June 25, 2025 • 60 mins
Midwife Audrey returns to unpack the complex evolution of maternal healthcare in America, revealing how historical class divisions, capitalism, and systemic racism have shaped how women experience pregnancy and birth today.
From the early days when aristocrats sought "painless" birth to elevate themselves above "peasant women," to the current system where scheduled inductions accommodate limited maternity leave, our conversation explores how childbirth transformed from a normal physiological process into a medical event requiring management and intervention. This historical context sheds light on why obstetrics superseded midwifery in American healthcare, despite evidence suggesting that most women would benefit from the midwifery model of care.
The reversal of Roe v. Wade adds another layer of complexity to conception and pregnancy planning, with impacts that will take years to fully understand. Meanwhile, America's capitalist values create a maternal healthcare landscape where privilege determines options, from who can afford time off for recovery to who receives proper pain management during labor.
Most disturbing is how these historical trajectories contribute to the current Black maternal health crisis. Outdated biases persist in medical education and practice, including misconceptions about pain perception in different racial groups. When combined with economic inequities and social determinants of health, these factors create a system where preventable complications disproportionately claim Black mothers' lives.
Yet, hope exists in solutions such as concordant care (where providers reflect their communities), cultural competency training, and system-wide recognition of how social structures impact health outcomes. By understanding how we arrived at our current system, we gain insight into creating more equitable maternal care for everyone.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Stephanie Theriault (00:12):
Welcome to the Maternal Wealth Podcast, a
space for all things related tomaternal health, pregnancy and
beyond.
I'm your host, stephanie Terrio.
I'm a labor and delivery nurseand a mother to three beautiful
boys.
Each week, week, we dive intoinspiring stories and expert
insights to remind us of thepower that you hold in
childbirth and motherhood.
We're here to explore the joys,the challenges and the
(00:35):
complexities of maternal health.
Every mother's journey isunique and every story deserves
to be told.
Please note that this podcastis for entertainment purposes
only.
It is not intended to replaceprofessional medical advice,
diagnosis or treatment.
Always consult with yourhealthcare provider for medical
guidance that is tailored toyour specific needs.
(00:56):
Are you ready?
Let's get into it.
Welcome back everyone.
We're excited to jump intoepisode number three with
midwife Audrey.
In this episode, audrey sharesher insights on conception in
(01:19):
the United States, especiallyafter the reversal of Roe v Wade
.
She discusses how modern womenmanage work and home life and
how they approach childbirth,including topics like inductions
, epigenetics and privilege.
We'll also explore themidwifery model of care, why
many women are drawn to it, evenif they ultimately choose
(01:41):
OBGYNs or maternal fetalmedicine specialists to be their
birth providers.
Additionally, we'll look intothe history of midwifery and
obstetrical care in the US andhow it all ties into the current
outcomes for women, especiallywomen of color, during child
birth.
Join us for a thoughtfulconversation on maternal health
(02:01):
care in the United States.
Midwife Audrey (02:12):
Thank you for having me back.
Stephanie Theriault (02:14):
I'm glad to have you here.
Let's get into it.
Midwife Audrey (02:17):
Options for conception what does conception
look like in today's societyfollowing the reversal of Roe v
Wade?
Well, I think I want to kind ofbreak this up into two parts.
So the first part would be whatdoes conception look like today
?
I think largely conceptionaltogether.
(02:37):
There's the what most peopleunderstand and know conception
to be, which is sperm eggcreates a fetus and then it
grows in a womb, and so on andso forth.
But now we have conception thatcan look like in a test tube,
where it is assisted outside ofthe womb and then put inside a
womb, whether it is of thebiological person who had that
(03:02):
egg or someone else.
Altogether, via a surrogate, itcould be inserting the semen
into the womb and it having ashortened or assisted path
towards the egg and maybeincreasing the chances of
ovulation if, for whateverreason, the morphology or the
(03:22):
mobility of the sperm, reallythey just are not capable of
getting the job done.
So there's so, so many waysthat conception can look like,
and through that there thenopens up the possibility of all
kinds of different relationshiptypes, where types where you can
have either same-sex marriageor you can have surrogacy, or
(03:47):
you can have an older couplestarting a family, or you can
have a couple of any age or anyhealth factor, for one reason or
another, starting a family, butthrough, maybe, what some
people would understand asnon-traditional means.
And there's even deciding tostart a family despite having
(04:10):
being settled with a quote,unquote partner.
So conception, the very I guessyou can say physical beginning
of motherhood, can startdifferent ways, and these are
some of the different ways thatI'm seeing conception look like
today.
Now the second part of thequestion following Roe versus
(04:33):
Wade, I think we need more timein order to know what that
impact looks like, holistically,meaning like like all the
different ways that it'simpacted it.
But maybe you know some of themost foremost and immediate ways
(04:55):
that the overturn of roadversus weight has impacted
conception is that, you know,for those who are of
childbearing years and fertileand capable of getting pregnant,
but who are still navigatingthe when they want to have a
child or let's say they justrecently had a child and they
(05:18):
know that they wanted a childspace or whatever the case is
you know, birth control is oneof those that is just flying off
the shelf and people are buyingit up in bulk because they then
somehow be in a situation wherethere's a pregnancy, that then,
for whatever choice or reason,they needed to then have an
(05:41):
abortion that's not readilyavailable and when you're
looking at potential options,potential consequences, such as
incarceration, fines or just allkinds of stuff like stocking up
and birth control, so that theyare minimizing the possible
(06:05):
risk of needing to navigate,needing access to an abortion
but not having one, and that'sonly one component of what does
conception look like after roe vwade.
That that doesn't um even weighinto the factor of those who do
conceive, whether it wasintentional or non-intentional,
(06:26):
or for health risks to mom orbaby or whatever the factor who
now are seeking an abortion anddon't have access to that, which
then creates his own leg ofmaternal health risk factors.
That can complicate things anddecreases the overall capacity
of wellness for people inAmerica, because we have a
(06:50):
health option that or access toa health care procedure that is
inaccessible for health reasonsor non health reasons, or, and
all of it, it is in health andwellness, especially if we're
talking about the whole personmind, body or spirit who is
having a termination, forwhatever the reason is, which
(07:13):
there are several differentreasons that one seeks that out
Looking at pregnancy.
Stephanie Theriault (07:19):
How has the landscape of pregnancy changed
in the present USA?
What are new risk factors thatare associated with pregnancy?
Midwife Audrey (07:28):
So the first further question is how has
pregnancy changed in the USA?
Yeah, how has the scope of carefor providers that can provide
(07:51):
them, and also inundatingcertain parts of the maternal
healthcare system by also nothaving it accessible.
I don't know that this datawould show us if we're starting
to see an increase inpregnancies that are desired and
(08:15):
pregnancies that aren't desired.
I don't know if we're seeing anincrease in the rate of
unintended pregnancies.
I think the rate of pregnancieshas always been what it is, but
what the statistics may showmay be that is actually
impacting, maybe certaincommunities where now, let's say
(08:38):
, that community has like onemidwife, but now we actually
need to have two or threebecause there are more
individuals that are pregnant inthat community.
I could see that kind of impactand I'm curious to see that.
After so many years, when welook back at the statistics,
(08:59):
what do we learn from this?
Stephanie Theriault (09:02):
What are some new risk factors that are
associated with pregnancy?
Post Roe v Wade Clinical riskfactors with pregnancy that
might not be known to manypeople.
Midwife Audrey (09:12):
Well, I think the clinical factors are still
the same before and after.
Now the option of what are wegoing to do about it is what's
changed.
Let's say, women who have riskof carrying a baby with a
genetic disorder or amalformation or whatever.
(09:34):
The case is, that statisticdidn't change now all of a
sudden because we don't haveaccess to abortions.
But how then that plan of carefor that pregnancy going forward
?
That is what changes, you know,post Roe versus Wade, which is
the having access to thedifferent options for your
(09:56):
maternity care that you wouldget to discuss with your
healthcare provider.
Now there are different optionsthat may have huge life factors
or implications for you.
An example could be you knowyou are pregnant and you're
excited, but now you found outyou have stage three breast
(10:17):
cancer and you need to doaggressive radiotherapy starting
tomorrow and you're literallyonly 12 weeks and your prognosis
can be good, so long as youdon't skip treatments and you
start immediately, which meansyou carrying your baby is not
something and getting radiationis not conducive to a healthy
(10:39):
pregnancy and will cause severeissues for that baby.
Well, that parent may determinethe thing that they need to do,
the health choice that theyneed to make that is in their
best interest and in the baby'sbest interest is to terminate
and get the treatments, gethealthy, be cleared of cancer
(10:59):
and then look into conceivingagain.
Many people are in this type ofcrossroads, where that's the
type of decision making thatthey are forced to navigate with
their healthcare provider andthen imagine now, here it is in
order to proceed withlife-saving healthcare risks,
(11:20):
you're needing to make certaindecisions.
That's not in your bestinterest because you don't have
access to determination and youdon't want to damage the baby
beyond irreparable belief.
But this also means you'resigning the time card on your
life and your prognosis.
Like, how crazy, how crazy.
That's not a decision that anylegislation should be able to
(11:42):
impact.
That any legislation should beable to impact.
And that's what the problem isis it should never be about the
I'm judging your choice to do athing in your body.
Who are we to even be in thatconversation?
The conversation should only bebetween the pregnant person and
whoever they're connected withthat is involved in that, along
(12:05):
with their healthcare provider.
That is it.
That is the full circle andloop for that conversation.
Stephanie Theriault (12:20):
Trying to get pregnant and trying to
balance pregnancy and work whatare some ways in which women can
find a more healthier balancewhile they're pregnant and
progressing in their pregnancy?
When you're 36, 38, 40 weekspregnant, how can we help better
manage that balance?
Midwife Audrey (12:41):
Yeah, well, there's.
What options do you have?
And fortunately, your optionsare largely dependent to the
level of like access andprivilege that you have to have
access.
So what I mean by that is doyou own your own company that is
(13:04):
well established andfinancially you can pay yourself
to then take however long youwant or need for returning
relief, right?
Not everybody has thatprivilege or that kind of access
.
So then the next one is are youpartnered with someone in which
they make enough to sustain thewhole entire household needs
(13:26):
and roof over the head and allof that stuff, while then you,
you know, stay home and parent,assuming that that's something
you want to do?
So this conversation reallymeets at the intersection
between what kind of privilegesdoes one have, which those tend
to be intergenerationally linked, and also what type of social
(13:50):
structures then do we have?
That's even accessible for anoption In other countries.
These things are integratedinto just how that country runs.
So there are then access tochild care and health care
integrated in the workplace, oralso they have paid leave, where
(14:12):
either parent or both parentsare paid to be able to stay home
and they are able to maintainroof over their head in the
things they need.
And so that is because thatsystem values the structure of
families and communities,knowing that that investment
then invests into the wellnessof the overall country.
(14:36):
And so it's crazy that thisreally leads to a larger
conversation in what is valuedand it's pretty obvious in
America what is valuedcapitalism, above all, above
wellness.
You know what works for for thethriving of, you know, our
(14:56):
healthy communities.
And so then, because now we'vekind of like broken it down and
depending on what like path orlevel of privilege that person
has access to, then of that iswhat they then navigate to have
their landscape of motherhoodlook like so for some people
(15:20):
it's this conversation, likethey wish they could even be
talking about whether or notthey could have the option to
take so many weeks off or thisor that.
For some that's not even anoption.
If they are not, you know,bringing in some kind of money
or resources, they have a verystrong, you know, likelihood of
(15:43):
losing a secure roof over theirhead and then having even more
potential risk factors be opened.
Up to now they don't havesecure housing, they don't have
secure food, and now they areimpacted by the elements, which
then also causes them to getillnesses and then have to be in
(16:04):
a healthcare system that theycan't pay for those illnesses,
and so these kind of things iswhere we see social determinants
of health that largely arepassed down intergenerationally
because of social structuresthat have been created, and so
this is part of how systemicoppression has an impact and why
(16:28):
we start to see differentlevels in equity and different
outcomes per racial capita, likewithin communities.
It's incredible just to followthe statistics and see where
these different policies camefrom and see how I guess you can
say how its intended impactthen actually unfolded years
(16:52):
later.
Stephanie Theriault (16:59):
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Talking about how the balanceof pregnancy and life,
(18:23):
responsibilities and survival,and the values in the society,
which is capitalism, monetary,how can we get the most money
out of the situation, and thattrickles into how women show up
to birth.
In this country, I believe inthe US, how women show up to
birth.
There has been a shift in theway we labor and how we labor
(18:46):
and how that produces a birth.
I want to talk about inductionsand the clinical reference and
the advice of inductions.
I think what we're talkingabout also represents in how we
show up to birth, to schedule aninduction, because we have to
balance work life, money,childcare and an induction as
(19:09):
opposed to just waiting forlabor to come and having that
social support.
Could you speak a little bit tothat?
Midwife Audrey (19:16):
To some degree, and I think you might even be
able to speak more so to it thanI can.
So, as a licensed midwife whopractices outside of the
hospital, my scope of care islow risk, you know, relatively
healthy pregnancies, and so withthat tends to also be a part of
(19:39):
what I was talking aboutearlier about like, what type of
things do you even have accessto?
So I tend to serve a communitythat has more options and
resources in terms of the typeof pregnancy path they have and
part of that pregnancy path thatthey seek with having a
(19:59):
licensed midwife, part of ourscope of care is we don't do
inductions.
So sometimes there can be thestress of like, oh geez, 42
weeks is coming up.
If this baby, you know, doesnot, if labor doesn't kick in on
its own, I may be facing aninduction.
Or if there's a concern with,maybe, how the baby is growing,
(20:23):
if they're growing too big, orif they're growing too small, or
if there's any concerns abouttheir wellness, sure then
there's, oh no, I might befacing an induction, to which
point then the OB hospitalist iswho oversees that process.
And so it's not so much for thelandscape of got to return back
(20:46):
to work.
But I do know that thatabsolutely is a factor, and even
in the population that I serve,even if they have the baby,
sometimes there's a concern forI'm not able to take six weeks
off because I have to get backto work.
Who's going to pay for thelight bill, the water, these
(21:06):
very resources they need inorder to ensure that they can
continue taking care of theirbaby.
Now they need to go out and goget these resources without even
being fully healed up to go doso.
That is a huge social problem,no matter whether you're with a
midwife or with an OB, that Ithink many women face, and
(21:27):
induction is sometimes part ofthat question of I'm only given
so much time of paid time offand I only have so many weeks of
maternity leave.
So in order to maximize howmuch time I have at home with my
child, I'm deciding to go aheadand get induced on XYZ dates.
So I still have so many days ofPTO and that, combined with my
(21:51):
maternity leave, which largelysometimes is unpaid or partially
paid, that'll buy me, hopefully, close to 10 weeks or 12 weeks.
Like, oh my gosh, how crazythat women are needing to
literally negotiate how muchtime they can take and what
(22:11):
things that they're willing todo to their bodies in order to
maximize times being home withtheir baby, you know.
So it's just like it's.
It's unfortunate that this isthe landscape, and so this
really then really revealsanother intersection where we
start to see scales of privilegewhere, even though that is
(22:31):
something somebody may need tonavigate all the way from,
they're back at work in twoweeks all the way to.
I, at least at my job, I'm ableto save up PTO and I do get
maternity leave, even thoughit's paid all the way to.
I do get maternity leave, it'spaid all the way to.
Oh, do get maternity leave,it's paid all the way to.
Oh, I don't even have to workbecause we get so much money.
(22:53):
So navigating motherhood inAmerica is so dynamic for so, so
so many mothers out there,because of the lack of social
structures that could be thereand create a basic level of
quality, meaning no matter whatlevel on the socioeconomic scale
(23:17):
you come from, we just knowthat babies thrive best when
they have a parent who is homewith them in those early years
for early bonding and connection, and we know that then those
families who have their needsmet, meaning their electricity,
their food, their this or thatare, then have less stress.
(23:39):
So then we're literallydecreasing trauma that is then
created in the homes that canthen be passed on to the
children.
And so if we were to start tocreate these kinds of social
systems in our country, thatright there would literally
start to heal and disrupt thepassing down of generational and
(24:03):
intergenerational trauma thathave largely been caused because
of mothers having to navigateentering the, reentering the
work for, you know, not beingable to enter the workforce and
giving up a loved passion andcareer because they need to stay
home, because it's notfinancially feasible, like all
these things, no matter whichway you look at it, making no
(24:25):
judgment on whether it's bestfor the mother to stay home or
not stay home or whatever thecase is, we know from a
statistical standpoint fromother countries doing it.
Having the ability to havebasic needs and resources met
decreases daily trauma, whichthen decreases the likelihood of
(24:52):
passing on that trauma, whichonly improves the quality of
life for the baby, because thequality of life of the caretaker
is improved, and so all of thatjust has a better trickle down
effect, without judgment of whoshould stay home and for how
long, and any of that.
It's really cool.
Stephanie Theriault (25:11):
So many times I find women presenting as
my patients in the hospitalwith birth plans that are low
intervention and essentiallyseeking the midwifery model of
care, but yet they hired an OBor MFM for their care.
As a midwife, could you sharewith us, with the listeners, a
(25:32):
little bit about what lowintervention looks like with
your care?
Are you primarily in a birthcenter or in the home setting?
Midwife Audrey (25:40):
Both.
So I primarily see clients inthe office, and our clientele
has the option to choose todeliver at home or to choose to
deliver at the birth center, andso referring the question again
(26:03):
interventions, and they'vehired an OB or MFM.
Stephanie Theriault (26:08):
I would love for you to share what your
model of care, what themidwifery model of care is for
women who might be on the fencein seeking a midwife but haven't
really had the opportunity tohear from a midwife, what your
model of care looks like and thebenefits of it.
Midwife Audrey (26:25):
Yes, yes, okay.
So the midwifery model of careis one that comes from a
philosophy that in a normal,healthy woman and a normal,
healthy developing pregnancy,that that body and person has
the resources in order todeliver, and our philosophy is
(26:48):
to encourage this normal process, either through emotional
support, clinical support,whatever support is needed in
order to make it to the otherside of a healthy and safe
delivery that had minimalinterventions.
So what that tends to look likeis really having conversations
(27:11):
centered around where the womanis at in her wellness and
getting her most securely onthat path of wellness.
Why is it that we keep focusingon that?
Well, because if the body,which is, if it's already
healthy and functioning well,will continue to perform well so
(27:33):
long as you maintain itswellness.
So no different than buying abrand new car.
Like my car is brand new, itworks fine.
I expect it to continue to workfine so long as I do the things
that it needs to do for it tocontinue working fine, meaning
if it gets its appropriate oilchanges.
We pay attention to any warninglights and then thereby satisfy
(27:57):
whatever needs to be done.
Like, let's say, it says tirepressure low.
Okay, give it more tire, moreair in the tire, like we can
then reasonably expect that thispiece of machinery is going to
operate at the standard of whatthat machinery should do and
what is his primary job To drive, and so chances are the car is
going to drive just fine.
(28:19):
So we take that approach withpregnancy too, meaning we have a
healthy, normal, low-riskindividual whose bodily
processes are happeningreasonably within a healthy way.
And, if you know, there aresome things that like, let's say
we get an indicator light, ielet's say we see some sugars are
(28:39):
coming back a little elevatedup.
We need to make lifestylechanges in which now the body is
metabolizing sugars normallyand when we have normally
metabolizing sugars we tend tonot then create an issue called
gestational diabetes or we don'tthen create macrosomic babies,
which then, if we're not doingthose things, the likelihood of
(28:59):
then needing the intervention ofinducing so that the baby
doesn't come out too big, orneeding to do the invention of a
C-section because a baby won'tcome out through the birth canal
.
We've literally almostaltogether eliminated the
probability of needing to dothose interventions for those
specific reasons, because we'vetaken care of the root of the
(29:20):
specific problem which causesthose things and the need for
those interventions.
Does that make sense?
It's literally a wholeconnected loop and cycle.
So whatever the risk factor is,and so it's within balance,
right.
So if someone has, let's say,asthma that's controls that
doesn't all of a sudden meanthey're not low risk.
(29:44):
It comes down to what is thescale of risk and can we
mitigate it.
Then we have a consultationwith maternal fetal medicine who
gives recommendations orfeedback.
We talk to the client abouttheir triggers and minimizing
their environmental risks thatincrease those things, their
(30:09):
pregnancy.
If they then don't have anepisode, then that's a risk
factor that's been eliminatedfrom then needing to do some
type of intervention to fix it.
Midwifery care is largely aboutholistic wellness and that is
where we put our greatestemphasis.
And should anything arise thenoutside of that, such as, let
let's say, after the delivery wehave too much bleeding, or
(30:32):
let's say baby needsresuscitation after delivery
that's why we have the skills wehave and that's why we go to
school and we're licensed is inthe event that we have some
complications that should arise,we have the ability to that
(30:53):
should arise, we have theability to mitigate them.
But really the best landscapefor overall maternity care is
one that's integrated, where wehave the midwifery model of care
, where, honestly, 85% ofAmerican women fit this model,
which is relatively low risk,meaning they don't necessarily
have preexisting hypertension,they don't have a genetic
(31:16):
disorder, they don't have somekind of ongoing health risk like
, let's say, a brain tumor.
They're just a person who's nowpregnant.
So, because 85% of thepopulation fits this category,
midwifery model of care is agreat model for those people.
The rest, of the 5% to 15%meaning this person has chronic
(31:42):
hypertension, is on all thesecrazy medications so that they
don't stroke out.
That's not a normal, healthypregnancy where we can expect
that nothing will arise.
There's all kinds ofcomplications that can arise
with that, and so those are thetype of patients that need to be
receiving care with an OB andwith maternal fetal medicine.
Unfortunately, we have thestructure of care backwards in
(32:05):
America, meaning we have, youknow, like 92% of our overall
delivering populations with OBsand maternal fetal medicine, and
then we have 8% with, you know,midwives and nurse midwives,
(32:25):
you know, delivering in low riskfashion with minimal
intervention.
So it's one of those thingswhere, just because you know we
have all the interventions wecan do, we see actually
statistically having all theaccess to all the interventions
we could do should we have acomplication.
(32:46):
It's not a good model forsomeone who is low risk, because
then it actually createsinterventions and problems that
weren't there, that then need tobe resolved, which then
altogether have a net sumnegative because now we had a
problem that we had to swoop inand do something about.
Stephanie Theriault (33:05):
So if we're not paying attention carefully,
we can sometimes think that,like being with an OB or
maternal fetal medicine isnecessary to prevent
complications, where that's notnecessarily the case at all do
(33:37):
you want to talk about thehistory and how obstetrical care
came into the mainstream,midwifery came out and then how
that kind of grafted into theinequitable care that women of
color are facing today?
Midwife Audrey (33:46):
oh my goodness, yes, understanding the history
is so important and when weunderstand it, then we also.
It just illuminates a littlebit more as to why things are
the way that they are and howthey got there.
So way back when, and evenbefore we had recorded history
(34:06):
the way we know it, the historyof women, largely, and even up
to this point, have not beenrecorded, but just through
different anthropological like,being able to surmise different
things and seeing how peoplehave evolved, and also just
looking at the statues and thedifferent things that
communities valued, you can seethat midwifery has always had
(34:29):
its place with humanity.
So, honestly, midwives havebeen around since the dawn of
mankind and when you start tosee the evolution of just
humanity through time, midwiferyand mothers and midwives were
just how humans came into thisearth, generation after
(34:51):
generation after generation.
Now let's fast forward to the,you know, 1700s, where we're
especially, you know, in Europe,having class wars, the
aristocrats and the lower class,and this and that and so on and
(35:12):
so forth, and now they'restarted to.
Part of that culture of thearistocrats was, oh my goodness,
even birth was just toobarbaric.
Birth needed to be painless, sothere started to then be the
like, striving for, in essence,becoming less of a lower human
(35:33):
who feels birth pains and whothe way in the.
In those times they said it waslike you could take a peasant
woman and aristocratic woman andthey're exactly the same woman
in birth.
And I think that was probablykind of unnerving for the
classes where it's just like no,but I'm a superior human, I
don't grovel and make noiseslike that and grunt and whatever
(35:58):
the case is and thisperspective came from a man, of
course, because back then menwere the only ones who were
allowed to be doctors and sothey started sticking their
noses into all things, and oneof those was childbirth.
Childbirth and normal andphysiological.
Why would you need a doctor forthat?
(36:31):
That's like saying you need adoctor for pooing Like why would
you need a doctor for that?
That's just a normal everydayprocess.
But one doctor was reallyparticularly obsessed about
creating painless childbirth andstarted to tinker with
different drugs and whatnot, andthis is the early beginnings of
(36:54):
the epidural.
And so in doing this, in thepursuit of a painless delivery,
which there was a demand for,that now that was something that
needed to be overseen by aphysician, because sometimes the
babies would die, or sometimesthe moms would die with these
chemical experiments, whichsometimes worked, or sometimes
(37:14):
had them just like completelyhigh out of their body.
They don't even remember whathappened and so it kind of
caught on, kind of like it'spainless simply because they
didn't remember.
It's painless simply becausethey didn't remember.
(37:35):
And so the practice actuallywas deemed rather barbaric in
Europe because it did kill somany patients and being barred
from being able to practice this, this doctor's like I'm going
to go someplace where I'mappreciated.
Well, now it comes into Americaand starting to get the
practice a little bit better andless mom and babies are dying,
yay, and some are even sayingthat they felt less pain.
(37:58):
Okay, great.
So now we have the pathology ofchildbirth becoming normalized.
Pathology meaning the diseaseprocess, the thing where things
can go wrong, whereas birth wasseen something that was not
worthy of a doctor's overseeingbecause it was so physiological,
(38:19):
like a bodily process, likethrowing up or pooping to now,
oh no, but they need a doctor tomonitor because a mom or babies
can die.
Then the medicalization ofbirth took hold and then
obstetrics was born.
So of the different practicesof medicine, whether it be
cardio, like cardiology, orlooking at like the bones and
(38:44):
osteopathy and all of that.
Obstetrics is a new, newmedicine compared to all these
other forms of medicine that wesee today as far as, like
different specialties doctorscan have.
And so from there it started totake place.
And it really took hold in theearly 1900s is twilight sleep,
(39:06):
and twilight sleep was viewed aslike a miracle innovation in
childbirth, because now womenhad a way to go through
childbirth with minimal pain orno pain.
Well, what it was was they gotmuch better with that drug
concoction.
They were doing Less.
(39:27):
Moms and babies were dying,Turns out.
The women still clearly feltthe pain.
There are actually records andnotes of how they had to tie
women to the bed because theywould curse and move and do all
kinds of things.
And again, this is coming fromthe idea of this aristocratic,
(39:47):
elevated like I'm too good tomake noises like that, like what
, and do what humans do whenthey're giving birth, like an
(40:08):
animal outside.
I want to have this experiencethat saves me from that.
I wouldn't remember thatexperience, so it felt like a
miracle, like oh my gosh, I justwent into the hospital and I
came back out and I had my babyin arms.
You can speak to many women,especially if they're still
(40:29):
alive today and can speak aboutthat experience, about what it
was like to give birth in the40s.
That was it.
It was.
No one taught you about havinga baby.
You didn't take classes Ifanything, the surgeon general at
that time.
You had a bulletin that andthis used to be on like
(40:50):
billboards about how womenshould drink alcohol and smoke
cigarettes because it would maketheir baby smaller.
Now, the rationale for that wasbecause during twilight sleep
that was the whole point wasthey literally gave you a
concoction of drugs.
They put a curtain up, you laidthere and they cut you open, ie
(41:12):
an episiotomy took forceps andjust pulled the baby out.
That was birth.
As we start to learn more andmore about the evidence of that
way of practice, we started tosee it created horrible
complications, even worsecomplications than the early
quote unquote epidural slash,pain-free birth we were trying
(41:33):
to do.
Now we were creating issueswith women's pelvic floors and
incontinence when they're youngand creating fissures and just
all kinds of things where it'slike they should not have these
kinds of complications.
These are young people Also.
Whoops, we gave a little braindamage to this baby.
The force that cut a little toodeep into the baby's brain.
(41:55):
So then, as obstetrics startsto grow, it started learning
from its mistakes like, oh geez,this actually is creating more
problems than it used to havewhen people just had a baby.
So they then practiced up alittle bit more and Twilight
Sleep then transitioned intosomething that was a little bit
more conscious, and we startedto then learn how the nerves
(42:18):
work and how to put inmedication, a narcotic, directly
in the nerve bundle so that itnumbed out the pain.
But now the woman can still beconscious.
So that's the whole processthat we got to here and where it
came from, and so thankfully wehave improved a lot of
(42:38):
different components of thetechnique and the risk factor.
But when we look at themedicalization of birth and its
movement into the hospital, itwas because of the introduction
of the concept of a pain-freebirth and also because doctors
were men and the men who wereallowed to be doctors were
(43:00):
aristocrats.
They was tied in with this ideaof nobility and of just like an
elevated status or elevatedstature.
So then a campaign to push outmidwives from childbirth
especially became a thing,because it's like, how are we
(43:21):
going to reasonably get peopleto leave this practice of seeing
midwives something that they'vebeen doing since the dawn of
mankind to finally come into ourneck of the pool, which is the
idea of.
This is the elevated way togive birth.
Don't grunt and grovel like ananimal anymore.
You could just be able to sitin a bed with a person who's of
(43:44):
elevated status, not a dirty,lowly midwife.
Come with a man, and who?
What type of men?
White men.
So it's this idea of like this,like this elevated, like we done
, moved up in the world.
Now we don't have to do it outin the field anymore, we don't
have to have pain like we didbefore.
(44:05):
We can, you know, have thiselevated status and do it in the
hospitals, and that's wheremodern day obstetrics, you know,
came from, and that's part ofwhy midwifery is no longer the
mainstream way of how peoplegive birth in this country.
That's not the case in othercountries around the world,
(44:26):
because that was not theirhistory, that was not the
process by which they got towhere they are today.
We're starting to see anincrease, a slight increase, in
midwifery in this country, whichis not well integrated into the
mainstream healthcare system,meaning it's not well integrated
(44:47):
with insurance policies, orwith hospitals or collaborative
relationships, where then therecan be the hierarchy of
maternity care, going frommidwifery all the way to
maternal fetal medicine, like itis in other countries.
But especially after the timeof COVID, we started to see
these changes, and that'sbecause women are waking up and
(45:10):
demanding more and demandingsomething different and wanting
to stand in their sovereigntyand their autonomy and how
they're giving birth and howthey're participating in their
own birth, which then leads usto where we are right here,
right now, today, in 2025.
Stephanie Theriault (45:37):
Statistics are showing that women of color
are dying at a higher rate thanwhite women in birth, and the
complications that women ofcolor are dying from are
preventable causes.
The statistics are showingthese numbers across the board.
As a labor and delivery nurse,oftentimes I'll be at the
(45:57):
nurse's station and I can lookat the board.
And what I mean by look at theboard?
I can look at the fetal stripsand oftentimes I'll hear why are
they sitting on this tracing?
And even though it's not mypatient, and more oftentimes
than not, the woman is a womanof colors, tracing the history
(46:24):
that you have just shared withus.
How and why is this happening?
How can we make a change?
How can labor nurses, maternalhealthcare providers, midwives,
obs, what can we do on aday-to-day basis to help change
these numbers?
Midwife Audrey (46:35):
Yeah, Well, it is no secret that we do have a
maternal, a maternity carecrisis in this country, and
especially a Black maternalhealth crisis, and it's to zoom
in and look at this one specificthing.
It really is part of a greaterwhole, and part of this greater
(46:58):
whole is part of what are thesocial structures that impact
the community.
And then from there, how is itthat the social structure that
impacts the community, how doesit impact her access and
resources, all the way to howdoes it impact her treatment and
(47:18):
whether or not she's seen andheard because of what's accepted
as cultural expectations thatwe have been programmed with,
that becomes a bias that thenimpacts how then we treat said
person.
So it is like a big, huge,interconnected puzzle that we
(47:40):
know that, the foundation ofwhich has to do with racial
systemic structures, all the waydown to the interpersonal
biases we hold and how itimpacts how then we show up or
how we hear the other person.
So, taking it from the I guessyou can say the system view,
(48:02):
there are a lot of education,even to this day.
That is miseducation, becausethere just has not been updated
information or updatedprogramming.
What I mean by that is thatthere are doctors and this has
been a study that has been doneamongst doctors in healthcare
(48:25):
systems and there is literallyand it's in some of the medical
books that nurses and doctorsare taught certain
misconceptions, such as, like aperson of color experiences less
pain than their whitecounterpart.
This is still a holdover fromslavery, where they literally
(48:46):
believe that Black people werebest suited for doing what they
were doing as slaves becausethey had the capacity, the
physicality and they didn't feelit.
They didn't have the pain, theydidn't have the whatever.
A lot of this was part ofwhatever made their
consciousness okay with doingwhatever they were doing.
It wasn't ever founded inscience and so, again, medicine
(49:11):
in this country was white andpracticed by the upper class, so
it's still this idea passeddown from the aristocrats in
Europe, this notion between thedifferences.
Other misconceptions, such aslike oh, black people or people
of color are easily drugaddicted and so it's best to not
(49:32):
like give them too much painmedicine, despite whatever their
affect, or what they're tellingyou, they are trying to
manipulate you, or what they'retelling you, they are trying to
manipulate you, and these arejust thoughts that then shape
how a doctor or a nurse behavesor reacts or responds to what
(49:52):
they're seeing in front of theirface.
Some of it is intergenerationalcultural teaching practices and
a lot of it is medical,societal cultural practices, all
the way down to that's what'sin their actual textbooks that
are teaching them about thepatients that they will be
taking care of.
(50:13):
So that's one major, hugefactor.
And then the other one then isthe actual lived experiences of
the individuals who have beenexposed to this systemic racial
oppression across thegenerations, which then creates
what we had mentioned earliersocial determinants of health,
(50:34):
to where, down to the zip code,we can create a probability,
statistical probability, of howlikely it is, what your chances
are, that you will have obesity,that you will have heart
disease, that you will havewhatever illness, or even down
to how likely you are to diebefore your time, and from what.
(50:56):
This is what these longstanding social structures, how
we can actually break it downstatistically to see what their
impacts are.
So then you take an individualwho is a match to these quote,
unquote statistics.
Now, what do we do about that?
It's really easy to be like, ohmy gosh, like we were just born
(51:16):
into this system and this isjust the way it is.
And these are the numbers wesee.
Yes, were just born into thissystem and this is just the way
it is.
And these are the numbers wesee.
Yes, the information, theevidence is showing us.
This is the current state.
That doesn't mean this is theonly state that we can occupy.
So, through the work of JennyJoseph and many other people in
the social justice andreproductive justice, we're
(51:38):
starting to see new evidencethat shows how to mitigate these
statistics, which, largely, aredeeply rooted in compassion,
empathy and meeting the personexactly where they are, so being
aware of the risk factors thatthey face and identifying them
and then coming up with actualsolutions for that particular
(52:03):
risk factor.
So if it is someone who livesin a food desert, because there
have been years and years andgenerations of redlining and
business practices so that therenever was a healthy food store
that was built up in thatcommunity, well, maybe that
might look like her care beingsubsidized with a partner that
(52:28):
grows healthy foods, and so nowthat healthcare provider is
connected with another communitymember for a resource that can
provide this person's need.
So just because someone has arisk factor doesn't mean that
they're doomed to having thatexperience, but understanding
the risk factor andcompassionately,
(52:50):
non-judgmentally, meeting thedeficit, for that is then how we
navigate it and how we can turnthe tides and create different
outcomes.
So I think there was one morepart of the question where you
said something about like howcan doctors, nurses, midwives?
Another way is also havingconcordant care.
What that is is having morehealthcare providers in all the
(53:15):
different fields that representthe communities that they take
care of.
When you come from a place oflived experience and shared
cultural experience, then it'smore likely that the person in
front of them is being seen andheard in their entirety and not
(53:35):
for the biases and the programsthat we've been taught to hear
and see.
You know so, seeing a providerwho like, let's say, a Black
woman who then goes and sees aBlack woman from her community
who is a midwife there arecertain things that don't then
need to be navigated or need tobe deciphered Meaning.
(53:58):
When they say a certain thing,we already know what they mean.
We can feel and understandtheir concern for the reality of
what they're saying and nothave it attached to well.
I was taught that Black peopleare really loud and they like to
over-exaggerate on things, orwhatever.
The case is that programming isnot, then, one that's even part
(54:20):
of your operating system,because you're seeing the person
, who is no different thansomebody who you grew up with.
Across the street it could beyour auntie, your uncle, your
friend, your whatevercommunication is already open
and honest communication, whichthen means there is a receptive
(54:43):
pathway to be able to understandthat when they're getting
educated on these are differentrisk factors, I need you to call
me if you experience X, y, z.
They're going to hear that morein a sense where, like, okay, I
will take I will really taketheir counsel, but also there'll
be the safety of knowing thatif I call this person, like they
(55:07):
said that I should call them,it's less likely that I will
have a negative outcome in whichDCF or the police or something
like that is called on me whenI'm just literally calling and
reporting the very thing thatthey told me to do.
And so this is the wounds thatracial structures have caused,
but one of the ways that it canbe mitigated currently is
(55:30):
through continued curiosity andcultural competency from people
who are from different culturaland racial backgrounds,
identifying their racial biasesand having just like
compassionate understanding forwhere they're coming from and
continuing to harbor an attitudeof eagerness to grow, learn and
(55:54):
change, and just know andexpect that you probably have
some blind spots, so that thatlevel of humility provides
openness to then really see theperson in front of you, so that
you're able to then continue toprovide high quality of care
that doesn't change depending onwho's in front of you and
(56:16):
that's paired with people whocome from the same cultural
background, the same livedexperiences, taking care of and
being closely I guess you cansay the ones closest to
providing the care intimately,so that when there are
complications it reduces thetime from when that complication
(56:41):
is made known to now it's beingreacted to appropriately with
high quality of care assumption,which can be, you know, racial
assumptions, which can then belike threatening to someone's
(57:02):
life, which had created amis-view of really what was
being presented in front of themfrom a clinical standpoint
(57:28):
midwife Audrey and I were sowrapped up in our conversation
that we totally lost track oftime.
Stephanie Theriault (57:34):
We had to wrap things up a little bit
quickly so I could head to myclinicals.
I really hope that you enjoyedour chat as much as I did.
We'll see you for episodenumber four.
Midwife Audrey (57:44):
Oh geez, I just looked at the time it's 1.22.
Oh my goodness, yeah, yeah,yeah, I think we covered it.
Stephanie Theriault (57:51):
I think we covered everything.
I think that was really good.
Midwife Audrey (57:54):
Yeah, yeah.
Yeah, that was very good.
You had amazing questions.
I hope you have a great class.
What are you teaching?
Stephanie Theriault (58:01):
I'm a clinical instructor, so I go to
a postpartum floor and I havesome nursing students, so it's
nice, it's fun.
Midwife Audrey (58:09):
Yes, I totally get it.
I'm a preceptor too, so I juston my last rotation, I was
teaching two students.
Well, I hope you have fun.
I know you're going to beamazing and we'll be in touch.
Stephanie Theriault (58:36):
All right.
Bye, stephanie.
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(58:57):
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(59:17):
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(59:38):
And remember embrace your powerand you got this.
Bye.
Welcome to the Maternal Wealth Podcast, a
space for all things related tomaternal health, pregnancy and
beyond.
I'm your host, stephanie Terrio.
I'm a labor and delivery nurseand a mother to three beautiful
boys.
Each week, week, we dive intoinspiring stories and expert
insights to remind us of thepower that you hold in
childbirth and motherhood.
We're here to explore the joys,the challenges and the
(00:35):
complexities of maternal health.
Every mother's journey isunique and every story deserves
to be told.
Please note that this podcastis for entertainment purposes
only.
It is not intended to replaceprofessional medical advice,
diagnosis or treatment.
Always consult with yourhealthcare provider for medical
guidance that is tailored toyour specific needs.
(00:56):
Are you ready?
Let's get into it.
Welcome back everyone.
We're excited to jump intoepisode number three with
midwife Audrey.
In this episode, audrey sharesher insights on conception in
(01:19):
the United States, especiallyafter the reversal of Roe v Wade
.
She discusses how modern womenmanage work and home life and
how they approach childbirth,including topics like inductions
, epigenetics and privilege.
We'll also explore themidwifery model of care, why
many women are drawn to it, evenif they ultimately choose
(01:41):
OBGYNs or maternal fetalmedicine specialists to be their
birth providers.
Additionally, we'll look intothe history of midwifery and
obstetrical care in the US andhow it all ties into the current
outcomes for women, especiallywomen of color, during child
birth.
Join us for a thoughtfulconversation on maternal health
(02:01):
care in the United States.
Midwife Audrey (02:12):
Thank you for having me back.
Stephanie Theriault (02:14):
I'm glad to have you here.
Let's get into it.
Midwife Audrey (02:17):
Options for conception what does conception
look like in today's societyfollowing the reversal of Roe v
Wade?
Well, I think I want to kind ofbreak this up into two parts.
So the first part would be whatdoes conception look like today
?
I think largely conceptionaltogether.
(02:37):
There's the what most peopleunderstand and know conception
to be, which is sperm eggcreates a fetus and then it
grows in a womb, and so on andso forth.
But now we have conception thatcan look like in a test tube,
where it is assisted outside ofthe womb and then put inside a
womb, whether it is of thebiological person who had that
(03:02):
egg or someone else.
Altogether, via a surrogate, itcould be inserting the semen
into the womb and it having ashortened or assisted path
towards the egg and maybeincreasing the chances of
ovulation if, for whateverreason, the morphology or the
(03:22):
mobility of the sperm, reallythey just are not capable of
getting the job done.
So there's so, so many waysthat conception can look like,
and through that there thenopens up the possibility of all
kinds of different relationshiptypes, where types where you can
have either same-sex marriageor you can have surrogacy, or
(03:47):
you can have an older couplestarting a family, or you can
have a couple of any age or anyhealth factor, for one reason or
another, starting a family, butthrough, maybe, what some
people would understand asnon-traditional means.
And there's even deciding tostart a family despite having
(04:10):
being settled with a quote,unquote partner.
So conception, the very I guessyou can say physical beginning
of motherhood, can startdifferent ways, and these are
some of the different ways thatI'm seeing conception look like
today.
Now the second part of thequestion following Roe versus
(04:33):
Wade, I think we need more timein order to know what that
impact looks like, holistically,meaning like like all the
different ways that it'simpacted it.
But maybe you know some of themost foremost and immediate ways
(04:55):
that the overturn of roadversus weight has impacted
conception is that, you know,for those who are of
childbearing years and fertileand capable of getting pregnant,
but who are still navigatingthe when they want to have a
child or let's say they justrecently had a child and they
(05:18):
know that they wanted a childspace or whatever the case is
you know, birth control is oneof those that is just flying off
the shelf and people are buyingit up in bulk because they then
somehow be in a situation wherethere's a pregnancy, that then,
for whatever choice or reason,they needed to then have an
(05:41):
abortion that's not readilyavailable and when you're
looking at potential options,potential consequences, such as
incarceration, fines or just allkinds of stuff like stocking up
and birth control, so that theyare minimizing the possible
(06:05):
risk of needing to navigate,needing access to an abortion
but not having one, and that'sonly one component of what does
conception look like after roe vwade.
That that doesn't um even weighinto the factor of those who do
conceive, whether it wasintentional or non-intentional,
(06:26):
or for health risks to mom orbaby or whatever the factor who
now are seeking an abortion anddon't have access to that, which
then creates his own leg ofmaternal health risk factors.
That can complicate things anddecreases the overall capacity
of wellness for people inAmerica, because we have a
(06:50):
health option that or access toa health care procedure that is
inaccessible for health reasonsor non health reasons, or, and
all of it, it is in health andwellness, especially if we're
talking about the whole personmind, body or spirit who is
having a termination, forwhatever the reason is, which
(07:13):
there are several differentreasons that one seeks that out
Looking at pregnancy.
Stephanie Theriault (07:19):
How has the landscape of pregnancy changed
in the present USA?
What are new risk factors thatare associated with pregnancy?
Midwife Audrey (07:28):
So the first further question is how has
pregnancy changed in the USA?
Yeah, how has the scope of carefor providers that can provide
(07:51):
them, and also inundatingcertain parts of the maternal
healthcare system by also nothaving it accessible.
I don't know that this datawould show us if we're starting
to see an increase inpregnancies that are desired and
(08:15):
pregnancies that aren't desired.
I don't know if we're seeing anincrease in the rate of
unintended pregnancies.
I think the rate of pregnancieshas always been what it is, but
what the statistics may showmay be that is actually
impacting, maybe certaincommunities where now, let's say
(08:38):
, that community has like onemidwife, but now we actually
need to have two or threebecause there are more
individuals that are pregnant inthat community.
I could see that kind of impactand I'm curious to see that.
After so many years, when welook back at the statistics,
(08:59):
what do we learn from this?
Stephanie Theriault (09:02):
What are some new risk factors that are
associated with pregnancy?
Post Roe v Wade Clinical riskfactors with pregnancy that
might not be known to manypeople.
Midwife Audrey (09:12):
Well, I think the clinical factors are still
the same before and after.
Now the option of what are wegoing to do about it is what's
changed.
Let's say, women who have riskof carrying a baby with a
genetic disorder or amalformation or whatever.
(09:34):
The case is, that statisticdidn't change now all of a
sudden because we don't haveaccess to abortions.
But how then that plan of carefor that pregnancy going forward
?
That is what changes, you know,post Roe versus Wade, which is
the having access to thedifferent options for your
(09:56):
maternity care that you wouldget to discuss with your
healthcare provider.
Now there are different optionsthat may have huge life factors
or implications for you.
An example could be you knowyou are pregnant and you're
excited, but now you found outyou have stage three breast
(10:17):
cancer and you need to doaggressive radiotherapy starting
tomorrow and you're literallyonly 12 weeks and your prognosis
can be good, so long as youdon't skip treatments and you
start immediately, which meansyou carrying your baby is not
something and getting radiationis not conducive to a healthy
(10:39):
pregnancy and will cause severeissues for that baby.
Well, that parent may determinethe thing that they need to do,
the health choice that theyneed to make that is in their
best interest and in the baby'sbest interest is to terminate
and get the treatments, gethealthy, be cleared of cancer
(10:59):
and then look into conceivingagain.
Many people are in this type ofcrossroads, where that's the
type of decision making thatthey are forced to navigate with
their healthcare provider andthen imagine now, here it is in
order to proceed withlife-saving healthcare risks,
(11:20):
you're needing to make certaindecisions.
That's not in your bestinterest because you don't have
access to determination and youdon't want to damage the baby
beyond irreparable belief.
But this also means you'resigning the time card on your
life and your prognosis.
Like, how crazy, how crazy.
That's not a decision that anylegislation should be able to
(11:42):
impact.
That any legislation should beable to impact.
And that's what the problem isis it should never be about the
I'm judging your choice to do athing in your body.
Who are we to even be in thatconversation?
The conversation should only bebetween the pregnant person and
whoever they're connected withthat is involved in that, along
(12:05):
with their healthcare provider.
That is it.
That is the full circle andloop for that conversation.
Stephanie Theriault (12:20):
Trying to get pregnant and trying to
balance pregnancy and work whatare some ways in which women can
find a more healthier balancewhile they're pregnant and
progressing in their pregnancy?
When you're 36, 38, 40 weekspregnant, how can we help better
manage that balance?
Midwife Audrey (12:41):
Yeah, well, there's.
What options do you have?
And fortunately, your optionsare largely dependent to the
level of like access andprivilege that you have to have
access.
So what I mean by that is doyou own your own company that is
(13:04):
well established andfinancially you can pay yourself
to then take however long youwant or need for returning
relief, right?
Not everybody has thatprivilege or that kind of access
.
So then the next one is are youpartnered with someone in which
they make enough to sustain thewhole entire household needs
(13:26):
and roof over the head and allof that stuff, while then you,
you know, stay home and parent,assuming that that's something
you want to do?
So this conversation reallymeets at the intersection
between what kind of privilegesdoes one have, which those tend
to be intergenerationally linked, and also what type of social
(13:50):
structures then do we have?
That's even accessible for anoption In other countries.
These things are integratedinto just how that country runs.
So there are then access tochild care and health care
integrated in the workplace, oralso they have paid leave, where
(14:12):
either parent or both parentsare paid to be able to stay home
and they are able to maintainroof over their head in the
things they need.
And so that is because thatsystem values the structure of
families and communities,knowing that that investment
then invests into the wellnessof the overall country.
(14:36):
And so it's crazy that thisreally leads to a larger
conversation in what is valuedand it's pretty obvious in
America what is valuedcapitalism, above all, above
wellness.
You know what works for for thethriving of, you know, our
(14:56):
healthy communities.
And so then, because now we'vekind of like broken it down and
depending on what like path orlevel of privilege that person
has access to, then of that iswhat they then navigate to have
their landscape of motherhoodlook like so for some people
(15:20):
it's this conversation, likethey wish they could even be
talking about whether or notthey could have the option to
take so many weeks off or thisor that.
For some that's not even anoption.
If they are not, you know,bringing in some kind of money
or resources, they have a verystrong, you know, likelihood of
(15:43):
losing a secure roof over theirhead and then having even more
potential risk factors be opened.
Up to now they don't havesecure housing, they don't have
secure food, and now they areimpacted by the elements, which
then also causes them to getillnesses and then have to be in
(16:04):
a healthcare system that theycan't pay for those illnesses,
and so these kind of things iswhere we see social determinants
of health that largely arepassed down intergenerationally
because of social structuresthat have been created, and so
this is part of how systemicoppression has an impact and why
(16:28):
we start to see differentlevels in equity and different
outcomes per racial capita, likewithin communities.
It's incredible just to followthe statistics and see where
these different policies camefrom and see how I guess you can
say how its intended impactthen actually unfolded years
(16:52):
later.
Stephanie Theriault (16:59):
We pause this episode for a quick message
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plus inclusivity, languageoptions, access to vaginal
breach services and moreAdditionally, be sure to check
out our Not your Average Birthcourse.
In this course, I discuss thevariations that exist in
hospital practices based onpolicies, staffing and budgets,
(18:03):
all of which can directly affectyour birth experience and
outcome.
Talking about how the balanceof pregnancy and life,
(18:23):
responsibilities and survival,and the values in the society,
which is capitalism, monetary,how can we get the most money
out of the situation, and thattrickles into how women show up
to birth.
In this country, I believe inthe US, how women show up to
birth.
There has been a shift in theway we labor and how we labor
(18:46):
and how that produces a birth.
I want to talk about inductionsand the clinical reference and
the advice of inductions.
I think what we're talkingabout also represents in how we
show up to birth, to schedule aninduction, because we have to
balance work life, money,childcare and an induction as
(19:09):
opposed to just waiting forlabor to come and having that
social support.
Could you speak a little bit tothat?
Midwife Audrey (19:16):
To some degree, and I think you might even be
able to speak more so to it thanI can.
So, as a licensed midwife whopractices outside of the
hospital, my scope of care islow risk, you know, relatively
healthy pregnancies, and so withthat tends to also be a part of
(19:39):
what I was talking aboutearlier about like, what type of
things do you even have accessto?
So I tend to serve a communitythat has more options and
resources in terms of the typeof pregnancy path they have and
part of that pregnancy path thatthey seek with having a
(19:59):
licensed midwife, part of ourscope of care is we don't do
inductions.
So sometimes there can be thestress of like, oh geez, 42
weeks is coming up.
If this baby, you know, doesnot, if labor doesn't kick in on
its own, I may be facing aninduction.
Or if there's a concern with,maybe, how the baby is growing,
(20:23):
if they're growing too big, orif they're growing too small, or
if there's any concerns abouttheir wellness, sure then
there's, oh no, I might befacing an induction, to which
point then the OB hospitalist iswho oversees that process.
And so it's not so much for thelandscape of got to return back
(20:46):
to work.
But I do know that thatabsolutely is a factor, and even
in the population that I serve,even if they have the baby,
sometimes there's a concern forI'm not able to take six weeks
off because I have to get backto work.
Who's going to pay for thelight bill, the water, these
(21:06):
very resources they need inorder to ensure that they can
continue taking care of theirbaby.
Now they need to go out and goget these resources without even
being fully healed up to go doso.
That is a huge social problem,no matter whether you're with a
midwife or with an OB, that Ithink many women face, and
(21:27):
induction is sometimes part ofthat question of I'm only given
so much time of paid time offand I only have so many weeks of
maternity leave.
So in order to maximize howmuch time I have at home with my
child, I'm deciding to go aheadand get induced on XYZ dates.
So I still have so many days ofPTO and that, combined with my
(21:51):
maternity leave, which largelysometimes is unpaid or partially
paid, that'll buy me, hopefully, close to 10 weeks or 12 weeks.
Like, oh my gosh, how crazythat women are needing to
literally negotiate how muchtime they can take and what
(22:11):
things that they're willing todo to their bodies in order to
maximize times being home withtheir baby, you know.
So it's just like it's.
It's unfortunate that this isthe landscape, and so this
really then really revealsanother intersection where we
start to see scales of privilegewhere, even though that is
(22:31):
something somebody may need tonavigate all the way from,
they're back at work in twoweeks all the way to.
I, at least at my job, I'm ableto save up PTO and I do get
maternity leave, even thoughit's paid all the way to.
I do get maternity leave, it'spaid all the way to.
Oh, do get maternity leave,it's paid all the way to.
Oh, I don't even have to workbecause we get so much money.
(22:53):
So navigating motherhood inAmerica is so dynamic for so, so
so many mothers out there,because of the lack of social
structures that could be thereand create a basic level of
quality, meaning no matter whatlevel on the socioeconomic scale
(23:17):
you come from, we just knowthat babies thrive best when
they have a parent who is homewith them in those early years
for early bonding and connection, and we know that then those
families who have their needsmet, meaning their electricity,
their food, their this or thatare, then have less stress.
(23:39):
So then we're literallydecreasing trauma that is then
created in the homes that canthen be passed on to the
children.
And so if we were to start tocreate these kinds of social
systems in our country, thatright there would literally
start to heal and disrupt thepassing down of generational and
(24:03):
intergenerational trauma thathave largely been caused because
of mothers having to navigateentering the, reentering the
work for, you know, not beingable to enter the workforce and
giving up a loved passion andcareer because they need to stay
home, because it's notfinancially feasible, like all
these things, no matter whichway you look at it, making no
(24:25):
judgment on whether it's bestfor the mother to stay home or
not stay home or whatever thecase is, we know from a
statistical standpoint fromother countries doing it.
Having the ability to havebasic needs and resources met
decreases daily trauma, whichthen decreases the likelihood of
(24:52):
passing on that trauma, whichonly improves the quality of
life for the baby, because thequality of life of the caretaker
is improved, and so all of thatjust has a better trickle down
effect, without judgment of whoshould stay home and for how
long, and any of that.
It's really cool.
Stephanie Theriault (25:11):
So many times I find women presenting as
my patients in the hospitalwith birth plans that are low
intervention and essentiallyseeking the midwifery model of
care, but yet they hired an OBor MFM for their care.
As a midwife, could you sharewith us, with the listeners, a
(25:32):
little bit about what lowintervention looks like with
your care?
Are you primarily in a birthcenter or in the home setting?
Midwife Audrey (25:40):
Both.
So I primarily see clients inthe office, and our clientele
has the option to choose todeliver at home or to choose to
deliver at the birth center, andso referring the question again
(26:03):
interventions, and they'vehired an OB or MFM.
Stephanie Theriault (26:08):
I would love for you to share what your
model of care, what themidwifery model of care is for
women who might be on the fencein seeking a midwife but haven't
really had the opportunity tohear from a midwife, what your
model of care looks like and thebenefits of it.
Midwife Audrey (26:25):
Yes, yes, okay.
So the midwifery model of careis one that comes from a
philosophy that in a normal,healthy woman and a normal,
healthy developing pregnancy,that that body and person has
the resources in order todeliver, and our philosophy is
(26:48):
to encourage this normal process, either through emotional
support, clinical support,whatever support is needed in
order to make it to the otherside of a healthy and safe
delivery that had minimalinterventions.
So what that tends to look likeis really having conversations
(27:11):
centered around where the womanis at in her wellness and
getting her most securely onthat path of wellness.
Why is it that we keep focusingon that?
Well, because if the body,which is, if it's already
healthy and functioning well,will continue to perform well so
(27:33):
long as you maintain itswellness.
So no different than buying abrand new car.
Like my car is brand new, itworks fine.
I expect it to continue to workfine so long as I do the things
that it needs to do for it tocontinue working fine, meaning
if it gets its appropriate oilchanges.
We pay attention to any warninglights and then thereby satisfy
(27:57):
whatever needs to be done.
Like, let's say, it says tirepressure low.
Okay, give it more tire, moreair in the tire, like we can
then reasonably expect that thispiece of machinery is going to
operate at the standard of whatthat machinery should do and
what is his primary job To drive, and so chances are the car is
going to drive just fine.
(28:19):
So we take that approach withpregnancy too, meaning we have a
healthy, normal, low-riskindividual whose bodily
processes are happeningreasonably within a healthy way.
And, if you know, there aresome things that like, let's say
we get an indicator light, ielet's say we see some sugars are
(28:39):
coming back a little elevatedup.
We need to make lifestylechanges in which now the body is
metabolizing sugars normallyand when we have normally
metabolizing sugars we tend tonot then create an issue called
gestational diabetes or we don'tthen create macrosomic babies,
which then, if we're not doingthose things, the likelihood of
(28:59):
then needing the intervention ofinducing so that the baby
doesn't come out too big, orneeding to do the invention of a
C-section because a baby won'tcome out through the birth canal
.
We've literally almostaltogether eliminated the
probability of needing to dothose interventions for those
specific reasons, because we'vetaken care of the root of the
(29:20):
specific problem which causesthose things and the need for
those interventions.
Does that make sense?
It's literally a wholeconnected loop and cycle.
So whatever the risk factor is,and so it's within balance,
right.
So if someone has, let's say,asthma that's controls that
doesn't all of a sudden meanthey're not low risk.
(29:44):
It comes down to what is thescale of risk and can we
mitigate it.
Then we have a consultationwith maternal fetal medicine who
gives recommendations orfeedback.
We talk to the client abouttheir triggers and minimizing
their environmental risks thatincrease those things, their
(30:09):
pregnancy.
If they then don't have anepisode, then that's a risk
factor that's been eliminatedfrom then needing to do some
type of intervention to fix it.
Midwifery care is largely aboutholistic wellness and that is
where we put our greatestemphasis.
And should anything arise thenoutside of that, such as, let
let's say, after the delivery wehave too much bleeding, or
(30:32):
let's say baby needsresuscitation after delivery
that's why we have the skills wehave and that's why we go to
school and we're licensed is inthe event that we have some
complications that should arise,we have the ability to that
(30:53):
should arise, we have theability to mitigate them.
But really the best landscapefor overall maternity care is
one that's integrated, where wehave the midwifery model of care
, where, honestly, 85% ofAmerican women fit this model,
which is relatively low risk,meaning they don't necessarily
have preexisting hypertension,they don't have a genetic
(31:16):
disorder, they don't have somekind of ongoing health risk like
, let's say, a brain tumor.
They're just a person who's nowpregnant.
So, because 85% of thepopulation fits this category,
midwifery model of care is agreat model for those people.
The rest, of the 5% to 15%meaning this person has chronic
(31:42):
hypertension, is on all thesecrazy medications so that they
don't stroke out.
That's not a normal, healthypregnancy where we can expect
that nothing will arise.
There's all kinds ofcomplications that can arise
with that, and so those are thetype of patients that need to be
receiving care with an OB andwith maternal fetal medicine.
Unfortunately, we have thestructure of care backwards in
(32:05):
America, meaning we have, youknow, like 92% of our overall
delivering populations with OBsand maternal fetal medicine, and
then we have 8% with, you know,midwives and nurse midwives,
(32:25):
you know, delivering in low riskfashion with minimal
intervention.
So it's one of those thingswhere, just because you know we
have all the interventions wecan do, we see actually
statistically having all theaccess to all the interventions
we could do should we have acomplication.
(32:46):
It's not a good model forsomeone who is low risk, because
then it actually createsinterventions and problems that
weren't there, that then need tobe resolved, which then
altogether have a net sumnegative because now we had a
problem that we had to swoop inand do something about.
Stephanie Theriault (33:05):
So if we're not paying attention carefully,
we can sometimes think that,like being with an OB or
maternal fetal medicine isnecessary to prevent
complications, where that's notnecessarily the case at all do
(33:37):
you want to talk about thehistory and how obstetrical care
came into the mainstream,midwifery came out and then how
that kind of grafted into theinequitable care that women of
color are facing today?
Midwife Audrey (33:46):
oh my goodness, yes, understanding the history
is so important and when weunderstand it, then we also.
It just illuminates a littlebit more as to why things are
the way that they are and howthey got there.
So way back when, and evenbefore we had recorded history
(34:06):
the way we know it, the historyof women, largely, and even up
to this point, have not beenrecorded, but just through
different anthropological like,being able to surmise different
things and seeing how peoplehave evolved, and also just
looking at the statues and thedifferent things that
communities valued, you can seethat midwifery has always had
(34:29):
its place with humanity.
So, honestly, midwives havebeen around since the dawn of
mankind and when you start tosee the evolution of just
humanity through time, midwiferyand mothers and midwives were
just how humans came into thisearth, generation after
(34:51):
generation after generation.
Now let's fast forward to the,you know, 1700s, where we're
especially, you know, in Europe,having class wars, the
aristocrats and the lower class,and this and that and so on and
(35:12):
so forth, and now they'restarted to.
Part of that culture of thearistocrats was, oh my goodness,
even birth was just toobarbaric.
Birth needed to be painless, sothere started to then be the
like, striving for, in essence,becoming less of a lower human
(35:33):
who feels birth pains and whothe way in the.
In those times they said it waslike you could take a peasant
woman and aristocratic woman andthey're exactly the same woman
in birth.
And I think that was probablykind of unnerving for the
classes where it's just like no,but I'm a superior human, I
don't grovel and make noiseslike that and grunt and whatever
(35:58):
the case is and thisperspective came from a man, of
course, because back then menwere the only ones who were
allowed to be doctors and sothey started sticking their
noses into all things, and oneof those was childbirth.
Childbirth and normal andphysiological.
Why would you need a doctor forthat?
(36:31):
That's like saying you need adoctor for pooing Like why would
you need a doctor for that?
That's just a normal everydayprocess.
But one doctor was reallyparticularly obsessed about
creating painless childbirth andstarted to tinker with
different drugs and whatnot, andthis is the early beginnings of
(36:54):
the epidural.
And so in doing this, in thepursuit of a painless delivery,
which there was a demand for,that now that was something that
needed to be overseen by aphysician, because sometimes the
babies would die, or sometimesthe moms would die with these
chemical experiments, whichsometimes worked, or sometimes
(37:14):
had them just like completelyhigh out of their body.
They don't even remember whathappened and so it kind of
caught on, kind of like it'spainless simply because they
didn't remember.
It's painless simply becausethey didn't remember.
(37:35):
And so the practice actuallywas deemed rather barbaric in
Europe because it did kill somany patients and being barred
from being able to practice this, this doctor's like I'm going
to go someplace where I'mappreciated.
Well, now it comes into Americaand starting to get the
practice a little bit better andless mom and babies are dying,
yay, and some are even sayingthat they felt less pain.
(37:58):
Okay, great.
So now we have the pathology ofchildbirth becoming normalized.
Pathology meaning the diseaseprocess, the thing where things
can go wrong, whereas birth wasseen something that was not
worthy of a doctor's overseeingbecause it was so physiological,
(38:19):
like a bodily process, likethrowing up or pooping to now,
oh no, but they need a doctor tomonitor because a mom or babies
can die.
Then the medicalization ofbirth took hold and then
obstetrics was born.
So of the different practicesof medicine, whether it be
cardio, like cardiology, orlooking at like the bones and
(38:44):
osteopathy and all of that.
Obstetrics is a new, newmedicine compared to all these
other forms of medicine that wesee today as far as, like
different specialties doctorscan have.
And so from there it started totake place.
And it really took hold in theearly 1900s is twilight sleep,
(39:06):
and twilight sleep was viewed aslike a miracle innovation in
childbirth, because now womenhad a way to go through
childbirth with minimal pain orno pain.
Well, what it was was they gotmuch better with that drug
concoction.
They were doing Less.
(39:27):
Moms and babies were dying,Turns out.
The women still clearly feltthe pain.
There are actually records andnotes of how they had to tie
women to the bed because theywould curse and move and do all
kinds of things.
And again, this is coming fromthe idea of this aristocratic,
(39:47):
elevated like I'm too good tomake noises like that, like what
, and do what humans do whenthey're giving birth, like an
(40:08):
animal outside.
I want to have this experiencethat saves me from that.
I wouldn't remember thatexperience, so it felt like a
miracle, like oh my gosh, I justwent into the hospital and I
came back out and I had my babyin arms.
You can speak to many women,especially if they're still
(40:29):
alive today and can speak aboutthat experience, about what it
was like to give birth in the40s.
That was it.
It was.
No one taught you about havinga baby.
You didn't take classes Ifanything, the surgeon general at
that time.
You had a bulletin that andthis used to be on like
(40:50):
billboards about how womenshould drink alcohol and smoke
cigarettes because it would maketheir baby smaller.
Now, the rationale for that wasbecause during twilight sleep
that was the whole point wasthey literally gave you a
concoction of drugs.
They put a curtain up, you laidthere and they cut you open, ie
(41:12):
an episiotomy took forceps andjust pulled the baby out.
That was birth.
As we start to learn more andmore about the evidence of that
way of practice, we started tosee it created horrible
complications, even worsecomplications than the early
quote unquote epidural slash,pain-free birth we were trying
(41:33):
to do.
Now we were creating issueswith women's pelvic floors and
incontinence when they're youngand creating fissures and just
all kinds of things where it'slike they should not have these
kinds of complications.
These are young people Also.
Whoops, we gave a little braindamage to this baby.
The force that cut a little toodeep into the baby's brain.
(41:55):
So then, as obstetrics startsto grow, it started learning
from its mistakes like, oh geez,this actually is creating more
problems than it used to havewhen people just had a baby.
So they then practiced up alittle bit more and Twilight
Sleep then transitioned intosomething that was a little bit
more conscious, and we startedto then learn how the nerves
(42:18):
work and how to put inmedication, a narcotic, directly
in the nerve bundle so that itnumbed out the pain.
But now the woman can still beconscious.
So that's the whole processthat we got to here and where it
came from, and so thankfully wehave improved a lot of
(42:38):
different components of thetechnique and the risk factor.
But when we look at themedicalization of birth and its
movement into the hospital, itwas because of the introduction
of the concept of a pain-freebirth and also because doctors
were men and the men who wereallowed to be doctors were
(43:00):
aristocrats.
They was tied in with this ideaof nobility and of just like an
elevated status or elevatedstature.
So then a campaign to push outmidwives from childbirth
especially became a thing,because it's like, how are we
(43:21):
going to reasonably get peopleto leave this practice of seeing
midwives something that they'vebeen doing since the dawn of
mankind to finally come into ourneck of the pool, which is the
idea of.
This is the elevated way togive birth.
Don't grunt and grovel like ananimal anymore.
You could just be able to sitin a bed with a person who's of
(43:44):
elevated status, not a dirty,lowly midwife.
Come with a man, and who?
What type of men?
White men.
So it's this idea of like this,like this elevated, like we done
, moved up in the world.
Now we don't have to do it outin the field anymore, we don't
have to have pain like we didbefore.
(44:05):
We can, you know, have thiselevated status and do it in the
hospitals, and that's wheremodern day obstetrics, you know,
came from, and that's part ofwhy midwifery is no longer the
mainstream way of how peoplegive birth in this country.
That's not the case in othercountries around the world,
(44:26):
because that was not theirhistory, that was not the
process by which they got towhere they are today.
We're starting to see anincrease, a slight increase, in
midwifery in this country, whichis not well integrated into the
mainstream healthcare system,meaning it's not well integrated
(44:47):
with insurance policies, orwith hospitals or collaborative
relationships, where then therecan be the hierarchy of
maternity care, going frommidwifery all the way to
maternal fetal medicine, like itis in other countries.
But especially after the timeof COVID, we started to see
these changes, and that'sbecause women are waking up and
(45:10):
demanding more and demandingsomething different and wanting
to stand in their sovereigntyand their autonomy and how
they're giving birth and howthey're participating in their
own birth, which then leads usto where we are right here,
right now, today, in 2025.
Stephanie Theriault (45:37):
Statistics are showing that women of color
are dying at a higher rate thanwhite women in birth, and the
complications that women ofcolor are dying from are
preventable causes.
The statistics are showingthese numbers across the board.
As a labor and delivery nurse,oftentimes I'll be at the
(45:57):
nurse's station and I can lookat the board.
And what I mean by look at theboard?
I can look at the fetal stripsand oftentimes I'll hear why are
they sitting on this tracing?
And even though it's not mypatient, and more oftentimes
than not, the woman is a womanof colors, tracing the history
(46:24):
that you have just shared withus.
How and why is this happening?
How can we make a change?
How can labor nurses, maternalhealthcare providers, midwives,
obs, what can we do on aday-to-day basis to help change
these numbers?
Midwife Audrey (46:35):
Yeah, Well, it is no secret that we do have a
maternal, a maternity carecrisis in this country, and
especially a Black maternalhealth crisis, and it's to zoom
in and look at this one specificthing.
It really is part of a greaterwhole, and part of this greater
(46:58):
whole is part of what are thesocial structures that impact
the community.
And then from there, how is itthat the social structure that
impacts the community, how doesit impact her access and
resources, all the way to howdoes it impact her treatment and
(47:18):
whether or not she's seen andheard because of what's accepted
as cultural expectations thatwe have been programmed with,
that becomes a bias that thenimpacts how then we treat said
person.
So it is like a big, huge,interconnected puzzle that we
(47:40):
know that, the foundation ofwhich has to do with racial
systemic structures, all the waydown to the interpersonal
biases we hold and how itimpacts how then we show up or
how we hear the other person.
So, taking it from the I guessyou can say the system view,
(48:02):
there are a lot of education,even to this day.
That is miseducation, becausethere just has not been updated
information or updatedprogramming.
What I mean by that is thatthere are doctors and this has
been a study that has been doneamongst doctors in healthcare
(48:25):
systems and there is literallyand it's in some of the medical
books that nurses and doctorsare taught certain
misconceptions, such as, like aperson of color experiences less
pain than their whitecounterpart.
This is still a holdover fromslavery, where they literally
(48:46):
believe that Black people werebest suited for doing what they
were doing as slaves becausethey had the capacity, the
physicality and they didn't feelit.
They didn't have the pain, theydidn't have the whatever.
A lot of this was part ofwhatever made their
consciousness okay with doingwhatever they were doing.
It wasn't ever founded inscience and so, again, medicine
(49:11):
in this country was white andpracticed by the upper class, so
it's still this idea passeddown from the aristocrats in
Europe, this notion between thedifferences.
Other misconceptions, such aslike oh, black people or people
of color are easily drugaddicted and so it's best to not
(49:32):
like give them too much painmedicine, despite whatever their
affect, or what they're tellingyou, they are trying to
manipulate you, or what they'retelling you, they are trying to
manipulate you, and these arejust thoughts that then shape
how a doctor or a nurse behavesor reacts or responds to what
(49:52):
they're seeing in front of theirface.
Some of it is intergenerationalcultural teaching practices and
a lot of it is medical,societal cultural practices, all
the way down to that's what'sin their actual textbooks that
are teaching them about thepatients that they will be
taking care of.
(50:13):
So that's one major, hugefactor.
And then the other one then isthe actual lived experiences of
the individuals who have beenexposed to this systemic racial
oppression across thegenerations, which then creates
what we had mentioned earliersocial determinants of health,
(50:34):
to where, down to the zip code,we can create a probability,
statistical probability, of howlikely it is, what your chances
are, that you will have obesity,that you will have heart
disease, that you will havewhatever illness, or even down
to how likely you are to diebefore your time, and from what.
(50:56):
This is what these longstanding social structures, how
we can actually break it downstatistically to see what their
impacts are.
So then you take an individualwho is a match to these quote,
unquote statistics.
Now, what do we do about that?
It's really easy to be like, ohmy gosh, like we were just born
(51:16):
into this system and this isjust the way it is.
And these are the numbers wesee.
Yes, were just born into thissystem and this is just the way
it is.
And these are the numbers wesee.
Yes, the information, theevidence is showing us.
This is the current state.
That doesn't mean this is theonly state that we can occupy.
So, through the work of JennyJoseph and many other people in
the social justice andreproductive justice, we're
(51:38):
starting to see new evidencethat shows how to mitigate these
statistics, which, largely, aredeeply rooted in compassion,
empathy and meeting the personexactly where they are, so being
aware of the risk factors thatthey face and identifying them
and then coming up with actualsolutions for that particular
(52:03):
risk factor.
So if it is someone who livesin a food desert, because there
have been years and years andgenerations of redlining and
business practices so that therenever was a healthy food store
that was built up in thatcommunity, well, maybe that
might look like her care beingsubsidized with a partner that
(52:28):
grows healthy foods, and so nowthat healthcare provider is
connected with another communitymember for a resource that can
provide this person's need.
So just because someone has arisk factor doesn't mean that
they're doomed to having thatexperience, but understanding
the risk factor andcompassionately,
(52:50):
non-judgmentally, meeting thedeficit, for that is then how we
navigate it and how we can turnthe tides and create different
outcomes.
So I think there was one morepart of the question where you
said something about like howcan doctors, nurses, midwives?
Another way is also havingconcordant care.
What that is is having morehealthcare providers in all the
(53:15):
different fields that representthe communities that they take
care of.
When you come from a place oflived experience and shared
cultural experience, then it'smore likely that the person in
front of them is being seen andheard in their entirety and not
(53:35):
for the biases and the programsthat we've been taught to hear
and see.
You know so, seeing a providerwho like, let's say, a Black
woman who then goes and sees aBlack woman from her community
who is a midwife there arecertain things that don't then
need to be navigated or need tobe deciphered Meaning.
(53:58):
When they say a certain thing,we already know what they mean.
We can feel and understandtheir concern for the reality of
what they're saying and nothave it attached to well.
I was taught that Black peopleare really loud and they like to
over-exaggerate on things, orwhatever.
The case is that programming isnot, then, one that's even part
(54:20):
of your operating system,because you're seeing the person
, who is no different thansomebody who you grew up with.
Across the street it could beyour auntie, your uncle, your
friend, your whatevercommunication is already open
and honest communication, whichthen means there is a receptive
(54:43):
pathway to be able to understandthat when they're getting
educated on these are differentrisk factors, I need you to call
me if you experience X, y, z.
They're going to hear that morein a sense where, like, okay, I
will take I will really taketheir counsel, but also there'll
be the safety of knowing thatif I call this person, like they
(55:07):
said that I should call them,it's less likely that I will
have a negative outcome in whichDCF or the police or something
like that is called on me whenI'm just literally calling and
reporting the very thing thatthey told me to do.
And so this is the wounds thatracial structures have caused,
but one of the ways that it canbe mitigated currently is
(55:30):
through continued curiosity andcultural competency from people
who are from different culturaland racial backgrounds,
identifying their racial biasesand having just like
compassionate understanding forwhere they're coming from and
continuing to harbor an attitudeof eagerness to grow, learn and
(55:54):
change, and just know andexpect that you probably have
some blind spots, so that thatlevel of humility provides
openness to then really see theperson in front of you, so that
you're able to then continue toprovide high quality of care
that doesn't change depending onwho's in front of you and
(56:16):
that's paired with people whocome from the same cultural
background, the same livedexperiences, taking care of and
being closely I guess you cansay the ones closest to
providing the care intimately,so that when there are
complications it reduces thetime from when that complication
(56:41):
is made known to now it's beingreacted to appropriately with
high quality of care assumption,which can be, you know, racial
assumptions, which can then belike threatening to someone's
(57:02):
life, which had created amis-view of really what was
being presented in front of themfrom a clinical standpoint
(57:28):
midwife Audrey and I were sowrapped up in our conversation
that we totally lost track oftime.
Stephanie Theriault (57:34):
We had to wrap things up a little bit
quickly so I could head to myclinicals.
I really hope that you enjoyedour chat as much as I did.
We'll see you for episodenumber four.
Midwife Audrey (57:44):
Oh geez, I just looked at the time it's 1.22.
Oh my goodness, yeah, yeah,yeah, I think we covered it.
Stephanie Theriault (57:51):
I think we covered everything.
I think that was really good.
Midwife Audrey (57:54):
Yeah, yeah.
Yeah, that was very good.
You had amazing questions.
I hope you have a great class.
What are you teaching?
Stephanie Theriault (58:01):
I'm a clinical instructor, so I go to
a postpartum floor and I havesome nursing students, so it's
nice, it's fun.
Midwife Audrey (58:09):
Yes, I totally get it.
I'm a preceptor too, so I juston my last rotation, I was
teaching two students.
Well, I hope you have fun.
I know you're going to beamazing and we'll be in touch.
Stephanie Theriault (58:36):
All right.
Bye, stephanie.
Hey there, amazing listeners,if you love what we do and want
to see our podcast grow, we needyour help.
By making a donation, you'll besupporting us and bringing you
even more great content.
I truly believe creating thisspace for women all across the
globe to share their story willallow us to collectively heal,
(58:57):
grow and become more empoweredin the space that we deserve to
be Motherhood, womanhood andhowever that looks and feels for
each and every one of us.
If you can head over to supportus today there's a link in the
bio to support the podcast.
Every contribution, big orsmall, will make a huge
difference.
(59:17):
From the bottom of my heart,thank you for being a part of
this journey.
Be sure to check out our socialmedia.
All links are provided in theepisode description.
We're excited to have you here.
Please give us a follow.
If you or someone you knowwould like to be a guest on the
show, reach out to us via emailat info at maternalwealthcom.
(59:38):
And remember embrace your powerand you got this.
Bye.
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