Episode 58: Let’s talk births! From vaginal birth to C-sections

Dr. Sophia
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the Dr. Sophia ObGyn podcast. Today I am gonna talk a little bit about one of my really favorite topics, which is delivering babies. Just, you know, thinking about patients and the questions that I get and some patient scenarios kind of made me realize that maybe all of you have some of these same questions or thought processes and why not talk about it. So as always, I am joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
Bon. Hello everybody. That's sort of like my French. I grew up in Canada, French Canadian, so I've been feeling French these past few, I don't know, weeks or so for some reason.

Dr. Sophia
Ah, Bon.

Touseef Mirza:
Bon Madam Bon, my accent is more Quebec than yours, which is more-

Dr. Sophia
The Haitian French, I guess. Yes.

Touseef Mirza:
The Creole French, and I am Quebecois French. So we wanted to talk about this and, and it's interesting because even though we were just like literally like five minutes before we just started to record this, I was like, okay, so this is a delivery and this is the delivery. And Dr. Sophia's like no. So there's definitely room for clarification in terms of the main ways to deliver a baby and what happens in different situations.

Dr. Sophia
For sure. So first of all, as we think about a delivery, most people think, okay, we're having a baby and we're having a baby vaginally. And in most places people say the normal way or the natural way. There's so many ways in which people conceptualize vaginal birth. And so I just wanted to go over that birth can be both vaginally or via C-section and even under vaginal conditions that there actually are a couple of different ways. A woman still has a vaginal birth, but it can be assisted.

Touseef Mirza:
When we say vaginal birth, we're basically saying that the baby's coming out of the vagina.

Dr. Sophia
Out of the vaginal canal. Yes.

Touseef Mirza:
Out of the vaginal canal. And that's how we've historically always delivered babies.

Dr. Sophia
Yes.

Touseef Mirza:
Yes. And, then the advent of science came along, and then we had C-sections, which have been around for over hundreds of years.

Dr. Sophia
Well, I say hundreds of years, but maybe a hundred years, more than a hundred years. It's been around for a long time.

Touseef Mirza:
And now both forms are considered normal ways of giving birth.

Dr. Sophia
Yes, exactly. Like I said, many people say, oh, I had the baby normally. And to be explicit about normally that many times when people say normally they mean vaginally. And that having a baby via C-section though doesn't feel quote unquote normal. I get that, but it's still like a mode of delivery.

Touseef Mirza:
So when you talk to your patients, do you say vaginal birth? And is that the same way that you speak to the nurses and everybody? Are there other terms or that's basically the way we call this?

Dr. Sophia
Yeah. In the medical field. I mean, if you're speaking with another healthcare provider or a medical professional, I usually use the medical terms and then I try to clarify things even when speaking with patients, just so that they understand when we do speak in medical terms, they feel included in the conversation. So the way I would always describe it is, okay, if this we're expecting a vaginal delivery or a vaginal birth.

Touseef Mirza:
Number one, do all of them understand right away what it means? Do you have to explain to them and or do they feel comfortable even saying vaginal delivery? Because a lot of people don't even, a lot of women don't even like to say the word vagina.

Dr. Sophia
I know. And so this is why I bring up the point that, you know, a lot of people say just the normal way or the natural way, and the implication there is that it's a vaginal delivery. You know, I have a patient and she, and we're going over her history, and I ask, well, have you had any deliveries? And she's like, yeah, I had three natural births.

Touseef Mirza:
Oh, that's true. People also say natural delivery.

Dr. Sophia
You know, they say, oh, I had a natural birth. Yes. Which to me indicates they had a vaginal delivery. But in my mind, and when I write it down, I write normal vaginal delivery.

Touseef Mirza:
Delivery.

Dr. Sophia
Okay. And even in writing normal vaginal delivery, I have to ask further questions. Did you need any help? Was there any complications or anything like that? Because even in a vaginal delivery or a vaginal birth, you can have like what we call assistance by either something called a vacuum, which is a small device that would go on the baby's head that is literally sound exactly what it sounds like a vacuum that would then help the mom deliver the baby with the, the healthcare provider actually, while the mother's pushing. And you are kind of guiding by pulling with this vacuum to get the baby out.

Touseef Mirza:
So it's basically through a suction cup?

Dr. Sophia
Yeah.

Touseef Mirza:
And this is literally during normal labor, it's happening at that point. It's not happening?

Dr. Sophia
Well, we're past the labor point. We're talking about pushing.

Touseef Mirza:
Right, right. So when, when the woman is actually about to deliver. But then for some reason it's more difficult.

Dr. Sophia
Exactly.

Touseef Mirza:
Okay. And at that point you can use that. And so does it create a vacuum or you're literally like putting it on the baby too?

Dr. Sophia
No, it literally goes on onto the baby's head. Create a suction cup in order to, as the mom is pushing, you are also guiding the baby's head out.

Touseef Mirza:
With the head.

Dr. Sophia
With like, you're pulling, you're pulling the head. Yeah, exactly. And that doesn't, and there are many different reasons why we would have to do something like this. Which we'll get there, I guess.

Touseef Mirza:
Right, right.

Dr. Sophia
Okay. Another way of delivering a baby would be something called forceps, which especially when I think of like back in my mom's day or something, forceps were very commonly used. Forceps are a device that goes along the walls of the vagina and kind of cups the baby's head. And then can do a couple of different things depending on the forceps that you use.

Touseef Mirza:
So the forceps, like tongs almost.

Dr. Sophia
It looks like tongs. Okay. Alright. I know it looks like tongs. And the forcep would go in a cup around the baby's head. And then again, you can guide the baby's head out as the mother is pushing, or you may need to rotate the head. So sometimes forceps were used in order to actually rotate the baby's head to make it easier for the baby to come out. And we still use these today, whether it's a vacuum or forceps, I would say that forceps may be less so, or it depends on what part of the country you're in. Providers being more comfortable using one modality versus the other. In my own hands, per se, I would say that I am way more comfortable to use a vacuum than I would be to use forceps. I would not use forceps just because I haven't done them in so long in my area of where I was trained, it was just less commonly used.

Touseef Mirza:
So does it happen often that you need to use these two like devices?

Dr. Sophia
I would say it's common enough that it's good for people to know that they exist. And it's what we call an operative delivery.

Touseef Mirza:
So what does the word operative mean?

Dr. Sophia
Meaning that we have to use some type of device in order to affect the delivery vaginally.

Touseef Mirza:
So the woman is still pushing, so Yes. So those devices, they're not doing all the work. It's really to help it. Yes. To help the whole process. Exactly. And usually you would first try to see if the woman can push by herself.

Dr. Sophia
Most of the time the woman is pushing by herself, but then something changes in the moment of her pushing, whether it's because she becomes exhausted or there's a change that's a more dramatic change in maybe the baby's heart rate, that it seems that it would be faster to help her with the delivery vaginally than it would be to, let's say, totally change course and go for a cesarean delivery.

Touseef Mirza:
And when you use these devices, it does, because literally the vacuum you're using it to, to pull the baby's head towards does that harm the baby.

Dr. Sophia
So in any way you do this, whether it's a vacuum or forceps, there's, there are all risks involved with this. And so the point of when it comes to doing some form of operative delivery, it must be that those risks outweigh the risk of continuing to push, for example, without affecting delivery immediately. It has to be a very calculated decision to do an operative delivery. Because even in a regular delivery where you have nothing, you do nothing, the woman pushes out the baby herself, there's still risks involved. And it, it really is a balancing act of what are we willing to accept.

Touseef Mirza:
So it's case by case and moment by moment.

Dr. Sophia
Absolutely. The one thing I wish more people could understand is how much things can change in an instant when it comes to having a baby. It's a process that can really change quite dramatically from one moment to the next. And yes, I would say, you know, more than 85% of the time things are happening great. But even under those circumstances, we have to think about the preparation of what if something can go wrong or, or things change in a way that makes us have to intervene.

Touseef Mirza:
So it's really more, it's not like, okay, it's taking forever, I'm going to use this device. It's really like, okay, we have to do something else now. Yes. Because either now something might go awry.

Dr. Sophia
Yeah. Awry. When I say awry, we are often a delivery, having a baby, your provider is managing two people. We are managing the mother and the baby. We are managing both lives. And in that end, what if the mother really is truly too exhausted to push a baby, and then that baby then is just kind of stuck in the birth canal and she's not able to push that baby through other things start to happen, the area around the baby in terms of the vagina, then become more swollen than making things again, more harder for her to deliver even more. That may be one thing also, by having the baby there for, you know, X amount of time, I'm not gonna give any specific timeframe per se, but the baby then starts to respond to that because it's just stuck. And the baby then can respond to that in a way that's adverse with the baby's heart rate changing and things like that. So it's like you, you, you have to kind of follow the signs.

Touseef Mirza:
So you're thinking, do you have like 10, 15 things going on in your brain? Like this is what's happening with the mothers, this is what's happening with the baby, this what's happening with the vagina to try to get to the right thing, to do

Dr. Sophia
The right balance of how to do or not to do at this point.

Touseef Mirza:
Right.

Dr. Sophia
To get to that right balance. And like I said, the majority of women are able to have nice, you know, like vaginal deliveries without interventions. They can push their babies out, they can, you know, women are exceptional and the woman's pelvis is an exceptional, exceptional, you know, part of anatomy in terms of what it is capable of. Which is what's so fascinating. Honestly. But at the same time, I think the beauty of being, what I consider myself as a birth attendant is someone who can affect change when it needs to happen right away to make sure that the baby is safe and the mother is safe.

Touseef Mirza:
What do you mean by birth attendant?

Dr. Sophia
Well, I don't wanna take, I don't wanna take on the role only and say that all deliveries have to be done by doctors. It could be a midwife. I mean, who is delivering the baby? It could be a nurse practitioner who's delivering a baby. It could be a PA who's delivering a baby. Like there's so many different healthcare providers when it comes to vaginal deliveries. And I think it's important to also pay homage to those who've been doing this for years and years in the villages and in the bush. And you know what I'm saying? Like even there, they are people who have been trained by their, you know, ancestors, et cetera, who have really taught how to do this. And I don't take anything away from that.

Touseef Mirza:
So we talked about vaginal delivery, and then when there's potential complications, then you make it more operative.

Dr. Sophia
Yes.

Touseef Mirza:
Which is through the vacuum and the-

Dr. Sophia
Forceps. Yeah.

Touseef Mirza:
I'm not there yet. Forceps. So in what situation then does it happen then there's a shift that could happen towards a C-section?

Dr. Sophia
So c-sections can be under so many different circumstances. I would say that perhaps, especially in this country and across the world, maybe even the number one reason that a woman may have a C-section is because she's had a previous C-section. And so that's why one of the things that is so important is that we try to prevent even the first C-section in the first place.

Touseef Mirza:
So let's describe what a C-section is.

Dr. Sophia
A C-section is an operative delivery. It's a form of an operative delivery. It's where the baby is delivered through the abdomen. So we have to cut the layers of the abdomen to get to the uterus, and then we cut the uterus in order to get to the baby.

Touseef Mirza:
And it's usually like below the belly button.

Dr. Sophia
Usually below the, yeah, definitely below the belly button. In some places where what's called a vertical incision is still the primary way that they do c-sections. Certainly in the olden days, this was a very common way in which c-sections were done.

Touseef Mirza:
When you mean vertical meaning-

Dr. Sophia
I mean going up and down. So like, let's say from the belly button down in a up and down way to just above the pubic symphysis or where, where we say the, the top of the vulva would be the mons pubis or where our hair vulva hair where hair starts. I'm trying not to talk to the doctor speak. I'm sorry. Yes. More commonly now, we do the quote unquote bikini line cut or in doctor speak would be a low transverse incision.

Touseef Mirza:
Which is horizontal?

Dr. Sophia
Yeah, which is a horizontal cut.

Touseef Mirza:
And that is very low, very low right above where the pubic hair starts.

Dr. Sophia
Right around in that area.

Touseef Mirza:
Yes. Okay. Do you still do both types of incisions?

Dr. Sophia
It really depends. Again, there's so many factors to why a person may have one versus the other, but I would say the most common way is to have the bikini cut, the horizontal cut the fan and steel cut. Those are all equivalent in some ways, but just so people can kind of understand if you've ever heard any of those terms, a vertical cut is typically done because of either the baby's position or a woman has had a previous vertical cut. And we like to typically go through similar, same scar, or she has some other anatomical reason why it's, it's better to do a vertical incision in order to have more access for delivery. I would say common reasons may include things like big fibroids, for example, may necessitate having a type of incision like the vertical incision.

Touseef Mirza:
And so when, when you do a cesarean, usually is it full anesthesia, local anesthesia?

Dr. Sophia
That's a great question Touseef.

Touseef Mirza:
Thank you.

Dr. Sophia
When we do cesarean sections, it's usually under a form of local anesthesia called a spinal or an epidural, which is anesthesia where the mother is still awake. And what it does is basically numbs the mother from the belly button down. And so in order to be able to operate without her feeling from the, basically like the waist down from the belly button down.

Touseef Mirza:
So she's conscious?

Dr. Sophia
Yeah. And in a c-section or a cesarean section, you'll feel, you can feel pulling, tugging, you'll feel touch. Sometimes you don't feel any of that, but those are very common to feel. But in a C-section, you really shouldn't feel sharp, but you may feel pressure. And you may feel people touching you. But you don't feel sharp. So the knife, for example, or you know, other instruments that we use.

Touseef Mirza:
How long does it take for it to have an effect?

Dr. Sophia
So it's very quick. Most of the time when we use a spinal anesthesia within five or 10 minutes, it's pretty effective.

Touseef Mirza:
So when you say spinal, is that something that you are injecting?

Dr. Sophia
It's the anesthesia that goes into the back. A lot of people are very afraid of needles just because most people are afraid of needles in the first place. And the concept of getting a needle in your back gives people even more heebie-jeebies.

Touseef Mirza:
That's in your lower back?

Dr. Sophia
And it's in your lower back? That is correct. And either a spinal anesthesia or epidural anesthesia both include anesthesia going locally through the back, and it's whether where, which space the medication goes through. Whether it's before the, you know, spinal cord or in the column where the spinal cord is or where the medication actually goes through. And that's getting very technical. But I guess the best way to understand it is that it's medicine that goes through the back where the nerves pass through, you know, the pain fibers. And it's to help anesthetize or numb those pain nerves from the, I would say about belly button down.

Touseef Mirza:
Okay. Yeah. So that's pretty wild to have surgery, but you're still awake.

Dr. Sophia
They're completely lucid.

Touseef Mirza:
You’re able to talk and everything.

Dr. Sophia
I talk to my patients, do you like music? Would you like me to change it? And then, and then the thing is, is that oftentimes when you're doing a C-section, it's pretty quick from the time you make your incision to the time that the baby's actually delivered. And so oftentimes it's just a few minutes and you get to kind of hear the baby cry and you know, you can, in some instances, I can show the mom the baby right then and there.

Touseef Mirza:
That's amazing.

Dr. Sophia
Yeah. And there's so many different reasons why a woman may need a c-section. Probably one of the more common reasons is just because if she's had a previous C-section and then outside of that, it's perhaps the baby's position. So another pretty common reason is something called the breech, or when the baby is sitting down in the pelvis or in the uterus and versus not, versus having the head being the presenting part or the head being down.

Touseef Mirza:
That's the first thing that comes out of the vagina.

Dr. Sophia
Exactly. Exactly. I would say for the most part that a breach delivery is very, is more uncommon now. It used to be that people, we did breach deliveries a lot more commonly, but in a country that has so much litigation and there's a lot more, it does require a lot of skill. And it's a skill set I feel like has been just getting lost more and more and more over the years because of the fact that going to a c-section is certainly considered a safer option. When it comes to a breach delivery. And then there are other reasons in terms of a woman who actually expects to have a vaginal delivery. This happens very often. We expect a vaginal delivery, we're in the middle of the delivering process, and for whatever reason, she either doesn't dilate all the way. You have to get to what we call fully dilated to have a vaginal birth. And for whatever reason, that just stops the dilation.

Touseef Mirza:
The opening stops?

Dr. Sophia
The opening of the cervix that has to happen in order for the baby to be able to come out completely just stops. And even with help, even with perhaps augmenting labor or giving her medications to continue to have contractions still doesn't allow her to continue to open. And so if she's not opening, then, you know, after several hours of this where the woman is considered in labor and we're doing all the things to try to get her to deliver and it's not happening, then we have to move on to a C-section. That's one possibility. Another thing could be that while she's in labor, something changes with the baby that causes the baby that we are watching while we're monitoring the baby that looks, that makes us feel that the baby may be in some kind of distress. And then that may be another reason why a woman may need a c-section. And under those circumstances, sometimes it's emergent or we have to do it right away in order to safely have a baby.

Touseef Mirza:
So as you're talking, when we talk about a C-section, are you trying at all costs not for the woman to go through a c-section?

Dr. Sophia
I would say yes. I know from, okay, so here's what I'm gonna say. I'm gonna speak from my own personal experience. This is what the Doctor Sophia ObGyn podcast is about. It's about talking about my own personal experience. I'm not here to give medical advice or to talk about what other people do or why they do it in my hands. The reality is, I love vaginal birth. It's such a great experience. It's definitely one of the things that drew me to the profession, right. But moreover, I recognize and understand how important it is to really prevent that very first C-section.

Touseef Mirza:
And why is that?

Dr. Sophia
Because the more c-sections you have that comes along with its own risks and it also increases the chance of having another C-section.

Touseef Mirza:
So when you say increases risks, what does a c-section increase risks in?

Dr. Sophia
One of the things that people may not understand or not even recognize is the fact that a c-section is truly major abdominal surgery. And so in that, it comes with the risks of bleeding infection, and further down the line, there's a risk of something called a small bowel obstruction. This is where scar tissue that may form and then kind of rubber bands around your bowels, and they get twisted.

It's just, don't get me wrong, c-sections are necessary. I do them all the time. And they really help women who are not able to have vaginal births, still have babies. Let's be clear, we need to be able to do C-sections. But I also think that sometimes we rush too much to do a c-section in a woman who may be able to do a vaginal birth. And we have to be clear on the indications and the reasons why we end up doing C-sections. Sometimes when we think about the mother and the baby or the fetus, the reality is that sometimes the fetus or the passenger is just too big for the mother.

Touseef Mirza:
Like a big baby.

Dr. Sophia
Like a big baby. So there are so many reasons why we have to do C-sections and thank God they exist, so that way we can still have a healthy mommy and healthy baby. But at the same time, I think women also have to be very supported in trying to have vaginal births.

Touseef Mirza:
So I think one point that you brought up, that's really important because we say C-section and because there's a lot of people that have C-sections, I think you're right, we have to recognize it is an operation and like with any operation, it's a big deal. Like it, it, anytime you open the body, yes. There are so many risks involved and that's one of those types of operations.

Dr. Sophia
A hundred percent. Absolutely. And I don't wanna take anything away from let's say a vaginal birth, right? So vaginal birth also holds its own risks. I mean other kinds of forms of birth trauma to the pelvic floor, to the vagina, it can lead to higher chances of women having things such as stress urinary incontinence. I mean, listen, the thing is things can happen on either side, but I would say that a vaginal delivery that goes smoothly with especially a very normal sized baby and a healthy mom, you know, the recovery of after a vaginal delivery is, is rather quick in the sense of being able to care for yourself, being able to care for your baby after a vaginal delivery.

Sometimes that process is a little bit longer. If you've had a C-section in terms of caring for yourself in terms of caring for your baby, it makes sense. A major abdominal surgery requires more pain medication, for example, may require more rest, which you need on both sides, whether you've had a vaginal birth or a C-section delivery. But the recovery from those two things are a bit different. And the bonding that needs to happen between the mom and the baby is a little bit different. If you've had a vaginal delivery versus a C-section, because after a C-section delivery, it's not that easy to do things like immediate skin to skin. You're still operating literally, you know? And so oftentimes-

Touseef Mirza:
Is it face to face?

Dr. Sophia
Face to face?

Touseef Mirza:
Like bringing the baby close to the moms face?

Dr. Sophia
Yeah we do do that. We do that. But even that just is for a moment of time as opposed to after a vaginal birth, where we're a lot, where the mother may have a lot more time with the baby doing skin to skin. There's a lot that goes into delivery. And I think that's partly why it was so important that we just talk about it in a very candid kind of way. Because there's no one size fits all. There's no right way, there's no this way or that way. It's just a conversation that I think it's important to have. You know, and, and many people, like I said, we just don't know. We just don't know the terms, the terminology, a C-section, A delivery, a vaginal delivery, a vacuum delivery, and then even let's color it with another thing, something called a VBAC, which is a vaginal birth after C-section.

So someone who's had a previous C-section and then has the attempt of having a vaginal birth and actually successfully has that vaginal birth is called a person who's had a vbac. But before they actually do that, we call it a trial. Okay. And all of those, I mean, literally women go through the gamut. They go through so many different ways of having a birth. And I just think it's important that we feel comfortable talking about it with our providers. You know, having honest conversations about how we feel about it. You know, I think most women really don't wanna have a C-section. And on the flip side, there's a subset of women who are like, I wanna protect my vagina at all costs. Give me that C-section.

Touseef Mirza:
And do women come to you? And also, especially if it's their first child going, I'm just so scared. Can I please have a C-section?

Dr. Sophia
100%. And guess what? That is their right.

Touseef Mirza:
They can ask for a c-section?

Dr. Sophia
That is, that is their right. I will say that when I get that woman who comes in and says, I'm just too scared, I do try to talk to them and really find out where the fear lies and, and give them a little bit more like context as to what a vaginal delivery may entail for them specifically. And it matters. Are they having other complications in the pregnancy? Are they having, you know, other reasons to have those concerns and fears? And so for me, I probably would say that I typically, even if a woman does come to me and says she just wants to have a C-section just full stop, I make it a much bigger conversation. For sure.

Touseef Mirza:
So as an obgyn, your default is to try to have a vaginal delivery. Yes. That being said, if a patient comes and starts the conversation with, I'm not having that, like, I want something else, then that's a place where you can have a conversation, but you, you're not going to yourself propose you want a c-section or vaginal birth.

No, that's not gonna be how I start the conversation is like, oh, well, you know, since you're pregnant now and you know, would you rather have a vaginal birth or would you rather have a C-section? I'm gonna be honest with you and say, no.

Dr. Sophia
No, that's not how I start a conversation. The default is that we're gonna try to have a vaginal birth, a c-section if it becomes necessary. And then that few subset of women who do elect to have what we call the elective primary C-section or that first C-section, I just have to be honest that that's just not the first place that I go. We have a lot of dialogue around it. And if ultimately we end up there, then we do, we, because like I said, the women have autonomy.

Touseef Mirza:
When you say, you know, that's how you function, you are also basically saying that different providers view this or have different approaches to that.

Dr. Sophia
For sure, for sure. There are definitely other providers who are like, okay, you wanna C-section? No problem, let's do it. You know? And, there's no further conversation about it. And again, I recognize it's because women definitely have autonomy. I can definitely say, Hey, I just, I'm either too afraid or I just don't want to, I just wanna have a C-section. And, yeah, they definitely, they're gonna find providers who are going to oblige. But there are certain circumstances where they're not wrong. You know, a woman who perhaps is 42, and I'm just throwing out an age here, guys, this is not an end all be all. Let's just say I have a 42-year-old woman, she's had three previous miscarriages.

She's gone through IVF to have this particular baby. She's gone through the pregnancy with all kinds of other, you know, small issues, what have you, and says this, I'm not gonna try to do this again. I am really scared and I just wanna have a c-section. That woman, I would say, you know what you're probably right. Let's just go ahead and have a C-section because she's, because that's, she's already at high risk for other things. And whether it's, you know, preeclampsia, gestational diabetes, et cetera, just, you know, the mere fact of her having an IVF pregnancy, her saying that this is it, I don't expect to have any more children. This was already hard for me. It is a conversation.

Touseef Mirza:
There's so many variables all the time that can change the course of how you wanna deliver a baby. Like that's what I'm really getting out of this conversation. That there's just so much like your, your brain when you're in that situation. I don't know what's going on, but it’s firing-

Dr. Sophia
Fire. Bing, bing, bing. What are we doing?

Touseef Mirza:
You're considering all these different things, so it can be quite complicated. It's not just, do we do this or do we do that?

Dr. Sophia
Yeah. I mean, it feels like it should just be very easy to listen to. Part of the reason why I love obgyn is because I consider it a happy medicine. I really do. Delivering a baby, being in that delivery room, whether that patient does have a vaginal birth or a cesarean birth. Honestly, my absolute favorite is it's really a place of sheer joy. A lot of variables can happen. A lot of things can happen, but at the end of the day, a birth is a birth and it's a joyous thing. And I feel like that birth, however the way we execute it, is a birth.

Touseef Mirza:
Meaning basically just by having a c-section doesn't make it less of a birth.

Dr. Sophia
Oh, that's what you mean, not, yeah, absolutely Not taking, having a c-section does not make it any less of a birth or your birth story. Your birth journey, your birth process. It doesn't take anything away from it. It doesn't take anything away from it. It's still pretty amazing. So I just wanna be able to help women have that, not just understanding, but I do want women to have the birth that they, they really want women birthing persons. This was really for you, and especially to my black birthing person may, your birth story and pregnancy and care handled with joy always all around you. As we say here on the Dr. Sophia ObGyn podcast, always embrace your body, embrace yourself, embrace your birth, no matter how it happens. It's beautiful. Thank you for listening. Bye for now. Bye. This is General medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.