Birth Trauma, Advocacy, and Empowered Birth Experiences with Hihi Stewart (Episode 583)

Full Transcript: Episode 583

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 583.

Today’s episode is all about birth experiences, birth trauma. I’m joined by HeHe Stewart. She is a powerhouse in the birth world and we are really talking about a few different concepts. So I’d say one of the concepts we’re talking about is knowledge and empowerment in terms of preparation. For many women, especially with their first birth, that maybe their only experience with birth in a hospital setting or a home setting or whatever the case it is. And there’s a lot of different aspects of birth to navigate. There’s a lot of different care provider, a lot of different expectations both on your end and the end of your care providers and navigating through that process for the first time without support can be incredibly challenging.

And so we talk about the importance of having support, the importance of education, being aware of what to expect, not only on a personal level in terms of experience. So preparing for labor and the different challenges around that, but also preparing for some of the challenges you may face within a hospital setting or even in a home setting. And if you do have certain preferences or certain expectations or certain plans that you’d like to have honored, even just understanding how to navigate those within the different settings and context.

So there’s a lot there. And as someone who has had three children, I’ve birthed my three babies at home. When I’m speaking to women who have had birth experiences in the conventional setting and hospital setting, I find that I feel like my experience is opposite in many ways because there’s a lot of fights I didn’t have to have. There was a lot of discussions and conversations that aren’t even a challenge outside of the hospital setting because you’re at in your home and it’s a little bit more relaxed in some ways. And so there’s certain preferences, certain requests that I would have liked, but I didn’t really have to fight for them. Just by definition, being in my house, there were certain things I could just — it wasn’t a big deal to wait to have the cord cut or for my husband to do it several minutes after the baby was born or whatever. It wasn’t this big thing that I had to advocate for.

But when I’m speaking with women who’ve birthed in the hospital setting, often these are bigger challenges. It doesn’t mean they can’t be done, but often it just requires a lot more effort, a lot more conversations and just a lot more advocacy to just anything that goes outside of the typical procedure that’s done within those settings. A lot more rigid. Obviously, it requires a lot more support and advocacy. So we talk about the role of education and knowing what to expect, having somebody there to support you who’s been through it. So the value in actually having a birth worker, somebody who, for example, if you’re birthing in the hospital setting, having somebody there who’s done that many times with various clients so that they can really help you, support you, inform you, educate you about different aspects so that when you’re going into it, you’re informed and also if you do have certain requests, finding the best possible practices for advocating to have those requests honored.

So we get into that. We talk about birth trauma. And before we jump in, I’m just going to take a moment to share a little bit about my guest. HeHe Stewart is the founder of Tranquility by HeHe, Maternity Concierge, and the creator of the Birth Lounge membership. With a master’s degree in human development and over a decade in life education and family life education, she helps parents prepare for birth with research-backed data-driven support, promoting informed, confident births free from fear and coercion. HeHe advocates for patient rights and autonomy in birth and also guides new parents through postpartum, infant feeding, and newborn sleep. She hosts the Birth Lounge podcast featuring top experts in pregnancy, women’s health, and early parenting. So, without further ado, let’s go ahead and jump into today’s episode with HeHe.

And I’m excited to be here today with HeHe Stewart. Thank you for coming on the show.

HeHe Stewart:

Hi everybody. Thanks for having me. I’m stoked to be here.

Lisa Hendrickson-Jack:

Yeah, I’m really excited to have you. Well, before we jump into the topic of the day, I’d love for you to share a little bit about your background for anyone who doesn’t know you.

HeHe Stewart:

Yeah, absolutely. Thanks for asking. So my masters is in human development and family studies. And I started my career actually in early childhood education. And so I got well familiar with those first birth through three years old. And I really was able to observe family systems in that time and how did families interact and what was that immediate postpartum like and I got to really step families through that child development in those first few years.

The deeper I got into that work — which I had already, I had my masters at that time — and so I understood very deeply the time that led up to that postpartum time. And the deeper I got into that work, I started to realize that there was so much work that could be done pre-baby that would make postpartum easier, smoother. The transition didn’t have to be chaotic and kind of frazzled, if you will. It could be joyous and harmonious and really grounded. And the two parents in the home could actually work together as a team if they were set up properly and someone had taught them to communicate. And if they had the proper education about what was coming their way, they wouldn’t find themselves struggling so often because they could have been better prepared.

And so the more I looked into birth and that pre-baby era, I started to realize, holy cow, in America, we just have so much work to do in this area. And this arena is just — there’s so many gaps. There’s so many gaps for women in women’s health and birth, particularly maternity care is just filled with gaping holes of where women fall through the cracks and then we ultimately are the ones that pay the price, not the system that drops us.

Lisa Hendrickson-Jack:

Absolutely. When you were talking about that, it made me think about why is it like this? Why is it so hard for women? Do you have — I mean I don’t know if anyone has an answer for that but I would love to hear your take on it. And one of the things that came to mind was, historically, women used to have more babies and we used to be around more families and children. So even for myself, when I had my first son, I was an only child. I did not have a bunch of babies in my house or my world. And it was like a bomb went off in my house. I had a steep learning curve when I kind of exploded into mommyhood. And I feel like a lot of women can relate to that. So I don’t know if that’s part of it, but I’d love to hear your take on like why is there such a disconnect here?

HeHe Stewart:

Yeah, I think there’s so many facets to this. So I think that disappearing village has a lot to do with it. So you’re right, we used to live around our moms and our grandmas and our aunties and we had that village built in our family. We stayed close to and so that village, it was there and they helped us raise our babies. And so we had the freedom and almost the luxury to have three, four, five children. And childcare, I think, was just part of that community that was around you. And now you’re paying upwards of, you know, $1,000 a week for childcare for a newborn in public childcare. So that’s really demanding on families.

I think that women wanting to be outside of the home has impacted it as well. I think when women have figured out that they can have their own identity outside of motherhood, it really kind of impacts how many children that we want to have.

I also think that we would be remiss to have this conversation and glaze over the fact that gynecological care was built on the backs of slaves, of Black women. James Marion Sims, who is known as the father of gynecology, he tortured Black women. He tortured slaves and called it science. And so there are so many practices that are around today that are still very barbaric and they are rooted in racism and they’re rooted in misogyny and they’re rooted in the hatred of women — of using women to get what you want and not give them proper anesthesia and not consider what their experience is like and not ask them what the mental load is of the procedure that they’re having.

I mean, we see the roots of what he did years and years and years ago still be present in gynecological care today — by the way that we place IUDs in women, and we don’t give them proper anesthesia. The way that we tell women, well, pubic symphysis is just part of pregnancy and hyperemesis gravidarum, so HG is just part of it, you should just toughen up, you don’t need a work excuse. And it’s the way that medical racism impacts Black women in birth and they’re dying at a four times higher rate. I mean, we just see it in all aspects. And so I think that has a lot to do with it. I think women are truly waking up to — why would I subject myself to a system, an industry that has not only traditionally, but still very much does not respect women and doesn’t prioritize our needs when we are the consumers of that industry.

Lisa Hendrickson-Jack:

I just have a couple thoughts when you were talking about that. And of course, historically, there was a whole kind of community midwifery aspect to birth where it was largely kind of in the hands of women, and then there was this point in time when things were more medicalized and all of a sudden that was outlawed. All of that knowledge and all of that experience would have been lost and replaced by our very medicalized model of birth. So that was one of the thoughts that I had around that. And another thought that I had about that, that I’ve had throughout my life, was that birth is positioned as a medical emergency, as opposed to like a natural process that unfolds. And even the language around like the doctor delivers the baby, whereas like midwives catch the baby. So it’s all very interesting to think about that.

And this was something that I was thinking about even as a young early 20s individual. I remember being in my early 20s and one of my best friends is a labor and delivery nurse. And we hadn’t, neither of us had had any children yet. And I remember — I read this book called Misconceptions and I believe the Business of Being Born, I don’t know if it had come out already around that time — but for whatever reason, this was on my radar in my early 20s. And I remember we had this conversation and I was like, well, you know, I want to have my babies at home because I don’t want to be at risk for unnecessary interventions and this kind of stuff. And she worked at a very high-risk hospital and so she saw the worst things that could happen and the only time she saw a midwife was when something had went wrong. So she actually had a very negative opinion about midwifery. So it was a very interesting, spicy conversation that we were having.

And I remember she was saying, she says, I don’t think I could ever have a birth at home because I just know all the things that could go wrong. Now years later, we ended up birthing in very similar ways because ultimately she ended up having her hospital birth experience and then choosing to move away from that personally because she had her own experience. Then of course I had all three of my babies at home.

So maybe share a little bit about just this concept of birth trauma — like what is it? We hear people talk about it all the time and I will leave that open-ended and let you take that and then we can just explore it.

HeHe Stewart:

Yeah, I think you did a really great job of kind of setting the scene that birth is a natural event that sometimes needs medical intervention, but in the US particularly, we treat it as a medical event that sometimes unfolds naturally and that is just such a backwards view of birth. Our bodies were designed to do this. It was meant to birth. Now there is a subset of the population that are high risk and they do need additional monitoring and they need higher skills of someone like an MFM, a maternal fetal medicine doctor, who is an OBGYN but then they have additional training and credentials to see those higher risk cases.

And I think birth trauma happens — well, I don’t think — the data shows that birth trauma happens in many facets. So there are some birth trauma that is unavoidable. So these are going to be things like loss. Unfortunately, some losses are normal, natural, statistical. That is going to leave someone with trauma and they didn’t do anything wrong and they didn’t do anything to deserve it and there was likely nothing that could be done to prevent it. That is an unavoidable birth trauma. Another one would be AFE, amniotic fluid embolism. It is very rare but is where amniotic fluid mixes into the maternal system and then the belief is that the maternal system then has an allergic reaction to the amniotic fluid. Very rare, unpredictable, unpreventable — is going to leave someone with severe trauma.

What we see though the most is what I call avoidable trauma. And it is where you are mistreated in labor in some regard. Now, sometimes this is blatant mistreatment. It is your provider coming to you saying, “If you don’t do this, I don’t want your baby to die, so you are a bad mom.” That’s horrible mistreatment. Sometimes it is the medical racism that we previously talked about. Again, horrible mistreatment. Sometimes it’s a little bit more sly though and they are a little bit sneakier with the things that they say or they do. It could be that you specifically said, “I’m not ready for pitocin, I’m going to take a nap.” And then you were woken up by horrible contractions and you look over and pitocin has been started without your consent and actually against your consent. You explicitly said, “I don’t consent to this medication.” Yet while you were resting, a medical provider of some sort took the authority to start a medication that you had not consented to.

Birth trauma can also come from things like being operated on after telling your medical team that you don’t have proper anesthesia coverage and you can in fact feel what they’re doing and they continue with the surgery instead of giving you additional anesthesia. It can also come from more kind of covert things — telling you that you’re weak or telling you, well, I had all three of my babies without an epidural, but if you really need it, I guess we can call anesthesia.

So there are many ways. It could be too that an emergency — something that’s unavoidable — an AFE happens to you and the entire room is operating around you and no one takes the time to say, “Lisa, you’re experiencing something very scary. It’s a rare complication. You’re in good hands right now. We are trying to start an IV. We’re going to get some medication going in your system and Dr. Jones is joining us right now.”

That simple interaction with a medical provider explaining to you what is happening can help not prevent all the trauma, but it can help prevent furthering that trauma. It will help mitigate the amount of trauma that you walk away with and then the amount of trauma that you have to cope with and heal from afterwards.

And so people will walk away with different levels of trauma. I am a personality that someone could look me in the face and say, “Well, I don’t want your baby to die.” I recognize instantly, “I also don’t want my baby to die, and you’re a bad provider. I will not see you again.” That was offensive language, and it was fear-based. It was coercion. I’m not offended by that, but you have lost access to me as a provider.

Other people who don’t have my personality or maybe the education or the confidence that I have would be traumatized by that because they might feel like, “Oh my gosh, I’m a bad parent. Well, I don’t want my baby to die either. I should do exactly what this doctor says.” Not realizing that maybe some medical manipulation is taking place. Now, I’m not dismissing the fact that emergencies happen or that babies don’t get in danger in the womb, but there’s a way to present that.

A better way to present that would have been to say, “Hey, HeHe, I know that you really wanted a spontaneous birth. I’m starting to get pretty concerned about your amniotic fluid levels and I was hoping that we could have a discussion that would make us both feel better. And I can talk you through some options of not only what I’m seeing but some ways that we might be able to resolve this. And then if it doesn’t resolve, I’d love to tell you what the next resolution would be.” There is a way to present very scary topics that you can help mitigate trauma for your patients and I think that is lost a lot of times in the hospital system.

Lisa Hendrickson-Jack:

Oh, you said so much there. There was so much. It’s such a complicated topic. And one of the things that strikes me when I have conversations with women who have had births in the hospital — there’s a lot more discussions that have to happen. There’s a lot more decisions that are just a big deal in the hospital that when I chose to avoid that personally in my experience, that I didn’t have to have.

So if I try to word what I just said in a way that makes more sense — there’s a lot of things that if you are more aware of the type of birth experience that you want, if you have started to research on some of the different practices that are done in medical settings and you’re not actually comfortable with some of those things, then everything is a fight it seems like in a hospital. And what you described goes beyond that to the level of like egregious — like abuse even — to be administering medication to someone who flatly said they didn’t want it, or operate on somebody and they can feel it. That would be like the dentist continuing to drill when you’re like, “I can’t.” Like that’s just obvious, that feels like assault.

So I feel like there’s definitely levels of it and I feel like you captured quite a bit of those. Like if there was a common thread, it would essentially be the person’s wishes are not being followed. The person’s wishes are not even considered valid. They’re overridden and it’s either they’re overridden, like totally overridden in the way that should be illegal, or they’re just overridden in the fact that they’re minimized and you’re just kind of coerced into doing what they want you to do.

HeHe Stewart:

My first thought is that you pointed out that there’s almost this tension. There’s this fight. There is a resistance in the hospital system versus in home birth. And I think it’s really important to evaluate both of those approaches and clinical models. In home birth — and it’s not only in home birth, but with midwifery care specifically versus the obstetrical model of care — the trust is often placed in the mother, in that birthing person, in the person that is having that baby. Midwifery care and home birth care is very good about valuing and respecting autonomy. They say, “Here are your options. Here’s what we’re looking at. What would you like to do?”

In the obstetrical medical model of care, the trust is placed in the system. And you can see that because they often present things as, “Well, this is hospital policy, so you can’t make your own decisions. You can’t decline this. You can’t go past your due date.” Where a midwife would say, “Well, you’re approaching your due date. Here are the benefits to continuing your pregnancy and waiting for spontaneous labor. Here are the risks to doing that. An alternative would be to induce and you’ve got risk and benefits to that. Or we could go ahead and schedule a C-section. Which one feels good to you?” Where the hospital is going to present it as, “Well, we don’t allow you to go past your due date, so we’re going to get an induction on the calendar for you.”

And you can see how the trust in those two medical models — midwifery care is a medical model. They are qualified medical professionals and I think people lose that sometimes. But these two medical models operate very differently and so the trust is put into different places.

Lisa Hendrickson-Jack:

While you think about your point, one thing I think it’s useful to say — and I’ll just say it — is that I wouldn’t paint midwifery as perfect. I mean, there were certain things that based on their experience that they would be pushing a little bit. And I would — how much do I want to talk about all of that on air? But let’s just in a very general sense say how many ultrasounds to have and how many pictures to take and those kinds of things where for me I was comfortable with to a point but I had some concerns. But I guess what I’m saying is that there’s always going to be negotiations when you’re having a baby, when you’re working with a provider. There is always going to be negotiations because I am not a midwife and so I have not seen what could go wrong. I’ve only had my experience.

You do have to have trust in the person that you’re hiring who’s going to walk with you through this process. And no matter who it is, you’re probably going to have some ideas that differ from theirs. I think the difference, as you said, is that I was able to express some of those things and they were heard and then it was a conversation. I just wouldn’t want someone to leave this conversation to have this opinion that like you could have a wonderful OB who is really tuned in and is willing to listen to you to the extent that they can within — like there’s more restrictions. So I would never want to put that idea out there that all medicine is bad and all midwifery is right, because that wouldn’t be accurate.

I think the older that I get and the more experience that I have, a lot of it rests with the person who you’re working with. And it’s either you have a really, really great provider regardless of which profession or maybe you don’t. Certainly, what I found is that within the medical system there are more rules. There are more barriers and there seems to be less of an openness. And it’s almost like if you don’t do it this way, you’re — should I say it — you’re like a crazy hippie. And like it’s almost like your ideas are not respected. So as soon as you start asking about different interventions, as soon as you start asking about like delayed cord, they’re kind of in their mind — you could almost see their eyes roll back — like, “Oh, you’re one of those hippies.” And they’re going to try to tell you why none of that is valid and why you need to stop that whole train of thought right now. Am I going too far?

HeHe Stewart:

No, no, you’re hitting the nail on the head. And I love how you say it’s very provider specific. And that’s why I do a lot of education about what I call your perfect provider. And when I say perfect I mean like as good as it’s going to get. You have to understand we’re still dealing with human interaction. So you and your partner, like your romantic partner, get along so so well, but you still have your differences. And so you mustn’t go into birth thinking, well, this provider is going to just see everything that I see eye to eye and it’s going to be absolutely perfect.

You should though feel very confident and safe to bring up your thoughts with your provider. And if you are not able to do that, it’s probably an indicator that you’re not with the right matched provider. Unfortunately, in the US, more than 50% of our country is a healthcare desert. And the further south and the further inland you get in the middle of our country, the worse the access gets. And that can really impede someone’s ability to be able to not only change providers, but change facilities. And so you may look around and realize, well, my nearest L&D unit is a three and a half hour drive, and they don’t take my insurance. And so it’s not always possible to change providers.

And so one of the things I really work on with the education I provide is how do we meet your needs with the access that you have, whatever that looks like. You may be in LA where you have so many hospitals and they’re all within 20-minute drive from you. And then you may find yourself out in Oklahoma where you literally do not have another hospital until hours and hours down the road. And so it is really important to find a provider that feels as aligned as possible with you, but more so that you feel safe with — because that trust is going to be what allows your labor progress to keep going. If you don’t feel safe, your body is going to know it. Your nervous system is going to pick up on that and you’re going to see stalls in your labor and that’s really what we don’t want.

Lisa Hendrickson-Jack:

Well, I mean, so one of the questions that comes to mind — I don’t know that, as you said, there’s different kinds of trauma and some are unavoidable. And even with best-laid plans, I thought of this a lot during my pregnancies and births because when the stars align and you have built a relationship with your provider and they happen to also be the one who delivers your baby. But even with midwifery care, I had a team. And I can tell you for my last birth, the woman who came to deliver my baby — that was the first time I met her when she walked in the door. So yeah, because there were some changes happening in the clinic, but also it was this person on the team. And then based on when I had my appointments, I had literally never met this person before.

Even when you try to do everything right, you still can — your OB could be called away to another pregnancy, another birth at the same time. So why don’t you talk a little bit about what are some of the ways that we can plan? What are some of the things that we can do? I mean acknowledging that birth is just — I think it’s tricky. And I’ve often thought of birth — so to share a Lisaism — I’ve often thought of birth as truly the entrance into motherhood. And you want everything to be how you want it, just like you want your baby to be how you want it. And then this child comes out and they have their own personality. They come out in their own way and welcome to motherhood. You didn’t get to choose at all. And now you have this little person who has their own little attitude and you’re just like, “Wow, this is amazing. This is not what I thought it was going to be like.”

HeHe Stewart:

I think flexibility in birth — and I think that was my second point a couple of minutes ago — was that there’s often inflexibility in the hospital system, and it’s not always our doctor’s fault. It’s usually the system’s fault. Your doctor is operating under the rules that you mentioned too. But you having flexibility in your expectations will set you up so beautifully.

So flexibility in the fact that maybe I’ll have a three-hour labor, maybe I’ll have a 43-hour labor. I don’t really know. I will be prepared for both. I’m going to know what to do if I have a precipitous labor, which is really, really fast — defined as six hours or less. Or I will be prepared if I have a really, really long labor known as a prodromal labor. I will be prepared if my doctor is on call and I’ll be prepared if I get the moonlighter that I’ve never met before and it just happens to be the way the cards fall. I will be prepared if I get my spontaneous unmedicated vaginal delivery. I will also be prepared for when I am ready for an epidural and that is so personal.

For example, one person may say, “If I have labored for more than 24 hours and my baby is not here and I am so tired, I’m going to feel confident in getting an epidural.” And then the next person may say, “I only want an epidural if I have tried everything else and I absolutely just cannot do it any longer.” Those are two different lines in the sand and only you know what’s right for you, right? And then you’ll be also prepared — that should not dismiss being disappointed — but prepared should you need an unwanted C-section or an unplanned C-section.

I think that flexibility is absolutely huge. One of the ways that you can do this is making a birth plan. I actually call it a preference sheet because well, for a couple of reasons, you can’t plan out birth. Birth is a natural event. Nature has a lot to do with it. You have a lot to do with it. And then your baby has a lot to do with it. And so if there are three parts to this pie chart and you’re only in charge of one pie piece, which is yourself, nature controls one and your baby controls one — there’s two-thirds of this equation that are totally out of your control. And so being flexible to what those two-thirds kind of throw your way is going to be really key.

The other thing is that it is preferences. So these are the things that you want to happen. You want a spontaneous unmedicated birth, but if at 36 weeks you develop HELLP syndrome, that will not be possible. That is an indicator for a medically indicated induction, so you would need an induction. I think being flexible throughout this whole process, even in your pregnancy, is a really great way to prepare yourself for motherhood because like you say, when these babies get here and you’re like, “This baby’s going to be so cute and sleep through the night. We’re going to have a beautiful breastfeeding.” And then they get here and the only thing that’s true is that they are cute and they do not sleep through the night and breastfeeding is really hard and you needed a lot more support than you had first originally anticipated. But being flexible with all of that will really help you not spiral. It will help you be open to asking for help and it will help you kind of go with the flow of what is being thrown your way.

Because remember, we are creatures that love control and we love rules and we love boundaries. But that’s not always possible. Sometimes we have to just throw up our hands and say, you know what, I’m just going to be flexible and I’m going to just go with whatever comes my way. And that can be really hard, especially if you’re like me — I’m very type A, I’m a firstborn daughter, I am an Aries. I mean, I just love structure in my life. And it can be really hard. So I think practicing that flexibility from day one, from the minute you find out that you’re pregnant, even beforehand, before you’re pregnant, as you’re trying to conceive, can be just super, super helpful.

Lisa Hendrickson-Jack:

Yeah, I love that. So important. And you had said something earlier about trauma and essentially giving an example of the same event happening to two different people. So it was kind of like if my doctor does this with me because of my experience, I might respond this way, but for someone else, they might respond the other way. And I think one of the challenges is that we all probably do have an idea of what we want. Now, what we want is very different. Like if you ask 10 different women what their idea of a perfect birth, it’s going to be 10 different answers. But we all kind of have this idea of what we would like to happen. And the question is — how attached are you to that?

And honestly, I would be really curious of your thoughts on — is it beneficial to listen to a lot of birth stories before you have your own birth? So often when I’m working with fertility clients and they get pregnant, it’s kind of like, oh, now I need a new podcast to listen to. And so I feel like just from my perspective, I tried not to expose myself to a lot of birth stories when I was in my third trimester and I tried to specifically — and I’m not saying this is the right thing to do, I’m just saying what I did — I only looked at like peaceful home births in tubs. I didn’t look at anything else and that was what worked for me. But on the other hand, I also have friends, lots of friends who are nurses. I’ve heard lots of stories, some of the worst possible things you could even imagine. And so I feel like I do have a sense of what could go wrong already. So for me personally, I didn’t necessarily need to expose myself to those things in order to have a sense of what reality could be. So I was more trying to get in the zone. What are your thoughts on that?

HeHe Stewart:

Yeah. So I think there’s kind of a two-pronged thing. First of all, if you have the experience and you feel like you know what can go wrong, I think that probably curating what can go right is better. Manifestation and birth is so, so real. I also think your personality has a lot to do with it and your past experience. So I’ve been a doula for 10 years. I’m well aware of the things that can go wrong. I’ve seen so much that can go wrong. I’ve also seen everything that can go right.

If you are someone who has anxiety about the things that could go wrong, but you don’t necessarily want to hear birth stories of things going wrong, consider taking an out-of-hospital childbirth education course that is going to teach you in a very neutral way. So this is how I do my education and we talk about complications that may arise and that’s exactly how I present them. Here is a complication that may arise. Here is how often it happens. Here are the risk factors. Here are the options if it happens. Here’s what you can expect from the medical staff if it happens. And here’s what recovery will look like. Here are further complications that may arise from that complication, and here’s how it will present in you and maybe impact your baby.

And so I think there’s a way for you to get very educated and confident in the things that may go wrong without having to hear really traumatic birth stories. But you and I are very similar in the regard that I want to only hear good home birth stories because that’s what I’m planning for myself — and not in the way that I don’t want to know what can go wrong. I already feel very equipped, educated, and confident in what can go wrong. Not only have I been stepping people through this for the last decade, but I have witnessed so much of it that I feel very confident in being able to handle those things and understanding them kind of thoroughly.

In this time in my life, in my pregnancy, I am really trying to curate that perfect home birth because I do believe so heavily in the power of manifestation. I believe that what we pour energy into will only grow. And so I want to spend time meditating with me and my belly and my baby. I want to spend time visualizing my birth. I want to spend time putting together my perfect birth team and having these deep discussions about what my preferences are in different scenarios and situations that may or may not arise. And that way, not only does my birth team know what I want, but my husband knows what I want. And that way I, when I’m laboring, will be able to stay in that birth brain, that labor land, that very primal state of being — and the people around me already know my wishes and my preferences. That is a privilege that you get having a very one-to-one team like a home birth team. In a birth center or a hospital setting, it’s going to be less likely, but not impossible.

Lisa Hendrickson-Jack:

Well, no, I appreciate that. I feel like that was really helpful. And then the question that I had as you were talking about that is for the woman who does want to have a hospital birth. I mean, I understand already that this question is so variable because it depends on where you live, what kind of hospitals are available. Some hospitals do have kind of like a birthing ward where it is trying to be the intermediary between home and hospital. So you do get a little bit more flexibility there and those kinds of things. Some hospitals, the midwives or the doulas might actually be able to attend whereas others they wouldn’t have those privileges. So obviously there’s a lot of complication anyways. But for someone who is wanting to, planning to have a birth in a hospital, what if anything could — what would be your advice?

HeHe Stewart:

Yeah, so I may be planning my own home birth, but for the last 10 years, I have primarily worked with women who are birthing in the hospital system. So it is kind of my specialty. Starting early with your questions, making sure that you really find a provider that is aligned with you. If lack of access in your area is a problem and is creating a roadblock with being able to swap providers, I really encourage you having just a very true and transparent conversation with the provider that you do have access to and just sitting them down and being very open.

And the conversation probably will sound something like this: “Dr. Jones, I have been feeling a little tension in our prenatal meetings because I can see that we’ve got very different ideas of what birth maybe can be like and should be like and I want to be on the same team with you. I want to make sure that you trust me and I want to make sure that I’m able to trust you and feel safe in your care. So I was hoping today in this prenatal that we could have a really transparent discussion about the things that are super important to me and why they’re important to me. And I’d love to hear your thoughts about them and get some feedback. And maybe this is not the only time that we talk about this. I’d love to continue this discussion in future prenatals. But it is really important to me that we’re working together because I want the birth of my baby to be a joyous event that I feel really glad and happy and supported by when I think about it. And I just want to make sure that the tension that I’ve been feeling can hopefully be resolved as soon as possible.”

I really mean having this transparent conversation. Go into your provider and lay it out on the line. They will appreciate that. If you are feeling the tension, so is your provider. They can feel the same tension. They are human too. And so I really think that there’s so much disconnect between providers and patients. And some simple, very clear, honest, kind, respectful conversations can really mend a lot of that relationship.

If you are unable to find a happy medium with the provider that you’re with, consider changing providers within that facility. And if that’s not an option, I would get really, really, really confident in advocating for yourself, because sometimes we just find ourselves in a situation where we aren’t going to be able to see eye to eye with the providers that are available to us. And unfortunately, that’s just a downfall of our current healthcare system. And fingers crossed that in the years to come, we are able to close those gaps by increasing midwifery care and increasing labor and delivery units across our country and increasing access to maternity care across our nation.

Lisa Hendrickson-Jack:

As you were talking about that, it made me think also about how important it has to be to find out what is actually possible. So to really get clear on what the actual restrictions are like and then figure out if there’s a way for you to kind of do what you need to do within that.

I feel like my perspective — and I feel like a lot of things I say are controversial — but if you are choosing to have a birth in a hospital or if it’s not even a choice and that’s how it has to be, you are actually submitting to their rules. So you have to find a way to make peace with that and to determine what those rules are, like how much give there really is. And sometimes the give is dependent on the person in front of you, because obviously — and I think that’s for me one of the hardest things ever — to know that the person in front of you could just be kind of a jerk and they’re going to say no because they want that power and authority, and it’s literally having a power trip all over your day. And that if you had a different person in front of you, this thing wouldn’t be a problem.

And I feel like this applies in situations outside of birth. If you have a period issue — a tested and true issue on Fertility Friday — and you go to your doctor, they’re going to tell you about the pill and they’re going to tell you about painkillers. It’s always a pill. And you kind of have to know that.

HeHe Stewart:

I think you hit the nail on the head in terms of when you walk into the hospital, you have to be okay with — you are walking into a facility that serves a specific type of experience. However, you do still have some control. So hospital policy is not law. So they may have a policy that says patients are not allowed to eat and drink in labor, but you know that as a low-risk laboring person, you have the right to consume nourishment and nutrition during labor. And so you just simply tell your nurse, “Nurse Lisa, thank you so much for informing me on what the hospital policy is. I’m choosing to decline that and I wanted to let you know I have eaten this granola bar or I’m going to eat this turkey sandwich.”

So there is a line of how much hospital policy can actually dictate what you can and can’t do. Hospital policy was written for the hospital staff to prevent the hospital from ending up in litigation, in legal trouble. Whereas hospital policy is very rarely written in terms of improving patient outcomes or actual safety. And when we look at a lot of maternity care policies, they are almost always very outdated. We see the same thing with things like VBAC bans — or hospitals that won’t, quote unquote, won’t allow women to have a vaginal birth after a cesarean. So instead, they engage in forced C-sections.

The other thing to know is while you may not be able to change providers in your area because there’s a lack of access, what you won’t have a lack of access to is nurses on that unit. And so if you have a nurse that’s in front of you that’s being a real jerk, or she’s just not your vibe, or you just find like every single thing you say she just is being hard to deal with — just ask for a new nurse. You can have your partner, your doula, whoever’s with you walk out to the middle and say, “We are requesting a new nurse.” You can tell that nurse, “We would like to get a nurse in here that maybe is a little bit more aligned with us.” Or if confrontation is really not your style, you just simply request the charge nurse to come and speak with you or a patient advocate. All hospitals will have a patient advocate center and or department and they can come in and you simply just say, “We would like to request a new nurse and we’re hoping they are a little bit more aligned with X, Y, and Z because those things are very important to us.”

Lisa Hendrickson-Jack:

Well, that’s such good information because the whole thing about self-advocacy is it’s so hard in many ways. It’s so unfair. I feel like it’s so unfair because if you don’t work in the medical field and you’re having a birth in the hospital, then you’re like never at the hospital. So you have no idea how it works and what the policies are and you’re being told that you have to do this and you have to do that and then they throw in that and if you don’t do this your baby might die stuff and then all of a sudden everything is just awful, right?

And having these conversations beforehand — I remember what I wanted to say before because you made such a good point about how you can inform yourself about the complications that can arise in pregnancy and how it’s just not — at the end of the day, those birth stories that don’t go well, even if like you don’t have the information in an objective fashion, you don’t understand even what complication was sometimes because a person is telling you it from their perspective and they may not even be explaining fully what the actual issue was with the birth. You’re just hearing the traumatic fallout of it. So I really liked what you said about that.

And one of the things I was thinking about as well is if you are a little bit more on the natural end and questioning certain interventions, and if you know of the whole controversy of delayed cord clamping — I mean, that’s even just when the baby is born in the hospital. And if you look at the research about how the umbilical cord continues to pulse for a while and that brings in so many nutrients to the baby — if you cut it immediately, that was just not optimal really from the standpoint — and I never had to have those kinds of conversations because I didn’t have to have it.

In addition to all of the other things, having an advocate — because you’re just not going to be in top form when you’re in the middle of having a baby to really be able to have these conversations at your best. You might be tired, you might be emotional, you might be scared. You need an advocate if you’re really trying to go against the grain.

HeHe Stewart:

Yeah. Well, that’s kind of the thing, right? Is that in an ideal world, we would be walking into a system that you didn’t have to have these conversations — and instead of having to advocate hard for yourself, they would be taking the onus to say, “Lisa, when your baby is born, before the placenta is delivered, there is a time that your baby is still connected to you through your umbilical cord. And there are a couple ways that we could manage this. Let me talk you through these options and you tell me which one feels best to you. I can talk you through the benefits and the risk of each of the options and then let’s have a discussion on which one you would rather.” That’s not what we find, right?

And so the onus is put on patients. And I feel much like you that it’s very unfortunate that the onus is put on patients because if you’ve ever had a baby, you’re not in the place to advocate for yourself. And you know that — you are in that birth brain, that labor land, that very primal space where you just want to go within, within yourself, within your own brain, within your own soul. It is such a transformation. And having to step outside of yourself and think logistically and have logistical conversations is just so disruptive to the birth process.

And so having someone there to advocate for you is going to be super beneficial. And it doesn’t have to be a doula, but if you are someone who is a little bit more reserved or you are someone who does question the system a lot or you are someone who maybe you know that you are going to want to stay in that birth brain and your partner is a little bit afraid of confrontation or maybe even they’re uncomfortable in the medical settings — that would be someone that you should highly consider having a doula there present with you. Because a doula’s role is to be this neutral third party. They work for you. They don’t have any loyalty to the hospital as long as they’re not a hospital-assigned doula. If you hire a doula that’s privately hired by you, that doula is there to truly advocate on your behalf and to keep your preferences and your wishes centered around all of the decisions that are made in your labor and that can be really, really pivotal.

Lisa Hendrickson-Jack:

There’s one thing that came to mind when you said that — which is before I had my babies, I would have thought that the midwife’s role is kind of what you described. The midwife is there for the baby. Now, the midwife is there for you too. The midwife is there to ensure that the baby is healthy and born safely. And so if you have all these dreams of having someone rubbing your back and like doing all this advocacy and stuff, the midwife is busy with the very specific things that need to be done for the baby. So I think that’s just something that I learned along the way as well where I never had a doula, but if anyone was a doula, it was the husband. It wasn’t the midwife because she is there to make sure that the birth goes smoothly and she has a whole list of things that she’s working on. And it’s not quite what you might think, I guess, if you have this kind of romantic notion of the midwife rubbing your back and stuff like that.

HeHe Stewart:

Yes, exactly, because they’re on a specific task and it’s very involved. Yeah, I mean, they’re medical providers. So the same documentation, the same monitoring, the same medical procedures that you see in the hospital, your midwife is doing the same thing. Whether that be in the hospital, home birth, or birth center setting, your midwife is doing the same thing. They have documentation. They have monitoring that they need to do. They are medical providers. You are more likely to have them rub your back. But again, when it’s time for them to listen to your baby’s heartbeat, they don’t have the option to say, “Well, we’ll just do it later.” No, it’s on a time schedule. They have to do it then. And they have to document not only that they did it, but what was the reading? And then what did that tell them about your birth and the progress that you’re making?

Lisa Hendrickson-Jack:

Well, HeHe — I mean, this conversation has been so fascinating and I honestly could continue to pick your brain for half of the afternoon, but I suppose it’s time for us to start wrapping up. But honestly, this has just been so fascinating. I feel like we’ve covered a lot of ground and we went in a lot of different areas. I still have 100 questions in my mind, but I will save those potentially for another time. One of the last questions I want to ask you to wrap up — given everything we’ve spoken about today and for the woman who’s listening who may be pregnant or may be planning to conceive or maybe very pregnant and delivery is imminent — what would you want her to take most from our conversation today?

HeHe Stewart:

You deserve to have the birth that you want. You deserve to be supported and to feel safe and you deserve to have care that makes you feel empowered in the choices that you are making. And I want your birth to be everything that you want it to be and that’s possible and you deserve that. So don’t let anybody tell you that you can’t achieve it or that that’s not possible or let anyone make you feel as if you’re not worthy of that because you absolutely are. Your birth is your right and it is your entrance into motherhood so you should make it everything that you want it to be.

Lisa Hendrickson-Jack:

Love that so much. Well, thank you again for being here. Tell us where we can go to learn more about you and what you do. Tell us where you are on the socials and if you have anything exciting happening on the horizon.

HeHe Stewart:

Yeah, absolutely. Well, if you’re interested in unbiased, non-judgmental childbirth education that’s going to present things in a very neutral way that gives you all the risks and the benefits and the alternatives and then leaves it up to you and respects your autonomy, you can find that at thebirthlounge.com. There’s also the Birth Lounge app which is going to give you childbirth education delivered straight to your phone. And on socials, I am Tranquility by HeHe and that will lead you to everywhere else. Come on over and join the party. The audience is really, really fun and filled with a lot of personalities and a lot of people that have way different births and you just feel safe there. We talk to each other with respect. We talk about our birth experiences. People are really open. They’re open to sharing what worked for them, what didn’t work for them, and what they’re doing differently this time. And I just think that’s a really beautiful community.

Lisa Hendrickson-Jack:

Oh, that’s amazing. And we’ll make sure to link all the places on the podcast. And one last thing I’ll say is congratulations, HeHe, because this podcast will be aired after you make your official announcement. So so excited for you to be able to finally apply all of your amazing knowledge to your own birth.

HeHe Stewart:

Thank you so much. I’m so excited to share this pregnancy with everybody.

Lisa Hendrickson-Jack:

Amazing. Well, thank you again for being on the show and we will be thinking wonderful baby dust, fantastic, perfect birth story thoughts for you throughout the remainder of your pregnancy.

HeHe Stewart:

Thank you.

Lisa Hendrickson-Jack:

Thank you for listening. If you enjoyed today’s episode and you’re wanting to share it with a friend or you’re wanting to grab any of the links that we talked about, head over to fertilityfriday.com/583.

I hope that you enjoyed today’s episode with HeHe. It was such a treat to have her on the show and to have the opportunity to dive into this conversation about birth. This is a conversation that I’m always thrilled to have. I find just talking about birth to be so fascinating. And as I shared in the episode, because my own experience of birth was limited in some ways because I’ve never experienced birth in a hospital, it obviously has shaped my perspective of it. And it’s interesting to think about how your practitioner’s experience is going to shape their opinion of it too. So if you are working with an OB/GYN who’s attended thousands of births in hospital, then what they think of as a normal birth experience is going to be very different to, let’s say, a midwife who has experienced a significant number of home births or births in birthing centers or births outside of the traditional hospital setting.

And so I feel like the themes that really came out in today’s episode are the importance of education and empowerment — really understanding the process as much as you can before you go through it — and also having that supportive person to help you to advocate. And I would say especially for women who are birthing for the first time. If you’re doing anything for the first time, you haven’t experienced it yet. So there’s a lot that you don’t know about it. And having somebody who has experience within these settings who can support you and help you to create a birth plan that makes it more likely that you will have your wishes honored — I think that that is really important because there’s certain things in certain situations that are really hard to advocate for.

Think about your experience. Just this week I was doing a presentation for women’s health professionals and I asked this question. I asked how many have either personally had this experience or a client had the experience of going to their care provider and having some issues with their menstrual cycle and seeking support. What are we always told? We’re told to go on the pill. Sometimes we’re told that the problem can’t be that bad or you’re too young to have this problem or whatever. So half the time we’re kind of gaslighted and not listened to. And then the other half, we’re just shuttled on to some birth control situation. Advocating in those situations is not easy. So imagine how much harder it is to try to advocate for some sort of natural intervention or if there’s an intervention that you don’t want in a hospital while you’re in active labor, and this is the first time you’ve ever given birth, and you’re not able to advocate for yourself properly because you’re literally in the middle of giving birth. So this is a huge takeaway from today’s episode, which is that it’s really worthwhile to consider having support and thinking through what it is that you want.

Birth is a very interesting experience and you’re bringing a new tiny human into the world. And I often say — whether it’s the experience of conception, so for women who’ve experienced more of a delayed journey to conception than they wanted to, or your experience of birth — it’s a metaphor for motherhood because children come out with their own personalities. All these things that you thought it was going to be like this or my baby’s going to be like this — you just, there’s so little that you have control over because it’s a whole human. And then you really have to adapt and welcome this person and get to know them and get to know what they like and what they don’t like and all of the different things. And often it’s very different to what you thought it was going to be like.

And so while I think it’s important to have a plan and to have a clear vision of what it is that you want and a good plan to try to make that as likely as possible, there are certain elements of birth that you can’t control and you don’t necessarily know how they’re going to go. So you want to have that autonomy and plan and honor that as much as you can, but still have some flexibility for what may come.

I think the biggest factor in my opinion for whether or not you look back and think it was a good birth experience is whether or not you felt like you had autonomy and whether or not you felt that your wishes were respected. And so having support is one of the best ways for that to happen because even if the birth doesn’t go exactly how you wanted, but you had a plan and you understand why things had to change and you still felt like you were making decisions and you still felt like you had that autonomy — then even when it doesn’t go the way that maybe you would have wanted, you still had that autonomy, you still felt respected.

And the birth trauma part of it arises often when women don’t feel like they had that control and when they feel that things were done to them and or that things happened and they didn’t understand why, and they didn’t understand what was going on until later, or they weren’t given a choice, or the doctor just did something and there was an intervention that was done that wasn’t explained to them and consent was — you know, all the things.

So I will stop there. There’s something about this topic that I can certainly talk about for quite a while. I hope that you enjoyed today’s episode. If it resonated with you, feel free to share it with a friend. Fertilityfriday.com/583. And with that said, I hope that you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.