with atrusted person, whether that is

(46:19):
your midwife, that is yourfriend who understands your
heart for what you wanted,whether that is your spouse, who
was like, dude, I went throughthat too, and I understand where
you're coming from, notnecessarily just anybody because
you get a lot of, well, just bethankful of that.
Like fill in the blank, right.
But being able to actually saylike, here's what I'm feeling.
I'm so happy on this hand thatmy baby's here.

(46:40):
I love my baby so much.
Or maybe you're still like, I'mstill trying to bond with this
baby.
Everything that happened kind ofimpacted that, you know,
particular feeling and you'resaying, this is not what I
expected, but I have this babyand I am thankful that they are
here.
I'm getting to know them.
Falling in love with them, allof that.
But on the other hand, thatsucked.
I hated that that happened.
I hated that I did all of thiswork that I spent all of this

(47:02):
time.
I did all I like, paid all thismoney, you know, all of it.
And then I didn't get what Iwanted.
And everybody says, Hey, get adoula.
Look at the percentage rate isso much lower.
Hey, get a midwife.
These stats are so much better.
Right?
And I did all their things.
Right, right.
And so then you're like, what'swrong with me?
And that's a lot of processingthat a lot of women do and kind
of come back to of like.
What hap what was wrong with methat this happened?

(47:24):
Of course, the answer isnothing.
Right?
Of course the answer is justlike birth.
We're, we don't live in aperfect world, like things are
fallen and broken and so thingsdo happen.
But being able to start toreframe some of those pieces of
not shoving them down, butsaying, where can I find, like
where in my labor was I reallystrong?
What am I proud of?
From, you know from thatexperience, what situation was I

(47:45):
in where I was like, man, thisis hard, but I'm still gonna do
it.
Right.
Starting over time to reframesome of those things, you may
need to do that with atherapist.
You may need to do that.
We'll link in on a show notes,some ways that we recommend kind
of processing some of thosethings.
But.
Actually doing the work andsaying, I'm gonna, I'm gonna
talk about this.
I'm gonna journal about it.

(48:06):
I'm gonna, you know, I'm gonnameet it rather than shoving it
down.
And recognizing also that timewill make you kind of go up and
down.
Sometimes you'll be like, thatwas great, or at least I'm okay
with it.
And then there's gonna be timeswhere you're like, that I'm dry
heaving and I'm so sad, youknow, about, you know, a
particular outcome or aparticular situation.
And so, eventually you may neverget to the place where you're

(48:27):
like, I am okay with that.
You may always be like that.
That was terrible.
Wish that didn't happen.
You can accept that it happenedand say, man, bummer.
Right?
Like such a huge bummer thatthat happened.
You may never get to the place.
And that, I just wanna say thattoo, just to encourage women
that if you still feel like,gosh, five years later and that
still kind of sucks.
Yeah.
It's.

(48:48):
It is, it, it's because thatsucked.
And I'm sorry that you wentthrough that.
But we can still take some ofthose pieces and move forward
healthily and wisely with that,where you can say, yes,
everything.
Ha oh, you know, everythinghappens for a reason or
whatever.
You, you know, kind of platitudeyou wanna say, but you can say,
I can do, I can use this forgood.
This helped me become the motherthat I am.

(49:10):
This helped me become the womanthat I am because I had to walk
through some of thatdisappointment and grief.
Through that.

Tiffany (49:18):
Right, and like I, I mean I've, I've probably shared
on the show before, it took mefour years to get to a place
where I accepted my owncesarean.
And that wasn't even anemergency situation.
That was just, I hated that ithappened and what that meant for
who I was as a person and a mom,and.

(49:40):
The disadvantages.
I felt that that brought ourentire everything.
And it's be, I I, it took me solong because I was stuck.
I didn't know how to moveforward.
And so I think your advice oncontinuing to process, getting
help, talking to somebody who istrained in helping women process
birth trauma and birthdisappointment is hugely

(50:02):
important.
And then allow yourself thespace to, have some more
processing of that if you decideto have another baby and that
you're different now, you'redifferent because of that
experience.
You're, you're bringing yourhistory into another pregnancy.
You know now what can happen.
The home birth picture is lessidyllic to you, and it can be a

(50:28):
really beautiful place to findyourself more rooted in the
concept of.
The transformation and thechallenge and overcoming and
victory in some of those spacesthat is not completely outcome
based and that there's some,there's some freedom in that and
being able to ex to, to processand experience birth in that

(50:50):
way.
But like you said, Kelly, likebeing, being gracious with
yourself, giving yourself sometime, not being afraid to look
at resources.
Totally.
Okay.
If you want to try to haveanother home birth.
And you wanna do it with adifferent team, potentially,
you'll, you absolutely lovedeverything about these people,

(51:11):
but you just can't do it.
There's pieces of it.
You just need to be different.
And so you're gonna hire adifferent midwife this time, or
maybe you need to do, maybe youneed to have a doover with that
exact team.
Maybe the, maybe there'ssomething important about.
You know, navigating that pieceagain, and there's other things
that you wanna bring, you know,some change in and differences

(51:34):
to, and everybody's gonna kindalike navigate that a little bit
differently.

Kelly (51:40):
Yeah, we've had, we've had clients who have chosen to
have a different team the nexttime, and I've never once taken
that personally because I'mlike, I get it.
And, and we have a goodrelationship, you know,
whatever.
Like, but you need somethingnew.
You need to write a new story,you want a different doula, you
want, you know, just somethingcompletely different.
Great.
And then we've had theexperience where we get to do a,

(52:01):
you know, plan another homebirth with a client who
transferred and get to do thatagain.
And it is, it's one of the moreexhilarating experiences to just
be on that side and be like, ohman, like to watch that unfold.
So much of the pregnancy isusually.
Processing that and saying, oh,I'm exci.
I wanna get my hope.
I do wanna get my hopes up abit.

(52:22):
I'm afraid of that feeling of,you know, feeling knocked down
again if things don't go the waythat I want them to.
But like, I can still be excitedabout this idea that I really
still want to happen in my life.
And you know, it's the samething, like when we have
feedback.
Clients who come to us, most ofthe pregnancy, we're like, we're
not really treating thisdifferently except we're doing a

(52:43):
lot of emotional processing for.
What birth can be like, what wewould like it to be like, how
we're gonna, how we managedisappointment, all of those
things.
So much, so much, so much of itis emotional processing that
happens.
And if you're not completely inthe space of like, yes, I, so
ready to get my hopes up, Iwanna be with that same team.

(53:05):
Like, we're going for this,whatever.
But you're still just like, I'mpregnant again.
I know that home birth would bereally great.
I'm still terrified.
I'm working through a lot.
It is okay to say.
I'm stepping back into thisrelationship.
I, I have a lot to work on thispregnancy.
I have a lot of, you know,surrender and places to get
through and to do that togetheris a really sweet thing that,

(53:26):
that we get to do.
And we get to witness thattransformation too.
I.

Tiffany (53:31):
Yeah, and for the woman who's listening who, who just
wants to hear about home birthtransfer, but has not had, is,
is still preparing and waitingfor her own birth, and is just
looking for context on how to beprepared for something like
this.
There's a degree in which liketo match with your personality

(53:53):
and how you like to be preparedand feel safe to continue to do
some research in this area.
There's a degree in which safetycan be talked about that is not
fear-based.
There's a way that beingprepared can, can be done
without expecting something togo wrong.
Right?
And so leaning into some ofthose pieces of having

(54:16):
education, having information.
Understanding different birthsettings and what they have to
offer.
Having some type of, you know,exercise in self-advocacy, even
if you don't have to do it withyour current care provider in
your, you know, in the birthsetting that you've chosen.
There's so many things that canchange and, and are somewhat

(54:37):
unpredictable with birth, and wedon't have control over all of
those pieces.
And so it is okay to some degreeto, play around with some of
those ideas and educationalpieces, and it's one of the
things that we're passionateabout discussing.
Obviously we, we want women tobe prepared and we think that
women who have the mostinformation are gonna be able to

(54:58):
make the best decisions forthemselves, even if it's a
decision that they weren'tprepared for.
They can still use that.
That advocacy muscle of how tomake an informed decision about
something that you don't knowanything about, it is completely
possible.
We teach a lot of that in ourchildbirth.
Education course.
You can grab the link in theshow notes.
We still have that 10% off codefor you guys too.

(55:21):
And I think we'll wrap up thisdiscussion now and see you guys
in our next episode.
But this is giving me a lot ofideas for future things that we
need to bring onto the podcastand continue to discuss.

Kelly (55:37):
Absolutely great conversation and just like the,
the foundation of it, that's thepiece that I love, is that now
hopefully women as you'relistening, can say.
Oh, that piqued my interest.
I'm gonna go research thatthing.
Oh, I'm gonna go have thatconversation.
Oh, I'm gonna go ask thatquestion.
That is exactly what we want tobe here for.
So hopefully that gives you lotsof food for thought and we will

(55:57):
catch you next week.
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(56:18):
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(56:40):
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