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 on the show, we have Kristin Pascucci from Birth Monopoly. Kristin is an advocate for women's rights in childbirth, who from her own child birthing experience was inspired to change careers and dedicate her life to leading the charge in birthrights activism. Today, we get into the nitty gritty of how the obstetrical model of care is failing women and how it's high time for us as consumers to speak up. Kristen is a force to be reckoned with, committed to shining light on some of obstetrics' darkest shadows. But as I was thinking about talking with you this week, I was thinking, like, okay, for someone who's never heard you talk, and for someone who doesn't you know, for someone who's not already familiar with the work that you do and the voice that you stand for, and who's never even considered that the medical model might need, a reorganization, what would you say on kind of pulling back on a more, like, macro level? What would you say to somebody who doesn't know anything about this stuff? What is wrong with obstetrics? And what is what is where's the error? Where's the imbalance in birth culture today?
Speaker 2
I'd say you think you're in charge of your birth, but you're not. What you're looking for when you are shopping for providers and hospitals is who is going to allow me to have the most control over what's happening? Because the default is you not having the control. Does that make sense?
Speaker 1
So you're saying that they should look for who's going to allow me to have the most control?
Speaker 2
Well, yeah. I mean, obviously, like, I wouldn't use that terminology. Yeah. I'm saying, like, that
Speaker 1
Even the concept of shopping for a provider, I think, is really new. Right? Like, because the default is you get pregnant, you call your insurance, and they send you to a provider in your network, or you have a physician or a g y n who's also an OB, and it just rolls over.
Speaker 2
Right.
Speaker 1
You know? So even yeah.
Speaker 2
And there's and there's this perception that doctors are all trained the same hospitals are fairly similar and there's this sort of standardization. If you're seeking medical care and that is just like an absolute fallacy, You know, you can, you can look at statistics and see how dramatically different different providers and hospitals are and practice and, and, what their outcomes, how different their outcomes are. Just for like a really quick example, we have in my town in Lexington, Kentucky, you can go to one hospital and you have like a less than one percent chance of having an episiotomy. You can go to another hospital that's like, you know, within thirty minutes and you have a twenty two percent chance of having an episiotomy. That's not because of the population difference. That's because of the providers, you know, whoever the, you know, whoever the group or individual providers are at that place, that's how they practice.
Speaker 1
Yeah. It's not because one one there's the vagina population that needs to be cut on one end of the state.
Speaker 2
Right. Exactly. And so that variation is true among hospitals and within hospitals as well. So you might even say, well, you know, this is the best hospital in town. I'm good there, right? No. No, you're not. You might have a doctor there with a fifteen percent c section rate and a doctor with a seventy five percent c section rate, and they all work at the same hospital. And they're all subject to the same marketing by that hospital.
Speaker 1
And
Speaker 2
I think, like, that is one of the things that people don't get, as
Speaker 1
far as, as far as marketing. Is it true that the hospital has to put out their, let's say, c section rates, but the individual doctor is not required to?
Speaker 2
No. It's not true because hospitals don't have to put out their c section rates. Well, I should say, let me put a disclaimer on that. In, there there, like, there's no, like, federal law that says that hospitals have to disclose c section rates. There are in certain, you know, in some states, the health department collects statistics or, you know, the CDC collects statistics based on data that hospitals are submitting. But it's not, it's not, it's population based data. So it's not like the CDC is coming out and saying, Wow, you know, X hospital has a sixty five percent C section rate. Somebody should do something about that. They will be like state numbers, you know? Where they don't report anything at all. I can't remember off the top of my head, but I know there's, gosh, I want to say it's like a South Carolina or something like that. Something in that area of the country where, like, they they refuse to the hospitals refuse to report their rates. And, you know, so, like, nobody knows what they are. There are other places in the country where nobody knows how many vaginal birth after caesareans or births after caesarean are happening because they just choose not to report.
Speaker 1
Yeah, and
Speaker 2
then there are, and then there are like various, kind of org, you know, private organizations that will collect numbers and sometimes hospitals, you know, voluntarily will give numbers or, you know, the organization will contact them and ask them for numbers and they, you know, will or will not provide them. But I think, like, the my point here is that it's it's variable. It's often voluntary. It's imprecise. Nobody's really, nobody's really like breaking this stuff down from like a, you know, you know, like there's a federal law that hospitals have to report C section rates and, And that those rates somehow influence policy directly or that there's like, a system of, you know, checks and balances about C section rates. It's not, it's really like this patchwork of, you know, reporting in systems.
Speaker 1
Yeah. And, and, and to go back to what you originally said, that, that, you know, the problem being you think you're in charge, but you're not. I think that that's true for a lot of people. And then I think there's also a population of women who very much do not want to be in charge and don't think they're in charge and are very comfortable, you know, saying, here doc, you you just tell me what to do. And and and I trust and believe that you're gonna give me the healthiest, most alive baby possible in this situation no matter what happens. And under under that, there is a false belief that the doctor and everyone, you know, everyone on the hospital staff is putting you and your baby first with evidence based information and that everyone has your best interest in mind. You know, and and obviously, we know that with fear of litigation and and, you know, the financial demands and and scheduling demands and all of the things that hospital staff have to deal with, that is often not the case.
Speaker 2
Yeah. Yeah. I mean, if you you know, generally speaking, you know, in American obstetrics, there's kind of one way of doing birth, And that's what you're that's what you're going to get if you say, hey, birth me.
Speaker 1
Yeah, exactly. Pull my baby out. Birth me.
Speaker 2
Yeah, like regardless of regardless of your health circumstances or your, you know, your individual circumstances or wishes. So, you know, if you if you choose to kind of turn yourself over that way, then I, you know, to my mind, you're you're kind of like putting yourself in this lottery of
Speaker 1
Mhmm.
Speaker 2
Okay, well, you know this hospital has a forty one percent c section rate and I am just like anywhere in that you know it's it's basically a grab bag you know as to like where I fall. -Um, so, yeah, I mean, obviously and, you know, that's what some people are comfortable with, and and that's Okay. I really believe that it's a shame that we have to insist that women are so extra prepared, so extra informed just to beat the system. Like, I wish we could just have a good system, you know, where you didn't have to go in with the expectation that you would, need to be asking for or fighting for, advocating for exceptions to their routine care. Totally. But, but, you know, I mean, you just look at the numbers, you know, nine out of ten women give birth on their backs.
Speaker 1
Right and and that we know that many routine you know mandated practices have been proved to be not evidence based or not even safe or healthy.
Speaker 2
Well are they they never were implemented because of evidence in the first place and I think that's I think that's really kind of the key is that, a lot of a lot of what we've done for many years has been basically experimental.
Speaker 1
Mhmm.
Speaker 2
And even when it didn't work, we still kept doing it. And so the onus has also almost been on scientific research to prove that we shouldn't be doing the things that we never had evidence to do in the first place and so it's like this very slow you know, arc of coming back from that into, like, we're trying to, you know, drag American obstetrics into, you know, twenty first century Yeah. Science.
Speaker 1
Totally. Yeah.
Speaker 2
Not not to mention not to mention human rights.
Speaker 1
Yeah. I mean, yeah, it's just it's it's it's a multi piece puzzle for sure. I mean, like we were touching on before we started recording, there's there's societal status and where you're birthing. And and if you already feel empowered to speak up or not, that can heavily determine your birth. But then, you know, some people speak up and they get punished for speaking up. So it's a Yeah. Very complicated. You know, and that that to me is the scariest part about the hospital system, specifically, you know, in obstetrics. The scariest part to me is not knowing what puzzle pieces you're gonna get at your birth and that you could get, you know, you could get the best nurse who's in the best mood, and she's just coming in after a good night's sleep, and she's excited that you are
Speaker 2
And she loves she loves doing she loves informed patients. Yes. She and,
Speaker 1
yeah, she loves doulas, and she loves that you're not getting an epidural because she had a home birth. And you just get that nurse that you're like, oh, god. I could kiss you, you know, and and you're she's amazing. And then you get that on call midwife who is wonderful and who loves using the birth stool and turns the lights off and forgets to call the resident, you know. And all of a sudden, you've got this beautiful mother led, you know, perfect experience. But it is only because of random circumstance that those puzzle pieces came together. It's not really mother led if it's actually only happening because you got this random puzzle piece.
Speaker 2
The mother got lucky.
Speaker 1
The mother got lucky. And and versus, of course, as we know, we could get a whole other mixture of people at the same hospital in the same room, you know, and that that's the piece.
Speaker 2
Yeah. And I think there are a couple of really good examples of that, in the last two or three years where mothers have brought lawsuits because they had one plan with their doctor and then they came in in labor. They got a different doctor and that that doctor switched everything up on them. So there's the one case in Alabama with Caroline Malatesta where she was planning a natural birth and her doctor wasn't on call and the nurses couldn't care less that that, that she was wanting a natural birth. And, you know, she she was, you know, forced physically forced onto her back and her baby held in. And, you know, she had she suffered a debilitating permanent injury from that. And then there's another, and she did win that case, by the way. But, and then there's another woman in New York State, Renata Dre, who was planning a vaginal birth after a cesarean with the, you know, support and the total support of her doctor. But then when she went into labor, he wasn't on call. And she got another guy who doesn't do v vaxx Yep. And rolled her back to the ER kicking and screaming.
Speaker 1
Yep. I mean, I've seen those first. Section. I've seen every I've seen all this, you know, the few cases that there that there have been, you know, I think birth workers have seen that multiplied in spades, you know? And and I
Speaker 2
love Right.
Speaker 1
I love that their their lawsuits are occurring, but, you know, three lawsuits to the thousands and thousands and thousands that this is occurring, you know, on a regular basis is is.
Speaker 2
Yeah. It's it's not much, is it?
Speaker 1
I mean, anything, any attention is better than where we've been, you know? And and that's another piece about, like, where we have been, you know, that doesn't get talked about and, like, that that so much of this is based on gender violence, and on, like you said, experimentation, and racism, and, you know, I mean, the history that obstetrics is built on in this country is
Speaker 2
Misogyny. Oh, my
Speaker 1
God. It's, yeah, it's just, It's appalling, and it's a it's appalling to me, which is unfair, I guess, to say because I'm just so in it that I do have a better understanding of it. But that, like, empowered, privileged, affluent women who self identify as feminists, and, like, you know, for the people or whatever are still choosing to birth in this system that is literally set up, you know, to to Well,
Speaker 2
you know, feminism has a problem with birth choice. Yeah. That's changing, but that's something that, you know, we all need to be working on consciously because that that is a big that's a big problem. And we
Speaker 1
all need to Do you agree on that?
Speaker 2
Yeah. I mean, I would say that, you know the idea of reproductive rights encompassing childbirth is unheard of or you know was unheard of for a very very long time. That, you know, I think there's there's just been, like, this sort of divorce between reproductive rights and actual reproduction in some ways, where reproductive rights end when you decide to have a baby.
Speaker 1
Mhmm.
Speaker 2
You know? And
Speaker 1
Because now we need a live baby, and everything's an emergency. And so I'm willing to give up whatever I need to give up or my hopes and dreams as long as there's a live, healthy baby. Well, you know, I would say,
Speaker 2
healthy baby? Well, you know, I would say, actually, in my, you know, ever evolving opinion, it looked it looks to me as if feminism at some point, you know, anything feminism at some point was how masculine can we be.
Speaker 1
Totally. And I
Speaker 2
know that I'm totally oversimplifying this, but, anything relating to home and hearth was almost like, you know, something that had to be, you know, pushed aside
Speaker 1
and pushed
Speaker 2
down and we're better than that and we're not gonna do that. And like, and I have a lot of compassion for this this is not like some big criticism of feminism or like rejection by any means, I just think like that's how it had to be at the time you know like we need to distance ourselves from that idea of women in the home, women as the center of the the home, as the child rearer, the child bearer and the child rearer and whatever. And so, you know, part of part of that was like, you know, deliver us from childbirth, you know, like we want to be epiduralized, we want to be knocked out. We don't want to go through this pain and horror in this super paternalistic system where childbirth is a horror the way it's treated.
Speaker 1
And and on the foundation that, you know, women are meant to suffer for their sins, you know, and and this is a way to check out of that and say, no, I don't have to suffer.
Speaker 2
Right. Right. Exactly. Like, I'm overcoming my biology. And, you know, there is there is some logic to that. Like, I I get it. Like, I understand where that's evolved from. But it's it's time to evolve on from there and acknowledge that, guess what? We don't have to be better than our biology because men are not better than women biologically. Mhmm. We can embrace our biology. We can we can be proud of it and appreciate the power of our biology and, not look at it as a weakness, but rather, you know, a source of strength and a source of power. So that's just, you know, a change that needs to happen in feminism. And so, I think there's like this knee jerk response to when you're talking about birth, you know, sort of traditionally it's been, the, you know, I think of it anyway as the feminist response to birth has been, let's just skip it. Like, you know, like the ultimate, sort of like the ultimate feminist birth to me is like a scheduled C section. Now this is just my opinion. And I can see that, like I get it. And I myself started out planning a scheduled c section with my baby because I didn't want to be degraded by birth. And all of the humiliation that comes along with you know being naked in a room full of strangers with like your genitals displayed and people doing things to your body But this is just all part of that evolution, that needs to happen, where feminists are reclaiming our bodies and reclaiming the functions of our bodies, including childbirth. Right. And, you know, we
Speaker 1
do can be a feminist and still be and still hold a lot of unexplored fear around childbirth, you know? And that that's where I think a lot of women are finding themselves, you know, also. Mhmm.
Speaker 2
Well, and you know, what's interesting is, like, I really see, like a an aspect of body shaming. And I am always, like, struck by how, like, the same feminist can be, like, so, you know, I'm gonna freebleed, and this is my period, and this is what I do, but, like, horrified at the thought of having an active empowered birth, you
Speaker 1
know? Totally. Same same with like like yoginis, you know, people who do so much yoga and meditation and all this, like, you know, enlightenment work, and then they just go to the hospital and have someone else tell them how things are gonna go down with their baby and their body. Mhmm. Yeah.
Speaker 2
It's really interesting. It really is, like, it's just
Speaker 1
It's like our last shadow, I feel like, in in feminism. I really feel like it is It really is this shadow piece that obviously you and I talk about all the time, but in mainstream, you know, society, it's really not discussed. It's still very private and very Yeah. Very, like, you know, you literally go to a building and get put in a small room and get a baby pulled out of you and then you get sent home. Like, it is very private.
Speaker 2
Yeah. Yeah.
Speaker 1
Or hidden.
Speaker 2
Yeah. I remember I remember, my friend Hermine Hayes Klein saying something like, at one point, like, sarcastically, well everyone knows you know any any good feminist knows that, feminism is all about turning your body over to the machine. I thought that was a really good way of putting it, you know. Right.
Speaker 1
And that is, like, last that, like, those that can end with this generation, you know, because that is that is very that that's that's totally it with this last hundred years and this whole, you know, crazy century we've gone through with with birth and feminism. And, yeah, I think we're moving into it.
Speaker 2
And we need to and and, like, from our point of view, I think, like, we need to approach this without judgment because, it is it is a piece of our culture. We were steeped in this culture that is, you know, we're not we're not at fault for having those you know having been programmed that way. It's just that at some point we we really need need to start moving on from that. And so
Speaker 1
And I think where where I struggle as where I've struggled the most is is actually not with the women who are, like, just manage my care and I'll do what you say. It's like, okay, cool. That that actually I don't struggle with. It's the women who say, I want an unmedicated birth. I wanna feel birth. I wanna do all this stuff. And then it's kind of just like an idea. And then they are completely annihilated at the hospital. And then they have, you know, so much trauma. And it's not even really judgment. It's like, I feel bad. I feel protective over them. I feel so sad that they thought that they were gonna be in a system that supported them because they were literally lied to. And there really isn't any, you know, aftermath sit like, situation. Like, they just have to now they have a newborn and they just have to survive and they have to, you know, figure it out.
Speaker 2
And and so often, unfortunately, their trauma response is,
Speaker 1
child
Speaker 2
you know, natural childbirth isn't all it's cracked up to be. And, you know, birth sucks, and it was, you know, way worse than I thought it was gonna be, and etcetera, etcetera. Essentially, they're blaming themselves.
Speaker 1
Totally.
Speaker 2
You know, they they might think they're blaming people. But it's really yeah. They're actually, like, blaming their own bodies, which,
Speaker 1
It's so hard to say.
Speaker 2
Which is horrible because it's it's it's the system that failed them.
Speaker 1
Well, and that's you know, and and I think about this all the time, time, like, you know, how many births I've been to where I saw a lot of abuse, and the woman didn't see it that way. You know? And and I wouldn't tell her that. You know, that's not for me to say to her, but but in terms of, like, abusive legal power and not practicing informed consent, you know, doing things she didn't understand, doing things she said no to. I mean, real real things that we would clarify as that we would define as abuse.
Speaker 2
You
Speaker 1
know, but then when you hear their story back, it's just void of all of that. You know? Because there aren't, like, tools or action items. Yeah. There aren't there is no set up spiritually, emotionally, or literally, or physically to hold, you know, the space of what do we do if we acknowledge that. And that that's what I wanna pivot to. Like, what what can we do to get people to pay attention? You know, what can we do to help people see that they are consumers? I mean, even on Medi Cal in L. A, there are many places Mhmm. With Medi Cal that they can go. You know, it's Mhmm. You you still at the end of the day, even with free insurance, you still do have some choice even though it's hard to know that because people don't necessarily frame it like that to you.
Speaker 2
You have to kind of fight for it or Mhmm. You know, navigate it.
Speaker 1
So how do how can we get people to, yeah, pay attention before they go in?
Speaker 2
Yeah. So to me, you know, I have been involved in legal advocacy efforts for several years now, and that's very important to me. What I have learned is that it's it is just as much or more about culture. Different people approach these issues in different ways. And there are, you know, for example, there are what I would call medical efforts to make care better, to treat women better, that are coming top down, in the medical in medical training and in medical practice. And then you have, you know, consumers, fighting in their own little spheres, you know, meeting with their hospitals to say, listen, we think you need to, you know, women are complaining about this or we know this has happened at the hospital and what do we do about it? And, and then there are people bringing lawsuits and many of us helping people, not many of us, but a few of us helping people bring lawsuits, etcetera, etcetera. But to me, culture is the key to all of it because none of those changes are going to be meaningful or lasting if we're not fundamentally changing the culture of birth as well. So I have just in the last year kind of done a little bit of a pivot with my own work into, you know what, I'm kind of done talking to the birth crowd about this stuff. I'm going to spend my time talking to the public and to influencers because this needs to get this needs to get out of our preaching to the choir and into the mainstream. And so, you know, for me, that for me personally, that means publishing articles, doing a radio show, making a film like a feature, you know, feature type documentary film. Like that to me is is like the next big step. And so, you know, two years ago, my friend Lindsay Askins and I did the Exposing the Silence project, which I know you are well aware of, Emily. And, like, the whole point of that was to give these women a platform and make sure that a lot of people saw them on that platform. So there was a, you know, deliberate and calculated media effort along with that, which is the same thing that I've done for a couple of or several, lawsuits that have gone on in the country. Which is like, you know, it's awesome that people are bringing cases but it's not going to benefit anyone outside of, like, a teeny tiny little jurisdiction if nobody knows about
Speaker 1
it. Totally.
Speaker 2
And also it's really important for women to see other women standing up for themselves. I know that, like, Alabama is just, like, a perfect case study on that, where Caroline filed that lawsuit, you know, it hit the it hit the press, and women all over Alabama were just up in arms, You know, like, yeah, you know, she hundreds of women contacted Caroline. Dozens of women contacted me to say, oh my God, you know, the same thing happened to me or something similar happened to me or it happened to my neighbor or my sister and, you know we all know we we thought it was wrong you know it felt wrong but everyone said it wasn't wrong and you know this is so validating basically to see that it was wrong they shouldn't have held her down you know they shouldn't have forced my sister to whatever. They shouldn't have given her that episiotomy that she said no to. So, yeah, I would love to see women
Speaker 1
kind of So then what? So those women so let's, like, follow that trail for a second. So now they get validation, they see that a lawsuit happened, and then they get pregnant with their second baby. How how can they make a different choice this time?
Speaker 2
Well, I mean, Alabama's a good example of that. They are they've gotten further than they have ever gotten in legalizing certified professional midwifery. That's an option.
Speaker 1
That's a new thing, right?
Speaker 2
Yeah. They've been, some people started trying to get licensure for certified professional midwives who are the midwives who, primarily almost exclusively practice at home or invert sectors so out of hospital, professionals and they, you know, they started over ten years ago and have worked really, really, really, really hard. Well, they got the most traction they've ever gotten this year. And there's no doubt in my mind that some of that is due to the publicity that Caroline's case has gotten. Well, and I also, you know, made sure that some other articles happened in Alabama or about Alabama that weren't, that weren't directly related to Caroline's case. But in my mind, it's all linked together. Totally. Because Caroline's one of those people who might have chosen a safe and legal home birth had it been an option you know. Yeah. But it's you know it hasn't been. So and then you know we're definitely seeing practice change. Like there's no question that the more women understand and can, like, picture imagine that they have other options, the more they start asking for it and the more the women start kind of sussing out who is the doctor who is best for this is most likely to, you know, quote, allow me to do this. And that's something that's happened in Alabama where I think that women left Brookwood Medical Center in droves, after Caroline's case. And guess what? They have to go somewhere else. So there are a few, very few doctors in Alabama who do practice, more evidence based rights respecting care, and they're getting a lot more business.
Speaker 1
Mhmm.
Speaker 2
As they get more business, they're able to expand. You know, they might be able to practice independently at some point or open a birth center or, you know, what have you. And in that in in that case, it's it's it's mostly privileged white women with, you know, with with financial flexibility.
Speaker 1
Yeah.
Speaker 2
Who are able to, you know, actually make those choices. And they're just, you know, they're voting with their dollars in a way that benefits everybody because, you know, the whole reason Brookwood and its competitor, Saint Vincent, were doing advertising campaigns about natural birth and birth plans and all that is because of community demand. Like, that's why they started doing those.
Speaker 1
They they just had to do those marketing. To Right. They couldn't actually follow
Speaker 2
through on the things, you know, that they were advertising. But
Speaker 1
Well, I think you're really I think you're really right with talking about getting out of the kinda echo chamber, you know, preaching to the choir and actually providing mainstream content so that articles, you know, do grab people's attention and that it can actually become a social conversation. You know? Because I feel like up until this point, birth was a woman's issue. Birth was not even a woman's issue, a pregnant woman's issue. You know, nobody Yeah. Yeah. Even thinks about any of this stuff until they're already pregnant, you know? And so, yeah, how do we get the conversation out to the actual public, which clearly has proved that they can talk about many, many, many different things that are not directly affecting their actual point of their life, you know?
Speaker 2
And Yeah.
Speaker 1
How do we Yeah. How do we add to that content and get that conversation brewing as a social issue, not just the pregnant mom Yeah.
Speaker 2
Which you're doing. Which is which is Yeah. That's what I'm trying to do. So And so are you.
Speaker 1
Yeah. Doing my best. So do you wanna wanna go over to the to the birth worker conversation and get into a little bit about doulas?
Speaker 2
Yeah. Sure.
Speaker 1
Yeah. So Yeah. You know, I mean, my my big thing I wanted to pick your brain about was just well, kind of, it's pretty blanket umbrella statement. Just around, you know, what's a birth worker to do? Like, how do you see the doulas role in all of this? And and where is it failing? And where can we do better? And I know you have this, you know, big vision with your with your project around the, Facebook group. And why don't you just kinda dive into that?
Speaker 2
Yeah. Well, I mean, I think it's a super, super complicated question. And, I want to see I want to see doulas doing more and I also understand and have a lot of compassion for the fact that they're literally at the bottom of the totem pole in this big system and so, I think it's impractical and unrealistic and unfair to put on doulas the responsibility for changing the system. Sure. At the same time, I think there are a lot of things that, you know, we could be doing better. Probably the number one thing is not colluding with hospital systems
Speaker 1
Yeah.
Speaker 2
In in in abuse. Yeah. That that that's a biggie. You know, I think I see a lot of sort of misunderstanding about power, which is, you know, the more we get along with the hospital, the more power we'll have in the hospital, the more we can do x y z. Now, I'm not making a blanket statement about that. That is that is true in some ways. And I'm a huge believer in building bridges and in collaboration and in all of those things.
Speaker 1
Well, and like you pointed out or somebody pointed out in in one of the groups about there are some hospitals. There's only one hospital to a town. And if if the doula screws up her relationship with those two or three doctors, she could not work. Yeah. Yeah. Yeah. Yeah. And that's I mean, that's not an issue I've ever had to deal with being in a big city. So that was definitely a different perspective for me because I I was like, woah. Okay. Yeah. That's a whole another way of approaching it.
Speaker 2
Yeah. Absolutely. Yeah. That's that's totally true. I think that, you know, I think that maybe it's just a conversation that we need to have, that that like I said, there's like there's just a misunderstanding about where that line is.
Speaker 1
Mhmm.
Speaker 2
And what part of the misunderstanding is, I think, the purpose of collaborating with and working with and having a relationship with a hospital is in order to give yourself more power.
Speaker 1
Mhmm.
Speaker 2
Like, that should be And money. Yeah. Like, that should be the ultimate goal. The the end goal is not in order to get along with the hospital. Like, it can't be the goal in and of itself to get along with the hospital. The goal has to be in service of something much higher, which is it's going to allow me to, it's actually going to, like, translate to more power for women and for my clients. And so, like, I've seen for sure some doulas or doula groups make that misstep where they think the ultimate goal is to have the relationship, when in fact that relationship is an ends to a means
Speaker 1
or
Speaker 2
I'm sorry, a means to an end, that that is much more centered around, you know, autonomy and respect for your clients.
Speaker 1
Well, and you add this this whole another layer of internalizing secondary trauma, you know, and it comes to this point. I think, you know, what I don't think we talk about this enough when we're attending births that have either high levels or subtle levels of abuse that it does seem like people come to this intersection where they either can as a way of actually coping with the trauma, they either go against it or go with it. You know, meaning Yeah. They justify Yeah. Become allied. And it is it is a tall order to go home and wrap your head around, you know, with very little support from from a birth community Yeah. You know, wrap your head around what you just saw, and did it really need to happen and what do I do when I'm seeing a woman say no and I don't have any power in the room and it I I see a lot of doulas kind of just I don't I don't know how to say it respectfully. Just just kind of, like, not know what else to do and therefore become a part of the system itself versus, you know, I will say for me, the harder but but more true route is to continue naming it and it's brutal. You know, it hurts. It hurts so much to continue naming what you just saw and were witness to was not right. You know? Mhmm. And and that Yeah. It is harder for sure. But, yeah, it does seem like there's this, like, part of the complacency, I do think, comes with literally not knowing how to navigate the the trauma.
Speaker 2
Absolutely. Yeah. There are no there's no instruction manual for this, you know? Like,
Speaker 1
people get into it like, oh, babies. And then it's like, oh, shit. Like, woah. This is yeah. This was this is, like, a whole, like, gender oppression issue. This isn't even about, like, oh, babies. You know? It's yeah. It's a real and it's a real slap in the face for a lot of doulas who have no idea. Right? And, like, most people, I think, don't know until they start getting into it. And it is it is really, like, what you thought it was gonna be is not what it is once you start getting into the hospital system.
Speaker 2
Yeah. Yeah. Which is a super, super, super tricky thing. Because the last thing a doula needs to be is defensive and antagonistic. And, unfortunately, though, that is what you know, that's a really common trauma response. Right? Mhmm. And we wanna protect ourselves. And so we go in expecting a fight or we go in, you know, with that, you know, defensive mindset.
Speaker 1
Hey, listeners. If you're liking what you're hearing, leave me a review
Speaker 2
I have actually a couple of online classes about legal rights as well as, articles that I think lay them out pretty clearly on my website. But in a nutshell, everyone
Speaker 1
has
Speaker 2
the right to informed consent and refusal, pregnant or not. You have this right. There's no exception for pregnant women for for the condition of pregnancy. And that and that essentially says that you you have the right to give or deny permission to other people about what they're going to do to your body. It's not the other way around. And I think a lot of people have this idea that it's the doctor who makes those decisions, and it's the pregnant woman who asks the doctor for permission to, is it Okay if I move around during labor? Can we talk about maybe not giving me an episiotomy? And that doctor centered or provider centered, I should say, because that's also true for nurses and other staff members. That provider centered view of decision making and authority is not consistent with human and legal rights of patients and people in general. So then, so then how
Speaker 1
are there cases when people get, like, court judge court ordered c sections and, you know, what what's happening in those kind of situations where a woman doesn't get to practice informed consent?
Speaker 2
Well, I mean, it's bad law is what it is. They're bad they're bad decisions and it's bad law. And,
Speaker 1
And, like, CPS, you know, CPS getting called when you decline vaccines at certain hospitals. Like, what? Well,
Speaker 2
what you're seeing is that, you know, state workers and medical professionals themselves do not understand informed consent and refusal and or are used to violating those rights as a normalized part of, you know, their work in the system. It's really, it's really common for me to have a conversation with a medical professional who is either completely misinformed or just completely disagrees with, the idea that that patients have these really basic rights I've had countless interactions with like obstetric nurses who say things like you know well she has to have such and such you know like well well, think about not making her do that, but she has to do that. And then you'll say, well, accept that she actually does have the right to make that decision. She has an informed consent right and a, and a refusal, a right of refusal. And they'll say things like, well yeah, but she signed those, she signed those consent forms. So, you know, at this point, you know, we get to do whatever we need to do or we have to do whatever we have to do, and, like, whatever's medically necessary, then, you know, from then on, we just do it. And that's completely inaccurate. That's absolutely not correct. But that is how they've been trained and taught, and how it's just, you know, normally practiced. And so that's what they believe. And then of course, patients get, get impressions from them about what their rights are. If your nurse tells you, you know, that this is the form you signed, and so this is the thing we have to do, who's gonna think to question the nurse about that?
Speaker 1
Yeah.
Speaker 2
You know? I mean, you shouldn't have to have a freaking law degree to to have a baby. Mhmm. But, you know,
Speaker 1
So that's the main that's the main legal right that women need to know about and partners need to know about, that they have the right to refusal and that they actually are the ones that have the legal claim to what happens to their baby as well. Right?
Speaker 2
Yeah. And I should, I should give a little bit more precise of a of a definition for informed consent and refusal. So informed consent basically says that the provider has the obligation and the duty tied to the patient information, like the relevant and accurate information about whatever treatment they are suggesting or are recommending. So they have to give you information about the risks and benefits of that treatment. And then they also have to provide you with information about alternatives to that treatment. And then they support you in whatever your choice is. So you might say, Okay, with that information, I am going to consent to this IV, you know, or whatever it is. I do, you know, yes, I will take the IV. Or you might say, you know what? With that information, I don't want an IV. I'm gonna have you know, I'm gonna snack on some stuff over there and, you know, I have a few bottles of water. So so if you were to refuse the recommendation of an IV, you would be exercising the right of refusal. And that is an almost absolute right. There are there have been, you know, multiple, cases on informed refusal. ACOG the American College of Obstetricians and Gynecologists has put out several ethics committee statements talking about the right of refusal and informed consent and
Speaker 1
you know So what what in the room then? So I'm I'm thinking of all these births where, you know, the nurse says, oh, honey, I'm sorry, but you have to have the IV. You know, it's hospital policy. It's mandatory. And they're using language like that, which is not is not right. You know, that's not legal to to say things like that and tell them they have to do it and that they can't refuse. So what can a birth doula in the room, you know, say and and do in a situation like that when you know they are not being Well given informed consent, which is their legal right?
Speaker 2
Yeah. Well, first of all, it's not it's not the doulas' rights. It's the patient's rights.
Speaker 1
Mhmm.
Speaker 2
And it's the patient who needs to be informed of those rights and, sadly, ready to advocate for themself. But the partner I think is a big key in that because partners kind of have this like weird semi I want to say semi legal, but they don't they don't have like, they don't actually have any legal status. But in the in our culture I think a lot of times especially male partners are given this semi legal status when it comes to you know how their wives or girlfriends or whatever are birthing a baby. I mean it's not that many years ago when you would hear doctors getting permission from fathers about certain things or Oh I still have
Speaker 1
to do that.
Speaker 2
And to this day, yeah and to this day, kind of taking the father aside to have the father convince the mother to do the thing, you know? So, so anyway, prior to birth, there absolutely needs to be some education of the patient and the patient's partner support person or support people for sure. I have a few handouts including one that's on informed consent, you know, that you can actually take with you so that in that moment of, you know confusion and somewhat sometimes awkwardness or you know confrontation that you can actually put your hands on something instead of you know trying to remember what you're supposed to say that's that's critical and then you know and then in that case the doula is there just as she would be in her role you know in any other aspect of the birth to remind you know to remind that that these rights exist to, to say, is there more information that you'd want about that? You know, remember we talked about how you have a right to information? Do you have any more questions? Are there any, you know, do you feel comfortable with the risks and benefits as they've been described to you or would you maybe want some more information on that? I think there's a way that you know doulas can just remind the patients and their support people of the information that they absolutely should have already gone over prenatally.
Speaker 1
Yeah. I mean, I've I've gotten to places at birth where I you know, the the mom has been laboring all night. She's exhausted. The partner is not checked in, and they're being told they have to do something, and it's not true. And, you know, I'll say, you know, hey, just to remind you, it's your legal right that you can refuse. You know, it's, like, casual. Like, it's not this, like I'm not being, like, this, like, you know, like, damn the nurse, and let's anarchy. You know, I'm not doing that. I'm just going, you know, just to remind you it's your legal right to refuse, and so, you know, you're
Speaker 2
Yeah, and you'll hear and I think that's perfectly appropriate. You'll hear nurses say that sometimes. You know? Like, we'll say, Okay, hon, you know, this is the thing, da da da. And then when the mom expresses a little bit of hesitation or, you know, or something, then the nurse says, oh, well, you know, you can refuse it. Unfortunately, you know, it's too bad that often the mom has to be the one to prompt the nurse, you know, that they don't just come out and say it. But, you know, it's great that they at least have an idea that, that the, that, that rate does exist and, you know, and clearly she's willing to respect it if she's, you know, telling a patient that she has the right. So what,
Speaker 1
what happens then with things like with c p s, with the baby? You know, I understand when you're pregnant in labor, though it's very hard to say no. You know, in many cases, they legally can. But is the line as blurry as it seems with the actual decisions around the baby and and the medical recommendations or, you know, them saying that they have to take the baby, let's say, to the NICU, and the mom says, Hold on. Wait. I wanna first see them. You know, things like that. Where does it legally come down to of who gets to make those calls? And is it is it a if the baby's not well, the doctor starts to get to make decisions or because that's kind of how it seems, but I've always wondered that because it's very, very it seems very blurry.
Speaker 2
Well, unfortunately, it is blurry in a lot of ways because it depends on where you are, how it's going to be treated. So you'll have some places that are absolutely respectful of the parents' legal right to possession of the baby and medical decision making about the baby and then you'll have other places that, they have what looks to me as just this like this possessiveness over over babies, which I think is very much a cultural thing. I you know, in my in my own town, the hospital across the street from me, like, has been known to say to parents that if they decline the, I wanna say, I think it's the eye drops, although I'm not one hundred percent sure, I think it's the eye drops. You know, if you decide to decline that for your baby, then we have to call CPS. Now, they don't have to do anything, but they say we have to call CPS.
Speaker 1
And And what's the premise for that?
Speaker 2
Like, what's the actual I think neglect. You know? That they're,
Speaker 1
that
Speaker 2
they're endangering their baby by refusing that medical intervention, by neglecting to allow, you know
Speaker 1
So, basically, you have
Speaker 2
that medical intervention.
Speaker 1
Your the parent is the legal represent representative of the child unless medical staff deems that the child is, like, under some umbrella of threat or neglect. And that Well, yeah.
Speaker 2
Except you still have a due process. I mean, that's why the the hospital can't appoint itself the legal authority over your baby. Mhmm. Report it to a state agency. Right. Well, they have to report it to a state agency, which, you know, is, you know, via a court system. You know, a a judge who set who looks at a case and says, you know, I I have determined that this baby was being neglected. These parents are guilty of medical here's here's what I think, you know, here's the the judgment going forward. The the thing the the really broken and dysfunctional piece of the system is that it often takes so long for that to happen. So you might have a a completely kind of benign incident where some, you know, hospital staff person gets pissed off at a parent and decides, I'm going to make this report, and I know I can. And it might take nine months for those parents to clear their names for something that was, you know, really clearly benign and, you know, not that big of a deal. But it's and and then you're in that system, and you'll kind of never not be
Speaker 1
in that system. And and it happens with free birthers. You know, if if there's a situation with the birth where they do wanna go to the hospital, let's say a retained placenta or, you know, they wanna get the baby checked out, maybe there's a question about that. You know, unfortunately, though, you'd think that the hospital would be a safe space for that. If they admit that they intentionally birthed at home, c p s is there. You know? Yeah. And and under what? Because it is legal to birth in your own home or to choose your place of birth in every state as far as I'm aware. You know? So it it's it's scary. You know? It's scary for a lot of free birthers of how to
Speaker 2
Oh, totally.
Speaker 1
Navigate, you know, the and and the polarization there and the gap there actually puts more mom and babies in harm. Right? Because if they don't feel safe to come to the hospital when there's really an issue and be honest about their experience
Speaker 2
Yeah. And how about, like, lowering just just lowering that threshold of safety, of that feeling of safety. It would be great if they could feel comfortable going in without an emergency, right? Like, you know what? The baby's, you know, two days old and whatever. Let's just go in and get her checked out, just just just out of an abundance of caution. Mhmm. Wouldn't it be awesome if they could do that routinely, no big deal, and feel very comfortable doing that? Like, who knows? You know, somewhere along the line, some baby might be saved, you know, because of because of that, that routine check checkup as opposed to the family, you know, really having to rigorously debate is this is have we reached the threshold? Is this the moment where we have to go to the hospital? Or like, can we wait till her fever gets a little higher? Can we, maybe we'll just give it, you know, just till morning instead of going right now. Right, it's not a safe
Speaker 1
space for a lot of people.
Speaker 2
Yeah. Yeah. Like, doing this, like, risk benefit analysis, which, which really sucks. You know? You should be able to go in there and use it as a service and not worry about getting punished for using a system that you're paying into.
Speaker 1
That and that really is the scariest part, you know, to me around the legal right stuff and around, you know, what should be legal right protection and what actually is. Because, you know, the the the cases in which I've seen CPS called for women I've worked with have been so ridiculous, you know, that I have not personally had a situation where it where it was actually appropriate, where the child or, you know, was actually in danger of any kind. It was just going against the grain. It was, you know, a really fast home birth and and they couldn't get to the hospital in time. And so they just birthed at home and they get to the hospital and and it's just, so much punishment, so much rude, you know, treatment and ridiculousness and CPS. And they need to debrief both parents and, because she had a fast birth at home. Give me a break, you know. But anyway, but with the the scary part around the legal representation of the child and, you know, baby getting taken away to NICU and then the baby, you know, not the parents not being invited into the NICU and saying, oh, you need to recover. That's a
Speaker 2
real problem.
Speaker 1
It's huge. And it happens all the time. And the mom, you know, is not able to be wheeled in or they're actually denied access. And so they don't know what's happening. And that's a blurry that's a blurry thing I think for a lot of doulas. I see doulas post a lot about that in our groups of what what can they do? What legally what access do they legally have to their infant who has now been taken away and they're denied access?
Speaker 2
Well, I mean, what I would we're so far behind on this. Like, so, so far, so far behind on this. I think of a friend of mine who's, in the political world who they basically did that to him with his when his when their baby was born in Northern California and it was some ridiculous thing you know they just said like well the baby's so big we you know we're worried about jaundice and like that was it you know there were like no other you know there's no reason other than you know it's possible that he might have an increased risk of jaundice even though there were no actual signs of it where you know he and his wife were like no no we want the baby now and like I think they did a couple tests or something you know and he was like no seriously we want our baby Anais threatened him with CPS and he said, awesome, bring CPS in here and bring your bring your mother effing lawyers. I'm getting my lawyer on the phone and he's gonna be down here and this is gonna be awesome. And because he's a, you know, a privileged, confident, well resourced, well spoken individual, he was able to completely intimidate them. And I think, you know, they probably sat back and went, well, you know, he does have a point. We don't actually have a legal basis, you know, for what we're doing. We're just really used to saying this to parents, you know? And, like, it is just one of those really crappy, like, just areas where it's super murky because
Speaker 1
But is there a hospital advocate available?
Speaker 2
Well, I mean, but that's the thing. It's a hospital advocate. So you don't necessarily know what you're getting. Often, I mean, you know, like, their paycheck is coming from the hospital, so,
Speaker 1
you
Speaker 2
know, there's there can be, like, well, there is sort of an inherent conflict of interest there, but with those people you might get someone who is, you know was just kind of put in that position with no real training for it. All the way up to somebody who has, you know, nonviolent communication skills and, you know, actually has training in advocacy and patient advocacy and, really knows knows something about it. You just don't know what you're gonna get. So, you know, I always tell people to ask for the patient, the patient advocate, and the chaplain because a chaplain sometimes can be, can have a really calming effect in like, you know, sort of a common sense, You know, somebody with some common sense in there.
Speaker 1
Mhmm. Yeah. And I mean, I be
Speaker 2
a little helpful.
Speaker 1
I, in the last couple years, just started telling my clients, you know, or suggesting to them that when they enter the hospital, it's either on their birth decisions document or, you know, they they voice it in a very kind, loving way. You know, we we are really happy to be here, and we are going to expect informed consent throughout this process. And I have seen some parents do that, and it has been really positive. And they were able to do it in a way that was totally respectful. Right? And getting over this story that that's gonna immediately cause all these waves. But you can absolutely say, we understand this is our legal right. We have a little nervousness. It has nothing to do with you guys. And so we are gonna expect this throughout the way. And let's let's just set that up from the beginning.
Speaker 2
I totally agree. I think it's really helpful to kind of set yourself up as a different kind of patient in a positive way.
Speaker 1
Yeah.
Speaker 2
I remember gosh I'm so mad at myself I can't think of where I heard this now so I'm not gonna be able to attribute it. But I remember this woman saying you know every time I go, every time I go into the doctor's office or go in wherever, I always start out by saying, Hey, listen, I just have to warn you, I'm kind of one of those patients. I have a million questions about everything and so I'm so sorry I know I'm gonna really bother you, I hope you don't mind explaining things to me I'm just kind of one of those people and you know she's like it puts everybody at ease like she's almost being self deprecating
Speaker 1
Look.
Speaker 2
I I know how absolutely ridiculous it is that we have to, like, train people to do stuff like this, but, you know, speaking practically here,
Speaker 1
It's also a manipulation tool, really. I mean, it's playing within the system. Yeah. So she names it. She identifies her.
Speaker 2
But I'd rather I'd rather manipulate people than be violated. Of course. Of course. Yeah.
Speaker 1
That's the name of your book. But,
Speaker 2
but, but yeah. And like and and here's the other the other really, really big piece
Speaker 1
is
Speaker 2
and this is like a whole other skill level that I really don't expect families to get to, but I think doulas should work towards, is is a genuine a genuine love and compassion for the medical team. Mhmm. Manipulation is a is a skill and it's, it's something you have to practice and it, it's it's superficial and it's, you know, it's not genuine. It's it's manipulation. It is really powerful when you can go in with a truly positive, inclusive, collaborative, loving, compassionate, attitude and you know, feeling towards the other people in the room. And even though you might think, oh, wow. Well, no. You know, you've got to be more defensive. Right? Like, the more you're expecting something, the more defensive you need to be. In fact, you know, it can absolutely have the opposite effect. And if you want people to, you know, to work with you and to soften and and soften and soften and soften instead of digging in their heels about you, loving them is the most effective way to do that. And then we get into, like, a much bigger philosophical decision or discussion about, you know, feminine energy and masculine energy and all those things and how, you know, being vulnerable and loving and soft can actually be an incredibly powerful powerful thing, much more powerful than, you know, hitting and fighting and violence.
Speaker 1
And how to do that loving soft, you know, all of that stuff, how to do that with power. Right? Yeah.
Speaker 2
Is is Oh, of course. It is. Yeah. Absolutely.
Speaker 1
Because, like, the old, you know, the old paradigm in how women are socialized is to be that way and be submissive and different and Right.
Speaker 2
You know, all
Speaker 1
of these other things. So, you know, how you can do that, it's like a really new story line to say you can actually be so powerful and so grounded and so clear on on your own body and autonomy and choices that you can, from that space, be incredibly loving and compassionate and still stay powerful and autonomous, you know. And and and that's, you know, obviously a tough little cookie to crack within
Speaker 2
for Well, that's why that's why I'm saying, like, my god. I to expect that of parents is just, you know unrealistic. You know as a doula I can say okay well you know you do this professionally so this is part of a skill set that you need to have if you really want to really serve your clients. And then it's something you actually have to work at, you know? Like, you've got to do some you've got to do a ton of internal work, my goodness.
Speaker 1
Yeah.
Speaker 2
And not to mention learning about your fellow humans. You know, I think it's something like over a quarter of nurses have work related PTSD that they are walking around with. Yeah.
Speaker 1
So you see how they're treated in the hospital. I mean, the hierarchy of power and the, you know, the the way the doctors talk to the nurses or the nurses talk to each other. I mean, it's Mhmm. You're really not I I can't say across the board, but it does seem like when you walk into a hospital, you're really dealing with a lot of abused people and a lot of traumatized people. And that's And that and that includes doctors. Absolutely.
Speaker 2
The medical training is often It's
Speaker 1
like military status.
Speaker 2
Abusive and Yeah. Yeah, totally. I just did an interview with, with an OB about that a couple weeks ago. And, you know she made a reference to like, you know, like in the military where they break you down in order to build you back up. And You can see it. That's mhmm. Yeah, that's how that's how they have been trained. And so you've gotta you've gotta walk in knowing that you're dealing with a bunch of damaged I shouldn't, I shouldn't say that across the board, but there's a, there's a really good possibility that you are going to, be ra be relating to at least some people who are damaged traumatized coming from you know a place some some really some really inaccurate deeply held beliefs about practice and about women and about power
Speaker 1
and all these things. And that are getting validated for what they did do, not what they didn't do. Right? Like the what's that line? The, the only c section that ever gets sued is the one that they didn't do. You know?
Speaker 2
Yeah. You only get sued for c sections you don't.
Speaker 1
You don't do. Yeah. Exactly. Yeah. So you're you're walking into this this
Speaker 2
Well and remember, it's not just that too but like for nurses, they probably do have a protocol that they're supposed to follow. They're not making up, you know, you have to have an IV. No, they've actually been told patients do have to have an IV. In Caroline's case, that was what came out during trial or during litigation was they did have a set of protocols. She was supposed to be on bed rest and she was supposed to have, continuous monitoring and she was supposed to have you know x y z all of these things and so those nurses are going well wait a second like we're just doing our job. I have to do this like what do you mean you're not going to do it? You have to do it because it's my job.
Speaker 1
You know? I mean, when you look at the stuff that they chart, you know, not only when they admit, but just, you know, on the hour and, you know, the the the pain scale and the, you know, all these different things that they are expected to chart on a pretty regular basis. It's it's challenging. It is. It's it's challenging for everybody involved because it's awkward to say no when you understand. And that's also another thing I see a lot is, you know, women women are in a sisterhood, and women don't wanna make other women's jobs hard. And, you know, women understand coming in in labor that they're just doing their job, you know. And so Yeah. It's just like, okay. I'll just go along with it because it's your job, and I don't wanna cause any trouble for you. Yeah. It is it is very interesting. Well, thank you so much for taking the time and and
Speaker 2
You're welcome.
Speaker 1
As you know, I am a a avid fan of yours. Where can people, you know, find you to learn more about your work?
Speaker 2
Birthmonopoly dot com.
Speaker 1
Wonderful. And It's all there. And you got a great Facebook group for Birth Monopoly going too.
Speaker 2
Yeah. It's, community dot birth monopoly dot com is that membership group that includes, a Facebook a Facebook group where the support happens, the doula to doula support happens. Yeah.
Speaker 1
And we can post the legal rights, share that document in the free birth podcast group on Facebook as well so people can look for that.
Speaker 2
Yeah. I think you actually have to subscribe to my newsletter to get, but it's like it's like three handouts. So they're they're good ones. Yeah.
Speaker 1
Great.
Speaker 2
Yeah.
Speaker 1
Awesome. Well, thank you so much, Kristen.
Speaker 2
You're welcome. Thank you.
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.
