Birth Allowed Radio

"I’ve got to turn around and go back and dig in to make it better for others." In this episode of Birth Allowed Radio, I speak with Dr. Tracey Vogel, an obstetric anesthesiologist from Pittsburgh who specializes in preventing birth trauma and re-traumatization during birth for people with abuse histories. As part of this care, Dr. Vogel mentors people through the process of filing complaints to hospitals about violating, traumatic, and inappropriate medical intervention. Dr. Vogel walks us through the bureaucratic structure of hospitals and how they receive and process grievances. We also discuss how people can effectively use their voice during birth in advocating for themselves, and the must-have details that you want to be captured if you are pulling together a formal written complaint. Finally, we examine the core issues at hand for many who want their traumatic experiences to be known - for the benefit of closure, and/or to prevent the mistreatment from happening to others - and managing expectations regarding the hospital’s response. Resources mentioned: Visit The Empowerment Equation (http://www.theempowermentequation.com/who-we-are.html) to learn more about Dr. Tracey Vogel and her work in trauma-informed care for obstetric patients. Click here (bit.ly/birth-rights) for all you need to know about Birth Monopoly’s “Know Your Rights - Legal and Human Rights in Childbirth” course and community. Use coupon code PODCAST to get 10% off access.

* Recorded October 2019 * In this episode of Birth Allowed Radio I am honored to speak with Sabia Wade, a Black, queer, full-spectrum doula in San Diego. She is the owner of Birthing Advocacy Doula Trainings, and Executive Director of For The Village, a reproductive justice non-profit providing free doula services to low-income and marginalized groups in the San Diego Area. We dive into the topic of advocacy and doulas - including how advocacy is defined in different populations and communities, and the affects of racism in the birth world. We also talk about the complicated communication dynamics for doulas - including how to navigate tricky conversations, how to read the room, how to identify who you can and can’t talk to you, the value of doulas and the importance of making a sustainable living in birth work. IN HER WORDS: “There’s so many different ways that you can advocate for somebody, and even with the clients that I work with, I feel like advocacy and what they expect from advocacy looks different de-pending on who they are, their income level, their race, their gender, their sexual identity. All the different things contribute to advocacy but it looks different depending on the person’s lens.” RESOURCES: Follow Sabia at her website (https://theblackdoula.com/), and on Instagram @theblackdoula. For more information on Birthing Advocacy Doula Trainings, visit birthingadvocacy.org, or Instagram @birthingadvocacy. Visit For the Village online (https://forthevillage.org/) and at Instagram @forthevillageinc. Go here to see the Evidence Based Birth® article, Evidence on: Doulas, which defines and examines advocacy: https://evidencebasedbirth.com/the-evidence-for-doulas/.

As I celebrated my birthday this month, I realized I had never really talked to my mother about my own birth story. Join me in reliving that experience with my mom, Michelle Pascucci, as she recalls what it was like to give birth - and feed a newborn - in 1979. While she had a great experience with childbirth education, there were times in the hospital she wished she was provided more guidance. “When they said ‘do you want an epidural?’ I’m familiar with it, but don’t know what’s going to happen. And so when I got numb, then I’m realizing ‘oh, that’s what the epidural does.’” As my mom and I delved into some family history, I also discovered some fascinating details about my maternal grandmother--who was a nurse for 50 years--including her relationship with the healthcare system during her time and some deep trauma that she suffered in her relationship with doctors. The story of that trauma, which I had never before heard even a whisper of, blew my mind. “My mom gave herself to her work in the health department - she did it the way she had always done it - but she carried that heaviness of not being able to reconcile his death along with vowing never to work in a hospital again.” RESOURCES: This program is supported by Attorney Susan Jenkins, specializing in business, governmental, and political issues related to birthing rights and the practice of midwifery. Reach her at 866-686-1348. Support Birth Allowed Radio! Contact us here (BirthAllowedRadio@gmail.com).

We are really in the midst of some major disruption for birthing families, in an already fragile healthcare system. In this episode of Birth Allowed Radio, I called on two seasoned doulas and members of the Birth Monopoly "Know Your Rights" community to provide a grounded and strategic perspective for the families who need it most. Miri Halliday of Spokane, WA is a birth doula and childbirth educator, and Lisa Gould Rubin of Burlington, VT is a doula, childbirth educator, and has had a virtual doula practice for over 10 years. Together we tackle the tough conversations surrounding doula access to their clients in hospitals and increased pressure on birthing families during the COVID-19 pandemic. Miri and Lisa reveal what they’re telling their families on how to prepare, what to expect at the hospital, how to cope under societal trauma, and what doulas, partners, and birthing mothers can control. “Everybody’s operating out of this place of fear and scarcity in terms of support and all of this unknown, and it is the worst thing that we want people to be feeling now that they are on the verge of having babies.” - Lisa Gould Rubin “There are going to be clients who are going to say - ‘I refuse. I’m going to have this baby in the lobby unless my doula comes with me.’” - Miri Halliday RESOURCES: Connect with Lisa Gould Rubin at thegoodbirthproject.com (http://thegoodbirthproject.com/), on Facebook (https://www.facebook.com/TheGoodBirthProject/) and Instagram (https://www.instagram.com/GoodBirthProject/). Follow Miri Halliday at hallidoula.com (https://www.hallidoula.com/), Facebook (https://www.facebook.com/hallidoula) and Instagram (https://www.instagram.com/the_oaky_afterbirth/). Click here (https://birthmonopoly.com/covid-19/) for all Birth Monopoly COVID-19 resources, including the Hospital Policy Tracker for Doulas and Visitors. Click here (https://birthmonopoly.com/3-things/) for all you need to know about the updated Birth Monopoly course, “3 Things Every Parent Needs to Know About Hospital Birth.” For the latest COVID-19 research and resources from Evidence Based Birth®, including the Virtual Doula Directory, click here (https://evidencebasedbirth.com/covid19/).

Melissa Pizzo has had four babies by Cesarean, and four completely different experiences! With her last birth, a scheduled Cesarean, she knew what she wanted and she made sure she got it. That included hiring a doula to hold emotional space for her and her husband in the OR. How ever babies are born, it's a special and sacred time, and one where the emotional, psychological, and social needs of the person giving birth should be priorities. In Her Words: I really embrace that this is what was supposed to be and this is how it is and I have these experiences--like, going from my first cesarean to my fourth cesarean, and seeing the progress and what has changed, I think that that part is where I can be like, oh my gosh, I’ve really grown! And I’ve really been able to voice what I want and what I need. And then being able to feel heard is very important. So those things have happened for me compared to that first birth when I didn’t feel heard and I didn’t feel like I had a voice, and I didn’t feel empowered at all. And I walked away very, very traumatized. To then have a completely different experience on the other side of it with my fourth cesarean. Hiring a doula for me [in the fourth birth] was really important for several reasons. One was to have someone in the room so that my husband can kind of focus on his own feelings, his own experience of the birth… And I want someone there to say what’s happening, what’s going, and also how are you feeling right now and rubbing my forehead. Just soothing me, while my husband doesn’t have to. Another thing that our doula did for us is she took pictures, which is amazing. Who doesn’t want pictures of your birth? There were other moments, too. Before I went into the OR, they were having a hard time getting an IV in. I was getting poked so many times, I was having a real meltdown at that point--like, we are not doing this! And Carrie was there, my doula, to be able to really talk to me and calm me down and she took out a little back massaging thing and definitely calmed my nerves, which was needed at that time. Some friends, some family members, might say something like, “You should just feel happy because your baby is healthy and nothing was wrong.” And I think that those words are not helpful. Not one bit. Because it is okay to say I’m so happy that I have a baby and I’m also sad that the birth didn’t go the way I wanted it to go. It’s really, really important that we love our scars. And that we are grateful for them. And that we take care of them. It’s a very tender spot now! It’s definitely still a work in progress, but it’s something I strive for. That I love my scar and that it birthed my babies and that I look at it and I’m like, wow, you are an amazing woman who was able to give birth four times this other way.

Advocacy, burnout, self care, sustainability, and the patriarchy--they're all in this episode! Our guest is Nickie Tilsner, the co-executive director and lead trainer of Cornerstone Doula Trainings, and co-author of RE:BIRTH - The childbirth preparation guide for all people to have an informed, dignified and joyful birth in any setting (due for release early Fall). Also announcing a first-ever collaboration between Birth Monopoly and a doula training organization to offer rights training to new doulas!!! The "Rights Informed Birth Advocate" certification will be offered through Cornerstone starting July 2019. > In her words In order to thrive in the work and have sustainability: feeding your purpose is what really holds resilience and what is actually being trauma informed for yourself and looking at things through a strengths based lens. And feeding your purpose is knowing that you’re effective in the work and being able to really embody the work. And in think that’s what’s going to keep people really going in this and feeling great about the work they’re doing and enjoying it. I burnt out about three years into my practice when I first started and had to take a break and came back with a new way of looking at things. I’m still learning what being trauma informed for myself means. Doulas and birth workers and anyone else in this space need to understand, your brain cannot discern whether this is happening to someone else or if it’s happening to you, when you’re in the situation. And even when you hear traumatic stories, your brain goes into a trauma response. This vicarious trauma is real. I want this to be a part of every dialogue when it comes to birth and birth work… Number one, how we view advocacy as birth workers, number two, how we view ourselves as less powerful than other people in the room, number three, how we are silent and how our silence is complicity. > Resources Cornerstone's next labor and birth doula training, including the "Rights Informed Birth Advocate" certification in collaboration with Birth Monopoly (!!), starts July 12 in Oakland, CA: https://www.cornerstonedoulatrainings.com/sign-up. More to come after that! Contact us at birthmonopoly@gmail.com if you'd like your organization to offer Know Your Rights training, too!

**TW: Alleged Sexual Assault and Birth Assault** This is Katherine DiPaulo's story. She alleges she was sexually assaulted by an obstetrician at a Philadelphia-area hospital in 2005. She has not been able to hold him accountable. Ms. DiPaulo would like to connect with other victims. If you have experienced sexual assault in your obstetric care in the Philadelphia area, please get in touch with us at birthallowedradio@gmail.com or complete this form: https://docs.google.com/forms/d/1SURd8e1KBVdm4vcG47Xab-FwKnqUCXO8tbJeqaWB1_k. Your privacy will be respected to the fullest. > In her words: Had I angered him, it could have been a lot worse. I was doing what I had to do to protect my baby and myself. But I still have a lot of guilt and shame and anger at myself for not stopping it, not doing something. But my body was frozen and in shock. I repressed what happened although it never left me. I started to have chronic insomnia, ... panic attacks, anxiety and depression, difficulty in my marriage. I have flashbacks all the time of this person. I have flashbacks of the event itself. I'm hyper vigilant. I'm scared I'm going to run into him in the grocery store. To be honest, I think if I do see him, I'm going to tell him off, because I'm no longer in that vulnerable position, being in labor and hooked up to all of these IVs and monitors. So, I'm not vulnerable any more, so there's a part of me that still has the strength that if I do see him, I'm going to tell him off. At this point, I'm so furious about it and just want to put it out there so other women can prevent something like this from happening to them. > Related episode: "'I found my voice and I'm not stopping' | Sexually Assaulted by Her OB, Marissa Hoechstetter Fights Back": https://birthmonopoly.com/episode-29/ > Know Your Rights: Legal and Human Rights in Childbirth for Birth Professionals and Advocates: https://birthmonopoly.com/know-your-rights-course/

What do you do when someone in your life has a stillbirth? In this episode of Birth Allowed Radio, Ada Johnson talks about losing her baby Button during birth and the aftermath of that event, and, along with her midwife Sarah, shares how providers and others can respond sensitively when someone experiences a stillbirth. I want to thank both Ada and Sarah for coming on the show and delving back into this deeply personal experience with us. Resources: Consulting and training services from our expert guest, Ada Johnson https://hawthorndoulacare.wordpress.com/provider-consults/ Resources for professionals from Empty Arms Bereavement Support http://www.emptyarmsbereavement.org/resources-for-professionals Compassionate Bereavement Care®Certification through the MISS Foundation https://missfoundation.org/compassionate-bereavement-care/compassionate-bereavement-care-certificationCDC statistics on stillbirthhttps://www.cdc.gov/ncbddd/stillbirth/facts.htm Thank you to Evidence Based Birth for making this episode possible!!

Janelle Hanchett is the author of “I’m Just Happy to Be Here: A Memoir of Recklessness, Rehab, and Renegade Mothering,” out in paperback May 7, 2019. In this episode, we talk about the politics of motherhood and why the idea that controlling our bodies in birth is controversial. Janelle also talks about 'how I discovered I am white' (her excellent post of that title is at her Renegade Mothering blog here: https://www.renegademothering.com/2014/12/09/discovered-white/) and her new book. > In her words this episode: "There’s this larger question: 'Is motherhood enough to turn us into perfect versions of ourselves?' I was really looking into the redemptive narrative surrounding motherhood. Like, this idea that we are saved by motherhood, that we are washed clean by it, that we are redeemed by it, and that the dark part of our self can be erased through love of our children. Spoiler alert, I think that’s bullshit. I think it’s more just subtle erasure of women, right? Because if you erase *any* part of me, you’re erasing me. What that’s basically saying is that the instant a woman has a baby, she is transformed into a vessel of motherhood for this child. She is no longer a fully formed human being. Human beings have fatal flaws! We aren’t that any more. We are now just this clean slate to be used and to nurture this child. And it’s bullshit! So--the book is a story about addiction and motherhood, but it’s really kind of a larger exploration of that theme." Follow Janelle at www.Facebook.com/renegademothering and www.Instagram.com/renegademothering

Marissa Hoechstetter is one of more than 17 women currently suing Columbia University and its associated hospitals for a 20-year "massive coverup" of Ob/Gyn Dr. Robert Hadden's sexual abuse of patients. In this episode, she talks about her long path to justice for the sexual assaults she suffered at Dr. Hadden's hands, getting his name off her daughters' birth certificates, and her ongoing advocacy for transparency in physician conduct and licensing and on behalf of survivors of these kinds of crimes. > In her words: We say support women, believe women, but then you come forward and it doesn't matter.... In my case and in others, there's evidence [the institutions] were alerted to this behavior and they just look away. They don't want to admit it. It's a business choice. With cases like [Larry] Nassar and [George] Tyndall at USC, there's been some high-profile cases of serial sex crimes by medical professionals. The way the media treats it still, it's like it's this one odd weirdo out there. But from the people I hear from who reach out to me now, and from my experience, I think it's more pervasive and present than we want to admit. The people I hear from aren't even sure if it's a crime. They don't know what to do with what happened. We're not talking enough about sexual assault by doctors. > Marissa's story in the news: https://www.buzzfeednews.com/article/albertsamaha/robert-hadden-doctor-sexual-abuse-cy-vance https://www.cbsnews.com/news/columbia-university-hospital-doctor-robert-hadden-sexual-abuse-lawsuit/ https://www.politico.com/states/new-york/city-hall/story/2018/12/09/victim-of-deviant-gynecologist-pushes-for-more-transparency-in-doctor-misconduct-735322 > By Marissa: https://www.bustle.com/p/my-abusers-name-is-on-my-daughters-birth-certificates-i-wont-rest-until-its-removed-12605285 > Learn more about Know Your Rights: Legal and Human Rights in Childbirth for Birth Professionals and Advocates at bit.ly/birth-rights

In a town with one hospital and two doctors, Amy Woods describes her labor and subsequent surgery without pain medication. She also talks about the effects on her and her family afterwards and the hospital's response to the incident. "The doctor said I had to have a c-section because I wasn't progressing. They were kind of, a little messy with the reasons for the c-section. As they were taking my husband to get him all dressed for the c-section, I just remember having the most distinct feeling that I needed to tell him how much I loved him. And that--I was going to die. I thought the safer option for [my baby] was the c-section. Then the OB came in and she did her poke test on my stomach and I told her that I could still feel all of it, that I had feelings in my legs. I could feel everything. And she just started cutting. And she just started going on with the surgery. I feel like at the beginning, I went into a little bit of shock. And then immediately after, I just started screaming."

Alabama doula Kirsten Clark talks about an intense experience watching obstetric violence happen right in front of her, and how her practice has evolved as a result. * TRIGGER WARNING FOR SEXUAL ASSAULT AND OBSTETRIC VIOLENCE * The doctor walked in, put on gloves, and stuck both hands into the laboring mom’s vagina. There was no consent. He didn’t tell her was going to do that or ask if she was okay with it. Moments later, he announced, “Oh, she is tearing already.” I had to look away because I could not physically handle what I was seeing. My body began shaking. I felt lightheaded; I felt frozen in place. [I felt] complete helplessness and fear and anger and grief. I walked away from that feeling responsible in a way for what had happened, and knowing that this mom had just experienced something that shouldn’t have happened, that something was really wrong. And that there was this visceral response in my body to what I was seeing. I just kind of remember being back in that place and feeling like there was nothing that I could do to change what was happening to this mom in that moment. [I knew] my body was responding to something… even though I wasn’t the person that it was happening to, I was still having this response and I needed to do something to work through it. I knew I didn’t want to be in that position again, feeling so helpless and frozen.

In this emotional episode, Jennifer Smith describes having a Cesarean without consent after medical staff ignored her decision to have a vaginal birth rather than repeat surgery, and her trauma afterwards. "I'm numb from the waist down and I have no idea what they're doing to my lower body. I'm just this object lying on a table for them to cut up. And they don't care. And I can't scream out. Because I don't think anybody's going to listen to me. And I'm scared... I'm trying to stay awake. And I remember it was awful because the whole time in my head--and I can't scream out and I was so frustrated because I can't scream out--I'm sitting there going, 'I don't want to do this I don't want to do this I don't want to do this, it's gonna be okay it's gonna be okay it's gonna be okay...' And I remember as this doctor's cutting me up, Dr. R, he's having a personal conversation with Dr. P about the Olympic male gymnast who broke his tibia. And I'm sitting there thinking, I'm not even here. Like I'm not even here. It doesn't even matter. I remember just trying to stay awake enough to hear my baby cry because I wanted to make sure he was okay." WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com

WARNING: This story includes graphic detail and may be difficult to listen to. Part 2 of 2: In this stomach-churning episode, nurse "Britany" describes witnessing what she describes as a violation and assault on a laboring woman: a so-called "manual episiotomy" by the doctor--a move she discovered was routine for him. Find out what happened when she tried to report the incident up the chain of command. This is Part 2 of Britany's story. (See Episode 24 for Part 1.)

WARNING: This story includes graphic detail and may be difficult to listen to. Part 1 of 2: In this stomach-churning episode, nurse "Britany" describes witnessing what she describes as a violation and assault on a laboring woman: a so-called "manual episiotomy" by the doctor--a move she discovered was routine for him. Find out what happened when she tried to report the incident up the chain of command. This is Part 1 of Britany's story. (See Episode 25 for Part 2.)

Sara Conrad worked in the marketing department at the hospital where she gave birth in Northern California. The last thing she expected was to have a life-changing trauma there. “I love doing C-sections, but that doesn’t mean you’re going to get one.” Sara immediately felt unsupported when a doctor she’d never met responded to her birth plan by telling her she loved performing Cesareans, and the nurse seemed terrified that Sara was laboring on her hands and knees. Things got worse from there. “Don’t you care about your baby?” Unable to speak while on heavy medication and ignored by her care team, Sara was rolled back for a Cesarean without her consent and without knowing why she was having surgery. Afterwards, she felt disconnected from her baby and, on top of that, guilty about not feeling more joy about her birth. “This is my friend, and she doesn't believe me.” Her trauma carried through to postpartum, and she eventually left her job--angry and feeling betrayed about how she’d been treated and the lack of empathy and accountability from her co-workers. "I have a lot of rage and I want to use that to propel me forward and try to prevent it from happening to other people." Today, Sara is still seeking answers and healing--following up to take the hospital to task and to advocate for other birthing women by working on the documentary film about obstetric violence and birth trauma, Mother May I. WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com

Kimberly Turbin made headlines and history when she sued her doctor for assault when he gave her a medically unnecessary and botched episiotomy during the birth of her child. The case was resolved in 2017, but Kimberly is still dealing with the effects of the assault. In this episode, Kimberly recounts not only her experience, but the aftermath of the trauma she experienced in 2013. “I posted the video just to see if I was crazy or not.” The video of the birth, posted to YouTube, ended up connecting Kimberly to a community of people who have supported her, and who she has supported, with the continuing process of her trauma. Her medical diagnoses, which included vulvar spasms, dyspareunia, vulvodynia and Post-traumatic Stress Disorder, still cause considerable pain. Unfortunately, the drugs that help the condition are both expensive and make it hard to parent or work. “My injury is forever and a lifetime.” In the medical community and beyond, there’s a tendency to disbelieve women’s pain. When Kimberly tries to warn medical professionals that she has been through both sexual assault and birth assault, they tend to feel attacked instead of sympathetic. It has changed the way she interacts with the medical community – even eye doctors - and it has also affected the way she parents. But Kimberly doesn’t want anyone else to feel pressure to respond to birth trauma the way she did. The process was and is challenging; the fact that the law suit was resolved does not mean the trauma is resolved. WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com

Trying to find support for a vaginal birth after a c-section (VBAC) can be a struggle; when you are black, overweight, on Medicaid, and in Alabama, it can be almost impossible. Our guest Sabrina Azemar recounts her difficulties convincing her maternal care providers to "let" her do what pregnant bodies have been doing for centuries. Sabrina is the mom of 3 children, and a breastfeeding and cloth diaper advocate who loves to teach women of color in her community sustainable and alternative ways to care for their families. “Your baby will drown in a uterus of your blood” Sabrina's doctor told her she was putting her baby at serious risk by considering a vaginal birth. She was told that women of color have low success rates with VBACs and she could potentially kill her child, just by doing what the body is designed to do. From Sabrina: “Giving birth is not a disease.” Giving birth is something your body already knows how to do, so it’s strange when they treat you like you have a diagnosis. “Birds born in a cage think flying is an illness.” Alejandro Jodorowsky “On Medicaid, you have a government birth.” You are supposed to listen to your doctor and shut up. They say every birth is different, but they treat every pregnancy the same. So what is Sabrina’s advice to other mothers in her situation? • Be confident when you go to your appointment and save your tears for the car. • Sit the regular chair in the exam room, fully dressed, until you understand and agree to the tests they want to perform. You are treated as though you are inferior when you are in the exam chair. • Have someone that can go with you to advocate for you. • Write down your questions on a physical sheet of paper; don’t let the appointment end until they have been answered. Practice saying your questions out loud. • Don’t be afraid to change doctors. • You have to be present in your pregnancy and birth. It has everything to do with your body. Own the experience. All people want is a conversation with their health care provider. There are good doctors out there, and it is important that you find one that wants you to have a successful birth. You deserve a good birth story. Alabama moms of color can join Sabrina's breastfeeding group at https://www.facebook.com/groups/1802852900033745/ WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com We would love to thank attorney Susan Jenkins for her support. Susan is a national advocate for midwives and birth activists; she can be reached at (866) 686-1348.

Normal, healthy births happen every day, and for women of every size. And yet birth care professionals often alienate plus-size moms-to-be with shaming, inadequate equipment, and mistreatment. In this episode of Birth Allowed Radio, we talk about plus size birth and how to find a practitioner who will treat you like a person, not a risk factor. My special guest is Jen McLellan, of www.plussizebirth.com. “My midwife was the first health care provider to ever touch my body with compassion.” Plus size pregnant women are often treated differently during the pregnancy and birthing process, even though 60% of the population in child-bearing years are considered overweight or obese. But our bodies are designed for this, and we can have healthy outcomes. And if we do develop complications, it isn’t because we are bad people. We should be fully supported along our journey to motherhood, and not to be made to feel ashamed. Let’s talk about people as human beings, not just statistics and worst case scenarios. Instead of focusing on negative possibilities, using shame and scare tactics, it is important to focus on the positive outcomes that we want. Women who are shamed are less likely to receive routine medical care and more likely to gain weight. If we make risks seem like foregone conclusions then what is the incentive to make the pregnancy as healthy as possible? It is important to connect with size-friendly care providers. • They have worked through any biases they have around weight and health. http://www.obesity.org/obesity/resources/facts-about-obesity/bias-stigmatization • They don’t classify pregnant mothers as high risk based solely on BMI. • They have the proper equipment (i.e. larger blood pressure cuff, larger speculum, scale with higher upper limit, appropriate labour bed). Your first clue about this is whether they have chairs without arms in the waiting room. The message is: “If you fit in here, then you are welcome. If you don’t, you aren’t welcome.” • They have honest and compassionate conversations about health and weight; this isn’t about avoiding talking about risks. “Pregnancy is an opportunity to change the relationship that you have with your body.” Resources mentioned: Get Jen’s Plus Size Pregnancy Bundle (30% off with code 30off) - https://plussizebirth.com/my-plus-size-pregnancy-bundle/ Become a size friendly professional - https://benourished.org/trainings-post/promoting-body-trust-in-clinical-practice/ Check out Jen’s new website: www.plusmommy.com WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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 anesobstories@gmail.com WANT TO LEARN MORE? Go to www.birthmonopoly.com WANT TO CONNECT? Email: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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: birthallowedradio@gmail.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 birthallowedradio@gmail.com 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: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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: birthallowedradio@gmail.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 birthallowedradio@gmail.com

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 womenshealth@arkansas.gov 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

In this episode, perhaps the most experienced midwifery law lawyer in the U.S. talks about why midwives need lawyers, as well as the David vs. Goliath struggles of families fighting hospital and medical lobbies for the right to maternity care outside of hospitals. BONUS: That time she was one of the first women lawyers to argue (and win!) a case before the U.S. Supreme Court.

In this episode, a doula based out of New York City talks about the abuse she experiences and witnesses as she supports clients during childbirth.

In this episode, Lexington, KY, couple Helen & Kris Nonn describe the home birth of their son, born "illegally" with Certified Professional Midwives, and talk about why they made that choice for his birth.

In this episode, Cristen talks with Mary Carol Akers, a certified nurse midwife who has been fighting local hospitals for years to open an independent birth center in Kentucky; Mary Kathryn Delodder, the head of the consumer coalition working to legalize out-of-hospital midwifery in Kentucky; and a Central Kentucky couple who was turned away from two hospitals *while the mother was in labor* for wanting to have a vaginal birth after Cesarean.