#150 | Myth of the Aging Placenta with Midwife/Author Dr. Rachel Reed

March 2, 2022

Dr. Rachel Reed, PhD, is a midwife and author of Reclaiming Childbirth as a Rite of Passage. Since earning her doctorate, she is inarguably now among the world’s leading experts on placentas. The publication of her book has come during an era in which women are often told placentas can “fail”, “calcify” and “stop working”, or even cause stillbirth. This rhetoric - all of which we discuss in the episode - is not only terrifying, but false and harmful, and consistently contributes to high rates of unnecessary medical interventions, such as labor inductions and scheduled cesareans.

Dr. Reed  also debunks the myth of the “aging” placenta and tells us the real reasons for compromised placentas. Spoiler alert: It has nothing to do with placental age and isn’t shown to correlate with stillbirth even when signs of it do occur.

By the end of this episode, you’ll know what the world’s research has and hasn’t shown, and you’ll develop both an understanding of and appreciation for the placenta, which will help to inform your own decisions around induction and your birth plan in general.

Dr. Rachel Reed

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View Episode Transcript

In the research looking at stillbirth with post dates, there is no evidence at all in any of that research that it's a placenta problem. So of course, nobody knows how to support physiology or understand physiology. So women are coming wanting a physiological birth, in a setting where it doesn't happen and nobody knows how to support it. They're almost set up to failure. And then the women are made to feel like they failed, not the system. When it was the system that failed, not the women. Students are assessed based on how well they do the interventions. That's it. They're not assessed on how well they are with women on how they advocate for women, because that's not what the system wants. It's, it's crazy.

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.

So I'm Rachel Reed. I am a doctor of philosophy, not a medical doctor. And my background is midwifery. I trained in the UK where it's separate from nursing. So I did a Bachelor of Science in just Midwifery, in order to become a midwife, practiced in the UK in a range of settings, moved over to Australia, and went into private practice in Australia after a few years here, got into research and academia. And that's kind of where I've been is practicing as a midwife, whilst also being an academic for many years, I no longer practice the midwife in terms of attending births, and I really focus on research and education. At the moment, that's where I am at the moment.

In the UK, were you practicing in hospitals or home? Or how was that done? Yes, it's a bit different in the UK, practicing the public system, the National Health Service. And it isn't there isn't a distinction between hospital and home as a midwife, your your role is to provide care wherever the woman needs care. So I worked in a hospital setting and I worked as a community midwife. And as a community midwife, I attended birth wherever women chose to birth, so most women believed in the local hospital. So I followed them in there, and other women birthday at home. So it really was around. So there isn't kind of the and when I came to Australia, that was a real shock to me that there was home birth midwives, and there was hospital midwives. Those in the UK, you're a midwife. And even as a hospital midwife, you could get called out into the community to attend a home birth if there wasn't enough midwives to attend that birth. So it was just part of being a midwife was going to people's homes and supporting them there.

And you are also the author of a fabulous book, reclaiming childbirth is a rite of passage, which I am currently reading and loving. Highly recommend that book though. It's fabulous. Thank you. So tell us a little bit more about anything else you want to share with us. Before we get into the topic for today. About yourself.

Yeah, well, I guess I forgot. I forgot to say I'm an author didn't have one that's actually more to do with the book.

Yes, I wrote wind actually matters some years back for a publisher. So reclaiming childbirth is a writer, which was really, I guess, the book that came from my, my heart.

It was part of my PhD and really encompasses what I learned during my PhD during my practice as a midwife. And I've tried to weave together all of the research in the history of her stories, I call it to explain what's happening now and also to really look at how we can reclaim childbirth, and particularly childbirth physiology, although I do talk about medical birth, how we can reclaim that, because that's that really needs to happen, you know, we've lost sight of physiology we've lost sight of, of birth is anything more than just an event where a baby's comes out of a woman often removed from the woman.

And I'm just currently finishing up my first online course, which will be just purely childbirth physiology. So I felt that that was a good place to start in terms of online course, courses, because that's the fundamentals. If we don't understand childbirth physiology, we can't understand pathology, we can't understand complications, and we can't understand how interventions alter physiology.

So Rachel, before we started today, I told you there were so many things we would love to speak with you about that we need to try

to narrow it down to a couple of things. And I said, the first thing we'd love to start with is the aging placenta. And you said, well, it'll be a very short conversation because there's no such thing. And I said, Absolutely hold your thought, because I wouldn't get all this in our episode, please, let's pick up from there and explain to us why the aging placenta is not a thing. There's no such thing. No, so I actually looked at this when I wrote my book wind actually matters, because this is the the common reason that women are given for inducing once they get past this particular date, the placenta somehow turns off, you know, it's got a best before date. That's how it's presented. And so I can, and it's very little research around this. It's just something as with most practices, that's just cultural. And this is what said, and people hear it said and say the same thing. And nobody actually stops. It was Hang on, let's actually have a look at this. Is there actually any research on it? I have not really been able to find anything. No, I think I ended up finding maybe one or two articles that were about the physiology of the placenta. And this debate, you know, on the one side, there's we do know that the percentage changes through pregnancy throughout pregnancy, it, it shifts and changes, because it's got different functions, you know, the baby's growing and getting bigger. So there's different things that the placenta needs to do. So the placenta does definitely change through pregnancy.

But it's not aging. It's not stopping functioning. And we've we've got into this situation what Yes, percenters? absolutely can. And I wouldn't call it aging, I would say their function becomes less effective, particularly with growth restricted babies, where there's actually a pathology happening. And what happens there is blood vessels, you know, stop functioning. And you can see that afterwards in a placenta where you've got little lumps of kind of gritty, dead blood vessels in that placenta that tells you that that placenta was some of the blood vessels were dying off.

But that's not aging, you know, that's not associated with gestation, you can see that, that 37 weeks, and yet a 43 week placenta can not have those little dead blood vessels. That's a patient of pregnancy, not a aging placenta. It's exactly the diagnosis of intrauterine growth restriction, which comes from the placenta being compromised. It's a true medical issue. Yes, exactly. And this is why we need to understand physiology to understand that to pathology, and you also cut, you also run into this, you know, really conflicting messages that what we're saying is that the placenta stops functioning. So you need to be induced to get the baby out before the placenta completely switches off. And then at the same time, we're saying, but you need to be induced if your pregnancy carries on because your baby gets really big and doesn't come out. So either the placenta stops working, in which case, the baby's compromised, or the placenta keeps growing a big healthy baby. Now what we know is absolutely at 43 weeks, your baby is likely to be much bigger than it was at 40 weeks, still not too big to birth, but the placenta will carry on sustaining that baby throughout the pregnancy. So yeah, placenta is don't age, I guess, in a nutshell, or is there any way to know if the placenta is? I mean, in the case of intrauterine growth restriction, you're saying there can be signs of aging on a placenta? That's a medical indication of something? Is there a way to know in pregnancy? If that's the case? Because that thought or that concern alone would have any pregnant woman wondering, well, I don't want to take any chances that could be me. How would they know?

Yes. So really, in pregnancy, what we've done with antenatal care is we've kind of got ourselves as care providers in between the woman and the baby, and kind of set ourselves as the experts in terms of whether what's happening is healthy or not healthy. When the baby is growing inside the woman. And if the woman is connected to her baby women absolutely know when things are not right, that they're babies. One of the key indicators is the baby slowing their movements down. If the baby's not getting well oxygenated through the placenta, then what they'll do is conserve energy. So they're slow down their movements. So babies will give lots of signs before, you know it's really in a really bad situation. Because they communicate with their mother. So if a woman's connected in with a baby and really trusting her instincts, and listening and understanding what's normal for her baby and not normal, she'll get signs that that baby's slowing down and telling her that I can't move quite as much you and then that's the time to then reach out for medical support, to have an ultrasound which doesn't look at the size of the baby. So we get really hung up on the sizes of babies which ultrasound can't actually tell us accurately what needs to happen is they need to look at the placenta. So look at the blood flow through the placental, the umbilical cord and look at what's happening there because that will tell you whether or not this baby's getting adequate oxygen through the cord. So there are signs and I think what happens is the idea intrauterine growth restriction sort of gets lumped in with just becoming past your due date. They're not wanting the same thing. Right now, going past term does not mean you're going to have intrauterine growth restriction, but they seem to sort of get lumped in together because the longer you're pregnant, the higher the chance of, you know, developing a little bit of high blood pressure or the possibility to preeclampsia.

And then that also kind of gets lumped in with this IUGR idea, and then it's all kind of blamed on the placenta. Yep. So placenta is calcify, and that's a normal part of the life cycle of the placenta. If they calcify, that is still a normal condition that would not warrant an induction. Correct. Correct. What you're actually wanting to know in terms of whether or not there's an indication to reduce or not to induce is, is this baby getting adequate oxygenation through their placenta at the moment, you can have calcification and still have adequate oxygenation through to the baby because all calcification means is that there's some blood vessels of, you know, stopped functioning and then calcified. Now, I used to see lots of calcification on placentas working in England in the north of England, where we had really socially deprived demographic and there was lots and lots of smoking. So it was really common for placentas to be really gritty, you know, like, lots and lots of calcification in those placentas and babies tended to be smaller. So it's not about it's not about aging, I think is the key thing. It's about placental function. And that's about smoking, which damages blood vessels and the placenta would compensate for that to a certain degree. But you'd have calcification, those dissenters, many, many normal healthy pregnancies, have placentas that have calcifications. We, when we examine a placenta after birth, you you almost always see them some much more than others. And if you see a lot of them, then you go back and sort of review in your mind. Did this mom have any risk factors? Did she have high blood pressure in pregnancy? Was she a smoker? Were there any signs of intrauterine growth restriction? And most of the time they're not. But it isn't. The whole point is that it isn't the placenta that that's aging, it is the smoking or the hypertension that is causing the placenta to not function as well, which is causing the intrauterine growth restriction, which is then being coined in a malfunctioning placenta. It's it's not a malfunctioning placenta. First, it's the chicken or the egg. It's the problem underneath it. It's a symptom of something else being wrong. Yes. Yeah, absolutely. But healthy placentas do not Ah, that's the takeaway.

I've had clients who have been told such impossible things as well, the placenta fails at that point. And the placenta was the other one that's so common, it fails, it stops working. And I always have to say to my clients, it has its own life cycle. It doesn't just up and stop working. It actually has a full life cycle. It's there's no justification for it to suddenly switch into another mode, as it does say when the baby is out and obtaining oxygen from another source. But it's such a terrifying thing to hear. And the problem is there's this implication that well, let's just induce you and not take chances, and no one is ever doing the research on what happens to all the women we're inducing. No one's ever looking at that. No, because we will focus very much on that kind of short term risk assessment that is organizational risk. So there's this huge generalized risk assessment of one very small thing that potentially could happen, even though it's less than 1%. And that's the focus not the much more likely thing, which you know, if you're being induced having your first baby, for example, you're both 30 to 40%, more likely to have a cesarean section with your first baby, not if it's not your first baby, which is where those stats get a bit muddled. So if this is your first baby, you're more likely to have a cesarean section now in your next pregnancy. Now you are more at risk because your placenta may attach over the scar, which then does compromise the placenta. So we're, you know, making that decision. You need to really think about future. But that's not taken into account when we're looking at, you know, offering an induction for postdates and the placenta is often just given us the the rationale because when women say well, why then that's the rationale is that the placenta stops working. It's like the whole thing about your if we don't induce you, your baby might die. So now they're just saying your placenta might quit on you. It's almost like it's a easier way of saying it. But we can't have this conversation without talking about the possibility of stillbirth and the reason that many women are pushed

be induced is because of that possibility of stillbirth. But what we know about stillbirth is very little under we have very little understanding of the causes of stillbirth, but we do know it's not because the placenta just stops functioning. No, no, absolutely not. And in the research looking at stillbirth with postdates, there is no evidence at all in any of that research that it's a placenta problem. So, for example, the big Cochrane review that looked at it the the group of babies who were stillborn, there was a high percentage of those babies, a high proportion of them had congenital abnormalities, you know, but they didn't find it wasn't about the placenta. So we've just made that connection. I think you're right, because it's just easier as a provider to say to a woman, we'll need to induce you because you've reached this particular date that we've imposed on your pregnancy. And if there's any questions about as well, because placenta stop working, that's kind of a really simple explanation. To give. Why does the stillbirth rate? Why do we think it does go up? Between especially 42 and 43 weeks, it goes up? I mean, it's still an extremely low number. But percentage wise, it starts to go up quite a bit between 42 and 43. In particular, why does it do we? I mean, if it's congenital, I don't know why that would happen so late in the game, why not at 39 weeks or 40 weeks as much as after 42? What could be the relationship between that higher stillbirth rate after 42 weeks? And whatever is going on? That's not related to the placenta, what could it be? Do we know? Well, nobody's really looked at that. So it's a really important question, isn't it? And nobody's really looked at that. There are some theories for what I'm about to say he was absolutely not supported by evidence. This is me, you know, thinking perhaps this is. So what we do know there's an increased congenital abnormality. And babies who have congenital abnormalities are more likely to be born premature, and more likely to be born post term. And that makes sense if you think about how labor begins, because it's the baby that initiates the start of labor. So the baby sends a message to the placenta to say, all right, off you go, tell tell my mother, I'm ready now. And then that kind of starts that cascade of changes that have to happen for for labor to start. So if there's a problem with the baby, maybe the baby is not signalling properly? Or maybe there's something happening there with that signal? Who knows? And the problem is that with a lot of a lot of things to do with birth and pregnancy, and breastfeeding, we often don't know and we probably will never know the answer, you know, so all we can do is be absolutely honest with parents and say, we actually don't know why there's a very slight increase that you know, it goes from naught point naught three to naught point 3%. You know, if induction versus waiting, so it's still very, very small, but there is an increase, and we need to be honest, and say, We don't know why, you know, and, and also to individualize those risks for women. So for a woman who naturally just dates longer in her, you know, women in her family gestate longer, then this is not going on very unlikely. This is a pathology that she's gone to 40 to 43 weeks, you know, I looked after a doula once and, and the women in her family, there was one who went to 44 weeks. So she was not expecting to and she'd gone to 42 weeks with her pregnancies and 43 weeks, we were not expecting to see her baby before 42 weeks. And if she hadn't had a baby at 38 weeks, we would have all been a bit Oh, I wonder what's happened there is that percent potentially a problem, versus a woman who's had all of our babies at 30, you know, 39 weeks, 40 weeks, and now we're getting on to 42 weeks, I will be asking the question, what's different here? Is there something happening that we need to pay attention to? Because this is not her natural gestation? Don't women also get those genes from their fathers?

I don't know. But they get the genes for breach from the fathers. I'm not sure about as you said, it's a theory worth considering.

One thing we do know though, but just to to go back to that point for a second. We don't really know what causes those late late term stillbirth, but we do know, and we have the evidence to say that inducing early does not prevent them.

Right, the arrive trial says inducing at 39 weeks does not change the rate of stillbirth so we don't know why. But we do know that the answer is not induction. So we can just take off the table. This fear that the longer we're pregnant, the higher the chance of having a stillbirth because our placenta is going to expire, which is what women are told all the time. Yep.

And Rachel, you mentioned earlier that it's a little bit of a risk if a woman has had a C section and the placenta attaches, I guess an anterior placenta over the scar. Can we just explain for our listeners Exactly.

Why that's a less than optimal situation, is it? Because if there's scar tissue where there would typically be open capillaries giving more blood and oxygen into the placenta? Is it that it could be an abruption situation more likely? How concerned should women be about whether they do have an anterior placenta? If they're a VBAC? Mom, can you just talk about that a little bit? Yeah, well, women will be concerned because they're concerned about everything in pregnancy because much no regular pregnancy is worrying about your baby and yourself. So what I can say is I have looked after women who have anterior percenters over a scar, and they've been fine, you know, the chances are that it will all be fine, but it's just an extra thing to consider. So you're right is it's scar tissue. So usually, the placenta kind of attaches itself to the top of the uterus, the fundus, where all that kind of thick, the muscles thicker, and there's increased blood supply, etc. So it's not usual for the placenta to attach further down. And if it does, it's not an issue. But if there's scar tissue there, then that may interfere with the kind of borrowing of the placenta into the uterine lining. It can interfere with their full blood flow into the placenta. And from my perspective, kind of as a home birth midwife in that scenario, I was more interested in the birth of the placenta after birth, in terms of it being attached over a scar and whether or not it would release in the same way. So that was really for me more of the concern than anything to do with stillbirth because the stillbirth is still teeny tiny. You know, we're talking again about less than 1% quick follow up to that. So if a woman is planning a VBAC, and her placenta does attach over the scar It by no means is a reason to - it's not a contraindication for her VBAC. Now, she should continue with your plan, okay, just wanted to make sure. So it's just a matter of sometimes having a higher risk of a retained placenta after baby's born. If it's attached, where there's scar tissue, it's more likely to sort of be embedded and not released. Well, also, if it's lower in the uterus, it doesn't get that nice, strong fundal contraction after birth to help it release. So you, you're more likely to have placenta that is either retained prolonged or partial separation, which could lead to postpartum hemorrhage. Yeah, so I guess from a provider's perspective, you're just aware of that and you're set up anyway to manage anything like the hemorrhage or retained placenta, but that's in the back of your mind as a provider, as a woman. Hopefully, it's not in the back of her mind, and she's just birthing as a woman having a baby because that's basically what she is.

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It's such it's such a difficult thing for us because we want full information and as you said at the outset, we will never have full information nor should we seek full information. You know, when I teach my clients that when a baby's head touches the perineum, and we get this incredible surge of relaxing and the perineum yields. It's like I say, well, that's really cool to know. But did you have to know that information? Or could you just have trusted that nature has a way of ensuring or I teach about cranial molding and I say well, it's really cool. Now you know that the plates of the skull can compress and they can eat

and overlap. But did you have to know? Or could you have just trusted that the baby would come out and nature Mater has this all taken care of, with or without your knowledge, like every other mammal has absolutely no knowledge and awareness. But it's it's very tempting to want full information because we think it'll bring us a greater sense of security. But really, it can increase anxiety, sometimes when we go down that path. It can and I write about that in my book in preparation around because I often get asked what, you know, what childbirth education, would you advise, blah, blah, you know, and it really depends on the woman, the primary, the primary focus in that preparation phase, which is pregnancy, is really cultivating trust in yourself self trust, trust that your body knows what it's doing. And if you know, and it's not blind trust, because birth does throw curveballs, you know, it's, it's a potentially dangerous transition for a woman. That's why we've got all of these kind of, you know, that's why all of the rituals were initially evolved to guide the woman through so it is Petite is chaotic, it's uncontrollable, etc. So ignore while acknowledging that it's about building trust in that your body has evolved to do this. And if things are not going well, that your instinct will tell you that, that you are the expert, and to connect in with that, and to really kind of focus inward for that, that, yes, there's people on the outside who are experts in general, but you are actually the expert, specifically on yourself and your needs. For some women, having that information about how the baby's head molds, and how the perineum functions really helps them to build self trust. So what I say to women is, what's going to help you build self trust and what's going to increase your anxiety. And if knowing I mean, I'm one of those people likes to know how everything works in order to trust how it works. So I was one of those people who needed to read everything and know everything in order to go, okay, I can now trust that I can do it because I understand it. A lot of women do not feel like that, I end it doesn't make an impact on the birth. That's the other important thing. You know, I see a lot of women who think they need to know all this stuff in order to have the birth they want and for birth to work. You don't need to know anything. Your body knows how to birth, and your body's not reading the books you don't need to know. But if you want to know to build self trust, that's fine. I've looked after women who have known everything. And I've not looked after women who've known absolutely nothing. And there's no difference. Rachel, when you are talking about women going into their birth, really not knowing anything, are you specifically talking about the physiology of birth? Or are we talking about going into birth sort of blindly like I don't have to know my choices, my rights, my the possibility of interventions, because we were just having a conversation the other week, about how dangerous it can be for women to go into birth, with an attitude of I'm just gonna see how it goes. If you're with the wrong provider, and you take that approach, you're likely to get swept down the funnel of cascade of interventions and end up with on a surgical table. You know, I'm purely talking about the physiology of childbirth. So you don't need to know how your body works for it to work. However, I also wrote in my book about sharing the map, which is how providers need to share the map with women. And the key things that women need to know if they're particularly if they're birthing in a system which most women are, you know, women who are free birthing on, but most women are birthing within a system that they need to know their rights, their legal rights, who are they likely to encounter? What are those people's philosophies and culture, what's the culture of the space, they're birthing in.

And really no, already have planned how to navigate that. So in order to navigate, they need to know the map, and then they can plan their plot their pathway through that. So they do need to know that. However, they don't need to know all of the research inside and out. Because the REITs cover that, you know, I've recently been interacting with a woman wanting to know, the research to go to her obstetrician to, you know,

to back up what is that she wants to do? You don't have to do that. The the obstetrician or the or the care provider who's recommending something, it's their obligation, their legal requirement to give you the information to support what it is they're telling you they want to do. There is no obligation the other way, you can say no, I don't want that. You can add Thank you, if you want to be polite, you don't even have to do that. No is just you know, no full stop. You don't have to justify the decisions that you're making. We said this recently, the whole the very notion of having to justify doing nothing is really unbelievable, because of course we should be justifying why to intervene, because and if you ask yourself, Why Why should why should it be that way? It's that every cell in your body is planning on a physiologic birth. That's the default. So if we're going to intervene in that default method of giving birth and getting in

Current driving somewhere is an intervention, not wearing your own clothes as an intervention an IV, even a half block in your in your arm in your in your arm is an intervention. We don't even appreciate the extent of the interventions that are taking place, you know, the lights on in the room that you wouldn't want on in the room removing a baby from from the from the mother bathing the baby. Those are what should be very well justified. But you're right. But knowing your rights takes care of all that because we don't have to go to a jury and get a show of hands and take opinions here and see who agrees. We don't have to negotiate and come to consensus. We get enough information to make our decision we make it. That's it. Yeah. So what happens when we get the wrong information? What happens when we the provider says, well, we need to induce you because the placenta is going to expire next week, that that's about around questioning, isn't it? And when I teach childbirth education, we did a lot around how to question and how to put a question to you know, because this can be quite intimidating as asking, you know, somebody the medical medical coat on an image like this, that or that expert to ask them a question, but how can you frame questions? How can you ask questions, that's a helpful thing to know. But you would ask, so if somebody's saying to you, the percent of stocks are really could you show me some more info? I'd like to read about that. Can you send me into the direction where could read about how the percentage stops working?

It doesn't. And I did that a lot as a midwife, and in particular, working with obstetricians because because what we need to understand is obstetricians intent is good therapists. But this perspective is different. And you know, that a lot of their training is not based on, you know, spoken to obstetrician, so it's not based on research is based on cultural norms and ideas about what it is how how to ensure women are safe. So that's their perspective.

And often, when you ask they there isn't any research behind that. So I got away with quite a lot, particularly in the UK, just saying, Oh, well, we're not going to start pushing now. Because there isn't any evidence to support pushing just because the cervix is open. And they go, okay, you know, it's having that conversation and realizing that an obstetrician is fantastic medicine, and really good interventions are really good at keeping women safe during intervention. That's their job. But they're not necessarily going to know all of the research on physiology, and why would they, you know, none of us know all of that. So, you know, don't

just acknowledge that. And if you want to know something, then find it out yourself or ask ask them to direct you to where it is that they're getting their information.

It's so highly problematic that they don't bother to learn and medical schools don't value the study of physiology, because they mess around with it so much. And they have the arrogance in those schools to believe that they are getting the baby out. And you know, in the vast majority of births, it's like I let me challenge you try to keep the baby in. Just try. Like, nature has every method of getting this baby out with or without your participation. But the very notion that they have to get the baby out, is, you know, it's great that they know medicine, you know, I have to say that to my clients, ask the right people, or go to the right person for the information you need. Don't ask me about medicine. Don't ask your pediatrician for breastfeeding advice just because you're sitting in the office breastfeeding when they walk in and want to tell you to start getting the baby on a schedule. But to know medicine, it's so valuable, but it isn't if they don't exactly know when to use it. And I think that's a battle we're not going to win because the textbooks even the midwifery textbooks are incorrect because the text you know, it all happened when birth moved into hospital settings. obstetric knowledge developed from time when birth and moved into hospital when it was pathological. So physiological birth was still happening at home out of the way. So they really learned how to support and use that and courts birth from women who needed medical interventions. And then when all birth moved into hospital and Midwifery, ended up coming under nursing and was moved into the medical system, that really when all of that those textbooks were written, and all of that knowledge was was kind of being written down was from observing women who were often in Twilight sleep on their backs, having babies removed by instruments. So this was not birth physiology. So our entire textbooks on physiology, I've got a book in my cabinet called physiology of childbirth. It's actually what happens when a woman is on her back with a doctor or midwife doing things to her to make the things happen. That's what we're seeing as physiology. So we're kind of missing the point and we keep when the textbooks are re

updated. All they do is use the same information and change the pictures a little bit, but it's still the same terminology. It's still based on stages of labor, which

You know, don't happen. According to latest research and women's experiences, it's based on the cervix opening, which we know it doesn't do in that way that the textbooks tell us. It's based on the mechanism of birth and which doesn't happen. You know, if women are physiologically birthing the mechanism absolutely does happen. If somebody is down there, pulling the baby's head to make it do particular things on the way out, then that reinforces the mechanism. So our real baseline knowledge textbook learning that we get in obstetric learning and in midwifery education is incorrect when it comes to physiology. And then we have practitioners going out into practice, never seeing physiology, never not intervening in a birth, because we're taught to do that, that's our entire training as midwives is how to do things, not how to be. So of course, nobody knows how to support physiology or understand physiology. So when women are coming, wanting a physiological birth, in a setting where it doesn't happen, and nobody knows how to support it, they're almost set up to failure. And then the women are made to feel like they failed, not the system, when it was the system that failed, not the women. It's, it's crazy. You're so right. I mean, what we really need to learn as birth providers is to sit back and let it happen. And it's so hard to do. I mean, even as a home birth midwife, I it takes restraint, to step back and not want to have your hands in there and not feel like you're meant to do something to support something to make something happen, because that was my training. Yeah. And mine, too, I was trying to do all kinds of important things as the baby was being born and during labor to make

them scolded as a student, if you didn't put your hands in the right place and do the right thing. That's still happening, that's still happening, that students are, you know, students are assessed based on how well they do the interventions. That's it, they're not assessed on how well they are with women on how they advocate for women, because that's not what the system wants. So, and you're right, it's, it's really hard. And it's also hard, because as providers, we have an ego. And that's kind of stoked that we're really important. And you know, that we need to do these things. And we feel this level of responsibility and kind of power, I guess, in the doing of the thing. And it's a huge learning curve, I found a huge learning curve to actually sort myself out, sort my ego out, step back and realize that when it comes to physiology, I'm actually redundant, and I am not needed. And my skill is a midwife. What women are paying me to do when I'm at a home birth, they're paying me for what I don't do, what I'm capable of doing, hopefully, and that I don't ever have to do. That's what my job is.

So let me put this question out.

Yesterday, when I was teaching HypnoBirthing, to my class, one woman said, Cynthia, because I talk all the time about what you keep saying, you have your best asset is your intuition. And you're going to need to cultivate this and rely on it as a mother, I assure you, the rest of your life, when you're 90 and your kids are 60, you're still going to want to be relying on that intuition to assure you that things are okay. And a woman asked in class.

How do I learn to better trust my own intuition?

I know what I said to respond to her, but I would love to hear what what both of you have to say to that too.

How would you respond to that? Because women are listening to this? And they're thinking, Well, how do I know I can trust my intuition? Or how do I know what's the difference between the fear in my mind and the intuition?

In my, you know, in my soul or in my body?

And again, that's to me like the childbirth education question. It's about that woman working out what it is that she needs to trust her intuition, intuition. What, what does she need to help her connect into her body? Because we live lives that are very disconnected from our bodies?

How can she What does she do some women is Yoga, you know, they enjoy yoga that helps us connect into their bodies. Because really, intuition is about, you know, being connected, so deeply connected into your body, that you you know, feel things and you trust your body.

Some women, it's yoga, some women, it's HypnoBirthing. Some women, it's really what is it that she needs for her to build trust in herself and in her intuition.

That's what would that would be my answer to that.

It's a hard question. It's a really hard thing. I think it's a really hard thing to explain how to learn.

But for me, I think the the most confusing part of understanding our intuition is trying to separate out fear from intuition because it really can feel it's louder. Really feel like Yeah, exactly. It's louder. But once you

You can start to know in your body physically how you respond to fearful and anxious thoughts versus good thoughts, right thoughts, the true intuitive hits with daily practice, trying to distinguish between those two things. And it's like a muscle it grows. And I think it's also about see really feeling where that fear is coming from, is it coming from outside in? Or is it fear that's arising from inside you? Because listen to that, you know, I've looked after a number of women who have just said, I just feel not right. There's something I just feel fearful and I don't feel, I'd feel there's something not right here. And they usually absolutely spot on because they're listening to what's arising from within them. So it's learning as you said, to work out what what is incoming Where's is the fear coming from, in outside into me? And generating fear? Or am I actually really deeply connected and feeling this sense of fear? That's telling me something that is my intuition speaking. And it's really difficult. It is. And when I was asked this question, I came up with two things yesterday, and I'm still thinking about it and wondering how else to get women thinking about cultivating that intuition or trusting the intuition they already have. The first thing I said was, look for opportunities and stories in your life up till this point where you did have good intuition or create a story around it. So you can create that belief. So look, for any time in life, let's say, you know, the first time I laid eyes on one of my best friends in college, I was just overwhelmed with this affection for her. And this, this feeling that she was already my friend. And I said, I, I've used that in my life. And she has to because it was mutual, and we joke about it. But you can use an opportunity like that to say, well look at what good intuition I have, I just knew, and or when you knew something wasn't going to work out. Or when you knew you were going to end up in a certain company working for a certain job. But consciously use your conscious mind to find times to create that story, to intentionally build a belief that you have good intuition. And this is never about whether the belief is right or wrong. It is simply a matter that the belief will serve you, if you take it in, if you believe it, believing it will serve you. And then the only other thing I came up with you both already talked about, I just said, it's a matter of getting quiet, of quieting the mind.

I was gonna I was gonna say, I absolutely think that if you can learn to practice meditation, even if it's just for five or 10 minutes a day, but you do it consistently. And you can get into that quiet, calm space. That's when you get downloads, like it actually just happens, you'll be sitting in meditation, and a thought will hate you. And it's, those are what I call like intuitive hits. It's like, Oh, that's right. That's right. That's a correct feeling. That's a correct decision. That's a correct instinct.

But it does getting quiet. If you're not quiet. How does it read you?

And physiology helps you know, Pregnancy is a time when you've got really high progesterone, particularly towards the end. Progesterone is this is the hormone that we that we release in our second half of our menstrual cycle, that really introspective drawing in connecting in which creative, you know, sense. So your body's doing it for you, it's actually encouraging you to draw in to draw in and listen and connect. So understanding that can sometimes help you know the physiology of chat. And that's why, you know, I wrote childbirth. Reclaim childbirth is a rite of passage and followed the pattern of physiological childbirth to explore that because actually, in that preparation phase, women are set up to do that. Ready for that birth, where you go draw even more deeply into yourself, you know, we never have a moment to just be still.

I love that I love telling pregnant women that they are primed. They're in their most optimal time in their life to trust their instincts.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

and actually had I didn't am talking about being still and listening to intuition. It was I did a wilderness solo quest thing where I actually have to go off three days by myself with nothing to read on nothing to. I'm a very mind, busy, busy minded person. I wasn't allowed to take anything I had to sit in the middle of the bush in Australia

It was actually a fire just run up a mountain a few weeks before, so everything was burnt and ash just sat there for three days. And that's when I just knew I needed to write the book. That was my download, if you like if you need to actually combine

all of your experience and writings and GPHG Yes, but you need to create something that you need to write a book. So that's what I did. And in the front cover, I didn't think about this until until a few months back, actually. So you know, the covers got that little golden goddess on the front.

I was doing a shamanic drum journey with Jane hardrick on a retreat. And all I kept getting in my vision was a production line of goddesses. It was really odd. And it was like a production line of goddesses being made little golden ones coming out the other end like a factory. That is really weird. I don't know where that's come from. And then, you know, on a day, who designed the book cover, created the book cover, and then it wasn't until a few weeks back again. Oh, look at that a production line.

On a book. Oh, my God, he designed that you didn't have any part in that design. You recognized it. Afternoon. No, I didn't recognize until maybe a few weeks months ago. And I looked at the cover of the book and I remembered that drum journey that was just really odd because I hadn't wanted to, I'd gone into do something else.

Find the drum genius really helpful because it really kind of stopped my brain from thinking and really get into that creative phase. So come out with that drum genuine, what the hell was that about? That wasn't, that wasn't at all what I was wanting. And then looked at the book a few months back went, oh my god, that was the shape of the goddess and that there was lots of them coming off the production line a little gold goddesses.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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