Birth Allowed Radio
Summary: Give birth on your own terms.
During pregnancy and birth, trauma can happen. Dr. Tracey Vogel, an OB anesthesiologist from Pittsburgh, Pennsylvania talks to us about the stories of such traumas – especially those related to anesthesia and surgery – that she will be featuring in her upcoming book, and how the medical community can help prevent further birth trauma. > “There is a big gap between how providers think they are doing, and how patients think those providers are doing.” There are many problems with how maternal care providers deal with their clients. First, they aren’t asking the right questions. The focus is almost exclusively on the physical; there is little to no addressing of the emotional or mental wellbeing of the patient. If they do ask the right questions, however, they aren’t considering that not all mothers want to tell you about their feelings, especially if they see you as responsible for their terrible experience. Care providers carry on thinking they are doing a good job. Meanwhile, women are traumatized. > “Women end up with PTSD after what should be a positive event.” Conversations about trauma and wellbeing should happen before anyone ever gets to the operating room. Be clear beforehand about views, wishes, and expectations, and talk about contingency plans. Instead of telling the patient how things will be done, there needs to be a shift to inquiry. In order to do that, the medical establishment needs to learn new skills – how to listen and how to plan collaboratively. Being open to feedback isn’t enough; there is a need for proactively seeking feedback, really listening, and being willing to dig a little deeper. So many people are so unaware that they have trauma, or that childbirth, under care, can be retriggering of that trauma. > “One size fits no one.” All of the protocols that we are adopting aren’t for everyone. Birthing needs to be a tailored experience. It’s hard to go through all of this training and find out we need to start again with new skills, but we do. Advice to other clinicians: - Get some education and learn listening skills. - Beware of the phrase “at least.” - Be careful with your words, even “congratulations.” Let patients put their own words to their experience. Resources mentioned: When Survivors Give Birth, Penny Simkin, https://www.pennysimkin.com/shop/when-survivors-give-birth/ You can reach out to Dr. Vogel at firstname.lastname@example.org WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen to the podcast. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org
MOTHER MAY I SERIES - http://bit.ly/consentmovie Rebecca Dekker, a nurse, teacher, PhD researcher, and founder of Evidence Based Birth®, talks with us about the hierarchy of oppression that exists in maternity care, and how that oppression relates to birth (especially doula) work and advocacy. You can learn more about Rebecca’s work at www.evidencebasedbirth.com. > The Hierarchy of Oppression in Birthing In the middle of the night one night, Rebecca got up and started doing research on systems of oppression. She found a theory that said that within any system that has a strong hierarchy, that hierarchy is propped up by two pillars of oppression. The first pillar is the oppressor and includes oppressive factors, like cultures, institutions and people with power that want to keep that oppression in place. Within the system of maternity care, this would include things like the laws governing midwifery. The second pillar, which people don’t think about as much, is the pillar of *internalized oppression*. This is where people lower on the hierarchy consciously or subconsciously accept that they are inferior, and thereby prop up the system. They also keep other people on the hierarchy down through horizontal violence, which is aggressive or hostile behaviours among the members of a group who are at the same low level in the hierarchy. You see this among people who have a lot of responsibility but very little power (think nurses and doulas!). All of this serves to preserve the status quo. When “lower” groups fight amongst themselves, they never come together and create change. Hurt and traumatized by the system, their lashing out is a side effect of the oppressive system in which they participate. Intersectionality is a term coined by scholar and law professor Kimberlé Crenshaw. Change begins with individuals who realize they are valuable members of the team. Just being aware of how you fit into the system can be helpful, because you can depersonalize the treatment and disrespect to respond to it more effectively. Resources mentioned: Evidence Based Birth® - www.evidencebasedbirth.com Cristen’s Doula Power Group – www.community.birthmonopoly.com WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen to the podcast. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org
There have been a lot of changes to how midwives can practice in Maryland – what was once a felony is now a regulated practice. Yet, it isn’t necessarily easier for parents or midwives now that it's "legal" to give birth at home with a professional midwife. In this episode of Birth Allowed Radio, we talk with a midwife who has been practicing for 38 years about what she has seen change, and what it means for healthy births moving forward. My special guest is Karen Webster, of www.womanwisemidwife.com. Karen has been investigated and charged in Maryland, Delaware and Virginia for practicing midwifery--and she says she would do it all again! She puts herself on the line to help women give birth as they choose. “I was illegal.” From the 1980s until just recently, it was a felony to practice professional midwifery in Maryland. It is now legal now, but so restricted that it makes practice difficult. “Not a week that goes by that I don’t have a mom say to me ‘they said that my baby might die if I don’t do this.'" We have created two separate and often hostile systems. Midwifery respects the client's right of refusal; they are the center of the care. It puts the onus on women to make decisions about their own care, without using fear or violent, disrespectful language. Other countries are following our lead when it comes to birth, which is unfortunate, because we aren’t doing a great job. The medical community is starting to realize that we are in crisis and is trying really hard to humanize the doctor-patient relationship--that effort just hasn't reached Labor & Delivery yet. “We are terrified of birth and death because it is taken out of our everyday reality.” Birth and death are so removed from our personal experience that we have given them both over to experts to manage for us at high cost. But that is changing. "What I see coming is a time when what midwives did in the late 60s, early 70s--the renaissance of midwifery, the re-creation of who we were [as] community midwives--is going to happen again. Because the restrictions being imposed on midwives are not realistic for women." Resources mentioned: Being Mortal, Atul Gawande, www.atulgawande.com/book/being-mortal/ WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen to the podcast. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org
In this episode of Birth Allowed Radio, we talk about obstetric violence, aggressive court orders, and the special trauma of early separation. My special guest is Lindsay Askins, a birth doula and birth photographer, and my partner in Exposing the Silence, a photography and interview project about birth trauma and obstetric violence. www.exposingthesilenceproject.com/ > The journey from doula to obstetric violence activist While acting in the role of birth photographer, Lindsay watched a mother fight to see her newborn baby after it was immediately taken from her by the medical staff. "She never even looked at the baby’s face. They just took it." Recently, a doula client had been given a court order to comply with a caesarean, despite having no medical indications that it was necessary. So many ethical and legal issues are raised when you witness birth. Sometimes mothers are not told anything about the procedures that are performed on them; informed consent is often not even an option. > What does obstetric violence and birth trauma look like? The common theme, when talking to women who have been subjected to obstetric violence, is the idea that they have no voice; they feel like no one is listening to them or including them in the discussion about their own birth. Another prominent theme in birth trauma has to do with separation of moms and babies at birth. Mothers want to be next to their babies – it is instinctual. Suppression of that biological urge can create very real bonding trauma. When breeding horses, it is well known that you would never touch a foal for at least 15 minutes post birth, unless absolutely necessary, to allow for proper bonding. Yet we don’t allow that same opportunity to human mothers. Lastly, there is a strong theme of objectification in these stories. Women feel like they are being acted upon, as if they are an inanimate object. They feel manhandled and as if things are happening to them without their knowledge or consent. Resources mentioned: Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror by Judith L. Herman WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen to the podcast. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org We would love to thank attorney Susan Jenkins for her support in this podcast. Susan is a national advocate for midwives and birth activists. Susan can be reached at (866)686-1348.
In this episode, we talk about the world of pregnancy, breastfeeding, and marijuana use. To help make sense of this topic – and sort the science from the pearl-clutching - I brought in a special guest: Heather Thompson, PhD. Heather discusses the research and helps make it relevant to worried moms and birth workers. Heather has a doctorate in molecular and cellular biology and has worked in clinical research in maternal and infant health for 25 years. She is now Deputy Director at the reproductive justice organization Elephant Circle. http://www.elephantcircle.net/ > First, a note about the relevance of most drug research. As a whole, drugs are not tested on pregnant women to see how they respond. Most drugs are tested on a “control” made up of white men, and we cannot always extrapolate drug effects onto other groups. The female metabolism, especially in pregnancy, differs greatly. *What are the benefits of marijuana use during pregnancy/post-partum?* During pregnancy, it is often used for morning sickness and extreme nausea (hyperemesis gravidarum), as well as migraines, pain, cancer, and other pre-existing health issues. Research indicates that about 2 to 4% of pregnant women in the U.S. use marijuana. It’s important to remember that for people using marijuana as medicine--for example, to relieve debilitating nausea--there is an exchange of risks and benefits, all of which must be weighed against the alternatives. It may be more acceptable to one mother to manage a condition with careful use of marijuana instead of exposing a developing fetus to prescription drugs with known risks, or in lieu of stopping medications altogether in pregnancy. > What do the studies say? There are three primary longitudinal studies on perinatal marijuana use, which report that the main potential adverse newborn outcomes are pre-term birth, low birth weight, and increased NICU admissions. It is important to note that marijuana alone does not cause lower birth weight or pre-term birth, especially with moderate use. Separating out the effects of other factors, like tobacco smoking and poverty, is challenging but critical to understanding the independent effects of marijuana use. We have been studying marijuana for quite a long time from the perspective of looking for harm, but we haven’t shown that harm definitively. One of the primary authors on the Canadian longitudinal study, Dr. Peter Fried, says that despite decades of research, it has been found that the harms to babies are small, resolved in a few weeks or months, and that the child’s environment plays a larger role in development than marijuana itself. Language matters. “Harm” has punitive connotations. “Expected outcomes” helps parents make reasoned decisions and brings less loaded language into the conversation. > What birth workers need to know Investigate your state’s mandatory reporting laws. Remember that you can add narrative to reports made to the state; nurses’ commentary about patients holds a lot of weight. Any time you feel you must act as a mandatory reporter, keep in mind that use does not equal abuse. Prenatal providers need to help clients understand both the health and the legal risks (such as investigation by child welfare services) for a complete risk/benefit analysis. Resources mentioned: "Hard labour: the case for testing drugs on pregnant women" by Emily Anthes https://mosaicscience.com/story/pregnancy-testing-drugs Check out Heather’s blog for more on this topic. http://www.elephantcircle.com/circle WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org
In this episode of Birth Allowed Radio, we talk about what it means to say no to a procedure in the delivery room, when and if implied consent overrides refusal, and who is the boss of your body. Spoiler alert: it’s you. This podcast is an extension of a recent article Birth Monopoly article. You can check it out here. http://birthmonopoly.com/impliedconsent/ My special guest is lawyer and birth rights advocate Hermine Hayes-Klein. http://www.hayeskleinlaw.com/ *Let’s Talk About Consent* Implied consent is a concept that has become skewed, in all aspects of life on the sexual spectrum, including birth. Whether we are talking about date rapists or hospital administrators, there is a lot of misinformation about what implied consent actually means. We are talking about the right to consent to or refuse treatments in the context of labor and delivery, as well as the absence of direct consent. This includes such things as medications, cutting or episiotomies, induction, and all other interventions and treatments, all of which can save lives when appropriate. But we also know that those interventions are massively overused. For instance, the rate of c-sections has risen from 5% nationally in the 70s, to 33% nationally. This hasn’t brought about improvements in outcomes. In the system in which U.S. women are giving birth, the reality is that there is an inclination by providers to use these interventions because of perceptions of things like liability risk and other incentives that impact recommendations. Rates of surgical birth range from 7% to 70% in hospitals across the United States, and studies show that is not because patient health profiles vary that drastically. Your right of informed consent and refusal is a critical tool to navigate the dysfunctions that occur. Providers often think women do not have the right to refuse, and the pushback against refusal can range from pressuring to violence. The fact is, even if the baby is going to die, the woman retains the legal right to make decisions. (Read more about related ethics opinions from the American College of Obstetricians and Gynecologists at www.birthmonopoly.com/acogethics.) A great deal of the fear of the right of refusal is based on the idea that doctors can predict with accuracy the baby’s need for these interventions, yet those predictions often cannot be made with certainty. These interventions are also not always evidence based, and the motivation to use them is often otherwise incentivized. A hospital admission alone does not imply consent for all interventions, and implied consent should never override explicit non-consent. There are gendered assumptions about female passivity and their own bodies that underlie the assumptions about consent. There is a mistrust of women contributing to this debate. Implied consent is also used to make it harder to litigate date rape and marital rape cases. Nonconsented birth interventions bear similarities to sexual assault, legally, and with the experience of the victim. Finding an advocate willing to pursue the case can also be challenging. *So What Needs to Change?* Training and education in our facilities need to happen to close the gap between the ethical and legal principle that women have the right to refuse medically recommended treatment and the realities that women are experiencing on the ground in maternity care. WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: email@example.com Facebook: www.facebook.com/birthmonopoly Twitter: www.twitter.com/birthmonopoly Instagram: www.instagram.com/birthmonopoly WANT TO SUPPORT US? Review us on iTunes, SoundCloud, or wherever you listen to the podcast. Businesses and organizations: Underwrite the show! For more information, contact us at firstname.lastname@example.org
In this episode, Cristen speaks with Gena Kirby, doula trainer extraordinaire, about her remarkable success at getting dads and partners involved in birth, mommy brain/birth brain, and how to survive a zombie apocalypse. This is a must-listen for doulas!
In this episode, Cristen speaks with Kesha Chiappinelli, an Arkansas lawyer who represents consumers working for better midwifery regulations. Right now, for example, the law requires a number of vaginal exams for home birth midwifery clients--something Ms. Chiappinelli describes as "state-sanctioned rape." (The regulations are similar to what is described in Birth Monopoly's 2014 article "Arizona: Mandatory Surgery or Forced Vaginal Exams" [www.birthmonopoly.com/arizona].) SEPT. 2017 CONSUMER ALERT: The Arkansas Department of Health will hold a public hearing on September 21, 2017, at 10:00 a.m. in the Auditorium of the Arkansas Department of Health, 4815 West Markham Street, Little Rock, AR in conformance with the Administrative Procedures Act, Ark. Code Ann. § 25-15-201 et seq. It is proposed to revise the Rules and Regulations Governing the Practice of Licensed Lay Midwifery in Arkansas pursuant to the Administrative Procedures Act as amended, and by authority of Ark. Code Ann. §§17-85-101 et seq. and Arkansas Code Ann. §§20-7-109. A draft copy of the proposed revisions is here under the heading "Midwifery": http://www.healthy.arkansas.gov/. Interested members of the public can submit written comments no later than 8:00 am on September 21, 2017 via Email at email@example.com Or mail to: Attn: Womens Health Section Chief Arkansas Department of Health 4815 West Markham Street Women's Health Slot # 16
In this episode, Cristen speaks with Traci Weafer, a Southern doula who believes that speaking up for laboring women and having great relationships with hospital staff are not mutually exclusive. As an example, she shares about the time she stopped a doctor from cutting her client when he started to do an episiotomy without consent.
In this episode, Cristen speaks with Caroline Malatesta, the Alabama mother who won a lawsuit against her hospital after she was permanently injured in a "wrestling match" with her nurses during childbirth--in a place that promised support for unmedicated birth. One piece of Caroline's journey that she has not spoken about publicly before is how, in the aftermath of the assault, her doula and the local doula community responded to her. It's an important perspective from a birthing mother and doula client.
In this episode, Cristen speaks with an experienced Labor & Delivery nurse about the obstetric violence she has witnessed and even participated in ("I’ve seen doctors pry women’s legs apart with their elbows… I’ve seen doctors check people [vaginally] while the women were saying, ‘no,’ ..."). She also talks about advocating to change a patriarchal system ("I truly believe that the women in any given community have way more power than they realize. [They] can take over if they really put their minds to it.")
In this episode, Cristen speaks with "J," an Indiana mother who recorded the meeting with her hospital about a non-consented procedure during labor that the hospital defended as "appropriate" and "part of" routine care. We'll hear the recording of the meeting, as well as the professional opinions of respected legal and medical experts on why the hospital's defense is dead wrong.
In this episode, Cristen speaks with Zawn Villines, lead organizer of the community effort to push back on Dekalb Medical's policies involving childbirth options and rights and their decision to push out a midwifery practice and doctor known for respecting patient decisions. Katie Kissel, a local mother, shares her surprise at discovering that the head of obstetrics at Dekalb as these events transpired is the same doctor who laughed at her birth plan and gave her an episiotomy without consent during the birth of her first child.
In this episode, Cristen speaks with an obstetrician who saw her practice's Cesarean rates drop after they implemented a feminist model--putting women in charge of their own medical decisions. She also discusses her own job-related trauma and medicine's blame culture.
In this episode, Cristen speaks with an Alabama doula about how her clients are treated in a maternity care system that is improving slowly, but still characterized by paternalism and a resistance to change. **TRIGGER WARNING** for description of assault of a laboring woman