122: A Healthy Baby Is NOT the Only Thing That Matters (& Is Home Birth Safe?) 122: A Healthy Baby Is NOT the Only Thing That Matters (& Is Home Birth Safe?)

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Katie: Hi, and welcome to “The Healthy Moms Podcast.” I’m Katie from wellnessmama.com, and I am so excited to be here today with Anne Margolis, who is extremely, extremely decorated in the birth world. She is a licensed certified nurse midwife, an OB/GYN nurse practitioner. She has a variety of other certifications beyond that, but what’s really cool is she’s the 3rd generation of her family to help bring babies into the world, and she has personally ushered in over 1,000 healthy babies, which is incredible. And her work and insights have been on TV shows, including “A Baby Story” on TLC and the Discovery Channel and the award-winning feature documentary, “Orgasmic Birth,” which I’ve talked about before. And we’re here today to really delve into separating the fact from the myth when it comes to birth, and what is actually safe, and what do women need, especially in birth. So, Anne, thank you so much for being here. I’m really excited for our conversation today.

Anne: Me, too. Thank you for having me.

Katie: Oh, absolutely. It’s an honor. And I wanna jump right in, because in the online world, and I’m sure you see it, too, but I often see it’s said online that moms should just be grateful if they have a healthy baby, because “A healthy baby is all that matters.” And, as a doula, I’ve seen a lot of moms, and I see how deeply birth affects them. So, personally, I think, obviously, a healthy baby is, of course, a super important part of birth, of course, but I don’t think it’s the only thing that matters, and from what I’ve read of you, you have an incredible story that kind of speaks to this. So, can you kind of take us through your story of all of your births and speak to this through your own experience?

Anne: I can, and when you said that, it just makes me cringe, just get over it, a healthy baby is all that matters, and that undermines completely the huge impact birth has on the mind, body, heart, and soul of a woman, and her family, and the baby. So, in terms of my story, you want me to go back into my first birth, you’re talking about?

Katie: Yeah, I would love to hear, because I know you had kind of a difference in birth experiences that really, like, brought this point home for you.

Anne: Oh, yeah. When I was in nursing school, I knew I wanted to go into obstetrics when I did my rotation, and I just was very excited. And in nursing school, you know, we talked all about how birth is beautiful and natural birth, you know, but my first job at graduating nursing school working as an obstetric nurse, I had to do a year of med-surg first, medical-surgical nursing. But my first job was nothing like what I learned, and I got really scared of birth, and I felt like, as a nurse, I was kind of rescuing a lot of the problems caused by interventions that were done to women. I did not see natural birth. I was a nurse assisting more cesareans than I felt comfortable with.

The only time really there was a natural birth was when a woman was giving birth in the car on the way to the hospital, but even then, like, the baby was put in the intensive care unit. You know, so birth as in my experience back then was fear-based, it was a lawsuit prevention sort of, you know, like a disaster waiting to happen. You know, it came true like what the media hype was about in terms of, you know, like “ER.” It was a crisis. There was always a crisis, and I saw some of the worst outcomes. You know, I saw mommies and babies die or damaged, and so I started to, you know, really…I was taking it to heart. You know, I was afraid to have my own baby, but my hands were tied as a nurse. I had to kind of follow the orders of the obstetricians and do these interventions to healthy women that were just coming in to have a baby, right?

So, I got pregnant, and I was young. I was just short of 24, and I was on the unit. You know, I chose a doctor who I trusted. I did not know of a midwife or doula at that time, there was no internet, and I was giving birth on the unit where I worked. So, I was given the royal treatment by the doctors and by the staff, by the nurses, but what happened was my entire pregnancy I just kept seeing a lot of, you know, what I was telling you, you know, a lot of crisis, a lot of emergencies. I was afraid, and fear is like kind of the enemy of labor. Inner fear really harms us on many levels in terms of our health in general.

Anyway, but what happened was so I given the royal treatment in terms of treated well, you know, “Oh, a nurse on our unit is having a baby. Anne is having a baby.” But when I got to the hospital, you know, I was given all pretty much the standard routine interventions, which at that time I did not realize how harmful they were. So, you know, just being told to put on a hospital gown, you know, then take off my clothes and put on a hospital gown. Now, I know as a midwife that disempowers you, that makes you feel sick, and so I was like, “Okay, the hospitals know what they’re doing. The doctors know what I’m doing. I have no idea what I’m doing, and I’m scared.” And then I was told I couldn’t eat or drink, and I was attached to an IV, and it’s like kind of running a marathon, 26-mile marathon, and not being able to drink and eat.

So, then I didn’t have the energy that I needed and the fluids that I needed, and then I was tied to a monitor on a bed, you know, so they can track every single heartbeat. And everybody is looking at the monitor, not looking at me, and, you know, just being told to be put, you know, flat on your back and you can’t move, because they had to keep the heart rate tracing, how can someone labor like that? You take any animal in the wild and put them in those situations, and their labor is gonna stop. So, even forget the mind-body relationship, you know, which they’re intricately connected, but even just, you know, think of gravity, like, we need gravity for the baby to come down, and when a woman is lying on her bed, the pelvis, which is on her back, which is three bones connected by ligaments, when the woman is on her back, the pelvis has a smaller diameter.

So, it was no surprise that the doctor kept coming in frequently and kept walking out saying to the nurse, my colleague, “She’s still 4, she’s still 4, she’s still 4 centimeters dilated.” And then at one point… You know, you have to dilate 1 centimeter an hour. So, I heard him say to my colleague who was my nurse, “Hang pit.” Now, as a nurse, I know what that means, hang Pitocin. She comes in and starts putting medication into my IV, and I’m like, “Oh no, I don’t want Pitocin.” And then she says, “Oh, but, honey, you don’t want a cesarean,” and she was right. Like, that was my biggest fear. I’m a dancer, I’m very athletic, and some of the more traumatic births that I saw were doing surgery, and I was scared, “No, I don’t want a cesarean.” So, once the Pitocin went in… Until that point, I was, you know, using Lamaze, that was really helping kind of cope, but once the Pitocin made everything stronger, more frequent, more intense, my Lamaze went out the window, and I wasn’t able to cope lying in bed, attached, you know, with these stronger, harder labor sensations, contractions.

So, then the epidural came, and that’s when, you know, they gave me an epidural, and my baby’s heart rate went down to very dangerous levels, what we call in medical terms, you know, terminal bradycardia or just, like, prolonged bradycardia, which is really severe low heart rate, and they called an emergency cesarean. So, here I was, you know, my biggest fear, and I’m the one on the gurney now, you know, stretcher, and they’re wheeling me into the OR, and it’s this whole crisis scene. Panic, you know, I’m seeing fear and panic on everybody’s face, and, of course, you know, I’m starting to feel that. I was put in the operating room and prepped for the surgery, and then everybody left. They didn’t allow my husband in. And so I’m lying there and out of, you know, terror that, not only am I gonna have…you know, something’s the matter with my baby, but it got worse, because it took an hour. Like, I looked at the clock, an hour, nobody was monitoring me, and this emergency STAT cesarean was not happening.

They were waiting for the assistant surgeon, and, you know, miraculously, the epidural after an hour caused me to fully open, and I started pushing. And then I called out for help, and then it was this crisis again in the operating room. You know, the doctor is like, “Get me a vacuum,” and he cuts this huge episiotomy, and he vacuums her out. Well, I did not wanna see her, because I thought she was dead by now. You know, we passed the damage, you know. Like, an hour of a heart rate like that, you know, as a nurse, I know what happens. So, I didn’t wanna see her, but the baby was totally, like, fine in terms of when you say you had a healthy baby. You know, she needed nothing at birth. She was totally vigorous and crying. She had a good heartbeat. She was breathing. She was pink. You know, I know now there’s a lot of research that’s out about babies feel trauma. They have nonverbal memories even dating before the birth, you know, and the pregnancy, but I was not fine. And so now I know what that was, which is birth trauma, but I didn’t know that, you know. I just was not fine. Like, I was petrified of that whole experience, and I really felt, like, traumatized by it.

So, that was baby number one, and I swore to my husband, “I am never having another baby,” and he wanted six. So, I don’t know how that was gonna work out, but I was really determined I was done. And, like, it was really hard then to work on the unit given my experience, and I was having nightmares and certain…it was hard for me to talk about birth. It was hard for me to even think about… Like, people would ask me about my birth, and I was just, you know, “Oh, we have a healthy baby.” Well, you know, it was probably the most scariest, traumatic experience, you know, I had as an adult, and so then we had an unplanned pregnancy. My toddler was about two and a few months, and then, you know, I was just even more scared. And I was still working as a nurse, but I had that fear kind of the whole pregnancy, and I didn’t really have a lot of resources to help me with this.

And I remember going in when I was in labor with her, and this is baby two, that I was seeing his partner now, his partner doctor. He stuck his hand up me, walks out the room, this was when I was in labor, told the nurse, “Prepare the operating room. The baby is too high and posterior, never is gonna come down.” Now, as a midwife, I know, “Of course, that baby can come down. Let’s get you up on your hands and knees. There’s all kinds of things.” I’ve seen plenty of high babies come down, but also talk to the mom. He didn’t talk to me. He talked to the nurse. I felt a little more confident in myself at this point, and I called him back, and I said, “I have given birth before. I don’t care what you need to do, but I’m not having a cesarean. Like, put your hands in there and turn the baby.” And he said, “Well, that’s gonna be agony.” I said, “I really don’t care. I don’t wanna have a cesarean birth.” And so he did that. You know, he stuck his hand inside and turned the baby manually, which was very painful, but I gave birth vaginally.

So, I was talking to a friend of mine, you know, maybe she was a couple years older, about my frustrations, not just with my birth. You know, no one wanted to hear me talk about, like, my traumatic birth, because, “You had a healthy baby,” right? But, you know, I was having lingering effects of what I now know to be as birth trauma, like I said. So, I was talking to a friend about my frustrations, about how I feel like I’m rescuing a lot of the problems caused by interventions, I’m seeing too many cesarean births, I’m not seeing normal birth, my hands are tied, I have to do with the doctor’s orders, and, you know, she’s like, “Well, why don’t you be a midwife?” And I’m like, “What’s a midwife?” I literally had no clue. I had not heard of a midwife, and she says, well, she is in school to be a midwife and I would love it.

So, I went to the library, I took every book out I could read about it, and I was like, “Oh my gosh, this is what I need to do.” So, I applied to midwifery school, and I literally felt like I came home. I came home. You know, it was the most amazing feeling to be part of a movement, of a profession that sees birth as normal and beautiful and kind of restores the humanity and celebration to the process of giving birth. And I was seeing, instead of, you know, women really traumatized or upset by their birth, they love their birth, and they were having beautiful experiences, and the families were involved, and I was seeing women give birth in all positions, and the more traumatic or, you know, interventive, highly medicalized situations and operations, cesarean, was more the exception, you know, the rare exception. So, you know, it was really amazing to, like, have a completely, like, I guess about-face or 180-degree turnaround.

So I believed in the midwifery model of care. I thought it was amazing, you know, that the philosophy of midwives is that, you know, women can birth like they breathe. Like, you don’t have to think about breathing. You’re just breathing. You don’t have to think about your heart beating. Your heart’s beating. So, just as in birth, if we get our mind out of the way or we get our mind to support what we’re doing, the body can birth like we know how to breathe. Of course, if somebody has asthma or heart disease, then they need medical or surgical intervention sometimes for serious complications, whether it’s with the lungs, with the heart, or with birth, but the vast majority of healthy women are normal. So, birth is normal to them otherwise, and so basically my role as a midwife is to preserve that space so that a woman’s body…like kinda get out of the way, like kind of let the woman’s body do what it knows how to do, which is birth, and the baby knows how to be born unless not, and then we can intervene.

But it’s always respectfully informed consent, like, you know, discussing it with the family, this is, you know, what’s happening. And sometimes it’s very simple interventions like, “You know what? I think we need to take a walk. Yeah, it’s 3:00 in the morning, and it’s raining outside, but I think that would be good. Let’s put on a raincoat and an umbrella, or let’s dance, or, you know, maybe you need a good fruit smoothie, you know, or some energy, or maybe you need to rest.” You know, sometimes it’s very simple, “Let’s get in the tub.” But, yeah, we are trained to do, you know, interventions, medical interventions, everything pretty much except surgery, and when something’s outside of our scope and it’s necessary, you know, we collaborate with obstetricians, who are surgeons and really are trained for high-risk complications and illness.

So, it’s great when they work together as a team, but all this sounded great, but then, of course, my husband wanted another baby, and I still had that birth trauma residual. And I got pregnant again, and I had more tools now to validate that I had birth trauma, to deal with the trauma, to heal, but I chose a midwife this time. And I said to my midwife, “Honestly,” I said, “like, I believe in the midwifery model of care, I really do, but for me to really promote it and be passionate about it, it has to work with me. And I’ve been through a hard time, and I really need to feel that it’s gonna work for me, and if I can do it, then, you know, anyone can do it, but it’s not in me yet.” So, she says, “Oh my gosh, don’t worry. It’s gonna be like such a different experience. It’ll be very healing for you.”

And, honestly, it was the most beautiful experience of my life. She was with me during the pregnancy. I mean, the visits were longer. She was really hearing me, with me, respectful, kind. You know, I was totally confident in her expertise if I needed her to intervene, but she just allowed, and she encouraged, and she reminded me of my strength and my body’s ability to do it. And I just had the most beautiful birth experience, and, like, I remember standing up. Like, I was so excited. It was so healing, because I’m like, “Now, I can be a midwife. Like, this works. This worked for me, and now I have not one doubt that it will work for every other woman that I help, you know, who’s healthy, and then I can authentically promote it.” You know, so it was healing on many levels, that birth, and then I had another on my 4th baby, very similar. So, I’ve been practicing midwifery ever since.

Katie: That’s awesome. That’s such a cool evolution of stories for all your births. How many years have you been a midwife? It must be at least a few, because you’ve got 1,000 babies.

Anne: Yeah. 1995 was when I graduated midwifery school.

Katie: That’s incredible. That’s wonderful. And the part that it made me think of when you were talking about the hospital environment, I was at a recent birth where a mom who chose to birth from the hospital because of high blood pressure, and her husband had graduated from law school. And it was just an interesting dynamic, because they were prepared for the birth that they had, and that’s what they wanted, but the dad kept noticing things that were happening in the hospital, and he’s like, “See, this is giving birth according to the lawyers, not according to what you actually want.” Because they’re the ones who are actually governing the policy, and, like, you have to think, like, I really do think most nurses and doctors get into what they do because they wanna help people. I don’t think you’d make it through all that school unless you want to, but their hands are tied. Like you said, they’re just managing their legal stuff.

Anne: They have malpractice. It’s huge. If you live in a litigious society or culture, but it’s not in other countries as much as it is here, but if anything goes wrong, there’s a very high percentage of people suing the doctor. Actually, more obstetricians are sued than midwives, but, thankfully, I’ve never been sued, but even if a doctor did nothing wrong, you know, they pay hundreds of thousands of dollars in malpractice insurance. And if there’s something that goes wrong, if there’s a baby that’s needing long-term care, that needs to be paid for, but there’s also like a look to blame sometimes, but it is an issue. You know, I know a lot of my colleagues, you know, we have part of our informed consent that if there’s ever a dispute that it’s handled via arbitration, because it’s just I don’t wanna practice out of fear of a lawsuit. I wanna practice to help women and their families and help babies and do what’s best interest in them, and just, like, this was so typical, I remember, when I was a nurse.

So, a woman would come in, and she was in really hard labor. She was rocking and rolling, and she was moaning, and, you know, really through like I would say transition, and the nurse is just looking at the chart and just like, “How much weight did you gain in the pregnancy?” And she was just, like, going through all these things, like all these questions, and she had to chart them, and it had nothing to do with what was going on right now. She wasn’t looking at the woman. The woman needed her, her support, but I just think that there’s just a lot of practice. That’s why we have one of the highest cesarean section rates in the world. That’s why we are using this continuous electronic fetal monitoring even though massive research has been studied that, not only has that not improved outcome, it just increases the cesarean section rate by like three to five times, and it’s not improved any outcome for the baby, but they’re still doing it, because if it’s needed in a lawsuit, we have the track of every heartbeat, and at least the doctor did this, he did all he could, he did a cesarean. And it’s a shame, you know, but I’m not gonna practice that way.

Katie: That is a shame. And I had a similar experience with a friend who I was doulaing for. She went into the hospital, and I knew from her history and just from knowing her that she had pretty quick labors. She had only been in labor for an hour. She went, and they checked her. She was at a 4, and so they were doing that same thing, asking all the questions, and she starts making all those sounds, as you know, as a midwife and me as a doula, I’m like, “She’s in transition.” Like, when you start making…they have certain sounds that come with transition, and she, like, tells the nurse like, “I think I need to push.” And the nurse is like, “Oh, honey, you don’t need to push. You are only a 4.” And I’m like, “You’re telling her she doesn’t need to push?” And she’s like, “Okay, but can you catch the baby?” It was they really were not even paying attention to her, because they were looking at her chart, and in their mind, she was still a 4, and it just boggled my mind, but I think you’re so right. A lot of people assume in today’s world that, with all the advances in technology and medicine in the U.S., in the developed world, that we have the best maternity care. But, is this actually true? Like, what have you seen from seeing both sides of this, both your experience and your research?

Anne: Well, first of all, I just wanna preface this by saying, you know, I’m very into holistic integrative care. That means that using the best of all of the modalities to help somebody when in need, and part of holistic care is embracing modern medicine when indeed it is lifesaving, you know. But, what we’re seeing in our country is we, United States of America, we rank among the lowest and among the bottom as compared to other developed countries around the world in terms of newborn and maternal mortality and morbidity. That means we are losing more mothers and babies or having more seriously ill mothers and babies related to the process of giving birth than most developed countries in the world, and we have high rates of birth trauma, we have extremely high rates of cesarean section.

And so the countries that actually have the best outcome, you know, it could be Sweden, it could be Japan, a lot of these European countries, what they have in common, and Dr. Marsden…I don’t know if you’ve heard of Dr. Marsden Wagner. He was interviewed on “Orgasmic Birth,” and he was a very famous neonatologist that headed the maternal child health division of the World Health Organization for many years, and, you know, I’ve heard him speak, and he’s amazing. You know, he says, “What do these countries have in common that they have such high rates of good mother-baby outcome? You know, they have low rates of intervention. It’s because they have a better use of a midwife and an obstetrician working as a team.” So, the midwife is seeing all women who are healthy.

So, when a healthy woman is experiencing a pregnancy, she goes to a midwife. The obstetrician is being used for what his or her expertise is, which is high-risk, serious complications, disease, and people that need surgery, right? So, when you have the two of them working together, you know, you have much better rates of healthy mother-baby outcome. Because when you have sort of the philosophy of obstetricians, you know, kind of looking for problems, treating…you know, using high technology and fancy diagnostic testing and procedures to screen for and look for problems and treat them with, you know, medicine and surgery, when you use that for the vast majority of people who are having healthy pregnancies in birth, then you’re gonna have high interventions and poor outcome. But when you’re using midwives to really give the kind of care that supports normal, healthy childbirth, and restores some of the humanity and the celebration to the whole process, and empowers the woman and her family, and really reserving the obstetrician for, yeah, when someone has insulin-dependent diabetes, or is expecting triplets, or has preeclampsia, serious high blood pressure in pregnancy, so then you have an amazing team. And the obstetrician is focusing on the obstetrician’s expertise, the midwife is focusing on her expertise, and that is best serving the population.

Katie: I 100% agree. I think that’s what is so sad to me, and at least in areas that I’ve seen, from being in Kentucky, like, we’ve been trying to actually license midwives and get them legalized, because they technically are practicing without any protection or a license at this point, and what we’re seeing is the doctors feel threatened by the presence of midwives. Like, midwives are willing to work with the doctors, and the doctors are not willing to work with the midwives, and there’s certainly a perception, especially among these big medical associations that are lobbying against us, that birth is dangerous, like, inherently dangerous, and that we have to protect women from themselves essentially.

Like, actually we had a senator say in one of the meetings like, “We can’t trust women to make good decisions about their own births,” and I almost had to leave. I was so angry. But, I think that’s such an important point, is in the best-case scenario when we see this at countries, they’re working together, because they both have their specialty, and I had a C-section for placenta previa, and it saved my life, and I’m grateful for that, but that doesn’t mean every birth after that needs to be a C-section, just because the doctors in my area don’t happen to wanna do VBACs, because then they have to be at the hospital. Like, if we could have those two working together, like what you’re saying, and we’ve seen this in other countries, I think that would go a long way towards improving a lot of these problems. But, I’m curious, what things do you think could change? Like, what can we do both as mothers and as birth professionals on both sides to try to improve these outcomes for moms in the U.S.?

Anne: Well, that’s why I do what I do, you know, and I think the change, like any change in history, comes from passionate people who speak up, passionate and powerful people who speak up. I can’t change hospitals. I can’t change malpractice insurance companies. I can’t change nurses and doctors, you know. What I can do is empower women and their families with the information from planning a pregnancy, all through pregnancy, and birth, and postpartum, and babies, all the information on how they can be empowered to make the decisions based on the pros and cons of every single test and procedure that is done to pregnant women and birthing women and babies.

But you have a choice, and I would like to make sure that women know that, when you go into a hospital, it is not a jail, you have a voice, you know. In fact, the code of medical ethics is, you know, to honor the personal authority. So, you know, a family has a choice, and most people don’t realize they have a choice. And so my whole thing is empowering women with the information and the confidence so that they can speak up and voice, you know, the kind of care that they wanna have or, you know, maybe switch providers and settings. You know, the name of my business is Home Sweet Homebirth, but it’s not about just home birth, it’s that model of care in home, in the hospital, in birth centers, and even in the operating room if a cesarean birth is necessary, you know. How can we restore humanity, compassion, and empowerment in any setting, right?

And the celebration and the beauty of it. I can’t believe you’re in Hyden, Kentucky. I mean, you’re in Kentucky. The oldest school of midwifery in the country is in Hyden, and it’s, you know, Frontier School of Midwifery and Family Nursing. How far are you from that?

Katie: Really close, and, ironically, they’ve been somewhat supportive, but then recently they’ve also done some things to kind of, like, undo the home birth bill. Like, they’re kind of like, “Well, we’re okay with home birth as long as there’s no multiples, no breeches, no VBACs, no moms over 35.” It’s like anybody who would actually…it’s frustrating, but I think you also brought up such an interesting and important point, which is just women taking back their power, because I hear all the time women say, “Well, I’m not allowed to,” or, “My doctor won’t let me.”

And that was with my first midwife birth, I remember that was the striking difference. Because even in my first interview with her, I was saying, “Well, am I gonna be allowed to do this? Will you let me do this?” And she goes, “Honey, it’s your decision. I’m here to support you. I’m not gonna tell you you can’t do anything. I’m not your mom. Like, it’s your choice.” She’s like, “I’ll give you advice and tell you what the risks are on both sides, but you have to make the decision,” and to contrast that with being in a hospital, like, when you talked about informed consent, and that certainly should be how it is, but I’ve certainly seen cases in hospitals where a question was worded as a statement, and women have no idea they can actually choose not to do something. Like, I hear often doctors say, “I’m gonna do an episiotomy now.” And I tell women like, “The doctor just asked you if you want him to do an episiotomy or not, and you can make this decision,” just reframing it to give it back to them like, “You get to make a choice here.”

Anne: Yeah, and I really… Today, especially if you’re gonna give birth with a midwife at home or in a freestanding birth center, or there are around the countries certain hospitals that are very, very supportive and are mother-baby friendly, and they’ve been CIMS, the Coalition of Improved Maternal and Infant Services. They have that certification so that they’re practicing in that way, but a lot of people do not, and just all over social media, people are contacting me about, I’m hearing this like all over the place, that the doctor just does this or just does that, and they don’t feel like they have a choice. That’s why I created this course, which is just like…and I think you need to prepare today if you are gonna be going to a hospital with an obstetrician that’s not in alignment with what you want. You really have to prepare and know, so when a person is in this situation or, “I’m cutting an episiotomy,” or they just do it without telling you, you’re not right at that vulnerable moment forced to think about the pros and the cons of that procedure.

I encourage everybody to look at all the different possible tests and procedures that are done through the whole process and come up with sort of a…looking at the pros and cons, and that’s what I do in my course and with the women in my practice, but coming up with sort of a plan written out, “This is how I want to have my pregnancy. I do not want this. I do want this.” It could be like, “I don’t wanna test to see if my baby has Down syndrome. I don’t want that test. I do want this blood test, or I don’t want an ultrasound.” You know, there’s no reason to have an ultrasound in a healthy pregnancy, but plenty of people are having them, and some people are having them every visit, which is just really crazy, but I just want people to know that they have that choice, right?

And bringing that all the way into the birth, you know, from do they want to wear…it could be from as what we think might be just very innocuous, which is, “Do you want the lights dim or light bright? Do you wanna wear your own clothes? Do you wanna wear the hospital gowns? Do you wanna be able to eat and drink and move around freely, or do you wanna be in the bed?” All the way down to, yeah, “Do you wanna have a scissor cut or a surgical incision to cut an episiotomy, or do you wanna let yourself birth without that? Do you want the baby to be suctioned? Do you want the baby put in a bassinet, taken him to the nursery? Do you want the baby given a hepatitis B vaccine?” You know, these are gonna be happening without the woman knowing it, necessarily without the family knowing it. So, with this information, you can at least make… You know, everybody’s reasonable. Most people are reasonable. Even if somebody wants to have a natural experience, you know, they’ll agree to medical intervention if absolutely necessary, you know, but not to be done routinely. You know, most people if given a choice will not want all these things done to them and their baby.

Katie: Yeah, exactly. And I think at least from the births I’ve seen, and you’ve seen many, many, many times the number I have, but that seems to be the key, is no matter what happens, not just, I mean, the outcome of the birth, but even just how the labor goes, the woman actually getting to make those decisions and actually having informed consent seems to be, from what I’ve seen, the biggest indicator of her being happy with the birth experience.

Anne: Absolutely, oh my gosh, yes. I’ve had women that, you know, they did have certain…let’s say a woman who does have a certain complication, and she did everything that she could to have her birth planned, right? I mean, most births don’t go as planned, but sometimes the plan deviates a little bit. Like, let’s say they wanted the kids at the birth, and then the kids are sleeping and don’t wanna be at the birth. I mean, it could be something as she wants a water birth, but when it’s time for pushing, she’s pushing on a squatting rope in the closet that we’re hanging from the pole, and she’s, like, pushing and like, “Do you wanna go in the water? You wanted a water birth so badly. Like, that was such a huge part of your plan.” And she’s like, “No,” you know, and she’s pushing. So, it could be like deviating like that, or it could be we need the compassionate use of an epidural, because the mom’s been up five nights in a row, and the baby is in a certain position, and no matter what we do, we can’t turn the baby, and we’ve tried everything A to Z, and she has her epidural, and then she gives birth vaginally.

I encourage everyone to just embrace…make that plan, but at least then when it’s time to make that decision…so with this woman, “Okay, you’ve been in labor 40 hours. You’ve been up five nights in a row. You’re still at a certain point in your labor, and it’s not progressing. We’ve talked about this over and over again. These are the options. What do you wanna do?” If everybody’s good, like mom’s healthy, baby’s healthy, she might say, “I wanna try another hour. I wanna try another two hours,” or, “I wanna do this. I wanna do that.” But, at the end, I say, “What do you wanna do? We could do this. We could do that.” You know, she is the one that says, “You know what? I want an epidural now.” You know, that’s her decision. Like, when we’re not dealing with an emergency…and, you know, most of the time we’re not, right?

If there’s really excellent care, there’s time to make these decisions, and I think even in a situation… You know, my cesarean section rate is 5%, but those 5% are still human beings, and that’s a birth, and that’s a celebration. And unless there was some emergency going on, that’s a decision that a woman feels that she can make, and that’s what needed, and that we can still keep the family, whoever is supporting her involved, she can still…you know, the gentle cesarean. She can sort of catch her baby, bond with her baby right away, have skin-to-skin, and nurse right away, and delayed cord clamping, all this kind of stuff even in a time where she has absolutely pretty much no control, right? We can encourage her to have as much as she can, and then she a lot of times will be much happier with her experience even though interventions were necessary. Anyone that needs intervention for complications is definitely gonna need a bit more healing physically, emotionally, spiritually, psychologically, but much, much less, much, much less than just we’re doing this and people just doing these things to you, to the person and as if they have no choice.

Katie: Yeah, I think that’s so key. Even when a birth doesn’t go as planned, that doesn’t necessarily make it an emergency, and I think you’re right. Like, understanding what’s going on and just having the ability to choose as you go, not only improves the birth experience, and I think it actually makes it statistically more likely for a woman to have a more natural birth experience, because she knows what’s going on, and there’s less fear, but it also just takes back the power over that.

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Katie: And I’d love to kind of go in a little bit of a tangent here, because I’ve had 2 home births and they were technically considered both breech VBACs that would’ve been absolutely automatic C-sections anywhere within 500 miles of me at a hospital. And when I say that, or I’ve written about it on the blog, the most common reaction literally is, like, shock and horror, basically with the assumption that a home birth is so much more dangerous than a hospital birth and how could I possibly risk my life like that. And especially where I live, like I said, we’re trying to make home birth an option for women, but I’d love to hear you speak to this. Is that actually true? Is home birth inherently dangerous as people assume? I know a lot of women are hesitant to birth at home, because either they or their partners are really scared of the outcome. So, can you just speak to that as far as your own experience and even the statistics?

Anne: In my own experience, the worst births and outcomes I ever saw actually were in a hospitalnsetting. So, there is a lot of research backing the safety of home birth around the world, you know, with trained midwives. The research is not necessarily good for unattended home births, right? But if a woman is attended by a trained, experienced midwife or obstetrician, I know obstetricians like Michel Odent who does home births, the outcomes are very good so much so that, you know, like the health regulator in the United Kingdom, NICES, The National Institute for Healthcare and Excellence, I think that stands for, they came out with urging out-of-hospital birth for low-risk healthy women, and that is either home birth, or midwife-led birthing centers, freestanding birth centers. This is the healthcare regulator. Like, they have the authority in the United Kingdom, like the CDC, for example here, or the NIH, right, Mayo Clinic, you know, big health regulator. Based on the evidence that healthy women who are attended by a midwife, the outcomes for mom and baby are at least as good if not better than if they would be going into a hospital.

Katie: Yeah, I think that’s important even just to understand that for women, because it does seem, because the perception in our society is so different. And I think here it seems more scary if you don’t really understand those statistics and understand how well-trained most midwives can be and how there is such a difference, obviously, between an unplanned home birth or an accidental home birth that wasn’t supposed to be and having a midwife there who knows what they’re doing and is very well-trained in everything but cesareans. Because at least, from what I’ve seen in doulaing both kinds of births, I mean, midwives are not only so in tune with the mom and what she’s experiencing at birth, but they’re extremely highly trained, and they know what they’re doing, and they can manage. Like, in one week, I saw two different births. I saw a midwife manage a shoulder dystocia and a doctor manage a shoulder dystocia, and the level of…like, both babies were completely fine, but the difference in, like, the fear in the hospital setting versus the midwife just calmly telling the mom like, “Hey, let’s turn over and get on your hands and knees, and I need you to just move like this for a minute.” The baby was totally fine, and the mom never freaked out and was never afraid, whereas in the hospital, like, you literally would have thought they were both dying for a second there. And so just seeing, like, the beauty of trusting women and trusting their bodies in birth is amazing.

Anne: Yeah, there’s a calm, there’s… I’ve attended women giving birth laughing, singing, dancing, even, like, kind of tapping into their sensual or their primal selves and really being in ecstasy with their experience. Now, I’m not saying it’s not hard, you know. You know, sometimes women can be challenged to the max. It’s the healthiest, hardest thing that a woman, you know, might ever do, but when they do it, there’s… You know, that’s why I love that movie, “Organic Birth,” it was called “Orgasmic Birth,” but it’s the same movie, that when women and families are supported in this way, sort of this model of care, that it’s not just about having a healthy, you know, breathing mother and baby with a heartbeat, it’s that there is this tremendous empowerment, this elation, this high that’s almost like orgasmic. Women wanna scream from the rooftops like, “I did this,” or it’s just transformative.

Anyone in that room, the father, you know, anyone in that room just, you know, brought to tears of the beauty. Well, unless you’re living on a farm or near nature or gardening, it’s almost like the last in the modern world connection we have to real life, like, as deep and as real as it gets, you know. In terms of baby outcome, there are some studies that do say there is a slight increased risk in newborn mortality risk, but it’s very low, it’s like 10 per 10,000 babies born at home, and that has to do with an extra transport time from the hospital, and especially if there are complications, right? So, one of the things that midwives do is we scream. I’m not going to attend the home birth of somebody who has very serious preeclampsia, or is on insulin, or has as a seizure disorder. There are certain situations where it’s more appropriate, it’s safer for that mom to give birth in the hospital, or let’s say if a baby has congenital heart disease, for example, that was detected on careful ultrasound, that baby needs to be born where they can handle that baby and if intensive care is needed. But the vast majority of people are healthy, and the outcomes, they’re excellent, you know.

Katie: Absolutely, for sure. So, close friends of ours have a saying using their family that we’ve adopted and that now I find myself using with doula clients, which is that you are made to do hard things. And, yes, birth can be difficult, and it’s hard work, but it’s also amazing and beautiful, and just like everything else in life, the things that you have to work the hardest for are the ones that you feel the most amazing about after. And I think that’s such an important lesson to teach our kids in all aspects of life about how cool to get to start their life that way, you know, to start from the beginning teaching them like, “You were made to do hard things, and your mom did hard things to get you here, and it was awesome.”

Anne: And you know why it’s awesome also is because, like, almost the modern world, everything is easy. You push a button, you get your dishes washed. You know, you push a button, your clothes are washed and dried. You know, everything is push a button, and this happens, and it’s almost like, “When are we really every so tested?” you know. And women really a lot of times when they come in the beginning, let’s say to me, if it’s their first baby or it’s their first experience of the natural, is they doubt their strength, and I am amazed, like, how every woman finds her strength to do what she needs to do. She just finds her strength, and, you know, women are strong, and they’re stronger than they know, we are stronger than we realize.

Katie: Yeah, so much so. And I’d love to kind of go back full circle and tie back into where we started and to even ask you to be a little vulnerable and go deep for a minute, because I have several close friends who have really struggled with postpartum issues, whether it’s actual full postpartum depression, or just anxiety, or illness related to that postpartum period, and I believe you have some experience with this as well. Just circle back to the healthy baby being obviously the most important thing, but not the only thing. The mom matters so much, too. So, can you tell your story about postpartum experience and any advice that you have for moms both before, during, and after birth to kind of help heal if there’s been a traumatic situation?

Anne: Yeah, so this is what I go through with every woman in my practice and, you know, in my course, is I help women in their pregnancy prepare for postpartum. It’s like the forgotten fourth trimester of pregnancy. You know, in hospitals, women are just sent home two days after a vaginal delivery and five days or four days after a major abdominal surgery. When most other surgeries are done microscopically, you know, cesarean is still major abdominal surgery. They’re just sent home in four days, and, like, you’re on your own, and it’s a time throughout history and around the world where we used to live in communities, in, like, tribes or communal settings where that woman who just gave birth was like a goddess. She was left to heal, and rest, and breastfeed, and all the women in the community took care of everything else, like childcare of the other children, her work responsibilities if she was working outside the home, errands, cooking, cleaning, all of that so that in the first few months that woman was so surrounded by this circle of love and support that she was nurtured psychologically.

It takes a village to raise not just a baby, but new parents, but, you know, she could also physically heal. And today, in our country and parts of the modern world, you know, families are just spread apart so much, and women are alone, not living in community, and even if they are, her mom, and sister, and all the women in her family might be working or might create tension for her, they’re not let’s say getting along or something like that. So, a lot of times women are alone. So, I work with women in the pregnancies, you know, in my practice and in my course on how to mobilize support for all of the duties that she does, because I want them off her plate, you know, and in my experience… So, you’re asking what… I became very passionate about postpartum, because I had my own postpartum illness, so always a lot of times when we have our own, I know pain, I know what it’s like. When I had my own postpartum illness, and I healed from it, and holistically, I feel like, not only do I know what it’s like to feel that way, but I also know what it’s like to heal and using all the different modalities to help women heal. So, that’s been one of my areas of passions and expertise, is to help women postpartum, because it’s not talked about or addressed as much as we need it to be.

Katie: Yeah, I was gonna say I absolutely agree with you. I think that that’s one of the things that, hopefully, people like you working and moms, like, understanding and making the difference that these will be the things that over time can change the birth outcomes in our country, but also just what the experience women have, because I think that over time is gonna be so healing of the culture and of birth in general, and I think I love that you are doing so much in order to do that.

Anne: There are certain risks factors, right, that sort of increase the risk of this woman might end up with some issues postpartum. If she had a traumatic or highly interventive birth experience or birth experience where she wasn’t honored, right, the things were done against her will or forced upon her, that can certainly increase the risk if she has no support around her postpartum. A single mom or even if the mom has a partner, but the partner has to go right back to work, we don’t have paternity leave in this country, and let’s say she can’t afford to hire a help, and her family is spread apart. So, that’s why I really like to help women prenatally to prevent it, but it’s real, it’s about 10% of the population suffer from what is called postpartum depression. That is, like, any symptoms of depression or anxiety that occur within that first year after birth, and that’s not the same thing as what they call postpartum blues. I don’t like the word “postpartum blues,” because a lot of times women are blue. It’s like that first two weeks postpartum where you got a combination of lack of sleep, you just gave birth, which is huge, and the hormone change, the placenta made all these hormones that were just nurturing the pregnancy, and so when the placenta is delivered, like, there’s a huge drop in hormones, and it’s like in a total exaggerated sort of PMS feeling. You know, people feel PMS from the fluctuations in their hormones and their cycles.

They’re certainly gonna have, like, feelings, having emotional reactions related to the drop in the hormones when the placenta’s born and then the baby’s nursing every few hours, or needs to eat every few hours, doesn’t always go back to sleep, so maybe they’re getting 4 hours in a 24-hour period. And then, you know, having a baby is a huge adjustment. It’s up there with, you know, getting married and, you know, major life changes kind of thing, so all these things. Even in the most well-supported situation, a woman could just have mood swings or cry and she doesn’t know why she’s crying, she’s so happy, this kind of thing, or a partner comes in and, “I made you eggs, honey,” and she’s like, “But, I wanted waffles.” So, it was like this kind of normal extra-heightened sensitivity, overtired, overwhelmed, and I say every day have a good hug, a good laugh, and a good cry, and it doesn’t have to be in that order, a good cry, a good hug, and a good laugh, but really need to sleep, like sleep when the baby sleeps. That’s the most important thing.

Like, everybody comes today. You know, all these visitors wanna give gifts to the baby. What the mom really needs is meals for, you know, a week. You know, the baby doesn’t need very much. You know, she needs to rest. So, she might need a cleaning lady, someone to clean the house or someone to, you know, babysit the other kids. You know, those are the best baby gifts that should be in all registries, right? Yeah, but if that starts to spiral down, and, you know, I go over with everybody the symptoms of postpartum depression and postpartum anxiety or worse. There are so many things that can be done. You know, there are so many things that can be done, and it’s so important that a woman knows that she can reach out for help, that it’s not to be ashamed of, this is real, and if you don’t reach out for help, usually it gets worse. So, there’s so much just to bring it up with someone who can help you. There are so many things that can be done.

Katie: Yeah, such good advice. And as we get near the end of our time, I just wanna have you make sure you tell people where they can find you online, and, of course, those links will be in the show notes at wellnessmama.fm, but let people know where they can find you, and if you have any parting words for moms, especially maybe a pregnant mom who is listening, just any parting advice you wanna share.

Anne: So, where you can find me if you’re on Instagram is Home Sweet Homebirth and also on Facebook it’s Home Sweet Homebirth. My website is homesweethomebirth.com, and maybe your listeners would benefit from…I have this download. It’s like an e-book that has… Over the years, I’ve collected I think it’s 154 of my favorite resources for women, for pre-pregnancy, pregnancy, birth, postpartum, siblings, partners, you know, inspiration, also like supplies, where to get them, you know, supplies if you do have a yoga or meditation practice, supplies to bring for your birth to kinda create that home sweet home birth kind of feel, whether you’re in a home, in a birth center, or in a hospital. You know, there are things that you… You can actually, like, move in, move in wherever you’re going and create that place where you can incorporate anything that inspires you, what you listen to, music that inspires you, what you smell, what you eat. You know, you’re using all the five senses to bring into your birth environment. So, that’s homesweethomebirth.com/gift, G-I-F-T. And, yeah, what was your last question? What I would like…

Katie: Yeah, just any parting words of wisdom for moms, or pregnant mommas, or someone who maybe has had a difficult birth experience.

Anne: Oh, well, those are two different things. If anyone has had a difficult birth experience, my gosh, reach out to me or to your local midwife. You know, like, I do like online consulting. That’s actually the most common reason, and people ask my all over Instagram, you know, “I had a really traumatic birth.” At least a third of people experience a traumatic birth, and that’s a lot of people, you know, “I had a really traumatic birth. What can I do?” I can’t answer that on social media, but that kind of birth this online, you know, sort of global consulting, which has been really amazing to reach women and help women all around the world, but in terms of… So, you don’t have to sit in your suffering. There are so many things that can be done, but it’s not just on one foot or one minute that I could say that to everybody, because everybody’s unique in what they need and what they’re suffering with. But in terms of women who are pregnant, I just want you to as much as possible know that your body knows how to grow, and birth, and breastfeed a baby, and your baby knows how to be born, and you have the strength in you. Even in the heat of things when you think you don’t, you still do have the strength within you to do it.

And what’s amazing is that, as you’re giving birth, about 300,000 women around in the world are giving birth, and billions of women have given birth before you, and it works. It is the most brilliant process that is more wise than any human being, and that to really trust it. And if that means we kinda have to get our brains out of the way, whether that’s in dancing, or journaling, or doing yoga and meditation, or whatever we need to do, tapping into the more of our right brain, our intuitive instinctual self, and trusting that our bodies know how to do it. And just I wanna tell you, so in 20 years of home birth midwifery practice, I have not once, not even one time have I had to transfer a woman to the hospital because she could not take the sensations, I don’t like to use the word “pain,” but she could not take the sensations of normal labor. I have not once had to transfer a woman to the hospital to get an epidural.

That’s a lot of women who are giving birth naturally, and, you know, it’s so possible for you to do it. Even if you think you can’t, you can, and with the right support and the right kind of care that encourages you to move around freely, and eat and drink, and trusting, and encouraging, letting the process unfold as it does. And I’m amazed and in awe every time I witness this, you know, and the more I practice, the more I realize how little we need to do, that it just works. Michel Odent, he’s an obstetrician from France who speaks all over, he was speaking in “The Business of Being Born,” and he spoke in “Orgasmic Birth,” that documentary. He says, “What do you think is the best…” I heard him at a conference, “What do you think is the best intervention that a midwife can do at a birth?” And it was a room filled of hundreds of midwives, and everyone was getting it wrong. What would you think it is that he said? What’s the best intervention that a midwife can do at a birth?

Katie: Nothing? Just stand back?

Anne: Right. Well, that’s kind of. He says, “To knit,” in his French accent, “To knit.” And why? Because we have a very calm presence of a midwife, her eyes are wide open, her heart is wide open, her ears are open, her mouth can talk, but her hands are occupied with knitting, which kind of, like, a woman who is birthing and is seeing kind of this wise midwife who’s been in thousands of births, and everything’s just going fine. She’s calm. She’s knitting, you know. She’s talking to the mom. She’s encouraging the mom, but it keeps the hands occupied so she doesn’t have to be busy with something else like interfering, right? And, of course, yes, if something needs to be done, she’ll put the knitting down, and she’ll deal with it, but I think it’s amazing to hear this from an obstetrician, that the best thing that an attendant can do at a birth is to knit.

Katie: Yeah. What a wonderful message to send to the mom, like, “Everything is perfectly wonderful and happening, and I’m so calm that I’m knitting.” That would be so encouraging.

Anne: “I’m so calm that I’m knitting. What color would you need your baby’s hat to be?”

Katie: That’s wonderful. I love that. Yeah, I think that’s the beauty of midwives, and I appreciate so much the work that you’re doing and so many other midwives that I love, is just reminding women that we were made to do this, and our bodies know what we’re doing, and, yes, there’s certainly a time and a place for interventions to save lives, but the majority of the time, like, your body knows what it’s doing, and you have the power to do it. And I love that that’s your message to share, and I’ll make sure it’s linked in the show notes, but thank you so much for your time. I love the message that you have for women.

Anne: Aw, thank you, Katie. It was wonderful to be here.

Katie: And thanks to all of you for listening. I’ll see you next time on “The Healthy Moms Podcast.”
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.

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