The EngagED Midwife

Cara Busenhart and Missi Stec

Empowered, knowledgeable, and engaging. Cara and Missi provide insightful, relevant conversations on midwifery topics that will enhance student knowledge and improve confidence for certification. Featuring current research and evidence based practice guidelines, the EngagED midwife podcast hopes to engage practicing midwives to enhance their robust knowledge base and elevate their clinical practice.

  1. 2d ago

    Do You Really Need To Know Every OCP?

    Send us Fan Mail A birth control pill “decision” can feel overwhelming until you strip it down to the parts that actually change. From the exhibit hall at a packed midwife meeting, we share the exact mental checklist we use for choosing a combined oral contraceptive pill without getting lost in brand names, colors, or marketing. If you’ve ever thought, “There are too many OCPs to learn,” this conversation is your reset. We start with the physiology that makes everything else click: progesterone is doing most of the contraceptive work by preventing ovulation, while estrogen mainly supports cycle stability and side effect control. From there we move into the real safety screen, focusing on who should avoid estrogen, including people with a history of DVT or PE, known clotting disorders like Factor V Leiden, estrogen-positive cancers such as breast cancer, smokers over 35, and uncontrolled hypertension. We also talk through how patient goals change the plan, whether that goal is lighter bleeding, acne or hirsutism support for PCOS, PMDD symptom relief, menstrual migraine management, anemia support, or endometrial protection in the perimenopausal years. Then we get concrete about prescribing: why monophasic pills are usually our default, how ethinyl estradiol dosing trends have shifted over time, and when you might adjust estrogen dose for persistent breakthrough bleeding or estrogen-related side effects like nausea, headaches, or breast tenderness. We also cover how progestin choice relates to androgen effects and what we actually know about thromboembolic risk, plus practical tools for adherence so the method works in real life. We end with the must-have counseling add-ons: condoms for STI prevention, emergency contraception, and how to be reasonably sure someone is not pregnant when starting.  If this helps you feel more confident, subscribe, share the episode with a classmate or colleague, and leave a review. What’s the number one thing you want your OCP “default plan” to solve?

  2. Oct 18

    Psychosis versus Depression: Managing Mental Health in the Postpartum Period

    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.

  3. Oct 4

    The Shit’s About To Get Real

    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

  4. Sep 20

    Early Pregnancy Loss Care From Diagnosis To Follow Up

    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.

  5. Sep 6

    Why Yelling At A Swim Meet Made Me Pee

    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

  6. May 31

    Cancer Survivorship Without A Finish Line

    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

  7. May 17

    Your Libido Is Not Broken

    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

  8. May 3

    What If The Dates Are Wrong And The Baby Tells The Truth

    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

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About

Empowered, knowledgeable, and engaging. Cara and Missi provide insightful, relevant conversations on midwifery topics that will enhance student knowledge and improve confidence for certification. Featuring current research and evidence based practice guidelines, the EngagED midwife podcast hopes to engage practicing midwives to enhance their robust knowledge base and elevate their clinical practice.

Information

  • Creator
    Cara Busenhart and Missi Stec
  • Years Active
    2021 - 2026
  • Episodes
    139
  • Rating
    Explicit
  • Copyright
    © 2026 The EngagED Midwife
  • Show Website
    The EngagED Midwife

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