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
Exciting news listeners. The Free Birth Society apparel store has opened. Head on over to free birth society dot com and check out the adorable onesies and toddler shirts, adult tank tops, hoodies, and more, all celebrating messages of free birth. Again, that's w w w dot free birth society dot com. Today, we pivot to directly discussing hospital culture and the regularly violated legal and human rights of women. I am privileged to be joined by an incredible lawyer and human rights activist, Hermine Hayes Klein, founder of Human Rights in Childbirth. She worked for five years to organize international conferences of maternity care stakeholders to discuss women's fundamental rights in childbirth. Hermine is a huge force in advocating and shifting the focus on the huge gap in care between honoring legal rights in the medical field and the reality of today's modern day birth culture. We also talk about what's a doula to do, understanding client legal rights, the ethical obligation of doulas, the problematic scope of practice, and the downside of professionalism.
Speaker 2
I'm a lawyer, and my work, in the area of birth justice is to advocate for, women's right to be the authority in all health care decisions, that they might have to make throughout, pregnancy, birth, and postpartum. Basically, all their reproductive health care decisions, including the decisions that they have to make in labor and delivery. What I want all women to understand is that they have the legal authority to make all the decisions about their care. It's a human right. It's a right under the right of autonomy, which is the human right to own your body and to make all the decisions about your body. And also under the right to privacy, which is the right to make private decisions about reproduction and family life. And, you know, again, I'm a lawyer, so this is the moment when I should probably say that nothing that I say in this podcast should be taken as legal advice about your situation. You should consult with a lawyer in your jurisdiction if you're trying to figure out your legal options where you live. But speaking generally, most states and nations, actually all that I've ever looked at, have laws protecting the right of informed consent and refusal. It's a basic, health care law, basic health care right. And, it applies it should apply in pregnancy and birth, but it is routinely violated and ignored in in in labor and delivery. So I guess the what I would want any woman to understand is, a, she has the right to make the choices about her care and to be supported on her terms in the way that she needs to be supported. And that the choice she makes of where and with whom she gives birth is going to be the strongest determinant of whether those rights are actually upheld in practice when she gives birth. So if she's planning a hospital birth and maybe she doesn't have a lot of choice about what hospital she's giving birth at because of insurance, for example, then, I guess that she and really that this would be true for all women no matter where they're giving birth should try to use the prenatal period to communicate about what her needs and expectations are around the birth. And and if you want to, we could talk a little bit later about birth plans and how the role that they can play in that. But she wants to make clear her intentions to, any providers that she might have contact with during the birth, which again is hard to predict or plan for in a hospital birth. But to the extent that she can, she should communicate her intention to be respected as the authority in the decision making if that is what she wants. And and what I think maybe I'll note on that. A lot of I mean, ideally, I think what we all want when we give birth is to be in a space and in circumstances where we can really relax and surrender and really trust the people that are around us. And that if those people were to say, hey, you know, I'm looking out for you, I'm watching over you, and a medical issue has arisen, then I think for the safety of you or the safety of your baby requires some kind of intervention. It would be really great to be able to trust and just go with it. And the extent to which you'll be able to do that really depends on the prenatal preparation and whether you have scoped out a provider that you're gonna be able to trust in that moment. But what everybody should understand, also providers, is that, you know, a woman can say, tell me what to do doctor and I'll do it. But she's still exercising her right of agency in that moment. If she chooses to go with the advice of her provider, she's still the authority. She she doesn't hand over her authority to continue making the decisions. She at most, she's agreeing to go with this decision and that decision, but that she has the right to change her mind at any time, including change her mind from something she thought maybe in her birth plan that she would want and to be respected in all of her decisions throughout care.
Speaker 1
So so where is that departure in medicine where none of this gets acknowledged? You know, none of this is actually exercised from the staff. They you know, things are almost never framed as, hey. It's your decision. It's it's it's never I've never seen it where it is assumed that the mother has the authority. It's quite the opposite. You know, from the nurse to the charge nurse to the triage nurse to the doctor to the resident, everyone that she will interact with in labor and delivery acts as an authority of this is what we're doing. We gotta hook you up to this IV tower or these, you know, continuous monitors. This is the routine, you know, that we do. Rarely have I ever seen, a, an an offer of informed consent or right to refusal, and then b, when tried to exercise that, I've often, therefore, then seen some real, of course, defensiveness and nervousness of the staff that this woman's gonna be
Speaker 2
Of course, staff.
Speaker 1
Gonna be trouble. So, all of what you just said is so beautiful, and, gosh, what a utopian, you know, medical model we would have if these legal rights were actually practiced. Right. But that is not at all what women are dealing with.
Speaker 2
And that's you could say, Emily, that that's, like, my, motivation. My motivation comes from this question of how much would change in maternity care if it was really clear to everybody involved, doctors, nurses, staff, and everybody, that the woman has the right to make all the decisions about her care on the basis of accurate evidence based information, uncoercive advice, and genuine support. It would be transformative, as you say. It it it would be, like, a hundred and eighty degree. It would be it would be transformative. And and yet we don't have to write new laws to get to that place. We just have to demand that the existing laws are respected.
Speaker 1
Well and I guess it gets super complicated with liability and obstetrical culture. You know, the the peer pressure that happens in obstetrics and the, yeah, the malpractice and the liability and the insurance mandates and all of that intersection of liability meets the culture of it, I think is really what this, like, monster is because it's very, very it is not fashionable at all to actually practice this beautiful, you know, legal, utopian dream that you just laid out. So what is a you know, it prenatally, if something that I've seen a lot is doctors will be seemingly quite agreeable with their birth plans and with all their, you know, questions, and, no, I don't cut episiotomies. And, you know, they really they really feed them the adequate answers. And then they show up in labor and everything's different, even if it's the same doctor. And so at that point, around legal rights, informed consent, right to refusal, I mean, all of these really important things, if a woman does want to exercise some authority, particularly if it's evidence based, like intermittent monitoring or moving around or whatever, but really it could be anything. What is she to do in labor and delivery when the whole floor, you know, or her or her doctor is is
Speaker 2
Doesn't understand that she has the right to make that choice.
Speaker 1
Right. Because then it's like, well, does she?
Speaker 2
I mean Exactly. Do you have a right when your rights Well, it it's like, do you can you be said to have a right when nobody around you knows about your right
Speaker 1
Yeah.
Speaker 2
Exactly. Respects your right and when there's no accountability for the violation of your right? That is the situation in which women are giving birth in the United States and not only in the United States, in many countries around the world. So one of your questions a few minutes ago was, like, why is it like this kind of thing? And, I mean, what you're describing is, it's obstetric culture. You know, like, it's like this widespread lack of comprehension of patient rights in obstetric culture, which, you know, is based on these sort of like pre feminist, early twentieth century, and earlier concepts of, the the female Yeah. And her relationship to the traditionally male obstetrician. You know, even in one of the things that I've encountered many times in talking about informed consent and refusal with doctors, with nurses, with many midwives, and even with reproductive justice advocates for whom the right of abortion is very clear and who will take to the streets like that to march for the right of abortion. You talk about the fact that women have the right of autonomy also in birth. And these same folks, well meaning folks, reproductive justice advocates will say some they will say, well, that, you know, that I I hate what you're saying about informed consent and refusal. I know it's right. But and then they they present this, like, they're getting to the complexity, you know, like the you know, but you didn't think about this, like, deep thing. And that thing is, but what if the baby's in danger? What if the, you know, say for example, and this at the LA, talk where I met you, that was the first hand up in the back row was from an OB guy who said, that's all well and good. I get the right of informed consent, but what if the baby's in danger? What if we've got a strip with a bad tracing, for example, and I know the baby's gonna die? And say that, mom, you're feeling a c section. What am I supposed to do then? You know? Just that that question.
Speaker 1
Mhmm.
Speaker 2
The answer the question has an answer. And it's dude, she still gets to make the decision.
Speaker 1
Yeah. Exactly. Even if you think
Speaker 2
the baby's gonna die. And, like, step one, and I remember Emiliano Chavira in LA raised his hand and just did a great job answering this question because he, he said, look, as obese, maybe we should have a little bit more, humility regarding our ability to know if the baby is going to die and to predict accurately when the evidence that we can see, is indicating actual actual fetal distress. We know that OBs are wrong about that the majority of the time. Thirty three percent of women don't need c sections, let alone half, seventy five, hundred percent around the world. So they're clearly wrong when they're telling women, you need surgery or your baby will die. You know, and and a lot of times that's based on the strip. The strip is absolutely unreliable as a predictor of fetal distress or for preventing cerebral palsy. And yet, here we have OBs saying that if there's a bad strip, they can override a woman's right of income consent refusal. So I guess what I've come to feel about that issue is that culturally because also, you know, people have raised their hands at law school classes and asked me this this question. So it's also law students. Right? Culturally, there is this assumption that we can't trust women, that childbirth can only be understood by doctors, and that the little lady couldn't possibly understand enough to be able to make a decision about her care. Childbirth is dangerous and doctors save women and babies. And, you you know, whatever happens in the birth, if you and your baby come out alive, the doctor's delivery gets the credit. It's even that reframing of the woman birthing to the doctor delivering, which has been, like, it's foundational for the movement of all birth into the hospital and the shift of authority over the reproductive capacity to, medical professionals. But we so we know that folks are coming into medical school with that bias. And when we think about so then what happens in the medical school training, right, that then gives rise to the culture on L and D that you're navigating as a doula or as a woman? They have the bias. So, the medical school has three things they could do. They can either address the bias, acknowledge the bias and address it and say, you know what? Here's this question. Does the woman have the right to say no if the baby's in danger? So, first, we're gonna read ACOG's maternal decision making statement from June twenty sixteen, which is fantastic and addresses this question very clearly. If the if the baby might die, she still gets the right to to make the decision. And as far as, like, doctors' bad feelings around that, get some therapy, go for a run, do what you need to do. But forcing this woman is not a way that you get to deal with your feelings about her decision and the risks created by her decision. So you could either address the bias and correct it, which is what the only way that you would have professionals in l and d who got informed consent is if that happened, but clearly that's not happening. No. And then so then what are the other two options that they can do? They either remain neutral with regard to the bias, which means that the medical training is built on top of the bias and the bias will still manifest, or they can even, and I suspect this is, in fact, what has been happening in medical training and probably obstetric residency for a long time, they can strengthen the bias by really reinforcing this idea that we are the we, the doctors, the authorities and, you know, even the language that they use and then you do this to her and then you do that and they're not talking about asking her for anything. So or, you know, the doctors themselves, like these doctors that, you know, I've seen speaking publicly and saying things like this that are authorities within the medical profession. Right? And they're still reinforcing this. So that's happening. Basically, in the training, the cultural bias is not being corrected. If anything, it's being reinforced. Mhmm. And so then the concept of responsibility is really important to understand also as a doula, also as a woman. What is the doctor's responsibility? What is the midwife's responsibility? If they frame their responsibility as guaranteeing the outcome, then they are in they are psychologically positioned to wanna control everything that happens so that they can do what they think best for ensuring that outcome. But that is part of the hubristic power grab of, the medical professional of of health care professionals. You're not responsible for the outcome. You can't be responsible for the outcome. You're not you're not God. What you're responsible for is doing your job in a nonnegligent way, offering the services that you have been trained and licensed to offer. And then if those services are accepted, providing those services in a way that is not negligent, you're not drunk, you're paying attention to what you're doing, and you do it in a nonviolent way that upholds your patients' health care rights. That's your responsibility.
Speaker 1
What a dream. What a dream that
Speaker 2
would be. When anybody talks about responsibility as if it is the outcome, you're being led down a path in which the woman has no authority, and that path is wrong. Mhmm. So just wind it back to understanding what the responsibility really is, and it's providing services in a non negligent way.
Speaker 1
I keep thinking about this repeat c section with a intent it was an intended VBAC. You know, the mom wanted a VBAC. And within twenty to thirty minutes of our arrival in the hospital, they told her that they thought it that it was a placental abruption. They thought it was very minimal bleeding. They thought that, and it was their responsibility to,
Speaker 2
you know Section her.
Speaker 1
Get the baby out. Yeah. To section her.
Speaker 2
Right. Because they they misunderstood their responsibility. Their responsibility was to inform her Right. About what they thought was happening and why. Inform her regarding her options at this point and the risks and benefits of each of her options, including the risk and benefit of doing nothing, and then to support her in making her decision. So in short, their responsibility was to offer their services and provide them if accepted, not to not to impose those services onto her body.
Speaker 1
Right. It's just so you know, I I just have all of these, like, flashbacks of actually being in in labor and delivery where this has been so misused, and it's so screwed up. I mean, we're so far off. You know? This isn't Yeah. We're so far
Speaker 2
in that place.
Speaker 1
Like, I've never seen that. I've never even heard of that. I've never had a mom talk to me and paint her birthing picture in hospital of that dynamic. Like, we're just so far from that that it it does feel like like, what what could we possibly do? You know? And so much of what you said, I mean, it's just so valuable for the consumer to know that this should be the standard. This is technically the legal standard. And so It's legally the legal standard. It's legally the legal standard. So, you know, but we know that There's a gap. There's a huge There's a huge gap. Departure from that. And And actually, you are actually risking, I hate to say this, but you are actually risking even worse treatment by trying to exercise this in the hospital because you can very quickly get labeled and treated as, you know, a dissenter. And and I've seen women be punished for trying to say no to stuff. I've seen them be physically punished.
Speaker 2
Absolutely. You know? And that's, that's the birth plan phenomenon. Right? Yep. So one of the ways that these kinds of violations happen are individual encounters, the violation of autonomy and childbirth. Another way that the violation of autonomy happens is by policy. VVAC bans are policy violations, policy level violations of the human right to refuse surgery, of the basic health care right to refuse surgery at the policy level, which just, again, shows how entrenched the disrespect of women really is legally or, you know, in practice, actually. The feedback bans haven't, to my knowledge, been legally challenged anywhere, which is a really interesting
Speaker 1
That's crazy.
Speaker 2
Something people have been talking about for years, but, I mean, nobody's ever no. I mean, it takes resources to bring a lawsuit like that and who's gonna pay for it. Mhmm. So what the research shows about birth plans is that women love making them. It makes them feel empowered to actually plan for the birth, to envision their ideal birth, to think, to educate themselves, you know, if they don't really know much about birth. So they learn in the process of writing this birth plan. Women really enjoy it. And they're like never respected. They're that having a birth plan makes you no less likely to receive any of the interventions that are discussed in the birth plan than if you didn't have a birth plan. And
Speaker 1
And in some cases, might make you more mistreated.
Speaker 2
Indeed. Because, in fact, what the studies show is that the fact that these is not that the birth plans aren't respected is not because the women can't give birth the way they wanted to or because, these are tell you know, alpha princesses who thought they wanted, you know, water, but actually whatever. In fact, the reason they're not respected is because of the pushback on the birth plans Mhmm. That we've seen. I'm sure you have seen those documents that are, like, published by different practices that are, like, you you have to sign on our birth plan. Our birth plan is that you will do everything we say that you're gonna do. Those are really ask Kristen.
Speaker 1
Yeah. There's no idea. Yeah. And I and I've seen birth plans crumbled up and thrown away right in front of the mom and laughed at, and we don't do birth plans here. And, or what might even be worse than that is when they say, oh, yeah, your birth plan, and they act like it's gonna, you know, be totally respected. And then just the and then the you know, one of the things on the birth plan is that they're, declining the heplock, you know, and and it's not noted on there, but I know she has a phobia of needles. And this was a really important piece to her. And she's declining the heplock, but she's eight centimeters and can't really have a great conversation about it. And now the charge nurse comes in, and then the OB attending comes in, and they're all in the bathroom hovering around her telling her that it's mandatory and that it's absolutely imperative for the safety of her baby that she agrees to this heplock. You know? And as the doula, it's incredibly awkward because I have enough knowledge to know that what's happening is illegal. This is not right. And she's choosing a birth here.
Speaker 2
Right.
Speaker 1
You know? She's she's choosing to go into a place that I don't think she's completely ignorant that she's gonna be giving away a lot of her agency. And so what is the, you know, hired bystander to do? It's just so awkward.
Speaker 2
Right. Well, the way that those conversations so often look is, I'm sure a little lady will respect your birth plan. We welcome birth plans here at Clinic XYZ. But what you should understand, my dear, is that birth cannot be planned. So, you know, while we're happy to respect your birth plan as long as things are normal, you know, it's possible that an emergency will arise and then we might have to deviate from your birth plan. And what is assumed in that communication is we will respect your choices as long as we feel like respecting your choices. And when we no longer feel like respecting your choices, we will stop. And and especially this, an emergency arises because for a lot of people, including people who obstetric providers, childbirth is essentially an emergency. It's frightening emergency.
Speaker 1
And so it's a One variability on the strip.
Speaker 2
The second stage is an emergency. Exactly. So second stage, your birth plan's out the window. And so therefore what?
Speaker 1
I I I have to say I started in recent years. I changed it to birth decisions, and right at the top says, I understand my legal rights to informed consent and right and right to refusal, and I expect blah blah blah blah blah blah blah. And it's just like the paragraph right at the top. And if if I'm with clients who are really gonna be down for that, you know, not everybody Right. Is interested in that level of, of authority, of having that authority. But if they are, I have had great success with that. You know? Exactly.
Speaker 2
Well, I that's what I was about to say is that, like, what my counsel for women has come to be regarding birth plans is that the basic birth plan, and you could say it right up at the top like you're doing, which is awesome, is you could basically caption it, the informed consent birth plan or my anticipated health care decisions. And then introduction, my plan is that I will make all the decisions about my care on the basis of information, advice, and support from you. Now below are what I anticipate maybe my health care decisions, you know, if things go normally or even if they don't go normally, but, of course, I might change my mind. I realize that things might come up during the birth. If they do, you will inform me about what's going on. You will advise me and you will support me. Do you agree? And so, if they don't agree
Speaker 1
yes or no.
Speaker 2
You know, it's I mean, it will it's like you should have that should be part of your panel conversation because if you get pushback because that's the core issue. What women want from their birth plan isn't necessarily to have the hap block or not have the hep block. You know what I mean? Like, most women, it's like whatever the intervention is, if it was genuinely necessary Of course. They would probably choose it, you know? And and even but some might not and that's also their choice.
Speaker 1
Mhmm. There's just no way to discern what's necessary. Right. We've lost we've lost the actual trust. Right. Because there's no way to know if if they're operating under the the, you know, mandatory policies and, you know, bullying from the hierarchy of the obstetrical model. There's and and high routine care. There's no way to know if this hep block if, you know, I I mean, because they just actually lie. You know, they they they just actually lie. But I I was just gonna go back to, you know, calling it a birth decisions has worked really well because there are some things that are not going to change. You know, like, no matter what, a client may absolutely not want erythromycin in the baby's eyes. You know, no matter what happens with the baby, that's probably not gonna change if someone doesn't want that. You know, all sorts of things like that. You know, there's actually quite a bit of routine interventions anticipated that the hospital's going to do on mom or baby that they could pretty comfortably say, this is unlikely to change.
Speaker 2
Right.
Speaker 1
You know? And there's a lot of power in that to say, this isn't a plan. This isn't Right. What I hope. This isn't my ideal. This is actually my legal decisions about what will and will not occur.
Speaker 2
So that you can plan.
Speaker 1
Right. Like, one of one of the lines is, I will decide if and when I want vaginal exams. You know? So so so I can't remember how I phrased it, but it's something like that. And, you know, that's, like, completely bonkers to the hospital staff because the patient doesn't decide.
Speaker 2
Right. You know? How could she even know what's
Speaker 1
going on? Even know? But, you know, to be fair to them, we're on a hundred years deep of women being unconscious, you know, from Twilight to
Speaker 2
Ethan. Passive.
Speaker 1
I mean, the whole thing. I mean, physically unconscious into now the epidural where they're conscious, but Passive. But they're
Speaker 2
The theme is passivity.
Speaker 1
Yeah. Exactly. Yeah. So to you know, I get it from the hospital's perspective. Like, how could somebody know if they're dilating? How could somebody know they have surrendered their autonomous sequence of, you know, of physiological labor into the hands of intervention? And so, you know, that that's a huge piece I feel like women don't understand about the epidural is is how much agency gets given away when you numb out. You know?
Speaker 2
How much more vulnerable you become. Yeah. Yeah. You're already vulnerable because you're in labor. I mean, yeah. I mean, I guess maybe some women feel a little bit more in control of themselves when they're not when they're in an environment where it doesn't feel safe to be experiencing that level of physical intensity, then the epidural gives a back a a feeling of self control. Yeah. You get it better than me because you've seen it. And you can yeah.
Speaker 1
You can text and you can have normal conversations and, you know, and the more macro, you know, experiences, you can be a good girl. You know, you cannot make noise and you
Speaker 2
Well, that's why everybody wants you to have it.
Speaker 1
You can be easily managed because I have three other rooms to tend to. I mean, it's just it's an impossible intersection because I totally feel for nurses too. I mean, it is it is such an abusive job both physically and, you know, mentally and the way that they are often treated and it's they have an impossible task of navigating all these different channels.
Speaker 2
Positions. Yeah. True. I think that video of the Utah nurse who tried to protect her client from the illegal blood draw was really important. Even though it was the police who violated her, in that case, her hospital stood by her, We know that nurses face those pressures when the authority standing over them is actually within their hospital, and they're still trying to protect their patients' legal rights. Mhmm. But the the authority in front of them is gonna punish them
Speaker 1
Yeah.
Speaker 2
Trying to do so.
Speaker 1
I I mean, there was yeah. There was tons of those stories and pushed about nurses, like, helping people escape, you know, if Yeah. If the if they were gonna come in with a mandated c section or, all all sorts of just really wild.
Speaker 2
Yeah. Nurses are heroes a lot of the time. So, yeah. I mean, I think that that informed consent birth plan can basically be a way of leading, you know, like, it's just a gateway conversation because if that person says, okay. I agree. If they say, no. I don't agree. Then you know who you're dealing with and you can either choose to stay or you can run. And if they say, I agree, then you can then say, alright. Well, let's talk through this stuff. Because a lot of the times what the providers feel is they're afraid. And they're afraid that the woman printed this off the Internet, hasn't really thought through, and is irrationally attached. Again, the bias assumption about women being irrational, irrationally attached to say no c section, which is a dumb thing to write in a it's a rational thing to write in a birth plan. I don't want a c section. No. What you mean is I don't want an unnecessary c section. You know? But, of course, in the culture that we're in, it's kind of assumed that most c sections are unnecessary. So women are writing, I don't want a c section, meaning I don't want an unnecessary c section. The doctor's afraid, well, what if it became necessary? Would you refuse? What are we dealing with here? And so that prenatal conversation where the doctor is invited to share to ask their questions. Like, what what about x? You know? And of course, again, we're in a broken healthcare system where most doctors don't have the time for those discussions.
Speaker 1
That's what I was just thinking was, you know, out the the low income women who have many restrictions around because of their medical or whatever it is of where they're birthing, and they're in county hospitals, and so they're way, way, way, way, way less likely to, first of all, be with the doctor they've done or midwife that they've done prenatal with, but also to be listened to or treated humanely at all.
Speaker 2
Then you need an advocate. I mean, this is everybody needs a doula. Yeah. You know, and so, and they need a doula for that moment when they are eight centimeters and the coercion begins. And and if they can't, you know, there's such a need for, accessible doulas for low income women. And I know that a lot of different organizations are working to try to develop that with no funding or support for the fact that this is such an economic solution for our maternity care problems to reduce the c section rate through, doula support.
Speaker 1
It's, like, adding in this extra fairly powerless piece because we can't actually fix the direct link, you know, to actually provide patient centric, you know, care. We're gonna like, you know, I run a nonprofit in LA that provides free doulas to low income women, and so we deal with this all the time. And so I'm having volunteers regularly call me ex you know, telling me the stories of their clients' births and how they were violated and the various degrees. And, you know, like, just just the other day, we had a a girl, you you know, she's a new doula. She texts me and says, hey. Something kinda weird just happened. I'm I'm at this birth, and the mom thought she was on an IV, you know, on IV fluids, but the a new nurse just came in and said, hey. It's time to up your Pitocin. And the mom said, well, I'm not on Pitocin. And she said, yes. You are. You've been on it for two hours. And so the mom and the the doula had been with her the entire time. There was never a conversation ever about starting Pitocin. It just happened according to this doula and to the mom. And so there was never and that was not the mom's wishes or intention at all. Right. You know, so at that point it's just so far gone at that point. It's so awkward. Right. The mom feels so violated. She's already on it. She doesn't know her rights. She doesn't she doesn't even know that she can do anything. And what is that really to do at that point?
Speaker 2
The I I heard from a doula this last week who had attended, a birth in the LA area. And, the the mom was in labor forty weeks plus five days, and this resident comes in and, like, keeps insisting that she needs a shot. She needs a shot. And they're like, what is the shot? What is that? And he, like, wouldn't know. You just need to take the shot. Your your labor is moving too fast. And she refuses the shot. And and then she looks at what's the shot, and the shot is terbutaline. Yeah. You don't give terbutaline to a woman in active labor. Are you
Speaker 1
Who has a term baby?
Speaker 2
Who has a term baby? Even a woman in pre in premature labor should be accurately informed consented about terbutylene and its likelihoods of success and the the risks that it imposes on her. Women, you know, again Mhmm. The lack of information, the the attitude of, like, here's what we're gonna do to you. Now sign here.
Speaker 1
And it's for your baby.
Speaker 2
And it's for your baby. And so, therefore, as long as you we're looking out for your baby. As long as you obey us, we'll assume that you're looking out for your baby too and are a good mom. And the moment that you don't obey us, then we will assume that you're in conflict with your baby because we're in alignment with your baby even though we just met you. What's your name again? It's so scary. Yeah.
Speaker 1
It's so scary. Like, what a powerful way to silence women.
Speaker 2
It's very effective.
Speaker 1
Because you're in their facility.
Speaker 2
That's why most of these conflicts don't get to the point of obstetric violence because,
Speaker 1
they
Speaker 2
say most women are shut down right away with Well,
Speaker 1
I don't know. I've seen I've seen pretty shut down submissive women still experience obstetrical violence.
Speaker 2
You're right. Yeah. Absolutely. And and I think it there's there are definitions of obstetric violence which would say that coercionism is violence. And so it's already violent by the time that she's being by the time domination is being imposed on her and a power dynamic is being is playing out, in l and d.
Speaker 1
So why do you think women who have privilege and choices choose this model of care?
Speaker 2
Well, a lot of women don't know that there's any other way. You know, I think that you'd probably agree that, like, for a lot of us, it's just like luck if you even you know, a girlfriend asked me to read Ina May's Guide to Childbirth with her. She was pregnant. I I never would have heard of that book. I never would have chosen to read a book about pregnancy and birth. If I hadn't encountered that book, would I have questioned the mainstream model or would I have just done what my whole culture was telling me was the only way to give birth? Childbirth is, a very powerful cultural event, culturally shaped, culturally determined event as Robbie Davis Floyd writes about so well in her books and, the book Birth and Four Cultures, I think was the first book to write about it. And, you know, what Robbie Davis Floyd then took Birth and Four Cultures and then turned to the United States with birth as an American rite of passage. And that book is amazing for just saying childbirth is always cultural, including in our sort of like Western technocracies. And then it unpacks all of the rituals of childbirth in the West as cultural initiation Mhmm. Since they have nothing really to do with safety.
Speaker 1
Yeah. So All just submissive submissions.
Speaker 2
Yeah. So from a, like, a as a pack animal, I think we're really, like willing to accept what our culture's recommendation for how we do childbirth. And so it takes like, you already have to be somebody who thinks for yourself about things like healthcare and sexuality and have the luck to encounter the other model. So I think a lot of it is just lack of knowledge. And then when women have some knowledge, there's, there's this deep cultural belief about our bodies, you know, and and, like, ignorance about our bodies. Childbirth is not taught in sex ed. So women really I've talked to educated, privileged women who told me about their ridiculous, unnecessary c section. And then after telling me this horrible story, say something like, well, I mean, I don't know what I could what could have happened differently. I mean, how would I assess whether I needed a c section or not? They can't imagine that this is something that they could because our culture has been so effective. Obstetrics no. The AMA was so effective, and and medical culture has been so effective since then at really convincing everybody that childbirth is, like, scientific knowledge that you need
Speaker 1
to And that it's, like, owned by something other than women.
Speaker 2
That's right.
Speaker 1
Like, that somebody outside of me could possibly have a better gauge.
Speaker 2
Right. So ludicrous. A better gauge of your body, but but also that you couldn't possibly understand unless you went to medical school.
Speaker 1
Because it's super complicated.
Speaker 2
Right. And, well, that was the power and the sort of revolutionary, force of Ina Mei's spiritual midwifery. The spiritual midwifery was, like, the first biggest book to take childbirth and put it back in women's hands in this really folksy handmade way with the hand with the hand drawings. You know what I mean? That's, like, it's not rocket science, ladies. Yeah. Oh,
Speaker 1
it's like it's like fertility awareness. You know? Like, understanding the basic signs that your body tells you when you're fertile to therefore not get pregnant or get pregnant. I mean, what a sacred piece of knowledge that is so simple and has been so successfully kept from women and girls for however long.
Speaker 2
By patriarchy. What patriarchy does, like, number one, is, to keep women ignorant about their own bodies and to replace any kind of self knowledge about what their body is with some narrative about it as impure, as corrupt, as simple, as broken. And so
Speaker 1
And part of that Stockholm syndrome to the hospital is leaving believing that I would have died. Yeah. They saved my baby. I will one hundred percent go back there because a live baby and and, you know, it's it's my fault. It was my body. It was my Absolutely. Inability to hang with this. That narrative is so prominent in birth circles, you know, and and therefore then just to pivot over to women who are choosing to not opt in to the medical model and who are saying, no, thanks, I'm good. That doesn't interest me at all, are then met with so much horizontal violence from other women in the birth community. And when I say birth community, I mean women who have babies, not necessarily birth workers, but in the family communities who say, well, that's irresponsible because I almost died. My baby almost died. So how dare you make an alternative decision
Speaker 2
That's right.
Speaker 1
Because you're not getting ultrasounds, but in my ultrasound, I found out x y z. Therefore, you're a piece of shit mom, and now we're we're polarized against each other. And I cannot support your decisions because of my trauma and my story.
Speaker 2
Or I gave birth at the hospital. There was a big scary commotion around me while I was giving birth, then my baby was delivered violently, and I was served the narrative that my baby almost died and they saved it. Therefore, if you don't give birth at the hospital, you're irresponsible. You're jeopardizing your baby. No real ability to actually assess what happened to them at the hospital. Yeah. So there's there's definitely that. There did you see the, like, freedom for birth Italy made a video that you should totally watch and you could put on our podcast? It's like a skit of, a couple in a hospital trying to naturally conceive. They're trying to have sex and, like, a lot of old.
Speaker 1
Right? Yes.
Speaker 2
Yes. A couple of years old.
Speaker 1
They're like That's cute.
Speaker 2
They're they're intervening. You know, they're doing all the things to this couple trying to have sex that they do to a woman trying to birth. Not surprisingly, they can't perform. And so then it's like, oh, we let you try. We let you have a trial, and it didn't work out. So then they, you know, do the IVF, and then at the end, the the, like, cherry on the cake of that video is the last moment when the couple are sitting across from the doctor and are like, thank you so much, doctor. We never would have conceived this baby without you.
Speaker 1
Yeah.
Speaker 2
That they nailed it.
Speaker 1
So Yeah. Yeah. I I I thank you for bringing that back into my mind. I do I gotta resurface that.
Speaker 2
Yeah.
Speaker 1
Yeah. It is. Well, and even on the IVF tip, how many women are told, you know, they can't conceive after twelve months of trying, but they don't know about when they're fertile, and so it's they're just completely going off of averages. So if they ovulate three days earlier, they're missing their window for twelve months. They're labeled infertile. Boom. You know, IVF or or whatever, moving on to a highly, highly, highly expensive and in some cases, completely unnecessary procedure. It's yeah. It's okay. So I I did wanna pivot a little bit to to home birthing and and women who are choosing to opt. I'm trying to reframe, not say opt out of the medical model, but reframe it as not opting in because, you know, it's I think it's, like, a big difference in terms of language. So women who are not opting in to the medical model and who are interested, you know, in birthing at home, where do you personally fall on or what's your thoughts around midwifery licensing in America?
Speaker 2
Well, so those are two issues. One is midwifery licensing. The other is, free birth or unassisted birth. Mhmm. And, on free birth, I think that women have the right to make all the choices about their care and about their bodies, including the choice of whether to welcome anybody to be around them while they're giving birth. And, you know, I I think that with unassisted birth and without a hospital birth, what our culture should be concerned with, if it is concerned with maximizing outcomes, is ensuring that folks who have not decided to opt in to the medical model or go to the hospital until they need a hospital, basically, that the hospital's there for them Right. When they if and when they need it. So it's like, you know, if you don't like a lady having her twins at home, you don't like a lady giving birth by herself without a midwife, If you don't, you know, whatever the thing is you don't like, it's not legit to say, therefore, how can we not allow her to do this? You know, that it's total, it's not legitimate. That's a violation of her human right. And you're already, what you're doing is wrong. So and so, you know, in the context of birth, if your concern is safety and outcomes and you understand what the patient's rights are, the person's rights are, and that you can't violate those by dragging them in an ambulance to a hospital, although as you know, that has been done. How can you back them up better? How can you let them know that you're there for them? How can you be a friendly and trustworthy presence? Which circles back to something you were saying earlier in this call, which is like the problem that obstetrics is dealing with is that they have become untrustworthy and that women cannot reliably trust them. And then in fact, it's not rational to trust a recommendation for a C section in this culture. It's probably not necessary. And that's a terrible position to be in because what if it's necessary?
Speaker 1
Right.
Speaker 2
And so the doctors are so afraid, but what if this C section that I recommend is the necessary C section and she doesn't believe me? Can I force her then? No, doctor. You can't force her then. No. You can't drag her to the hospital. If you want that to change, if you want women to do what you say when you rec you know, to accept your recommendation for a c section, then rehabilitate your trustworthiness. Take a good hard look at your profession, the way that you have been treating women for the last twenty years and previously and rebuild trust. But it's not our job to trust you because you wanna be trusted. It's your job to to be trustworthy, and then the trust will happen.
Speaker 1
Well, and women, you know, not all women, but a lot of women don't want to feel like they're coming in to be conquered anymore. You know? And that's the, you know, the, like, the Viking who's conquering. Yeah. You know? And they're gonna just come in and do the vaginal exams or, you know, it's it's it's their delivery.
Speaker 2
They don't wanna have their baby delivered. They wanna give birth to their baby.
Speaker 1
I've had doctors confused when I've brought up about vaginal exams before. I I remember this one specific one in LA who said he he said, okay. I understand that, you know, understand that, you know, some women have sexual assault and and some women, you know, wanna be asked, but if they're coming to the hospital, they are coming here for my services. They are coming here to find out what I know. Therefore, it is implied to me, this is what he said, it's implied to me that of course they're going to be agreeable to vaginal exams, therefore why would I need to ask? Like, if you
Speaker 2
say that. I've heard doulas say to their clients, you hired me for my expertise, and here I am telling you what the information is, and you are not following my advice.
Speaker 1
What?
Speaker 2
I'm a quit. Or, you know, like, you you you like or like being angry at their client.
Speaker 1
Oh my God. I I it's just More abuse to that poor woman.
Speaker 2
It's more abuse and it's also just like how widespread Yeah. Misunderstanding of your role is.
Speaker 1
And we all love control and authority. I mean, I I've really needed I've really needed to spend a lot of honest reflection in unpacking my earlier years of doula ing and and, you know, I will definitely admit I loved the authority my clients gave me. I had to make a conscious effort to stop taking it, you know, after a while because I was just another person that was taking away their agency. I was just another person telling them what to do. And I think that feels really good sometimes, you know, with our ego and feels like, like you said, when an outcome or you hinted at something like that. When the outcome goes well, I feel like I walk away taking a little bit of credit for that. You know? And and I had to yeah. I had to really I mean, honestly, I had to step away from dueling to really wrap my head around it that, you know, this this new wave of birthkeeping that interests me is how do you hold space without taking authority? And that is not something that is taught in doula ing efficiently, I don't think. I don't even know if it's possible when attending hospital births because you have to be somewhat protective and on guard and aware and hawk eyes of everything because it is an untrustworthy environment. You know? And doulas are hardly even allowed to say that.
Speaker 2
Mhmm.
Speaker 1
You know?
Speaker 2
Well, of course, but allowed by whom?
Speaker 1
Yeah. They're certifying boards and their culture and community. I mean, it's it's I'm I'm regularly having doulas contact me saying, I just realized how medical my training was, under the medical model or how patriarchal my, training was. And I now just saw ten births, and I'm fucked up from them. And it is not in alignment at all with what I've been trained because I feel like I've been trained to be submissive. And so what do we do? You know? And I'm a perfect perfect person to talk to about it because I'm fairly radical about all of this. But Mhmm. It's sad. You know, we have a real epidemic with this doula wave where women are with the best intentions drawn to this work, often from their own births, you know, whether it was traumatic or beautiful. But, you know, like like Jennifer Block said in her book, if you're hiring a doula, there's you're already acknowledging to some degree that you don't trust the system. Because if you're bringing in somebody else and spending money out of your pocket for someone independent, you know, you have some understanding that you're gonna need help that your hospital can't provide.
Speaker 2
Which I mean, so what you're not trust thing in the system then is that the system will provide you with all the support you need to give birth. Yeah.
Speaker 1
Or and and even further that you might need someone to protect you, which is technically not a good role for doulas, but a lot of people do think that that's what doulas are gonna do.
Speaker 2
Right. But, I mean, I I would say if there's a foundational distrust of the system that is reflected in just the fact that a woman would hire a doula, it's not that the system will hurt her necessarily, but that the system will not is not equipped to provide her with the genuine support that she needs, especially to have a physiological birth.
Speaker 1
And that's what blows my mind because people would pay me three thousand dollars to go with them to a hospital, whereas they could have just paid, like, a thousand dollars more, two thousand dollars more, not had me, and just done a birth at home with a midwife.
Speaker 2
Right.
Speaker 1
But that jump is too big.
Speaker 2
Safe in their home.
Speaker 1
Yeah. It's too big for most people Yeah. Even though it's not based in evidence, which don't even statistics and data don't even matter, of course. We all just make emotional decisions.
Speaker 2
I I think that doulas walk a really fine line, as you know. And because that especially when they're in a space over which the woman has no authority. Right? So they're in a space, a hospital room, in which they're all guests.
Speaker 1
Mhmm.
Speaker 2
And the do they could call security and and kick that out. And so doulas are facing that. And
Speaker 1
And that doctors will say, if a doulas been quote unquote bad, a doctor in a small area can just say, oh, I don't I don't take birth with her.
Speaker 2
Right. Exactly. So the doulas especially if doula is, framing this work as her profession, as her business, then she's becomes more invested Mhmm. In being thought well of Mhmm. By those medical providers. But I believe that a doula has an ethical obligation. If she has any ethical obligation, it's to stand by her client. I think a lot of standard of practice talk for doulas is, problematic.
Speaker 1
Yeah.
Speaker 2
They're not a health care profession. It's not a standard of practice. A woman can knit in the corner and have another woman's risk of a c section. Right. I'm not sure you should need to be certified for that.
Speaker 1
There's no legal scope of practice for it.
Speaker 2
There's no legal and and if there was, if anybody, you know, it would be really problematic to propose one Yeah. For for a woman knitting in the you know, who who can do enough just by knitting in the corner or rubbing a back. So scope of practice is problematic and a lot of the way that scope of practice is talked about in doula communities is about don't you dare give her any advice. Don't you dare give her your opinion. You know, that's for the professionals to do it. That's at the same time that we're using this professional language, scope of practice. The kind of the purpose of it is to make clear to those with power that we're not gonna encroach on their scope of practice. Exactly. So, a, I think any rule or sort of cultural discussion that would put a gag over the mouth of a woman talking to another woman about reproductive health is, like, should be is, like, really questionable. It should make everybody's red flag go up. It's like, what's going on here? And and two, I think that a woman has a right to ask anybody she wants what she should do. So if her doctor says you should get induced at thirty nine weeks, I think she has the right to ask her pharmacist, her mailman, her butcher, her doula, whoever her best friend what she should do. And none of them should feel afraid to share their opinion. The woman holds the responsibility to weigh all of that input in the balance and make her best decision. It is her responsibility to know that she's talking to her doc to her doula versus her doctor versus her mailman to weigh each of their advice
Speaker 1
Mhmm.
Speaker 2
Accordingly and to make her decision. I find it as problematic when a woman listens to her doula, then turns around and blames her doula for the decision she made as when a woman, chooses a VBAC Totally. Experiences a uterine rupture and sues her doctor for having allowed her to choose VBAC.
Speaker 1
A hundred percent. I mean, this this is one of the core intersections of the problem. Yeah. Because people are not we are not in a culture that's taking responsibility for themselves. If we were, maybe doctors would be less afraid. Maybe midwives would be less afraid. You know? I mean,
Speaker 2
ideally, a doula is an educating presence for all involved and is shifting the tone in the room through modeling respect for for this for the birthing woman. She's creating a energetic vibe, a tone that hopefully will be repeated mirrored by the other hospital professionals who come into the room. But I I think that what we should be talking about with the doula community a lot these days is, like, as you build those bridges, as you work to make sure this hospital will let you come back, are you standing in integrity or Right. To your client? Because she hired you to stand by her. The moment that you're walking away by from her interest, and I don't mean what other people think her interest is, but what she thinks her interest is, what she wants. You are out of you've you've lost integrity as a doula. When you and so just to be really conscious of how you as a human being are affected by those power dynamics, just like the woman, just like her partner. Right? We're all part of this culture. Even lawyers giving birth can go in and, like, find themselves acting like good girls and having a hard time using their voice. You know, it can absolutely happen.
Speaker 1
Mhmm.
Speaker 2
So, you know, doulas too were just people in this culture. They've been patients at hospitals. They're being disrespected. It's really hard to find your voice when somebody's treating you like you have no voice.
Speaker 1
Mhmm. That's what I that's what I always say to my, you know, to my clients and to my doula friends, like, part, you know, part of the scope of practice is, doesn't give secondary advice. It doesn't give a second opinion to medical advice, and it's like, yeah, I'm totally down to do that once the advice is evidence based. You know, once it's actually with respect, informed consent, and right to refusal, well, then I wouldn't need to have an opinion on anything because if they were actually practicing within their scope of practice and within their legal rights, then it's very unlikely that we would actually be batting heads.
Speaker 2
Well, but then your opinion would be that sounds like evidence based advice.
Speaker 1
Right.
Speaker 2
That then you'd be sharing your opinion that that's evidence based. Mhmm. It might be that you can share your opinion that that's not evidence based. Yeah. Right? You can share either of those opinions if you believe that that is true. It it's not your responsibility to hold your tongue. It's her responsibility to make an informed choice.
Speaker 1
Well, I think that's such a good a good point that to remember as the doulas, you know, that the we should not play into this idea that a woman is so easily influenced and that she's
Speaker 2
The paternalism.
Speaker 1
Yes.
Speaker 2
Yes.
Speaker 1
That you are not you are actually you cannot give an opinion that you that she then can blame. Like, there's no responsibility in giving I don't know how to articulate it. Well, that
Speaker 2
it's the idea and it happens with the home birth midwives too, or with the persecution of home birth midwives.
Speaker 1
Mhmm.
Speaker 2
The little lady couldn't possibly have made an autonomous decision. Somebody made that decision for her. So if she didn't obey the doctor's advice, if she didn't come to the hospital like we wanted her to to do, it must be because somebody else encouraged her.
Speaker 1
Yeah. Right?
Speaker 2
And so that's the idea with the doulas. That's the idea with the home birth midwife who shows up for a breach that she didn't choose this. Yeah. You encouraged her and underlying that is misogyny.
Speaker 1
Yeah. So intense. No wonder all these women free birth.
Speaker 2
Yeah. I mean, because they've lost trust in that the system will be there for them. And, you know, I guess, what I would if my counsel for a woman who's gonna free birth would be understand your backup. You might have to rely on that system. And if you do, you don't want it to be, you don't want it to be any messier than it has to be.
Speaker 1
Totally. If it's
Speaker 2
if it doesn't feel legally safe to let them know that you are, coming in, at least go find like, visit the hospital. You know, like, do what you can to just find out where would you be going Mhmm. And be really clear on who will be going there with you if you have to go, and how will they protect you Mhmm. Advocate you.
Speaker 1
Yeah. Yeah. There's a lot of conversation in the birth in the free birth circles about, you know, what happens if you do need to transfer and, you know, how to how to do it in a way that, you know, you won't be treated like shit, basically. But, right, the the larger
Speaker 2
But as smooth as possible because smoothness saves lives.
Speaker 1
But unfortunately, the smoothness has to come with lying. Right. You know, which Right. But that's on the hospital, you know. That's that's such a sickness of
Speaker 2
Oh, you have to lie if telling the truth means that you're gonna be disrespected and abused. Yeah. And that's an unacceptable position for women to be in.
Speaker 1
And no wonder people are wanting to birth at home more and more. I mean, look at
Speaker 2
It's rational when a third woman is exceptioned.
Speaker 1
Holy moly. And it'll you know, a lot of hospitals, it's more than that.
Speaker 2
That's right.
Speaker 1
Well, thank you for your time.
Speaker 2
My pleasure.
Speaker 1
I really appreciate it. I love talking with
Speaker 2
you. You too.
Speaker 1
Alright. Keep it down.
Speaker 2
Keep it up.
Speaker 1
The good work, Emily.
Speaker 2
Mwah. You too. Bye. Alright. Bye.
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.
