This week we look at postpartum mood disorders, get a little personal, and push through some tough stuff.

There are two things I’ve found studying postpartum mood disorders:

* They are wildly understudied and not talked about nearly enough. Postpartum anxiety and rage in particular are never discussed.

* There are so many social things we can do to mitigate ppmd. Better maternity leave, prenatal care, postpartum care, better treatment in childbirth, stronger social ties, walkable communities, and so on.

Transcript below:

Hello and welcome back to Birthzillas! This week we’ll be talking about postpartum mood disorders, and it’s really important to remind you that I’m not that kind of doctor. If any of what we talk about today brings up some tough stuff for you, please make sure you check in with a trusted health professional and reach out where you can for support.

We’re looking at mood disorders this week because conversations about “the Baby Blues” and postpartum depression really don’t cover enough of what is going on for parents. We’re going to talk about the difference between Baby Blues and PPD, but also postpartum rage and anxiety as well as postpartum psychosis. Not exactly a light-hearted episode, but, let’s go!

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When we’re talking about postpartum mood disorders, the postpartum period is usually considered immediately after and up to a year after birth. It’s difficult to compare accurately across countries because some count the time frame as only a few months, but we’ll stick with primarily a US context, so it’s 12 months post birth.

One thing few people tell you about it the hormone dump in the immediacy after the baby is born. Within the first 24-48 hours there is a major dump of estrogen and progesterone in your body. This can mess with your “happy” neurotransmitters like serotonin and dopamine and it can really push your hormones to the edge. For some people, including me, this results in dizziness and shaking. I was sweating through multiple shirts a night and shaking uncontrollably. It was awful.

But for some people this is the beginning of what they call the “baby blues” which happens to about 85% of new mothers. It can result in fatigue, crying, and generalized mood swings. For many people, this is where it stops and people start to climb out of that.

For some, however, it leads to larger postpartum mood disorders. The most common one we know about is postpartum depression. If you have some kind of anxiety or depression or mood disorder, you’re more likely to develop PPD. PPD affects between 10 and 20% (but remember, these are soft numbers) of new parents.

Then there is postpartum anxiety. This affects

Postpartum psychosis is by far the most concerning, affecting around 1% of people. PPP is likely what you’re seeing when you hear those stories of people hurting their children. PPP is marked by things like hearing voices, confusion, hallucinations, disassociating, missing time, lack of consciousness, etc.

Why are we talking about these things?

Well, part of the politics of childbirth puts us in a spot where too many people lack a community of care. The idea that it takes a village to raise a child sometimes gets derided in the media or oversimplified. But the reality is, it takes a community to care for all of us. Children, babies, and the elderly can be uniquely vulnerable to social isolation, but new moms can too.

I wrote a book (as yet unpublished if there are any agents listening in) which is a dark comedy about a woman who goes a little bit crazy with her mal-adaptive daydreaming. She jumps down the social media rabbit hole and really thinks she shares a special connection with her celebrity crush? Why? Because she’s stuck at home with a new baby and is basically in solitary confinement for hours out of the day because she has no community of support. She can’t go outside since there are not sidewalks for her to stroll her baby on, and she doesn’t know that she needs help because she’s never experienced this before.

When I tell other moms about this, they lament that it isn’t published (me too, but for different reasons). They see themselves represented in a way that new moms too often aren’t: as prisoners of a system in which they don’t even know they’re prisoners.

Out modern isolation in rural and suburban areas makes connections hard. In cities, finding people can be easy but getting to places can be hard with poor public transit and a lack of walkable areas. This means moms who need to see other moms might not do so.

Plus, if moms are also having to go back to work because (remember our episode on maternity leave) they don’t have proper leave policies, can’t affoard to stay home, or don’t want to miss career opportunities from taking time off, that makes all of this harder. Most kid activities are during the day, mornings especially (which made it tough for me and my night owl), and moms who work during the day outside the home are already exhausted and feeling like they want to be with their babies, so there’s no time for connection.

There’s no time for connection. I’m saying that again because it’s important.

Some parents are able to recognize when they have postpartum depression, but many are not. Having connections can help you. I remember when I was so exhausted with my colicky little screecher baby. I posted something on Facebook and my friend Amy just somehow knew I was in dire need of help. She showed up at my house, told me to go sleep, and became known as “the baby whisperer” because the kid finally stopped crying. Shortly after that, my grandmother started coming over to help. But I just remember at first feeling so completely alone even though I had this new (very loud) person stuck to me 24/7.

Many moms don’t have a grandmother who can come help. Or friends who will, especially if you’re not having kids at the same time as your friend group.

It gets even more difficult to understand when you need help if you have a lesser talked about issue like postpartum rage or postpartum anxiety.

It’s normal to be somewhat anxious as a new parent, especially if you’re in a group that’s already under attack (for example, LGBTQIA parents are facing a lot of political and social hatred right now, including an absolute trashcan of a person asking the Supreme Court to overturn marriage equality). In times like now, where there are real reasons for everyone to be anxious, it can be very difficult to tell when you have postpartum anxiety, especially if you (like about half of new parents don’t know it exists). Postpartum anxiety is marked by excessive anxiety (not just nervousness) related to your new baby and your role as a parent. This can include feeling restless, lack of sleeping, and actual panic attacks.

Moms can drive themselves actually sick with too much of this, including psychical symptoms such as headaches, teeth grinding (which can mask as migraines by the pain occurs along your jaw/neck), headaches, and so on.

Postpartum rage is another under discussed area. This one is tough because there’s so much shame around it. Women are taught not to be angry, and having uncontrollable anger when you have a newborn is so shameful. This happened to me, and if there is a Bad Place, that’s where I’ll be dropped if I go there. I remember feeling like every day was a struggle to control my anger, and it was terrifying. I confided this to a friend and she told me, with a ton of relief that I wasn’t going to judge her, that she had to put her son down in his crib and do punch and scream into a pillow because she was just so angry she didn’t know what to do and was afraid of hurting him.

And here’s the thing. Postpartum mood disorders make you afraid because you don’t want to hurt your baby or yourself, but there are chemical and other imbalances going on in your body that are changing your behavior.

Without someone there to help you recognize it and guide you towards help, you can feel absolutely lost in the woods. This can lead to long-term psychological and physical damage to your own body, strain on your relationships including with your partner, and harm of your child or children.

What I’m saying is two things: 1. Check on your friends who just had kids, 2. If you just had a kid and any of this sounds familiar, reach out to a trusted medical profession to get some help. It does get better. The deep dark of isolation or the grey horror of depression can end. It can take time to figure out how to get through it, and it helps to have help.

I know some moms are worried they will lose their babies if they seek help, and I hate that this is something parents have to worry about. Social workers are trained to help you in this, as are most psychologists. Getting help shows that you are aware of the issues and that you want to protect your baby. It’s okay to reach out.

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But I see by that clock on the wall, it’s time to wrap it up.

School is starting for my kids at the end of this month and listenership has been dropping off, so Birthzillas is going to be moving towards a bit of a different model.

I’ll be keeping an eye on birth and birth related laws in the news and send you out a weekly explainer about what it is and what’s going on.

We’ll be releasing a second podcast called The Civic Flame in Septermber (on Constitution Day!) that covers some basics about the US Constitution and what it means (in case you missed civics class!).

Until then, check in on each other, check in on yourself, and try to hold space for everyone who needs it (including you!).

Take care of yourself and each other!

This is going to get complicated, and I’ll try to explain it the best I can. I apologize to everyone involved if I pronounce your names incorrectly, my Danish is non-existent, so I’m doing my best.

Let’s go!

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As I talked about last time with Dr Breisacher, I work in reproductive justice research, not just reproductive rights. What’s the difference? Well, reproductive justice was founded by about 13 Back women who wanted to include all aspects of the reproductive journey and not just abortion/contraception. When other women (yes, white liberals) ignored them, they just went out and started a movement and scholarly stream that said: you should be allowed to not be pregnant, but that you should also be allowed to BE pregnant AND to raise your children in a safe environment.

Why the addition? Because for white women, especially non-poor white women, the struggle has been to not be pregnant when they don’t want to. So, abortion, contraception, and making marital rape a crime. These are all good goals, but they also ignore what non-white women and a lot of poor white women have also faced: not being allowed to have children or not being allowed to keep children.

There is a history of reproductive coercion in the form of forced mandatory sterilization (from hysterectomies to “tubes tied” to experiments with long-term birth control without consent). There’s a documentary called L’Operation which centers the US government’s deliberate involvement in a plan to sterilize (often without their consent) a massive portion of women in Puerto Rico. The numbers are see are that in the ‘70s, 30-35% of Puerto Rican women were permanently sterilized, again, many without consent.

This isn’t the distant past, either. While Black women were used as slave-producers and had their children stolen from them, once those children were no longer profits for rich, white folks, Black women became the targets of campaigns to forcibly sterilize them. Hysterectomies became so common they were called the “Mississippi appendectomy.” In Becker’s new book the Politics of Hysterectomy, she talks about how even today when dealing with reproductive issues white women and Asian women tend to have to fight for hysterectomy while Black and Latine women are offered, encouraged, and coerced into them.

And let’s not forget the doctor during the Trump 1 ICE detainments who was known as “the uterus collector” who forced permanent sterilization onto people who could not give full consent.

So, like, the ability to keep your ability to have kids is a deeply political and historically rooted issue.

What about the third thing? The ability to keep and raise children in a safe environment? Well, as Dr. Breisacher and I discussed, taking children away from their families and giving them to other families to erase their identity is cultural genocide. This is something that is currently happening in Ukraine with hundreds of children missing (or as it’s actually known, being trafficked) and showing up on Russian adoption websites.

These laws come from the global attacks on indigenous people in dang near every country where indigenous people lived. The US, Canada, and Australia, in particular have finally been open about their truly horrible histories of native children removal. (but we’ll circle back to this)

In the US it wasn’t just Native American schools (where white people would take children from indigenous families and torture them and otherwise try to break their spirits). It goes back again to slavery. Black women were raped and forced to have children and then those children were stolen from them and sold to other people. It’s still unclear to me why slavery isn’t considered genocide. Like, is it because we wanted to work them to death before they died?

But this goes into a long history of snatching people’s kids.

Now for the main issue of our story. Ivana Nikoline Brønlund, a young Greenlandic mother (and if you don’t know, Greenlanders are indigenous people, though Greenland is part of the Kingdom of Denmark even though it is a self-governing land since 2009.

Why does this matter? Well, Ivana is Greenlandic, born to Greenlandic parents. The history of indigenous erasure. This kind of racism and supremacy is not something you get rid of with a policy, and sure enough, despite (as reported) going through multiple conversation before her child was born, she was still forced to endure the torture of newborn separation.

So, what’s up with these parental competency tests? Well, they are meant to measure competency, but not like we think of it with say, early parenting classes. This isn’t really about “how do you change a diaper” or “how to breastfeed,” but it’s more a psychological test. What’s the problem? Tanya Dutt of Health and Me.com describes elements of the test: “The test assessed parents in a series of areas, such as their responses to imagined scenarios, self-concept, physical and mental well-being, outlook on life, and plans for the future. Most importantly, it was based on Western conception of good parenthood and delivered in Danish, with minimal attention to Greenlandic language, customs, or kinship systems. This incompatibility resulted in regular misinterpretations of the capacity of Greenlandic parents and sometimes led to children being taken from their parents.” Around 1% of Danish cases result in child removal. But when you study Greenlandic families, the cases rise to 5-7%. That is a large difference.

In fact, in both 2022 and 2023, not only Danish Human Rights groups, but the United Nations found this test to be culturally bias. This resulted in the test NOT being applied to Greenlandic parents, like Ivana.

Ivanna was told she “wasn’t Greenlandic enough” for the exception to count for her. Instead of going for some low intervention help, the Danish government chose to remove the child at one-hour old. If you know anything about child development, the first 24 hours are known as “the Golden Hours” because there are a host of emotional and developmental impacts of parent-child bonding that go on. This is why skin-to-skin contact with both parents, but especially the gestational parent—is seen as vital to infant wellness during these first hours. Not only was Ivana Denied this, but her baby was too. This could actually leave lasting trauma on the child. And will almost certainly lead to lasting trauma on the part of the mother.

It's so distressing to see this kind of racist separation being played out in this day and age. Really, any time is bad, but we know so much about how flawed and problematic this test was that the government claims to have stopped doing it. Unfortunately, that’s not been the case.

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While it was nice to focus on a policy outside the US that sucks, it’s time to wrap up for the day. Keep your eye on the news and see what happens with this case. In the meantime, think about how these legacies of child separation still shape policy today. In the US this is a major problem with social services and protocols for family separation.

Next week, we’ll be back with whatever fresh hell I can find for you. Until then, take care of yourselves, and each other!

Fortunately, public health, reproductive justice, legal and social movements around the world, and increasingly OBGYNs are not as stuck on a patriarchal relationship with liberalism and institutions like mainstream political science is. So, I’ve both qualitative and quantitative stuff to share with you below.

As always, when we talk through the tough stuff, take care with your health and step away if you need to.

Take care out there! Transcript below.

Hello, and Welcome back to Birthzillas, The Podcast! I’m your host, Amber Vayo, and this week I’m sliding into your play list just to totally depress and enrage you. You’re welcome. But seriously, this week we’re going to get into some of the parts of birth we don’t talk about, in fact, when I’ve talked about half the time I’m looked at like I’m completely nuts. We’re going to talk about birth trauma.

Over the weekend I saw an article about women being traumatized in labor and delivery. Then last week on LinkedIn, I saw a post that someone had started researching rates of PTSD that stem from birth. Because this is an important (and understudied area), I thought I’d bring it to yoru attention. But also since it’s something that is often silenced, I hope that if this resonates with you, you fell a little less crazy!

Let’s go!

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What is Birth Trauma

What do I mean when I say “birth trauma?” Interestingly, if you google it, you’ll usually get articles about babies who have been hurt during birth. But what we’re looking at is the role of moms.

My most recent article, published with Law & Policy is about people’s experiences during childbirth and how they can lead to PPD and PTSD. During my interviews, I’ve had mothers break down in tears recounting their experiences. Other mothers have decided not to have more kids just because they didn’t want to relive the treatment they experienced at the hospital.

Birth trauma is associated with what’s called voluntary infertility: when people who can have more children choose not to.

One such story was of a woman who gave birth in central Massachusetts. Between the pushing and being forced to lay on her back in labor (which has actual health problems and is counter to the natural way your body wants to push—you know, down). She fractured her tailbone. She also believes this herniated her disc. It took months for the hospital to take her pain seriously as something other than “oh, that’s just postpartum pain.” One of her husband’s colleagues, a doctor who worked at that hospital said, “if you love your wife, take her to another hospital.”

This woman was so upset because she had wanted to have a big family and felt like she couldn’t because there was nowhere safe to give birth.

But also, we have to consider the implications that she wasn’t in enough pain (something that several people told me nurses actually said to them when judging how far along their labor was!). Women’s pain is so often ignored. Women are far more likely than men to be diagnosed with mental health issues that later turn out to be actual physical issues than men. Women are overprescribed anxiety medication when they complain about symptoms.

Twilight Sleep and the Drug Use in the “good old days”

The “mother’s little helper” ideology from the 1950s when women were alcoholics, abusing prescriptions tranquilizers, or being given literal lobotomies, is not as far away as we like to think.

My grandmother was given something called “Twilight Sleep” which is a mixture of two drugs: one that makes you forget or hallucinate and one that is supposed to be for pain. In the 1950s there was an article about this called “Cruelty on the maternity ward” because so many women, when they could remember what happened, were having nightmares about it. Other women came out of the drugs with mysterious bruises and no recollection of what happened.

A nurse said that it was so ubiquitous that the first time she even considered it might be a problem was when a woman came in so far along that she delivered her baby in the hallway on the gurney. The baby was pink and happy and not blue and lethargic like the Twilight Sleep babies.

Couple of things here. Women were being drugged into literally not knowing what happened. Few people seemed to consider this a problem. The first sign of real trouble was when someone (finally) considered that this might affect the baby. Overall, it showcases that we have some serious problems with how we think about birth and who gives it.

Kimberly Turbin and Obstetric Violence

In more modern cases you see issues like Kimberly Turbin who caught her doctor on camera cutting her while she screamed for him to stop. The doctor responded with “what do you mean why? I’m the expert here.” Which was ironic since the episiotomy he was doing is not recommended procedure.

I talked to a doctor who gave birth at her own hospital. She referred to her treatment as obstetric violence. Her doctors wouldn’t let her put her leg down, even though they knew she had hip problems. They twisted her body and held her down to the point where both she and her husband had nightmares from the experiences. Fun fact: I have discussed this before and there’s always at least one person who chimes in with “well, we don’t know what was going on…and what about the baby?”

Even if we stipulate that this kind of treatment was acceptable, the fact that no one explained it to the patient (in this case a doctor herself), means that it’s still on the hospital for traumatizing the patient.

Ultimately, this shouldn’t be the most controversial thing I talk about, but people hate trusting women when they say someone hurt them (just look at, you know, everything). And when it comes to women saying “a doctor hurt me and even though I was pregnant, I should have been treated like a person” people lose their damn minds.

Mothers are afraid of having their babies taken away if they complain

There is also the trauma of child and family services. I talked to a mom who was so ashamed of being accused of drug use and having a note on her file that said to call DCF (department of child and family services) that she decided to stop having kids even though she wanted more.

And what did an article on CBS News just say? That there is even more evidence (there was always evidence) that these drug tests are not accurate. Imagine the trauma to the baby, the mother, and the family of removing a newborn from its parents because of a faulty drug test?

Imagine being told that mommy is going to the hospital to have a baby. But mommy comes home without the baby and freaking out because the police took the baby for no reason. Now you have a mom traumatized. You have a dad traumatized both because his kid got taken away and because he feels like he can’t protect his wife and family. You’ve got kids traumatized because they realize the the government can come take them away for no reason and there’s nothing mom and dad can do about it.

That kind of stuff leaves a legacy of mistrust, trauma, and pain. All because fool government policies and cheap hospital tests. That’s insane and immensely traumatic.

My own ridiculous birth story

One of the reasons I wanted to give birth with my first daughter at home was because I didn’t trust hospitals. But my midwife, after 17 hours said it was time to go to the hospital. So we did. And the first staff there were really nice. But after an hour, the shift changed, and the night crew sucked. The doctor talked smack about me when she thought I couldn’t hear her. They said I hadn’t been in labor long enough because it was only 2 hours (because that’s how long I was there).

They told me I was having contractions because the machine readout said I was (I wasn’t). They didn’t believe me when the epidural didn’t work. And finally, just to get the hell out of there I “elected” to have a cesarean (and this is why we should all be skeptical about the number of “elective” cesareans…because a lot of those are not truly a free choice).

TO get permission to give a me c-section, a male doctor I didn’t know, walked in, didn’t even talk to me, stuck his fingers in my vagina and walked out.

They were going to start the c-section because I had the epidural despite me telling them it didn’t work, Fortunately, my doctor believed me because he poked me to test the epidural and found out that it really hadn’t worked.

A news article I read, and at least 12 people I have talked to, felt all or some part of the first few cuts of their cesarean. Another news article pointed out how many women felt their organs being moved around even if they didn’t feel the pain.

I was cut incorrectly and lost two litres of blood and went into shock. Which no one told me, but I figured out when my teeth were literally cracking from grinding them out of shock.

And I consider my birth experience far less traumatic than most of those I’ve heard about.

Did you see the CDC report that the US birth rate is at its lowest? Wonder why?

There’s economic, political, and environmental reasons that make the idea of children a total turn off. But there’s also the ever-increasing body of knowledge that shows women are in danger. It’s like Whoopi Goldberg in Ghost: you in danger, girl!

If it’s not the maternal mortality crisis, it’s physical trauma. If it’s not physical trauma, it’s emotional trauma. It’s getting your kid taken by DCF. It’s having a strange man shove his fingers in your vagina. It’s being told you don’t know what you are feeling in your own body as you are feeling it.

And still there are grown women who will argue and try to carry water for this catastrophically broken system. But not on this show.

Birth trauma is real, and it is incredibly harmful to families. More than that, birth trauma leads to lingering medical mistrust that ripples throughout the rest of people’s lives. Birth trauma is not only a reflection of medical misogyny and racism and a broken health system, but the inciting incident in a public health crisis in many communities.

Research around the world has shown that people who mistrust medical systems don’t receive follow-up care, fall victim to anti-science expertise, and so on. It’s bad medicine, it’s bad business, it’s bad for people, and yet it persists in ways big and small.

Lack of Consent in most maternity wards

For many parents the trauma came in the form of being forced to have IVs they wanted to being refused food and water for over 20 hours. But for others it was being held down, it was being forced or coerced into interventions (including cesareans) they didn’t want, it was they way people spoke to them. One Black mom I spoke to was told immediately after her doctor repaired a tear from her episiotomy, “you have to have all c sections from now on” and then the doctor just left. She had no idea why he said that or what was going on. She was worried that she had been given the “husband stitch” which some people say is a myth, but there’s reason to believe it is not, where you are given an extra “stitch” in your vagina to make it tighter for your husband’s sexual pleasure. This is incredibly harmful physically but also deeply unhygienic and potentially disastrous for your health (and remember folks, the idea of “lose” vaginas has no basis in society and only exists in the minds of men who think their penises are so important that they change our very physiology). Or, in the words of my boy George Carlin: “It’s bull s**t and it’s bad for ya.”

These cultural myths of dangerous practices have roots in reality. Just as cultural fear of birth has roots in reality. I have problems telling people to just not feel afraid, because there are red flags they should be apprehensive about.

US maternity care is not evidence-based, it’s actually against a lot of evidence

Some of those red flags include: difficulty finding your hospital’s policies online (including grievance policy), doctors and nurses who do not take your questions serious, care providers who simply say “no” without giving a reason, people who treat you rudely and unprofessionally, hospitals with really low rates of vaginal birth, and so on. Most states will or consumer agencies will have some information on the level of intervention in your hospital. You should be able to ask about the patient-to-doctor ratio, see if there are midwives as well.

One thing to remember when looking up rates, though, is if your hospital has a NICU, it means they deal with a lot of higher risk births. That means their c-section rates are going to be higher. That’s not necessarily a problem, so you need to use a few different metrics to make your judgement call, not just one. Previously, I’d suggest asking community members on social media, but as more and more of the internet is taken over by bots, we are approaching the ‘dead internet” timeline where a lot of comments sections are actually bots talking to bots, so there’s no real help there. Overall, try to find real live humans you can ask and get a few different ideas about what’s going on. Parenting and pre-natal classes can be a really useful place for this and help you build a community of support for when baby comes. Prenatal yoga and exercise classes can also work (if you’re not doing prenatal classes, which you really should do). There are lots of ways to look at what’s out there, but for some people, you might not have a choice about yoru hospital. In that case, I suggest asking yourself what information you will need to feel safe, and practicing asking questions about that. For instance, if someone says you need an IV or fetal monitoring, what information do you need to feel ok with that? Now work backwards and figure out what questions you need to ask to get the information.

(Transition music)

I see by that mean old clock that it’s time to go. This week, the call for action is as simple and as hard as this: listen to and believe women! And when someone doesn’t believe you, call them out on it.

We’ll be back next week in our quest to demystify the tough stuff by talking about postpartum mood disorders, it’s more than just postpartum depression.

Until then, take care of yourselves and each other!

Transcript below:

Episode 3: Fertility

Hello, and welcome back to Birthzillas! We’re rolling right along in season 2, and it looks like the “heat bubble might have finally burst,” so it’s a bit cooler in the studio than it has been. (The studio is my office, which is cool, but I’m trying to make it sound cooler).

This week on birthzillas we’re going to talk about how to get to the birth part. No, not the sex. If you want the sex talk, there’s a Salt N’ Peppa song from the ‘90s that’s got you covered. Although, I did consider being a sex ed teacher, but my tween has assured me that the ground will literally swallow her whole if I come in to her school talking about condoms and STIs. So, I’ll keep that in my back pocket in case she bugs me.

This week, we’re talking about fertility, and in particular fertility issues. Why? Because there’s so much isolation and shame out there I want to talk about the commonality of fertility issue and hopefully help some people remember that just because it sucks doesn’t mean you need to feel shame over it,

Let’s go!

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So, there are several key fertility issues that come up a lot. One if infertility, and I want to talk about this because there is some confusion between infertility and sterility. But I figure we might need a quick rundown of the conception process to make sure we’re all on the same page. The basic version: during ovulation, the ovary releases the egg. The egg travels into the Fallopian tube towards the uterus. If the egg meets sperm, it gets fertilized in the Fallopian tubes becoming a zygote, and continues dividing into multiple cells forming a blastocyst and snuggling itself right up in the endometrial lining of your uterus.

Now there’s some longstanding myths about this process. One of my favorites is the idea of the “wandering womb.” This is the notion that women’s hormones are explained by the uterus moving around the body looking for a baby. This was popularized in ancient Greece and lasted until well into the 18th century, though there were people who believed it well into the 20th century. (maybe Plato should have stuck to outlining the Republic and left the reproductive stuff to surgeons like Greek and Roman surgeon Galen who was like, just because it’s the 100s CE doesn’t mean we have to believe in wandering wombs.

In western medicine the idea gradually became that men shot tiny babies into women (who were functionally wombs on legs). This idea continues today in many ways in our misunderstanding of what the role of sperm and egg are. It also continues politically with multiple politicians referring to women as “hosts” (both male and female, because remember folks: trash men would not exist if trash women didn’t support their bull s**t). There are a lot of damn fool women, especially the Trad Wive crowds who insist online that they don’t “build the baby or make the baby, I’m just a vessel for the baby.” But we’re not going to get too into that because my whole brain will just explode right here and you’ll end up with no podcast.

So, why do I say the baby cannon ideology still persists? Because we still think of sperm as these straight shooting racers who charge to the passive little eggs and fertilize it. But over the past decade, scientists have discovered that that’s just not true (yet, we don’t talk about it because it’s too feminist). What really happens is that there is, surprise-surprise, some mutual work between a sperm that kind of corkscrews around and an egg that can move towards sperm it wants. Certain sperm make it farther than others, and the egg releases a scilla, kind of like a hair, to help grab the sperm it wants, and then once it finds on it likes, it secretes a chemical to help pull the sperm into the eggs (there’s more on this, if you Google (and I love this) “cryptic female choice” not only will you feel bad-ass, but you’ll learn all about the silent feminist revolution in understanding.

I should also point out that the idea that women have a shelf life of fertility and men don’t, has also been shown to be nonsense. Sperm degrades over time. As men get older their sperm changes in sperm count, in shape (morphology), mobility and its ability to get anywhere, and increased potential for DNA fragmentation. (So, all the 50 year old guys online fetishizing getting 15-17 year old children pregnant, should not only be institutionalized but don’t realize the limits of their own fertility….don’t be like them).

So, now that we’ve got that out of the way, what happens when it doesn’t go according to plan? Then you have a fertility issue. Typically, a fertility problem is diagnosed after one year of heterosexual intercourse without birth control that does not result in a pregnancy. Sometimes if you’re over 30 and trying to conceive, your doctor will knock that down to six months. These appear in two broad categories: sterility and infertility.

Sterility is means no conception can happen. This can occur naturally or because there has been some kind of surgery (like a hysterectomy). Infertility means that you can conceive (even if it is difficult) but that there is some problem carrying a child to term.

There are also primary and secondary infertility. Primary infertility is when you’ve got an issue right out of the gate. Secondary is when you have completed a pregnancy to term but are having trouble with follow-up pregnancies. This one is not talked about a lot because, as people say, “well, you already have one baby….” Which is a lousy thing to say to a parent who wants a bigger family and is dealing with secondary infertility. So, don’t say that.

As I often say, I’m not that kind of doctor, so if you need a diagnosis about your fertility or you want to learn the ins-and-outs of IVF (in-vitro fertilization) or other fertility pathways, talk to a trusted medical professional. If you can’t do that right now, start with some good sources online like the Mayo Clinic, Brigham and Women’s hospital website, and so forth. What I want to talk about with IVF is the personal and policy sides.

In my 100 plus interviews for my dissertation, I talked to about 20 people who had gone through IVF. Every one of them talked about guilt. I didn’t ask them about guilt, but they talked about it. They talked about guilt that they “couldn’t” get pregnant and needed IVF, they talked about guilt when they saw a pregnant lady and felt jealous, they talked about guilt when they were the pregnant lady and other people were not. It just seemed like a ton of guilt.

I hope that if anyone going through or thinking of IVF right now hears this, that they can put down some of that guilt. There’s no shame in needing or wanting help in this area. There’s not shame in having a successful pregnancy even when someone else can’t. Our bodies are deeply annoying sometimes and they do what they’re going to do. We can’t always control that.

IVF is a physically and economically stressful situation as it is. Parents have talked to me about the havoc the IVF hormones released on them. One kept saying “and I was arguing with my wife, and I felt so bad because I didn’t want to be arguing, but I couldn’t control the hormones!”

Others talked about their feelings of being judged for wanting a medicalized birth (like wanting a c-section and wanting all the tests and wanting all the monitoring).

Others talked about the grief of miscarriages (which we’ll get to in a minute).

Many talked about the money aspect of it. And we want to being it back to law and politics, as this podcast does, because it is important to note that a lot of IVF is available to heterosexual couples but no LGBTQ couples. But then there is the money that it costs. Insurance companies are hit or miss whether they cover it, and different states have different rules.

With laws as they look now, there are questions how much IVF is going to be allowed. The nonsense ideology that embryos are people will have dramatic consequences for IVF sooner or later.

And one of the biggest health issues and stress issues comes from fear of or history of miscarriage.

Between ten and forty percent of pregnancies end in miscarriage, depending on your age. For many people this results in a chemical miscarriage happening before they even know they are pregnant.

Other folks have to have what is an abortion to help complete the miscarriage (so they don’t die from sepsis or something else). Things like ectopic pregnancies which happen when that fertilized egg gets stuck in the Fallopian tube and grows there risking exploding the tube happen early on. A few years ago, politicians re-traumatized a bunch of women by convincing them that you could save an ectopic pregnancy and didn’t need surgery. You can’t. That’s just politicians trying to convince people that abortion is not health care (which it is. In fact, I have multiple friends who would be dead if they didn’t have access to abortion. It is health care).

Most miscarriages happen in the first trimester, but later term miscarriages can happen and are incredibly dangerous. Again, this is where life-saving abortions take place.

Miscarriage comes with a lot of emotional baggage as well as the physical baggage. Because so many miscarriages happen in the first trimester, a lot of people go through them alone. They don’t tell anyone they are pregnant because they’re afraid of miscarriage, then, if the miscarriage happens, they have no one to turn to because they didn’t tell anyone.

It gets harder for people with multiple miscarriages because they run the risk of telling people who won’t be supportive (a lot of people it turns out tell unsupportive parents of siblings).

The emotional drain of miscarriage, even without the unsupportive crowd, is intense. It goes back to similar guilt/shame constructs with IVF in general. I don’t know what to do to help people not feel guilty about this other than keep talking about it. Hopefully, knowing how common miscarriage is, how common fertility troubles are, how stressful IVF is, will help those experiencing it realize they are not the problem. It’s just hard some times. It just sucks sometimes. And sometimes, our bodies just do frustrating s**t.

(transition)

But I see by the clock that we’re over time for this episode. But you may be thinking, aside from abortion, how is this political and what can I do about it?

Well, first of all, paid leave for miscarriages, affordable and accessible IVF, and abortion policies are all political. How we treat women and the ways in which personal and family culture push women to feel like their only job in life is to reproduce (well, that’s political, and it contributes to the guilt that makes women feel like failures if they don’t reproduce).

What can you do about it?

Look up your states laws on IVF and paid medical leave.

Share content to increases awareness of fertility issues and de-stigmatize miscarriage and IVF

Support yourself and your friends who are going through tough times

If you can, donate to Planned Parenthood or other organizations dedicated to actual reproductive health

(outro)

Next week, we’ll return talking about birth and the role of birth trauma.

Until then, take care of yourself and each other!

Transcript below:

Episode 3: Maternity Leave

Hello, and welcome back to birthzillas: the Podcast. I’m your host, not-that-kind-of-doctor Amber Vayo. Last week we talked about the politics of childbirth, and this week we’re going to kick off our newest stuff by talking about one of the most clearly political things about childbirth: maternity leave. Or rather, the complete lack of it in the United States compared to everywhere else in the world.

So, zip up your angry trousers because this one is a doozy. Let’s go!

(transition)

Fun fact: most reputable dog breeders won’t give you a puppy until it’s 8-12 weeks old. It is considered developmentally problematic and cruel to separate mom and pup before then. Too bad human parents aren’t given the same consideration.

The United States actually has no particular maternity leave policy. The federal Family and Medical Leave Act (FMLA) does allow up to 12 weeks maternity leave under certain circumstances, but most of the time it is up to your employer or your state.

Consider this in light of the maternal mortality crisis in the US: over ½ of maternal mortality happens after people leave the hospital. With proper maternity leave to rest, heal, and go to follow-up medical appointments, The American Medical Women’s Association, among other medical organizations, has shown that maternity leave can decrease maternal death.

Multiple medical journals have reported on the ways in which maternity leave decreases maternal mental health issues, including postpartum depression and anxiety.

For more on this I highly recommend the National Partnership for Women and Families website. They have a great, short PDF that includes lost of fun data. Including that every week of paid maternity leave decreases maternal stress and anxiety.

Other reasons for paid maternity leave (and here’s the thing, if it’s unpaid maternity leave, then a majority of women just cannot afford it). Paid maternity leave decreases rates of intimate partner violence. Remember that, according to the American College of Obstetricians and Gynecologists, when it comes to intimate partner violence, 1 in 6 people first experience it in pregnancy and immediately afterwards. That means that when they are physically, emotionally, and economically the most vulnerable, their partners choose to hurt them. One in four women and one in seven men are victims of intimate partner violence.

According to Sanctuary for Families, a study of intimate partner violence in 25 high income countries, the US accounts for 70% of all femicides—murders of women. Major anti-domestic violence organizations report that men beat women on average of one every nine seconds in the US and men kill about two women every week,.

“Why doesn’t she just leave” does not work as an excuse when you’re talking about pregnant or postpartum women who are economically and physically vulnerable. Where are they going to go? Financial support in the form of paid maternity leave can help ease some of this burden by giving women a way out of a dangerous situation. (And if you’re the type of person that is thinking “well, that’s what they get for making bad choices and why should I support someone who stays with an abuser,” you can take that victim-blaming mentality and shove it up your own butt and do us all a favor and never voice your opinion again because I’m not here for that.)

The Journal of Women’s Health as well as several newspaper reports have shown that violence against women does drive up maternal mortality rates. Meaning that so many women are killed during this period that it is actually shaping a major health crisis. For this reason I get nervous about mandatory maternity leave (because I don’t want women stuck at home when that’s a dangerous place to be) but paid maternity leave it also essential. So, it’s a difficult needle to thread.

So, should it be mandatory?

One this we learned about the Affordable Care Act, including as @DearGirlFriday notes a lot of people didn’t know it was the same thing as ObamaCare, is that making it mandatory helped. Making it mandatory helped make businesses and government support it because people could not be coerced to opt out. And that’s the thing, right? Because if it is optional, employers can coerce women into “choosing” not to take it.

This is also part of why I think paid maternity leave should be part of a broader national public health policy and funded by state and federal government.

A Racial Component

There’s also a major racial component here. As the National Partnership for Women and Families reports, low-wage workers disproportionately are hurt by lack of maternity leave policies, and this is a lot of Latine and Black women. The racist structure of our economic system that keeps low wage workers in poverty and that hits Black and Latine families hardest is also replicated in

How do other countries do it?

Like everything else that’s broken in the US medical “care” system, we don’t have to reinvent the wheel to make a good system. We just have to look at the literal rest of the world. They have paid maternity leave, and functioning economic systems and freedom with civil liberties and all that. Basically all of the “if the government gives you maternity leave we won’t have freedom and we’ll all be broke” doesn’t hold water for two reasons: one because almost every country in the world has some form of paid maternity leave and they have functioning economies and rights. Also, given the state of the US right now we don’t have freedom and individual rights that we think we do, and the Big Beautiful Bill is going to make a lot of us broke (though, Republicans have scheduled it to take effect after the midterm elections so they can a) blame democrats if democrats win, and b) embrace their lack of accountability lifestyle).

So, how do other countries do it?

The Bipartisan policy Center reports that the US is one of only 8 countries in the world and the only OECD country to not have maternity leave. (For you non-nerds, OECD means Organisation for Economic Co-operation and Development. It was started in 1961 and represents 38 countries in basically a CO-OP to help each other economically and developmentally).

Not only do 37 out of 38 OECD countries offer paid maternity leave, but 26 of them offer some form of paid paternity leave (for dads). The UN Women’s rights studies have been saying for decades that women’s rights in the US have been lagging behind other OECD countries, and this is one of the things they talk about.

Most countries rely on some sort of social safety net program (like unemployment insurance or Medicaid that comes out of a general tax pool), although especially generous countries like Sweden rely on a mix of private and public funding from employer and government.

Why Can’t We have nice things?

There are a lot of socio-political reasons. One is, of course, the US attitude towards social safety nets. The hyperindividualized ideology that has tied itself to our particular brand of corrosive capitalism means that there are a lot of people who do not want to fund the programs that would back paid maternity leave. This also ties in with attitudes towards women and motherhood. There are a lot of people who are still living in the fantasy land where they think a household can be supported by one person and one person (usually mom) stays home with the kids. If you can and want to, great! But the reality is that most of us can’t sustain that long term, and a lot of women do not want to take years-long breaks from their careers (because the way employment works is that it punishes women for taking this time off).

So we need both social and political changes to make this happen. Will we do it? I don’t know. But the reality is that parents need and deserve support. Babies need healthy grownups around them; whether that is mom stays home on maternity leave or multi-generational families or licensed and safe childcare personnel. Babies need nurturing, but so do people who have just given birth. Next week we’re going to talk about this kind of leave for pregnancy loss as well because we’re going to get into miscarriage (I swear I’m not just picking topics that are meant to bum you out!).

(transition)

Until next time:

I see by the mean old clock that it’s time to pack it in for the day. Make sure you’re following us on Instagram or Facebook. We’re still not on Tik Tok because my brain is just not ready to learn a new platform. Check out our YouTube page. I’m continuing to learn how to make Whiteboard explainer and other videos.

Feel free to reach out and let me know if there’s anything you want to put on the schedule.

If you can, send an email to your state and federal representative in support of maternity leave policies.

And as always, take care of yourselves and each other!

(outro)

In this episode, we rehash the economic, health care, and power politics that shape childbirth in the US. Grab your stress blankie, and let’s go!

Transcript below

Hello and welcome back to Birthzillas! For those of you who are new here, welcome. For those who have been waiting for Season Two, thanks for the waiting and welcome back! As usual, I’m not-that-kind-of-doctor Amber Vayo.

There’s a lot going on here in birthzillas ville. I’m finishing my book Birthzillas and getting ready to send the completed manuscript to the University of Kansas by my November deadline. I got a full time job as a Visiting Assistant Professor at Worcester State University. And I’m building the Birthzillas media outreach. So, make sure you follow us on Instagram, Facebook, and/or YouTube.

This season we’ll be tackling a bunch of different stuff we’ll get into some tougher stuff in the prenatal phase (miscarriage, IVF), childbirth education and the decisions you’ll need to make in labor, and some important postpartum stuff (mood disorders, culture wars over feeding and diapers.

One of the things that’s important to me is getting information out to the people (hence why I’m a teacher!). I use Instagram for data graphics and some good quotes. My Facebook I use to share good posts I see on Facebook and help get through the bs of algorithms. My YouTube page is more for longer form stuff like book recommendations and (coming soon) explainer videos. So, whatever you’re looking for, we’ve got you covered.

We’re also still at birthzillas at gmail dot com. So, if there’s something you want to hear more about but don’t want to contact us through social media, then feel free to use email (it’s okay, I’m an Xennial, we’re totally fine with email).

And as we fade out, I want to thank my husband for being my sound guy and coming up with our very pubic-radio-esque intro and outro.

Today, we’re going to take a look at the politics of childbirth and what the heck that even means. We’ll end with some news about the YouTube page.

Let’s go!

Politics of Childbirth

Okay, so if you’ve seen my Instagram post you have a) see my poster of George Carlin that sits behind me when I record this, and b) know that some people have asked me why I’m being so political.

I mean, it’s kind of in the title. The Politics of childbirth. I’m a political science professor. I have a PhD in political science and law. I mean, it’s kind of my deal. But, as my friend over at the @DearGirlFriday podcast notes, it is really important that we abandon ideas that anything political means a partisan discussion (also, if you’re not getting the Friday brief, I highly recommend it. Super accessible and a short rundown that won’t make you want to build a bunker).

So, what do I mean when I say politics isn’t partisan? We’ve really been primed by the media and politicians to view every “political” think through a partisan lens (in other words, through a Democrat or Republican lens). This works great—if you’re a politician who doesn’t want to have to do any work.

Think about it. If politicians know we’re going to support whichever party has the letter we like best, then they don’t have to do their jobs. They just make sure they have the same letter as the majority amount of people in their district. No accountability for politicians because they never have to worry about facing real electoral consequences, which is evidence by our 80+% incumbency rate (meaning the person in office wins the election).

You know who this isn’t great for? Everybody else. When we only think of political issues as partisan issues, we are geared up to fight for our “team” no matter what the issue is. It turns off the thinking part of our brain and turns on the believing part of our brain. Not ideal for fixing problems.

So, when I talk about the politics of childbirth, I mean politics in the “who gets what, when, and how” kind of way. Politics is the study of who has power. Who makes decisions and who benefits or gets squeezed by those decisions?

The politics of childbirth isn’t some new, woke thing to just make one more thing political. Childbirth has always been political, and politics has always shaped childbirth.

History

In the US childbirth used to take place at home. Moving to the hospital and changing OBGYNs from midwives was actually NOT a health thing, it was an economics thing. Renee Cramer’s book Birthing a Movement, which I have a review for coming up on YouTube, does a great job explaining this.

But basically, the ABOG, what ACOG used to be called, established a propaganda department (yes, they called it that) to paint midwives as dirty, bad women. Episode 4 and 5 from season 1 covers a lot more of this, but basically it was both an anti-immigrant thing (Eastern European ladies weren’t considered White yet, so they got a lot of racism as immigrants) and money.

How do we know it was money? Because the OBGYNs got a law passed that they could be the only ones who could attend births. But when family doctors (all men) complained, they got let back in. Midwives (all women) who complained were criminalized.

These attitudes and criminalization still persist today. Maybe I’ll make up a YouTube Explainer, but every study I’ve read (and I’ve read dozens) representing thousands of births show that midwives have as good and usually better outcomes than OBGYNs. Not that there’s anything wrong with OBGYNs, it’s just hat midwives are trained to deal with “normal” birth and have fewer patients. OBGYNs are trained for surgical birth and have more patients at once. The structure creates conditions for what is happening.

Midwives are cheaper to patients, too, which could help some hospitals stay open, but because the US laws require OBGYNs to supervise midwives, it is not cheaper for the hospital. Homebirth midwives are a whole other kettle of fish (as my friend Sharon says, which I don’t get).

Economics

The economic aspect is another way that birth is political. It costs so much money to give birth in the US compared to everywhere else, where it is usually free.

But also, economics can determine not only where, but how you give birth. If your hospital closes due to a lack of funding, you have no choice. You live in what is called a Maternity Care desert. I’ll share a link to the March of Dimes research on this showing millions of women of childbearing age living in these places where maternity care just doesn’t exist.

As we’ll talk about later and my friend from VBAC Facts talks a lot about, if you had one cesarean, some hospitals will force you to have another one, whether you need it or not. This is especially tough if you live in a maternity care desert.

One of the reasons for this is often that they don’t have enough stuff. But that is, guess what? A political choice. There are policies that mandate a certain staff-to-patient ratio in ICUs. Why don’t we have those in childbirth? (I know it’s because the professional lobbying power of insurance providers and medical associations spend a lot of money maximizing their profits….see Open Secrets if your anxiety level was getting too low and you really want to breathe into a paper bag for the rest of the summer). But the CommonWealth Fund reported that the US has about 14 care providers per 100,000 live births. The next closest country was Norway with 35. That’s more than twice as many. Sweden has more than 70, and birth outcomes are so much better there.

Maternal mortality

By birth outcomes, in this case, I just mean surviving. The US is still going through a maternal mortality crisis. We are the most dangerous industrialized nation in which to give birth. And it’s probably going to get worse as more states restrict doctor’s ability to make decisions with their patients.

The maternal mortality crisis is 100% political. How do I know? Because there’s a decade and a half of studies that show we could get it under control by spending some money and putting some policies in the system. And we keep not doing it. Is this because the maternal mortality crisis is 3-4 times worse for Black women? Probably not directly, but it’s not NOT the reason either. As long as maternal mortality is framed as a Black women’s problem, there are going to be plenty of people who ignore it.

Going Forward

I’ve talked a lot about these issues in previous podcasts, but this season we’re going to branch even farther out and look at the social side of this politics of childbirth. Think about how expensive IVF is, or how hard it can be to get help for a miscarriage. But think too about the lack of discussion or support for postpartum mood disorders like depression and rage. Then of course there is maternity leave issues.

But also the so-called “Mommy Wars” where everything gets polarized along those same useless to us as individuals lines as partisan politics: formula or breast milk, cloth diapers or disposable, day care or stay home? It feels like every choice you make as a mom is put into conflict with other moms. This isn’t an accident. This is cultural control. As long as moms (and really women in general) tear at each other and judge each other, no one in power ever has to worry about us getting together to change the world for the better. What can you do about that? Make your choices based on a combination of data and desire, and deal with the fact that those are your choices. You don’t need to judge other people for them in the same way they don’t get to judge you. Imagine that?

Call to Action

I see by the mean old clock on the wall, and I really do have a clock despite having a phone, a wrist watch, and a laptop, that it’s time to let you go back to your regularly scheduled lives.

Until next week, take a look at our social media platforms and keep an eye out for that YouTube Explainer. Feel free to poke at me if I forget about it.

Thanks for tuning in this week, and I hope to see you back. Until next time, as usual, take care of yourselves and each other!

But for a while, we’re going to talk about why birth stories are so important and why we still—and always—center them in our discussion.

Transcript below!

Hello Birthzillas!

*intro*

Welcome to our last episode this season. This time around we’re going to talk about birth stories and how birth is portrayed in the media. I’ll give you a sneak peek about what season two will look like and where we go from here.

*transition*

Let’s talk about stories.

I started this podcast by talking about how important it is to hear about childbirth stories from people who—you know—did it. This is because, despite there being so many different stories from everyone, and even wildly different stories from the same person about different births, hearing from individuals is an important cultural touchstone. People need to share their stories and others benefit from hearing them.

One of the things I noticed when I interviewed moms for my dissertation was that talking to me was the first time many of them had told their story, and for almost all of the rest, it was only one of a handful of times. The people who had told their stories before were people who worked in childbirth or people who were storytellers already.

The biggest predictor of who joined my study wasn’t whether someone had a good or bad experiences, it was pretty evenly split. It was that people just wanted to tell their stories to someone. And despite some questions about the efficacy of Zoom, I think I ended up with more intimate conversations that I would otherwise. People wouldn’t have shared as much in person if we were in public, and they wouldn’t have been as calm with the in-person chaos in their homes if people hadn’t been adjusted to zoom and covid lockdown.

There were people who were breastfeeding, folding laundry, straightening their hair. One mom was in the middle of home schooling because of covid school shutdowns, one was hiding in her bathtub (the kids found her anyway), and one was powerwalking after her kid at sports practice. It was such an interesting look at interviewing procedures and the lives of moms.

When I started by asking them “where did you get your expectations,” a few said from their moms, relatives, or friends, but over 70% said TV and movies!

The problem with this is that birth is portrayed on many TV shows and movies is with a woman screaming in pain, in a hospital, legs in stirrups, and a sea of doctors looking at her birth canal. While this isn’t all of the movies and TV shows, it’s a concerningly common issue.

To build up the drama for the TV show, there’s so much pain, trauma, and doctor-as-savior complex. A recent article in biomed center journal pregnancy and childbirth noted that particularly among reality TV shows: there is a lack of normal birth on TV and there’s a massive presence of birth trauma.

This lack of representation for normal birth increases medicalization of birth on the side of the doctors who, as nurse Veronica I interviewed said, “we see ourselves as heroes.” It normalizes the idea of giving birth on your back, which is actually a really hard way to give birth. When you’re on your back, the birth canal is narrower than when you’re squatting. In addition, when you’re on your back, you’re pushing up away from gravity versus in a squat where you can use gravity to help you.

But it also increases fear of birth and of doctors from mothers. The study further showed these kinds of shows leave parents with a lack of understanding of birth, how long it takes, what normal birth looks like, etc. It makes it so that people look negatively at midwives in hospitals, at homebirth and homebirth midwives, and birth centers: all of which are evidence-based ways to improve birth outcomes.

An article in time magazine talks at length about dramatic pregnancies and traumatic births on TV, but also as pregnancy as a vehicle for horror movies. Think Rosemary’s Baby or whatever weird crap was going on in M. Night Shymalan’s Old.

Look, while it feels like it takes 9000 years when you are pregnant, it is also dramatic. This is especially so in labor and delivery. You go in as one person and come out as two people! It’s like 37-42 weeks of waiting all leads up to a few hours or days where little diva dramatically emerges.

It can be scary and intense. This is great fodder for TV and movie writing. You want drama, you want tension. And birth provides it.

This happens in other areas of course, where things look more dramatic and tense than they are in real life. Romance movies, the people who make bad decisions in horror movies, and so forth.

What is really different about birth is how much people don’t have any other frame of reference than what they see on TV or read in books. This makes mass media depictions of birth a powerful learning tool. So, when you see over and over the drama, the trauma, the fear, it gets into people’s heads unchallenged and can be a real problem.

One way to deal with this is to get better tv and movies. Hopefully that’s going to happen. I’ve heard great things about Call the Midwife (which I still haven’t watched despite at least 7 people telling me to do so).

A more practical way it to listen to people tell their stories. Be wary about so many birth influencers online dramatizing their stories for some reason or other. Try birth circles of mother’s clubs. Many midwives and OBGYNs have information on support groups and birth circles that could be useful to you.

In addition, talk to family and friends and ask them to share their experiences. Hear from people who gave birth in different places, that can give you some expectations of what to prepare for.

One thing I recommend to people in birth classes is that they listen to people’s stories because it is impossible to prepare yourself for every situation. Listening to other people can help you know what to expect or how to deal with questions or conflicts (even if they’re telling you what not to do. As we say about my sister, “she’s not a total loss, she could always be a bad example.”)

*transition*

As we move to get ready for the second season, I just wanted to say thanks for listening in this long! I’ll spend the next few months building up season two where we talk about c-sections, Pitocin, the future of childbirth policy, and more.

In the meantime, share widely and let’s drum up some support for season two. Thanks so much for sticking with us this far, and I can’t wait to talk to you again!

Until then, take care of yourselves, and each other.

Want to find out how good dads can change the world? Let’s go!

(And if you want to find out how good men in general can change the world, then take a look at our Civic Flame podcast that includes a playlist on AI, technology, and democracy!)

Transcript below.

Hello birthzillas and welcome to episode 9, our second to last visit this season. This week I want to talk about dads and non-gestational parents and (gasp) feminism. We talk a lot—as we should—about moms and gestational parents, but this week I want to talk about the importance of listening to dads, understanding the unique burden they face, and of considering how birth and birth trauma affect them.

Let’s go!

(transition music)

If you know me by now, you know that I am a fierce advocate for women and all people who give birth. What you might not know is that I firmly believe good dads can save the whole world.

Good dads are the bomb! Good men are the bomb. The idea that women like “bad boys” is almost always put in the media by male writers who hate women but don’t know they hate women. Most of us know that there’s nothing sexier than a good guy. Integrity’ll get me weak-kneed every time.

Why? Because that’s where the power to change the world is. Men who have the guts to be good in a world where the path of least resistance is for them to be mediocre and then coast on not being abusive.

Dads who show their kids love and affection, are men who model for their families healthy behavior. They show their kids that men can show love and affection and set up their children for healthy relationships later on.

Bad dads, unfortunately, can go the other way.

I taught preschool yoga for six weeks, and I’ve never been as bad at anything in my whole life! I don’t love working with little kids, but it was going fine. Right up until day two, when little Boy comes in and says, “my dad says, yoga is for girls” and he wouldn’t do yoga anymore.

The next week, it’s two little boys who don’t want to di it because it’s “for girls.” The week after that, none of them wanted to do it until I made it Star Wars yoga. Fortunately, the girls liked Star Wars—because girls are allowed to like anything while boys are stuffed into a box.

But all it took was one shitty dad to turn the whole class of boys into gender warriors and tell them they it was shameful to like the yoga they liked because that was a girl thing. It was shameful to like what girls liked because girls liked it. This was in like 2015 or 2016, too. So, not that long ago.

I don’t know if it’s nature or nurture, but so many of the men and boys I know have been locked into this kind of hierarchical mindset: one bad guy up the chain of command ruins it for the rest of us.

When I was teaching at the Naval Academy, a colleague once referred to my plebe (that’s freshmen) English class as me being stuck in there with 20 Golden Retrievers. He was referring to their general energy and good nature, but he was also talking about the hierarchy. They really wanted to fall in line, which means they had to know where the line was.

When I think about the guys I’ve known who are the most rigid and hierarchical, it’s the ones who have the most daddy issues, and they get ideas into their heads about what being a man means and then just become the most unadaptable folks.

And the guys I know with good dads are usually much more flexible in their thinking willing to do what they enjoy rather than what they think they should like.

Obviously, this isn’t a one-to-one thing. There are plenty of people who rise above lousy parents and become good parents themselves, which is important. But it’s not easy when you don’t have a template.

And I think it’s actually harder for men than for women. Girls and women can be anything they want! They can listen to men or women, like boy stuff or girl stuff. They can see themselves as any number of different types of heroes or villains on TV or in movies.

Boys and Men, on the other hand, are constantly bombarded with such a narrow view of what a boy or man is, that it’s hard to tell equal rights movements happened from them.

Think about how many boys are radicalized down the incel, manosphere pipeline. The fact that the DHS, not known for being feminist types, has started to recognize the manosphere as a place of dangerous radicalization should let you know the scope of the problem we’re facing. Not an extinction level event, but we’re getting close.

These groups work hard to recruit men through very subtle radicalization. The two first gateways? Misogyny and body shaming. Men are trained to blame women for all of their problems (women use DEI to skip the line and get ahead, women slept their way to the top, women only like tall guys, whatever it is), then they’re body shamed by other men (and called “low value men” and convinced that “high value women” don’t like “low value men”), and the body shaming builds upon and exacerbates the misogyny. It’s not just that we’re going to body shame you, but we’re going to remind you that your body is why women hate you and remind you to hate them for all of the pain we’re inflicting on you because it’s their fault even though we’re the ones inflicting the shame…..and it freaking works.

Before you know it, they’re in what the DHS calls the man-osphere.

As a mother, I worry a little about my daughter coming home pregnant. I worry more about someone raping her, her falling victim to a cult, and men stalking and harassing her. For the young boys in my life, I worry about them getting so radicalized by this nonsense that they ruin their own lives, engage in acts of violence against others, or kill themselves.

I worry a lot. For my daughters, the biggest threats are external. For men, in many ways, they’re internal. The call is coming from inside the house, and unless they have good dads and good male role models, they might not know it until it’s too late.

Consider some of the major influencers for young men. Andrew Tate is literally is selling a class on Spotify on how to sex traffic women. The guy has admitted to rape, calls himself a misogynist, advocates and has engaged in physical and sexual violence against women, and he is running around training other men how to rape and traffic women.

Ben Shapiro and Jordan Peterson are their kind are less physically violent, but intellectually, they are part of the same for-profit misogynist rage machine. They take these men and instead of being good father figures they say “if you just listen to me, you’ll understand!” Not for nothing, but when Ben Shapiro said the female orgasm was a myth, I almost peed my pants laughing. Wow, dude, way to tell the whole world you’re bad in bed but pretend it’s a woman problem. I’d feel bad for his wife, but she enables him, so let her enjoy the lousy sex she deserves.

But what happens when young men and boys listen to this stuff and fall down these rabbit holes on Reddit, TikTok, YouTube, Instagram, Twitch, Discord, and other platforms? They stop listening to women about what women because they are told that women are “indirect communicators” (please know that’s just something rapists say to justify not taking no for an answer).

So, instead of asking women what they want—or more appropriately, asking a woman since we’re not all the same thing—these men fall down these rabbit holes where they keep listening to angry losers who are getting paid to keep their listeners angry. Then those listeners wonder why they’re angry. But instead of blaming the for-profit rage mongers, they continue to blame women.

I’m just saying, if I was using a product for months and it was doing the opposite of what it said it would do, I’d blame the product. But the misogyny product starts by saying “everything bad is women’s fault” so if the product keeps making them angry and keeps them from getting into healthy relationships, it’s women’s fault not the product. Better to blame women than take some personal responsibility and admit you fell victim to one of the world’s oldest cons.

And boys and men walk into this absolute forking nightmare often by complete accident. They have no idea how to get out, and very little understanding of how bad it’s making their lives until they’re too far gone.

One of the biggest mistakes of the second wave feminist movement was thinking that once women were liberated, men would be too. The problem is that our cages were built different. Women’s cages were constructed largely externally by law, society, religion, family expectations. Men’s cages were built largely by other men and by themselves. Naturally, women though men would self0liberate and just break their own cages, but those cages have proved remarkably resilient because when patriarchy has been handed to you as a power source, letting it go feels like losing power. Even if the patriarchy stuff is what’s been killing you. Of course, now you have nonsense trad-wife movements trying to drag young women down the same path as these angry men and men posing as trad wives online to drive up the idea to other men that “women want you to be like this and you should want women like this.”

And look, I was a stay at home mom when my kids were little. And I really appreciated it. But, trad wives is not about stay at home moms. It’s about a mythic past that never really exists. And to have the more “traditional” gender roles that the manosphere claims to value is almost impossible because you can’t have that without mutual trust and the manosphere drives up mistrust against women.

If you want to safely be a stay at home mom, you need equal financial access. But the manosphere simultaneously tells men that they need stay at home wives but all women are gold diggers. So, when stay at home moms ask for equal financial access, that’s a sign that they’re gold diggers not stay at home moms who need financial security, then the men don’t want them anymore.

And even if you want the trad wife life (which you don’t because if your husband leaves you or dies you have no way to support your children), you don’t get the right to demand that anyone else wants to be that.

But of course, that’s what the manosphere does. Noncompliance and non-conformity just show the weak foundations of these nonsense gender ideologies. And men are routinely getting trapped in them.

So, why do I think good dads can break this cycle? Because the guys looking for this nonsense online often don’t know they’re looking at it, and if they’re not too far gone, they don’t want it. That’s why the entry points are so subtle. Most men are decent and want to live good, decent lives with families that love and respect them. But they might not know what that looks like. They need a real, in person, guy who cares about them to say “no, this isn’t what we do.”

How does this relate to birth?

In a lot of ways. When we see birth trauma, imagine the toll that takes on dads. We know and can talk about the toll it takes on women. But dad’s want to protect their families. And when they see their partner in this vulnerable position and they see their new tiny baby being born, the helplessness they can feel can be really harmful. And it often does not go addressed.

One of my friends was there when his wife and baby coded. The doctors brought them back and they were fine, but the first time I saw him afterwards he just walked over and hugged me. A lot of new dads out there really need a freaking hug. But over and over we see that men have fewer friends than in generations before and can be really shamed if they try to show platonic affection.

I see online guys complaining that no one compliments them. I’m torn between feeling bad for them, because they deserve a compliment, but also wanting to explain that it’s dangerous for women to compliment men. We can’t say something nice because if you use that as a reason to sexually harass or assault us or stalk us, then it’s our fault for “leading you on.” And maybe you’re a good guy who would never do that, but in the world of the manosphere, y’all all look alike and it’s scary.

So, we end up living in two totally different worlds that are harder and harder to communicate across. For new dads, this is extra difficult. They don’t have the same resources to pull on as new moms do (and as we talked about, most new moms don’t even have enough).

When new dads complain about being tired, they’re kind of shushed because it’s not their turn to complain. Inequality in relationships, home life, and parenting have left such a lasting anger among so many women, that even men who are pulling their weight are afraid to complain about it because they don’t want a lecture on how they’re probably not pulling their weight.

At least women have a viable path to complain about how much new parenting can suck.

We also do a terrible job of training men to recognize abuse. A lot of men don’t know that their partner shaming and denigrating them is abuse. They don’t know men can be emotionally abused. They don’t know men can be physically abused, even when it happens, many men just let it go as a trope they see on TV.

Men are in a really vulnerable position when facing emotional abuse and physical abuse from a partner because our system is not set up to help them. Any partner facing abuse has to worry that is they leave, then they’ll have to share custody of their children with an abuser. An 8 year old boy at my daughter’s old school talked about wanting to kill himself because the court ordered him every weekend to go to his dads where is dad would call him useless and worthless and swear at him.

I want that boy to grow up. And I want him to grow up healthy. But the odds are not in his favor.

Our system justice system needs to take violence against men seriously without turning that into a way to laugh at violence against women. I’m thinking of the Gabby Petito case. I heard that her boyfriend was chummy with the police who were making jokes about how he was an assault victim…shortly before her murdered her.

That’s the kind of stuff we don’t need. And the problem with making changes to get things better for men is that there are shitty men waiting in the winds to weaponize those changes against men and women.

And it can start by helping new dads navigate childbirth. Father’s groups, forums for men to talk about it, and just giving dads the same grace we give moms to complain about how tough it is, can do a long way to keeping good dads in the game.

But I see by that clock that it’s time to go.

(transition music)

It’s been a lot this week, as usual. Next week we’re going to talk about changing the narrative on birth stories!

In the meantime, what can you do?

Check out resources in your area for new dads or find positive online support groups. So when new dads (or not so new dads) mention they’re stressed, you can recommend them.

Believe men when they tell you they are also tired. Sure, if the are actually slacking, you can tell them about that later, but in the moment, assume they’re actually just exhausted and cut them some slack.

Remind new dads that they rock. That they have the power to change the world. And that dads can make all the difference.

Until next time, take care of yourselves and each other

Let’s go!

Transcript below.

*Intro*

Hello, and welcome back to Birthzillas, the podcast. I’m your host, still-not-that-kind-of-doctor Amber Vayo. There’s a lot going on in Birthzillas world this week! Tomorrow I’m meeting with the editor of my book Birthzillas and Madwives, my friend Girl Friday and I are still trying to coordinate a team newsletter, but one of the best parts of my week is sitting down with all of you. Today we’re going to talk about reproductive justice and what I mean when I say autonomy in birth. If you’re looking for some first steps to helping improve childbirth culture, this is a good episode for you!

Let’s go

Transition Music

So, most of you have heard of reproductive rights. It’s basically the catchall terms we use when talking about abortion and contraception. But as it turns out, there’s a lot more to reproductive politics than that.

Reproductive rights has a focus on law and individual rights (which is important). It looks at things like birth control access and legality, abortion access and legality, and basically the ways an individual should have a right (and have access to that right) to not be pregnant.

Reproductive justice has a different focus.

In the interest of full disclosure, a white woman colleague told me I shouldn’t do reproductive justice research because I’m white and that’s a women of color field. There are times when I think this kind of “stay in your lane” warning is true (for example, the feminist epistemology that resonates most with me is Black Feminism, but I’m not out here calling myself a Black feminist because that would be weird). But with reproductive justice, the point is to be inclusive and that everyone should be using this lens because to do so would help the most amount of people.

So, I’m rolling with it. Reproductive Justice and Birth Justice are the research lenses I most believe in and that to me make the most sense in the real world. What I tell you next is not me trying to usurp or Columbus things and claim that I discovered something that already exists. It’s to provide you some history and context of an activist and scholarly movement and show you some examples of how it looks in practice.

Compared to reproductive rights and the law-policy-individual focus, reproductive justice goes much bigger. According to Loretta Ross, one of the fabulous founders of the reproductive justice activist and scholarship movement, reproductive justice has three parts: the right to not have a child, the right to have a child, and the right to parent children in safe and healthy environment.

Others have added wider reproductive health elements like the human right to make personal decisions about sexuality, gender identity, and family.

Notice the right to not have children is the same. A fundamental part of choosing to be a parent is the choice, which means the choice not to do so. Much like with consent, if you can’t say yes, you can’t say no.

But the last two provision: having a child and raising a child in a safe and healthy environment are different. This rights/justice lens is different for a handful of reason.

A mental lens is essentially the same thing as a camera lens or eyeglasses. It’s what we’re looking through. That lens shapes out ability to see or not see certain things. It can magnify some parts, focus on others, and so on.

What a rights lens does is focus on the smaller, individual rights. It focuses on the laws. And in this case, it focuses on the laws around not having to be pregnant. In a lot of ways, the rights frame is a narrow focus lens.

The justice frame is your wide-angle lens. It pulls back and says, “yes, not having children is one part,” and “yes, the law staying out of our reproductive choices is one part.” But it brings into the conversation a vital part of activism, history, and scholarship that reproductive rights misses: there’s a history of reproductive coercion (or forcing people to do things) in Black, Asian, Indigenous, and Latin communities.

Reproductive justice came about because during the arguments about Bill Clinton’s healthcare plan in the 90s, white women pretty much closed ranks and refused to work with Black women to get their reproductive health priorities into the legislation. Reproductive rights policy advocates were primarily white women who were focused on this concept of law guaranteeing personal, individual rights not to get pregnant.

Black women were trying to bring up the fact that they have several other problems: forced sterilization, the foster-care to prison pipeline, police violence in their communities, the racist notions of them as “bad” or “dangerous” mothers or welfare queens. And they wanted that addressed as much as the legislation was able.

They were basically brushed aside. So, they did what innovators always do: when the door slammed on them, they made their own door.

They focused on justice rather than legal rights are individual, not community. Legal rights can be taken away by laws (certainly as we’ve seen throughout the 90s and 00s, all the way to Dobbs). Regarding Dobbs, I would like to invite everyone like me who was told for decades that “this won’t happen, they’ll never ban abortion, you’re over reaction” to hit the pause button and throw something across the room. … Feel better?

The issue with rights is that what the court or the policymaker giveth, the court or the policymaker taketh away.

Justice is harder to pin down, but at its core, is related to fairness of procedure and outcome, it is inclusive and has a doctrine of not deliberately causing harm. Some people use it to mean what is good or rights or peaceful. To me, good, right, and peaceful things tend to flow from justice.

But think about when you’re watching a bad guy get what’s coming to him (or her or them) in a movie, and you think “ah, justice.” There’s some level of people got what they deserved and anyone who caused harm got in trouble for it. There may have been a damage, but it was meaningfully repaired and there was accountability.

See why rights are easier to enact through laws? I can pinpoint a right that says I can have access to birth control. How do I pinpoint a right to say I can raise my child in a healthy and safe environment?

Justice is also about good and resources and how they are distributed. The way I can be guaranteed to raise my child in a healthy and safe environment means there needs to be some level of environmental protections (we know that majority Black, Brown, and poor neighborhoods have an environmental justice problem). This correlates with asthma rates, diabetes, and other issues. In a time when your zip code at birth can accurately predict your earning potential and life expectancy, we’ve clearly got some work to do on neighborhood justice.

But raising my child also requires the police not shoot my child, schools not put my children in the school-to-prison pipeline, social workers do not use racist stereotypes to put my kid in foster care. So much of the attitudes that shape the social interactions that lead to these injustices are just that social and very difficult to get to through law. Because as much as we’d like it to be so, law and justice are not the same. We like the to be related, but at best they’re cousins not twins.

A few weeks ago, I told you the story about Elizabeth, who was accused of drug seeking behavior and the hospital wasn’t going to let her take her baby home. These kinds of things happen in the US, and white women are disproportionately given a pass when it comes to actual drug use while Black and Brown women are given a heap of suspicion whether they have a history of use or not.

As someone raised by a drug user and dealer, I understand the dangers that puts children in, but given my sisters’ stories of foster care, I’m not entirely sure how much better that worked for them. I took the “it’s the mid-1990s, so I can just run away from home and live with friends’ approach,” which worked for me. Today, I feel like we’re more stringent about that sort of thing (for better and for worse).

But these kinds of interactions with social service can become problematic for people, especially if you’re living in a socioeconomically poorer area. So, RJ addresses that.

Even more than the issue of raising children in a healthy environment, RJ activists (or those who would become RJ, anyway) wanted to get into the Clinton health care plan a level of understanding that the fight NOT to be pregnant was only a small part of their struggle. That for women of color, especially Black, Indigenous, and Latina women, there was also a struggle to have children.

There was a history of state-sanctioned reproductive coercion in the form of rape of enslaved women and steal, selling, and torturing their children (hence the RJ focus on the fight to safely raise your own children). But there was also forced tubes tied or hysterectomies that were so common among Black women in the South that they were called Mississippi appendectomies. These kinds of forced sterilization practices needed to be talked about, but RR people said it was too distracting.

Likewise for Latinas, there was a history of coerced sterilization. I was reading a book on Global Women’s Health and found that the US had sterilized almost 70% of women in Puerto Rico at one point, many without their consent. I thought that was crazy, so I looked it up and found multiple academic books and articles to support it.

Indigenous women experienced the genocide of their people and culture, then residential schools where their children were forcibly abducted from them (in a cultural genocide), and a host of ecological disaster we do not talk about enough like the US dumping nuclear waste on Navajo land or testing nuclear weapons on Shoshone land or stealing or polluting Lakota water and Mashpee land. All of these relate to the ability to have a child and rise them in a healthy (particularly non-genocidey way).

Reproductive justice is a cornerstone of understanding advocacy around reproductive freedom and autonomy. In childbirth itself, there is Birth Justice movement.

Within that, there are also organization like Birthing Advocacy Doula Trainings that are there to help teach people what to do with all of this information. Founded by Sabia Wade, BADT is where I did my doula and childbirth educator training. I learned so much from Sabia and the BADT team because they were able to focus in on these difficult conversations: reproductive coercion, maternal mortality crises, the medical industrial complex, gender identity and sexuality issues, medical racism, and so many others.

This group trains doulas in reproductive justice to be advocates during childbirth. As I’ve said before, and I’ll talk about (probably next season), doulas are fundamental to childbirth. Doulas are professional labor support who work with and for the person giving birth.

The more RR-centered groups view doulas as basically there to hold your water and rub your back and say they have no role in patient advocacy. More radical groups, like Sabia’s, center the fact that for many people, part of a healthy birth and part of RJ is having someone to advocate with you. This doesn’t mean the doula talks to the doctor for you. It means they help explain to you what the procedures and interventions are, help you map out a plan in advance and plan what you need to be supported, and help make sure you’re getting some level of autonomy in childbirth.

This is really difficult for some people to understand because they view childbirth as an experience where (despite doing all the work) the birth giver is a passive participant who is there to be a hole the baby escapes from. When you put it in those terms, they get offended (gotta be careful for those delicate sensibilities…). But think about the kinds of rules we have in our culture. Most people are hooked up to IVs even if they don’t need them, they’re put on a clock and told they have to meet certain labor progression standards, even if those are statistical numbers not real experiences. They’re forced to stay in bed, they’re lied to (I had someone tell a doula client that an epidural would put her so asleep that she’d probably have to wake up to push; then when the epidural didn’t take away all the pain, the same nurse said, “I don’t know who lied to you, but it doesn’t take away all the pain” of course, this nurse also assured the client the Pitocin contractions don’t hurt more, when they definitely do. One mother I talked to say the Pitocin contractions were so strong she felt like throwing herself out the window).

Women are cut with episiotomies even though natural tears heal better. They’re denied food and drink during labor. The doctors are the ones who “deliver” the baby even though all they did was catch it.

And when women ask about interventions or progress, there are still far too many doctors and nurses who get combative, as though any questions about “why are you doing this to me” is the same as saying “I hate my baby and want it to die.” If you’ve ever been in a delivery room in any capacity, you may have seen the level of disrespect, suspicion, and hostility women are treated with for the most basic self-advocacy questions: can I have a glass of water, why did you recommend this intervention now, I don’t want an IV.

That is why birthing advocacy and reproductive justice go hand in hand. Both are vital elements needed to improve birth culture in the US.

*Transition sound*

I see by the mean old clock that it’s about that time again. This week has been a whirlwind look at some important cultural and advocacy movements, and I hope you take a look into more of them. Improving birth is something that needs an all-hands approach, and we can’t do it through law alone.

There needs to be social and social movement change, policy change, nursing and medical school education change, lawyers and advocates change, and a host of other things that are social in nature. We need to put the justice in there, not just the rights.

What can you do this week?

Take a look at any of the birthing advocacy or reproductive justice networks in your area. Figure out what they’re doing.

Find places like Birthing Advocacy Doula Training, Sister Song, Birthing Justice, Reproductive Justice, Pregnancy Justice, VBAC Facts, Evidence Based Birth, and Birth Monopoly on your social media platforms. Check out what they’re sharing and boost their posts.

Check out Sabia Wade’s book: Birthing Liberation: How Reproductive justice can set us all free.

The nice thing about such a big problem with so many parts is that you don’t have to do it all.. in fact, you can’t. But by working on a tiny bit of the problem, you become part of a massive network of people driving up a solution to make childbirth better and get reproductive justice for all. At the end of the day, as Dr. King, and Maya Angelou, and Fannie Lou Hamer, and so many others have pointed out: we’re either all free or none of us are. So, let’s get free together.

Until then, take care of yourselves and each other.

*outro*

Transcript below.

Intro

Hello and welcome back to Birthzillas. I’m your host Amber Vayo, and as usual would like to remind you that this is a law and policy podcast and not medical advice. I’m not that kind of doctor!

I am the kind of doctor that studies maternal health data, though, and that’s what we’re going to take a look at today. We’re going to talk about what it means to say that the US has a maternal mortality crisis, combat some myths about why maternal mortality is so high among Black women, and talk about what we need for future research. I do believe that the only pathway to justice is through confronting the uncomfortable realities of systemic oppression, so get ready and bring your sledgehammer because we’re pushing through today!

Let’s go!

*transition music*

Let’s get right into it. Last episode we talked about the maternal mortality crisis just a little bit. What I want you to know about the maternal mortality crisis is this: US women are more likely to die in childbirth than women in comparative countries. This is a significant difference, and it has been an ongoing problem for over a decade.

According to maternal mortality commissions, the World health Organization, Amnesty Internation, and the CDC, between 60 and 85% of these deaths are preventable. What’s even more wild is that for every women who dies, 70 come close.

So, what’s going on in our health care system? There are a couple of ways in which the US is an outlier in maternal health medicine. Last time we talked about our rates of midwives vs obgyns as one part of it, and of there being so few providers in the US system compared to others.

If you weren’t with us last time, we checked out the Commonwealth Fund data site and it showed how for every thousand births in the US there are three to seven times FEWER care providers than in countries with much better maternal mortality. We don’t have enough people working with the patients: or to put it another way, the doctors and midwives have too many patients per provider.

This is an easy law and policy fix in terms of mandating staff to patient ratios. It is not an easy political fix. The medical associations donate a lot of money to Congress, and part of keeping physicians highly paid is keeping their numbers small (this is the wholesale misapplication of the supply-demand ideology to areas in the economy where it is totally not supposed to go).

But even the medical associations are having a problem because there’s expected to be an OBGYN shortage by 2030. The shortage is supposed to be around 5,000 doctors. That’s a lot. Add that to the fact that states with severe abortion restrictions are losing doctors and medical students, and those states—which already have higher rates of maternal mortality—are going to be in some serious trouble in the future.

We can midwife the system (and regardless of OBGYN shortages, we should). Like we talked about last episode, midwives are cheaper for the patients and the insurance companies, and are associated with better birth outcomes. But, hoe birth or hospital birth, midwives are not appropriate for all births. High risk pregnancies need some guidance from people who are trained in high risk birth. Surgical birth, whether it’s becomes someone wants a cesarean or they need one, requires well…a person trained in that kind of surgery.

This leaves us with competing problems: our system is too reliant on OBGYNs and we need more midwives; but we don’t even have enough OBGYNs for what we do need. It’s looking tough out there.

The lack of care providers, as we talked about last time, leads to a lot of reliance on technology that we don’t see in comparative countries. This leads to more inductions and more cesareans. Again, if you wanted a cesarean, that’s your business. This isn’t against anyone wanting a cesarean. This is a matter of understanding that if you take all the people in the country who had babies, we see that compared to other countries, the US has higher than average cesarean rates for no reason.

And cesareans are not without risk to parent and baby. Which is another problem.

Add medical racism to the mix and we have ourselves a heck of a ball game. But not a good ball game like baseball. A bad ballgame like dodgeball. Except the balls are time bombs waiting to blow up and make everything worse.

What do I mean why I say medical racism? Do I mean that doctors are trading in white KKK robes for white coats and coming in to do some damage? Not really. I mean that the systems set up and the education we receive (remember those epistemic frames we talk about) lead to racist results.

The maternal mortality crisis is 3-4 times higher for Black women, in part, because of how Black women are treated throughout prenatal care and childbirth. Another report just came out talking about how Black women were giving much higher rates of unnecessary cesareans.

The Health Secretary, and wholly unqualified not a doctor absolutely playing on his family name DEI hire, RFK Jr, recently, in front of Congress, repeated the racist myth that Black people don’t feel pain the same way that white people do. Until recently, this was in medical textbooks.

When you have doctors who see Black patients asking for pain meds, but they think those patients don’t feel pain, against a backdrop of a political culture that paints Black women as dangerous, you have an inordinate number of Black women accused of drug-seeking behavior and threatened with child services.

You have Black women ignored in labor even with a history of medical complications. Serena Williams, who is more physically fit in one hour than I will ever be in my whole life all put together, nearly died in childbirth. Even with a history of blood clots, she had to argue that her doctors should check her and make sure she was safe. With her money, her fame, and her health, she still had to fight the system that says “Black bodies don’t feel pain the same way.”

And the doctors and nurses don’t think they’re being racist because it’s just common knowledge from medical school that Black people don’t feel pain the same way.

That’s insane. People are people. The only group of people shown to have different tolerances to pain are redheads, and that’s basically only shown that something about the red-hair gene can make it harder to give you Novocain and that kind of stuff.

The idea that Black people don’t feel pain the same way we do is a holdover from slavery days when people had to make up all these myths to justify the rape, torture, and murder of other human beings.

So, white people saw themselves not as raping a woman, stealing her children, and torturing her. They saw themselves as victims of hypersexualized Black women, taking kids from people who don’t care about them anyway, and working someone who can’t feel pain anyway.

Sound familiar? If you look at the stats on how often Black people get their kids taken away versus white people for the same reason, it sounds a little less like I’m crazy and a little more like we’ve got some work to do as a society.

For those of you about to hit the pause button and never listen to me again, don’t do that. This is a conversation we need to have. Our culture of toxic positivity, good vibes only, don’t talk about politics, is literally killing people. It’s killing people because it’s keeping us stuck in a mindset that says, my mental discomfort with this awful issue is more important than working through it and solving it. So, hit that pause button, grab a drink of water, and come back ready to go.

I’ll be posting some books on my YouTube page, but for sure read Sabia Wade’s Birthing Liberation, Dr. Uche Blackstock’s Legacy, Harriet Washington’s Medical Apartheid, and Dorothy Roberts Killing the Black Body. They’ll get you some good data on what’s happening here.

And this history of medicalized racism plays out today in hospitals where Black babies are 3 times more likely to die when cared for by white physicians than Black physicians. We know that culturally congruent care saves lives. In a society as segregated as ours, it helps to have someone who speaks your language and shares your experiences.

Unfortunately, in addition to the looming OBGYN shortage, the DEI-scares at universities might make it harder to recruit diverse talent in the medical profession. Meaning fewer doctors.

This too has structural roots. As I mentioned last time, the 1910 Flexner Report rerouted the entire US medical culture. Part of what the Flexner Report did was to call on doctors to manage and study disease and conditions, rather than patients. This is why today so much of our healthcare system focuses on risk factors instead of patients.

Flexner believed in doctors having a more cloistered life, taking medical schools away from the general population and bringing doctors away from the home-visit physicians to the hospital based doctors that we see today. Obviously there were some good impacts of standardizing medical education and (hopefully) medical care, but Flexner’s focus on what he viewed as “the rational” made it harder for women to get heard or be taken seriously, and his focus o a very specific set of institutional arrangements meant that almost all Black medical schools closed.

This set up our contemporary culture where there is a lack of communication between medical professionals and patients. Younger physicians are starting to center that, and there are training programs too, but even the most well meaning doctors are still stuck in institutions that do not give them the support they need to be successful.

Over half of OBGYNs are feeling burnout, and that mirrors the rest of the medical profession. The long hours (the doctor at my client’s birth was working a 24 hour shift), the lack of mandated staff-to-patient ratios, and the constant fighting with insurance companies has lead meany doctors to quit or take reduced roles.

My previous general practioner, when I asked her about going to medical school, told me that she would never have done it if she knew what role the insurance companies would have. She later left practicing medicine for years. My current doctor also hates insurance companies and talks about how they break trust between doctor and patient.

These doctors want to help their patients to the best of their ability, but understaffed, overworked, and fighting with hospital administrators (who are responsible for the understaff and overwork) and insurance companies is demoralizing the heck out of them.

How does this relate to maternal mortality? Well, it turns out that along with a decades long crisis, we have decades worth of research that all says the same thing: we need to fix the institutions. We need to have more people, less technology, more midwives, and fewer c-sections.

We also need to revisit the scope of practice in hospitals. Some hospitals don’t allow midwives to catch babies, because that’s what doctors are paid for. In hospitals where doctors are paid for their shift, you don’t see the same rise in cesareans as you do in hospitals where they are paid by procedure.

Health Equity is looking into areas where there has been discrimination or a lack of services in health care, whether that is by race, gender, economic status, or any other reason and finding ways to bring quality, equitable care into those areas. Health equity scholars have spent so much time and effort doing the research on maternal mortality, they have finally said, enough is enough and started posting the hashtag Fund the Results. Because at the end of the day, it comes down to money. The system exists the way it does because it is very profitable. But those profits come on the backs of people who need care. It’s time to do some thinking about a better way to thread that particular needle.

In addition, with the NSF, NIH, and other government organizations censoring what kinds of research can be funded, you’re going to see the problem get worse. The Musk-Trump censorship rules include over a hundred words and phrases, including women, gender, equity, Black, disparities, racism, and diverse. This is going to crush research into ending maternal mortality and research into women’s health in general.

As we go through the next few months, we’re going to see some massive restricting of organizations that said they were committed to health equity. Only time will tell what kind of toll this is going to take on maternal mortality in this country, but it is almost certainly going to get worse.

Conclusion

If you’re going to leave today with one thing, I hope it is this: even an institution full of good people can still be a problematic institution. When we forget that, when we fail to hold institutions accountable because we like the people who work in them, then we contribute to the problems they cause.

So, what can you do about this big old issue I sprung on you this week? Get the 5 calls app and start sending your legislators messages about birth stuff that’s important to you. Start with yelling at them about censoring scientific research and the words we can use. Tell them that health care, especially maternal mortality, is important to you.

Call or write to your local or state rep supporting any patient to staff ratio laws in your area. Support organizations that are trying to increase access to midwifery!

Next episode we’re going to look at maternity care deserts and why the closest hospital to you might not be close to you at all.

Until then, take care of yourselves and each other.

*outro*

00:00: 30 Welcome to Birthzillas

00:01:18 What is a birthzilla?

00:02:04 Hill’s Give Birth Like A Feminist

00:02: 41 Birthzillas: The book coming up

00:04:30 What are the Politics of Childbirth

00:05:46 Maternal Health Disparities

00:06:30 Racism is the risk factor, not race

00:07:00 I know it’s not all white people

00:07:40 Change is always radical

00:08:00 we can’t personal choice our way out of structural problems

00:08:18 Why Birth Stories Matter

00:09:00 We need more qualitative public health data

00:09:30 We need dad stories too!

00:10:00 Centering Storytelling is an act of justice

00:11:00 Conclusion