Speaker 0
Welcome to the Free Birth Podcast, a supportive space for people who are learning, exploring, and celebrating their autonomous choices in childbirth. Together, we'll unpack truths, share personal stories, and claim our ability to birth freely and intuitively. Here's your host, Emily Saldea.
Speaker 1
Today, we are joined by doctor Eden Fromberg, an OB GYN from New York who, get this, truly supports female autonomy, self authority, and even free birth. Doctor Fromberg shares her story of coming into OB GYN and being appalled at what she saw in the system, Witnessing abusive games and sexualized violence in the medical field. It became a mission for her to finish her training and present another way for this field to quite literally operate. I should state before we dive in that this episode reveals some incredibly sick and upsetting stories about doctors abusing women. Perhaps, if you are blissfully ignorant to the dark nature of obstetrics and are already choosing to not use the medical paradigm, you may consider skipping this episode.
Speaker 2
Well, my story really begins with my own birth because my mother, she chose to have a natural childbirth in nineteen sixty five when that wasn't a choice that any of her peers were really making. It was pretty unpopular actually. And she had miscarried the baby before me. So she actually had a lot of fear around birth. But, so she negotiated to have her glasses and her watch and who who who she was breathing. And, I ended up being born with no doctor or obstetrician present because they really actually didn't know how to figure out when she was giving birth. They were, rushing her down the hall in a stretcher. So I heard these stories as a child growing up, and I thought, wow. Where was that obstetrician? And I became very interested for reasons that I didn't fully understand at the time in birth, in women's bodies, in my own body. I had various experiences as I was growing up that reinforced that such as when I started to have vaginal discharge when I was around eleven years old. And I asked my mother about it, and she didn't really have too much to say about it. So we went to the pediatrician, and I was put on a muscle relaxant, which I refused to take. And I was given an antibacterial soap, which I used a couple times, but it didn't really seem to be doing anything. And I got yeah. And then I got my period. Right. And so, you know, a few years later, as I started to read different books, I started to oh, oh, that was normal. That was the mucus that had to do with my fertility. You know? So what happened was I was kinda a bit hippie in high school. So my mother brought me up vegetarian. We come from a big tradition of vegetarianism. So there was this sort of alternativeness. You know, I mean, my mother did have natural childbirth with me against all odds, but, you know, she only took it so far. So, of course, when I'm seventeen, I hitchhike out to a rainbow gathering, and I meet these women who are carrying around all the books like, spiritual midwifery, Suzanne Armes' books, immaculate deception, Margaret Nosicker's book, the cooperative method of natural birth control, and Janine Parvati's book, Hygiea, women's herbal. And so those books and those women kind of became the people who are inspiring me at the time, and I realized that there was another way. And I went to Oberlin College, which should be part of Oberlin College. It's kind of intellectual yet quite alternative at the same time. And so, there were actually people we we had a, alternative women's health group, and people were going off and working with midwives in Brownsville, Texas and different things like that. So I, I got some speculums. I got them from my local gynecologist who laughed when I suggested taking a mirror off the wall to take a look at what was going on and sort of like, you know, yeast. So, so I just think I was like, vaginal politics. I was reading these different books. I started to look at myself with a mirror, and a light, with the speculums that I got. And, we really just started to learn ourselves. You know? This was in Oberlin, Ohio when I was seventeen, eighteen, nineteen years old. And so that really started me off in taking an interest in helping other women. I come from a very, academic Jewish background where, you know, it's like going to medical school and becoming a Jewish doctor is, like, you know, a great thing. And so my mother really encouraged me. She was like, oh, you know, midwifery. Yeah. Naturopathy. Yeah. Like, she was interested in natural childbirth. She was interested in naturopathic medicine. I mean, my first doctor or pediatrician apparently had been a naturopath. She breastfed me and all these kind of things. But somehow, you know, there was this sense that you have to be careful. Like, you know, we're immigrants. We can't, you know, stir things up in the society and culture too much. We won't be successful. We'll be judged. You know, we have to be small. We have to not be noticed. And so there was, like, this this struggle even in my own path of, like, well, how do I succeed? How do I fulfill my mother's dreams for me? And at the same time, honor clearly what even her own behind the scenes true, inclinations and orientation is.
Speaker 1
Wow.
Speaker 2
So that's where it all started, and I had a lot of academic support. And that led me to Santa Cruz, California at the age of nineteen on purpose, of course, because I had heard about midwifery. So I thought, thought, oh, I wanna go out to Santa Cruz. I need to get some credits for my pre med. So why don't I do that out in Santa Cruz where I can, you know, try to meet some midwives and see what's going on with home birth because I really felt, you know, you know, let's let's see. So I went out to Santa Cruz and, I did meet some home birth midwives and they encouraged me to go to medical school. So, yeah. So I was in Santa Cruz, California finishing up, some biology credits towards my degree. And the Santa Cruz midwives and I connected, and they encouraged me to go to medical school because they felt like, wow, you're young, you're smart, you're capable. We would love somebody like you to back up people like us. And, I had some misgivings about it because I thought it would be a really hard path, but my mother was very, very supportive of that path. And the academic achievement was very, very important to her being an immigrant. Like, she her mother had only gotten a, education up to about third grade. She had to apprentice to a wig maker where she took individual strands of hair to make wigs. So, you know, there was this sense of, like, wow. You know, you have this opportunity to go to medical school and be the first person in our family to have this achievement. You really should do it. And what's really funny is that on the other side of my family, I hear that my grandmother had been a midwife. I don't think that she was a very independent midwife, but I think she did work in childbirth in New York City, you know, in the beginning of the nineteen hundreds sometime. And so, so, yeah, so I decided that I would go to medical school. And, yes, it was a really, really, really hard path, especially because I went for the purposes of doing something different. You know? I wasn't there to be indoctrinated in that system. You know?
Speaker 1
Interesting. So so do you feel like you chose the the medical path because of what you just articulated about your family and and almost the cultural pressure? Because it seems so challenging to go into the system not really ready to be with the system.
Speaker 2
Yeah. Well, I think that I had a sense that, I had a mission, and that that mission was to empower women who were giving birth in ways that my mother sort of, like, took that power for herself and kind of got lucky because I came in an hour and a half, and they didn't have time to really do anything. And my sister came in twenty minutes. Me and my mother had it all figured out. She's good at that. But I knew that in my life, I wouldn't necessarily be so lucky. So, so I mean, there was but I think that, yeah, I had a mission and a passion, and I didn't actually, at the time, know where it came from. But I remember sitting in the back seat of the car. Me and my sister and my mother would be like, what do you wanna be when you grow up? I wanna be an obstetrician, and I wanna be an osteopath. And I ended up actually becoming both. So it's but, no, it was really from a sense of wanting to help and empower women. It was some of those books that I had read, as a late teenager, like the Suzanne Arms Immaculate Deception. Big time that book influenced me. Big time anime's books influenced me. And I felt this is really an important thing and, you know, somebody has to really support it. And I felt like, you know, I guess everything is pointing to that I, you know, do this. So I really felt that I went into it with a sense of purpose and mission. And I actually didn't know for sure that I was going to be an OB GYN. I actually thought maybe I would be a family practitioner, but at least give me some power to be part of birth. And I was aware that family practitioners could go to some special programs where they could learn c section skills. And there's actually a family practitioner in the area where I am now in Columbia County, New York that I think does that. So, yeah. So I had all kinds of ideas going into it, but, of course, those ideas changed radically when I did go through medical training. And, you know, I I woke up to the reality of it, which was both better and worse than I could have ever dreamed.
Speaker 1
So, yeah, take me there. So you're going through the schooling and what about it are you realizing is better and worse than you could have dreamed?
Speaker 2
Okay. So reading books like Immaculate Deception, some of the practices that were discussed were not still being done. So when I was in I started medical school in the late eighties. So, like, you know, eighty six, eighty seven. So I was kind of getting into the hospitals by, you know, maybe eighty eight, eighty nine, let's say, and seeing what was going on there. And what it was is that I was in inner city Philadelphia. The doctors who were the doctors in some of the hospitals that had the highest volume of OB were from places like Africa and other parts of the world. And the patients were from places like Puerto Rico and Vietnam and other parts of the world themselves. It was also the height of the crack era. So a lot of the, patients were teenage girls, like, literally fourteen to sixteen years old, high on crack. And it yeah. So it was a very, difficult situation, but it was very high volume OB. And I got really lucky because the resident who was my supervising resident when I was as a medical student, He had worked as a family practitioner in Texas, and he had backed up secretly home birth midwives and had told me stories about, like, eleven minute shoulder dystocia home birth transfers in the hospital parking lot that he successfully, you know, resolved. And so some so, basically, as a third year medical student, I was given this information and experience. I mean, he was like, yeah. Sew up everybody you want. Do vacuum extractions on everybody. So I got this sense. Oh, I'm kind of good at doing all this obstetrical stuff that I really thought that, I wouldn't be very good at. And, I can do this, and I can do it in a different way. And after I learn how to sew up people, I can learn how to not sew them up. Right. And so after a while, you know, they stop looking over your shoulder. And so somebody let's say, Prima Cara having her first baby, nine pounds, four ounce baby, not a single tear, and it's her first baby. Well, that's supposed to be impossible. Of course, you have to cut an episiotomy on everybody having
Speaker 1
their
Speaker 2
first baby. But once the doctor looking over your shoulder saying that is not standing there looking over your shoulder anymore, you can just kind of not cut the episiotomy and say, wow. Look. You didn't have an episiotomy. You didn't have a tear. I was able to support the perineum. What a miracle And realized that this could be done. So I basically made my training somewhat of a laboratory for alternative methods of birth that I had read or heard about because it actually seemed to be something that some of the women preferred, and they were actually being really mistreated and abused and slapped around by these doc. You know, mostly, I have to just admit, the nurses, the obstetrical nurses as is often the case in situations where it's low socioeconomic or rural or where people aren't paying as much attention. The nurses are really calling the shots, running the show. You, like, yo, don't listen to your supervising attending. He doesn't know what he's talking about. Get in there right now. Mhmm. Yeah. So that and some of them were likely midwives. I mean, who knows? But that
Speaker 1
would Did you get any flack for, you know, when they would would peek back over and you weren't cutting episiotomies or you weren't using vacuum and or was it just like, oh, wow. Cool. Glad that worked out.
Speaker 2
Well, you know what? They would pretty much yell at you all the time for essentially nothing or everything. So you kind of got I mean, when you were going into a room and the patient was clearly Asian or Vietnamese and your Nigerian attending was saying, hola.
Speaker 1
Oh my god.
Speaker 2
Oh, come on. You know? It's like they couldn't even
Speaker 1
Oh my god.
Speaker 2
They I mean, so there was there were there were enough issues going I mean, then you would hear rumors that they
Speaker 1
failed their boards for time. Yeah. So, you
Speaker 2
know, I also was at hospitals that were, you know, much more, you know, educated and outstanding. Thank goodness. This was not my only training experience. But, yeah, the situation
Speaker 1
important for you to have that reference because a lot of hospitals are like that.
Speaker 2
Oh, yeah. And I would I felt like at some point, I would have to sometimes protect the women from the attending physicians as strange as that may seem. But the issue would be that they would be high on crack, and they would be moving around a lot, and the fetal monitor would not be picking up the baby's heartbeat very well. And this would freak out the attending physicians to no end because if you can't get a good heart tone, you have no defense in court was how they looked at it.
Speaker 1
Mhmm.
Speaker 2
And so they would practically be tackling these women and wanting to strap them down. And we actually were part of the Philadelphia prison system. And so some people were strapped down, and I would I would really try to get them unstrapped. And But even
Speaker 1
if they weren't high on crack, I mean, any woman who is not numbed and drugged is gonna be moving around while being monitored. Like that's a really normal encounter with fetal monitoring that they're constantly falling off if you're, you know, just being a a normal birthing person.
Speaker 2
Yeah. I agree. And in that situation, it was not progressive at all. It's funny because there was hospitals at during the same years that I was in my residency that it was, like, night and day. Like, there was another hospital that absorbed the Booth maternity midwives and patients from, you know, it was basically a hospital that was run by midwives, and they only had two rooms that did c sections. And it closed while I was there. And so what some hospitals were completely, like, pro midwife, pro, like, double breech, vaginal births, and other hospitals were, like, the one that I just described where it was, you know, very inner city, low socioeconomic, and people played games. I mean, there were doctors there who okay. They would they would shower and shave in the resident's call room, put on their little red underwear, and, you know, he would be going out to lunch. They there was a doctor. I have to just say this publicly because it needs to be heard. I did not see it, but it was told to me. They there was this sense that, poor women, women on Medicaid, women on crack, teenagers, that they really didn't deserve to have more children. And I didn't think this, but I certainly saw that my attending physician sometimes thought it. And what they would do during a c section is they would, quote, explore the woman's fallopian tubes, which would mean that they would take hemostats, and they would crush the woman's fallopian tube Oh my god. Illegally, illicitly so that they would have ectopic pregnancies or not be able to conceive in the future because they thought that they could be that person and make that Yeah.
Speaker 1
That is not the first time I heard that, but that is that invokes a level of rage and overwhelming feelings in me that I can't even articulate. Yeah. I mean, I was just I was just reading.
Speaker 2
How as a medical student, I I felt that it was a mission for me that I had to go through this training and come out the other end and present an alternative to people.
Speaker 1
It's so interesting because it's like, on the one hand, yes, of course. And why isn't everyone in alliance with that? I mean, how how are you this rare duckling when everyone else, or at least the vast majority, are instead becoming indoctrinated into this abuse and into this violence. And and then they go on to be those people too. I mean, it's it's insane. It's absolutely insane that you are such a rare, such a rare person in this profession that you would see that and be appalled and further your mission to to, you know, provide alternative care. I mean, that's it just says so much. It says so much. I was just reading an article about, these anesthesiologists that just went to prison, just got outed for, molesting the women when they were unconscious, and that these women were having vague memories, real foggy memories under sedation, later that these memories would come back of a penis being on their face or holding a penis. And finally, they this particular anesthesiologist got, caught and he's in jail. But, it's just such a I mean, you know, like, why are people surprised that women want a birth outside the system? These are not, this is it's just such a big deal. That I mean, yeah.
Speaker 2
There No. I want I wanna speak to this because I was lecturing in Woodstock the other day about pelvic floor and sexuality, and a woman asked, she said, do people, do people have this experience where they remember things when they were under anesthesia? And I didn't know at the time why she was asking, but I wonder if she heard what you're talking about. And what I would say is that when I see and hear people do and say things when people are under anesthesia, I discourage that because I've heard of this. And because in medical school, one of the doctors who trained me, his wife woke up under anesthesia or knew what was going on. And, it it's terrible.
Speaker 1
Oh my god.
Speaker 2
I've had, no. There were residents who I trained with and they would say things like, spread your legs, bitch, when the woman got her anesthesia because her legs were stiff. Or they they would say, oh, she's total shit because she had no prenatal care. You know, just judging
Speaker 1
Just somebody.
Speaker 2
Is so intense. That was gone. Yeah.
Speaker 1
Yeah. Totally. I'll send you the article that just went around. It was, quite appalling. And, yeah, I mean, you you were there firsthand to see
Speaker 2
And I was actually you're not gonna believe this. So not that long ago, in an operating room in New York City, an anesthesiologist told me that at another hospital where he works, that when, a neurologist was trying to wake up his patient, he would tweak her nipple. Ew. And I said, are you he said that I he said, I warned him that he could lose his license if he's, you know, identified that he better not do that. I'm like, yeah. You better warn him. You might wanna you know, I I couldn't believe that this is still happening in this day and age.
Speaker 1
Well, and this goes into a whole another conversation that I talk a lot about with with my colleagues around, the perversion of men being in the birth world. And we get a lot of flack for this, but I cannot wrap my head around with stories like that. I cannot wrap my head around where it is appropriate for there to be a male OB GYN, because you can bet your ass women aren't doing that. Women are not molesting other women under anesthesia. You know, and that this is this is just, like, a thing. That the power and the perversion around women's bodies and the power when they're sedated or they're in control or they're cutting them open. I mean, we we we don't talk about this. And this is so, so, so inappropriate. And that, you know, the vast majority of people totally get away with it. Even on lesser levels, even just simply, you know, forcing c sections and then those few cases that go to court, you know, it always falls to, well, the doctor did everything he could, the doctor is the authority, you know, the the little lady doesn't know anything, you know, that's that's how our culture treats women and that's how our cultures treat doctors, you know, that they're they're the gods of of our society and, anything that is done to them even if it's violent, even if it, you know, leaves a birth injury which is so common. You know, it it was, of course, under the, oath that they were doing everything they possibly could, you know. And I've seen as a as a doula in Los Angeles, you know, I don't need to go too far into this because you are not gonna be surprised by any of the horror stories I have, but, you know, I've been to births where, a woman is pushing and the doctor comes in for the first time with the vacuum already in her hand. And she, you know, one of them, she she looked up at my client, my friend, and said, I have to pick my daughter up at four thirty and vacuumed the baby out and ripped her to her anus and, was awful and just awful. Shamed her and, blah blah blah and was out the door by, four four twenty or whatever it was. And, you know, that was one of my last hospital bursts because I was like, okay. Cool. I think I have seen enough here.
Speaker 2
I actually have a story that was published years ago on Midway Free Today, one of their q and a or something. But it's exactly that story where, you know, I'm standing there. The mother's pushing. She doesn't get the epidural that she was promised because she's a rich lady from the suburbs. So clearly, she deserves an epidural according to her doctor. And then he rides in practically on a white horse, I might add. And the baby is crowning, and he needs to step in and put on a vacuum extractor and force the epidural on her and rip her into her anus.
Speaker 1
Yeah. And that's the thing I want people to understand who are listening to this. You know, this is not, I am I am angry at the system because of this. You know, there there are so countless, endless, infinite stories around this. The stories we just shared are normal and common. These are not, you know, one offs at all. And so, you know, some people will contact me and really not understand what I'm doing or why I've chosen to leave the system or, or why I'm supporting women to birth outside the system. But, you know, and I think some people would credit, you know, your voice over mine because you are an OB GYN and you're, in a way, at least presumably part of the team, you know, and part of the system. And so it's so powerful for you to be speaking out about this in any way that you can through this platform and others because you're you you have nothing you have nothing to gain in the system by by speaking the truth of what you're witnessing. And and, of course, it's just as a woman witnessing fellow, you know, women be violated aggressively on a regular basis because I already know what's happening in the in the hospital system. I've seen women be held down and be raped with instruments and fingers. You know, I've I've seen stuff that still haunts me to this day and it it always will because it should. It should haunt me. Right? Because it's absolutely horrific. So okay. But let's go back to your story. So you've gone through school and residency, and now talk to me about your practice and and just the course of that in the, yeah. Just I'm so curious. So you've gone through schooling. You're done. And now what do you do?
Speaker 2
Okay. So one of the things that I did during, my medical, rotations was I did a rotation up in the area where I am now in upstate New York with a practice where the obstetrician, who was the chief OB at the hospital, was married to a home birth midwife. And, there were home birth midwifery in the practice. So I went and worked with the practice as a medical student, and I hung out with them, went to births with them at the time. Basically, you know, went to all the prenatals with the midwives. So I learned how to do obstetrics in my very first OB GYN rotations from a doctor who had backed up midwives and then another doctor who was actively backing up midwives in a midwifery positive practice. And so then after I graduated from my residency, I went back to work in that very same practice. And so the first two years after I was out of my residency, as I was getting my case load for my boards, I worked in that practice. So I became one of the two obstetricians who was backing up the two midwives. And the way that we had it organized was that there were two other OBs in the area. And our practice, all of the first call was one of us. Even if it was one of the other doctors in town backing it up, it would be the midwives taking first call for all the births. So all of our patients had the choice of home hospital or birth center, although his malpractice changed and we had to sort of cut doing home births only just because we couldn't get coverage. So again, the system rears its head and changes how you're able to practice. Mhmm. But that anyway, that being said, the the birth center was a, an attic room that you had to climb up, like, a kind of ladder to get to. And there was, you know, rocking chairs that you had to take the seat out of, and you could pee in, like, a bucket underneath. And it was very, very rustic and beautiful and amazing and deer out the window. And that was also our office. And so I worked in that practice for two years backing up midwives and driving all over at Hudson, Catskill, Woodstock because we had three offices. And, it was a wonderful experience, but it also, you know, took a lot out of me. You know? So I really it was very difficult and hard on the body. Yeah. It's full on. That. Mhmm. Yeah. It it really was. But there were experiences like this. So the way that we would do VBACs is if somebody wanted to have a VBAC, they would, be required to have a heplock, but sometimes they would refuse the heplock, in which case we would document refusal of the heplock. And I remember VBACS where I would be on and I do I do a lot of yoga and there's a reason for it because I don't think I could have continued to do OB if I didn't do yoga because there were all kinds of pretzel positions that I would find myself in as part of doing obstetrics and doing deliveries, and then I would have to find my way out of it. So So in any case, I would sometimes find myself with sheets on the floor, on hands and knees, with, the patient squatting or being supported under her armpits by somebody else. And then, you know, catching the baby that was slithering out in that position and all kinds of other scenarios. And, so, yeah, I was very, very open minded. I had a lot of faith in the birth process. I was very, open, and supportive and had a lot of energy to help people. I felt that I had a lot of support from the practice that I worked in from the male doctor who was my backup and support. We had things like low dose pitocin protocols where we would up the pitocin. Like, the the half life of pitocin is forty minutes. We would not up it more than, like, point five every forty minutes to an hour, giving people plenty of time to change. Whereas during my residency, there were times that they would up it so quickly. Like, one every fifteen minutes until some or they would double it, and then somebody would be having tectonic contractions and fetal distress. Literally, that never happened in our practice in upstate New York. And the other thing that we would do is we would actually, we would follow guidelines that would say that we could go to forty three weeks before we would have to induce and that we would go to forty one weeks before we would start to have to do biophysical profiles and non stress tests. And so we were following valid guidelines, But some other docs and in more urban areas, what I was seeing is they would see a study that would say, oh, you know, there is more morbidity and mortality after forty two weeks. So even though we're going to be doing a bunch of unnecessary cesarean sections, we don't really care about that. We just care about whether we get sick at the end of the day. But what I would do is well, here's an
Speaker 1
Well, anything for another c section, I mean, how much easier is that?
Speaker 2
Yeah. So we would have a patient who she had already given birth. Her baby was over eleven pounds. It was a vaginal birth, and she was fine. And her sisters did the same, and her mother did the same. And her mother's, birth, pregnancies always went to, like, forty four or maybe forty five weeks. And so here would we be at forty three weeks saying, you know, you're forty three weeks now. The baby seems to be estimated fetal weight of eleven pounds nine ounces. We really should induce your labor now.
Speaker 1
And
Speaker 2
she would say, no. Thanks. And we'd say, well, you know, but all the guidelines say, no. Thanks. Mhmm. So we would what would we do? We weren't going to bully her. We weren't going to berate her. We weren't going to alienate her and make her feel judged. We were going to just share with her what the obstetrical guidelines and protocols were. And if she refused, we would document her refusal. And when she came in at forty four and a half weeks and delivered the twelve pound baby with, you know, and everything was fine vaginally, we would document that too. And I'm not saying that every scenario is going to turn out fine like that. But, I mean, we aren't going to be sending somebody to her house to arrest her. I mean,
Speaker 1
it's just And that's and that's not the point about everything turning out fine. The point is that the woman gets to decide and that you were doing the radical notion as a doctor of honoring the woman's right to refusal of your guidelines. And that is almost completely unheard of, you know. So it it doesn't matter. It doesn't matter if it's if it's a good outcome or not. Ultimately, of course, it matters. I don't mean to say that that that's a casual thing. It's that you are not in charge of this woman's choices, of her mothering, of her choice to induce or not. All you can do, as obviously you know, is make recommendations based on your experience and your education and your knowledge and your licensing, and then the woman does what she does. So I wanna
Speaker 2
get sued. And that's where the problem
Speaker 1
came in. Exactly.
Speaker 2
And that is where the problems came in for the practice that I'm talking about because, literally, there was, an incident before I started to work there probably between when I was the med student or maybe right around that. But, they had they had been doing primate breech delivery. So, you know, first time mom having a breech birth. And, there was a outcome that didn't turn out well. And even though they gave the woman complete support and, everything seemed fine between them, of course, one thing leads to another, and she did eventually sue. And, you know, when you realize that So she
Speaker 1
had used she had exercised her right to refusal, had a bad outcome, and then sued.
Speaker 2
Yes. And that made it difficult
Speaker 1
for them
Speaker 2
to feel that they could ever do a vaginal breech birth for somebody having their first baby ever again. And in fact, it made them feel that they really couldn't do breech births ever again at all. And this is where we get into standards of care, you see, because we as obstetricians, if nobody else in our profession in the region that we practice in or nationally in one of those American College of Obstetricians and United Colleges guidelines, you know, if there's nothing to back us up, then we're out on that limb. Things don't go our way. We're going to get sued, which is exactly what happened
Speaker 1
to me. Suicide. Yeah.
Speaker 2
And that's exactly what happened to me after two years in upstate New York. I went to Bali, and I worked with Robin Lim, and I did home birth in Bali for a year. And when I came back, I, had a job in a hospital in a suburban area where it was basically like epidurals and paint your nails and watch videos and labor kind of scenario. And they would yell at me, like, why aren't you giving her an epidural while she's pushing? Because she can't feel anything and she can't push. It was just a very bad situation and there ended up being a, uterine rupture because the nurses pushed the baby up with a c section scar when I was trying to explain to them that that wasn't a good idea. And, you know, it was completely all they tried to put it all on me because I was the weird doctor who had worked in Bali and ate tofu. And Mhmm. Then they figured out that the nurses were sisters and their case fell apart. But
Speaker 1
And and to go back to
Speaker 2
to the
Speaker 1
and and with these stories, the other huge problem that it creates is that when a woman exercises her right to refusal and then has a bad outcome and then turns back and says, never mind, you guys should have made me do this, or you it really was your guys' responsibility, What that then does is perpetuate this whole culture that says we shouldn't trust women. And so, if a woman is going to take responsibility for her choices and not follow recommendations and not, you know, choose for management and actually stand in her own, choices for better or worse, to then turn around and blame the system that they refused is so problematic on so many levels because it absolutely, proves this cultural narrative that we can't allow little dumb women to make our own decisions. We don't know what's best. Right? Because then look what happens. Look what happens when we give women this freedom. And so it's it's I get what you're saying. It's just, it's so complicated. Yeah. I find it very complicated because, I taught at the midwifery today conference at
Speaker 2
the end of April, and I met a lot of midwives who are not licensed. Some of whom were co teaching with me as a matter of fact. And many of their, many of the people that they serve are Amish or Mennonite or plain folk or orthodox Jewish or people who come from a specific background where maybe they're less likely to sue because they're so committed to that. And it's but it's not like we should have to screen or it it becomes very difficult. You know? It's like, who are our communities, and what does that mean? You know? It's like, I've been working in New York City a lot and in upstate New York. And, what I noticed is, after the business of being born came out, the film, it inspired a lot of people. But I I often wondered, and it was even, you know, talked about in the media. It's like, you know, is home birth trendy? And, you know, it it talks about that people really do need to have a certain level of understanding, I think, in commitment and to really being in their bodies and understand what they're doing. And it's like you can't just do this, like, well, you know, if everything goes okay Exactly. You know? Yeah. Yeah, you have to really be all in. And I think that for me, I was aware going into obstetrics, I would be a person who would be all in. I wanna be there for the people who are all in, but I'm also aware that not everyone is all in. And I'm also aware that there's a system that really would love to just take my license if I am not careful. And so I find the best ways to support without doing things that I think will be really dangerous for me because, you know, the system can really burn you, and you have to really be aware of that.
Speaker 1
And I know this is kind of, like, ignorant, but isn't the whole point of documenting right to refusal isn't the whole point of that to that that does that in theory would protect you?
Speaker 2
In theory Right. Which is but I'll give you one example that I'm thinking of. There is a woman who drank alcohol to excess in her pregnancy. There's actually something I saw on social media this week about alcohol in pregnancy, I think, where they're like, oh, come on. It's not a big deal. Why are people so judged? And it's like, well, actually, a little bit of alcohol does make a difference to your fetus's brain development. But, like, you know, who would be who would I be to make you feel judged? But the fact is there was a woman who was drinking heavily, and her obstetrician told her, hey. You're we really shouldn't drink during pregnancy. Your baby could be mentally retarded. Your baby could have fetal alcohol syndrome. And guess what? Her baby did have fetal alcohol syndrome, and her baby was mentally retarded. Oh. And she sued the doctor. What? Because and she won because the doctor hadn't emphasized it enough. So it's really difficult when you get to
Speaker 1
this It actually it's more than difficult. It's impossible. This is not this is not a dynamic that's ever going to work or win. It's it's it's it's impossible. It's absolutely impossible. I I wanna go back
Speaker 2
who will not even discuss home birth, even though they may be mildly supportive or think, you know, everyone should be able to make their own choice. They will not discuss it with their patients because they are afraid of what other obstetricians and others in the profession would say or think or what it would mean for their license. Because, I mean, you know, Frank Chervenak, he's, he's the chair of OB at a hospital in New York, and I think he's he's part of the editorial board of the Grey Journal, American Journal of Obstetrics and Gynecology, and I believe that he's had articles out. Ina May has showed me these articles, Ina May Gaskin in which he basically says, hey. Home birth is not a valid choice. We should not be discussing it as if it were a valid choice. We should be actively discouraging. And any doctor who wants or OB GYN who wants to discuss this with their patients should really have their license examined. And I won't stop talking about it because I think it's ridiculous and that that's just an opinion Of course. That he happens
Speaker 1
to have. There's another opinion, though.
Speaker 2
I can't talk about it.
Speaker 1
Yeah. No. I mean, the culture yeah. The obstetrical culture of colleagues runs deep. I mean, even even, you know, doctors who would otherwise support VBAC or even Breach, you know, they can quickly get, shut down in a community. And and that's what this is really about, is pitting people against people when a when a person when a trained medical person has to and is trained to, and quite frankly, it's smart to protect yourself and, practice conservatively and not be outright supportive of, alternative ideas or or concepts, all under the very real, very real, you know, notion that they they need to prepare if this goes to court. How is this gonna look? You know, it gives so much context to what we see and and what we hear and and all of these, you know, horrific stories and lines that people come back to me and and share. When you see it from this other perspective, it's like, what do you expect? You're literally if you choose to engage in the system as a pregnant woman, if you choose to engage with an OB, you are choosing to engage with somebody who could lose their license if they x y z. And so it just becomes an impossible scenario to get what you want, quote unquote. If what you want is to do anything outside of their recommendations, then it's already a losing battle because it's gonna make the OB uncomfortable and and the nursing staff and, like you said, I mean, even just the continuous monitoring for for liability reason. Like, there are cases exactly like you're saying where women turn around and say, you know, in so many words, this was still your fault. Even though I refused. Even though I was exercising my legal rights, this is still your fault. And sometimes they win. And those are the exact reasons why this is an impossible dynamic. And and I think I think women who are choosing to engage in obstetrics should have context for this because, you know, this wouldn't surprise you. But I can't tell you how many women I talk to who say, you know, I'm gonna have a natural birth at the hospital. My doctor is totally cool with it. He or she said, yes to everything on my birth plan, and then, obviously, no surprise, they get there and everything's turned upside down, and they wind up with whether it's an induction or a c section or or a highly medicalized birth that they never anticipated, but they are engaging in a system that is only set up for that. If you escape a highly medicalized birth in the hospital, you are one of the few, and you're very lucky. And that was a perfect storm of situation, that you got that. That's not that's not normal.
Speaker 2
I think that it's amazing that you're saying this because I think a lot of people don't believe me when I tell them this. I actually have people who review me who are like, oh, she's biased. And it's just like, no. I'm actually not biased. I'm just the only person who's telling you the truth. Well, what
Speaker 1
does bias even mean? Like, you're biased towards helping women?
Speaker 2
The other obstetricians aren't biased. Like Right.
Speaker 1
Exactly. Everyone's biased. We're all biased. Of course.
Speaker 2
You just get a few opinions, and you'll notice that. But, no. So let me tell you what Even going to somebody like me before I had certain experiences that made it kind of impossible for me to continue to do obstetrics in hospitals anymore happened. But let's just say So, you were coming to me in my heyday when I was, you know, delivering babies in hospitals, when I was delivering babies in the birth center, where, I My way of backing up midwives because I couldn't do it officially was to say, well, you know, I'm seeing the patient. You're seeing the patient. If she's thirty four weeks and in preterm labor, you come in with her and be her doula, and, you know, we're all having a party in that context instead of the home birth you know, it just gave me more continuity with the people who I was serving and the moms. And so, so even in that situation, this is an example. I get a call one o'clock in the morning and, you know, it's you know, you know when it's time to go in. Contractions are close enough together, water's broken, whatever the case may be. And I call the hospital. Okay. I have somebody coming in to use the birth center. We don't have any nurses. I mean, what do you mean you don't have any nurses? Nah. We don't have enough. Somebody called and said. So I'm like, but she has been waiting nine months to use the birth center. We need to have a nurse freed up to go and help in the birth center. And so, you know, at this point, I'm already stressed out. My heart rate's up. I'm not sleeping. I'm not on my way to the hospital, and I'm calling administrators and at home and getting them out of bed and making them very upset with me and calling nursing supervisors and having them page. And this is taking me an hour to an hour and a half to accomplish to get a nurse freed up who will come and meet my patient at the birthing center, which they finally, finally do, of course, because they have to. And then I'm totally stressed out, and I come in there. And so now you have me completely stressed out, having held space for that to happen. Guess what? Now the nurse says, Oh, I'm not listening to fetal heart tones when she's in the tub. Why is that? I'm not getting my arm wet. Okay, so I guess I'm still not sleeping and now I'm listening to heart tones in the tub. And then guess what? There's a guideline that says that you can't give birth underwater. And so I either have to drain the tub or do all sorts of shenanigans to get your bottom up on something while you're in the middle of pushing out your baby. This is very, very hard for me, I must say. There were times when it got to the point where I felt like the eraser had worn off the pencil that was me, and I was still scraping, scraping, scraping into the situation.
Speaker 1
Absolutely.
Speaker 2
It means you are fighting.
Speaker 1
All. Yeah. Exactly. It is it is it is a battle. That's exactly what it is. It is a battle.
Speaker 2
Aren't motivated as I am, which I could say I'm no longer that motivated. I'm I'm over fifty. Forget it. I don't have that kind of headache. I'm out of my thirties. It's hard. And then they make it practically impossible. So unless you're somebody like me who went into all this with the sense that you wanted to do something different, there's no way you would ever do that. And there were times that I remember that I would have someone in labor for three days and midwives helping and all kinds of things. And I would be like, I am so tired that I can feel the part of me that wants to just throw in the towel and do a c section starting to come up. And this is evil, and I can't do this, but I am so exhausted.
Speaker 1
I have so been there as a doula, which is less important. But You know? Yeah. I mean, I have been I have been so tired and so over it at birth where a part of me was, like, just get the epidural. Like, just just do it so we can all sleep, you know, which is which is which is horrific. And not and and I didn't actually do it, but I felt it. Absolutely. And and it's way more significant for a doctor because they're actually the ones that are managing and influencing, of course, in a way that doulas would not or cannot. So I want
Speaker 2
And you can't show that you even have any feelings about any of these things. It's kind of credible what we're expected to deal with very much so. So, you know, I don't do births in the hospital anymore. I don't really know that I could. You know, it would be very difficult. And, I I do try to educate people a lot, but I think that people really, they this is what some people say, but, don't I have a choice? I can just refuse, can't I? And I would say, actually, yes, you can, but it's not gonna work sometimes.
Speaker 1
Mhmm. Exactly.
Speaker 2
And that's what people don't realize. You can't tell the doctor how to practice because there there's another patient and that's your baby. And that's why certain people who have more religious thoughts about this wanna get involved in childbirth. You
Speaker 1
know? Yeah. Well, Anne yeah. I mean, so if we were to just look at the black and white laws, which it is irrelevant because how they are enacted, countless births where a woman thought that she was empowered by understanding her legal rights, and she had me, and she had a husband who was willing to speak up, perhaps. She was with a doctor who's given her lip service her whole pregnancy. Maybe we got a nice nurse. But then all of a sudden, you know, she wants to decline the heplock, which she's been told she can, but a different OB attending is on today and he's absolutely not comfortable with it. And so now everything has shifted into four people in the bathroom, you know, telling her that this puts her baby at risk and da da da da da. And very quickly, you're gonna break a laboring woman down, for anything that they want you to do, whether it's a second or third or fourth or fifth sixth exam, whether it's you know, rupturing your membranes, whatever it is, it's what people don't account for is knowing your legal rights. Okay. That's that's great. We we all should. But in the moment when you are in labor and you are now on their turf, you are a tiny, tiny, tiny, minuscule, little, ultimately powerless person in this whole system when you will actually have multiple people coming in, bullying you, threatening you, manipulating you, while you're trying to do the most, you know, deepest physical work.
Speaker 2
And they'll get the hospital attorneys involved. Totally. I don't think they won't. You know? There were times when they get court orders if they
Speaker 1
have time
Speaker 2
for c sections. Yep. And, of course, I've been in c sections where the woman was coerced, and the reason would be macrosomia. And then the baby would only be eight pounds, and the obstetrician and Zola looked at each other over the I mean, this is when I was a resident. I remember this. There was there were experiences I had during my training that made it clear to me that the crazy midwifery stuff that I was reading was completely correct and true.
Speaker 1
So, okay, that's what I wanna get to with the last part of our episode here is I I wanna kinda run over some of that stuff. So let's let's talk about that with the the often false estimation size of the baby. So, even though that's all been debunked and even ACOG has put out that, you know, that big baby is no longer a cause for, for c sections. So, it's still being done all the time of this overestimation as a means of justification to, just to either to basically end the pregnancy at whatever, whatever gestation the doctor is is ready to end the pregnancy. So, what do you
Speaker 2
think They're trying to push to thirty nine weeks. Right? Like, they did redefine full term and an attempt to try to push to thirty nine weeks. But, of course, the first thing that happened was they were like, okay. Then we should induce everyone at thirty
Speaker 1
nine weeks. So what do you think about this whole estimation size of baby? From what I have read, it is the estimation off of an ultrasound is within a two point five pound variation. And I have seen that personally to be quite true. What do you think about that? You've obviously experienced it. Do you think there's any validity to estimating the size of a baby with a technology that has been proven to be so unreliable?
Speaker 2
Well, you know, what's funny, I I, it it yeah. I was gonna say at least a two pound discrepancy at full term with, estimations. And of course, if there's, you know, bony parts in the pelvis, right, like the head's engaged, it's going to be much harder. There It's funny because there are reports that show that a woman who has been pregnant before is actually more accurate than a sonogram at estimating the weight of her baby in relation to her previous babies. Did you I mean, yeah.
Speaker 1
That's so crazy.
Speaker 2
More accurate than the sonogram. Okay? So I all I think that it's important that we have skills outside of technology. Did you hear of a case recently? It's a huge big deal where they did a c section on a woman who wasn't even pregnant because they didn't have heart tones.
Speaker 1
Shut up.
Speaker 2
Yes. Yes. Look this up. So the woman is not even pregnant. She shows up at a hospital and has a c section done, and there's no baby.
Speaker 1
Oh my god. Okay. Wait. Hold on. Hold on.
Speaker 2
She's not even pregnant.
Speaker 1
So but did she think she was pregnant?
Speaker 2
Apparently, she did. Yeah. But, you know, you would think that an obstetrician would be able with a sonogram machine no less, could figure it out. Right?
Speaker 1
Like, if you
Speaker 2
don't see fetal heart tones, you should see the fetus. You should
Speaker 1
see Right. Exactly.
Speaker 2
You should
Speaker 1
see you could feel
Speaker 2
the baby. Wow. Yeah. And so there's something that where, when I do hands on palpation or Leopold's maneuvers as they're called in obstetrics just to see where's the baby's head, where's the baby's bottom, where's the baby's heartbeat, Things like that. Sometimes people comment, oh, nobody else has ever touched my belly. Or if I'm in an environment with nurses, they'll say, oh, no one none of the other obstetricians touch the patient.
Speaker 1
Oh, that's that's that's that's absolutely the norm. The vast majority actually, I can't think of one time where I've talked with a woman and said, you know, that my doctor palpated and that's how we discovered my position or, or any of that. I mean, that's not, you know, that's not a thing. So, okay. So then the next thing I want to talk about is, I'm just gonna throw out a couple different things. So what do you think about breach? You know, I I know the history of it. I I, you know, have a have a relatively solid grasp on why it became such a big deal with that study that got debunked in the early two thousands and and blah blah blah. But but your personal feeling around, around women, let's say, choosing to birth at home, with breach deliveries, is there anything that you feel like women should know? I don't know how much experience you personally have with breach. Just any any thoughts to throw in the pot.
Speaker 2
Yeah. So, in terms of breach, breach births were still being done when I was in my medical training as a student even, and I remember being told this is the last breach birth you you'll ever see so many times. It's I mean so, anyway, I've seen a bunch and attended a bunch. And when you're a resident in a hospital system where the attendings don't like to hang out in the hospital, If people roll in at all hours and say, yeah. I've delivered breaches, breached twins. So, and, yeah, fortunately, everything has gone well. Then again, I am aware of bad outcomes and that there are stats about that. So what I remember through the University of California San Francisco conferences, maybe it was, you know, mid two thousand, so maybe two thousand and three, two thousand and five, somewhere in there. The stat was that seven out of eight breech births will go just fine, that the morbidity and mortality is only one out of eight. And so then it becomes a question of let's individualize. Like, what are the factors there? You know, if somebody has given birth before, what are and then here we get into size estimates potentially again. Is the head flexed or not? So, you know, in the beginning, of my training, I remember they would actually do x rays to see about the position of the breech, but, you know, that can cause leukemia.
Speaker 1
Yeah.
Speaker 2
It's not a good idea to x-ray a baby, so I wouldn't recommend it. But that is, you know, that's how long I've been in obstetrics, like, since, I guess, nineteen ninety ish. So do you like that.
Speaker 1
So do you think it would largely come down to the position of the breach that would be the type of breach that would cause it to be more or less dangerous?
Speaker 2
Well, you know, there are, of course, concerns that people discuss having to do with footling breach because with a footling breach, the feet come first, and then there's all this, fluid that could just theoretically pour out and bring the cord out with it, which could then be a cord prolapse. And that's often an obstetrical emergency because if the cord comes first, then the baby body could crush it. So you don't want that to happen. Right? That being said, I think that you need somebody who is skilled in handling these situations because I was aware when I was in my medical training and I talked to him, there was a doctor named Leo Sorge. And he was out on, in Massachusetts, I think Boston, Cape Cod area. And he was doing a lot of vaginal breech births. And so I was aware that there were people who were doing them. And, it's just kind of a lost art. But, like, even doctor Musali, who was the chair at St. Vincent's, which was a very midwifery and birth answer supportive hospital in New York that closed, they were teaching, forceps skills to the residents there before they closed the hospital. You know, there there were certain values in obstetrics that I have encountered, but they're just sort of, you know, kind of fallen by the wayside and Well, this is they're alluding skills.
Speaker 1
Yeah. And this is kind of what I'm getting to is, so, yes, I know it's considered in obstetrics this lost art, but let's just put that aside for a second. Women birth and women birth all different types of fetal presentations. And so, I guess, what I'm curious about is I know multiple women who are who have free birthed their breech babies at home, whether because that was their first choice or it was their third choice and they couldn't find anyone to support a vaginal birth, and they may have preferred to have somebody around who was familiar, with it and couldn't find it. As you know, that's a huge problem. And so, obviously, in obstetrics today, it's almost exclusively an immediate c section. There are Yeah. Very, very, very few providers, you know, we could probably count on one hand across the whole nation who, will do it. And of the ones I know, they almost always provide I'm sorry, require, an epidural and and for it to be fairly medicalized. So
Speaker 2
Yeah.
Speaker 1
What I'm wondering about is okay. So, like, the the three things that I am familiar with with home birth breach is because these women, have to free birth because midwives are not allowed to support them, unless they're doing it underground and going against their licensing. The three rules I've always heard is hands off the delivery, meaning nobody's pulling, nobody's, nobody's forcing the baby quicker than than the baby's being born. The second rule is hands and knees is a good position because the baby can dangle and and come out on their own time. And then, lastly, to hold off on pushing for as long as you possibly can, so that the baby can really descend as far down as he or she can before you're really giving it giving it your all. I guess that's what kind of what I'm getting to is, like, this idea of this lost art, even that terminology takes away from it doesn't matter if somebody over here is trained or not in breach. Women are still pregnant with breach babies and have been forever and will continue to be because it is a it is it's it's a small percent, but it always has been and it always will be. It's a thing that happens. And so, I guess what comes up for you thinking about breach, you know, home births and particularly because women don't have other options, if they are unwilling to consent to an unnecessary surgery because people are not comfortable or skilled in, how to attend a breach, and there's so much energy around it. Like, I I interviewed a woman the other day for the podcast who it was her it was not her first baby, but it was a free birth, and she had a surprise breach and didn't even know until afterwards when they looked at the film. And so I love that story because it it was just a normal birth for her and had the baby in the tub. And, I think her husband may have caught the baby. And then afterwards, one of her friends who was there said, you know, that baby came out, but first, you had a breech baby. And she had no idea, which I just love. Is it
Speaker 2
just Yeah. Well, surprise breaches are fun because, of course, then all the, like Energy. Political and legal issues aren't
Speaker 1
there. Exactly.
Speaker 2
Actually, with with listening to what you're saying, it actually is really making me angry because, you know, the lost art. Remember, midwives had this these skills and had this Mhmm. These and and because obstetricians have had so much, you know, success, you could say, in locking down the power and really making it very difficult for midwives to practice. This is an art that is lost and that we have to take this on and not even have a midwife in our communities who is often comfortable taking this on. I mean, of course I'm aware that there are midwives in New York City who occasionally will do a breech birth, but they're not advertising it because it would get them in trouble and inhibit their ability to ever do so again. And so, yes, there's a lot of politics about it. But some of what I think of is that a lot of preparation of having skills in, not kind of becoming neurologically overwhelmed so that you have a lot of ability to have calm and rocking as a mom while giving birth. Because that urge to kind of, like, let's just, like, push through or, like, you you really kind of have to hold back a little bit at times with a breech birth. And it's true that, hands off the breech is often said, and the reason is because once you start to pull and now remember, the baby is participating in the birth processes. It it isn't just about the mother's body opening up or letting go or pushing. It's also about the baby who is navigating and turning and twisting and tuck the chin and things like that. I mean, I often would feel that if I, you know, put my hand to touch, I will feel the baby moving and trying to navigate that, corkscrew pathway, so to speak. So I think that, hands off is really good. You know, keeping the baby warm and wrapping the baby, is sometimes very important because it'll take a little time. But then some, as the head comes, it's good to have the head flex because a deflexed head may not come out. So just be aware that there are ways to maybe put a finger in the mouth if necessary. Mhmm. But really just that hands off and being able to rock back and forth. So being on hands and knees can be good because then you can rock back and forth different ways. I see no reason why you couldn't also, be on your feet. I really like the feet, but I know not everybody is, good at squatting, but it is certainly something that you could practice and kind of get your hips more. And it'll it would be helpful at the time of birth. But, yeah, a position in which you're able to rock and kind of move the pelvis back and forth and move the hips, in relation to the core and the pregnancy definitely would be helpful.
Speaker 1
Yeah. Yeah. It's just so interesting that we've become very quickly in our society so polarized around birth that there's no middle ground with breach is a great example. So it's either c section, which is I don't care how common it gets. That is a big fucking deal. And that, you know, increases your maternal death rate with every subsequent c section and blah blah blah blah blah blah. I mean, it is such a big deal to have an unnecessary surgical delivery. And so if that is your only other option, because midwives are so handcuffed and and are not taught this anymore because of of their handcuffing, you know, if the only other option is to wing it at home, you know, which also is a pretty big deal and and and does come with inherent, risk, you know, just like a c section does. It's just so it's just so intense that we've gotten to this place very quickly where it's either c section or completely unassisted birth and nobody there may know much of anything. And I support both if that's what the woman is choosing wholeheartedly, you know, but and this actually kind of leads me into the next thing I wanted to talk about which is around legal rights and informed consent and and right to refusal. I have increasingly come to believe that there's no such thing as consent, in in any situation where somebody has an authority over you. So can you really consent when you're in a system that is assumed that you will submit and, everything about it, you know, and even sexual consent. You know, if there is an authority, this is why, you know, adults aren't allowed to have sex with kids or teenagers because there is an a sense of authority of a teacher to a student, where consent, you know, becomes void. And so it's it's an interesting conversation because, you know, an informed consent and and, right to refusal and all of these things are really, like, buzzwords right now with hospital culture. But I don't even think it's real because of the stuff we've already covered and because I think you can't actually consent. You're not actually consenting to a c section if if a c section occurs. If everybody's told you that you have to have it and your baby's in danger and they haven't laid out truly supportive alternative options, you didn't you know, and then the story is I had to have an emergency c section. No. You didn't. But because you're in a system that requires submission, you know, this implied consent, which is not a real, you know, it's a real thing, but it's not a legal thing. Implied consent is is really what's what's happening. Right? So what I'm wondering is around legal rights, yeah, just kinda like what do you think of that? Do you think it's possible to, to practice informed consent? I heard you say earlier at the birth center that, you know, some women would decline recommendations or guidelines and and you would document it and you wouldn't fearmonger them into it. That's incredible and and unfortunately very rare. Today in your practice, you know, how how do you manage all of this as a provider?
Speaker 2
Well, since I'm not doing hospital births, fortunately, I'm not confronted with these issues because, they are really difficult issues. And I would say that once you enter an institutional birth setting, you are going to be somewhat subject to those in that those institutional considerations, those institutional guidelines. There is usually a consent form that is given to you while it might be in labor in the middle of a contraction and having many other things that you'd rather be doing. But all of a sudden, all this paperwork is shoved at you and one of the consent form. And I would say a lot when I would have, the consent form signed, and people weren't always happy about it. But then somebody else would come and sort of make them sign it. And what the consent form essentially would say is you're consenting for a normal spontaneous vaginal delivery or a vacuum delivery or forceps delivery or any e section or intervention or or drug or anesthesia or blood transfusion or, oh, you're a Jehovah's Witness. Well, I guess we'll scratch that out, but everything else. And, that was pretty much the way it would go. And when you when people would refuse, it would just cause trouble. All of a sudden, people are rolling their eyes behind the woman's back and saying things about her behind her back and treating her differently and talk I mean, I heard only the other oh, yes. No. There was a woman, and I met her completely out of context of my practice at a yoga retreat, and she was clearly fully pregnant. And we got into a conversation, and she has a fibroid. And she's being told by her obstetrical providers and her midwives because she already had a home birth, and she wants another home birth that she has to deliver in the hospital and that she pretty much has to have a c section. And her thought is, well, can I just see what happens? And if the fibroid gets in the way, then we'll go and do a c section. But if it doesn't get but there it's like this whole fear mongering scare tactic. Like, nobody will support her now. Like, just nobody will support her. And it's just like it's just a fibroid. It's like, if the if it's really in the way, it will know. I've certainly you know? Yeah. So so the whole concept of informed consent, yes, it becomes much more muddied here because there is this implication of consent. I'm thinking of a time that, a woman, she was just she was a very tiny woman. Her husband was very large. And even though many babies can be born vaginally in those scenarios, her baby was really huge, and it really was just not coming out. And after hours and hours, I said, hey. You know, we should probably do a c section. Your baby's fine, but it's really not coming. And everything that we've tried isn't working.
Speaker 1
And was she unmedicated?
Speaker 2
You know what? I honestly don't recall, but I feel like everybody at that hospital was medicated, so she probably was. Yeah. You know, it's like It's
Speaker 1
a lot harder to get a big baby out.
Speaker 2
Yeah. I was in a group. So when you're in a group, you don't get to decide
Speaker 1
these things.
Speaker 2
Right? So in any case, she wanted a second opinion, so I got somebody else, but, of course, they're what what was their opinion that could be other than mine? You know what I mean? If you are Right. Anything else that I said, I was gonna but here's my point. It's just like you're kind of at the mercy of who's there to take care of you. Right? Because you only know as
Speaker 1
much as you know.
Speaker 2
And, you know, there are many, many stories of coercion. Of course, it's maybe easier to do something coercive in some place like India where I've been you know, people have reached out to me wanting to discuss what's happened to them, but I've certainly seen and heard of it right here in America. But isn't it all coercion? Choice and my consent.
Speaker 1
But it's all coercion, really. I mean, the the implied consent concept that you show up and that they just tell you, put the gown on, go pee in this cup, lay down for your vaginal exam, here are the monitors. You know, there's no, Right. That's just the that's just standard. And there's not there's no point of these interventions where they're asking, you know, do you want this? This is our recommendation. Do you want this? No big deal if you don't. And those are just, like, the simple, simple things. That's not even the the, you know, the I was at a birth a couple years ago where the woman thought she was on a saline drip. It was, she was already in labor. She showed up. I showed up after she she thought she was on a saline drip. And I looked at it and I said, oh, why are you on Pitocin? And she said, oh, no, I'm not. It's just it's just fluids. And I said, no, girl. This is oxytocin. You're you're on Pitocin. And she was very upset, of course. She had no idea that it was, it was put on. So it's almost like that story kind of illuminates this, like, step over coercion where things are just done and they're not even, they're not even talked about, you know. And then what are you gonna do once you're on it? And then the the impossible position it puts the patient in, is she gonna cause a fuss with the people who are there to care for her and her baby? Of course not. What are you gonna do? You're stuck. If you have an epidural and you're on pit, you're not going anywhere. So now you have to figure out, you know, and then we add in the socialization of of, you know, womanhood to please everybody and not hurt anyone's feelings and not, you know, ruffle any feathers. And it's no surprise that we we found ourselves in a situation that we have. So okay. We're we're we're we're gonna wrap up. One more question. My last question to you is, how do you feel about free birthing and whatever you know about it and and just kinda what are your what are your thoughts around it?
Speaker 2
Well, I I would say that my thoughts are in a way selfish, but also, well, and I it's you you would think I mean as a as a professional or as an obstetrician. No. It's because I'm a woman and I have a body. And here's what I say, that if I was told that I couldn't have my baby the way that I wanted, I would have a free birth. I mean, I would already, you know, think to have a home birth with a midwife. And since I have friends who are midwives, it wouldn't necessarily be a problem to get one of them to show up at my birth, I figure. But if there wasn't one available, I would probably free birth. You know? I'm aware that my friend Robin Lim, when she moved to Bali after having home births, there was really no midwife or competent provider that she wanted to have at her birth. So she had a free birth. And I'm thinking of other friends of mine who were doulas, who even though they had midwife friends, they really didn't want them to, they really wanted to take on more responsibility and just have those midwives kind of be back up. And I think the midwives are kinda like, well, I'm either in or I'm out. You know, you decide. And so, you know, is there that option to kind of have somebody, like, you know, waiting on the other side of the curtain, like in the wizard of Oz just in case? I mean, is it you know, you you tell me, you know, where you would draw the line with free birth. But the way that I see it is that, you know, these are our bodies and our babies and our, you know, phenomenological experiences. And I know that we're, you know, supposedly not allowed to have good experiences, but I think that overall, the best birth is the physiological birth, is the birth in which mind, body, spirit, emotions, setting, and orientation are all really, symphonically on track with each other. And so whatever we can do to organize around that goal, I think, is the best. And sometimes that can actually happen in a hospital, although there's often uphill battles. And sometimes the best place for that to happen will be at home and possibly in a free birth. And so I think that it's important that women be aware of our options and, you know, have that power in our own bodies. You know? There's talk about, you know, who's empowering who, and it's like the power is within us.
Speaker 1
Right.
Speaker 2
We just need to find the best ways to support its expression. And I think that's true of so many areas of, you know, female life empowerment and expression and biological expression to me is very, very important for me as a woman is being able to express biologically through my own body. And I don't want the culture telling me that that is no longer okay because of whatever cultural or social reason.
Speaker 1
Yeah. Yeah. Absolutely. And it goes back to, you know, what we already touched on around women who are willing to take responsibility for themselves, that that ideally needs to be culturally supported. And, yes, there are people who kinda ruin it when they turn around and and still blame people, but the vast majority of women and the women that I interview and the women who I know who are all about this this free birth movement, it is about, you know, against against the cultural narrative that says we can't be trusted, we can't make our own decisions. What does it look like to take back our birth? And to utilize the system as we see fit, you know. I don't know if you're familiar with my birth story, but, you know, I got to use the system in my time of need. It was not my first choice, but it was my only choice when I felt that I needed help, to assess myself.
Speaker 2
And Well, at least you got out.
Speaker 1
Exactly. And that's very rare.
Speaker 2
I mean, I Do you know my friend, Janine Parvati? She passed away, but she's one of the free birthing midwives of all time, right? Because her story was that when she was having her twins, she was hemorrhaging. And so she went to the hospital to be checked and because she was hemorrhaging after they checked her and determined that, you know, it wasn't like an abruption or a preview or something. She was like, alright. Well, I'm leaving now. And and the doctor stood in front of the door and said over my dead body. And Janine said that could be arranged
Speaker 1
and walked out. Oh my god. Well and that's and this is where, you know, there's there's a lot of privilege involved and this is there's a lot of luck involved because that could have gone a lot of different ways and it went the best way. You know, they could have called CPS. They could have, especially with no prenatal records. I mean, anytime a woman dissents, they are risking them. True. They're they are taking a risk and I was very aware of that, which is why it is such a big deal if free birthers choose to use the medical model or if they choose to, you know, go there for any reason. It has to be taken really seriously because it is not a safe place. It's just not. It can be a helpful place, it can be the right place, but it's not a safe place because you don't know what you're gonna get. And you touched on this earlier about how hospitals are also different. There's no, like, standard of care, first of all. You know, one hospital's gonna be, yeah, upping your pit without consent every fifteen minutes to, illegal levels, you know, or they're gonna be, you know, more gentle or, you know, there's not even any standard between providers. You could be a part of a group and be an awesome OB who's relatively supportive and then you are on vacation and your partner's there who's an asshole who who violates you. You know? So there's no there's just no way to anticipate how it's gonna go down.
Speaker 2
Yeah. No. It it it it's so difficult because of the institutional considerations and standards of care at this point for any provider to really go outside of it too much because there's so much potential legal and medical risk. I mean and at, you know, at the end of the day, there was a time when, you know, I had to consult a bankruptcy attorney because of a law suit against me from the late nineties. I mean, this is like no joke when it starts to really affect your personal life and finances and family. Yeah. So there's a lot of checks and balances and and threats to keep certain things perpetuated the way that they are, unfortunately. And I really think that that's why, you know, anybody who chooses free birth and chooses to go out this outside of the system, it's very important that you understand the level of responsibility that you're taking because that's that's really what it is. And, I very much support, self authority and the way that we can really have true informed consent. But I don't know that that's available because where are we getting the information? Who's giving it to us? You know, there are all sorts of different ways that people kind of cobble that together or which books they read or which class
Speaker 1
Exactly. You know what I mean? Mhmm. Exactly. Yeah. Well, I really appreciate your time. We could talk forever. I'd love to have you on. I'd love to have you on again and, yeah. Just it's so refreshing. This is the first time I've obviously had a doctor on, but it's also the first time I've been able to engage with with a doctor in this way, you know, and it's it's kind of bittersweet. Right? Because I know you are an anomaly and this is not the norm for for people who have the training that you have and have been involved in birth in the way that you have. So it's refreshing, and it's such a reminder that this is so rare. This is, you know, maybe it's that much more special that you and I got to talk today. So thank you so much.
Speaker 2
So, yeah, so, you know, one of the ways that I have to deal with this is that I offer what I call educational consults, which means if you're having a baby or you're a midwife or a doula or birth worker or you just wanna talk, if I'm not, you know, speaking in a medical context as your direct provider, I'm not diagnosing, I'm not treating, I can say anything and discuss any you like. So feel free to call upon me for an educational consult anytime.
Speaker 1
And where where could we find you?
Speaker 2
Oh, so, w w w dot doctor Eden Framberg dot com is my primary website. You can find me there, and we'll be, you know, having some new things up soon where you can easily, you know, find me remotely anytime of the day or night.
Speaker 1
Awesome. Very cool. Cool. And we'll put that website up with when we share this episode.
Speaker 2
Thanks. Yeah.
Speaker 1
Okay. Great. Thank you for your time.
Speaker 2
Yeah. You too. Have a beautiful day.
Speaker 1
That's it for today, everyone. Join us next week for another episode of the free birth podcast. Thanks for joining us, and remember, your body, your choice. Lots of love.
