54. [WISE WOMAN] WITH DR MELANIE JACKSON OF THE GREAT BIRTH REBELLION PODCAST - REBELLING AGAINST THE SYSTEM : THE WHAT, WHY & HOW
As I told Mel at the beginning of the episode, I am likely her greatest fan in the US. I send all of my clients to her podcast The Great Birth Rebellion. I am so honored to have her on the show.
Dr Melanie Jackson (AKA Melanie The Midwife) loves to help midwives and women around the world better understand and apply the research relating to matrescence (the process of becoming a mother). She does this as the host of The Great Birth Rebellion Podcast, supporting and mentoring midwives, as well as educating mothers.
Melanie has a PhD in Midwifery - Birth Outside the System: Wanting the Best and Safest. She has various publications in academic journals. Mel has worked in multiple research roles and lectured at Western Sydney University.
Since 2009, Mel has been a Privately Practising Midwife, providing homebirths in the Blue Mountains. She has mentored midwives into private practice in every state and territory across Australia and supports rebellious midwives around the world through The Assembly of Rebellious Midwives and The Convergence of Rebellious Midwives.
In this episode we dive in to the 'what, why, & how' when it comes to rebelling against the system.
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Music The Ancients (feat. Loga Ramin Torkian) by Azam Ali
Disclaimer:
The information and resources provided by me are not intended to constitute or replace medical or midwifery advice or a Mother’s intuition. Instead, all information provided is intended for education purposes only. My advice is not to be seen as medical diagnosis or to treat any medical illness or condition of Mother or baby/fetus.
The following transcript is AI generated and will have errors
[00:16] : Welcome to Soul Evolution.
[00:19] : My name is Emily, also known as the Birth Advocate. I am a retired nurse, health coach, women's circle and ceremony facilitator, and the host of this podcast. Here we dive deep to reclaim our rites of passage with a big dose of birth story medicine, intentionally curious conversations with embodied wisdom keepers, and a sprinkle of polarity as we will hold space for our men from time to time too.
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[01:20] You will walk away feeling ready, body, mind and soul, knowing that everything you need to birth your baby already exists with within you. Your questions will be answered, guaranteed. Your fears will be quelled.
[01:34] I walk you through, step by step, exactly how to prepare yourself, your partner and your home for the most incredible experience you get to have in this lifetime. Birth is a sacred rite of passage worthy of honoring.
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[02:37] You will find photos and videos of my guests on my Instagram account, Earth Advocate. You can always email me at connec@birthadvocate.Me. I'd love to hear from you. Now let's drop in to today's episode.
[02:57] : Welcome Melanie to the podcast.
[03:00] : Oh my goodness.
[03:01] : I'm so excited.
[03:03] I. I'm gonna just say I'm probably your biggest fan in the United States. Yeah, I'll just declare that you. You are a wonderful human being. You're doing such amazing work.
[03:12] I'm so happy to have you here.
[03:15] You know, for me, it's like you provide this sturdy ground for informed decision making and it's based both on evidence and your embodied Knowledge. And this is helping to steward the shift in our understanding of birth.
[03:31] You know, you are a truth teller, one that provides a service that I believe is going to ripple out into humanity forever. Because the way that we give birth and the way that we're born, it matters.
[03:44] We need empowered parents and babies entering with love and safety imprinted on their nervous systems.
[03:50] There truly is a great birth rebellion happening. I don't think that your podcast could have a better name. You totally nailed it.
[03:59] : Yeah, that came to me and I couldn't let it go. I was like, that has to be the same.
[04:03] : Oh, my God, you nailed it. Yes. And you know what? I'm just going to bring this in here because I pulled a card right before we hopped on and it says, gather your tribe.
[04:12] And I'm like, her and I, we are totally in a tribe together. Like, we are rebellious.
[04:18] So today our theme is going to be rebelling against the system. The what, the why and the how. And again, I felt like you were an excellent guest to have on because you're, you're an expert at interpreting the evidence and delivering it in these digestible bite sizes and laying it out objectively, you know, for a truly informed decision.
[04:42] And you're also an expert when it comes to physiological birth because you're a private home birth midwife. So you have numerous episodes, which I'm going to link out to in the show notes, where we'll, you know, all these topics we're going to talk about.
[04:55] You go deeper, but briefly, you know, why we are rebelling. We're going to talk about authoritative knowledge, knowing where you and provide, you and your provider are along the medicalized spectrum, which is such an excellent episode and why it's important how we emerge from these rites of passages and the birth imprints.
[05:14] I'm a broken record. I say this all the time.
[05:19] : Is really simple, but we have to keep saying it over and over again to reach as many people as possible.
[05:25] : And I will, I will say it till I'm blue in the face.
[05:29] It's also important because our intuitions are valid and simple truth telling, you know, what does the evidence actually say? And this growing body of anecdotal evidence and observational studies which I think have a lot of merit when it comes to physiological birth.
[05:47] So anchoring in, you know, that the future of humanity really does rest in women's hands and women's wombs. And it's a very rare occasion that we need our medical industrial complex and of course, how to be a rebel.
[06:02] So I'm sure we'll probably pepper in throughout or maybe at the end we can give some tangible tips. But essentially I feel like everything comes down to that. Voting with your dollar right.
[06:13] And being in integrity with your choices.
[06:17] So you again have a whole episode, episode 117 on how to change the system. And that's beautiful, but we'll dive into it. But I'd like to give you an opportunity now just to tell the folks about yourself and give you a big welcome.
[06:31] : Oh, thank you. Thank you so much for having me. I just before we started recording I was like, wow, it's amazing. The us is hearing all the stuff that I'm sharing.
[06:40] It's amazing.
[06:42] So who am I? So officially Dr. Melanie Jackson. It's a title I'm not particularly comfortable with, but I have a PhD which is why I get to say doctor but not medically trained.
[06:57] So my PhD is called birthing Outside the System. And it was the first Australian sort of research investigation into birth outside the system, which included free birth, but also women who choose to have a home birth with a midwife when they've got risk factors.
[07:14] So any woman who would usually be excluded from a low risk or midwifery model in a hospital setting. So that was my work for that. And through that work I was able to develop just a research prowess, my research skills to be able to understand evidence and research papers.
[07:33] And so I was able to use that knowledge, combined with my work as a private midwife, to be able to share evidence based information with my clients. You know, I thought that was a unique skill set.
[07:45] A lot of midwives are midwives, great clinicians, but they get really frightened of research papers and they don't know how to turn that evidence into information for their clients.
[07:55] And so I felt like I had this unique skill set in a way. Sometimes academics just work as academics and their midwives just work as midwives. And it's difficult to find a meeting point.
[08:06] So I do see myself as that little meeting point. And then I wanted to make the podcast the Great Birth Rebellion to help share that intersection of knowledge.
[08:19] Mostly it actually started out because I feel like I just tell my clients the same thing over and over again each time we have an appointment. And I kind of wish there was a resource that I could send them to that they could use ahead of time.
[08:33] You know, for example, if I'm going to talk about gestational diabetes testing, I would say, hey, you know, listen to this episode. And then next time we, we see each other, we can talk more detail about your specific scenario.
[08:48] So that was the idea of the podcast. And it turned out that lots and lots of midwives and birth workers and doulas and women also appreciated having that information. So that's where that came about in 2022.
[09:01] So that's kind of my academic and clinical background. And I've been a private midwife for 16 years, attending home births. I have two children of my own. They're 11 and 7, and they were born at home.
[09:14] And just continuing with the home theme, we also homeschool them and we homestead. So we've got five. And it's just like, you know, and we'll talk about authoritative knowledge later.
[09:28] But it's all. A lot of people talk about how, you know, there's always this package deal, like if you homeschool, you also home birth, and you also grow your own vegetables.
[09:38] And I don't think it's packaged. I think it's. There's an underlying philosophy that leads us to make these decisions, and I think it's about different ways of knowing. So we'll talk about that.
[09:47] But what else? I love to crochet, and some people may have seen on Instagram, I was.
[09:56] : Gonna make a joke, like, where's pregnancy? I thought I was interviewing pregnancy.
[10:01] : She's a whole different beast. So pregnancy is my Ulta pregnant alter ego. And for those who haven't seen yet, you can have a look at Melanie the midwife on Instagram. But she is a crocheted pregnancy suit with all the anatomy, vulva, pubic hair, breasts, like the whole deal.
[10:19] We.
[10:20] : Full anatomy.
[10:21] : Full anatomy. She's. She's very out there on the social media. I pretty sure she's been banned from TikTok. They won't show her anymore.
[10:31] : Serious?
[10:31] : Yeah, that's okay. I had a feeling. Instagram has not censored her yet, so that's cool. But that's me mostly. Yeah.
[10:43] : Also you teach midwives and the rebellious midwives. Convergence. What is that?
[10:50] : Right? That's true. Yes, that's right. So we have an online assembly of rebellious midwives. You know, when you start a podcast, people kind of say, hey, we want more of this stuff.
[10:59] We don't just want the podcast. So I was like, okay. So I started this online assembly of rebellious midwives, which is a platform for midwives who, like me, look at the system and just feel like there's this real disconnection between the type of care that we're expected to give women and the type of care that they are supposed to be getting and the type of care they deserve and what's in the evidence.
[11:25] So midwives get very frustrated by the system, as frustrated as women do. And there's this. Just this overlay of moral distress that governs the work of midwives. Most midwives, because we have a.
[11:39] A physiological mindset, we're taught to care for women based on what they actually need in labor. But the hospital requires us to work in a different way. Hospitals do the system, and that creates this distress, what we call moral distress, within the midwife, and it slowly wears them down.
[11:57] And there's quite a short career for a lot of midwives in terms of number of years that they are willing to work on average.
[12:05] And so the assembly was a response to that. It was a place for midwives to come together and realize that they're not the crazy ones. You know, midwives always feel like, you know, am I.
[12:17] Am I crazy for thinking this? But no, it was a place for solidarity and learning.
[12:23] So we do case studies together and we go through research papers, so it's an opportunity to go deeper. And then the assembly said, hey, we want to meet in person.
[12:34] Can we have a conference? Like, whoa, okay, let's do a conference. So there was born the Convergence of Rebellious Midwives, and that's a live conference. It is actually available to anyone.
[12:47] But I couldn't come up with a better name that communicated that it, you know, anyone can come.
[12:52] : It's the best name. It's the best name.
[12:58] : So I was like, I can't. I can't make it any different. And then we. We going to do that every year. And actually, Anna May Gaskin is keynoting this year's Convergence.
[13:10] So it. It's all amazing. And obviously I'm just trying to keep up with the amount of things that everybody would love for me to share with them. So. Yes, working that out.
[13:21] : Yes, yes. Again, your work is just so appreciated, and I'm just waiting for it to trickle over to the United States.
[13:31] : Well, you know, I. Yeah, as many people as you can share it with. Because I'd love it for it to be international knowledge. You know, research is international, mostly.
[13:40] : Absolutely. And everything you're talking about, it's. It isn't just unique to Australia. I mean, what we're going to be talking about today is worldwide.
[13:50] : Yeah.
[13:51] : So let's get into it. As Melanie would say, let's get into it. So in episode 41, I did, I released lesson one, module one, lesson one of my course, where I go into her story of birth.
[14:06] So if you guys want a Deeper dive on, you know, the origins of how birth became medicalized. Go to my episode 41.
[14:15] But the thing is here, like, we live in modern times now, right? However, women, we. They still believe that birth is a medical event best managed by the experts.
[14:26] And I really want to dive in here and like, piecemeal it out. Like, why is that?
[14:32] So, Melanie, what is authoritative knowledge and why is it crucial for women and their families to understand this concept?
[14:42] : So authoritative knowledge, you can't see it, but you can feel it.
[14:47] So let's think about the. Every topic in the world can have authoritative knowledge around it. And authoritative knowledge is kind of the. The main knowledge or the main understanding that overarches a thing.
[15:04] So for birth in Western countries, the authoritative knowledge says birth is a time of danger, that you and your baby are living in a constant state of risk, and therefore you should be cared for by somebody who can monitor, manage and respond to the risks and complications that you're inherently in because you're pregnant or in labor.
[15:31] And so that's the authoritative knowledge that just filters through society subtly, you know, through media, through healthcare providers. Through the very fact that everybody or the majority of people go to hospital to have a baby keeps reinforcing this message, this authoritative knowledge message that that birth is dangerous.
[15:53] And therefore we need medical experts and hospital facilities to keep us all safe.
[16:00] And that could be true for some women, that their particular pregnancy has created a state of danger for them.
[16:07] However, the authority has decided that everybody is at risk who's pregnant and hasn't differentiated between women who are just experiencing a very normal life stage and they happen to be pregnant and those who actually have pathology.
[16:25] So birth or pregnancy. And birth has been what we call pathologized. It's basically not a state of. Considered a state of wellness anymore. It's considered a state of illness. And that's because the medical society has sort of taken ownership of.
[16:41] Of pregnancy and birth as something that they are responsible for. And a medical philosophy is all around making sick people well again. You know, they see things, they see problems that need fixing, and that's their job, is to try and heal sick people, which is amazing.
[17:03] And we definitely need these people because we're not always well.
[17:07] But because they are in an authoritative position in society, they get to define what is considered health and what is considered illness. And if they decide to define something as illness, then they take ownership of it as part of their role and they become the experts.
[17:26] Now, the problem is with that is that it's not true that most Pregnancies and births are dangerous. It's true that some are dangerous and that there is danger and risk in there intermingled amongst the most likely chance that everything is actually well.
[17:44] But that distinction has not been made. So we treat all women as if they're unwell.
[17:49] And so we give them all blood tests and ultrasounds and constant monitoring and checking so that we can immediately pick up when something goes wrong and fix it. But we're, we're managing them in a sense that we're expecting something to go wrong.
[18:07] And so that's the authoritative knowledge about birth. And it's come around because of the medicalization of birth, because medicine has said, look, that's our job now we own that, we're applying a medical philosophy to this.
[18:21] But it's actually a state of wellness.
[18:24] And so where treating pregnancy and birth like an illness, instead of treating it as a life stage, you know, an event in somebody's life.
[18:35] So we pathologize it. We, you know, medicine does that to a lot of things. You know, there's lots of commentary on the pathologization of, you know, erectile dysfunction and, you know, menstruation and menopause.
[18:51] You know, we pathologize a lot of normal life things and we attribute them to a medical problem where actually the problem could be very different.
[19:00] So that's authoritative knowledge. And authoritative knowledge is not one of the things about this. And there's anthropologists that write about authoritative knowledge. This is not really like a midwifery thing.
[19:13] It's an anthropologist.
[19:16] But they will say that authoritative knowledge is not necessarily the knowledge that it's most true or most accurate. It's the knowledge that counts. It's the knowledge that has authority.
[19:28] It doesn't have to be true to be authoritative. And that's the catch point, is that just because a lot of people believe doesn't mean that it's true. And that's true of authoritative knowledge across other topics as well.
[19:43] : And therein lies the dilemma, right, with the fear propaganda and this, the risk disclosure. I wanted to kind of dig into like absolute risk versus relative risk. And, you know, because it is very difficult to look at a study and understand what the heck you're reading, which is again, why I brought you on, because you're so good at doing it.
[20:05] But yeah, this whole, this whole thing with risk disclosure. Do you want to say a little bit about it?
[20:10] : Yeah. So because now of this medical paradigm that pregnancy and birth exists within, all of the language about birth is about safety and risk and your Level of risk. And so medicine, and you know, the modern management of birth now wants to categorize women as low, medium or high risk so that they can pigeonhole them into certain care models so they can apply kind of care formulas to their care.
[20:39] You know, a lot of care is policy based, I call it birth by numbers. So you know, if, if you come in and you have gestational diabetes, you are, this is applied to your care management.
[20:51] We have a 10 step process for how we're going to look after you in birth. And so this way of caring for women means that we're very interested. I say we as the collective maternity care system, not me personally, but we want to be able to slot a woman into one of those risk categories.
[21:15] Are you low, medium or high risk? And so then that's part of it for our own way of caring for them, but the other part of it is that we can't provide care to women until they allow that they have to consent to the type of care that we're going to offer.
[21:33] And so there's a whole process of educating, I'm saying educating in inverted commas, educating women about their personal circumstances so that they can make decisions about the type of care that they want.
[21:49] The problem is that this education or information giving is often biased. And the care provider will only tell the women information that will kind of guide her to make the decision that her care provider wants her to make.
[22:07] Rather than giving her all the information that's available so that she can make her decision, the care provider will give her the information that they believe she needs to make the decision that they believe she should make.
[22:20] And that sits in this whole idea of them positioning themselves as the expert.
[22:27] So they say, I know what's best for this woman because I am the self appointed expert expert or society appointed expert in this scenario.
[22:37] And so I want to give her this type of care. However, she's an autonomous person and she has a choice. However, I want her to make the choice that I think she should make because I know best.
[22:49] This is the overarching philosophy. I'm not saying it's right.
[22:54] So then in order to kind of convince women of what decisions to make, they need to present the information in a way that communicates the level of risk that she's in.
[23:04] So she kind of goes, whoa, that's scary. Yeah, sure. What can you do to help me? How can what do? What decisions can I make to save me from this risk?
[23:14] So then we talk about these two ways of communicating risk language like this is risk language. So absolute risk or relative risk or comparative risk. Right. So in, in the great Birth Rebellion podcast, I like to talk in absolute risk language because that gives people, it gives the percentage representation of how likely is this to happen.
[23:41] So let's say, for example, we use the example of uterine rupture for women who are planning a VBAC vaginal birth after cesarean. So the uterine rupture rate sits somewhere between 0.7
[23:54] and 0.9%. Okay, so that's the absolute risk of a uterine rupture if you've had a previous cesarean section for your next birth. 0.7 to 0.9%.
[24:06] A lot of women say, wow, that's like, that's a really low risk of this happening to me, considering that 99.1% of the time you won't have a uterine rupture. And then you tell them about the fact that actually the chances of a catastrophic uterine rupture where, where you're actually in quite significant danger is even less than that.
[24:29] And the vast majority of those ruptures, you know, 80% of those ruptures are not necessarily life threatening. So again, they go, okay, so I could have a uterine rupture, but there's an absolutely low risk of, of myself and my baby being in significant danger.
[24:48] Now, if you were to communicate that same information and use relative risk language, you might say to somebody or somebody, you know, the care provider might say to somebody, you've got, you are at seven times more risk of uterine rupture if you attempt a vaginal birth after a cesarean section.
[25:11] All right? And it's, it's probably even more than that. I, you know, the risk of having a uterine rupture if you haven't had a previous cesarean section is something like 1 in 5,000.
[25:20] You know, it's not impossible, but it happens. It can happen during an induction, all kinds of things, even if you don't have a scar in your uterus. And they might say, actually, you're 50 times more likely to have a uterine rupture compared to somebody who doesn't have a scar on their uterus.
[25:35] Well, that level of information, that kind of way of communicating risk is very frightening. So it's not like you have a 50% risk or even a 10% risk of uterine rupture.
[25:46] You still have the same absolute risk of that 0.7 to 0.9. But when you compare it to people who haven't had a cesarean section, it's it's a significant number of times higher than when you compare it.
[26:01] And so that's not helpful information for women to help to make decisions. And you know, they will talk about the stillbirth risk. So every time, every week that you're pregnant from 37 weeks, we know that there's an increased chance that your baby will be stillborn.
[26:20] That's information.
[26:22] But, and so, you know, now we induce a lot of women, you know, they don't let women go 10 days past their 40 week due date. And sometimes it's even less now.
[26:33] And they say it's because the stillbirth rate doubles every week that you're pregnant. And that's not untrue. You know, at 41 weeks, the stillbirth rate is approximately six or seven in 10,000.
[26:47] And when you're in your 42nd, 41st and 42nd week, that does double each time up to about 11 or 12 every 10,000.
[26:57] So that 11 or 12 in every 10,000 is the absolute risk of stillbirth. The relative risk of stillbirth is that it doubles in risk from 41 weeks to 42 weeks.
[27:12] Both are true.
[27:14] But when you talk about, when you talk to women in absolute risk, it gives them information they can use to make a decision and information they can use to decide their own level of risk.
[27:26] Because that percentage might sound too high risk for some women. They think, I'm not willing to take that risk. That feels too high to me. Other women would say, I'm willing to take on that level of risk.
[27:38] And we do that every day. We get in cars and we use toasters and we cook with gas and we do all these things that have a small risk of not going right, but we balance the risk and benefit of our behaviors and we choose to take on a level of risk that benefits us.
[27:58] And so when people give relative risks to statistics, they are saying, I believe this is a high risk situation and I'm trying to convince you that you're in a high risk situation.
[28:13] And so the clinician has taken on the risk assessment instead of letting the woman decide, is this a risk I'm willing to take? And so if your care provider is talking to you in relative risk, chances are is they are trying to convince you to their way of thinking so that you make the decision that they've made already.
[28:35] Whereas if they talk to you in absolute risk and they say, you know, your uterine, your risk of uterine rupture is 0.7%.
[28:43] And in fact, if I give you an induction Your risk of uterine rupture is now 1.5%.
[28:51] Or they could say, if I give you an induction and you've had a previous cesarean section, your risk of uterine rupture doubles. They could tell you that, too. Not untrue.
[29:02] But it doesn't tell you what the original number was or how high is the risk now. So those are the two ways that we can communicate risk and how people communicate risk kind of gives you some insight into their philosophy and where they see themselves in terms of the level of expertise in your circumstance.
[29:24] : Yes, yes, thank you for explaining that. It's so crucial the way this information is delivered. And even just for women to understand that there's another way to perceive it. You know, women, some women, they just don't.
[29:38] They haven't had the experience yet. So the other thing that I'd like to talk about as far as the. What is, I get so fired up about this, how so many policies are consensus based and not necessarily evidence based and also like access to care and policy making, like these things you just did a great episode on.
[30:03] I probably wrote it down somewhere here. But as far as, like what the evidence shows, you know, continuity of care, midwifery care, like, all of the evidence supports this, but like that access is so limited, it's basically out of pocket.
[30:16] And policies, they're just not evidence based, they're consensus based. And it just, it gets my panties in a bunch. But if you want to say something about that, I'd love it.
[30:26] : I wonder if we talk about what's a policy. And a lot of people don't even know that when they walk into a hospital, they're being cared for based on a policy.
[30:37] So basically, hospitals are. They're a system. Let's think about it. And this is possibly a bit extreme of an example, but if we think about a hospital as a factory or an institution, right, it's big.
[30:51] Or it could even be considered a business. You know, I'm a businesswoman. I know that in my business there needs to be a structure and a system for how we do things so that everybody involved is aware of what the processes are and that there's no sort of.
[31:10] If you allow everyone to do what they want, you're not going to get consistency. There's going to be an issue. Nobody knows what's going on. We need to have a process and a way of doing things.
[31:21] And that's what hospital policies are. They tell everybody who works in there, this is how we do things. And then it also says this is your role in executing this policy.
[31:32] Okay? Which is great. If you're running a factory or if you're making something, you want it to be systemized, smooth. You know, you want everybody to know their role. You want there to be a seamless process between one step in the factory chain and the next.
[31:50] It's. It's good for productivity. It's. It reduces mistakes. You know, it's good. But when you apply that to a hospital system and to people, and where there's a variable, for example, like, everyone's labor is different, everyone's body is different, every baby is different, every woman's needs is different.
[32:12] You can't apply this one size fits all policy and process to birth. So they've tried to apply this factory way of doing things and these like, grand ideas of productivity to a process that doesn't match that.
[32:30] And so now we're trying to force women to fit into how the hospital system runs.
[32:37] And women can't do that because that's not how our bodies work. And we're actually complex beings. We're not just little robots growing a baby, and then it comes out, and then off we go.
[32:47] And so now what you have, when you try and apply that way of doing things to the human body and to the birthing experience, you end up with high cesarean section rates, high induction rates, and high intervention rates.
[33:00] Because the system is so invested in making women fit into the way that they do things, that if they don't fit, they will manipulate the birth process to make it fit.
[33:12] And that means augmenting people with artificial oxytocin to make their labors go faster. Because the policy says you're supposed to dilate in your cervix at a certain rate. And if your body doesn't fit that, then we will make it by giving you medicine.
[33:28] And then if you haven't given birth by a certain time and we think it's been too long, then we'll give you a cesarean section, or if you've been pushing too long.
[33:36] So there's not a lot of room for clinicians to be very individualized in their care and to actually tap into their own knowledge. They're expected to follow procedure.
[33:51] And then women, you know, if they have the audacity to want to have a choice in their care, you know, they throw a spanner in the factory works, and nobody knows what to do.
[34:01] They're like, what? She doesn't want to go through our production line?
[34:07] We do not have a process or a way of caring for her now because the production line goes in three directions and she wants a fourth direction. And so care providers get really frustrated with women who expect to have autonomy because they have to suddenly not think in terms of policy.
[34:27] They have to think more clinically, I suppose, like more kind of individually for that woman and make allowances. And that's not welcome in a system that values productivity and process and policy.
[34:43] And so that's how money.
[34:47] Well, yeah, And I guess it would be different for you guys in the U.S. i mean, it's. We have a very. You know, our hospital system is publicly funded. And yes, of course, the hospitals get certain values of money based on procedures that are performed, but individual clinicians for us are still paid the same.
[35:06] You know, there's not. We're not. I mean, other people would have a different story, but mostly we're not inspired to intervene because it attracts a higher dollar value.
[35:19] I think our system is a bit more subtle, potentially, than the US where, from what I understand, you know, cesarean section attracts more money than a normal vaginal birth. And every time you add an intervention, it equals more dollar signs.
[35:32] : Right.
[35:33] : Yeah. So, you know, there's lots at play where the system is actually geared towards giving women highly medicalized and standardized care. But pregnancy and birth aren't a standard journey. You know, you want to apply a policy to something like an appendectomy, like if you're taking someone's appendix out.
[35:53] Yep. You want to follow step one to 10 with a few variations if there's some change in anatomy or a complication.
[36:02] But that is a procedure. That's a process. But childbirth isn't a procedure. But they try and write policy as if it is.
[36:13] So. Yeah. Does that answer your original question?
[36:16] : It does. And of course, I want to dive deeper in here. Maybe we will when we get down to the how. Because this right here, this is a big part of the how do we rebel against the system?
[36:28] Because. Yeah. Anyway, we'll get there.
[36:33] Moving into the why.
[36:35] This risk of being the good girl who follows the expert versus the deviant rebel who follows her internal guidance system.
[36:47] Yeah, we can talk all about the risks there.
[36:50] I mean, trauma, like medical.
[36:54] Medically induced trauma, all these women walking away with birth trauma. The dehumanization that happens like the. Of our humanity.
[37:03] It's. It's. It's just heart shattering. But again, there is a great birth rebellion happening. So. So, yeah, let's talk about why we are rebelling against the system.
[37:17] : And I think, you know, some people think, okay, we're rebelling that means we're not going to do anything they say, and that it's. That's different to what I think when I, you know, the great birth rebellion is about women having the information that they need to make their own choices.
[37:33] And they may choose that the very best thing for them is to have a private obstetrician in a private hospital and have a highly medicalized and managed birth, which is their own.
[37:49] That's them taking that decision making on for themselves.
[37:53] And that, I think is what I'm talking about in terms of rebellion is not just going with the flow of thinking. Okay, whatever my clinician says, that's what I'm going to do because they're the expert and I'm going to leave it in their hands.
[38:07] That's what the system would like us to do. Just trust us. Let us do to you what, what we believe you need and be a good girl and just comply with that.
[38:19] So when I'm talking about, you know, being rebellious against that, I'm saying, take back the responsibility for the decision making. Know that you have the capacity to make decisions. Maybe you decide that, that what is best for you and what you actually want is in line with the hospital system's usual policy.
[38:40] But I think that's great. You've chosen for yourself, and that's the important thing. And that is what reduces trauma is where women feel like they were able to make decision.
[38:52] They had all the information they needed to make the decision, and their decisions were respected. They weren't challenged on them. And so regardless of what they choose, you know, I've had clients who have consciously chosen that they need a cesarean section for some reason.
[39:07] And then my job as a midwife is to say, okay, here's all the information I can give you about that choice, and here's how I could set that up for you.
[39:18] And here's. And, and I have, in the past, you know, I've said, okay, let's make that happen.
[39:23] And women coming out of their births and just going, that was the best, like I had. They had a cesarean last time, which was traumatic. Their next cesarean section that they chose and that they opted for and that they had all the information for and that they controlled the events for was not traumatic.
[39:42] And so it's not necessarily the events that occur that create trauma. It's how much choice and autonomy that they had within that to make the decisions.
[39:53] So I'm encouraging women to be rebellious by being informed and making their own decisions, because that's a rebellious thing in this system, they don't necessarily want us to be so informed that we will make decisions that are against usual hospital policy.
[40:10] And so that's how the education is geared. So it's rebellious to be educated and to make your own decisions.
[40:18] And, and I suppose in that way we're rebelling against authoritative knowledge because we're saying we want to choose. We very well might choose a medical way of doing things, which is fine, so long as it's your choice and it's not something that you've been forced into.
[40:35] And alternatively, you might choose something that's completely against all medical advice.
[40:40] And again, so long as you have all that information and you've used your own authoritative knowledge, then, you know, that's the idea of rebellion. And that's what we found in my PhD, is that women who make decisions outside of the system actually reject the social, socially accepted authoritative knowledge.
[41:02] And they value their own knowledge, they keep their own knowledges as authority and they use that. They, they kind of take the power of the authoritative knowledge away from the expert and they position themselves as the expert.
[41:17] : Yes.
[41:18] : And you know, in a partnership, in a maternity care partnership, the, the care provider has some expertise, but it's not always needed because the woman has expertise as well. And so in a, in a balanced and equal partnership between a care provider and a woman, each respects their own expertise.
[41:42] And so the woman might say, look, I have all this intuitive knowledge, I have all this other knowledge that I, that only she can hold about her baby and herself.
[41:51] And then she realizes, but I don't have some knowledge that maybe my midwife does have. And so I'm going to use my midwives expertise as a resource as I make my decisions.
[42:03] Rather than deferring all expertise to her midwife, the midwife or care provider just becomes a resource that the woman can choose to use or not.
[42:16] And so, yeah, there's this balance of, yes, most of the time a woman's expertise and intuition is enough.
[42:24] And then sometimes for some women, there is a level of expertise that she can access from her care provider that might improve her scenario or give her information that she needs.
[42:34] So it's a bit more complex than rejecting authoritative knowledge altogether and rejecting experts altogether and actually finding one that somebody that you trust that you are willing to accept their expertise and who's also willing to accept or that a woman has expertise that we don't have.
[42:53] : Yes, yeah, yeah, I really, it's, it's disheartening to me all the dogma out there in the world around birth Especially on the extreme ends, you know, like I. In that medicalized spectrum, which we didn't bring in, maybe we'll weave it in here.
[43:09] But like, you know, I, I hang out around, not quite at Free Birth, but like, you know, one little step over, like that midwife that I can trust to be, you know, sitting on her hand, trusting birth, trusting me.
[43:23] Like, I am absolutely the authority figure in the room. But if I need help, I'm going to ask for it. If I want her opinion, I'm going to ask for it.
[43:31] Those kinds of things. So, yeah, I think it's just so important for us to normalize celebrating these alternative ways of knowing, you know, our intuition. This is what the rite of passage of birth is about.
[43:43] Again, it's for women to emerge feeling empowered and as if they are the authority over their body and their baby. They aren't outsourcing and feeling, you know, incompetent. This is what it's all about.
[43:58] : This is why.
[43:59] : And again, babies, birth imprints, you know, most of us born in the 80s were, you know, pulled out with forceps or induced and like, slapped on our bum and separated from our mom.
[44:12] And it's just, it's horrendous.
[44:14] : So, yeah, yeah. And I think the medical way of understanding birth doesn't value intuitive knowledge because there's lots of different ways of knowing. And medicine appreciates really objective, hard information every, every, you know, information that everyone can see, whereas there's knowledge, intuitive knowledge that women have in, inside them.
[44:40] But it takes a skill and a confidence to respect that intuition.
[44:46] So, you know, I personally make a lot of decisions based on intuition. How does it, how does this feel? And intuition is such a complex way of knowing. It's like our brain, it gathers all the information from within itself that it's developed over the years and makes a snap decision in our, you know, and it feels intuitive, but actually it's based on a lot of life experiences and knowledge and all that that we've gathered through our lives.
[45:16] And so intuition is a way of knowing and of making decisions. So, yes, this feels right. I'm going to do it. No, this doesn't feel right. I'm not going to do it.
[45:25] But can we always pinpoint why that doesn't feel right? Not necessarily, but I think it's okay to still trust that intuition, even if you don't fully understand.
[45:38] And, you know, midwives use intuition too, but we're not encouraged to.
[45:43] So, you know, when I'm at a birth and I think, oh, I can't Put my finger on it. But something doesn't feel right. Like, what is it? And in I'm internally grappling with, is this some fear coming in, or is this based on something my intuitive midwifery intuition is putting together and trying to warn me about?
[46:03] And so women have that same thing. You know, we all. As you develop through life, you build an intuition, but the skill is whether or not you trust that intuition or not.
[46:16] And some women will trust expert information or authoritative knowledge over their intuition and their intuition be saying, oh, no, this doesn't feel right. But I would do it anyway because my doctor said so.
[46:31] And then later on they might go, I knew I should have. I should have followed my intuition. And that's sometimes a regret that women have.
[46:42] But it's sort of not fair to say to women, follow your intuition, when all through their whole lives they have not been used to following their intuition or they don't trust their intuition, or that's not usually how they make decisions.
[46:56] : Yeah.
[46:57] : So it's interesting to learn through pregnancy if women are usually making decisions with their intuition or if they have shut that down completely.
[47:07] : Well, I mean, that's the work that I do as. As a doula. I mean, talking about the good girl, talking about your relationship to authority, talking about your intuition. I mean, that's.
[47:18] That's literally like the work that I do with women.
[47:22] : Yeah, yeah. So it's, you know, it's a skill to tap into and trust your intuition, and then you're just applying that skill in the scenario of pregnancy and birth. Yeah, yeah, yeah.
[47:36] : Moving into the how.
[47:39] This obviously could be a very long podcast all on its own, but let's maybe try to boil it down to some practical tips, ways to question authoritative knowledge, how to be well informed, how to be a confident rebel.
[47:55] And this could be geared towards either women or birth workers.
[47:59] : Mm. Yeah. Oh, look. So this is again. Yeah. Could be an entire podcast. In fact, it's probably the whole great Birth Rebellion podcast.
[48:11] : Exactly.
[48:12] : How do we.
[48:14] I think the question is, how do we confidently make our own decisions and know and get those. And get those things that we've decided we want?
[48:24] And I think it all firstly comes down to choosing. Well, no, let's go back. It comes down to first understanding your philosophy about birth.
[48:34] So if you fundamentally believe the medical message that, yes, I am in a state of absolute and complete danger and there are risks involved with the fact that I'm pregnant and giving birth, and that's where you definitely sit and you're frightened of things going Wrong, then you will make different decisions.
[48:52] To a woman who says, I believe I'm just in another normal part of my life, I happen to be pregnant. This is not a state of illness, this is a state of wellness.
[49:05] And that, you know, you're not a ticking time bomb. Things are not just always going to go wrong. Those two philosophies, they'll make very different decisions about who's going to look after them.
[49:19] So women who fundamentally believe that birth is relatively safe and unlikely to go wrong will choose low intervention birth models and care providers. So maybe they'll choose free birth or home birth or birth centers with midwives or doulas.
[49:33] And because they're not frightened so much of things going wrong, midwives can help you in a complication. And so sometimes they might say, okay, yeah, look, mostly birth's fine. But I do know, I acknowledge that sometimes things don't go right, and I would like an expert there to be able to identify when that might be and to be able to act in an emergency.
[49:57] And so, okay, if you have that philosophy, then you'll probably choose a midwife.
[50:02] If you go right to the spectrum where you think, you know what, birth always works, there's never a complication. If only the scenario and the environment and my mental state were completely pure and amazing, then nothing will go wrong.
[50:17] Then maybe you do not have the motivation to choose a care provider because you fundamentally believe that things will go wrong so few times. And if they do go wrong, maybe you have the skill or you believe in yourself to be able to manage that.
[50:35] Maybe those people would choose free birth instead.
[50:38] And so your fundamental beliefs about birth will put you in a position for what, what you're going to choose in terms of who's going to be there and where it's going to be.
[50:48] : Two most important decisions you can make.
[50:51] : Exactly. And, and these things all need to be made really early on in your pregnancy. Because if you choose, I mean, here in Australia, if you choose where you're going at 10 weeks, you might have missed out on the midwife that you wanted and the, the birth model that you wanted is full already.
[51:08] : Yeah.
[51:09] : And so these are the things that you kind of have to work out before you're pregnant when you're trying to have a baby, you know.
[51:14] : Exactly.
[51:15] : Yeah. And then you think, right, you know, and I have been interviewed by women who are like, we are trying to conceive and we're trying to choose our midwife so that the minute we're pregnant, we can call you and say, we're pregnant, we want you.
[51:29] So I mean, that's the best way because a lot of the maternity care services that are midwifery led and that are more physiologically minded boutique, they're hard to get into, they often book out.
[51:43] So if you sit in that philosophy where you know, you want something different from the hospital, you have to be proactive in choosing it before you're pregnant and phoning these people in early pregnancy before they get booked up.
[51:57] So I think women have to. Actually, some women don't even understand that there's this spectrum of beliefs, of philosophies. And so firstly it's identifying where you sit, just immediately asking yourself, am I frightened of birth?
[52:10] Do I think everything can go wrong? And should I be in a hospital with a doctor? And if you think, oh, yeah, I do think that you're okay, well, now I know where I sit on the spectrum of how medicalized I think things should be.
[52:22] And then some women don't want to be there. They know they've got fears and they think, well, actually I should just address these fears so that I'm not scared of birth because I don't want to be scared of birth, but I am for some reason.
[52:36] And some of the times it can be subconscious.
[52:39] Sometimes it can be for very good, real reasons. So is my intuition telling me there's something wrong? Or are my fears rooted in society's lessons that they've taught me about birth or somebody's story that I heard?
[52:54] You know, where did these fears come from?
[52:57] And so only then, once you work that out, can you decide where your education and information is going to be for the rest of your pregnancy. What do you need to work on?
[53:07] If you're choosing to free birth, you got some work to do because you need to almost fully understand the whole pregnancy and birth process because you are your own care provider now.
[53:20] And you've got to work out, how am I going to work out if everything is still beautiful and normal? And how am I going to work out if something is not right and then be able to act on that?
[53:32] So that's your work to do. If you've got a home birth midwife and you're planning on having your baby at home again, you've got to choose your midwife, you've got to get educated.
[53:41] There's only so much your midwife will offer you. There's other things that you need to do. Prepare your home, you know, work out, how am I going to work through contractions and labor pains and, you know, what are My strategies there.
[53:54] And then if you're going to hospital again, you're like, okay, I have a lot more learning to do because the hospital is going to lead you down a particular way.
[54:04] And if you don't want that way and you need to fight against it, then you need to come up with advocacy strategies and. And, you know, gather alternative information more than what the hospital is going to offer you.
[54:15] So I think it's about. It's for women identifying where they sit in their philosophy, choosing their location and care provider that matches it, and then it's about educating themselves as far as they need for their scenario.
[54:29] I'm cautious about advising women to get educated because then it becomes such a cognitive activity all through their pregnancy and you forget to enjoy the fact that you do pregnant and growing a baby.
[54:43] And, you know. So, yeah, it's this really weird line. I think, just get enough information that makes you confident in making a decision, make the decision and move on from it.
[54:56] You know, don't get stuck in these things. Don't try and get more and more and more and more and more because it's like a swirling vortex. You'll never feel like you have enough information because there's so much out there.
[55:10] And then obviously it's about tapping into, you know, the work that you do with learning to trust your intuition.
[55:17] : Yeah.
[55:18] : So, yeah, I would forget about sort of like, how can I rebel against the system and think, how can I get the best for myself?
[55:29] And sometimes that will be fighting against the system. Sometimes that'll be working against your partner or the father of your baby in terms of, you know, because they have their own philosophy, too.
[55:43] So if your partner's frightened of birth, but you're not, you're gonna have a situation in birth where their decisions are gonna be based on fear and yours are gonna be based on something else.
[55:54] Or it could be the other way around. They might be completely relaxed and want you to have a home birth and have a midwife. And you're like, no, I need.
[56:01] I need a doctor in a hospital.
[56:03] Yeah.
[56:05] : So shifting gears just a little bit towards midwives, birth workers. You know, you had mentioned in. In a recent episode that you don't actually think that the system is changeable or something.
[56:20] You said something to that degree. And. And, like, I totally agree, but, like, we don't actually want to burn it down. Or do we? I mean, maybe we do, but you had such beautiful words to say about, you know, relating it to permaculture culture and.
[56:36] And it was so sweet the way that you put that together, it was a speech that you had done. So I'll just link out to that episode. But what I took away from that, what I boiled down from it was, was integrity, right?
[56:46] So birth workers working in a place where they feel without that cognitive dissonance. Like, I was a nurse for 15 years and I operated in cognitive dissonance for a long time before I finally got out.
[56:59] But, you know, so, like, are you serving a system that you don't agree with? Are you, are you choosing a provider just because that's what your insurance covers? Or is there another way for you to manifest the birth of your dreams?
[57:13] So being in integrity with yourself and making these decisions on purpose so that we're supporting this rebellion against the assembly line?
[57:25] : Well, this is the thing, because I feel like in today's society and the way that birth is set up, it requires women to have resources if they're going to choose something that's opposite to what's most accepted.
[57:40] So society will make it easy as possible to use the services that are in existence to go down that assembly line. They'll make it as easy as possible in terms of financial cost and accessibility.
[57:55] But if you want something different, women start to feel like they can't get it because they have to invest their resources in getting it.
[58:04] So here in Australia, if you want a private midwife at home, you pay out of pocket. There's some that is rebated by the government.
[58:13] But if you go to a public hospital that's completely free, it doesn't matter if you need to stay for two weeks, it doesn't matter if your baby needs three months of special care or if you have a cesarean section, it's all covered, it's free of charge.
[58:26] And every, you know, there's a hospital close by. Usually unless we have a big. We have quite a large area in Australia, a lot of women live in rural areas and they have even more, even they, even more barriers to getting care that they want.
[58:40] Their closest hospital might be two hours away and they know that the only option they have is to go to that hospital unless they do things like move to a better resourced location or I've had clients who've moved into my area for a month in order to hire me as their midwife for their home birth, because they can't get one in their area.
[59:03] So to go against the flow, it takes resources like money, it takes time, it takes support from the other people in your life. So it's a heavily resourced like journey.
[59:19] So if you want to go against the flow, you have to put a lot of time, effort, and money in usually. Sometimes you don't. You can, you know, if you get lucky.
[59:29] But that's why it's hard to change the system, because sometimes women don't have that option. They know they don't want to give birth at their local hospital, but they don't have a choice because they don't have a spare five or six thousand dollars to access the service that they want.
[59:47] Or maybe they have risk factors and the local home birth service or birth center say they're too high risk. You can't come here. And so then slowly their options get whittled down to only having access to this free service.
[01:00:01] And this is where women start to consider free birth is they go, I don't have the resources or access to the particular options that I want. And they're forced to consider free birth because when they look at the option of free birth and they compare it to the other option that's available to them, free birth looks really sweet.
[01:00:19] It looks nicer in so many ways. And there are risks and benefits to both of their options, but they choose to take on the risks and benefits of free birth instead of the risks and benefits of this hospital option that they've got.
[01:00:37] And so that, again, is a sad scenario. The system has let these women down because they're not choosing free birth out of a fundamental belief that it's the best. They're choosing free birth because it's kind of the best that they have available to them.
[01:00:52] And that's different. You know, a lot of women who choose free birth are like, I didn't really want a free birth, but it was way better than the other option I had.
[01:01:02] And so for women, it's hard because they know they want one thing, but they have to be able to resource it if it's against the system.
[01:01:11] And this is why the system really probably won't change very fast, because women have to keep using these services.
[01:01:18] And so that's where the money keeps going. That's where the people keep going. And so that's what will continue.
[01:01:24] So unless women make a conscious decision to financially invest and, you know, inconvenience themselves quite significantly to access other options, then I don't think things will change, because things will only change as women start making different decisions, because government will fund things.
[01:01:43] If 50% of women start choosing the home birth, government will be like, whoa, we need to move the resources from there to there. Because all these people, like our population is making a different decision.
[01:01:56] Whereas, you know, if 1 or 2% of women are home birthing, government's not going, oh, we really should support this choice. Like we should, you know, they're not thinking like that.
[01:02:06] So that's how the pendulum has to swing. Women would vote with their feet and with their finances. But that is asking a lot of women.
[01:02:17] : And, and I think about again, you just did, you just released an episode, I think it was episode 128 where you were talking about that article, but at the very end you were giving a beautiful summary and you were talking about the importance of accountability.
[01:02:34] And I was going to ask you because there are like my, my mentor Anna, she deregistered, you know, like Dr. Rachel Reed, she deregistered. And there's these people that are deregistering to like fully step out of the system, but they're still working and serving women and there's no, you know, regulation, there's no accountability.
[01:02:54] And that sounds kind of nice until you have those bad eggs out there.
[01:03:00] And, you know, that's a concern. So, I mean, I, I was born a rebel. Like, I really don't like following rules, but at the same time, like, it makes sense that you want to have accountability.
[01:03:13] So it's a dilemma.
[01:03:15] : Yeah, well, this is what happens. So, you know, there's this big argument around people, you know, some people on the very end of the spectrum who might choose free birth and who have a fundamental beliefs that childbirth is super, super safe.
[01:03:28] Very rarely it goes wrong. Then a lot of the time, tomatoes are thrown at midwives who, they say, just puppets of a regulatory, like a regulated system.
[01:03:39] The thing though, with midwifery being regulated, what it means is that we can maintain a particular standards. So, you know, and there's processes in place to identify people who aren't doing a good job.
[01:03:54] And I realize people are going, yeah, but that doesn't work. People are always not doing a good job. I realize that there are definitely flaws. The problem is when there's no regulation at all, it relies on people being fundamentally good at their job and sensible and have the capacity to self regulate.
[01:04:16] And sensible people can do that. And the vast majority can self regulate. They can maintain their identify and maintain their own boundaries and are reflective in a way of having people to bounce things off.
[01:04:30] So part of being a midwife is that we're required to do peer review. We're required to constantly consult with other people around the type of care that we're providing. That's a version of accountability in a Sense that, you know, if a woman has a risk factor, one of the guidelines that we have to follow as private midwives says, if you've identified this, we recommend that you consult with somebody.
[01:04:56] Okay? So it's. That's our process, a little bit of accountability. So say I have a client and she has. I've just diagnosed gestational diabetes. Okay, my client has gestational diabetes.
[01:05:07] I say to my other colleague, hey, I've got this client, she's got gestational diabetes. Here's what I'm thinking of doing. She might say, hey, yep, that's a great plan. I've done that before.
[01:05:17] That's where the evidence is, you know, and as a clinician, I'd say, right, where's the evidence sit? She would say, yep, that's a great plan. Let's do that. If anything changes, we will revisit this.
[01:05:26] Or she might say, ooh, that's really complicated. Maybe we should speak to somebody else. Okay, I'm going to get an obstetrician to speak to and learn. We're obliged. We're required to do that.
[01:05:38] And so regulation kind of gives the public some kind of confidence that there's a set minimum standard for our behavior. There's codes of conduct, there's kind of ways that we're expected to behave and skills that we're expected to have and maintain.
[01:05:55] And we're also expected to get it right as often as possible.
[01:06:00] And in a circumstance where we don't get it right, questions are going to be asked, like, what happened there? Why did your skills fail in that scenario? Like, you as a midwife, should have been able to do that.
[01:06:13] Why couldn't you do that in that scenario? And we're encouraged to reflect. You're like, okay, well, I think maybe I just haven't done it in a while. And that's why maybe my skills aren't sharp enough in that area.
[01:06:24] And they go, okay, great.
[01:06:26] Here's what you need to do to sharpen your skills in that area. If you're going to continue to be able to call yourself a registered midwife, then you're going to need to sharpen that skill.
[01:06:36] And so there's these checks and balances to make sure that we are maintaining a high standard of care.
[01:06:43] So that's only necessary, though, if you're intervening and if you're offering actual clinical management. So for people who are doulas and you're offering all types of other care, just not clinical care, why does that.
[01:07:00] That doesn't need regulating because you're not doing things to people. Like we need a standard because this is like a.
[01:07:10] It's hard to explain. I mean, I don't think doulas should be regulated because their scope of practice isn't medical or clinical.
[01:07:17] But then I do think doulas should be regulated because there's a small proportion who are starting to not recognize the boundaries of being a doula and they're starting to double in, in, in care that I'm trying to say this very carefully because I don't, I don't think it should be heavy handed regulation, but where people start to operate out of their scope.
[01:07:43] So, you know, this article that you're referring to for people who haven't heard is, you know, a birth keeper who was doing vaginal exams and told a woman, you know, that's the baby's head, everything's fine.
[01:07:55] Whereas it became obvious over time that that wasn't the baby's head, that was the baby's shoulder and this baby was never going to be born vaginally. But the bigger problem is, is why was this birth keeper doing vaginal exams?
[01:08:07] That's not the scope, that's a midwifery skill. It takes so many vaginal exams to be able to confidently feel like you have felt the right thing. You know this.
[01:08:22] And so to think that you've got midwifery skills when you haven't been trained as a midwife is a, a breach of your scope. And so that kind of behavior needs regulating because it's clear that that person wasn't self regulating.
[01:08:35] They weren't identifying their skillset accurately or communicating that accurately to the parents and they were overstepping the line.
[01:08:43] So, you know, but doulas can do whatever they want out of sight, which is fine if you're a sensible doula working within your scope. It's not fine if you're doing whatever you want out of any regulatory gaze and you're overstepping the mark.
[01:09:02] And then these kinds of things can happen, right?
[01:09:04] : It's like that pendulum really swinging and.
[01:09:09] : The midwifery pendulum has swung too far in and so far is that we're starting to act too medically.
[01:09:15] And what people want is for us to start acting as midwives again, which is the valuing of physiological birth.
[01:09:22] Because historically midwives were trained by the other wise woman who went to birth and who was chosen by the community to go to births for her whole life.
[01:09:34] But she would have been apprenticed too by the wise woman who went to all the births for her whole life. And so there was this huge collective knowledge about birth that was gathered over time and passed down very strategically through apprenticeship, through on, like hands on learning.
[01:09:53] So there was a really formal way of historically educating midwives. So it's never been this throwaway skill that you could learn in a course.
[01:10:04] It was never that historically, but then it changed to being taught at university as a kind of our new brand of apprenticeship. And then we work as students in the hospital.
[01:10:14] That's our other way of apprenticeship.
[01:10:17] But we've been taught to work as medical midwives. So if you want to work any other way, you have to fight against that, as I did. But again, a lot of investment, financial time, investment into doing things an alternative way.
[01:10:32] : Right?
[01:10:33] : Yeah. So the alternative is not to kind of take midwifery and create it into something else and like become midwives in some other way, because that's never through history how midwifery has been done.
[01:10:47] : Right.
[01:10:48] : But that's, that's really the rub, though. Like here where I work, I have two midwives that I know of that I can feel confident referring people to. But, you know, they can only take so many clients because, like, I know that these two midwives, like really, truly trust birth.
[01:11:03] They're hands off. They're willing to not, you know, listen to the fetal heart rate after every pushing contraction. They're willing to let her push, you know, a little longer than what her parameters are.
[01:11:13] But like, that's really the rub, right? There is like, for midwives, I feel like, and even for women, choosing their provider is, you know, the regulations that midwives have to abide by and how frustrating that is when you're trying to honor variations of normal.
[01:11:29] : Well, and I think that, you know, the idea of regulation is really oversold as a restrictive barrier.
[01:11:36] So I'm a regulated midwife, but there is, because I'm registered, right. So I'm a registered midwife and registration comes with regulation and when you register somebody. So here in Australia, midwife is a protected term.
[01:11:50] So if anybody is saying I practice midwifery and they're not a registered midwife, it's actually illegal.
[01:11:57] So I don't know if that's the case in America.
[01:11:59] : It's, it's. I don't think it's actually illegal, but it could get you into trouble. Like, I think that it could. I don't know that there's a precedent set yet, but it could certainly get you into trouble.
[01:12:09] : Yeah. So, you know, but when, but even as a registered midwife, I can practice home birth with women of all Level of risk that our guidelines are quite flexible. There's ways around almost everything.
[01:12:25] So, you know, I do attend women at home who have gestational diabetes and vaginal birth after cesarean and just now really kind of becoming a bit more comfortable with breech birth at home.
[01:12:38] I don't, yeah, I mean, I don't have a comfort level around twins because I've never been able to gather that skill. So, yes, while I would say to a woman, look, if you've got a skilled clinician confident in twin births, then sure, do it at home, but I'm not your midwife for that.
[01:12:58] I don't have that level of skill and that's not in my scope. So I have no place saying to you that I could offer you a twin home birth. That doesn't mean I shouldn't, you shouldn't do it with somebody who does have that scope.
[01:13:11] But I've personally recognized my own scope. So I actually think here in Australia, at least our regulatory body doesn't limit us so far that we couldn't provide care to most women as a private midwife and still stay within regulation and registration.
[01:13:30] So I think a lot of people overestimate the amount of power that regulatory bodies have over our practice. Having said that, I have been reported to our registration body three times, you know, which is congratulations, I mean, which is the case whenever you're working outside the system.
[01:13:49] You know, fortunately I'm a very reflective practitioner and I take excellent notes and I stay within my scope and I practice in an evidence based way. So I'm confident that I could defend myself against any reports and have quite easily.
[01:14:07] And they've all three times gone, oh, you did everything. You know, we're not, we're not pursuing this argument, this report, but I know I expect to be reported because I'm working outside of the system.
[01:14:23] People don't understand.
[01:14:24] And then I go, yeah, I need to just expect this, but I can defend it. And so, you know, some midwives would be frightened by being reported and they'll say, look, I'm not doing that because I don't want to get reported.
[01:14:39] And that's their prerogative. I mean, they can, but I just think, you know, a lot of people sort of like don't go with midwives. They're so regulated they can't give you really what you want.
[01:14:48] I don't think that's true. I think that is an overreaction.
[01:14:52] Yeah. So I, I kind of really shy away from this absolute language that demonizes all midwives and Blames regulation for everything.
[01:15:01] You know, when we don't regulate something, you allow a few bad eggs to spoil the batch.
[01:15:09] And so I think if we want to legitimize the option of home birth and of midwifery and continuity of care models, we want to keep demonstrating, actually we can do this safely.
[01:15:20] : To sum it up, I think it's very important for women, to the people that I'm speaking to, my audience, they are healthy mothers wanting a natural, physiological birth. And so, you know, do your research, interview your provider.
[01:15:37] I have an amazing free resource called Questions to Ask youk Midwife. When Wanting a physiological Birth, your rights and what is legal.
[01:15:45] I cannot, you know, press that enough. You need to interview them thoroughly from the beginning. And where you choose to birth is that second most important decision that you're ever going to make.
[01:15:56] So, yeah, this has been a lovely conversation. I've been looking forward to it. But if you would, Melanie, please share where people can find you and maybe something that you're up to now.
[01:16:08] : Yeah, well, the best place to find me Instagram at Melannie the Midwife or at the Great Birth Rebellion. And the podcast is the Great Birth Rebellion. So that's probably where you're going to get the most cohesive information that I share is on the podcast.
[01:16:26] And then certainly for people who love that and who want more, there's the option of the assembly of Rebellious Midwives, which is open to any midwife.
[01:16:35] You can come to the Convergence of Rebellious Midwives. Anyone can come there. That's August every year. And you can go to my website, melaniethemidwife.com to find information about that.
[01:16:48] And if you just love the podcast, there is an option to be part of the premium hub, which has a little bit extra in there. You can ask me questions in there.
[01:16:59] There's some extra resources around the topics of the podcast, and it's just a way to financially support the podcast, to keep going. And we've got some great, beautiful merch that you can buy.
[01:17:11] You can join the mailing list. Anything that kind of throws you support behind this, give the podcast a review.
[01:17:18] You know, all these things just kind of keep momentum on the podcast and on resources. And so I guess if people love what I'm putting out, then somehow throw some resources in the pot.
[01:17:34] Either your time in doing a review or a few dollars in joining the hub or buying some merch and then, yeah, we'll get there. Slowly, slowly.
[01:17:43] : Yeah. Well, speaking of the merch, I went to order something and it's like twice as Expensive just to have it shipped over here.
[01:17:52] : So we're coming up with a solution. I know because the warehouse that sends it is Australian and I don't have. So we have a place that warehouses it and sends all of our merch.
[01:18:04] And they said, then they told me the international shipping. I was mortified. But it's out of my hands. So actually my assistant lives in the US So we're working. Yes.
[01:18:16] So we're working out a way to ship her like a bulk, bulk produce, bulk products and then she can post from the US but we're yet to set that up.
[01:18:28] But you're right, the US Postage, international postage is too much.
[01:18:35] If, if you did a bulk order, like if you got 10 people to go in, you know, you could share the cost 10 Ways of the postage and it would be okay.
[01:18:44] But I, I totally hear you. We're trying to come up with a solution.
[01:18:48] : I think the solution of sending Julia a bunch is perfect. I'll be one of the first to order.
[01:18:56] Thank you, Melanie. I appreciate all your time and all your effort and all your energy and just you a.
[01:19:03] : Thanks, babe. Yeah, we got to stick together, I think. Big job.
[01:19:09] : Exactly. Tribe, gather your tribe.
[01:19:12] : Gather the tribe.
[01:19:17] : Thank you for listening through to the end. I do hope you found good medicine in today's episode and that it encourages your own soul evolution. I have a few new offers, both in person and virtual, that I'd like to tell you about.
[01:19:34] Beginning in January, I will host a free in person perinatal women's circle for anyone trying to conceive, pregnant or postpartum, seeking community and support. There will be a focus on preparing for natural birth and healing from birth trauma.
[01:19:53] Children are welcome. You can sign up via my website.
[01:19:57] I also now offer a monthly online virtual village circle for families seeking an empowering physiological conception, pregnancy, labor, birth and postpartum. It's just $10 a month or free when you purchase my online course.
[01:20:15] So you want home birth? You can gain access by signing up via my website.
[01:20:21] As always, I host women's circles once a month at my home in southern Maine. All women are welcome. For details, go to my website.
[01:20:32] I have 20 years of experience in the medicalized system. I let my nursing license expire in 2023, and now I walk with women seeking a physiological, instinctual and deeply spiritual conception, pregnancy, labor, birth and postpartum journey.
[01:20:51] I help prepare and repair for the most expansive rite of passage that women get to experience in this lifetime. It is my greatest honor and sole mission to hold sacred space and witness women as they claim their own inner authority, authority and power.
[01:21:11] I am a fierce advocate and guardian of natural birth using the culmination of my life's experiences including my own embodied wisdom when it comes to being a home birthing mother, nearly two decades of experience in our healthcare system and a year long sacred birth worker mentorship with Anna the Spiritual Midwich.
[01:21:35] I support births with or without a licensed provider present at home birth centers and the hospital.
[01:21:44] I offer birth debriefing and integration sessions for women, their families and birth workers.
[01:21:51] I offer therapeutic one to one sessions, individually tailored mother blessings, closing of the bones and fear and trauma release ceremonies.
[01:22:02] If any or all of this resonates, I offer a free 30 minute discovery call if you have a birth story to share or if you're a embodied wise woman, witch healer, medicine woman.
[01:22:17] : I am also interested in sharing your.
[01:22:20] : Contribution to our soul evolution.
[01:22:23] You can book in via the link in the show notes.
[01:22:27] Thank you so much for your love and support everyone. Until next time, take really good care.
