Ep 178: The Power of Personalized Prenatal Care, interview with CNM Carson Ragan of OB2me

In this episode of the Aligned Birth podcast, Dr. Shannon interviews Certified Nurse Midwife Carson Ragan, who shares her personal journey through motherhood and how it shaped her career in midwifery. Carson discusses the importance of personalized care in prenatal settings, the creation of her practice, To Me Healthcare, and the innovative concierge care model that allows for deeper relationships with patients. She emphasizes the value of support systems, including doulas, and offers insights for expecting mothers on navigating their birth experiences.  They also discuss the importance of doulas in labor support, the necessity of childbirth education, the various options available in midwifery, and the significance of shared decision-making in maternity care. They emphasize the need for personalized care and the value of building relationships with patients to ensure a supportive and informed birthing experience.

Connect with Carson:

OB2me website

OB2me facebook

OB2me instragram 

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• 11:21 (Cont.) Ep 178: The Power of Personalized Prenatal Care, interview with CNM Carson Ragan of OB2me

Transcript

Dr. Shannon (00:01.787)
Hello, hello, this is the Align Birth podcast. I'm Dr. Shannon, prenatal chiropractor, one of the hosts of the show. And today is an interview day and we have certified nurse midwife, Carson Reagan on, and she is the owner and founder of To Me Healthcare. I have a little bit of a fangirl moment, so just pardon me while I'm like so excited to have her on. This has been a while in the making, but good things take time. So, and believe it or not, she's just at a birth.

Carson Ragan (00:22.83)
you

Dr. Shannon (00:30.906)
I feel like she's at a birth all the time. So it's hard to get these birth workers to come on the show, but I want to focus on today, like certified nurse midwife, midwifery care, that model of midwifery care, what that looks like for moms, how she came about creating this business, what shared decision-making looks like in prenatal care. Like we're gonna talk about all of those things, hopefully in a condensed manner, but Carson is with us today.

She's a Georgia native, started her family at a young age. She experienced an emergent premature birth with her second baby. And so she started thinking about a career in either working with infants in the nursing world or labor and delivery. But so she went to nursing school and she had her third baby while she was there, under care of a certified nurse midwife. And that was, think, I'm gonna, I'm telling her story here and I'm saying that was her like aha moment where she was like, okay, this is what I want to do.

So we're gonna put all of those years together. She became a certified nurse midwife in 2010. And then over the years has now formed this To Me Healthcare and she's the owner and founder of that. So I am so flipping excited to have you on the show today, Carson. Welcome.

Carson Ragan (01:44.856)
Wow, thank you so much. What the introduction, my goodness. was, I'm like blushing.

Dr. Shannon (01:52.101)
people are like, that was me? I'm like, yeah, that's you! It's awesome!

Carson Ragan (01:56.696)
Thank you so much for inviting me to your podcast. And I am so sorry it's taken us a hot minute for us to get together, but I'm like, yeah, sure. I can do it if I'm not at a birth, if I'm not at a birth, if I'm not at a birth, but I'm not at a birth right now. So we're good. I do have several pending in the next few days, but hopefully we can get through this podcast together and share a little bit about my story, my passion, my practice. Like I just, I love it all. I told you, please feel free to like.

Dr. Shannon (02:05.009)
Famous last words. Yay!

Dr. Shannon (02:13.439)
huh.

Dr. Shannon (02:19.675)
Yes.

Carson Ragan (02:25.388)
you know, cut me off if we need to because, you know, birth work is my passion and I could go on and talk about that forever. But your initial question, I think, was, you know, what led me to Midwifery? And as you were describing, I had quite the journey myself in my births. They were all drastically different. And I was a teen mom and I got pregnant at the young age of 16.

Dr. Shannon (02:37.861)
Mm-hmm.

Carson Ragan (02:52.014)
had her when I was 17, I knew absolutely nothing. And I went to a traditional practice, it even like a teaching practice. So there was like a ton of people I didn't know. And they're really, unfortunately, it wasn't a great program for teen moms, especially because, mean, at 17, what do you really know? In regards to, you know, growing a healthy baby and pregnancy options and delivery. Yeah, yeah.

Dr. Shannon (02:55.596)
Mm-hmm.

Dr. Shannon (03:09.861)
Mm-hmm.

Right, right.

Dr. Shannon (03:17.915)
Well, and caring for yourself at that point, you know, like you're super vulnerable at that point. Yeah,

Carson Ragan (03:22.644)
Absolutely. And that baby is 30 years old and gave me a grandbaby a year ago. So we have really grown up together. But that birth was, I mean, I had an epidural, I had four sips, a pesiotomy, like all the things that of course none of my patients want now and I don't want that for them either.

But I think also 30 years ago, that was even more of the norm. Like there was just, didn't know anything about other options. So that was a little traumatic at 17 to go through all of that. And then also had not figured out how babies were made. And then, you know, a little while later I'm pregnant again with my second daughter. They're 13 months apart.

Dr. Shannon (03:53.713)
Mm-hmm.

Dr. Shannon (04:07.6)
gosh.

Carson Ragan (04:09.038)
And she was eventful from birth. Like she was a STATC section at 27 weeks for a complete previa that was hemorrhaging. Like, I mean, she actually majored in drama in college. So it's quite appropriate that she started very dramatic and she ended up getting a drama degree. She's 29 now, but that was...

Dr. Shannon (04:20.655)
You had all the things. Yeah.

Dr. Shannon (04:26.435)
It started prenatally.

Carson Ragan (04:33.998)
You know, I got a little intro into the maternal health world with my first. And so I was like, oh, this is interesting. I was interested in nursing of some sort. I wasn't quite sure, you know, moms or babies. And then when my second daughter came in, you know, she spent three months in the NICU. It was scary. Not knowing at now 18 years old, really, I, I, part of me is glad that I was not a healthcare worker then just knowing all the horrible things that could have happened with her.

Dr. Shannon (04:53.635)
Mm-hmm.

Dr. Shannon (05:03.749)
Mm-hmm

Carson Ragan (05:04.11)
But she did very well. But as I was immersed in that NICU for three months, you know, learning, I was like, yes, I definitely want to do something with labor and delivery and babies. And this is my jam. This is what I want to do. So I started nursing school when she was six months old. So here I was, 18 with a 13 month old and a special needs preemie child. And it was a lot. But I went to nursing school and

Dr. Shannon (05:29.498)
Yeah.

Carson Ragan (05:32.846)
got pregnant with my son while I was in nursing school still hadn't gotten to the chapter on how babies are made. And so I actually started seeing a nurse midwife. I'd never heard of a nurse midwife. I didn't really understand what that was, but it was game changer for me. Here I was with two very difficult, somewhat traumatic birth stories of my own. And then when I met her, he's 27 now, so VBAC was very different.

27 years ago and the options. And so I had a midwife through the whole pregnancy of care. My visits were different. She did so much more teaching and education. It wasn't the quick in and out, belly check, bye. And then I was able to have a successful unmedicated VBAC. And that was just truly life-changing for me because it was such a different experience.

Dr. Shannon (06:02.927)
Mm-hmm.

Dr. Shannon (06:14.395)
Mm-hmm.

Dr. Shannon (06:23.558)
Mm-hmm.

Carson Ragan (06:27.542)
He was my biggest baby and my fastest baby. And it's just like, was such a healing experience for me, even though it was really tough. 21 years old, you know, having, you know, three kids under three was a lot. but I'm glad I did it when I was younger and had all the energy. can't imagine it doing it right now, but, so I finished up nursing school. That was a wonderful experience and knew, okay, yes, not only do I want to do labor and delivery, but I want to be a midwife. Well,

Dr. Shannon (06:32.817)
Mm-hmm.

Dr. Shannon (06:44.177)
Yeah, right

Carson Ragan (06:55.438)
When I graduated nursing school, I wasn't able to go straight into a graduate program having small children and I was the breadwinner for my family at the time. So my husband stayed home and I worked and I got a lot of great experience in labor and delivery. I'm, I don't know, I think things happen for a reason and I think it was helpful for me to have so many years of bedside labor and delivery nursing and getting that kind of gut that you build up of, okay, this is what normal is, this is what not.

Dr. Shannon (07:07.313)
you

Dr. Shannon (07:22.768)
Mm-hmm.

Carson Ragan (07:24.718)
normal is. And so I was able to go back to school later on. But while I was a labor and delivery nurse, I had my fourth baby. I did know where they came from at that point though. So yes, but I was a labor and delivery nurse and her birth was also very different. I was actually working night shift when

Dr. Shannon (07:35.333)
I was going to say, did we figure it out at this point?

Carson Ragan (07:47.598)
I had gone on an ambulance transfer for a patient. I was like, please let me go on the bumpy ambulance ride. Maybe it'll get me into labor. was 38 and a half weeks. And I really think the ambulance driver thought we were crazy to send the pregnant nurse with the pregnant patient going to another hospital. But I was like, it's fine. I got back from the transfer. My water broke five minutes later at the desk and no contractions. And here I am, my V-back mom, no contractions. I have now PROM'd, which is premature rupture of membranes with no labor, which is not my favorite.

Dr. Shannon (08:11.547)
Mm-hmm.

Dr. Shannon (08:15.835)
Mm-hmm. Mm-hmm.

Carson Ragan (08:18.51)
So I went home and they're like, you're going home? I'm like, yeah, I'm not contracting. So anyway, I started feeling guilty and thought eight hours after my water broke and there's no labor and I'm a previous C-section, I should probably go in for monitoring. I did. Had to have the pitocin, all the things to get me going. But once I got going, she was born in like 20 minutes, you know, so, but it was 23 hours later on my fourth baby that that happened. So I feel like all of my births were,

Dr. Shannon (08:36.014)
Hmm.

Dr. Shannon (08:45.026)
Mm-hmm.

Carson Ragan (08:47.774)
extremely different. And I'm thankful for all of them. I learned a lot personally and I think it made me be able to relate with moms that the birth plan isn't going quite like we all planned. She was another successful unmedicated feedback. So that was also nice.

Dr. Shannon (08:49.295)
Mm-hmm.

Carson Ragan (09:13.624)
but I really do, I love my VBAC moms. When it's safely possible, I am your biggest cheerleader, right? But there's some times that it's just not, and the safer option is another path. But I do love my VBAC moms and my teen moms, although I don't see teen moms a lot anymore. But that was also my passion, because somebody took time to invest in me as not just a patient, but also kind of

Dr. Shannon (09:19.045)
Mm-hmm.

Dr. Shannon (09:29.229)
Yeah. Yeah.

Dr. Shannon (09:37.069)
Right.

Carson Ragan (09:44.002)
fostered my desire to go on and be a midwife.

Dr. Shannon (09:45.702)
Mm-hmm. Well, and it's, you the hindsight is 2020 aspect of, know, all I'm thankful you had all those experiences. I don't I'm not thankful that they maybe were traumatic, but in the aspect of like how you can use that and how you use that now in your practice, because that happens a lot with birth workers, you know, and it's it's a hard area to be to where you don't want to you don't want to take your birth trauma into that space to you have to be you have to honor that but then

Carson Ragan (09:51.212)
Mm-hmm.

Carson Ragan (09:58.249)
Right.

Carson Ragan (10:03.149)
Mm-hmm.

Right.

Carson Ragan (10:11.286)
Right, exactly.

Dr. Shannon (10:14.981)
Really honoring the potential in the mom and and like what what that mom needs and that support and what she needs so Okay, so you'd be That's kind of what led you to midwifery Did you? How did OB or how did to me health care come about? No, that's fine if you need to go yes

Carson Ragan (10:21.506)
Mm-hmm.

Carson Ragan (10:28.238)
Mm-hmm.

Carson Ragan (10:34.926)
Sorry, that's my emergency phone going off. That's the I might be in labor sound. Excuse me one second. I know, I think we're okay. I just want to make sure our baby's not coming. Okay, no, we're good. I'm sorry to interrupt. It was a spam text message. We're good. It's not the call I was anticipating of a mama who's

Dr. Shannon (10:45.435)
that sound.

Dr. Shannon (10:53.381)
real life. Okay, no, that is.

love it.

Carson Ragan (11:04.238)
currently drinking the midwife's brew. So I like, I want to make sure that was not her. I know, right? So, but I'm sorry. So your question.

Dr. Shannon (11:06.129)
Oh, okay, bring on the baby. Yes, yes. But yes, so how did, no, no, no, you're fine. So being in that midwifery space, how did, I'm assuming you practiced somewhere before then looking at creating that To Me Healthcare. Did you still see that there was, in creating To Me Healthcare, what does that mean? What does that look like? And what other, what else was lacking that you saw you could fill that space?

Carson Ragan (11:31.512)
So I worked in a couple of big, busy, traditional OB-GYN practices. One was based out of Northside, one was based out of Kennistone. They were both great practices, great providers, delivering quality care, all the things. I have nothing negative to say about either of them. And what I started to find out, it's kind of crossed the board on what traditional OB-GYN care is now. You know, most patients,

if they're in a traditional model, they have to wait in the waiting room for 30 minutes to two hours, depending on what's going on. And then they only get five or 10 minutes with their provider. And for me, I just don't think that's enough, but unfortunately, just the way that, you know, our, our system is wired and with insurance and this, that, and the other traditional OBGYN practices have to get in.

Dr. Shannon (12:15.376)
Mm-hmm.

Carson Ragan (12:26.74)
volume right to to be able to pay the bills and so as a provider in that situation you know when you're trying to see 20 to 30 patients a day and document and do all that it didn't leave a lot of time to I mean you can certainly do your belly check and your weight and blood pressure and blah blah blah but it didn't give you a lot of time to be proactive and really sit down and talk about previous births and what do they want to see at this birth and what can we be doing proactively to

Dr. Shannon (12:28.281)
Mm-hmm.

Dr. Shannon (12:55.324)
creating a relationship.

Carson Ragan (12:56.248)
help. Exactly, exactly. And I feel like it was almost a gift if I walked into the room and labor and delivery and I had actually met the person before, you know, because there were 10 of us. And so, you know, you see all these patients, but you probably aren't going to be the one there for your birth. And I just like to bond with my patients. So I preferred to be able to build that relationship and that continuity. And so when I saw kind of the same practice model, even though everyone's

Dr. Shannon (13:06.801)
Hmm.

Dr. Shannon (13:16.143)
Mm-hmm.

Carson Ragan (13:24.916)
delivering wonderful care, I just felt like I could do it differently. And my husband and I were actually watching a series on TV called Royal Pains. I don't know if it's still on TV anymore, but it was about this concierge doctor up in the Hamptons and he would go to all these billionaires homes and provide, you know, primary care medicine. And I told my husband, looked at him, I remember the day I was like, why don't they have this for

like pregnant women. mean, they have to go to the doctor's office 14 to 16 times and just a normal pregnancy, you know, and then they might have kids at home and whatever. And then why do you have to be a billionaire to have this service? So that's what got the wheels going. Many years ago, I was like, I'm really going to look into this. I'm going to see how I can do it differently. and so that's kind of where it all started. And it took many, many years to kind of develop it and, and

Dr. Shannon (13:56.934)
He

Dr. Shannon (14:02.321)
You

Dr. Shannon (14:15.021)
Mm-hmm. Mm-hmm.

Carson Ragan (14:18.734)
you know, bring it to where we are now, which I love it because now, um, you know, I have a wonderful collaborating, uh, physician that's very supportive of the mammary model of care and, know, allows us to, you know, even though we are, you know, all of our patients are a part of her practice that they elect, you know, concierge care, then we can provide that continuity and give those patients that extra time, that extra TLC.

Dr. Shannon (14:29.457)
Hmm.

Dr. Shannon (14:41.179)
Mm-hmm.

Carson Ragan (14:45.408)
and really, really try to customize their care based on their specific concerns, risk factors, things like that.

Dr. Shannon (14:56.793)
So describe what a if a mom is coming in and that concierge care with you, what does that look like? And it's like, do they get you specifically? Is there one where they might get you, you know, like in that unit? As far as like one of the doctors on care or something like that, I was like, here's the you get the midwife. What does that concierge look like if someone were to start up?

Carson Ragan (15:22.636)
So if someone chooses the concierge model, then they only see either me or one of my concierge midwives. And right now we have three wonderful of us. There's me and two others. Unfortunately, one of mine is going out on medical leave soon. So there'll be two of us. Eventually I'll probably bring on a third, but it's really hard to find somebody that really loves this model of care and make sure that it's a good fit for my patient population.

Dr. Shannon (15:47.781)
Mm-hmm. Mm-hmm.

Carson Ragan (15:51.598)
But if they're in the concierge model, even though they are a patient of my collaborating physicians practice, they would only see me or the concierge midwives throughout their pregnancy. We work very closely with our collaborating physicians. So any better that has higher risk factors, you know, they may have a meet and greet with her, but we're consistently collaborating with her and consulting as we need to. And we also block our travel schedules. So around the time of the...

Dr. Shannon (16:01.467)
Mm-hmm.

Carson Ragan (16:21.292)
mom's birth, then we're going to be on call for them. So we're going to come and we're going to meet them at the hospital. So they have the opportunity to, it's going to be one of two, maybe three people that they're going to see their entire pregnancy. And one of us is going to be there for them for their birth, their postpartum. They can stay on and do annual visits and things with us afterwards. So it's really building that relationship.

Dr. Shannon (16:39.438)
Mm-hmm.

Dr. Shannon (16:46.107)
Mm-hmm.

Carson Ragan (16:46.4)
that I love the most, you know, because I feel like in the birth world, so many people feel like they need to come in like on the defense or like be ready to fight or advocate for X, Y, Z. And I don't feel like that's the case with our patients because we spend so much time getting to know each other and having that transparent relationship and really being proactive about creating that, that

Dr. Shannon (16:57.113)
Hmm.

Dr. Shannon (17:08.837)
Mm-hmm.

Carson Ragan (17:13.646)
plan, obviously, you know, we want it to go all these ways, but what does it look like if it doesn't and knowing that it's not just because somebody is coming in and they're got to get to their golf game at five o'clock and we're just done, we're going to have a C-section, you know, it's not like that. So we've gotten to know each other a whole pregnancy and going through that journey together. feel like it's a, I don't know, I just love it. was my passion. So,

Dr. Shannon (17:28.518)
Hmm.

Dr. Shannon (17:38.284)
Yeah, I mean, you know, it is creating those relationships. And I know whenever moms do allow you to post pictures on social media, I always love it because it's always just I don't know. It's so neat to see who was in that birth space. It's a beautiful birth space that you have. And like, I'll see the duals and I'll see the dads. And it's just it feels it feels different because I know personally, I didn't.

necessarily have those experiences either. So it's like you see that and you're like, oh, it can be like that. You know, it doesn't. And I like that you had mentioned too that coming in without it being so combative, but also probably knowing that they have time with you instead of coming in and it's like, oh my gosh, I'm going to see the doctor 15 minutes. I have to ask, you know, all of these things. Um, and just, it eases that a bit too because birth is a vulnerable space.

Carson Ragan (18:12.034)
Mm-hmm. Yeah.

Carson Ragan (18:26.232)
Mm-hmm.

Carson Ragan (18:33.57)
I think so. And it's very vulnerable. you know, whether you're coming into it as your first, and there's kind of those fears of the unknown and what to expect, or you've come from a situation that maybe your last birth didn't go as well. The mom that we had delivered this morning, she, her first baby was a C-section somewhere else. And she came and had a successful VBAC with us before. then

Dr. Shannon (18:37.008)
Mm-hmm.

Dr. Shannon (18:46.459)
Mm-hmm.

Carson Ragan (19:00.046)
Um, still, still took her a little bit longer, but still was a wonderful VBAC. And then this morning she rolled in nine and a half centimeters and pushed out a baby in minutes. So it's just like, it's so rewarding. I know, um, it's so rewarding though, to become the family midwife, you know, to have that consistency of now, now I'm catching, you know, third babies of, of patients that, you know, I started this practice in 2019. So it's been truly an honor and a blessing to be able to.

Dr. Shannon (19:10.065)
You're like, did you want me here?

Mm-hmm. Mm-hmm.

Carson Ragan (19:30.198)
continue the next journeys and being able to just be a part of such a very, very special time in somebody's life and trying our very best to make it as wonderful experience as possible.

Dr. Shannon (19:44.367)
What?

Who do you get, who reaches out to you the most? Like what patient population? Do you have a lot of like VBAC moms or do you have a lot of first time moms or is it second time that are like, want something different? What, and you might pull in a little bit of all of that, but yeah, give me an idea of that, know, patient population.

Carson Ragan (20:09.742)
I mean, I would say just demographically anywhere from 25 to 47 year olds. That's my oldest mom that I've had this most recently, that age group. But I would say mostly in their thirties, I would say I have just as many, I don't know, just as many. I'd have to look back at my stats to be honest, but first time moms, but also I get a lot of moms that want something different. I mean, maybe they didn't have

Dr. Shannon (20:20.987)
Uh-huh.

Dr. Shannon (20:35.248)
Mm-hmm.

Carson Ragan (20:36.696)
birth trauma per se, but it was not a good experience last time and they want something different. They want other options. So I feel like it's really all over the board, but I do have a lot of patients that have, you know, history of white coat hypertension or, you know, they need, they need that extra time and TLC. We don't take the blood pressure for those patients at the beginning of a visit. We do the whole visit.

Dr. Shannon (20:40.932)
Mm-hmm.

Dr. Shannon (20:55.227)
Uh-huh. Uh-huh.

Carson Ragan (21:02.508)
do that at the end, we let the patients take their blood pressures at home and send us logs. We really try to customize what works so that we're not jumping the gun per se on something that, okay, that's probably not truly accurate reading right now. Let's just, right, right. Yeah, yeah. So we try to customize.

Dr. Shannon (21:09.061)
Mm-hmm. Mm-hmm.

Dr. Shannon (21:17.261)
making a tense situation worse. Like it's like, I know I went for a physical the other day and they were like, are you excited to be here? And I was like, yes, can you tell from my blood pressure? Thank you very much. Okay. And well, and all of that started with my prenatal care. So I tell you what, yeah.

Carson Ragan (21:27.534)
Right, right, right, right.

Mm-hmm. Yeah, so we we try to cater to that and if we know You know what we do know because we do a deep dive on okay. Tell me about your previous birth What went well, what would you like to improve what you know? happened so that we can kind of meet the patient where she is and and try to either Prevent maybe what may be happened in the past if possible or just being very very in tuned and aware of just certain words or certain

Dr. Shannon (21:42.491)
Mm-hmm.

Dr. Shannon (21:48.005)
Mm-hmm.

Carson Ragan (22:01.742)
processes that might be triggering for that patient if they had a less than desirable experience with a previous birth.

Dr. Shannon (22:04.24)
Mm-hmm.

Dr. Shannon (22:08.955)
Definitely. Here's kind of a fun one. What do you, I guess in all of your years and using your own birth experience too, what do you wish women moms knew about birth? Like how would you kind of describe it? I know.

Carson Ragan (22:25.518)
Oh my goodness. There's so much I want them to know. I think going into pregnancy and birth with an open mind, I have many patients that want it to be this way and birth is so unpredictable. Even between birth of the same mom, like even my own story, every birth can become completely different and taking some of that pressure.

Dr. Shannon (22:47.161)
Uh-huh.

Carson Ragan (22:53.076)
off of themselves that it has to be this way and be open to the possibility of things may be different than what you anticipated or expected or even wanted, but also about the value of having that support team during their pregnancy. Like all of our patients get referred for chiropractic care, pelvic floor PT. It's not that there's a problem.

Dr. Shannon (22:57.701)
Mm-hmm.

Carson Ragan (23:19.64)
But let's be proactive, you know, like instead of reactive. Yeah.

Dr. Shannon (23:21.251)
and use the words because you probably experienced it and you mentioned it too. There were no one ever mentioned doula to me. So it's kind of like I didn't know what I didn't know. So at least mentioning it and then you do the research and you say, okay, that is for me or that's not for me. No, that's perfect.

Carson Ragan (23:27.796)
Mm-hmm. Mm-hmm.

Carson Ragan (23:34.638)
No, doula's chiropractic pelvic floor PT that is on the first conversation of highly recommend. Here's why. Here's some names to reach out to and let them go and interview them and see if that's something I've been joking for a while. And I'm like this close to like requiring my first time moms to have a doula just because I think they're so valuable.

Dr. Shannon (23:40.154)
Mm-hmm.

Dr. Shannon (23:44.379)
Mm-hmm.

Mm-hmm.

Carson Ragan (24:01.198)
I would love for all of my patients to have a doula, but especially those first time moms that there's so much to learn and having that additional support person. I haven't implemented it yet because sometimes just financially it's a lot for people, but I just, if everybody could have a doula, my gosh, that would be amazing. Like I just, think they're so beneficial and I'm sometimes disappointed when I walk in and there's not a doula. Cause I was like, I like working with these doulas so much.

Dr. Shannon (24:04.134)
Mm-hmm.

Dr. Shannon (24:14.307)
I know. I feel the same. Yeah.

Dr. Shannon (24:19.973)
Mm-hmm.

And there's not a do it. huh.

Carson Ragan (24:29.298)
We have so many fantastic doulas in this area, you know, and I still haven't met them all, but I've met a lot of them and they're all wonderful. And I get very excited when the patients say, yeah, I picked out my doula. I'm like, yes. So that's great. So, and teaching them that it's not just for the birth, you know, it's the preparation. It's the postpartum period. That fourth trimester that nobody talks about is having your team to support you all the way through.

Dr. Shannon (24:32.162)
huh. Yeah.

Dr. Shannon (24:40.557)
Uh-huh.

Dr. Shannon (24:47.013)
Mm-hmm.

Dr. Shannon (24:56.334)
No. Do a lot of your moms, do most of your patients and families have a doula? I know you mentioned that they don't, but I do. always, a lot of the pictures I see, I'm like, they've got their doulas, you know? And so that's always fun to see. Yeah.

Carson Ragan (25:12.014)
I would say the majority, yeah, the majority do. The majority do have a doula, which is great. I love working with doulas. It's a little bit different in our model in labor and delivery than what I had to practice in a bigger group. When I was in the bigger groups, I might have 10 people in labor and work in a 24-hour shift and you're literally just going room to room to room.

Dr. Shannon (25:19.674)
Yeah.

Dr. Shannon (25:34.758)
Mm-hmm.

Carson Ragan (25:39.074)
you know, just bouncing in so you don't really have the time to sit with the patient. Now that doesn't mean that we're in the patient's room the entire time, but we're able to be there a lot more and be a little bit more proactive and being like, okay, well let's try this position for a little bit. Okay, well why don't we try this? Dad, here, let me show you how to these hip squeezes. know, having more time to utilize that in labor and delivery is one thing that I really enjoy.

Dr. Shannon (25:46.361)
Right.

Dr. Shannon (26:02.757)
Mm-hmm.

Carson Ragan (26:06.828)
But knowing that they also, and we work in tandem when there is a doula, we're all on the same page. like, yeah, what do you think? You want to try this position next? And then we'll get on this almost circuit of, okay, we're going to do this one and then we're going to change it to this one. And so we're all speaking the same language, which is, it's wonderful for me. And it's great for the families to have that consistency. And like I said, there's not any of the advocating or having to like push to get.

Dr. Shannon (26:12.784)
Mm-hmm.

Dr. Shannon (26:35.632)
Right.

Carson Ragan (26:36.558)
delayed cord clamping. That's just standard. As long as that baby comes out screaming and crying, everybody's going to get delayed cord clamping and skin to skin and golden hour and all the things. that's not something that somebody has to, right. It's like we do that anyway. Yeah. So I joke with my patients. like, okay, I want you to, everybody brings in their birth plan around 36 weeks. We've been talking about it for a whole pregnancy.

Dr. Shannon (26:43.682)
Hmm.

That's the standard for you guys. You don't have to fight for that.

Carson Ragan (27:00.268)
And then we take an extra time and are at visit just to kind of go through it. But I tell them the majority of everything on that birth plan, I promise you, we already do anyway, assuming you and your baby are normal, healthy, everything is going well. But it's really more to help communicate to the nursing staff, you know, do you want vitamin K? Do you want IOAM and do you want the baby to have that? You know, those kinds of things, but twinkle lights are a must. Old verse have to have twinkle lights.

Dr. Shannon (27:10.693)
Mm-hmm.

Dr. Shannon (27:23.941)
Huh? I love the twinkle lights. I'm like, some good twinkle lights. I know.

Carson Ragan (27:28.642)
my other midwife that was with me this morning. was so cute. we, it was close to delivering in the car this morning. That's how fast she was going. And so she was already at the hospital. I was on my way and she plugged in the twinkle lights. They didn't get hung up on the wall, but they were plugged in and on by golly. And she comes in and minutes later have a baby, but we got the twinkle lights in the room. So, but it just, it, I just think creating that space, you know, of trying to not have that chaotic.

Dr. Shannon (27:36.538)
gosh.

Dr. Shannon (27:42.481)
favorite.

Dr. Shannon (27:48.141)
But you got the twinkle lights on. I love it.

Mm-hmm.

Carson Ragan (27:58.476)
you know, 30 people in the room, the fluorescent lights on, people talking really loud. That is overwhelming. And that's just not the kind of space that I like to provide if possible for those moms is having them kind of ease on in to labor and delivery and hopefully a calm manner, keeping the lights down, the voices down. Everybody has their role and knows what to do. But we've talked about all the things that are important to them before we even get to the...

Dr. Shannon (28:11.067)
Mm-hmm.

Dr. Shannon (28:22.609)
Mm-hmm.

Carson Ragan (28:27.416)
labor and delivery space. And so I think that's where it's well, a lot better for me, whereas in my previous larger practices, I don't know this person, I've never even met them, I'm coming in, I don't know anything about their, you know, real preferences and previous birth experience. mean, yeah, I've got their chart, like, okay, she has asthma, but that's not, I need more than that. So we're able to do that. Yeah.

Dr. Shannon (28:45.09)
Right. What's going to calm them? Yeah. Exactly. Yeah. That doesn't help with the communication. And I think that's because I had one of my questions on here was like that midwifery model of care differ from that medical OB and that's pretty much, you know, what you kind of summed up in there too. It's just it's it is that feel it is the time. It's that patient volume. It's that individualized, you know, authentic care.

and you really getting to know the person. So that can make all the difference.

Carson Ragan (29:15.566)
Well, and think midwives in general, I think look at pregnancy and birth as more of a normal life process and not a disease process, which I think just in general in midwifery care, that's why we go into it because we know this is a normal life event. Now, that doesn't mean that it can't be a higher risk situation and there are disease processes like diabetes and hypertension that we

Dr. Shannon (29:26.085)
Mm-hmm.

Mm-hmm.

Dr. Shannon (29:38.896)
Mm-hmm.

Carson Ragan (29:42.846)
know, co-manage with our physicians, but still trying to keep some normality to the process, even though there might be other interventions or diagnoses that are affecting pregnancy, we still try to keep that relationship.

Dr. Shannon (29:48.625)
Mm-hmm.

Dr. Shannon (29:58.532)
Yeah, to honor that. No, definitely.

As far as, and you mentioned you love the dual support and like kind of that birth support team and going over the, sorry, that's my dog. If you hear it, going over the birth plan. There we go. I don't know what she's barking at. Somebody must be walking a dog. do you, not that you can require, but like as far as childbirth education.

Carson Ragan (30:15.95)
I told you you might hear my grandbaby here in a little bit, so her nap time is going to be over soon.

Carson Ragan (30:31.042)
Mm-hmm.

Dr. Shannon (30:31.345)
What do you like? Because I know, I guess what I'm getting at too is if you're birthing in a hospital, sometimes they'll have their hospital courses. And so I know with me, I took that. I didn't really know any better. That really doesn't go through everything. And then there's the independent childbirth education classes and so many different things out there. So how do you approach that with your moms?

Carson Ragan (30:55.138)
Well, I think any education is better than no education. know, it might be more biased in one location than another, but I think any education is helpful. But I do, I would love to require, but I strongly encourage all of our patients to have some form of childbirth class, have a lactation class if they're planning to breastfeed.

Dr. Shannon (30:58.288)
Mm-hmm.

Mm-hmm.

Dr. Shannon (31:06.417)
I know.

Dr. Shannon (31:17.702)
Hmm.

Carson Ragan (31:18.112)
infant CPR and potentially a newborn care class if they're not familiar with babies or even if they've been around babies, just kind of being very, very, again, the word proactive of like, get that information, get prepared. But once I find out what kind of birth are they trying to have, are they wanting to have an unmedicated water birth? Then okay, you might want to consider like more of a hypno babies or hypno birthing type.

Dr. Shannon (31:28.037)
Mm-hmm.

Dr. Shannon (31:35.119)
Mm-hmm.

Carson Ragan (31:44.302)
style class or you're like, Nope, dude, I want an epidural as soon as I have my first contraction. Still want you to be educated about what's going on and you know, the process of labor and kind of what to expect and things that you can do. But what is it? It is, it is their decision and we don't judge either way. If you want to unmedicated water birth, great, let's do that. You want an epidural birth, we're going to do that. But that doesn't mean you're going to be laying flat on your back. We're going to be flipping and flopping you and making a rotisserie chicken with a peanut ball, you know, and just really.

Dr. Shannon (32:12.709)
Yes.

Carson Ragan (32:13.672)
being proactive in that space, but they need the education regardless of what they think they want from their birth. And so I try to get them connected to the types of classes based on what they think they want. And then do they have a doula? Do they not have a doula? If they don't have a doula, then I'm much more strongly encouraging an in-person class so that they can learn some hands-on things so dad can learn, okay, well, when she does this, it would be a good time for you to do that.

Dr. Shannon (32:15.781)
Hmm.

Dr. Shannon (32:27.461)
Mm-hmm.

Dr. Shannon (32:36.368)
Mm-hmm.

Carson Ragan (32:43.542)
you know, so they can do that early labor stuff at home and still have some sort of support. So yes, I am a huge fan of childbirth education. There's so many great options out there for people. It's just meeting them where they are, finding out what works for them, their schedule, their budget, their birth plans, and try to connect them with somewhere where I think they'll be able to actually take advantage of that.

Dr. Shannon (32:44.164)
Mm-hmm.

Dr. Shannon (33:03.771)
Mm-hmm.

Dr. Shannon (33:13.79)
And I that you went exactly where I wanted you to go with that answer because it's you've reformed the relationship with them So, you know them because I do this a lot in the office too where I'm like I really think this tool is gonna be the one for you I think this class is gonna be really good not that you can't look at other ones but Check this one out because I know you now. I know what stresses you. I know it brings you calm I think this class would be good, you know, so it's that individualized but at least

Carson Ragan (33:23.214)
Mm-hmm.

Carson Ragan (33:35.214)
Mm-hmm.

Mm-hmm.

Dr. Shannon (33:40.131)
mentioning something to them rather than just, you the hospital has this class and then leaving it at that because I too, I never took childbirth education. So I wish I always speak the things I wish I had done.

Carson Ragan (33:41.922)
Right.

Mm-hmm. Mm-hmm.

Yes.

I will say with my first 30 years ago, I did go to childbirth class. I was at a hospital and it was the traditional, you go for two hours or six or eight weeks or whatever. And I'm still in touch with a mom that I met in that class. because we had like little play groups with our babies afterwards. So I do think there's something to be said for those in-person classes. Not necessarily that they have to at a hospital, but just getting people connected.

Dr. Shannon (34:06.699)
Ugh. Uh-huh.

Dr. Shannon (34:12.282)
of

Dr. Shannon (34:16.238)
Mm-hmm.

Carson Ragan (34:16.654)
Um, especially after we've been through this whole virtual time through COVID and everything, like everybody just got really isolated and nobody was getting together anymore. And so I think, I think the in-person is my favorite just because you can connect with other moms. can hear questions that you're like, Oh, I didn't think that, or, Oh, I was thinking the same thing. So I think that's my preference, but, um, you know, as long they do something, it makes things a lot.

Dr. Shannon (34:23.227)
Mm-hmm.

Dr. Shannon (34:28.965)
Mm-hmm.

Dr. Shannon (34:37.51)
Yeah.

Carson Ragan (34:41.686)
a lot better. But like you said, I like being able to point them in the right direction based on what I know about them and give them maybe two or three options instead of 200. And they're so overwhelmed that they don't follow through and get it done. know, so, right.

Dr. Shannon (34:42.747)
Yeah.

Dr. Shannon (34:53.506)
Yeah, you get a little bit of a exactly because sometimes that yeah, that's overwhelming. So some sort of direction. Yeah with with the classes And you mentioned too. I I feel like sometimes if people hear Well, I'm gonna have a midwife at my birth. Sometimes you think immediately. well, that's just gonna be some unmedicated water birth like it's gonna look a certain way and so

Carson Ragan (35:16.232)
Mm-hmm.

Dr. Shannon (35:19.533)
speak to the different types of births that you support and see moms have.

Carson Ragan (35:27.502)
Well, it's funny that you mentioned that because people that don't know a lot about midwives kind of picture us to be like wearing Birkenstocks and dreads and like, you know, tie dye stuff and that we're going to have you squat behind a tree and bite on some bark and there's no medication. Like this is farthest from, from what really happens. And there are different kinds of midwives and you know, there's more medical minded midwives and there's more crunchy midwives. And I feel like I'm somewhere in between.

Dr. Shannon (35:41.241)
Uh-huh.

Dr. Shannon (35:48.037)
Mm-hmm.

Dr. Shannon (35:52.219)
Mm-hmm. Mm-hmm.

Carson Ragan (35:57.868)
I think it's helpful for people to understand that they have options. And I'm not going to judge you because, you want an epidural. Great. No, absolutely not. If that is what you want, then let's do that. But let's also be proactive. Like I mentioned before with your positioning and it doesn't mean that you're going to be flat on your back. You can move. You can't get out of bed, but you can move. We're going to move you. I mean, I've caught babies in hands and knees with epidurals. You know, it just depends how dense the epidural is.

Dr. Shannon (36:03.835)
Hmm.

Dr. Shannon (36:08.42)
Mm-hmm.

Dr. Shannon (36:18.001)
Because you can move. Uh-huh. That's beautiful. Right.

Dr. Shannon (36:27.931)
Mm-hmm.

Carson Ragan (36:28.046)
And if they want an unmedicated water birth, then let's do that. But if things change, just trying to help them feel supported in that change and that they've not failed as a woman because maybe they did decide that they needed something for pain and supporting them through that process and knowing that they have options and that there's no set way things have to be, especially when moms and babies are doing fine. mean,

Dr. Shannon (36:39.889)
Mm-hmm.

Dr. Shannon (36:46.587)
Mm-hmm.

Carson Ragan (36:54.766)
I've caught babies on hands and knees, on the floor, in the tub, on the side, like pretty much standing up next to the bed, know, upright birth. So, I one baby in the shower, wasn't really planning on that one, but you know, so it's just, there's options and supporting women in knowing what they are. And then if things do change, helping navigate to, okay, well, let's try this or let's try that. And I think that's been helpful, so.

Dr. Shannon (37:09.574)
Yeah.

Dr. Shannon (37:20.593)
Yes, I know it's just those that's why I wanted to touch on those preconceived, know Because we do have those those midwives out there, but I love that we have those options I'm glad you mentioned that and that's why I wanted to like it doesn't have to look a certain way and With birth, it's probably not gonna look the way you you would want it or intended anyway So you got to be a little flexible there. Um, I As far as shared

Carson Ragan (37:34.817)
Right.

Dr. Shannon (37:49.04)
decision making goes and I kind of wrap up with this as far as and you've really, I mean you've touched on it this whole entire interview and our whole conversation, but what does that mean to you and did that play a role in how you have set up your office and what you want it to look like and what you want that experience to be?

Carson Ragan (38:15.758)
I think shared decision making is incredibly important. And I think it's much more attainable in this model of care. Not that in a traditional model, you don't have shared decision making. So please don't take that away from this conversation. But I'm saying when you've built that relationship and you've had these conversations and it's not over five minutes and I need you to make a decision right now, are you going to do your glucose or do you not? You know what mean? That pressure of

Dr. Shannon (38:36.144)
Mm-hmm.

Carson Ragan (38:44.78)
only have five minutes with the doctor. I have to make a decision right now instead of really having the time to sit down and be like, okay, here are the recommendations from ACOG, CDC, whoever it is that we're talking about. Here's what's recommended in pregnancy. Here's why, here's the options. What do you think about that? And, you know, generally that stimulates questions and then we go through that and, or are there other alternatives?

For example, a big thing that a lot of patients are worried about is the glucose screening test. I do think it's important to screen for diabetes in pregnancy, but we have an alternate in our office, the fresh test. All my crunchy moms love the fresh test. It's organic, it's non-GMO, it tastes like Chick-fil-A lemonade. So we try to meet people where they are on things like that. We have some patients that are planning to decline ROGAM.

Dr. Shannon (39:10.299)
Mm-hmm.

Dr. Shannon (39:19.621)
Mm-hmm.

Dr. Shannon (39:24.345)
Mm-hmm. I tell my mom's about it. Yeah. Yeah.

Dr. Shannon (39:38.597)
Mm-hmm.

Carson Ragan (39:38.67)
because they're RH negative. Well, now there's a blood test if they're doing an NIPT that can tell us if the baby's blood is positive or negative at like 10 weeks. So then they can make an informed decision of, okay, I know my baby is positive and I'm negative. Then they can make an informed decision on if they still want to decline the ROGAM at 28 weeks, which patients do, and that's totally their choice. But at least they have the information to make that. And yeah, so I think that's

Dr. Shannon (39:49.712)
Nice.

Dr. Shannon (40:05.541)
You have the info.

Carson Ragan (40:08.424)
really the biggest thing about getting all the information, sitting down, understanding the information and the wise. And then if that is not what you prefer to do, then being somewhat supported in that so that you don't feel like, know, my gosh, this is going to be like, what's the word I'm looking for? uncomfortable interaction with the provider now and the same in the same breath, I like to say that

Dr. Shannon (40:32.679)
Mm-hmm.

Carson Ragan (40:38.26)
I want to get to know these patients because I want to feel comfortable with what you feel comfortable with also. For example, if you told me you wanted to have your twin, breach birth at home, that's not something that I'm comfortable with. I'm not saying someone else out there is not, is, you know, an option for that, but that's outside of my comfort zone. And so I think by having that relationship and being able to be transparent with each other and finding some.

Dr. Shannon (40:44.123)
Mm-hmm.

Dr. Shannon (40:53.297)
Mm-hmm.

Dr. Shannon (41:00.39)
Mm-hmm.

Carson Ragan (41:06.316)
you know, kind of not middle ground, cause it's not like you're fighting, but just that support where you're both feeling that this is a great decision. And if one of us is concerned both ways, being able to talk through that. yeah, yeah. So, that's what I love about that part of the shared decision-making is because we have the time to really talk through it and think about it and know that there's other options sometimes than just the standard.

Dr. Shannon (41:14.319)
Mm-hmm.

Dr. Shannon (41:18.117)
You can

Dr. Shannon (41:27.245)
Mm-hmm.

Carson Ragan (41:34.038)
model and that's where it comes to customizing each and every experience every way that we can.

Dr. Shannon (41:40.177)
well, I think you have set up a way to do that beautifully. wow. So tell me where people can reach out to you, connect with you, websites or social media or all of those things.

Carson Ragan (41:45.496)
Thank you. Thank you.

Carson Ragan (41:54.658)
Mm-hmm.

So you can go to our website. Our blanket company is To Me Healthcare, but we have separate divisions within To Me Healthcare, and one of those is OB To Me. So you can just go www.obtome.com or www.tomehealthcare.com, and you'll get to us. For anyone that's considering pregnancy, trying to conceive, already pregnant, we offer a free phone consult to those patients.

one to find out a little bit about them, their history, what are they looking for? Is it something that am I, am I at the best fit for them? I might not be. And so I'd rather do that over a free phone consultation. And maybe if it's not me, then I can direct them in the right direction. instead of, know, I don't want to waste anyone's time having them take off work, coming to see us, do all those kinds of things. So I try to really. We're interviewing each other basically in that consult to see, this a good fit? You know,

Dr. Shannon (42:27.053)
Mm-hmm. Are you a good fit? Mm-hmm. Mm-hmm.

Dr. Shannon (42:38.587)
Mm-hmm.

Dr. Shannon (42:49.989)
Mm-hmm.

Carson Ragan (42:53.048)
whether it be health-wise or personality-wise or can I offer you what you're looking for? So we offer that to everyone. And then we do have some patients that aren't quite ready to start their families, but they want to get established as a patient. So they come in as a GYN patient and do their annuals done. Yep, yep. And then that way it kind of helps them because when they do get pregnant, they kind of get first dibs because we do cap how many moms we take per month based on

Dr. Shannon (43:11.461)
Yep, I've got some moms that do that with you.

Yeah.

Carson Ragan (43:23.264)
the acuity, our travel schedules. Yeah. So if they're already a patient, well, you know, they're going to get first dibs over someone that's, you know, just reaching out. So it's nice. And we can start that relationship much sooner. And again, the word I've probably said 30 times, if you count it, being proactive, like, okay, you are planning a family at some point. Are there any health concerns to be able to look at now? What can you be doing to prepare your body to, you know, be ready when you're ready?

Dr. Shannon (43:23.535)
Well availability.

Dr. Shannon (43:31.503)
Mm-hmm.

Dr. Shannon (43:39.057)
Mm-hmm.

Dr. Shannon (43:50.667)
Mm-hmm. I don't know how you do it, but I am so thankful that you do.

Carson Ragan (43:56.32)
I have a great support system. have a wonderful team and I just so many wonderful people in the birth community that have just, tell people all the time, Atlanta is a big city, but the birth community is pretty small. know, so yeah. Yeah.

Dr. Shannon (44:03.493)
Mm-hmm.

Dr. Shannon (44:08.505)
I love our birth community. It's so good. It's so supportive. It's so good, no. And I know there's areas around that are lacking and need help and we know that, but I do love our birth community. But again, too, I'm so thankful for what you do and how this has turned into your life's work and all the lives that you've been able to impact in all the generations. I guess one of my take home things.

Carson Ragan (44:15.244)
Yeah, yeah.

Carson Ragan (44:19.63)
Yeah.

Dr. Shannon (44:34.812)
from you and I didn't really think that it was gonna be this, but this element of time kept speaking to me when you were talking and that's like, that's what you are giving to people's time, like your time and energy because that's how you make shared decisions. You've got to have the time and that space for it. And so you're allowing that space with the business model that you created for all these families. So again, thank you so much for taking your time today between babies.

Carson Ragan (44:45.998)
Mm-hmm.

Carson Ragan (44:51.64)
Mm-hmm.

Carson Ragan (44:55.15)
Yeah.

Carson Ragan (45:00.206)
Well, thank you so much for inviting me. I really appreciate it and I appreciate all you do in the birth community and hopefully you can hang out with us sometime.

Dr. Shannon (45:03.825)
to come chat.

Dr. Shannon (45:10.648)
I know. I was, yeah, we were chatting beforehand and I was like, I don't get to see you. I'm not like the duelist and I don't get to like hang out with you and I want to hang out in the birthday. So I'm gonna come hang out one day. I know, I know. Again, thank you so, so much. I appreciate it.

Carson Ragan (45:15.342)
Well, come on. Yes, we can at least go to lunch or something and catch up. So yeah. Well, thank you so much. Okay. Have a great day.