Ep 208: Candace’s Birth Story – Reclaiming Your Birth Story After Obstetric Violence

When Candace learned how dangerous it is to be Black and give birth in the US, she started looking for solutions. Using her skills as a professional data scientist, she determined that she would be safest opting for an unmedicated birth at a birthing center.

There, the staff was patient, respectful and communicative. But at 39 weeks, after days of prodromal labor, a hospital transfer was necessary. That’s when her whole experience took a dark turn.

About 20% of all birth center births will result in a hospital transfer. The most common reason for transfer is pain management. If we do a little back of the napkin math, that means that Candace’s story is incredibly common. That’s just unacceptable. We can and should do better and this episode shows how the simplest efforts can make big impacts.

In this Episode, You’ll Learn About:

Which four factors Candace determined improve outcomes for Black parents
What respectful medical care looks like
How Candace discussed racial healthcare disparities with her care team
Why she decided to switch doctors mid-delivery
What convinced Candace it was time for a c-section
How she managed the emotional pain and trauma she felt in the wake of her birth

Links Mentioned in the Episode

Make a Birth Plan the RIGHT Way
The Birth Preparation Course
Follow me on Instagram - I'm doing live Office Hours and posting helpful daily content!
Join my email list
You can connect with Candace on Instagram @CandaceBrown7
Read Tressie McMillan’s work
Go back to episode 203 for more information on maternal morbidity and mortality
Get Your FREE Labor Pain Management Guide
Take a quick, fun labor pain quiz
Join my email list here!

Keywords

birthing center, black mamas, Black mothers, hospital transfer, maternal morbidity, maternal mortality, obstetric violence, prodromal labor

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Transcript

All About Pregnancy & Birth Podcast Transcript

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Dr.Nicole (00:00:00): This is a little bit of a longer episode, but I mean, when I say that everyone needs to listen to this birth Story episode, it encompasses so many of the problems within our US maternity system, but also highlights some of the really easy solutions. Welcome to the All about Pregnancy and birth podcast. I'm Dr. Nicole Calloway, Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy in birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full at //drnicolerankins.com/ disclaimer. Now, let's get to it.

(00:01:07): Hello there. Welcome to another episode of the podcast. This is episode number 208. Whether you are a new listener or a returning listener, I am so glad that you're spending some of your time with me today. In today's birth story episode, we have Candace. Candace is a data scientist and mother of one based in the DC metro area. Candace has several degrees in mathematics and computer science, and she works developing predictive models for the government. She's also currently pursuing a PhD in artificial intelligence, focusing on recognizing and mitigating racial bias within AI technologies outside of work and studying. Candace enjoys spending time with her son and husband traveling. Now, Candace prepared for, and I mean, prepared for, and had every intention to have her son unmedicated at a birth center. However, after experiencing prodromal labor for five days, yes, five days, she was exhausted and opted for a hospital transfer.

(00:02:11): And side note, that's actually one of the most common reasons that people transfer from a birth center to a hospital is for pain management. Transfer happens about 20% of the time. Now, it is in the story of what happens in the hospital, including needing to fire the OB mid berth. That story demonstrates the problems in our system, but also some potential solutions. Again, everyone having a baby really needs to hear and understand this story to get a sense for what is going on or what can potentially go on when you give birth at a US hospital. Okay. Now, one of the things you're going to hear Candace talk about is how she wished she would've prepared more for the possibility of giving birth in the hospital. That, of course, is what I specialize in helping you get prepared for. One of the main ways I do this, of course, through the podcast, and the second way is through my online childbirth education class, the birth preparation course, it is specifically geared for those who plan to give birth in the hospital. It'll get you calm, confident, and empowered. To do so, you can check out all the details of the birth preparation course@drnicolerankins.com slash enroll. All right, let's get into the birth story episode with Candace.

Dr.Nicole (00:03:34): Thank

Dr.Nicole (00:03:35): You so much, Candace, for agreeing to come onto the podcast. I'm really excited to have you share your birth story about being transferred from a birth center to a hospital.

Candace (00:03:44): Yeah, thanks for having me. I'm excited to be here.

Dr.Nicole (00:03:46): Yeah. So why don't you start off by telling us a bit about yourself and your family?

Candace (00:03:49): Sure. So I'm Candace. I live in the DC area. I work full-time as a data scientist supporting the government. I live with my husband, Daniel, and we have a two year old son together, and his name is Javi Javier. We have two dogs.

Dr.Nicole (00:04:05): We're a

Candace (00:04:06): Dog family. We are kind of like a culturally fused family. Me being black, my husband is Mexican. So everything we do in our life, everything we do in our household is very culturally like deliberate. Right,

Dr.Nicole (00:04:21): Right. I love it. Love it, love it. So why don't we start, in order to understand the birth, we got to understand what the pregnancy and prenatal care was like. So I guess my first question is, what made you decide that you wanted to go with a birth center? Did you know that fairly early? What was your thought process around that?

Candace (00:04:38): Yeah, actually, it's hard to tell that story without telling the backstory. Sure. So, because I'm a data nerd and I analyze numbers all day long, and that's how I make a lot of my decisions at work and in my personal life, I was listening, and I'm also like a podcast geek. And so I was listening to an audio book by Tracy McMillan, and it's called Thick, and she, it's a series of essays, and one of the essays is called Dying to Be Competent. And in that essay, she describes her experience with obstetric violence as a black woman. And in it, she mentions, that was the first time I had heard the statistic that black women in the United States are at an elevated, have an elevated maternal mortality and morbidity rate regardless of socioeconomical level. And so that was a little bit jarring to me, and that came at a time where my husband and I knew we wanted to start trying to have a baby.

(00:05:43): And so I said, before we start trying, let me verify this information first and see if that's true, because that will steer the next set of decisions that we make about the pregnancy and the birth thing and all of that. And so I did the research, I validated what she said, and then through that research, I looked at all of the different components and factors throughout prenatal care that women can choose or experience or whatever to see what pieces created the best outcome for black mothers. And so that came down to unmedicated births at birth centers with doulas present, and an emphasis on midwife care throughout the pregnancy. And so those are the four factors that I wanted. And I looked and I looked for and secured before we even started trying for the baby.

Dr.Nicole (00:06:42): Oh my gosh. Okay. So you were a planner and you were like, I, I'm going to have all of the things lined up. So you knew all of those even before going into it. All right. I love it. I love it. So then what was you, then you got pregnant. So then what was your pregnancy and your prenatal care?

Candace (00:07:02): Because I did all this research ahead of time, everything was as I expected it to be. Like for example, one of the things we did before we hired our doula, before we finalized the selection of the birth center was we asked, we interviewed them, and we asked them, are they aware of the statistic? What do they do in their practice to help minimize that statistic? What do they do to advocate? Those kind of things. And what were

Dr.Nicole (00:07:27): Their responses? Were they, I,

Candace (00:07:29): So my doula, it was funny because we sought out a black-owned do doula company, but the doula that we ended up deciding on, she was white. And so I asked her it because that was our rule. We were going to

Dr.Nicole (00:07:44): Ask,

Candace (00:07:45): We were going to ask the uncomfortable question. And so we asked her, and she immediate, as we were asking her, she was nodding and validating, and she was like, yep. She was like, I'm aware of it. She was like, I know about it. I advocate for it. And she was in my practice. That's like most of the mothers that I care for are black mothers, and I make it a point to use my demographic to advocate harder for my mom's. Okay. And so I was like, sure. Okay. And she was aware, she was in favor of advocacy regardless of where you were birthing, who you were, whatever. And so we felt really comfortable with her. We felt like, okay, she's on our team. We're going to be okay. She knows our concerns at a deeper level.

Dr.Nicole (00:08:34): Sure, sure, sure. Okay. And what about the midwife and the birth center practice?

Candace (00:08:39): Yeah, so the birth center was really a fantastic experience for women's healthcare and for prenatal care because I, as far as women's healthcare, I was very much used to going to a OBGYN and going to a doctor's in the clinical setting. But going to the birth center and working with the midwives, it was almost like going to a therapy session. All of the appointments were 45 minutes to an hour, but there was no pressure to use the whole time, or there was no pressure to stay within that timeframe. And so we would always start the session by talking, just chopping it up and talking about our day and just really casual and then going through concerns. And then at the end of the visit, we would do all of the measurements and those kind of things, but it didn't feel so clinical. It just felt like, yeah, this is a natural thing that women can do. We don't need to poke and prod every time you're in here. And then later into my pregnancy, I had this body image thing, and I stopped wanting to step on the scale, and they were like, that's fine. You don't have to step on the scale. You're healthy. This is not the be all end all metric. Sure. You don't want to step on the scale. Right,

Dr.Nicole (00:10:02): Right. Gotcha, gotcha. So that's interesting. You said even the things, the measurements, that part was towards the end. It wasn't like you come in, get on the table. That's very different than, than traditional prenatal care. Okay. So overall, you felt like everything, you were very happy, it sounds like, with your prenatal care experience?

Candace (00:10:25): Yes. Yeah. I felt like the emphasis on body autonomy and self advocating and all of that was in the forefront. I felt like a person, I didn't feel like just a patient. I felt this was really the team of people that I'm going to be going through this life-changing process with. Gotcha. I felt like a team.

Dr.Nicole (00:10:46): Gotcha. Gotcha. And were the midwives black?

Candace (00:10:49): So my main midwife was black, and the rest were a variety of different races. It was a really diverse practice.

Dr.Nicole (00:10:57): And you met with all of them or just

Candace (00:10:59): I primarily met with mine, but if she was busy or had a birth or something, then I met with other ones. Gotcha. And even still meeting with different ones, it was still that feeling of talking to a friend or talking to a therapist. Sure. That it still felt very comfortable.

Dr.Nicole (00:11:15): Okay. Awesome. Awesome. So what did you do to prepare for your birth? Or what did you not do? Maybe a better question.

Candace (00:11:23): Honestly, that is a better question because it sounds like I did a ton and I did, me and my husband, we did a ton. We also did a Bradley Method birthing class because we wanted to make sure that he was a really big part of the experience and my support team. And sure, he put in a lot of work. But something that I didn't do that I wish I had done is I was so driven by numbers and statistics, and this is the, to have success. I didn't even consider complications or what happens if a hospital transfer is necessary, what a C-section entails. I didn't research any of that. I only researched the pieces that would make my winning combination. So well, once my birth story started to unfold, there were the holes in the planning started to show through. Gotcha.

Dr.Nicole (00:12:21): Gotcha. Did the midwives that at any point during your care, talk about what would happen if there was a hospital transfer?

Candace (00:12:28): They talked through if I needed. What were common reasons that people ask for hospital transfers, and then what the logistical process is if there's a hospital transfer. So they have hospitals they're partnered with and they make the call and they schedule blah, blah, blah. So it was very like a checklist. It wasn't in depth. It wasn't like, this is how you should mentally prepare for this if it has to happen.

Dr.Nicole (00:13:00): Got it, got it, got it. Yeah. Got it. Okay. Okay. And then I guess just to clarify though, so you did the Bradley method class. Were there any other classes or books or things that you did

Candace (00:13:11): Listened to your podcast? I listened to tons of birthing podcasts. I listened to yours religiously. I listened to what pregnancy dot coms weekly pod. Oh, I think it was like pre-recorded each week, the size of the baby and all of that. I listened to that. I listened to

Dr.Nicole (00:13:35): Evidence-based birth, maybe.

Candace (00:13:37): Yeah. Yeah.

Dr.Nicole (00:13:39): The birth hour. A lot of people listened to the birth hour, birth stories on the birth. Did you not listen to that one?

Candace (00:13:44): I don't think I listened to that one. Okay.

Dr.Nicole (00:13:45): Okay. Okay. All right. And then, so you were ready. You were prepared. What are some things that you wanted for your birth?

Candace (00:13:51): Oh my gosh. I envisioned this very serene, calm birth. I envisioned being able to put some of the Bradley Method methodology into practice meditation, deep breathing, relying on my partner. My vision was that I was going to give birth to my son in a birthing tub with nice soft music playing. And we hired a birth photographer, and it was just going to be the thing that I had envisioned. Kind of like when you playing your wedding. Sure. Exactly what it's going to look like in women.

Dr.Nicole (00:14:30): Right.

Candace (00:14:31): That's what I had going on in my head.

Dr.Nicole (00:14:33): Got it. Got it. Got it. Okay. So then let's talk about how things unfolded for you.

Candace (00:14:40): So I labored for five days, four of which were completely unmedicated. And so it's day one started maybe around three in the morning. On day one, I woke up and I was having cramps, but I had been having cramps prior to that. And they were just like, oh, it's Braxton Hicks. Sure. Contractions. It's fine, whatever. And so I woke up and they were a little bit more intense. So I went to the bathroom and I noticed what I thought was my mucus plug, and I was like, oh, maybe today is the day. Right.

Dr.Nicole (00:15:20): And how far along were you near before your due date? At your due date?

Candace (00:15:23): After I was at 29 weeks.

Dr.Nicole (00:15:26): 39. I

Candace (00:15:27): Mean, not 29. 39. Yeah, 39.

Dr.Nicole (00:15:29): Okay. I was at 39 week. Gotcha. Yeah. Gotcha. Okay. Okay. So that was day one.

Candace (00:15:37): Yeah. So that was day one. So I was able to go back to sleep, and then I had contractions throughout the day. They were like 20 minutes apart for most of the day. And then into the evening, they started to pick up, and they started to become more intense. And then around eight o'clock that night, they started to be around three minutes apart. And so the birth center was like, oh, well, come on in. And so we went up there and the contractions got really, so when we got there, I was two centimeters dilated. So I was there laboring, doing all of the techniques that we had learned, all the breathing exercises. We had our go bag, we were ready. We thought for sure the baby was going to be born that night by, I don't know, maybe by two or three in the morning. The contractions were about a minute and a half apart. And they checked me again, and I was four centimeters. And then by seven ish in the morning, everything stopped,

(00:16:37): Just completely stopped. And they were like, oh, that's okay. Maybe your body's tired. Sometimes this happens. You know what you should do? You should just go home, rest, and your contractions will start up again at some point, and then we'll have a baby. And I said, okay. So it it's day. That was day one. And so I was kind of like okay with it, because I was really tired, so I was like, sure, this is a nice break. We'll just have em tomorrow. So then day two starts, and it's more of the same. It's kind of like a carbon copy of day one. So going into day three, I'm a little frustrated. So my midwife, I'm not my wife. My doula comes over to the house once my contractions start up again. And she's like, we're going to do some exercises and some stretches that will hopefully help the baby's head put more pressure on your cervix. Because at this point, I still hadn't dilated past four centimeters. And so we did all kinds of different stretches and positions, and some of them were really uncomfortable, and with the hope that that would happen, and it did feel like his head had dropped down a little bit. So then contractions pick up even more. We go to the birth center. I'm at the birth center doing curb walking and doing, bouncing on the yoga ball ball and

Dr.Nicole (00:18:01): Just

Candace (00:18:02): Trying to get this baby going. And the same thing happened about eight hours later, completely stalled out. I was in tears. Oh, I don't think what is going on. I feel like I'm doing all the things that I'm supposed to be doing. It's not working. So then day four comes and we labor, or I labor most of the time at the house in the middle of the night, leading into day four, my contractions start and they're really strong, but I knew that this was probably going to stop at some point. So my husband, we were sleeping in our room, and I was like, I need him to sleep, and I'm not going to call my doula because I need her to sleep too, because we've been at this for three and a half days. And so I'm like, I'll just go into the other room.

(00:18:51): I know how to manage my pain and breathe through it. I'm going to go in labor in our guest room, and it'll probably stop by the morning. So I was able to get through that. By the morning, they slowed down, and then again, later in the evening, they started up again, or later in the afternoon, excuse me, they started up again. So we went to the birth center. And again, we're hoping we're like, this time has to be it, right? It's day four. I have to have dilated past four centimeters. Right. Cause they're really strong and they're starting to creep their way into my back and into my butt. I don't know what you

Dr.Nicole (00:19:30): Yeah, no. Yeah, yeah, yeah.

Candace (00:19:33): So it's becoming a whole new sensation of discomfort. And so we go to the birth center, I'm like, we have to be at least six centimeters. It has to have changed. And the midwife does the exam, and she looked like she was going to cry, and she was like, I am so sorry. You're still at four centimeters. And I was like, what is happening? Why is my body not working? Right? And I was just like, I can't do another day of this. I'm mentally tired. My body is tired. I'm hurting. Right. And I felt heartbroken that I had to say, I need a hospital transfer, because I felt like I had failed. I felt like somehow I was unprepared and I missed a step, and things didn't work out. And it was just a big ego hit for me.

Dr.Nicole (00:20:29): Sure, sure, sure. Okay. So then you decide you want to go to the hospital. Were the mid midwife, did they try and talk you out of it, or was it No,

Candace (00:20:40): No. They were very supportive. I think they realized I needed the support, and they understood why I was asking for one. Okay. It was a tall order, four days of sure. Of labor with no progress. Sure, sure. Yeah. They were very supportive.

Dr.Nicole (00:20:58): So then how did they help facilitate the transfer?

Candace (00:21:01): So they had a list of hospitals that they preferred. They had two that the birthing units had midwives mixed amongst the nurses and doctors. And so they called them first to see if they had any openings that I could take, and they didn't. So they were like, okay, well, the next one down the list, we have a doctor that comes to our practice every now and then for high risk moms just to do checks on them, and so we could send you to his hospital. And so I was like, okay. And so they were like, okay, you can go there, but you can't go. They don't have a spot for you until about 10 o'clock at night. And I said, well, I mean, I don't have any other options. So open. Right,

Dr.Nicole (00:21:48): Right.

Candace (00:21:49): So my husband and I, we go home, we eat dinner, we pack a bigger bag, because now we're anticipating staying overnight or a couple of days at the hospital, instead of going back home after the birth, we would've done at the birth center. And so around the time to check in, we head over to the hospital and we go to registration. And immediately, it was just a night and day difference between what I had experienced at the birth center, and it was very jarring. And it immediately, I felt like it became so clinical and so very regimented. And height, weight. How many weeks are you pregnant? What's your birthday? Nobody asked me, how are you feeling? What are your concerns? Was none of that. It was very fill out, this form change into this gown. And even the changing into the gown, when they gave me the gown, when the nurse gave me the gown, the registration woman was still in the room taking my insurance information, and she was like, I need you to change to this gown. And I said, okay. And so I'm holding the gown talking to the registration woman, and the nurse is like, I need you to change now. And I was like, but everyone is still in the room. Can you give me some privacy? And she is. She's like, okay, hurry up. And then they turn around. They didn't even leave the room. They just turned around. And I was like, okay, well, this is really insensitive. Oh my God. So from the beginning, I was like, oh, boy. Right. I don't know.

Dr.Nicole (00:23:31): Right. Oh, that just, that just sets, you just feel like from there, how is this going to go? Yeah. So I guess just talk. Let's get into it. Okay. How did things go from there? Yeah.

Candace (00:23:49): Yeah. It was an adventure. So finally we get to my labor room, my labor and delivery room, and I get set up in there. And so the nurse comes in, a different nurse now. She comes in and she asks me if I want Pitocin and an epidural. And I said, ideally, I don't want either. And she said to me, well, if you're not going to get Pitocin or an epidural, then you need to leave because that's the only way that you're going to deliver here. And I was like, what? I was like, okay, well, maybe Pitocin to help me dilate. And she was like, if we give you Pitocin, we're going to have to also give you an epidural. You're not going to be able to handle it. And I was just like, oh, okay. Okay, fine. We'll do both. I was tired, I was overwhelmed.

(00:24:45): I was, oh, I was all the things. So I was like, okay, let's do them both. So then the anesthesiologist comes in to do the epidural, and he walks in with a tray of instruments and things and a whole bunch of stuff that are super unfamiliar to me. And he's like, I'm going to put in your epidural. And I was like, okay, how is that done? And he was like, I put it in, and then you'll go numb from the waist down. And I was like, yeah, but how do you put it in? It's not an iv. How is it done? And he's like, I take this needle. And I put it in. He was like, now I need you to open up the back of your gown and bend forward. And I was like, wait, wait. I don't understand how it's done. I just want to know how it's done. And he is like, I don't know what you're asking me. Can you please bend forward? Can you please bend forward? And then my husband was like, stop. And everybody stopped. And he was like, she wants you to explain how you put it into her, how it works. And he was like, oh. And so then he stopped. He explained it, and I was like, okay, go ahead. And I didn't know it goes into your back. I didn't. So that was new information to me.

Dr.Nicole (00:25:55): My mouth is open. I just that, oh, that is so wrong. Okay. I mean, it's just so unacceptable. That is not how you explain. You don't know you, you've never had a baby. How are you supposed to know how an epidural were? And even for any procedure, the physician is supposed to explain the risk, the benefits, all of those things. And that doesn't sound like that happened. Did you feel, were you scared to have this person with this needle? I was terrified.

Candace (00:26:26): Okay. I was terrified. I felt like how Tracy McMillan probably felt when I was reading her essay, right? That I am a highly educated middle class woman. I have great health insurance, whatever. Why am I being treated? I'm an idiot, right? Why am I being treated? I'm a burden. I'm not a burden, but I'm being made to feel like that just because I asked how something is done. And it made me feel like there's this social mindset construct that people generally blindly will trust people in uniforms or people with a certain dress that makes them look like something familiar to the doctor's outfits and police and whatever. And so that intrinsic trust, I guess, or intrinsic obedience

Dr.Nicole (00:27:27): Even, yeah. Yeah.

Candace (00:27:29): Is probably what some of the people in that hospital were used to. Sure. And weren't used to people asking and wanting informed consent. And so that was off-putting to them. Or maybe they felt like I was challenging them, but I truly wasn't. I was sure was it was new to the

Dr.Nicole (00:27:48): Game. I just want you to explain what you're doing to me. Yeah. That's not asking a lot. I mean, this is the bare minimum, actually, of what is supposed to happen that you get explained. They explained to you what happens during a procedure. Okay. So did the epidural, at least the placement go well, and did it work?

Candace (00:28:08): Yeah, that went well. Okay. As soon as it kicked in, I was on Cloud nine, I felt so much better. Okay.

Dr.Nicole (00:28:16): Well, that's good.

Candace (00:28:17): Yeah. That piece went

Dr.Nicole (00:28:19): Well. Okay. Okay. So then what happened with the rest of your labor?

Candace (00:28:23): So I was able to fall asleep pretty soon after the epidural and the Pitocin kicked in. And so I slept for maybe three or four hours. And then the nurse woke me up and told me that my contractions were super close together. And I was like, oh, I didn't even realize I was having them. And she was like, yeah, I'm tracking 'em on this thing. And she was like, since your water's not broken, I'm going to break your water. And I was like, oh, okay. How's that done? And she was in the room for the epidural, so she was like, let me just tell this girl how it's done. So she explained how the different ways you can break someone's water and what she was going to do, and she did that, and it was a wild sensation.

Dr.Nicole (00:29:08): It is weird because it's like something is coming out of your body and you have no control over it. It's like, yes. It's very, it's a very odd, yeah, it's a very odd sensation. It sounds like she presented it as this is what is going to happen and not as an option. Yeah. Is that,

Candace (00:29:27): Yeah. It was very much like, okay, the next thing in this saga is I break your water and there's no left, or it's straight through. Right. Okay. So I was like, okay, I guess that's what we're doing.

Dr.Nicole (00:29:40): Right, right. Okay. And it was the nurse who did it. Interesting. That's not the case in a lot of hospitals, so that's interesting. Okay. All right. So then I'm just, all this is, I know.

Candace (00:29:54): Yeah.

Dr.Nicole (00:29:54): It's all

Candace (00:29:56): Over the

Dr.Nicole (00:29:56): Place. Yeah. So then how she were people nice? Were they, or was it all just

Candace (00:30:07): At this point, it was still all just really regimented. And we hadn't called my doula yet because we wanted to save her hours for the actual birth. So we hadn't called her to come in yet. Sure. So she broke my water. And then she, this might be a little bit graphic, but No, go

Dr.Nicole (00:30:28): Ahead.

Candace (00:30:29): So when you have a puppy, you get those puppy pads.

Dr.Nicole (00:30:33): Yeah.

Candace (00:30:33): Okay. So she put several of those underneath me, and then as the water's coming out, she's moving them and moving them and moving them. Finally, it stops. And she has me kind of roll so she can put a new sheet, and she does all of that. She cleans the bed, but she didn't clean me. And although I'm numb, I can still feel like the wetness and I feel gross. And so she leaves the room, and I asked my husband, I'm like, I'm so sorry. I have to ask you to do this, but can you wipe my butt?

Dr.Nicole (00:31:12): Girl, this makes me, so this is one of the, my pet peeve, I'm thinking of some of my l and D nurse friends who would be mortified at a nurse doing this. You get your patient cleaned up. You don't just leave your patient and just, okay, okay. That's just so wrong. That is not how it should be, period. So your husband has to help clean you up.

Candace (00:31:40): And so I get cleaned up, I get comfortable again, and

Dr.Nicole (00:31:45): Oh, do you know how dilated you were around that time?

Candace (00:31:47): Around this time, I think she said I was six centimeters, which is super exciting because I'm like, okay, progress, things are working. Right,

Dr.Nicole (00:31:54): Right.

Candace (00:31:56): So she brings out a big peanut ball, and she has me lay on my side and with the peanut ball between my legs. And then she comes back an hour later and I lay on the other side, and she's like, this will help you dilate. And it did. After a couple of hours of that, I was at eight centimeters. And then we were like, wait, let's call the doula. And so my doula gets there, and then the OB comes in for his first visit, and he introduces himself, and he is this big massive man. And I'm like, oh boy. Okay. Right. And he walks in, he's like, I'm Dr. So-and-so, I'm going to be your ob. And he puts on a glove, and he walks right over to the bed and he does a pelvic exam. And he wasn't gentle and didn't ask, he didn't even warn me that he was going to do that.

(00:32:49): He just did it. And it was jarring to me. It was jarring to my husband. It was jarring to my doula. It was not jarring to anybody else though. And he was like, well, it's not time to push yet. You're only eight centimeters or whatever. And I was speechless. And he was like, I'll be back later. And then he left. And I was like, that was weird. And I was talking to my husband and my doula. I was like, that was weird. At the birth center, they always said, I'm going to do an exam now. And then they would take their hand and put it on my thigh and say, this is my hand. And they would kind of pat up your thigh so that their touch doesn't shock you and say, okay, is it okay if I do it now? And you say, yes, and then they do it and it's fine. But there was none of that. It was just like, boom. And I had no words to describe how I felt. I felt inhuman. So

Dr.Nicole (00:33:51): I mean, I'm almost in tears. This is so awful. And the part about it that is so heart break, I mean, it's just heartbreaking all around. But this is a common culture problem in obstetrics. He probably thought he was doing nothing wrong, because that is what he's always done, and that is how he always does it. And we don't, as a specialty, start to real realize we have a human being in front of us. I mean, even I never, never been that aggressive or anything like that before. I'll be honest. For a while, it didn't occur to me early in my practice that we're, so, you need to stop and ask someone before you put your fingers in their vagina for God's sakes. This is not like, why are we not, this isn't hard. Why do we not think about these sort of things? Yeah. So then how did you feel after that? What did you decide to do? Or how approach things after that?

Candace (00:34:51): So after that, I was like, well, maybe I was shocked. So I was trying to rationalize it in my head, and I was like, this is the nurses here. And the staff here, when they told me who my doctor was, they were like, oh, he's great. Everyone loves him. He's super friendly. And I'm like, maybe he was in a rush. Maybe that's not normally how he does things. So he comes in again a little later, and he does the same thing again. And so at this point, so prior to him doing the exams, I had had exams done, obviously at the birth center. And I had, don't know, three or four done prior to his. And so at this point, I am extremely sore, extremely sensitive. Sure. Down there. So he comes in again, and he does it again. He does the same thing, does the exam.

(00:35:44): And after he does the exam, he goes, well, you're not progressing. And I see this a lot, and you're, you're going to fail at pushing, so we should probably just get ready for a C-section. And I was like, how are you saying this? Explain this to me. Why are you telling me I'm going to fail? I, huh. Right. And it was just like, he was like, Nope, I see this a lot. This isn't going to work. And very matter of fact, very upsetting. And so I was like, no. And so my doula at this point comes in and she's like, well, let's give it a little bit more time. And you see if you dial, because I was at nine centimeters at that point, and she's, it's almost there. Let's give it a little more time. I'm sure if we do some more position changes, we can get the pressure down and we can get to 10.

(00:36:40): Just give her a chance. And he's like, okay. And he walks out, and I tell my husband and my doula, well, I told the nurse first. I told his nurse first. I was like, I don't want him to do any more pelvic exams on me. And she was like, what do you mean? And I was like, it hurts when he does it, he doesn't ask, and I don't feel comfortable with it. And I was like, I would actually prefer maybe if you did them. And she was like, oh, I can't do them. And I was like, why not? And she said, he has to do them because he's the one who has to give you permission to push, or else he won't get paid by your insurance or something like that. And I was like, huh. I'm like, how is he going to give me permission to push that?

(00:37:24): What my God? And so I was like, okay. And so I turned from her, and now I'm facing my husband, and I'm like, I don't want him to touch me anymore. I don't care what that means for insurance. He needs not touch me. I don't care who they bring in to do if a pelvic exam is needed, but it can't be him. And so my husband's like, okay, I'll fire him. And I was like, okay. Because prior to this, I had read a thing, or maybe I listened to a podcast and found out that you can fire your doctor.

Dr.Nicole (00:37:58): I had it in a couple episodes. Yes.

Candace (00:38:02): So maybe it's your podcast if someone on the staff is making you uncomfortable. Sure. You can ask for to see someone different. And so I was like, okay, I'm going to do that. Right. I'm going to stand up for myself a little bit. And so he comes back in, puts on the glove, and I can tell he's about to do the thing again. And so my husband's like, can I talk to you outside doctor? And he's like, sure. And so they go into the hallway and my husband tells him, I couldn't hear them, but my husband told me what he said. Right. But he tells him, Candace is uncomfortable with you touching her, so we're going to ask for a new OB to do her care. And he was like, what? And he was like, what did you not understand? And he is like, he's like, what do you mean she doesn't want me to touch her?

(00:38:52): And my husband's like, she's not comfortable with you touching her. We want a new doctor. And he's like, fine. And so he leaves and we get assigned another doctor. And that doctor ended up being fantastic. She ended up being a breath of fresh air. Prior to being at that hospital. She had worked at a birth center amongst midwife. So it was finally light at the end of the tunnel. So she comes in, I think my doula and my husband kind of briefed her before she came in to talk to me, what was going on, why I was there, why we fired the doctor. So she came in, she sat down next to me, and she introduced herself. And she said, she told me her background and how her care is different than that guy's care and whatever would make me comfortable, she's willing to do.

(00:39:51): And I told her I cannot tolerate any more pelvic exams. And she was like, I validated me. I hear you. She was like, I need to do just one. I just need to do one, and then I won't do anymore, I promise. And so I was like, okay. But she did the same thing they did at the birth center. And I'm going to do an exam now. Here's my hand. Pat, pat, pat. May I perform it now? And so it still hurt because I was already pretty sore, just sure. But it was a different experience. It was finally, I feel like a person again. And so now the care team is getting back to a good place, but then physically things are not going okay. Things are not going to plan. So I can't remember what they called it, but my cervix was swollen on one side,

Dr.Nicole (00:40:52): Maybe an anterior lip. Yes. Sometimes we call

Candace (00:40:54): It an anterior lip. So that side wasn't going to stretch anymore. It wasn't going to expand anymore. And so they were like, you're nine and a half, you can push, but it might take a while. It might be difficult, whatever. So she gave me permission to push. We started pushing. I changed positions so many times, and I was pushing for about three and a half hours. Oh, wow. Okay. And the baby did not, my husband said he could see the top of his head, but he did not come out of the cervix the entire time. And the more I pushed, the more inflamed my cervix got, and the more pain I got. And I didn't realize that epidurals are kind of gravity based. So if you're, you're elevated on your hands and knees or something, all of the numbing will go to the lowest part. And so it felt like the epidural was in my shins and in my feet and not where I needed it. So the pain level spiked. It was

Dr.Nicole (00:42:02): Just

Candace (00:42:02): Okay. It was awful. And so I asked, I was like, can I please have something, some kind of pain medicine? Can I have something? And so I don't know what they gave me. They gave me something, and it didn't help with the pain, but it made me really woozy and spaced out

Dr.Nicole (00:42:19): It maybe fentanyl.

Candace (00:42:20): Okay. Yeah. So I felt like, oh, whatever. I felt very, whatever. I could still feel the pain, but I didn't care so much. So then that's when the pain really shifted. And then this is going to sound really graphic, but I don't know how else to describe it. Yeah. I felt like I was sitting on a railroad spike.

Dr.Nicole (00:42:40): Oh my God. Oh, yeah. Okay.

Candace (00:42:42): Yeah. It was a really sharp pain in my butt, and it was too much. Okay. It was way too much. And I turned to my doula and I was like, I'm done. I was like, I want a C-section. And she was like, no, you can do it. And I was like, no, no, no, no, no, not,

Dr.Nicole (00:42:58): You're not hearing what I'm saying.

Candace (00:43:01): I'm like, no, no, I don't. That's not what I need. I don't need a cheerleader right now. I'm telling you this is, I'm done with this. Right. I can't. Right. It's okay. Right. I've come to terms, this isn't it. Right. This isn't how I have my son. I was like, I want a C-section. I got to be done with this. So she was like, okay. So she told the doctor. The doctor immediately starts to set it up, and about 20 minutes later, they wheeled me back to the OR. And I don't, again, I didn't research. I had no idea how they were supposed to be done. Sure. So I go back first to get prepped, and they were like, your husband will join you later. And I said, okay. And so they put me on the table, or they shift me to the operating table, and they put this big drape up, so I can't see what's in front of me. And then they strap my arms to the table. And I don't know if that's normal or not, but it was, you don't have to. I thought it was

Dr.Nicole (00:43:54): Odd. This is you. It we used to do. It's unnecessary. Oh, we do it when people have general anesthesia because they can't, literally can't control their arms when they're completely asleep. But when people are awake, we actually do not need to strap their arms. It's a leftover thing that we still do for that. Some hospitals still do for no reason.

Candace (00:44:13): Okay. Well,

Dr.Nicole (00:44:15): Yes. Well, it was done. Of course. Yeah. Of

Candace (00:44:16): Course. It would happen in my story. Why not? So arms are strapped. So I'm in a T and the doctor said, or the anesthesiologist is like, you might trem tremble a little bit because of the medicine. And I was like, okay, whatever. I, I don't, I don't know what that means. And so he starts the medicine. I go numb from the chest down, and I start violently shaking, and I'm like, this is

Dr.Nicole (00:44:45): Bizarre, weird.

Candace (00:44:46): This is crazy. And my husband comes back and he's like, why are you shaking? And the doctor's like, oh, it's normal. And we're like, okay. And so we're like, whatever. At this point,

Dr.Nicole (00:44:57): This is, it's just such a reminder. We see these things. So we know that. But the person in front of us does not know that. And it's going to seem crazy that they're shaking uncontrollably. We need to do a little more to, anyway. Okay. Then how did the C-section itself go?

Candace (00:45:18): So the C-section was fine, the same. She performed it, so she's doing what she needs to do. I'm hearing sounds of things. My husband is talking to me to keep me calm. And then she was like, okay, here comes the baby. And I was like, okay. And I feel this enormous amount of pressure. It didn't hurt, but it was an overwhelming amount of pressure. And then it was pop. And then I hear a scream and I'm like, oh my God, my baby's here. And so they take him and they pop him around the curtain. They're like, here he is. And then I was like, yay. I get to hold him. And then they take him away and they took him over to the cleaning station and to do all of that. And I'm like, oh, okay. I don't get to be face-to-face. Right. Or be the first person to touch him or whatever.

(00:46:14): And so I'm like, okay. So they take him and they're cleaning him up, and they're like, I'm, can my husband come over there? And they're in a minute? And I'm like, okay. And so eventually they're like, okay, come on over, dad. And so he goes over, he cuts the umbilical cord, he gets to hold Javi. And I'm like, can I hold him? And they're like, you can't hold him until you leave here, until you leave the operating room. And I'm like, okay. And so they finished closing me up and taking me off the medicine. They wheeled me back to the laboring room and set me up. And then they bring, my husband brings Javi over to me. And that's the first time I held him. So 20 minutes after I gave birth to him, I got told to him.

Dr.Nicole (00:47:01): So they didn't try to do skin to skin in the or, it sounds like. No. Yeah. It wasn't offered as an option. No. Okay. It certainly can be done, especially now, granted, it can be awkward because you're laying on the table. See, and that's part of the reason they strap your arms down. I'm get getting off on a tangent in my head about some of the thoughts or things, but people get so used to doing things a certain way that they can't see what can't see the things that can be changed. And I

Candace (00:47:41): Get that was, I get that. What was going on to, well, to the doctors and the medical staff, this is their day job. So it can be very routine. And they pop out babies all the time. But to the person on the other side, me, this is a life experience. This is a core memory being formed, and I get my core memory as your day job. But try to remember that a little bit, like the bedside manner, just a little bit.

Dr.Nicole (00:48:16): Yes, yes, yes, yes, yes. Okay. Oh Lord. Okay. So then what was the postpartum period

Candace (00:48:25): In the hospital? It was kind of more of the same.

Dr.Nicole (00:48:28): Sure. Okay.

Candace (00:48:29): So I didn't know that they come in and push on your stomach immediately. That was horrible. Right. So that was what it was. Okay. They wheeled me up to wheel to the recovery room, and they were, remember, this is during the pandemic. This is 2021. Sure. Okay. So no visitors we're not allowed to leave our room and all of that. And so they wheel us up, hobbies in the little baby Tupperware thing. And the nurse that was assigned to me in there, she was like, okay. She was like, do you want to stand up? And I was like, yeah, I want to stand up. And she was like, okay, let's try to stand up. And so I tried to sit up and I was like, hold, this is the worst pain I've ever felt. And she was like, oh, did you just have a C-section? And I was like, yeah. She was like, oh, you're not. You're going to stand up today. And I'm like, why'd you offer it? Then

Dr.Nicole (00:49:35): I need you to read my chart before you come in the room, please. I was

Candace (00:49:40): Like, what?

Dr.Nicole (00:49:41): Right. Oh my

Candace (00:49:42): Goodness. She was like, oh, why didn't you say? So I'm like, are you serious? This

Dr.Nicole (00:49:46): That,

Candace (00:49:47): Okay. Yeah. Okay. So I'm like, okay. No. Standing up. And again, didn't prepare for what recovery after a C-section entails, but that was a beast in itself. So continuing the thing that we had started of informed consent and advocating. And so the next morning, a pediatrician comes in and he walks. He's like, I'm going to be your son's pre pediatrician, blah, blah. And he walks over and he goes to pick up Javi. And I'm like, what are you doing? And he was like, I'm going to check him out. And I was like, what does check him out mean? And he is like, I'm going to perform the exam. I was like, but what does the exam, what are going to do? Right. And he was like, I don't understand. I'm like, are you going to weigh him? Are you going to take his temperature? Are you check his heart?

(00:50:33): What are you doing? And he was like, oh. And then he named all the things. Sure. So after that visit, anytime he came in, he would announce himself, tell me what he was going to do, and then do it. Yes. And so he was like, okay. Yeah. And then the rest of the care, maybe they wrote it on my chart. I don't know. But everyone started to do that after that. And then things started going smoothly. And so now it's day two after the C-section. And I still haven't, like, I've now learned to figure out how to pull myself to a sitting position and enough to shuffle to the bathroom. But that was kind of all on my own. And I had asked the nurse, I was like, is someone maybe from physical therapy or something going to show me how to walk again or how to move around after having a C-section? And the nurse said, oh, yeah, they usually come in right before you discharge. And I thought, that seems late. I feel like that should be maybe towards the beginning of the care. So day three comes and we're preparing to discharge from the hospital, and I think the last appointment was physical therapy to show me how to s to show me the stuff that I had pretty much already figured out.

Dr.Nicole (00:51:59): Right, right.

Candace (00:52:00): And so then after we left the hospital, I wanted to make an appointment with, at the birth center with the care team there. And it was a little bit upsetting because they were like, okay, we usually do two visits with mom after the baby is born, but since you did a hospital transfer, all of your additional care has to be through the hospital. And so I was like, Ugh, this sucks.

Dr.Nicole (00:52:32): Right. Right.

Candace (00:52:34): So I did my follow ups on the C-section at the hospital, and I don't know, that was pretty routine.

Dr.Nicole (00:52:42): Right. Okay. And did you breastfeed?

Candace (00:52:45): No, we exclusively formula fed.

Dr.Nicole (00:52:48): Okay. Okay. And then did you see the doctor who had done the C-section, or did you see other

Candace (00:52:55): I saw, I don't, I don't even remember her name, but it was a different doctor. Okay. Each time I went for the two I did at the hospital, they were different doctors.

Dr.Nicole (00:53:04): Okay. I'm surprised the birth center didn't see you at least once afterwards. That is a little bit, yeah. I'm just surprised they didn't see you at least once afterwards. Yeah,

Candace (00:53:14): I thought so too. Right.

Dr.Nicole (00:53:15): I thought

Candace (00:53:16): At least just to catch up and see the baby.

Dr.Nicole (00:53:18): Yeah. Right, right, right.

Candace (00:53:20): I did end up taking him up there to see for them to see him, but

Dr.Nicole (00:53:24): Yeah. Gotcha. Gotcha. So I guess as we wrap up, how do you feel overall about the experience?

Candace (00:53:34): So if you were to ask me this three months afterwards, I was in full on postpartum depression. I was really disappointed in myself. I sure. I hated how my birth experience turned out. Sure. It was just a really, really bad memory, really upsetting memory. My husband, he even had nightmares about seeing me in that much pain and going through, oh. And I feel like that's also a thing that we don't really consider is agree the effects of these things on the birthing partners, but he definitely had his own mental struggles with that one. But it took a lot of processing to accept what happened and make sense of it and see the light in it and see. Sure. We did everything that we could have done and everything that we could have done that we ended up doing, we did well. I labored for four days unmedicated. Yes. That's a feat. Yeah.

Dr.Nicole (00:54:41): Absolutely. Absolutely. Absolutely. Did you seek any professional help to help process things?

Candace (00:54:48): Yeah. Okay. I definitely did. Okay. I saw a therapist who specialized in postpartum depression, and I met with her twice a week in the beginning. And then we phased back to once a week and then every two weeks as things.

Dr.Nicole (00:55:03): Oh, twice a week. Okay.

Candace (00:55:05): Yeah, I was,

Dr.Nicole (00:55:07): Gotcha.

Candace (00:55:08): I don't know. It was a weird adjustment period. I don't know if it was because my son came from a C-section, but there were moments in the first three months where he could have been anyone's baby. It didn't click with me that he was mine. I almost felt like I was babysitting. Right. I don't feel like I, like that mom closeness clicked in until maybe around six months, and then I was like, oh, yeah, this is me. This

Dr.Nicole (00:55:38): Is mine. I grew this human. Yeah. Yes. It was

Candace (00:55:41): Weird. I'm like, where did this baby come from? Right. This guy was in here. Right,

Dr.Nicole (00:55:46): Right. Okay. And then what is the one piece of advice that you would give to people who are preparing to give birth? I think I have a guess what it is, but let me see what you say.

Candace (00:55:56): Prepare for the unexpected.

Dr.Nicole (00:55:58): No, I knew it. Yeah, that's what I figured. Yes. At

Candace (00:56:02): Least have an idea of, well, I mean, you may not know about premal labor, is that what it's called? Where your labor starts? And you may not know about that, but Sure. You know, should look into what happens in a C-section or what happens with how an epidural is put. Even if you don't plan on having that, just knowing Right,

Dr.Nicole (00:56:23): Right.

Candace (00:56:24): Would've made things, I think, maybe a little bit less stressful for me. Gotcha.

Dr.Nicole (00:56:28): Gotcha.

Candace (00:56:29): And also to advocate for yourself,

Dr.Nicole (00:56:31): 1000%. Yeah, 1000%. So where can women connect with you? You can say nowhere if you want.

Candace (00:56:37): I am on Instagram. Okay. Okay. Yeah. My Instagram is Candace brown. Seven. Okay. Candace spelled a c e.

Dr.Nicole (00:56:47): All right. Well, we will put that in the show notes. Well, Candace, thank you so much for agreeing to come onto the podcast. Your story just unfortunately highlights so many of the problems in our traditional hospital system, but also I think shows how it doesn't have to be that way. It just doesn't have to be. So thank you so much for sharing. I appreciate it.

Candace (00:57:12): Yeah, I appreciate you giving me space to share. I know it's a heavy story, and I don't want to trauma dump on anyone, but it does feel good to share that story. And I do want to mention that I know that my story is not what is to be expected out of a pregnancy and out of a delivery, so I don't want to scare anybody off, but being prepared, sure.

Dr.Nicole (00:57:44): But we have to be honest about the reality of what people are experiencing. If we don't know it, then we can't do better.

(00:57:58): Okay. Wasn't that a lot? I'm so glad that Candace came on and shared her story. I really appreciate her taking the time to do so. Again, it just highlights some of the major issues that can happen in our system. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Candace. Two of them are quick, one of them is a little bit longer one. I want to say that how she talked about labor, starting stopping, starting stopping for a number of days, that is not uncommon. So definitely be prepared for the possibility that that can happen. I'm not going to say it happens to most people, but it certainly is a possibility that sort of prodromal labor can last for hours, days, sometimes even weeks.

(00:58:46): Okay. Number two, I want to reiterate the importance of preparing for possible things that could come not just in a hospital birth, but in birth in general. That is one of the things that I focus on in the birth preparation course. I have a whole module section on preparing for possibilities, so definitely check that out. The birth preparation course is my online childbirth education class. You can learn all the details at //drnicolerankins.com/ enroll. And then the thing that I want to spend the most time on in my Dr. Nicole's notes is the culture problem that we have with obstetrics in the us. And by cultural problem, I mean a culture of not explaining things appropriately to patients. A culture of this assumed deference to authority, that business-like approach to medicine and checklist and doing all the things, doing things like a vaginal exam without explicit consent.

(00:59:47): All of those things, unfortunately, are things that are pretty, or can be pretty routine within our system because that's the culture that is learned and perpetuated. As I said in the episode, these are things that I myself have done before in the past. I'm ashamed to say that it never occurred to me until I was out of practice for probably a solid, I don't know, seven, eight years that I should ask consent before doing something like a vaginal exam where I'm placing my fingers in someone's vagina. Just the culture just does not teach that. That's something that's important to do. We don't center the person giving birth in their experience, and that doesn't mean that people aren't nice. I would never say that I was mean or forceful or anything like that. And people in the hospital with Candace said that this doctor was nice, friendly patients love him, but nice is not the same as actually centering the person in their experience.

(01:00:48): We just have a serious culture problem. And that culture problem gets perpetuated because those doctors and nurses in the hospital, they see the way that they practice. That's how people around them practice. And that just continues, continues and continues. We very much so practice in silos. That is so much of why my work is about expanding those silos and expanding people's awareness of the ability to approach medicine a different way. That's what I do a lot on my professional facing social media like LinkedIn and Twitter, that kind of thing of demonstrating that there's a different way that we can practice. And I also want to say that these problems exist for all people giving birth, but they are more certainly amplified for black women and other people from marginalized communities. And in Candace's case, her education did not protect her. It didn't matter that she had degrees in math, computer science, she's working on a PhD.

(01:01:44): None of that protected her that none of that mattered when she showed up. And that is an experience that all people can face, but it is most certainly amplified for black women. And it's not always easy to speak up in these situations. You're in a vulnerable position. You may be in pain. You don't want to be labeled as difficult because that can have some consequences or you worry that it may have consequences on your care. And that's why a couple of things are really important about approaching these situations. Ideally, you want to know ahead of time as best you can that not in that type of situation. So you want to prepare yourself, ask questions during the prenatal period, but in the moment of birth, you absolutely need to have an advocate with you who can communicate on your behalf if need be. This is just a must.

(01:02:32): The reality is this is a must. You need somebody who feels comfortable speaking up for you on your behalf. And I'm not saying you need to go in there guns blazing, yelling, mean, screaming, that kind of thing. Demanding, because that doesn't necessarily set a good tone. So start from a place of kindness in expressing your feelings like, this makes me uncomfortable that you're not asking my permission before you're doing this exam. That's why I don't want you here anymore. Or say that I feel scared or I feel worried, or these are the things that I want. I just want people to explain things to me. I want people to ask me before they do things. Those are not things that are too much to ask. You can even relate it to if your wife, your sister, your mother, your friend was giving birth when you want them to be able to have these things too.

(01:03:22): So those things are absolutely crucial. Now, the other thing that I want to highlight is that she also, in her story, demonstrated how it ain't got to be this way, okay? It's not hard for us to really just stop for a moment and center the person and the experience, explain things, that kind of thing. She talked about how the replacement doctor was much better, and that is because that doctor had trained with midwives. She was incorporating aspects of midwifery care into her practice. This is a hill I will die on, and this is something that physicians can start to do right now. It is something that I found that I did in my practice incorporate aspects of midwifery care into the way physicians approach practice. We are not anytime soon going to be able to, if have a midwife for everyone. That is not going to happen anytime soon.

(01:04:17): And we need to be able to take care of the people who are giving birth right now. We can all very easily incorporate some of those aspects of midwifery care into our practice, and they make such a big difference in the experience. Like this is not a hard problem to solve. Okay? So again, we have that culture problem in our system, and in order to combat that, do your best to know your doctor, know the hospital situation ahead of time. That comes from asking questions in the prenatal period. Making a birth plan. My birth plan class is a great way to do that. That comes from preparing yourself with childbirth education. Again, my course helps specifically for hospital birth and just have somebody with you who can advocate for you on your behalf if need be. That's just so, so, so important. All right, so there you have it.

(01:05:13): Do me a solid share This podcast with a friend. Sharing is caring. It helps me to reach and serve more people. I'm on a mission to help as many folks having a baby as I can, and I would appreciate your help in doing so. Also, subscribe to the podcast wherever you're listening to me right now. Apple Podcast, most folks listen on Apple. So Apple, Spotify, wherever you're listening to me right now, go ahead and subscribe and then come follow me on Instagram. We can continue the conversation there. I'm on Instagram at Dr. Nicole Rankins. I'd love to hear what you think about the show. Send me a dm, me a show, ideas, topics, all of that good, great stuff. And also get all the good information that I share there and post there as well. That's Instagram at Dr Nicole Rankins. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.

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