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RC: Hello everyone. This is Liz Harvey coming to you from our studios in New York City where we are dedicated to bringing you cutting edge interviews from many of the leading industry professionals across the US. In today’s episode, we are speaking with Stephanie Heintzeler. Stephanie is a German educated midwife, a US educated doula and acupuncturist and she’s a certified lactation counselor. She is known as the New York Doula. Stephanie has delivered over 1,200 babies and has experience with twins, triplets, breech babies and water birth. She also works with newborn parents in their postpartum stage and holds classes and seminars for moms and dads to be. With a wealth of experience and knowledge in her field, Stephanie Heintzeler is widely considered to be one of the top doulas in the country. She is also a contributing member of our national network of industry professionals.

Today, we’re going to talk about a very important topic, birthing philosophy. Hello Stephanie. How are you today?

Stephanie Heintzeler: I’m good. Thank you. How are you?

RC: I’m good. Thanks so much for being here today.

Stephanie Heintzeler: Thanks for having me.

RC: To start off, what are the different options women have for how and where their baby can be born?

Stephanie Heintzeler: There’s a lot of options. Basically, the parents can decide whether to have a home birth, whether to go to a birthing center or whether to go to a hospital which of course in the US most women choose but even the hospitals have huge differences. There are hospitals who have a high C-section rate. There are doctors who don’t have the natural approach. There are other hospitals or doctors or midwives who would have a more laid back approach. Not every hospital is the same versus another one. The next question is do I want a natural birth, meaning no medication. Do I want a vaginal medicated birth, meaning an epidural. If you want medication, that’s the most common one. Do I want a C-section? Do I want to wait until my due date or after? Do I want to get an induction? It’s not so much recommended to have an induction very early but if a mother is a little older or is high risk, if there are twins – so of course those are things that need to be discussed. There are a lot of options.

RC: Many women would like to have a natural childbirth without medication. What are the various drugs and medications that could potentially be used during childbirth and what are they used for?

Stephanie Heintzeler: You can start with light stuff. There are certainly midwives who work with homeopathic remedies for example. Acupuncture in early labor can be done. Those are things that you can do from your side or choosing a provider who offers that because that can be tremendously helpful and it doesn’t have any side effects. If you use real drugs during your labor, what you can ask for is to get an opioid which is a strong pain medication. Something that is used often in New York is Stadol. It’s something that’s given through IV or in your muscle. Hospitals don’t really give it though. They have it but they don’t like to give it. They prefer the epidural. It’s easier. It’s small money for them. It’s done continuously. The epidural though is much more invasive. It’s a catheter that’s going through, like a needle that’s going through the disc into the dura canal and then there’s a catheter put into it so the mother continuously gets medication but at the same time because it is such an intense medication that numbs the body, she needs to get monitored a lot.

The blood pressure needs to be checked every 15 minutes. Some moms have oxygen masks. They get a catheter because they can’t pee. The baby needs to get monitored all the time and the contractions. There’s so much. It has a huge ripple effect but it is the very main medication. In New York, there’s a 90% epidural rate. With the doula, it’s a 50% epidural rate so it’s much lower. The reason is not that doulas are against it, it’s the mom feels comfortable and she’s going through it and she’s doing okay. That’s the main reason. If you don’t want an epidural, I highly recommend getting a doula.

RC: If someone wants to deliver their baby at home, what factors really need to be considered?

Stephanie Heintzeler: The main factor is what is the pregnancy like? Do you have low risk pregnancy? It needs to be low risk pregnancy. Both parents, father, mother or partner, everyone needs to be on board with it. If the partner is not comfortable with a home birth, you shouldn’t do it. Everyone needs to be on board. For low risk pregnancies, there’s no reason to not have a home birth. It’s considered safer in a way to have a home birth than a hospital birth because you’re one on one. There’s someone with you all the time. No midwife would ever take any risk and wait until there are real problems. Home birth midwives do have a transfer rate of around 30% because they want to keep things safe and if anything is a little bit off track like a little bit high blood pressure or the water broke and no contractions for days or so then yes, you might need to transfer.

UK or Netherlands or Germany have a much higher home birth rate but at the same time, they have a very good rate in terms of natural hospital birth because there’s midwives involved and not doctors who are on the parents’ side and who don’t like interventions. It’s a very thing to look at that too. The mortality rate is double, is high versus Germany or the Netherlands, double. That shouldn’t be the case. It’s not that you need a home birth necessarily to have a good birth experience, but you need to find the right provider, maybe even in a hospital who could do a home birth like birth in a hospital. It’s absolutely possible to just have a great birth in the hospital setting where you feel maybe safer because you just know there is a NICU next door or the C-section could be done. It’s so important that you feel comfortable wherever you are like your brain and your gut feeling is really aligned.

RC: What issues would be included in the birthing philosophy if someone is having a scheduled C-section?

Stephanie Heintzeler: With a scheduled C-section, the good part about that is that the parents know. They know why. They probably went through all options. Maybe the baby is breech. Maybe twins and they’re in a risky position or maybe there was a C-section before and it’s really not recommended to try a vaginal birth after a Cesarean. Is the mother comfortable with the scheduled C-section? Is it close to the due date? That would be great. The birthing philosophy could really be to get the C-section closer to the due date as possible so maybe the mom didn’t go through labor but at least the baby is ready to come out. There are two things that can be done, meaning you can take an oil into the delivery, into the C-section or OR so that when you’re nauseous, you have something that helps you. You could have your baby skin to skin. Some hospitals do that. They could lower the screen so you see quite a bit of the baby’s birth if you want to.

Of course, the partner can be in the room. Sometimes even the doula. That can be very helpful. The mom could also get a swab, a vaginal swab to wipe over the baby after birth. NYU did a study and they confirmed that if the baby is wiped with the microbiomes that the mom has in her vaginal that the baby will have nearly the same intestinal flora months after the birth than a vaginally born baby versus a C-section baby, they don’t have anything. Try to have a holistic C-section as much as possible. In New York, there’s a lot of hospital doctors who are very open to that and try to do their very best so the parents have a good C-section experience which is really an amazing change.

RC: Lastly, who is included in the birth team? What is the best advice for making sure that everyone on your birth team is on board with your birthing philosophy?

Stephanie Heintzeler: In the hospital, the birth team is very big. There are a lot of people who will be involved that the parents don’t know like the nurses and sometimes even the doctor who will deliver them. It’s a big team. A lot of staff will come in and out. Pediatricians, pediatric nurses and so on. Again, a doula, she’s the one person who you know. You hire a doula specifically. That’s the person who will make the connection between the parents and the team because the doulas know the hospitals. They usually know the teams. They know how to communicate. They know what issues could come up. Going over a birth plan with a doula can help tremendously. Not that we really follow that birth plan necessarily, but you have this set. It’s like, “This is where I’m coming from.” Let’s say a mother really wants an epidural and things go wrong with the epidural, the epidural doesn’t really work the way it’s supposed to work, then we really know, “Okay, this was such a big thing for this mother that now we’ll really work on making a good birth experience happen despite the fact that the epidural wasn’t working.”

As a doula, then I really know, “Okay, this was the biggest deal for this mother anyway,” but a mom who didn’t even want an epidural in the first place and then she ends up having one, she’s usually better off when the epidural isn’t working so well. She’s like, “Well, I was planning on not having one anyway.” It’s very important to know where the mother is coming from because that way, we can really catch problems or deviations easily. If it’s a natural birth that was planned, maybe mom wanted to give birth on her hands and knees and the doctor doesn’t allow it, then we can really try to communicate and make it happen. Some doctors are really open to it. It’s really important to communicate beforehand and ask questions beforehand, like ask, ask, ask. There’s a whole list of questions I give to my moms because it stands and falls with the team in the end, the team who is in the hospital room.

RC: Great. Well, thank you so much, Stephanie. We know you’re extremely busy, so I just want to thank you for your time and your help today.

Stephanie Heintzeler: Thanks for having me.

RC: For our listeners across the country, if you are interested in speaking with Stephanie Heintzeler, you can either go online to www.thenewyorkdoula.com or call 917-399-2031 to schedule an appointment. On behalf of our entire team, we want to thank you for listening and we look forward to bringing you more top quality content from our country’s leading industry professionals.