Advertise on podcast: The EngagED Midwife

Send us Fan Mail A postpartum depression screen can be the start of the story, not the diagnosis and that difference can save a life. Recording live from the annual meeting in Kansas City, Cara and Missi dig into postpartum bipolar disorder and why it is so often missed, even by experienced clinicians who are doing their best with limited time and fragmented care. We walk through what bipolar disorder actually means in DSM-5 terms, including the real-world texture of mania and the easy-to-miss signs of hypomania. Then we connect the dots to the postpartum period: hormone shifts, labor and newborn sleep disruption, and why many parents show up looking depressed, confused, or guilty rather than “manic.” One of the most important takeaways is the 2023 ACOG guidance pointing out that a meaningful share of positive postpartum depression screens may reflect bipolar disorder, and that matters because antidepressant monotherapy can trigger mania. We also get practical about perinatal mental health screening and next steps, including the Mood Disorder Questionnaire (MDQ), the CIDI bipolar stem, and how to pair bipolar screening with the EPDS. From there we talk treatment and safety: mood stabilizers, breastfeeding-friendly options like quetiapine and olanzapine, how to think about lithium, and why we treat sleep like a vital sign with partner support and realistic feeding plans. We close with what we never want anyone to miss: postpartum psychosis is a psychiatric emergency, suicide prevention requires a real safety net, and reducing stigma changes outcomes for whole families. If this conversation helps you, subscribe, share it with a colleague or friend, and leave a review so more parents and providers can find it.

Send us Fan Mail Constipation is common, frustrating, and way more nuanced than “did you go today.” We talk through what constipation really means in real life: straining, hard pellet-like stool, feeling like you can’t fully empty, and how meds and life changes can quietly shift your baseline. We also share the cut-and-dry definition (fewer than three bowel movements a week) while reminding you that comfort and stool form matter just as much as the number.  We translate the Bristol Stool Form Scale into plain English so you can stop guessing and start describing what’s happening. We also walk through how we assess constipation as midwives: the history that matters most, the medication list to review (GLP-1s, opioids, anticholinergics, iron, calcium, and more), and when labs like TSH or glucose are worth considering. Then we draw a clear line around red flags like rectal bleeding, unintentional weight loss, anemia, and new bowel habit changes that should prompt faster referral and appropriate colorectal cancer screening.  From there, we lean into constipation relief that’s low intervention and actually doable: timed toileting, better bathroom posture with a footstool or Squatty Potty, hydration, exercise, and a realistic plan to increase fiber without misery. We cover evidence-backed foods like prunes and kiwi, discuss pelvic floor physical therapy with biofeedback for defecatory dysfunction, and give you an over-the-counter ladder that starts with polyethylene glycol (Miralax). We also say the quiet part out loud about Colace and why the evidence doesn’t support the hype. Finally, we dig into GLP-1 constipation, including why it happens, what to try first, and why dehydration and kidney risk deserve attention.  If this helped you, subscribe, share the episode with a friend who needs a straight answer, and leave us a quick review so more people can find the show. What constipation tip do you wish someone had told you sooner? #stoppedup #cantpoo #number2 #squattypotty

Send us Fan Mail Bleeding in early pregnancy can turn a routine visit into a high-stakes clinical puzzle, and the worst move we can make is pretending one lab or one ultrasound tells the whole story. Cara and Missi walk through early pregnancy loss and miscarriage management in a step-by-step way that’s built for real practice and for exam prep, starting with the terminology that shapes your differential and your charting: threatened vs inevitable abortion, missed or silent loss, incomplete vs complete expulsion, anembryonic pregnancy, and pregnancy of unknown location where ectopic pregnancy has to stay top of mind. We dig into what transvaginal ultrasound can and cannot diagnose, including the timing of normal landmarks and the ACOG criteria that help confirm pregnancy loss without rushing the call. We also connect ultrasound findings to beta hCG trends, because the pattern matters more than a single value, especially when dates are unclear. Along the way, we talk about progesterone and why it can be a game-changer in very early bleeding for some patients, plus the practical labs we consider like CBC and Rh status. Then we get concrete about management options: expectant management, medication management, and surgical care. We break down the preferred regimen for medication management with mifepristone and misoprostol, what side effects to prepare people for, what return precautions should sound like, and when surgical management offers the predictability some patients want. We also spend time where midwives shine most: emotional support after miscarriage, myth-busting about waiting to conceive again, and how families decide when to share pregnancy news. Before we close, we zoom out to scope of practice realities and why every APRN needs to know their state rules before they’re in the moment.

Send us Fan Mail If you’ve ever leaked a little when you laughed, sneezed, worked out, or yelled from the sidelines, you already know how fast “no big deal” can turn into planning your whole day around bathrooms and backup clothes. We’re Missi and Cara, and we’re putting urinary incontinence on the table with equal parts honesty and clinical clarity, because leakage is common but it’s not normal, and you deserve better options than just crossing your legs and hoping. We walk through the big categories of urinary incontinence in plain language: stress urinary incontinence (pressure-related leaks), urge incontinence and overactive bladder (sudden can’t-wait urgency), plus mixed, overflow, and functional incontinence. Then we get practical about what actually helps clinicians and patients pinpoint the cause: a simple 3-day bladder diary, the right history questions about severity and quality-of-life impact, and a focused pelvic and pelvic floor exam that looks for genitourinary syndrome of menopause and pelvic organ prolapse. From there, we lay out evidence-based treatment paths: pelvic floor physical therapy and bladder training, dietary and constipation management, and why topical vaginal estrogen can be a game-changer for perimenopausal and postmenopausal symptoms. We also cover devices like pessaries and over-the-counter supports, when medications may be appropriate for overactive bladder, and when it’s time to refer to urogynecology or urology for advanced options like slings, Botox, neuromodulation, or urodynamic testing. #incontinence #urinarycomplaints #weshouldntleak #commonnotnormal

Send us Fan Mail “Survivor” sounds like a finish line. For many people, it feels more like a label you’re handed while you’re still trying to process what just happened. Cara and Missi get personal about cancer survivorship, using Missi’s breast cancer journey to talk about the part nobody can fully prepare you for: living in the in-between, where every new ache can trigger scanxiety and “life after” doesn’t come with a clear map. We walk through what survivorship means clinically and emotionally, including the three phases often described in the literature and why the extended phase can feel like a muddy mess. We also unpack the real-world logistics of post-cancer care: how your team can grow from a PCP and OB-GYN to a surgical oncologist, medical oncologist, breast navigator, physical therapy, lymphatic therapy, and mental health support. If you’ve ever felt overwhelmed by appointments, paperwork, and the mental load of decision-making, you’ll feel seen. We dig into high-interest survivorship topics for breast cancer patients and the clinicians who care for them: endocrine therapy (aromatase inhibitors like anastrozole and SERMs like tamoxifen), fatigue and brain fog, bone density loss and DEXA scans, osteoporosis treatment options such as bisphosphonates, Zometa, and Prolia, and the evolving guidance on topical vaginal estrogen for genitourinary syndrome of menopause. Cara also shares what she’s learned about lymphatics, lymphedema, compression sleeves for travel, and why protecting an arm after lymph node removal can be a forever habit. If this conversation helps, subscribe, share it with someone who needs it, and leave a review. Send us the topics you want next, and come see us in Kansas City in October for the annual meeting. #CancerSurvivorship #BreastCancer #BoneHealth #Lymphedema #LifeAfterCancer #BodyMindSpirit #TheNewNormal

Send us Fan Mail Sex can change fast after birth, and it can change again in perimenopause and menopause, but that doesn’t mean you’re broken. We dig into why libido, arousal, and comfort often shift when estrogen drops postpartum and later in life, and how that hormone reality shows up as vaginal dryness, painful sex (dyspareunia), and the sense that your body isn’t responding the way it used to. We also talk about the common brain-body mismatch many women experience and how mental load can shut desire down even when the relationship is solid.  We walk through the postpartum hormone landscape, including the steep fall in estrogen and progesterone after placenta delivery and how breastfeeding keeps estrogen low through prolactin and oxytocin. Then we get practical about what helps: pelvic floor physical therapy (and what to expect so it’s not a surprise), using plenty of lubricant, considering vaginal estrogen for atrophy, and expanding intimacy beyond penetration while healing happens.  From there, we transition into perimenopause and menopause, including genitourinary syndrome of menopause, irritability and sleep disruption, and why libido issues are often tied to androgens like testosterone. We cover options clinicians may consider for hypoactive sexual desire disorder, plus the overlooked impact of medications like antidepressants and blood pressure meds. We wrap with the PLISSIT model so midwives and clinicians have a clear framework to open these conversations with permission, simple education, specific suggestions, and referrals when needed.  If this helps you feel more informed or less alone, subscribe, share the episode with a friend, and leave a review so more people can find honest, evidence-informed sexual health support. #LetsTalkAboutSexBaby #SexualHealth #SexAcrossTheLifespan #PostpartumWellness #HormonalHealth #PelvicHealth #IntimacyAfterBirth #MenopauseSupport #SexualWellness #EmpoweredAging

Send us Fan Mail A newborn arrives fast, the dates are fuzzy, and everyone in the room is sure they know how far along the pregnancy was. Then the baby tells a different story. That’s where a solid gestational age assessment and real bedside pattern recognition can change the entire plan in minutes. We talk through the Ballard assessment in a way that’s built for busy midwives, midwifery students, and anyone responsible for newborn care. We explain what the Ballard score is designed to do, when it matters most (limited prenatal care, language barriers, uncertain dating, misleading third-trimester growth ultrasound), and why the exam usually isn’t asking you to memorize a chart. The goal is safer clinical reasoning: term vs preterm vs post-term, and what that means for newborn transition, thermoregulation, blood sugar monitoring, and when to consult pediatrics. You’ll hear our highest-yield neuromuscular maturity checks (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear) and the physical maturity signs you can spot head-to-toe (skin texture, lanugo, plantar creases, breast buds, ear cartilage, and genital findings). We also work through real clinical scenarios: a “term” baby who acts like a 34-weeker, a baby with post-maturity features, and a small-for-gestational-age newborn who is physiologically mature, pointing you toward growth restriction rather than prematurity. If newborn assessment has ever felt intimidating, this is your reminder that “normal” is the foundation and your best safety net. Subscribe for more midwifery exam prep and clinical refreshers, share this with a classmate who wants more newborn confidence, and leave a review. What’s the first sign you check to decide if a baby is truly term? #Newborn #BabyBabyAreYouOkay #GestationalAge #Transition #Term #Preterm #Postterm #NewBallardScore #Maturity

Send us Fan Mail Trying to conceive can turn into a crash course in hormones overnight, and the medication list can feel like a different language. We slow it down and translate what fertility medications actually do in the body, why midwives still need to understand them even when we are not the prescribers, and how to support patients through the stress that often comes with IUI, IVF, and “why is this taking so long?” moments.  We walk through the most common reason fertility care starts: ovulation problems. From anovulation and PCOS to the sometimes overlooked conversation about luteal phase length and early progesterone support, we talk about what might be happening on the HPO axis and what clinicians are trying to change with treatment. Then we break down the big names patients hear, including Clomid (clomiphene citrate) and letrozole (Femara), comparing how they work, what side effects to expect, and why practice has shifted toward letrozole for many people with PCOS and insulin-related hormonal patterns.  We also dig into metformin and insulin resistance, because PCOS is not just “about weight” and fertility care should not be built on shame. Finally, we zoom out to the broader IVF medication lineup, including gonadotropin injections, GnRH agonist or antagonist protocols like Lupron, the hCG trigger shot, and progesterone support. We end with practical safety counseling, including multiples risk and ovarian hyperstimulation syndrome warning signs, plus clear guidance on when it is time to refer to reproductive endocrinology and infertility (REI).  #FertilityMeds #PathToPregnancy #TTC #NavigatingFertility #PharmacologyForMidwives  #ConceptionSupport #ReproductiveEndocrinology #EvidenceBasedMidwifery #InfertilityCare

Send us Fan Mail Milk supply can feel mysterious when you’re tired, sore, and staring at a hungry newborn. We sit down and make lactogenesis practical by walking through what’s happening in the breast during pregnancy, what flips hormonally right after the placenta delivers, and why “milk coming in” usually peaks around days 2 to 5. Along the way, we translate the science into the questions we hear every week: Is leaking in pregnancy a good sign? Why does engorgement happen? When should we worry about a lump, redness, or nipple discharge?  We also get honest about the lived experience of feeding in the real world. We talk delayed lactogenesis and the common culprits like retained placental fragments, postpartum hemorrhage and pituitary effects, PCOS, cesarean timing, and edema from heavy IV fluids that can make latch feel impossible. Then we shift into lactogenesis 3, where supply becomes locally regulated and milk removal drives production, including the role of the feedback inhibitor of lactation. If you’ve ever panicked because your breasts suddenly felt soft or you stopped leaking around week 3, we explain why that can actually be a sign your body has calibrated beautifully.  Letdown is its own puzzle, so we dig into oxytocin, what blocks it (stress, fear, pain, cold), and simple tools that help, including warmth before feeds, cold after, and the “three Ws” that support pumping and letdown: warmth, water, and watching. We wrap with fast myth-busting and one of our favorite postpartum interventions: teaching partners and families how to protect the “oxytocin bubble” so the feeding parent can focus on rest, baby, and recovery. Subscribe for more evidence-based midwifery conversations, share this with a friend who’s feeding a newborn, and leave a review with your biggest milk-supply question. #TheGoldenHour #Breastfeeding #ChestFeeding #NourishingNewborns #DemandAndSupply #Lactogenesis #BreastfeedingJourney #ProtectTheOxytocinBubble #Support

Send us Fan Mail What if the biggest driver of a healthy pregnancy isn’t found in a chart, but in a bus schedule, a work shift, or a zip code? In this episode, Cara and Missi pull back the curtain on social determinants of health and talk candidly about why late or no prenatal care rarely means a patient doesn’t care—and how midwives can meet these barriers head-on. We break down the big five domains—economic stability, education, healthcare access, neighborhood and environment, and social context—and connect them to preterm birth, preeclampsia, and low birth weight. You’ll hear real stories from triage to community clinics that reveal why “proximity” isn’t the same as “access,” how immigration fears suppress visits, and how chronic stress leaves a physiologic mark. Then we get tactical: validated screening tools like PRAPARE and the AAFP Social Needs Screening Tool, the three fast questions that catch most needs, and scripts that normalize sensitive topics without stigma. From there, we move into action. Warm handoffs, bedside calls, and referrals that put the follow-up burden on the system—not the patient—turn intentions into impact. We dig into practical documentation with Z codes that make populations visible, and we frame advocacy as a clinical skill that spans workplace notes, hospital policy, and conversations with legislators. Along the way, we draw a bright line between equality and equity and share simple ways to right-size support: flexible hours, interpreters, transportation help, and trauma-informed consent. If you’re ready to turn empathy into outcomes, this conversation will give you tools you can use on your next shift. Subscribe, share with a colleague, and leave a review with the biggest barrier you see in your community—and how you’re tackling it.

Send us Fan Mail Day-one decisions shape a newborn’s first week, and small changes can prevent big problems. In this episode, Cara and Missi dig into what’s truly evidence-based now—delayed bathing to protect vernix and temperature, uninterrupted skin-to-skin to reduce energy burn, and clear thresholds for when to check and treat low blood sugar. Along the way, we unpack how updated NRP guidance simplifies early care: extend cord clamping to at least 60 seconds when possible, start term babies on room air, broaden ventilation rates to 30–60 per minute, and skip routine suctioning unless the airway needs clearing. Less fuss means warmer babies, steadier vitals, and fewer glucose crashes. Cara and Missi clear the fog around GBS prophylaxis. Penicillin remains the standard, with cefazolin for low-risk penicillin allergy and vancomycin when high-risk reactions are present or clindamycin sensitivity isn’t confirmed. That clarity matters for maternal safety and newborn outcomes, especially in units where ampicillin lingers from past shortages. If your patients report a penicillin allergy early in pregnancy, consider formal evaluation to avoid unnecessary second-line antibiotics later. Finally, we connect physiology to practice. Newborns lose the maternal glucose “buffet” at birth and lean on glycogen and brown fat to bridge the gap; cold stress accelerates that burn, making hypothermia and hypoglycemia frequent partners. We outline who needs screening—IDMs, SGA, LGA, late preterm, and resuscitated infants—and how to manage lows with a calm, stepwise approach: warm the baby, feed early and often, use donor milk or glucose gel when indicated, and escalate to IV dextrose for symptomatic cases. It’s a practical, exam-friendly, and family-centered guide to safer newborn care. #Baby #Newborn #BabyBabyAreYouOkay #Resuscitation #EatingAtThePlacentaBuffet #BloodSugar #NRP #SkinToSkin #GBSProphylaxis

Send us Fan Mail The ocean isn’t magic, but it helps the healing. We went to the beach with a full slate of work—course updates, new cases, retreat planning—and a fuller heart, talking honestly about what it takes to recover and what it means to care well. Missi is four weeks post‑mastectomy, relearning daily life without lifting, reaching, or rushing. Cara remembers months on bed rest, the longing for a hair wash, and the quiet panic of being still. Together, we map the gap between “Let me know if you need anything” and help that actually helps. We get specific. Meals that work now: soup kits, coordinated signups, gift cards for flexible nights, and a simple text that asks, “What are you craving?” Practical gear that makes life easier soft button-front pajamas, the best mid-calf socks, body butter, pillows, and just things to make you comfy. We talk about partners who carry silent fear, why giving those people a break matters, and how to name needs without feeling guilt. We share how to build an Amazon list so friends far away can send the right things, and why short notes and small jokes land in the loneliest hours. There’s identity work too. Losing the “before” version of yourself—the runner, the teacher, the do‑it‑all person—hurts. We name the grief, celebrate tiny wins like sleeping in a bed again, and lean on survivors who text the latest guidelines at just the right time. No Googling spirals, just trusted teams and steady pacing. If you’ve ever asked, “What should I do for my friend who’s sick?” or struggled to ask for help yourself, this conversation hands you a clear, compassionate checklist you can use today. #DeliverEDExamPrep #RelaxED #YouveGotAFriendInMe #RecoveryJourney #BreastCancer #Bedrest #WeBelongToEachOther #LoveWins #WeCanDoHardThings #Survivor #Brutiful @somaintimates @ugg @lululemon @lolablankets @takethemameal @giveinkind

Send us Fan Mail Ready to land a midwifery job that actually fits your philosophy, pace, and life? We open up about our own first-job journeys—what went right, what we’d change, and how each step shaped our expectations. From researching practice models to reading culture, we walk through the practical prep that matters most: knowing how the team truly functions, how midwives share call, and how collaboration shows up when the unit gets busy. We also get tactical about interviewing without sounding scripted. You’ll hear simple ways to show your value as a new grad, even without L&D experience: bring a lean portfolio, summarize your clinical sites and numbers, and frame weaknesses as active growth plans. We share the questions that reveal the soul of a practice—what a clinic day really looks like, how decisions are made, and where midwives can train in procedures like first assist, colpos, or circumcisions. We also address the productivity myth, explaining how OB-heavy roles unlock revenue capacity across the team while improving access and experience. Career seasons don’t always unfold on your timeline, and that’s okay. We talk about handling rejection as redirection, running mock interviews with mentors, and keeping notes on what bothers you so you can ask sharper questions next time. If you want a job that respects physiologic birth and evidence, values your voice, and gives you room to grow, this conversation will help you get there. #DreamCatch #BabyCatchers #MidwifeLife #NewGradMidwife #MidwivesSupportMidwives #MidwiferyCareers @growmidwives

Send us Fan Mail A new season meets a new reality: we’re grateful for 100K downloads, proud of students who crossed the finish line after multiple tries, and honest about a recent breast cancer diagnosis that changed the rhythm of our days. Missi walks through the surprise pathology, why we chose an aggressive plan, and what bilateral mastectomy and a forced season of stillness look like for a do‑everything human. We talk openly about anxiety, support, and “aggressive optimism,” because clarity and community make uncertain roads feel possible. Then we shift gears to a masterclass on the labor patterns every clinician grapples with: malposition and asynclitism. We break down synclitism versus anterior and posterior asynclitism, how to read the sagittal suture and fontanelles, and why uneven effacement is a blazing clue. You’ll hear practical tools for OP and OT that move beyond clichés—mapping interventions to the inlet, mid‑pelvis, and outlet so each position serves a purpose. Think the jiggle as gentle myofascial work, forward‑leaning inversion to free tension, and strict sidelying release with stacked hips. We show how peanut balls, fire‑hydrant, rock‑the‑boat, sacral massage, and internal femur rotation widen the right spaces at the right time. For second stage, we dig into manual rotation: when to attempt it, how to disengage enough to succeed, and how skilled hands can shorten labor and prevent operative delivery. Along the way we highlight nurse‑midwife teamwork, patient‑centered pacing, and trusted resources like Spinning Babies and the Labor Progress Handbook that give units a shared language and a sharper plan. Variation in fetal position isn’t failure—it’s an invitation to find the position, create the space, and encourage the movement. If this conversation helps your practice or your spirit, follow, share with a colleague, and leave a quick review. Your support fuels more teaching, more tools at the bedside, and more stories of perseverance and healing.

Send us Fan Mail A packed hallway at the ACNM Annual Meeting turned into the perfect backdrop for a clear, compassionate deep dive on adolescent gynecology. We talk candidly about what really helps teens feel safe in care: transparent consent, real confidentiality, and avoiding unnecessary pelvic exams. From there, we walk through the high-yield topics every clinician faces with young patients—irregular cycles after menarche, painful periods that derail school days, and the difference between normal discharge and vaginitis that needs treatment. We spotlight the red flags that can’t be missed, especially ovarian torsion posing as vague lower abdominal pain, and why transabdominal ultrasound often beats transvaginal imaging for adolescents. You’ll hear how we build a thorough menstrual history that captures timing, flow, and impact on daily life; how we normalize the maturing hypothalamic-pituitary-ovarian axis; and where first-line therapies like NSAIDs, combined pills, progestin-only methods, and levonorgestrel IUDs fit. We also lay out a patient-led approach to contraception counseling—centered on goals like bleeding control, privacy, and ease of use—while weaving in emergency contraception, STI screening strategies, and the crucial role of the HPV vaccine in preventing cervical and other cancers. Throughout, we keep the focus on trauma-informed practice. That means offering safe words like stop and out during exams, letting teens handle instruments to reduce fear, and moving complex conversations to when patients are fully dressed. We include considerations for transgender and gender-diverse adolescents, from menstrual suppression to reputable clinical resources. By combining practical tools with a respectful tone, this episode gives you a roadmap to adolescent gyn that improves comfort, detects danger early, and builds trust that lasts into adulthood. If this conversation helps you care for teens with more confidence, subscribe, share with a colleague, and leave a quick review to help others find the show.