#146 | Finding Autonomy and Asserting Your Birth Plan with Fierce Lizzie

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Welcome Lizzie Bolliger. From fierce Lizzy on Instagram, we're so happy to have you on the podcast today as a guest host. And the topic for the day is going to be how to best advocate for yourself in a hospital setting when your intention and your plan is to have a natural birth. So Lizzie, before we get into some examples of how best to advocate, what do you think is the best way to start off the thought process and the discussion on this topic at large. So anyone that knows me, I like drill this home. When you're planning for your birth or even your postpartum breastfeeding, knowledge is power. And you have so much more control of your situation when you know what to expect when you know what your options are. So I always tell moms to start with that. And typically what we see with you know, the typical mom is planning for her birth. It's the birth plan, I need to write the birth plan. What template I see this all the time in mom's groups, what template does anyone have a template for an unmedicated birth? And that's like, that's what I call the biggest mistake is just focusing on that one piece of paper, when really like the power within that birth plan comes from the before getting really educated. And the after, or the during, and having a voice behind that birth plan and not just letting it be a piece of paper that gets handed off to someone.

You call yourself fierce Lizzy for a reason. So I assume this is the reason so tell us a little bit about what it means to be a fierce birth advocate. What does it mean to be a fierce Lizzy?

Slowly I it's so funny. I actually had the name fierce Lizzy before I became a birth worker. And then I started really advocating for birth and the internet. What do you mean you had to name your parents gave you your nickname in high school? No, no, no, no, no. It just it's your baptism in my rebirth name. Yes.

What's the real story?

Well, I just you know, I needed an Instagram name. And it's funny because Lizzie is actually my like online persona. And people that actually know me in real life. Call me, Liz. But now my online persona is getting so big that people call me Lizzie now. And I like it. Nobody calls me fierce, Lizzie. But and I wouldn't even really say that I'm a fierce person. But I get pretty fierce on my platform when I talk about birth. And stick with it. Right? Yeah.

So tell us what it means. What does it mean to

be fierce? Okay. Yeah, that was your question. It means getting what you want. And it's not too much to ask for you to have the birth experience that you want. I mean, of course, we know that birth can take some variations of normal and that's sometimes out of our hands. But a lot of your experience is in your control, contrary to what we're led to believe. And if you're going to really take control of your birth experience, especially in the hospital setting, you're going to have to be fierce and you're going to have to know your rights and you're going to have to speak up and you're going to have to do it a different way than the typical hospital birth goes.

Do you think that most women go into birth thinking that they really have no control? They have some control. They have minimal control. Some women I think go into birth and think they have all the control. And that's problematic to add Where's the right place to be?

Well, I think more women go into birth. With the mindset of, I'm just gonna go with the flow. And I think that's been programmed a lot into us. By, you know, we can say, Who is the one, my providers, because you need a visit, and this is how it happens. A woman starts asking about, well, I'm thinking about having natural birth, or do you ever have women who don't get an epidural? And or I'm taking a HypnoBirthing? Class, I hear this one a lot. And the response is like, well, that's great that for you, pat, pat, on the head, you know, we'll just have to see how it goes. And I talk about that phrase a lot. Because when someone says to you, we'll see how it goes, that is very strongly implying, it's out of everyone. That's like saying, you know, I'm going to be going on a flight. And we'll see if the plane leaves on time, we'll see what the weather conditions are, it implies that it's that much out of our hands, which is absolutely not the case. With birth, there's so much more in our control than we can recognize not only who we hire, not only the decisions we make knowing our rights, but our very physiology is within our control, which is I think some area people don't even dare to believe. I think that's how it starts, though. It's that insidious language when people say things like that,

do you think it's do you think it's overwhelming for women to think about learning how to take charge in their birth? Is that why they want to just enter it in a go with the flow? Like, I just want to kind of relinquish to the more superior provider who knows more than I do? And it's easier to just sort of like, sort of, give it over to that then to go through the process of figuring out, okay, what do I really need to know Lee? And then I have to take responsibility for it. Exactly.

Exactly. The point, that's the hard part, taking responsibility is the core in and that's how we are set up and pushed through the funnel is you show up to the appointment, and you're told what to do. And don't worry about making a birth plan, because birth is unpredictable. And it is overwhelming. Also, because of how society presents birth to us. It looks scary, it looks like an emergency and, and how do you prepare for that like that is really overwhelming. And so I think a lot of moms just walk in as ignorance is bliss, I'm just going to go in and have my baby. And when we do that, we're completely relinquishing our control and handing it over to the provider,

we we also then can relinquish the responsibility if it doesn't go the way we want, we can sort of say, you know, I wasn't my wasn't my doing with someone else's.

You know, one thing I sometimes say when I'm speaking to a group of pregnant couples who haven't decided whether they'll take my class yet, or I just want to get them thinking, I say, Look, I can't say this class is for everybody do I believe it would serve everybody, I do believe it would serve everybody. But this will rock your world. If you're not a little bit aligned already. And here's a way to know, if you're sitting at a prenatal visit. And you start expressing some anxiety or nervousness around birth, and your doctor says to you, don't worry, I'll get that baby out of you. There are women. Yeah, you're reacting to that as as I would. There are women who think whoa, I beg your pardon. I'd sort of kind of like to have a role in this as well and be a participant in my own birth. But there are many women who sigh with relief and go okay, you will feel okay. That, if that's where that woman is in her journey, I think this would this benefit her? Yes. But it will rock her world so much. It might be out of her comfort zone, you have to have that spark in you to say, Hang on a second, don't bulldoze me here. Don't I'm not putting my entire birth and life and body in your hands. I am looking to have a relationship and a partnership in this process with you. I think that's how you start to know if you've got that spark in you that's ready to really learn that mean, do you see that difference? Yeah, absolutely. And the interesting thing is that in any other partnership, this is a partnership, you and your provider, it's a joint venture on the birth of your baby. And I think that in any other situation, like we are strong, independent, critical thinking women here, we would never let someone tell us what to do. But then in our birth, we do.

Yeah, we've, we've, we've discussed before on the podcast that women will often put more time and energy into figuring out, you know, the contractor who's going to fix their house, or certainly a wedding planner. I mean, think about how much you get in their face. And if you don't like something you're like, you know, no, we're not doing it that way. We're doing it my way. Give me options, and I will set off white flowers, not white flowers,

I mean, and then we get and then we get to our birth And we're like, whatever you say, whatever you say I trust, we believe that they know more about our body and our baby than we do.

I have one more example on this topic when I was pregnant with my son, my first is my son. And we were hanging out with a couple. And the woman, they already had three children, and they lived in our area. And I said, Oh, can you recommend a pediatrician? I completely forgot. We even have to start looking into pediatricians. It's overwhelming. Do like your she was like, Oh, my gosh, I love my pediatrician. And I immediately felt so relieved. And then I asked a really good question. Without realizing it was such a good question. Why do you like your pediatrician? I asked. Because how many people recommend doctors and these women didn't have the birth you want? You don't really know why they like their doctor. I mean, you have to dig so. So I said, Why do you like your pediatrician? And she said, you know, from the first visit, he said to me, You know what, you don't want to be one of these moms who's googling everything and getting all worked up about stuff and getting all you like, just leave it to me, you do the mothering? I'll make the decisions, and everything is gonna go well. And I'm telling you, she told me this, I was. I was shocked to recognize that this friend wasn't a close friend. But it was a lovely acquaintance of ours. I was shocked to recognize how different she and I were, because how do you look at the mother of a child and say, leave anything to me? Right? Absolutely. Like my mama bear radar would be like going off. I didn't even have a baby yet. But I thought you gotta be kidding. If you let another adult speak to you this way. I said it was unbelievable to me. And yeah, it really comes out after you give birth. But anyway, did you have a story on that topic? Same with so with my second birth, I, I wasn't familiar with any of the providers in the area. And I went with the one that everyone recommended. And this was before he became a doula. So I didn't know, I didn't really know that much. And, you know, he had great recommendations because he was nice and personality versus practice is, is it's completely different. And that was actually the birth where I felt the least supported. Yet this doctor had, you know, five star reviews from every mom in town. So it all depends on what kind of birth you want. I feel like all moms know like, I'm need to write a birth plan. It's like on the checklist. If you open up the Baby Center app, it says 36 weeks start writing your birth plan. And we typically go find a template and we check the boxes. But there's really no power in that birth plan. If you don't know why you're checking those boxes. If you don't know why you are declining cervical checks, when the provider says we need to check your cervix, you're gonna say, Oh, well, it was in my plan to not check the cervix. But if you think so then let's do it. And I think this is why you hear so many women say, Well, my birth plan went out the window. And that's because you didn't advocate for it. You didn't say, this is really important to me. And you didn't say that, because you didn't know why you didn't know why it was important.

This goes back to the conversation that we had in January with hee hee about radical boundaries in birth. It's not enough to just have the idea on the paper of what you want. It's easy to say I don't want cervical exams and labor. But you have to know why. You have to know why and how far you're willing to go. What is a hard boundary, what's a soft boundary, what's flexible? Are cervical exams flexible for you, meaning, if your provider feels really strongly that a cervical exam is going to make a difference in the progress of the labor or the next step in planning, maybe you're deciding about getting an epidural, maybe you're deciding about an intervention? Is that a decision that you are going to be flexible on? Or is it a decision that you are an absolute? No, doesn't matter what situation is not going to change where I stand? Certain things like a PC Atomy are probably an area where you need to have a hard boundary, things like newborn interventions such as erythromycin ointment, that might be a hard boundary for people. It doesn't matter what your provider says there's no way because you know where you stand on it. So that's the work you're talking about. It's not putting the stuff on paper, it's not checking off the boxes. It's getting underneath all that and saying, Why am I making this choice? And how firm am I in this decision?

Absolutely. And I feel like a lot of times we have the mindset of all or nothing like it has to be yes. Or it has to be no. I mean, I think that the biggest takeaway about birth plans is that the process of making your decision on each item I remember the first time we looked at a birth plan and I was overwhelmed. I remember saying to my husband, when does it end? When does every time I learn one every time we encounter one more thing we don't understand that leads to something else we don't know. to standard we don't know about. So it's so much effort to say, I don't know, do you want to do this? Do we not? Let's read about it? What does it say? How do we make our decision. But if you go through that painstaking effort, it for the hours, it'll take leading up to your birth, you really do develop resolve, which then makes everything going forward easier.

Often does. It does for a very large percentage of my clients. And it did for me personally, what a blessing that is. Now, one last thing about birth plans. It's funny, because it's so hard for so many women, I'll say, in particular, to advocate for themselves. And we talk about this a lot, because there is definitely something in how most of us are raised to find this balance between being absolutely strong, and powerful, but also polite, and also getting long. I joke. I mean, I had both of my children in water. But it's only because when I got to the birthing center with my son, they said, you know, do want to try the water. And I said no thanks. And then they were like, try it. And I joked that I only got into be polite, because I was this crazy part of my mind that that well, they did drawback for me, you know, the least I can do. And of course, I fell in love with it and vowed to never birth any other way. But I think it's ludicrous that I got in out of politeness. Like, that's really weird. I'm not, I'm not super proud of that. And yet, I had one woman who took my class years ago, and she got to her very high intervention hospital, she ended up having two natural births there. But in her first labor, she got there. And someone greeted her and said, Would you like a wheelchair, and she confessed in her second pregnancy that she snapped. I'm pregnant, I'm not sick. And she said she sort of went through her birth so prepared for a fight that she was like fighting with everybody. And they were really wonderfully supportive of her birth. So the second time she knew she had to just like chill out a little bit and trust a little more. We have to find this balance. Yeah.

It's okay. Yeah, first, right. It's getting in my way.

Are you going rolling up your sleeves? And that's great. I mean, it's better than the alternative. But let's talk about finding this balance between like, Sure, I'll get in the water because you do the bath and having that's, that's way too extreme. That's not good. And like going and ready to take everything the wrong way. So let's talk about what happens in labor with many women. When they're told their doctors are nodding the whole pregnancy. Sure, sure. It sounds great natural birth. And as they get close to that due date, they start shaking their head. No, I'm no we can't do that. And because they've got you then you're not going to change providers when you're 41 weeks pregnant, and fighting about induction. What do you do in the hospital? If you got there a little too early if labor is prolonged, if they're mentioning Pitocin, you're well aware it wasn't FDA approved for labor augmentation. Let's talk about that. How do we self advocate because even if you hire a doula, it is still ultimately you who has to advocate for yourself.

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This really falls back a lot on your personality too. And so us recovering people pleasers have a hard time really putting our foot down on that hard boundary, even if it is a hard boundary for us. So one of the things that I like to suggest to moms is to, if saying no right off the bat isn't, if that's not going to come out automatically, then start asking questions. Ask the question, is this medically necessary? What is the benefit of this? A lot of times in our maternity care, we're not given true informed consent. We're just told what to do. And by asking these questions, you're forcing them to tell you what they should have already told you. It's buying you time. It's it's giving you time to process and really understand the intervention. And I really think that sometimes once you start asking these questions, the provider realizes, Oh, wait, maybe this isn't the best course of action for this mom, who has a preference of an unmedicated birth, who really values physiological birth.

A lot of times, providers are just sort of following the path of least resistance, let's just kind of like throw out the intervention and see if they bite and that helps speed things along, and the birth will be done faster, and it's easier for them. And sometimes, it really isn't that you have to fight that hard. Sometimes it really is just that you have to give a little bit of pushback and ask the right questions. And then your provider will hopefully respond appropriately, and answer those questions and make your decisions easy. Or leave you alone for a little while. Sometimes it's just buying a little bit more time. But this is a great chance to go through the brain acronym. We've we've talked about it on Instagram, I don't know if we've ever really talked about on the podcast, but it's such a simple way of remembering what to do in those moments how to ask those questions, because people don't even know what am I supposed to ask? So the brain acronym stands for asking what are the benefits? Are is asking what are the risks? A is asking, what are the alternatives? What are my alternatives? VR AI? Next is checking in with your intuition. What is that's the hard one.

That's best one.

That's the most important one. It is the hardest one. What is my body really telling me in this moment? What am I really feeling? What do I really, really want to do? Not what they want me to do? Not what my doula wants me to do, not what anybody else in the room wants me to do. But what feels

right. I really like to prompt moms to on the intuition, we have a hard time tapping into our intuition. But to think like, what would my cave woman self do right now, just to kind of, you know, if your preferences and unmedicated natural birth, like what would my body do right? Now, if I didn't have all these things going on? Did you say n

know that I was gonna say well, that in when you can't, when you're are unsure about all of the above, and you're not sure what your intuition is saying the the brain acronym is so great, because it ends with n, which is nothing, do nothing. What happens if I do nothing, it's, it's the easiest default. So if all those other things before that don't really get you to where you want to go, you can always go with a little bit of time of doing nothing. Just let the process unfold, let it do its own thing by doing nothing, you're not really doing nothing. You're letting it take its course,

there's so much of everyone asking women to justify why they want a natural birth or a doctor saying what's the problem? Why don't you want Pitocin? Right now, what's the problem? What's your objection to induction? It's flipped on its head. I mean, did that we should only be justifying why to intervene. Because every cell in your body is not anticipating any intervention. So we need to have the rationale for intervening. It's not that it's always the wrong thing. But there must be a reason for it. I don't have to defend why we're, why we're doing the default, which is to give birth, like every ancestor of mine, 4.2 million years has done it. It's because society and culture has a big role in this. A lot of times too. And this is a good way to kind of read your providers. If you ask for more time, if you ask for doing nothing and they're okay with it. Well, there was your answer on how medically necessary this intervention was. And so that's that is one that I like to slip in mom's back pockets as asked for more time asked to do nothing, and see how their responses and that should give you a good indicator on how how important that intervention was in that moment. When something

is really truly medically necessary in birth, you're going to know most of the time what they're suggesting is not and believe me, you will not be mistaken when your life or your baby's life is truly in danger truly. Not just If you don't want your baby to die, not that garbage,

you will know. And it will want intervention, you'll want it and you will want it. Exactly. Yeah, that goes to the problem of, of assuming that mom would never want the best thing for her baby the assuming mom choosing an unmedicated natural birth. We have to like put that disclaimer, as long as baby is doing okay, well, no, of course, that's what you want. Of course, you want the best outcomes for your baby. And we know that leaving birth alone does have the best outcomes. In most cases, you want a good outcome, far more than any doctor or midwife or other human being on earth could possibly want the very idea that a woman is putting her own baby at risk is outrageous. I mean, women would die for their baby, they would go through any suffering for the sake of their baby to act as though they're being selfish. They're trying to prove something. It's just manipulation, honestly of the situation. I you know, when we were talking earlier about having providers justify what they're recommending, and you were saying, like, sometimes it makes them rethink it, or I think it's just a matter of the fact that they can't save face. Here's a really good example, I think, one couple that took my class, they went on a little baby moon, like when they were at the end of pregnancy, a little road trip. And when they got back, their doctor had left a message on her machine, like, Okay, I'm going to need you in Monday morning for an induction. And this client called me like, What could this be? I forgot how many weeks she was. But it wasn't a factor, let's say 40 weeks. She was groupie strapped positive. So I said, I can't imagine what do you mean? She just said, your induction? She never mentioned this. Did your membranes release? Does she think you have any other things? She said, No, my membranes haven't released? I, I can't believe this. I said, What are you going to do? She's like, well, I'm going to go, but I just I don't understand. And I said, Listen, you've put a lot of work into your birth so far. So make sure this is a conscious decision. And when you see her, you're allowed to leave Sabrina and you're allowed to say, what is the medical indication? Why am I here? So they called me from the waiting room, they waited a really long time, the doctor was really, really late. So we were on the phone for a long time we hung up. And she called me back a little while later, maybe an hour later. And she was in the car with her husband, and she was laughed. They were laughing. And I said, What what happened? And she said, You can't believe this. The doctor walked over and said, Okay, are you ready for your induction? And she said, um, I said to the doctor, can you just tell me why I'm here? What's the medical indication? And she said, the doctors words were Oh, I'm sorry, did you not want to be induced today? They were like, you have to be kidding me. Like we came home from vacation to this urgent message come into the hospital. And she said, I'm sorry, did you not want to be induced? It was that casual. And the doctor immediately recognized she didn't have a justification, she had to act that way to save face. There was no reason. And here's the thing is someone that wasn't educated would have just went along with it. And I really so yes, be right. Yeah. And I really do think that it's becoming so normal to be induced, that anytime my moms are declining, their mom friends are like, why would you not want to have your baby at 40 weeks, like they just, they just don't know, are just not on the same page.

That's why this woman got on the schedule, just unknowingly and routinely, because it was like, Oh, she's approaching this date that are on the indexing indiginous schedule, because most people kind of want to be pushed through and get why not get the pregnancy over with.

It's like, it's the providers like checklist, like Oh, client is this many weeks, this many weeks? This is what we do. And so sometimes advocating for yourself really just requires that you interrupt that checklist enough to make sure your preferences and your values are known with your provider. You mentioned asking for time, which is a great strategy, you have the right to ask for time, you have the right to say can we have privacy? Can you leave the room and give us privacy and they must give you privacy if you ask for it. You can have them leave the room and make a phone call to a trusted person and have a conversation talk among yourselves. You have the right to say can we have two hours? And then that two hours you can ask for full privacy? Can nobody come in the room? Can we just have privacy? And you know and HypnoBirthing and a lot of other methods that understand the mind body connection. You want to spend that time relinquishing visualizing feeling happy, loved, touched, cared for. And so often you will be all the way at 10 and having your baby in that window because you finally have privacy as all other mammals do when they're giving birth. I mean, they seek privacy as well. It's an instinct for some women, not for others. Some women love to be surrounded by loving arms the whole time, but you have to feel trust and in some scenarios, you're going to feel trust with privacy and others you're going To feel more trust with community. But I think that's a key point. Another one is, when you're having that conversation with providers, one tip I give my clients is, when you're having that conversation, let's say about labor augmentation, I always say, Never ask a yes, no question. Because they will always answer in the way that's going to serve them. And so ask an open question. Don't say, are you concerned about something here? I promise you their next word will be yes. But what will follow the yes will likely be rhetoric. Well, you know, I've seen this before. And just let's just say babies do Better out than in. Now, that's the kind of nonsense that women listen to. And it's haunting, it's intimidating when you hear it, you want to look for data you want to look for, what is the medical indication, I like both of those types where you are kind of doing like a wait and see when you ask for more time because sometimes that quote, unquote, issue problem that's part of the problem will resolve itself and then you don't have to worry about that confrontation. And one other thing I like to tell moms is just to practice assertive and respectful communication, where you just put your foot down because you ultimately are the decision maker. It really doesn't matter what your provider says, it is 100% up to you and your preferences. And like we said, of course, you want the safest option. So you will consider what your expert provider knows in terms of the medical birth, but assertive, respectful communication is a good way to tell your provider what is going to happen without being super rude, or, or combative. And so something like let's say, your provider wants to do a cervical check wants you on your back. And you can say, You know what, I'm really comfortable using movement right now. I'm going to stay right here. And we're so you're not saying no, there's not really a conflict very, you're just telling your provider, what you're going to do with your own body, which is your your right,

then I can see the provider saying, Well, you know, we really can't increase the Pitocin or start the epidural, if we don't know how far dilated you are. So I'm really going to need you to just just take a minute and get in the bed, and I promise it'll be quick and easy. And then we'll be able to make a decision.

So this goes back to where we feel like being nice, like, oh, you drew the bath, I'm gonna get in the bath. And providers love, I shouldn't say all providers, but providers like to make you feel like you're inconveniencing them. And it'll just be really quick. It's just a cervical check. It's just fetal monitoring. It's just this it's just a C section millions of women do it. Yeah. Well, I mean, that's why intuition matters. Because if someone has to talk you into something, then that's because your intuition is saying otherwise. And you both know it. And this, this, it really makes me so mad, because they're, you're worrying about being inconvenient to someone who's at work. They're at their job, and this is your how many times are you going to give birth in your life? I met three, that's it. I think those three days my preferences take precedent over something being convenient to the provider or routine for the hospital. Three days in my life, I get to say what goes it's all manipulation, conflicts of interest. It's an unfortunate system that we have. That's 100 other conversations that can get the mind working about improvement that needs to happen. You know,

it really I think it really just comes down to women really need to understand and feel confident in their ability and their right. To say no, no matter what, the circumstances. And this was something that I didn't even really understand that well until I started having all these conversations on the podcast, like as a provider. Women don't really say no, to me, like, I have the conversation with them, and they express their viewpoints. And we come to an agreement together. And I you know, I believe that as a provider, I'm always respectful and the conversations are always respectful. And my don't run into those conflicts because of that. But rarely does somebody really just say

no. Which makes you realize you could abuse and take advantage of the situation if you were so inclined. I would have you just aren't.

Absolutely. But in the end, you can always you always have the right to say no to decline, whatever it is, and I think it's just so hard for women to feel confident in their ability to do that and we feel if I say no, am I making the wrong Choice, am I going to feel guilty? Am I going to feel? What if I say no, and then something bad happens? How do I deal with that responsibility? How do I deal with then feeling ashamed of my choice, and I made the wrong decision. It's tough. But when you know, you know, and when, you know, you have to be able to stand in that. And like you said, Cynthia, that comes down to that, in that piece of intuition. Like nobody can make you do something that you truly feel is wrong.

I think it's important to recognize that establishing your boundaries has nothing to do with how kind you are, how sweet you are, how polite you are, nothing, we have to recognize, like we know our own hearts, we know when we're kind we know when we're, we know when we have respect for another human being. But when you have that self respect, and that self compassion, you feel unapologetic in establishing your boundaries. And that's where we have to be we have to be unapologetic. That's not about being rude. That's about being clear. And frankly, it's the best relationship you can have with any other person, when you're clear on your boundaries with someone who's clear on theirs.

I think it's worth it's worth pointing out to that sometimes your know, might change with another person, sometimes you say no to something because of the dynamic with the situation of the person that is trying to force something upon you. And you say no, in that moment, and you might change providers, and you might go elsewhere. And you might decide in an in a different situation that you want an induction at 42 weeks when you said no at 40 weeks with somebody else. And you have that right? Of course you have the right and you and you change your position and you change your decision because you feel more supported by that provider and you feel more trusting of the relationship and you feel then that it's the right decision.

Absolutely. And this is your entry into motherhood. So don't let someone take that from you. Like this is your birth experience and you deserve to have the experience that you want. It's yours.

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