The EngagED Midwife
The EngagED Midwife
The One Where We Empty Our Inbox
Wrapping up Season 11, Cara and Missi dig deep into their fan mail bag to answer questions from listeners spanning clinical practice, education, and professional development. With their characteristic warmth and wisdom, they tackle everything from postpartum mental health screening to specialized pharmacology knowledge that you won't find in textbooks.
The conversation flows through practical clinical topics, starting with the importance of comprehensive mental health screening for postpartum patients. They share touching feedback from colleagues about creating supportive collaborative practices with physicians, highlighting how direct, respectful communication builds successful interprofessional relationships.
For students and new midwives, the hosts offer a treasure trove of specialized resources. They offer insights to suturing resources, discuss scope of practice questions, and answer questions galore. Pharmacology pearls abound as they discuss innovative approaches to breakthrough bleeding, the exact formulation for All-Purpose Nipple Ointment for treating breast yeast infections, and compounded antiemetic gels for pregnancy nausea.
Before previewing exciting topics for Season 12—including ovarian masses, cancer screening, osteoporosis, fertility treatments, and AI in midwifery—Cara and Missi remind listeners of the best ways to reach them with questions. Their generosity in sharing expertise and resources demonstrates why this podcast has become such a valuable companion for midwives at every career stage.
Email your questions directly to missi@deliveredexamprep.com or cara@deliveredexamprep.com to become part of future episodes, and visit deliveredexamprep.com to access the resources mentioned throughout this knowledge-packed finale.
Welcome to the Engaged Midwife Podcast. This is Cara, and this is Missi.
Cara:Missi!
Cara:End of season 11. I know it's crazy, crazy to think how many episodes we've done.
Missi:How many many episodes we've done, how many. I was just, you know, working night shifts. I just got off work and I was telling you that I had a meeting this morning with some of the grandmothers of midwifery education. It is the craziest thing to see people in a meeting with you that you're leading, whose names are on textbooks. It will never cease to amaze me.
Cara:Yeah, the funny thing about this, though, Missi, is that you know I I talk about my first um midwifery director meeting, and it was all the textbook authors and the people writing all the journal articles. You are one of those people, um, and you know I was also thinking back the other day to the fact that I am the age that my program director was when I was graduating, and it's just wild. I mean, aging is crazy. Lots of years of experience.
Missi:It's crazy to just know that, like I said in this meeting, I'm like I've been a midwife for 20 years and watching some of these girls who, like women who have known me since I was a student yeah, Be like, how have you been practicing for 20 years? I was like, yeah, I know. Thanks. I am excited about today's episode because we are going to dig deep into our bag of fan mail, and this is something that we've never done in 11 seasons is look at fan mail and respond to people who've got questions, and some of this is just like reading some comments that we get.
Missi:We don't get that much fan mail. We get maybe like one person a month or so that sends us a note, but we wanted to go through these today and talk about them and share some resources. And I think the first thing I wanted to start with is, if you ever have questions, our fan mailbox does not allow us to respond to you. So the best way to get ahold of us is missi@deliveredexamprep. com or cara@deliveredexamprep. com.. You can email us questions directly. That is the number one way to get ahold of us. We are really good about answering our email and that is just because we are well-conditioned academics who don't have good boundaries.
Cara:I would also say that people can probably reach us on all of our socials as well, so we're on Instagram and Facebook, and that's a way that you can always reach out as well.
Missi:Yep On Instagram. I am @babycatcher76, Cara I don't know, @carabusey ?
Cara:I can't remember.
Missi:You are you are. That's right. And then also you can find Delivered Exam Prep on Instagram as well and you can DM us there. We do love a little message slid into our DMs, sometimes in the best possible way. So I think we'll get started. What do you think, kara? And I'm going to pull up some fan mail and we'll read some stuff and answer some questions and, yeah, see where we go from there. So we know some of these don't have names on them. So if you send us fan mail, let us actually know who you are.
Missi:But this poster said I wanted to thank you for a topic on postpartum depression. My great grandmother died of postpartum psychosis and I had postpartum depression with two of three of my kids. I've been a nurse for 28 years and always like to discuss signs and symptoms. Who to call, especially if they have a psych history. I hope to expand this once I graduate from Frontier in about a year. So thanks so much for reaching out.
Missi:We do think that this idea of adequately screening for postpartum depression is so important Timely for me in that last night I got called for a patient who had an EDPS of 15 and really just need somebody to go talk to her and she's young, first baby, not a lot of resources, not a great social situation, so, and with a psych history. So they will, you know, say, hey, do you really want to start a new antidepressant, do you? I'm going to send social work to see you. Is there anything I can do for you right now? Right, and sometimes it's just like having an empathetic person to listen to. So I appreciate this message from it looks like all the way from California.
Cara:Well, and this was a message from back in October. So getting so much closer to graduation and I'm excited to see that she's interested in really focusing on psych history, Just a quick reminder that we're not just focused on depression and psychosis but anxiety disorders, the potential for bipolar disorder or OCD in those postpartum patients. So really appreciate the shout out and it's just another chance for us to mention it again of how important it is.
Missi:Yeah. So this message came from Lawrenceburg, indiana, which is actually just around the corner from where I live in Cincinnati, and this is about our episode where we talked about like oh, you're getting midwives right and the collaborative work that's done between our physician colleagues and midwives. I'm just going to give you a little snippet of this. It says, coming from a background of being a brand new midwife in a place unfamiliar with midwives, a physician practice that's unfamiliar with midwives all the way to the opposite end of the spectrum and joining a place with full integration youwives all the way to the opposite end of the spectrum and joining a place with full integration. You hit all the highlights.
Missi:I'm so fortunate to be part of an excellent team of nurses and supportive physicians and participating in education of residents, med students, nursing students and midwifery students. Curiosity and mutual respect are essential, as well as celebrating our successes and venting our own frustrations. Another thought is our ability to communicate kindly and directly with one another, especially in difficult situations. Our specialty is such a unique, often miraculous, sometimes heartbreaking and frequently unexpected space to share. Our reputation can be drastically changed when we forget to speak kindly and directly with one another. Especially consider in consideration to timing and surroundings.
Missi:Thanks for all you do Well. Thanks for your notes. That's so great. You know what it's. People will forget what you said and how you like, but they'll never forget how you made them feel I. That quote is in my head and so this goes right back to that right, and I do think when you're in a situation where you're either in a non-supportive practice or in a place where they don't understand your role, it's really difficult. But it sounds like this poster is in a really great place that has, you know, a supportive integration of physicians and midwives and all kinds of learners.
Cara:Yeah, and this I just love this message because it hits on so many things that we've talked about over the years, but it's just a nice reminder about communication being key, about respect and kindness, and I love that. They really focused on being direct. I, as you were reading this, I was like you know. I always try to think about giving feedback to someone the way I would want to receive it, and not everyone will want to receive it the way I do, but I want someone to be direct with me. I don't want them to be hurtful, I don't want them to be mean, but I do want to know what the critique is or what the feedback is, and I really like open lines of communication.
Cara:So, really great comment here and it's nice to just hear other people's perspective. You know, especially sharing that this person has been in a not so great situation all the way to a really really wonderful working situation and just know that if you're in the midst of something difficult, there's other options out there or you can work to try to get it to the place that you want it to be. So, yeah, I love this comment. Thanks for thanks for writing in yeah, I love this comment.
Missi:Thanks for thanks for writing in. So, kara, sometimes I had forgotten that we also get fan mail, as in our DMs, when I was just talking about Instagram. So this next one comes from our Instagram and it's a little bit older. From the poster is an encompass midwifery and it says hey, I just found your podcast on the midwives and on group on Facebook and I'm really loving it. I wondered if you would consider adding the ACOG committee opinion numbers to your episode descriptions. I just listened to somebody's watching me and I had to go back and find it.
Missi:So, yes, one of our goals in the next two weeks is on our website. We have a website called wwwdeliveredexamprepcom All one word, just like it sounds and we have a podcast link on that page, and so what we're gonna start doing is posting all of our resources there. So there's a couple other things that we're gonna get up there. But, yes, we are working on trying to get those committee opinions up, and Kara and I will go back to this message from 23 and figure out which committee opinion number it is. But somebody who's watching me is probably, I would imagine, on fetal monitoring would be my best guess, and I think that there is a committee opinion there that we have. We also have the guidelines for intermittent auscultation that were published in the Journal of Midwifery and Women's Health, and that would be another great resource for us to put up. So we will make sure that those are up. So thank you for your Instagram message.
Cara:About. Can I mention something about ACOG? It just made me think of this is that, as a member of the American College of Nurse Midwives, or ACNM, we have the ability to get discounted ACOG educational affiliate membership, and it is well worth every penny that you spend on this. I used to think, oh, I don't need it because I have access to all the ACOG resources through the library that I work at the university and so forth, but it really has been incredible to add this membership on. I know dues are expensive, but if you can get your employer to pay for this for you, it is well worth every penny.
Cara:You get all of the ACOG committee opinions. You get all of their online resources. They send out emails and advocacy alerts and all kinds of different things. But I highly recommend adding this on, if you can. And then I think it's a great idea that we start having a way to really link resources, and we'll do that through our website, like you mentioned. I think that's going to be the best way that people can find specific online resources that we mentioned. We also try to tag any other social media accounts if we mention them, so we will definitely do that.
Missi:I love it. Kara, do you want to read our next little bit of fan mail?
Cara:Yeah, so this is from a new graduate CNN and she mentioned that she loves the podcast. We're so glad you are our intended target audience, so that's wonderful. Um, and she says I cannot find the link for the sheet of natural menopause treatments mentioned in this episode. Can you send it to me? And, um, this was from back in january, but I think it's also the list that we just mentioned in our most recent episode and we are finding a way to list that online for you. Like we just mentioned, we're going to add it to our online repository, but this is that list of menopausal treatments that Dr Schulte mentioned and that Missy has available. So we will definitely get that linked for you.
Missi:Yeah, that's going to go up on our webpage as well, so thanks for that. I'm going back to the Instagram messages. So I can't find the show notes where you include resources including the use of calcium and Tums for intrapartum labor dystocia. I'm in my residency and trying to show my CNM preceptor. Any chance you could send the resources to me Now.
Missi:I would love Morgan this is from Morgan to say that I actually did this when you asked me for it. I'm not sure that I did, but I am here to say that there's a good research article in PubMed. It's called calcium carbonate as a potential intervention to prevent labor dystocia and it's a literature review and basically it says that there's no harm. But in the literature it's not well documented and it basically says, hey, somebody should do some research on this, which I never disagree with, right. But I just want, in the in the case of using Tums or calcium carbonate for for labor dystocia, let's just think for a second about the pharmacotherapeutics, of how oxytocin works and it works on our calcium channels, right? And so what you're thinking about when you give somebody Tums is increasing the amount of calcium that's available to the muscle fibers which can help with, like uterine contractility, et cetera. So that's all.
Missi:This also goes along with the idea of pit breaks. Right, we don't have really good research about turning off the pit, although now we do. I should walk that back a little bit, because there's actually a really good article about what happens when we turn off the pit. But the Tums or the calcium carbonate is not going to hurt, right in terms of preventing labor dystocia.
Missi:So I have pulled down this article, this really good review of the literature, and I am going to post it on our page so that you will have that evidence. The other thing I will do is I will pull down that article also about when we stop the Pitocin and what the resources look like for that. And you know, those of us who've been in labor and delivery for a long time will tell you, oh, like a 30 minute pit break or an hour pit break. But I'm going to I'm going to blow the lid off of this one when I tell you that this article talks about an eight hour pit break and what that looks like in terms of of decreasing primary C-section rate, increasing vaginal delivery rate. So I'm going to pull both of those articles and I will definitely post those on our website as well. So thank you and just a quick reminder, Missy.
Cara:This was great because this person, I think you said, reached out online through social media. But then at least we have a way to send you back resources. If you email us, we can also. Missy and I are both in academic institutions where we have ready access to many, many, many articles and links and different things that we can send to people. So please email us or, in your message, make sure that we have a way to contact you, Because if you're sending what is called fan mail through our podcast, we don't get your contact information, so we don't have a way to send it to you.
Missi:Yeah, if you're listening out there Buzzsprout, make it easier for us to respond to our fan mail. Yeah, we love it. I'm looking back at some other social media messages. This message came from Becca and it actually was a post that she tagged us in, so I'm going to do a little shout out to Becca, healy, cnm, and it was ask me anything in my first semester of CNM school advice question mark, and what she did is she put up an Instagram story and it was all of the answers to her question. I'm in my first semester what is your advice? And the thing that she wrote was that somebody wrote to her was plan to do extra prep If your program does not offer a comprehensive review course. I felt very prepared by delivered exam prep and the midwifery and women's health nurse practitioner certification review guide, previously from Beth Kelsey, and so this was just a nice message where she gave us a little shout out, for example, yeah, so fun, yeah.
Cara:The other thing is manage your calendar, but every due date, put every clinical, put every class expectation, put reminders to yourself to go to put a post in a discussion board, whatever it is. Manage your calendar and do what your calendar tells you to do. That would be my advice.
Missi:Kara, do you always do what your calendar tells you to do?
Cara:No, but you know OK. So, Missy, this is going to be like kind of mind blowing to you, I think. But a new job is such a fresh way to reset and to start new habits that are really good, and so I have been blocking my calendar. I also asked you know my friend Gemini and chat GPT I haven't named them. I have friends that have given names to the AI bots, but maybe I need to work on this.
Cara:But I asked them for a morning routine because my new employment, my job, the place that I work, is two hours behind me half of the year and an hour behind me another part, and so I'm like, well, let me use that hour or two in the morning to really tackle and make some really good practices that I can get going, and it is all around managing my calendar and my email inbox and I am starting fresh and I'm excited about it. I also did download an app that helps me deal with my procrastination issues. So there's that. Look at you. I know it's such a new, fresh start. I feel really amazing. All right, You're up again.
Missi:Fan mail.
Cara:Yep, we have another question here about did you guys post the online course about suturing that Kara referred to and this was from back in April and I would. We did not post it, but I would be happy to share about it now. So back during COVID, when all of our education programs were scrambling to find ways to teach our students when we couldn't bring them to campus, our program started using a program, a tutoring course, that is from Midwife CE and the website is midwifececom and there's all kinds of courses available. But we use the online suturing workshop and it's 11 and a half hours of CE. It's really wonderful in that students have access to it for a long period of time, that they get to come back to it over and over and over again and that it just does a really nice job of walking people through the steps of suturing. You have access to it for a year, so if you bought it during your educational program and then continued to revisit it over and over and over again, it does a really nice job of explaining physiology, pharmacology, case studies, hands-on workshops, all kinds of different things. So that is something that our program has utilized. In Kansas, our students have had such increased confidence since we started using that and our preceptors have had really great comments as well.
Cara:But I want to make sure that you also know there's a product available from GuideZone. It's pretty pricey but I hear there are a lot of educational programs that use it as a way to teach suturing and then kind of the midwife guru of everything suturing is Nell Tharp and Missy and I are fortunate to know Nell and she has all kinds of workshops available that are in person or virtual. You can go to her website, which is Nell Tharp N-E-L-L-T-H-A-R-P-E-C-N-Mcom. If you also just Google Nell Tharp suturing, it will get you to her website and she has classes available on a midwife suturing camp that is in person. She's got courses on assessment and repair of birth lacerations and repair of birth lacerations and then she has also started teaching other midwives how to teach suturing. So midwife educators of how to teach. I love this because she knows that we all can't be her and we can't all spend time with her, and so teaching other educators how to teach this really important topic is so wonderful. So those are several different options available for suturing courses.
Missi:I also would like to give a plug for Anne Fry's book, which is the Healing Passage. It is sometimes hard to find, but let me tell you that Anne has self-published this book and it's got a brown cover. It's spiral bound. It is called. The actual title of the book is Healing Passage, and if you want to dig deep into understanding the perineum and the musculature and how things should go back together and learn some suturing that you probably didn't learn when you were in school, that is the book to buy.
Missi:I have it on my shelf. I pull it down occasionally here and there when I'm like, hmm, could I have done that differently? And I've been doing this 20 years. So, yeah, I definitely think like that's another great option for suturing. All right, I'm diving into the archives of Facebook Messenger Makes me sound kind of old for this question from Terry Lynn and she said I know CNMs can get credentialed in vacuum deliveries, but is manual rotation in the scope of practice for midwives?
Missi:And I love this question because I will tell you that one of the number one causes for C-sections, especially in primips, is malposition in terms of persistent OP presentation. Right, and so, yes, manual rotation is in our scope and there have been manual rotation workshops in sessions at our annual meeting for several, several years. I remember it's always one of the most popular sessions. One year I went and it was like standing room only. It was so insane. But manual rotation is also a kinesthetic skill that I think takes just a lot of practice right and having the right person teach you right how to do manual rotation properly. And one of the things I tell students when we're talking about manual rotation is the biggest thing about manual rotation is really knowing what the baby's position is, and if you're not good at that, that's the first thing you should be working on. Right Is really getting a strong understanding of how the baby is oriented in the pelvis.
Cara:Yeah and so and there's from from what I understand, missy, because this is not something that I've done or had training on um, but you know, there's an kind of ideal time to try to do the manual rotation. It's not always waiting until you've been pushing for a long time. It's actually, you know, earlier than that. Is that correct?
Missi:that correct. So you want to try to manually rotate babies, usually at like zero or plus one Okay, plus two is fine. But what you have to remember is you have to disengage the head to really adequately maneuver a rotation, and so when they get too low, you know you're. It's hard to get their heads. You know from where they are in the pelvis, so you know a little higher is better. But, yes, some manual rotation is in our scope and um, and I think if you want to learn about that, that you know the finding the right person in your practice that does that and also getting really, really good at understanding head position right when in the pelvis are the fontanels.
Missi:I'm also reaching back to a note from Facebook from Amanda and she said if a patient's been on birth control combined hormonal contraception and has breakthrough bleeding, I normally increase the estrogen and or put them on a pill containing norephedrone acetate.
Missi:I remember listening to an episode where you guys were talking birth control and there was one specific one that you mentioned that was a great option for breakthrough bleeding. So one of the things I mentioned in that episode and thanks Amanda for your notes was using local administration of systemic hormones. So that's a NuvaRing right, and NuvaRing avoids first pass metabolism. So when you put this is a this is a theme with Kira and I when we talk about things that go in your vagina but when you put something in your mouth, it has to go through your liver and be metabolized before it can work on your ovaries, whereas when you put something in your vagina, that the hormones are then being absorbed through the vaginal wall and you get better availability of the estrogen that's in there. So it's a low dose of estrogen but it's more bioavailable, and so then you get less breakthrough bleeding. So I hope that that is what you were talking about, kara. Do you have other suggestions for breakthrough bleeding?
Cara:No, I think you hit on it.
Cara:You know I'm a big fan of any monophasic pill, really, and we've talked a lot about that in the past, but finding a couple of pills that you're fond of and using them a lot to prescribe it's really helpful, just because you get so used to them, and advising people on it. There's a question here that and we get this question you know a fair amount about do we have a discount code for exam prep? And we don't mind this question at all. We want to get exam prep out to as many people as possible, but I think the best way to know if we have a code available or a discount available at any given time is to really check our Facebook page and our Facebook feed, as well as our Instagram feed. That is where we put any special offers that we have going on. It's the way that we can get the message out to the most people, and then you can also obviously visit our website, which Missy mentioned, deliveredexamprepcom, and if we have discount codes available, they would be on our socials or on our website.
Missi:Yeah, I also was like digging through the archives of mail in our socials and there's a lot of questions about exam prep, questions about our notebook, which is also available on our website, and so, yeah, like all things, exam prep definitely get on our socials and we're happy to like talk exam prep, talk prepping for comps, whatever it is that you need. Um, okay, so one more piece of fan mail that I see here from tampa, florida, that just came in. It said I just listened to the pills and protocol podcast with your pharmacist friend great information. I have three questions. What's the magical paste formulation for breast yeast infection? So that's the first part of this question. So this is. It's got a lot of different names. Some people call it Newman's nipple cream, some people call it all-purpose nipple cream. Kara, are those both the ones that you would call it?
Cara:Yeah, all-purpose nipple ointment APNO.
Missi:Yeah, those are the names, All right. So I'm giving you the prescription right now, how you would write it, and then I'm going to post it when we get our page up. It is mupiricin ointment 2% 15 grams. It's also 15 grams of beta-methazone ointment of 0.1% beta-methazone, and then the compounding pharmacy adds 2% myconazole. So we add enough myconazole powder to get it to a concentration of 2%. So your total prescription is 30 grams of ointment. And then they apply it sparingly after each feed and you don't wash it or wipe it off, you just let the baby like, use it. It also, if they've got thrush in their mouth, will help with that. So again, it's mucin ointment 2%. Beta methadone ointment 0.1%, and mucin or myconazole powder into this compounded slurry. So there's your breast, there's your magic paste for breast yeast.
Missi:The next question in this same van mail is what is the Phenergan or Compazine gel that your pharmacist was talking about? So I am going to post a little link from Dr Ash about the gels, right? And the promethazine topical gel is basically 25 milligrams in 0.1 ml and, yeah, you apply it to their wrist. It's like a cream or a gel, and so these are available. It's a compounded situation. So again, if you're in a place where you have a compounding pharmacy and your patients aren't doing well with tolerating pills or they don't want to take pills they don't want to take like the traditional antiemetics or they don't want to be on a Zofran pump, these are ways that you can get them antiemetics in a compounded way. So that's where these things come from, is compounding pharmacies. So you can call your pharmacist or your compounding pharmacy and say I need, you know, a compounded Spennergan gel or I need a compounded Compazine gel that is transdermal, so that's a great question and sometimes your general pharmacies can do some compounding, so don't rule it out.
Cara:You could always call them and ask or, if they're not able to, they will tell you the closest reputable compounding pharmacy that you could reach out to.
Missi:So, and then she has another great question. I'd like to hear Dr Ash answer the question on which is the best antibiotic to choose when it is listed with an MIC rating. Do you go lower or higher? And what does it mean? So for those of you who don't know what MIC, so MIC is the minimum inhibitory concentration of a drug, and so the MIC number is the lowest concentration in micrograms per milliliter of an antibiotic that inhibits the growth of a given strain of bacteria.
Missi:Okay, so basically I have a fact sheet on MIC here that I will also post, and basically it says that the MIC number for one antibiotic cannot be compared to the MIC for another antibiotic.
Missi:So you can choose an antibiotic based on MIC, but you also use the site of the infection and the antibiotics breakpoint. And then Dr Ash, in her response to this question, also said that you should avoid using MIC to guide therapy, because really all that matters is if the bacteria is sensitive or resistant and because you can't compare MICs across classes of drugs. So I hope that that's a great answer for this fan mail that came out of Tampa, and I will post these resources as well under that episode. So I think that covers the fan mail that we have and the social media posts that we have gotten, the direct messages and the messages that we've gotten. We've heard from a lot of you just thanking us for the podcast, and you know, honestly, we wouldn't be here without listeners and we're quickly approaching a big number of downloads that we will celebrate when we get there, but we're always looking for episodes too, so continue to message us with ideas that you have for podcast episodes. We have actually accomplished, I think, most of the things that people have asked for.
Cara:Yeah, it's amazing, and we really want to deliver what you want from us. So, please, please share please share topics and ideas and, um you know, if you have a special expertise that you would love to share with other midwives and nurse practitioners and students, we would love to highlight you and your expertise as well.
Missi:Yeah, um, a little teaser for season 12. So we're going to take a couple of weeks off here, because that's what Kara and I do in the summer is take a couple of weeks off and regroup before we start a new season. But we have some fun topics, I think, planned for season 12. I love the idea about talking about ovarian masses and cancer screening, cancer detection, especially with Gynoc. We'll see if we can't find a good resource to come talk to us a little bit about that. I think ovarian cancer is probably one of the scariest things because there aren't any screening tests for it. Right, that's right. We haven't done an episode on osteoporosis and osteopenia, so that's on our to-do list of things to do. I also like the idea of talking I think we're going to talk a little bit about fertility and fertility medications, not just about IVF, but really how we can be doing things in the office and what we can be doing to promote fertility in our patients who desire pregnancy. Yeah, other ones you're excited about, kara.
Cara:No, I mean yes. I'm just excited anytime that people give us ideas and you know we definitely hear everyone wanting to hear more about being successful in your first year and really having the support that you need, so we're always looking for ideas around that topic.
Missi:Yeah, I think we're going to do a great episode on AI use too and talk about how we use that in midwifery education and what the future of that looks like. I have some opinions that maybe aren't super popular, but we'll see. Carol loves her AI.
Cara:I just think work smarter, not harder Like, but still using our noggins and our expertise and our clinical judgment to make it even better.
Missi:Amazing. Well, keep that fan mail flying in. If you do happen to use fan mail on your podcast provider, make sure you give us a way to get back with you Now that you know that we can't respond or email us or, like I said, reach out to us on Instagram or Facebook. We love, love, love engaging with our listeners and answering questions and just being a resource as much as we can to all of you. So thanks for listening for 11 seasons. We're so grateful, overwhelmed happy, that we can bring the podcast to you on a regular basis.
Cara:Yeah, thanks, missy. I love this podcast. I love our listeners. It's so fun.
Missi:It is so fun. Well, thanks for joining us for the Engaged Midwife Podcast. We can't wait to talk to you again, take care.