#479: An Emotional Week & Some Data On Uterine Rupture

This week, Blyss and Stu run the gamut, from joy and grief to frustration, research, and a whole lot of questions about who really gets to decide what “safe” birth looks like.

After sharing personal updates and a moving remembrance of Dr. Rob Biter, Blyss and Stu turn their attention to autonomy in birth. They discuss a mother struggling to find a midwife willing to truly meet her where she is, the ongoing fight over traditional midwifery in Pennsylvania, and what happens when regulation and institutional standards begin limiting the choices available to birthing families.

Then, Dr. Stu dives into new research examining oxytocin (Pitocin), TOLAC, and uterine rupture. What does the research actually tell us about uterine rupture when Pitocin is used during a VBAC? How much does the risk change compared with spontaneous labor? Does a higher dose matter? And perhaps most importantly, are we paying enough attention when a laboring body, or the woman herself, is telling us something isn't right?

Blyss brings the midwifery perspective to the data, questioning directed pushing, prolonged augmentation, hospital timelines, and what can happen when physiology is pushed rather than supported. Together, she and Stu unpack the difference between relative risk and absolute risk, how the same research can be used to either support or discourage VBAC, and why informed decision-making requires more than simply being told what the “standard of care” recommends.

References:

Reclaiming Birth Gathering

reclaimingbirthconference.com/

Allowed to Birth Ashland Screening

birthinginstincts.com/events/allowed-to-birth

Inquirer Article: Why Pennsylvania quietly repealed its 1929 midwifery law — and is now getting sued for it

https://www.inquirer.com/politics/pennsylvania/midwives-pennsylvania-budget-law-20260804.html

PubMed study: Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean

https://pubmed.ncbi.nlm.nih.gov/41325062/

Discussed in This Episode

• Remembering Dr. Rob Biter and his contributions to physiologic birth
• What’s happening with traditional midwifery in Pennsylvania
• How regulation can indirectly restrict access to home birth
• Newest Research on Pitocin use during TOLAC
• Uterine rupture rates with spontaneous labor vs. oxytocin exposure
• Relative risk vs. absolute risk when counseling families
• Why increased Pitocin doses may be telling us something about the labor itself
• Directed pushing, augmentation, and listening to the body
• How confirmation bias influences the way research gets interpreted

Podcast Produced by: Raquel Hernandez, Pride and Joy Doula Care 

This show is supported by

• LMNT | Got to drinklmnt.com/birthinginstincts to get a free sample pack with any order
• Christian Hypnobirthing | Go to christianhypnobirthing.com and use the code BI50 for 50% off the first three months of your monthly subscription.
• Restorative Roots | Go to restorativeroots.com and use code BIRTHINGINSTINCTS to get $20 off
• Girls Who Know | Go to girlswhoknow.com and use code INSTINCTS for 15% off

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