Maternal Wealth Podcast - Own Your Birth
The Maternal Wealth Podcast creates a collective space for sharing all birth-related stories. I want to acknowledge birth's uniqueness, honor its variations, and remind us of the power we hold in giving birth.
As a Labor and Delivery Nurse, I see the impact of our stories. Let's share those stories with those who come after us to prepare them for what's to come. For those who came before us, allowing them to reminisce and heal as we realize we were not alone in our experiences.
Maternal Wealth is currently streaming in twenty-five countries: New Zealand, Australia, Slovakia, Canada, Finland, South Africa, Belgium, the United Kingdom, Rwanda, Poland, India, Sweden, Germany, Puerto Rico, China, Italy, Denmark, Brazil, Indonesia, Vietnam, Spain, Greenland, Cyprus, Tanzania and the United States.
Maternal Wealth Podcast - Own Your Birth
The Complex Evolution of Maternal Healthcare in America (Part 3)
Midwife Audrey returns to unpack the complex evolution of maternal healthcare in America, revealing how historical class divisions, capitalism, and systemic racism have shaped how women experience pregnancy and birth today.
From the early days when aristocrats sought "painless" birth to elevate themselves above "peasant women," to the current system where scheduled inductions accommodate limited maternity leave, our conversation explores how childbirth transformed from a normal physiological process into a medical event requiring management and intervention. This historical context sheds light on why obstetrics superseded midwifery in American healthcare, despite evidence suggesting that most women would benefit from the midwifery model of care.
The reversal of Roe v. Wade adds another layer of complexity to conception and pregnancy planning, with impacts that will take years to fully understand. Meanwhile, America's capitalist values create a maternal healthcare landscape where privilege determines options, from who can afford time off for recovery to who receives proper pain management during labor.
Most disturbing is how these historical trajectories contribute to the current Black maternal health crisis. Outdated biases persist in medical education and practice, including misconceptions about pain perception in different racial groups. When combined with economic inequities and social determinants of health, these factors create a system where preventable complications disproportionately claim Black mothers' lives.
Yet, hope exists in solutions such as concordant care (where providers reflect their communities), cultural competency training, and system-wide recognition of how social structures impact health outcomes. By understanding how we arrived at our current system, we gain insight into creating more equitable maternal care for everyone.
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Welcome to the Maternal Wealth Podcast, a space for all things related to maternal health, pregnancy and beyond. I'm your host, stephanie Terrio. I'm a labor and delivery nurse and a mother to three beautiful boys. Each week, week, we dive into inspiring stories and expert insights to remind us of the power that you hold in childbirth and motherhood. We're here to explore the joys, the challenges and the complexities of maternal health. Every mother's journey is unique and every story deserves to be told. Please note that this podcast is for entertainment purposes only. It is not intended to replace professional medical advice, diagnosis or treatment. Always consult with your healthcare provider for medical guidance that is tailored to your specific needs. Are you ready? Let's get into it. Welcome back everyone.
Stephanie Theriault:We're excited to jump into episode number three with midwife Audrey. In this episode, audrey shares her insights on conception in the United States, especially after the reversal of Roe v Wade. She discusses how modern women manage work and home life and how they approach childbirth, including topics like inductions, epigenetics and privilege. We'll also explore the midwifery model of care, why many women are drawn to it, even if they ultimately choose OBGYNs or maternal fetal medicine specialists to be their birth providers. Additionally, we'll look into the history of midwifery and obstetrical care in the US and how it all ties into the current outcomes for women, especially women of color, during child birth. Join us for a thoughtful conversation on maternal health care in the United States.
Midwife Audrey:Thank you for having me back.
Stephanie Theriault:I'm glad to have you here. Let's get into it.
Midwife Audrey:Options for conception what does conception look like in today's society following the reversal of Roe v Wade? Well, I think I want to kind of break this up into two parts. So the first part would be what does conception look like today? I think largely conception altogether. There's the what most people understand and know conception to be, which is sperm egg creates a fetus and then it grows in a womb, and so on and so forth. But now we have conception that can look like in a test tube, where it is assisted outside of the womb and then put inside a womb, whether it is of the biological person who had that egg or someone else. Altogether, via a surrogate, it could be inserting the semen into the womb and it having a shortened or assisted path towards the egg and maybe increasing the chances of ovulation if, for whatever reason, the morphology or the mobility of the sperm, really they just are not capable of getting the job done. So there's so, so many ways that conception can look like, and through that there then opens up the possibility of all kinds of different relationship types, where types where you can have either same-sex marriage or you can have surrogacy, or you can have an older couple starting a family, or you can have a couple of any age or any health factor, for one reason or another, starting a family, but through, maybe, what some people would understand as non-traditional means. And there's even deciding to start a family despite having being settled with a quote, unquote partner. So conception, the very I guess you can say physical beginning of motherhood, can start different ways, and these are some of the different ways that I'm seeing conception look like today.
Midwife Audrey:Now the second part of the question following Roe versus Wade, I think we need more time in order to know what that impact looks like, holistically, meaning like like all the different ways that it's impacted it.
Midwife Audrey:But maybe you know some of the most foremost and immediate ways that the overturn of road versus weight has impacted conception is that, you know, for those who are of childbearing years and fertile and capable of getting pregnant, but who are still navigating the when they want to have a child or let's say they just recently had a child and they know that they wanted a child space or whatever the case is you know, birth control is one of those that is just flying off the shelf and people are buying it up in bulk because they then somehow be in a situation where there's a pregnancy, that then, for whatever choice or reason, they needed to then have an abortion that's not readily available and when you're looking at potential options, potential consequences, such as incarceration, fines or just all kinds of stuff like stocking up and birth control, so that they are minimizing the possible risk of needing to navigate, needing access to an abortion but not having one, and that's only one component of what does conception look like after roe v wade.
Midwife Audrey:That that doesn't um even weigh into the factor of those who do conceive, whether it was intentional or non-intentional, or for health risks to mom or baby or whatever the factor who now are seeking an abortion and don't have access to that, which then creates his own leg of maternal health risk factors. That can complicate things and decreases the overall capacity of wellness for people in America, because we have a health option that or access to a health care procedure that is inaccessible for health reasons or non health reasons, or, and all of it, it is in health and wellness, especially if we're talking about the whole person mind, body or spirit who is having a termination, for whatever the reason is, which there are several different reasons that one seeks that out Looking at pregnancy.
Stephanie Theriault:How has the landscape of pregnancy changed in the present USA? What are new risk factors that are associated with pregnancy?
Midwife Audrey:So the first further question is how has pregnancy changed in the USA? Yeah, how has the scope of care for providers that can provide them, and also inundating certain parts of the maternal healthcare system by also not having it accessible. I don't know that this data would show us if we're starting to see an increase in pregnancies that are desired and pregnancies that aren't desired. I don't know if we're seeing an increase in the rate of unintended pregnancies. I think the rate of pregnancies has always been what it is, but what the statistics may show may be that is actually impacting, maybe certain communities where now, let's say, that community has like one midwife, but now we actually need to have two or three because there are more individuals that are pregnant in that community. I could see that kind of impact and I'm curious to see that. After so many years, when we look back at the statistics, what do we learn from this?
Stephanie Theriault:What are some new risk factors that are associated with pregnancy? Post Roe v Wade Clinical risk factors with pregnancy that might not be known to many people.
Midwife Audrey:Well, I think the clinical factors are still the same before and after. Now the option of what are we going to do about it is what's changed. Let's say, women who have risk of carrying a baby with a genetic disorder or a malformation or whatever. The case is, that statistic didn't change now all of a sudden because we don't have access to abortions. But how then that plan of care for that pregnancy going forward? That is what changes, you know, post Roe versus Wade, which is the having access to the different options for your maternity care that you would get to discuss with your healthcare provider. Now there are different options that may have huge life factors or implications for you. An example could be you know you are pregnant and you're excited, but now you found out you have stage three breast cancer and you need to do aggressive radiotherapy starting tomorrow and you're literally only 12 weeks and your prognosis can be good, so long as you don't skip treatments and you start immediately, which means you carrying your baby is not something and getting radiation is not conducive to a healthy pregnancy and will cause severe issues for that baby. Well, that parent may determine the thing that they need to do, the health choice that they need to make that is in their best interest and in the baby's best interest is to terminate and get the treatments, get healthy, be cleared of cancer and then look into conceiving again.
Midwife Audrey:Many people are in this type of crossroads, where that's the type of decision making that they are forced to navigate with their healthcare provider and then imagine now, here it is in order to proceed with life-saving healthcare risks, you're needing to make certain decisions. That's not in your best interest because you don't have access to determination and you don't want to damage the baby beyond irreparable belief. But this also means you're signing the time card on your life and your prognosis. Like, how crazy, how crazy. That's not a decision that any legislation should be able to impact. That any legislation should be able to impact. And that's what the problem is is it should never be about the I'm judging your choice to do a thing in your body. Who are we to even be in that conversation? The conversation should only be between the pregnant person and whoever they're connected with that is involved in that, along with their healthcare provider. That is it. That is the full circle and loop for that conversation.
Stephanie Theriault:Trying to get pregnant and trying to balance pregnancy and work what are some ways in which women can find a more healthier balance while they're pregnant and progressing in their pregnancy? When you're 36, 38, 40 weeks pregnant, how can we help better manage that balance?
Midwife Audrey:Yeah, well, there's. What options do you have? And fortunately, your options are largely dependent to the level of like access and privilege that you have to have access. So what I mean by that is do you own your own company that is well established and financially you can pay yourself to then take however long you want or need for returning relief, right? Not everybody has that privilege or that kind of access. So then the next one is are you partnered with someone in which they make enough to sustain the whole entire household needs and roof over the head and all of that stuff, while then you, you know, stay home and parent, assuming that that's something you want to do?
Midwife Audrey:So this conversation really meets at the intersection between what kind of privileges does one have, which those tend to be intergenerationally linked, and also what type of social structures then do we have? That's even accessible for an option In other countries. These things are integrated into just how that country runs. So there are then access to child care and health care integrated in the workplace, or also they have paid leave, where either parent or both parents are paid to be able to stay home and they are able to maintain roof over their head in the things they need. And so that is because that system values the structure of families and communities, knowing that that investment then invests into the wellness of the overall country. And so it's crazy that this really leads to a larger conversation in what is valued and it's pretty obvious in America what is valued capitalism, above all, above wellness. You know what works for for the thriving of, you know, our healthy communities.
Midwife Audrey:And so then, because now we've kind of like broken it down and depending on what like path or level of privilege that person has access to, then of that is what they then navigate to have their landscape of motherhood look like so for some people it's this conversation, like they wish they could even be talking about whether or not they could have the option to take so many weeks off or this or that.
Midwife Audrey:For some that's not even an option. If they are not, you know, bringing in some kind of money or resources, they have a very strong, you know, likelihood of losing a secure roof over their head and then having even more potential risk factors be opened. Up to now they don't have secure housing, they don't have secure food, and now they are impacted by the elements, which then also causes them to get illnesses and then have to be in a healthcare system that they can't pay for those illnesses, and so these kind of things is where we see social determinants of health that largely are passed down intergenerationally because of social structures that have been created, and so this is part of how systemic oppression has an impact and why we start to see different levels in equity and different outcomes per racial capita, like within communities. It's incredible just to follow the statistics and see where these different policies came from and see how I guess you can say how its intended impact then actually unfolded years later.
Stephanie Theriault:We pause this episode for a quick message from our sponsor. At Maternal Wealth, we aim to ensure that you have access to the best and the most appropriate care. That's why we created a Maternal Healthcare Provider Database. Maternal health providers can easily create profiles to promote their services and business, helping to increase access for those seeking their care. This is a one-of-a-kind database that offers a new and exciting way for women to search for and find maternal health providers near them and tailored to their specific needs. Profiles feature badges that highlight various services, such as TODAC-friendly practices, all-female practices, lgbtqai plus inclusivity, language options, access to vaginal breach services and more Additionally, be sure to check out our Not your Average Birth course.
Stephanie Theriault:In this course, I discuss the variations that exist in hospital practices based on policies, staffing and budgets, all of which can directly affect your birth experience and outcome. Talking about how the balance of pregnancy and life, responsibilities and survival, and the values in the society, which is capitalism, monetary, how can we get the most money out of the situation, and that trickles into how women show up to birth. In this country, I believe in the US, how women show up to birth. There has been a shift in the way we labor and how we labor and how that produces a birth. I want to talk about inductions and the clinical reference and the advice of inductions. I think what we're talking about also represents in how we show up to birth, to schedule an induction, because we have to balance work life, money, childcare and an induction as opposed to just waiting for labor to come and having that social support. Could you speak a little bit to that?
Midwife Audrey:To some degree, and I think you might even be able to speak more so to it than I can. So, as a licensed midwife who practices outside of the hospital, my scope of care is low risk, you know, relatively healthy pregnancies, and so with that tends to also be a part of what I was talking about earlier about like, what type of things do you even have access to? So I tend to serve a community that has more options and resources in terms of the type of pregnancy path they have and part of that pregnancy path that they seek with having a licensed midwife, part of our scope of care is we don't do inductions. So sometimes there can be the stress of like, oh geez, 42 weeks is coming up. If this baby, you know, does not, if labor doesn't kick in on its own, I may be facing an induction. Or if there's a concern with, maybe, how the baby is growing, if they're growing too big, or if they're growing too small, or if there's any concerns about their wellness, sure then there's, oh no, I might be facing an induction, to which point then the OB hospitalist is who oversees that process. And so it's not so much for the landscape of got to return back to work. But I do know that that absolutely is a factor, and even in the population that I serve, even if they have the baby, sometimes there's a concern for I'm not able to take six weeks off because I have to get back to work. Who's going to pay for the light bill, the water, these very resources they need in order to ensure that they can continue taking care of their baby. Now they need to go out and go get these resources without even being fully healed up to go do so.
Midwife Audrey:That is a huge social problem, no matter whether you're with a midwife or with an OB, that I think many women face, and induction is sometimes part of that question of I'm only given so much time of paid time off and I only have so many weeks of maternity leave. So in order to maximize how much time I have at home with my child, I'm deciding to go ahead and get induced on XYZ dates. So I still have so many days of PTO and that, combined with my maternity leave, which largely sometimes is unpaid or partially paid, that'll buy me, hopefully, close to 10 weeks or 12 weeks. Like, oh my gosh, how crazy that women are needing to literally negotiate how much time they can take and what things that they're willing to do to their bodies in order to maximize times being home with their baby, you know. So it's just like it's.
Midwife Audrey:It's unfortunate that this is the landscape, and so this really then really reveals another intersection where we start to see scales of privilege where, even though that is something somebody may need to navigate all the way from, they're back at work in two weeks all the way to. I, at least at my job, I'm able to save up PTO and I do get maternity leave, even though it's paid all the way to. I do get maternity leave, it's paid all the way to. Oh, do get maternity leave, it's paid all the way to. Oh, I don't even have to work because we get so much money.
Midwife Audrey:So navigating motherhood in America is so dynamic for so, so so many mothers out there, because of the lack of social structures that could be there and create a basic level of quality, meaning no matter what level on the socioeconomic scale you come from, we just know that babies thrive best when they have a parent who is home with them in those early years for early bonding and connection, and we know that then those families who have their needs met, meaning their electricity, their food, their this or that are, then have less stress.
Midwife Audrey:So then we're literally decreasing trauma that is then created in the homes that can then be passed on to the children.
Midwife Audrey:And so if we were to start to create these kinds of social systems in our country, that right there would literally start to heal and disrupt the passing down of generational and intergenerational trauma that have largely been caused because of mothers having to navigate entering the, reentering the work for, you know, not being able to enter the workforce and giving up a loved passion and career because they need to stay home, because it's not financially feasible, like all these things, no matter which way you look at it, making no judgment on whether it's best for the mother to stay home or not stay home or whatever the case is, we know from a statistical standpoint from other countries doing it. Having the ability to have basic needs and resources met decreases daily trauma, which then decreases the likelihood of passing on that trauma, which only improves the quality of life for the baby, because the quality of life of the caretaker is improved, and so all of that just has a better trickle down effect, without judgment of who should stay home and for how long, and any of that. It's really cool.
Stephanie Theriault:So many times I find women presenting as my patients in the hospital with birth plans that are low intervention and essentially seeking the midwifery model of care, but yet they hired an OB or MFM for their care. As a midwife, could you share with us, with the listeners, a little bit about what low intervention looks like with your care? Are you primarily in a birth center or in the home setting?
Midwife Audrey:Both. So I primarily see clients in the office, and our clientele has the option to choose to deliver at home or to choose to deliver at the birth center, and so referring the question again interventions, and they've hired an OB or MFM.
Stephanie Theriault:I would love for you to share what your model of care, what the midwifery model of care is for women who might be on the fence in seeking a midwife but haven't really had the opportunity to hear from a midwife, what your model of care looks like and the benefits of it.
Midwife Audrey:Yes, yes, okay. So the midwifery model of care is one that comes from a philosophy that in a normal, healthy woman and a normal, healthy developing pregnancy, that that body and person has the resources in order to deliver, and our philosophy is to encourage this normal process, either through emotional support, clinical support, whatever support is needed in order to make it to the other side of a healthy and safe delivery that had minimal interventions. So what that tends to look like is really having conversations centered around where the woman is at in her wellness and getting her most securely on that path of wellness. Why is it that we keep focusing on that? Well, because if the body, which is, if it's already healthy and functioning well, will continue to perform well so long as you maintain its wellness. So no different than buying a brand new car. Like my car is brand new, it works fine. I expect it to continue to work fine so long as I do the things that it needs to do for it to continue working fine, meaning if it gets its appropriate oil changes. We pay attention to any warning lights and then thereby satisfy whatever needs to be done. Like, let's say, it says tire pressure low. Okay, give it more tire, more air in the tire, like we can then reasonably expect that this piece of machinery is going to operate at the standard of what that machinery should do and what is his primary job To drive, and so chances are the car is going to drive just fine.
Midwife Audrey:So we take that approach with pregnancy too, meaning we have a healthy, normal, low-risk individual whose bodily processes are happening reasonably within a healthy way. And, if you know, there are some things that like, let's say we get an indicator light, ie let's say we see some sugars are coming back a little elevated up. We need to make lifestyle changes in which now the body is metabolizing sugars normally and when we have normally metabolizing sugars we tend to not then create an issue called gestational diabetes or we don't then create macrosomic babies, which then, if we're not doing those things, the likelihood of then needing the intervention of inducing so that the baby doesn't come out too big, or needing to do the invention of a C-section because a baby won't come out through the birth canal. We've literally almost altogether eliminated the probability of needing to do those interventions for those specific reasons, because we've taken care of the root of the specific problem which causes those things and the need for those interventions. Does that make sense? It's literally a whole connected loop and cycle. So whatever the risk factor is, and so it's within balance, right. So if someone has, let's say, asthma that's controls that doesn't all of a sudden mean they're not low risk. It comes down to what is the scale of risk and can we mitigate it. Then we have a consultation with maternal fetal medicine who gives recommendations or feedback. We talk to the client about their triggers and minimizing their environmental risks that increase those things, their pregnancy. If they then don't have an episode, then that's a risk factor that's been eliminated from then needing to do some type of intervention to fix it.
Midwife Audrey:Midwifery care is largely about holistic wellness and that is where we put our greatest emphasis. And should anything arise then outside of that, such as, let let's say, after the delivery we have too much bleeding, or let's say baby needs resuscitation after delivery that's why we have the skills we have and that's why we go to school and we're licensed is in the event that we have some complications that should arise, we have the ability to that should arise, we have the ability to mitigate them. But really the best landscape for overall maternity care is one that's integrated, where we have the midwifery model of care, where, honestly, 85% of American women fit this model, which is relatively low risk, meaning they don't necessarily have preexisting hypertension, they don't have a genetic disorder, they don't have some kind of ongoing health risk like, let's say, a brain tumor. They're just a person who's now pregnant. So, because 85% of the population fits this category, midwifery model of care is a great model for those people.
Midwife Audrey:The rest, of the 5% to 15% meaning this person has chronic hypertension, is on all these crazy medications so that they don't stroke out.
Midwife Audrey:That's not a normal, healthy pregnancy where we can expect that nothing will arise. There's all kinds of complications that can arise with that, and so those are the type of patients that need to be receiving care with an OB and with maternal fetal medicine. Unfortunately, we have the structure of care backwards in America, meaning we have, you know, like 92% of our overall delivering populations with OBs and maternal fetal medicine, and then we have 8% with, you know, midwives and nurse midwives, you know, delivering in low risk fashion with minimal intervention. So it's one of those things where, just because you know we have all the interventions we can do, we see actually statistically having all the access to all the interventions we could do should we have a complication. It's not a good model for someone who is low risk, because then it actually creates interventions and problems that weren't there, that then need to be resolved, which then altogether have a net sum negative because now we had a problem that we had to swoop in and do something about.
Stephanie Theriault:So if we're not paying attention carefully, we can sometimes think that, like being with an OB or maternal fetal medicine is necessary to prevent complications, where that's not necessarily the case at all do you want to talk about the history and how obstetrical care came into the mainstream, midwifery came out and then how that kind of grafted into the inequitable care that women of color are facing today?
Midwife Audrey:oh my goodness, yes, understanding the history is so important and when we understand it, then we also. It just illuminates a little bit more as to why things are the way that they are and how they got there. So way back when, and even before we had recorded history the way we know it, the history of women, largely, and even up to this point, have not been recorded, but just through different anthropological like, being able to surmise different things and seeing how people have evolved, and also just looking at the statues and the different things that communities valued, you can see that midwifery has always had its place with humanity. So, honestly, midwives have been around since the dawn of mankind and when you start to see the evolution of just humanity through time, midwifery and mothers and midwives were just how humans came into this earth, generation after generation after generation. Now let's fast forward to the, you know, 1700s, where we're especially, you know, in Europe, having class wars, the aristocrats and the lower class, and this and that and so on and so forth, and now they're started to.
Midwife Audrey:Part of that culture of the aristocrats was, oh my goodness, even birth was just too barbaric. Birth needed to be painless, so there started to then be the like, striving for, in essence, becoming less of a lower human who feels birth pains and who the way in the. In those times they said it was like you could take a peasant woman and aristocratic woman and they're exactly the same woman in birth. And I think that was probably kind of unnerving for the classes where it's just like no, but I'm a superior human, I don't grovel and make noises like that and grunt and whatever the case is and this perspective came from a man, of course, because back then men were the only ones who were allowed to be doctors and so they started sticking their noses into all things, and one of those was childbirth. Childbirth and normal and physiological. Why would you need a doctor for that? That's like saying you need a doctor for pooing Like why would you need a doctor for that? That's just a normal everyday process.
Midwife Audrey:But one doctor was really particularly obsessed about creating painless childbirth and started to tinker with different drugs and whatnot, and this is the early beginnings of the epidural. And so in doing this, in the pursuit of a painless delivery, which there was a demand for, that now that was something that needed to be overseen by a physician, because sometimes the babies would die, or sometimes the moms would die with these chemical experiments, which sometimes worked, or sometimes had them just like completely high out of their body. They don't even remember what happened and so it kind of caught on, kind of like it's painless simply because they didn't remember. It's painless simply because they didn't remember. And so the practice actually was deemed rather barbaric in Europe because it did kill so many patients and being barred from being able to practice this, this doctor's like I'm going to go someplace where I'm appreciated. Well, now it comes into America and starting to get the practice a little bit better and less mom and babies are dying, yay, and some are even saying that they felt less pain. Okay, great.
Midwife Audrey:So now we have the pathology of childbirth becoming normalized. Pathology meaning the disease process, the thing where things can go wrong, whereas birth was seen something that was not worthy of a doctor's overseeing because it was so physiological, like a bodily process, like throwing up or pooping to now, oh no, but they need a doctor to monitor because a mom or babies can die. Then the medicalization of birth took hold and then obstetrics was born. So of the different practices of medicine, whether it be cardio, like cardiology, or looking at like the bones and osteopathy and all of that. Obstetrics is a new, new medicine compared to all these other forms of medicine that we see today as far as, like different specialties doctors can have. And so from there it started to take place.
Midwife Audrey:And it really took hold in the early 1900s is twilight sleep, and twilight sleep was viewed as like a miracle innovation in childbirth, because now women had a way to go through childbirth with minimal pain or no pain. Well, what it was was they got much better with that drug concoction. They were doing Less. Moms and babies were dying, Turns out. The women still clearly felt the pain. There are actually records and notes of how they had to tie women to the bed because they would curse and move and do all kinds of things. And again, this is coming from the idea of this aristocratic, elevated like I'm too good to make noises like that, like what, and do what humans do when they're giving birth, like an animal outside. I want to have this experience that saves me from that. I wouldn't remember that experience, so it felt like a miracle, like oh my gosh, I just went into the hospital and I came back out and I had my baby in arms.
Midwife Audrey:You can speak to many women, especially if they're still alive today and can speak about that experience, about what it was like to give birth in the 40s. That was it. It was. No one taught you about having a baby. You didn't take classes If anything, the surgeon general at that time. You had a bulletin that and this used to be on like billboards about how women should drink alcohol and smoke cigarettes because it would make their baby smaller. Now, the rationale for that was because during twilight sleep that was the whole point was they literally gave you a concoction of drugs. They put a curtain up, you laid there and they cut you open, ie an episiotomy took forceps and just pulled the baby out. That was birth.
Midwife Audrey:As we start to learn more and more about the evidence of that way of practice, we started to see it created horrible complications, even worse complications than the early quote unquote epidural slash, pain-free birth we were trying to do. Now we were creating issues with women's pelvic floors and incontinence when they're young and creating fissures and just all kinds of things where it's like they should not have these kinds of complications. These are young people Also. Whoops, we gave a little brain damage to this baby. The force that cut a little too deep into the baby's brain. So then, as obstetrics starts to grow, it started learning from its mistakes like, oh geez, this actually is creating more problems than it used to have when people just had a baby. So they then practiced up a little bit more and Twilight Sleep then transitioned into something that was a little bit more conscious, and we started to then learn how the nerves work and how to put in medication, a narcotic, directly in the nerve bundle so that it numbed out the pain. But now the woman can still be conscious. So that's the whole process that we got to here and where it came from, and so thankfully we have improved a lot of different components of the technique and the risk factor.
Midwife Audrey:But when we look at the medicalization of birth and its movement into the hospital, it was because of the introduction of the concept of a pain-free birth and also because doctors were men and the men who were allowed to be doctors were aristocrats. They was tied in with this idea of nobility and of just like an elevated status or elevated stature. So then a campaign to push out midwives from childbirth especially became a thing, because it's like, how are we going to reasonably get people to leave this practice of seeing midwives something that they've been doing since the dawn of mankind to finally come into our neck of the pool, which is the idea of. This is the elevated way to give birth. Don't grunt and grovel like an animal anymore. You could just be able to sit in a bed with a person who's of elevated status, not a dirty, lowly midwife. Come with a man, and who? What type of men? White men.
Midwife Audrey:So it's this idea of like this, like this elevated, like we done, moved up in the world.
Midwife Audrey:Now we don't have to do it out in the field anymore, we don't have to have pain like we did before.
Midwife Audrey:We can, you know, have this elevated status and do it in the hospitals, and that's where modern day obstetrics, you know, came from, and that's part of why midwifery is no longer the mainstream way of how people give birth in this country.
Midwife Audrey:That's not the case in other countries around the world, because that was not their history, that was not the process by which they got to where they are today. We're starting to see an increase, a slight increase, in midwifery in this country, which is not well integrated into the mainstream healthcare system, meaning it's not well integrated with insurance policies, or with hospitals or collaborative relationships, where then there can be the hierarchy of maternity care, going from midwifery all the way to maternal fetal medicine, like it is in other countries. But especially after the time of COVID, we started to see these changes, and that's because women are waking up and demanding more and demanding something different and wanting to stand in their sovereignty and their autonomy and how they're giving birth and how they're participating in their own birth, which then leads us to where we are right here, right now, today, in 2025.
Stephanie Theriault:Statistics are showing that women of color are dying at a higher rate than white women in birth, and the complications that women of color are dying from are preventable causes. The statistics are showing these numbers across the board. As a labor and delivery nurse, oftentimes I'll be at the nurse's station and I can look at the board. And what I mean by look at the board? I can look at the fetal strips and oftentimes I'll hear why are they sitting on this tracing? And even though it's not my patient, and more oftentimes than not, the woman is a woman of colors, tracing the history that you have just shared with us. How and why is this happening? How can we make a change? How can labor nurses, maternal healthcare providers, midwives, obs, what can we do on a day-to-day basis to help change these numbers?
Midwife Audrey:Yeah, Well, it is no secret that we do have a maternal, a maternity care crisis in this country, and especially a Black maternal health crisis, and it's to zoom in and look at this one specific thing. It really is part of a greater whole, and part of this greater whole is part of what are the social structures that impact the community. And then from there, how is it that the social structure that impacts the community, how does it impact her access and resources, all the way to how does it impact her treatment and whether or not she's seen and heard because of what's accepted as cultural expectations that we have been programmed with, that becomes a bias that then impacts how then we treat said person. So it is like a big, huge, interconnected puzzle that we know that, the foundation of which has to do with racial systemic structures, all the way down to the interpersonal biases we hold and how it impacts how then we show up or how we hear the other person. So, taking it from the I guess you can say the system view, there are a lot of education, even to this day. That is miseducation, because there just has not been updated information or updated programming.
Midwife Audrey:What I mean by that is that there are doctors and this has been a study that has been done amongst doctors in healthcare systems and there is literally and it's in some of the medical books that nurses and doctors are taught certain misconceptions, such as, like a person of color experiences less pain than their white counterpart. This is still a holdover from slavery, where they literally believe that Black people were best suited for doing what they were doing as slaves because they had the capacity, the physicality and they didn't feel it. They didn't have the pain, they didn't have the whatever. A lot of this was part of whatever made their consciousness okay with doing whatever they were doing. It wasn't ever founded in science and so, again, medicine in this country was white and practiced by the upper class, so it's still this idea passed down from the aristocrats in Europe, this notion between the differences. Other misconceptions, such as like oh, black people or people of color are easily drug addicted and so it's best to not like give them too much pain medicine, despite whatever their affect, or what they're telling you, they are trying to manipulate you, or what they're telling you, they are trying to manipulate you, and these are just thoughts that then shape how a doctor or a nurse behaves or reacts or responds to what they're seeing in front of their face. Some of it is intergenerational cultural teaching practices and a lot of it is medical, societal cultural practices, all the way down to that's what's in their actual textbooks that are teaching them about the patients that they will be taking care of. So that's one major, huge factor.
Midwife Audrey:And then the other one then is the actual lived experiences of the individuals who have been exposed to this systemic racial oppression across the generations, which then creates what we had mentioned earlier social determinants of health, to where, down to the zip code, we can create a probability, statistical probability, of how likely it is, what your chances are, that you will have obesity, that you will have heart disease, that you will have whatever illness, or even down to how likely you are to die before your time, and from what. This is what these long standing social structures, how we can actually break it down statistically to see what their impacts are. So then you take an individual who is a match to these quote, unquote statistics. Now, what do we do about that? It's really easy to be like, oh my gosh, like we were just born into this system and this is just the way it is. And these are the numbers we see. Yes, were just born into this system and this is just the way it is. And these are the numbers we see. Yes, the information, the evidence is showing us. This is the current state. That doesn't mean this is the only state that we can occupy.
Midwife Audrey:So, through the work of Jenny Joseph and many other people in the social justice and reproductive justice, we're starting to see new evidence that shows how to mitigate these statistics, which, largely, are deeply rooted in compassion, empathy and meeting the person exactly where they are, so being aware of the risk factors that they face and identifying them and then coming up with actual solutions for that particular risk factor. So if it is someone who lives in a food desert, because there have been years and years and generations of redlining and business practices so that there never was a healthy food store that was built up in that community, well, maybe that might look like her care being subsidized with a partner that grows healthy foods, and so now that healthcare provider is connected with another community member for a resource that can provide this person's need. So just because someone has a risk factor doesn't mean that they're doomed to having that experience, but understanding the risk factor and compassionately, non-judgmentally, meeting the deficit, for that is then how we navigate it and how we can turn the tides and create different outcomes. So I think there was one more part of the question where you said something about like how can doctors, nurses, midwives? Another way is also having concordant care. What that is is having more healthcare providers in all the different fields that represent the communities that they take care of.
Midwife Audrey:When you come from a place of lived experience and shared cultural experience, then it's more likely that the person in front of them is being seen and heard in their entirety and not for the biases and the programs that we've been taught to hear and see. You know so, seeing a provider who like, let's say, a Black woman who then goes and sees a Black woman from her community who is a midwife there are certain things that don't then need to be navigated or need to be deciphered Meaning. When they say a certain thing, we already know what they mean. We can feel and understand their concern for the reality of what they're saying and not have it attached to well. I was taught that Black people are really loud and they like to over-exaggerate on things, or whatever.
Midwife Audrey:The case is that programming is not, then, one that's even part of your operating system, because you're seeing the person, who is no different than somebody who you grew up with.
Midwife Audrey:Across the street it could be your auntie, your uncle, your friend, your whatever communication is already open and honest communication, which then means there is a receptive pathway to be able to understand that when they're getting educated on these are different risk factors, I need you to call me if you experience X, y, z.
Midwife Audrey:They're going to hear that more in a sense where, like, okay, I will take I will really take their counsel, but also there'll be the safety of knowing that if I call this person, like they said that I should call them, it's less likely that I will have a negative outcome in which DCF or the police or something like that is called on me when I'm just literally calling and reporting the very thing that they told me to do.
Midwife Audrey:And so this is the wounds that racial structures have caused, but one of the ways that it can be mitigated currently is through continued curiosity and cultural competency from people who are from different cultural and racial backgrounds, identifying their racial biases and having just like compassionate understanding for where they're coming from and continuing to harbor an attitude of eagerness to grow, learn and change, and just know and expect that you probably have some blind spots, so that that level of humility provides openness to then really see the person in front of you, so that you're able to then continue to provide high quality of care that doesn't change depending on who's in front of you and that's paired with people who come from the same cultural background, the same lived experiences, taking care of and being closely I guess you can say the ones closest to providing the care intimately, so that when there are complications it reduces the time from when that complication is made known to now it's being reacted to appropriately with high quality of care assumption, which can be, you know, racial assumptions, which can then be like threatening to someone's life, which had created a mis-view of really what was being presented in front of them from a clinical standpoint midwife Audrey and I were so wrapped up in our conversation that we totally lost track of time.
Stephanie Theriault:We had to wrap things up a little bit quickly so I could head to my clinicals. I really hope that you enjoyed our chat as much as I did. We'll see you for episode number four.
Midwife Audrey:Oh geez, I just looked at the time it's 1.22. Oh my goodness, yeah, yeah, yeah, I think we covered it.
Stephanie Theriault:I think we covered everything. I think that was really good.
Midwife Audrey:Yeah, yeah. Yeah, that was very good. You had amazing questions. I hope you have a great class. What are you teaching?
Stephanie Theriault:I'm a clinical instructor, so I go to a postpartum floor and I have some nursing students, so it's nice, it's fun.
Midwife Audrey:Yes, I totally get it. I'm a preceptor too, so I just on my last rotation, I was teaching two students. Well, I hope you have fun. I know you're going to be amazing and we'll be in touch.
Stephanie Theriault:All right. Bye, stephanie. Hey there, amazing listeners, if you love what we do and want to see our podcast grow, we need your help. By making a donation, you'll be supporting us and bringing you even more great content. I truly believe creating this space for women all across the globe to share their story will allow us to collectively heal, grow and become more empowered in the space that we deserve to be Motherhood, womanhood and however that looks and feels for each and every one of us. If you can head over to support us today there's a link in the bio to support the podcast. Every contribution, big or small, will make a huge difference. From the bottom of my heart, thank you for being a part of this journey. Be sure to check out our social media. All links are provided in the episode description. We're excited to have you here. Please give us a follow. If you or someone you know would like to be a guest on the show, reach out to us via email at info at maternalwealthcom. And remember embrace your power and you got this. Bye.