True Birth

The American College of Obstetricians and Gynecologists released new clinical guidance on April 17, 2025 that recommends, as they see it, reimagining prenatal care in the U.S. Instead of the traditional 12–14 in‑person visits, ACOG now advocates for individualized prenatal care schedules—especially for average‑ and low‑risk patients—tailored based on medical, social, and structural determinants of health as well as patient preferences The guidance encourages early needs assessments (ideally before 10 weeks), shared decision‑making, coordination of social support resources, telemedicine, and group care modalities to reduce barriers and drive equity Drawing on the PATH framework developed with the University of Michigan, ACOG presents sample visit schedules and monitoring strategies reflecting evidence that fewer visits—with flexible modalities—can maintain quality while improving access and patient experience

As clinicans who have been offering unparalleled care for decades, find out what Dr. Abdelhak and his team at Maternal Resources think of groundbreaking this new update.

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Dr. Mosses comes to Maternal Resources after serving as the Medical Director of the OB/GYN department at Ezra Medical Center in Brooklyn, where he built a thriving obstetric practice from the ground up, now averaging over 50–60 deliveries per month. Prior to that, he was a senior attending physician at NYU Langone in Midwood, Brooklyn, where he maintained a cesarean section rate of under 10%—a testament to his skill in supporting vaginal births, including twin deliveries and VBACs (vaginal birth after cesarean). His approach combines clinical rigor with a strong belief in giving patients safe options for physiologic birth.

Expertise in Vaginal Twins, VBACs, and Minimally Invasive Surgery

Known for his hands-on experience with high-volume deliveries, Dr. Mosses has a deep expertise in managing vaginal twin deliveries and has successfully supported many patients through VBACs. He has performed thousands of deliveries and a wide range of gynecologic surgeries using open, laparoscopic, and vaginal approaches. Whether managing a routine pregnancy or a more complex case, his goal is always the same: to deliver excellent care that respects patient autonomy and promotes healthy outcomes. This commitment perfectly mimmics the core of what Maternal Resources is all about.

Training, Awards, and Teaching Excellence

Dr. Mosses completed his OB/GYN residency as Chief Resident at Richmond University Medical Center, where he received the Society of Laparoendoscopic Surgeons Award and completed advanced training in gynecologic oncology at Sloan Kettering. He has also supervised and trained residents at multiple academic institutions, including NYU Langone and Lutheran Medical Center. His academic background, combined with his leadership and research accolades, reflects his ongoing commitment to advancing women's health.

Dr. A. Jay Mosses has been recognized for his outstanding contributions to the field of obstetrics and gynecology with several prestigious awards. During his residency at Richmond University Medical Center, he was honored with the Society of Laparoendoscopic Surgeons Award, acknowledging his excellence in minimally invasive surgical techniques. Additionally, his research on the use of double balloon cervical ripening catheters in managing massive hemorrhage in cervical ectopic pregnancies earned him the First Place Award at the 2016 Annual Residents' and Fellows' Research Paper Competition. These accolades reflect his commitment to advancing clinical care through both surgical skill and academic research.

We're honored to have Dr. Mosses on our team and know our patients will benefit from his skill, warmth, and unwavering dedication to their care.

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In this powerful and eye-opening episode, we explore birth stories. Through candid, firsthand birth stories, we highlight how listening to your body, trusting your instincts, and building the right care team can make all the difference.

Whether you're planning a hospital birth, birth center experience, or home delivery, this episode reminds us that not all providers are created equal—and sometimes, your OB just doesn't know when it comes to birth.

Who This Episode is For: Pregnant people, birth workers, doulas, midwives, and anyone curious about the realities of modern maternity care.

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Epidural anesthesia is a type of local anesthetic that is injected into the epidural space. This procedure numbs the spinal nerve roots and provides a block to the lower abdomin, pelvic and lower extremity portion of the body. It is the safest and most effecive method of pharmacologic pain management in labor available.

When it comes to managing labor pain, epidurals are one of the most commonly requested and effective options. But despite their widespread use, many expecting parents still have questions or concerns. Here's what you need to know.

An epidural is a type of regional anesthesia that blocks pain in a specific part of the body—most commonly from the waist down. It's administered through a small catheter placed in the lower back and can significantly reduce the intensity of contractions without making you drowsy or disconnected from the birth experience.

One of the biggest benefits of an epidural is flexibility. It can be adjusted throughout labor depending on your needs and comfort. Some people feel enough relief to rest, while others maintain enough sensation to push effectively during delivery. Contrary to popular myth, an epidural does not usually slow labor or increase the risk of cesarean delivery in most healthy pregnancies.

Like all medical interventions, epidurals do carry some risks—such as a drop in blood pressure, headache, or in rare cases, complications related to placement. However, for many, the benefits far outweigh the risks, especially when monitored by an experienced anesthesiologist.

Choosing pain relief is a deeply personal decision. Whether you plan to get an epidural, go unmedicated, or keep your options open, the most important thing is that you feel supported, respected, and informed.

Remember, there's no one "right" way to give birth. Empowered birth is about making choices that align with your values, goals, and comfort. An epidural doesn't take away your strength—it supports your journey.

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In this episdoe, we explore how biometry is used to measure key metrics like Biparietal Diameter (BPD) and Head Circumference (HC), shedding light on what these measurements reveal about your baby's growth and development. We talk about their role in predicting potential challenges during labor, and how they help ensure a safe and healthy birth. From understanding head size's impact on delivery to offering expectant parents valuable insights, this episode unpacks the critical connection between fetal head measurements and the labor process.

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Understanding Unicornuate Uterus: What It Is, Prevalence, Risks, and a Positive Outlook A unicornuate uterus is a rare congenital condition where the uterus develops with only one half, or "horn," instead of the typical two-horned shape of a normal uterus. This happens during fetal development when one of the Müllerian ducts, which form the uterus, fails to develop fully. As a result, the uterus is smaller, has only one functioning fallopian tube, and may or may not have a rudimentary horn (a small, underdeveloped second horn). This condition falls under the category of Müllerian duct anomalies, which affect the female reproductive tract. For those diagnosed, understanding the condition, its implications, and the potential for a healthy pregnancy can provide reassurance and hope. What Is a Unicornuate Uterus? The uterus typically forms as a pear-shaped organ with two symmetrical halves that fuse during fetal development. In a unicornuate uterus, only one half develops fully, creating a smaller-than-average uterine cavity. This anomaly can occur with or without a rudimentary horn, which may or may not be connected to the main uterine cavity. If a rudimentary horn is present, it might cause complications like pain if it accumulates menstrual blood, as it often lacks a connection to the cervix or vagina. The condition is often diagnosed during routine imaging, such as an ultrasound, MRI, or hysterosalpingogram (HSG), typically when a woman seeks medical advice for fertility issues, pelvic pain, or irregular menstruation. In some cases, it's discovered incidentally during pregnancy or unrelated medical evaluations. How Prevalent Is It? Unicornuate uterus is one of the rarest Müllerian duct anomalies, occurring in approximately 0.1% to 0.4% of women in the general population. Among women with Müllerian anomalies, it accounts for about 2% to 13% of cases. The condition is congenital, meaning it's present at birth, but it often goes undiagnosed until adulthood because many women experience no symptoms. Its rarity can make it feel isolating for those diagnosed, but awareness and medical advancements have made it easier to manage and understand. Risks Associated with Unicornuate Uterus While many women with a unicornuate uterus lead healthy lives, the condition can pose challenges, particularly related to fertility and pregnancy. The smaller uterine cavity and reduced endometrial surface area can increase the risk of certain complications, though these are not inevitable. Below are some potential risks:

1. Fertility Challenges: The smaller uterus and single fallopian tube may slightly reduce the chances of conception, especially if the rudimentary horn or other structural issues interfere with ovulation or implantation. However, many women with a unicornuate uterus conceive naturally without intervention.
2. Miscarriage: The limited space in the uterine cavity can increase the risk of miscarriage, particularly in the first trimester. Studies suggest miscarriage rates may be higher (around 20-30%) compared to women with a typical uterus, though exact figures vary.
3. Preterm Birth: The smaller uterus may not accommodate a growing fetus as easily, potentially leading to preterm labor or delivery before 37 weeks. Research indicates preterm birth rates in women with a unicornuate uterus range from 10-20%.
4. Fetal Growth Restriction: The restricted uterine space can sometimes limit fetal growth, leading to low birth weight or intrauterine growth restriction (IUGR).
5. Malpresentation: Babies in a unicornuate uterus may be more likely to position themselves in a breech or transverse position due to the confined space, which could complicate delivery.
6. Cesarean Section: While not mandatory, a cesarean may be recommended in cases of malpresentation, preterm labor, or other complications. However, this is not a universal requirement.
7. Other Complications: Women with a unicornuate uterus may have a higher risk of endometriosis or painful periods, especially if a non-communicating rudimentary horn is present. Kidney abnormalities are also associated with Müllerian anomalies, as the kidneys and reproductive tract develop simultaneously in the fetus.

Despite these risks, it's critical to note that not every woman with a unicornuate uterus will experience these complications. With proper medical care, many achieve successful pregnancies and deliveries. A Positive Outlook: Normal Vaginal Delivery Is Probable The diagnosis of a unicornuate uterus can feel daunting, but it's important to emphasize that a healthy, full-term pregnancy and a normal vaginal delivery are entirely possible. Advances in obstetrics and prenatal care have significantly improved outcomes for women with this condition. Here's why you can remain optimistic:

• Personalized Care: Working with an experienced obstetrician or maternal-fetal medicine specialist ensures close monitoring throughout pregnancy. Regular ultrasounds can track fetal growth, position, and amniotic fluid levels, allowing for timely interventions if needed.
• Not Doomed to Cesarean: While some women may need a cesarean due to specific complications, many with a unicornuate uterus deliver vaginally without issue. The decision depends on factors like fetal position, labor progression, and overall health, not the uterine anomaly alone.
• Full-Term Pregnancies Are Achievable: With careful monitoring, many women carry their pregnancies to term (37-40 weeks). Preterm birth is a risk, but it's not a certainty, and modern neonatal care can support babies born slightly early if needed.
• Healthy Babies: Countless women with a unicornuate uterus give birth to healthy, thriving babies. The condition does not inherently affect the baby's development or genetic health.
• Support and Advocacy: Connecting with others who have similar experiences, whether through online communities or support groups, can provide emotional strength and practical advice. Knowing you're not alone can make all the difference.

A unicornuate uterus is a rare but manageable condition that requires awareness and, in some cases, specialized care. While there are risks to consider, they are not insurmountable, and many women with this anomaly experience successful pregnancies and vaginal deliveries without complications. With the right support, you can embrace your unique journey, knowing that a unicornuate uterus does not mean you're destined for preterm birth, cesarean delivery, or pregnancy complications. Instead, it's a testament to your resilience and the incredible capabilities of modern medicine to support you every step of the way.

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When a c-section birth is done with care and precision it can make all the difference in the healing and recovery for the mother. Operating the right way will also enable a woman to continue to have more pregnancies in a safe and secure way.

In this episode, Dr. Yaakov Abdelhak, a high risk perinatologist MFM specialist, lays out his method for operating in a c-section and includes what can be discussed ahead of time from a woman to her provider. What an opportunity as he reveals his unique method for conducting C sections step by step in this episode of The True Birth Podcast. He explains the best ways to perform the surgery to minimize the risking scarring, post-operative pain and complications.

Planning C-Section

[3:45]

No one thinks they're going to have a C-section until the time comes to have a C-section. Because the heart rate in labor may stop progressing, you won't have time to develop a C-Section when the time comes. It is something that needs planning, like a birth plan. Doctors, on the other hand, dislike being taught how to operate. However, they will tell you things that are entirely feasible and reasonable.

Plan C

[4:43]

When a patient is on the operating table, the personnel in the room, such as the surgeon and nurses, must take a timeout to ensure that everyone is on the same page and help the patient clarify the surgical case.

[5:48]

Before Dr. Abdelhak makes an incision, he uses a marker and draws a line about two inches above the pubic bone. Some people have a natural line that is sometimes faded or darker in pregnancy because of more melanin deposits.

Why Dr. Abdelhak has a marker

[10:31]

If you put a patient back together just a half-centimeter off on the skin, which has the most nerve ending and they're going to feel it, it's important to pay attention and make sure you get them back exactly the way they came apart.

Performing C-Section

[11:51]

Once you open up the skin, the next step is to now get through the subcutaneous fat. Most of the time, you take the electric cautery, and you burn down to the fascia so that you can see the fascia. The fascia is the membranous connective tissue that holds everything together. It's the linings of the muscles that come together in the midline. It's a white, very thick sheet that's holding your abdominal sheet. Cut down to the level of the fascia only in the midline with the electric cautery. Then bluntly separate the rest on the right and left with your fingers because what you're doing is you're pushing the blood vessels laterally instead of cutting them.

[15:06]

When you open the fascia, you have to do it in the same direction as you're doing the skin. Underneath the fascia is a muscle, and now you have to get through the muscle. Doctors learned that it is terrible to cut the abdominal muscles because it's better to pull them to the side. After all, there's a natural kind of separation between the two.

[15:45]

Pull the muscles to the side, stretching before you pull both sides. You have to separate that overlying fascial sheet from the muscles to the side. Then you enter the perineum that is holding all your abdominal content. Now you have exposure to the uterus. At this point, you are making sure that you have enough exposure.

[17:12]

Making a small incision on the skin is very important to have a good recovery. If you have a repeat C-section, you have to go more prominent because you need more exposure. If somebody has a repeat C-section, they might think about opening a larger incision. You have to make no incision on the uterus. Before you go inside the uterus, look at the bottom to make sure the uterus is not tilted to the right or left. It's essential to know that if it's tilted, you can end up cutting some blood vessels.

The Bladder Flap

[19:05]

The bladder runs directly over the uterus, and the perineum joins the bladder to the uterus and becomes the uterus's skin. There is a stage in between where it exits the bladder and forms the uterine skin. You can see on the uterus a potential space. You lift that space, you make a minor incision, you lift it, and when you push the bladder up and away from the uterus, you have more exposure to the lower uterine segment.

Opening the Uterus

[20:36]

When you open up the uterus, you have to be careful not to cut the baby. It would help if you had a "butterfly touch" whenever you are cutting through the uterus. You can use the suction, then use your finger, and you rub it. It will cause the cut to open up more rather than performing another incision.

[24:03]

The thick borders are critical because the uterine wall collected at the lateral edges is protective from extending the incision. So when you pull the baby's head out, if you have a sharp edge there, it's straightforward for the pressure or your hand and the baby's head to cause that sharp edge to elongate. When it elongates, it goes where it wants, usually towards the side and the uterine vessels, and then you get a lot of bleeding. But if you are careful and have thick borders, it's much less common when you pull the baby's head out.

Getting the Baby Out

[26:52]

You're trying to push from the top and shoehorn the baby's head out because you want the baby to come out, not just straight down. When you move on the top, you put your hand in to help guide the head out. You're shoehorning the baby out. Keep as much space as possible for the head and not your hand.

[27:44]

Occasionally, Doctors will produce a vacuum to assist with vaginal deliveries. This suction can also be used for C-sections. The vacuum is very nice as it puts on the head, and you can quickly bring the head out without having your hand in there. You can guide the head, and you don't need to have a big incision.

[28:31]

Once you get the head out, make sure the cord is not around the neck or reduce it, and then you bring the baby out ultimately. Clamping the cord can be done then show the mother her baby. Then give the baby to the nurses so they will dry and clean up the baby.

Closing the Belly

[33:25]

Once you get everything cleaned out, you look at the uterus again and make sure it's dry. If you created a bladder flap, don't repair it as it sits naturally there and heals fine. You don't need to put an extra layer of sutures.

[34:10]

You have to close the perineum because if you don't, you have a much worse adhesion. Failure to close the perineum will lead to many complications and can become messy in the surgery room, so it is imperative to close it properly to prevent that from happening.

[34:53]

If you have a cut edge, it's going to heal whatever is around it. If you put things together with the way they came apart, they heal together. There are areas of the uterine wall, which are still a little raw because you close it, or there are scrapings on the serosa. But just from manipulating the skin, it's going to heal to whatever it's touching.

[37:02]

Do not simply contract the muscle. What you're doing is you're taking sutures, and you're bringing the muscle to the midline, and you're switching the right side to the left side every two or three centimeters. Many women have had C-sections. The muscle was never re-approximated to the midline. Then they have abdominal diastasis, where instead of having a flat belly, you have this pouch right in the middle that bulges out because your muscles are not working to hold everything in nature.

Using Needles

[41:19]

When you use a straight needle, you're holding the needle with your hand just like you're sewing. When you use a curved needle, you're using a needle holder.

Not every C-Section method is the same.

[41:45]

There's not a recipe to do C-sections. Understand that there are many optional steps and different ways to do this. If you understand the difference between a human being and a monkey, it's about 98% the same DNA. That 2% difference is a lot. Somebody else would only consider that 90%. But that 2% makes a huge difference as far as recovery and other factors in the body.

Scarring

[43:32]

Patients hate the scar from C-sections. They would look right at fascial skin incisions as unfavorable. However, there is a way to get rid of the scar, but it takes time. However, you finish up with a cosmetic scar concealed. That is why a Pfannenstiel incision is used in 98 to 99 percent of C-sections since it is considerably more preferable to a woman who does not want a scar.

Things to remember

[46:01]

Minimize the skin incision as small as you like. Then close the perineum. Then bring the muscle to the midline with a suture and get the right side to the left side to avoid being marginalized.

[47:33]

Make sure that you ask them to make a minimal incision on the skin. Ask your surgeon to close the perineum and bring the muscles to the midline. Those are crucial things.

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In this podcast we shedding light on rare and complex obstetric conditions that impact pregnancy and maternal health. Without the need for unnecessary alarm, which can happen in pregnancy, we dive into challenging medical cases, exploring the science, emotional weight, and real-world implications of conditions that are often under-discussed. Connect With Us:

• YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources.
• Instagram: Follow us for daily inspiration and updates at @maternalresources.
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Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com.

First vs. Second Pregnancy: What to Expect According to Birth Experts

Having attended over 10,000 births together, experienced Dr. Yaakov Abdlehak OB/GYN and certified nurse midwife Kristin Mallon consistently observe differences between first and second pregnancies — both in the body's physical response and in the way care is personalized.

1. Labor tends to be faster in the second:

• In a first pregnancy ("primip"), the cervix, uterus, and pelvic floor are going through this process for the first time. Labor (especially early labor) is usually longer because the body is "learning" how to stretch and open.

• In a second pregnancy ("multip"), the cervix and uterus often respond more quickly. Labor tends to be shorter and more efficient — sometimes dramatically so.

2. Physical symptoms show up earlier in the second:

• Many women "show" earlier during the second pregnancy because the abdominal muscles and ligaments are already stretched from the first.

• Common symptoms like back pain, round ligament pain, and pelvic pressure may also appear sooner.

3. Confidence and mental preparation are different:

• First-time mothers often seek more reassurance, detailed explanations, and frequent check-ins because everything is new.

• Second-time mothers are often more tuned into their bodies, more trusting of the process, and ask for more autonomy. They typically want care that respects their previous experiences — whether that means avoiding past mistakes or replicating positive memories.

Tune in and listen as these two experts dive into these and other topics, sharing real-world insights, practical advice, and what every mother should know for her first, second, and beyond.

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In this special episode of TrueBirth, Dr. Yaakov Abdelhak, a board-certified OB/GYN and Maternal Fetal Medicine specialist, relays his inspiring story of how he founded Maternal Resources in 2002. From a solo practice to a thriving multi-location center of excellence with 4 physicians, 3 midwives, over 30 dedicated team members including sonographers, physician assistants, nurse practitioners, billers, and administrators—Dr. Abdelhak shares how he scaled a vision rooted in compassionate, comprehensive maternity care into one of the most trusted women's health practices in the region.

Connect With Us:

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• Instagram: Follow us for daily inspiration and updates at @maternalresources.
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Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com.