#173 | Obstetric Violence with Home Birth Midwife Anne Margolis, CNM, RN

So so midwife goes to midwifery care and gets all excited about physiologic birth. And then she goes to work for a hospital where they enforce obstetrics. They enforce policies that are outdated and not evidence based. And her hands are tied because she's got to practice that way. And even the World Health Organization is calling it obstetric violence that is likened to rape for a woman. We have the highest maternal mortality rates among developed countries and even some underdeveloped countries. And our newborn mortality and morbidity is embarrassingly high. Our maternity system is failing.

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.

Anne Margolis, I'm a certified nurse midwife now for 27 plus years, I got my Bachelor of Science in university Pennsylvania School of Nursing. And then I got my master's with Case Western. And I've practiced both in a home birth center and hospital settings. But predominantly, I have moved towards the home the home birth and I've caught about oh, you know, well over 1000 babies in my practice, help 1000s of moms around the world now because I have not just an in person practice but my work has gone online through a lot of very large social media following that my daughter put me on and I said what's that but but it just blossomed and you know, created all these you know, online courses and online coaching from both professionals and moms. And then it led me to write my two books. One is called natural birth secrets the an insider's guide to how to give birth holistically healthfully and safely and love the experience, Second Edition, and then the other is called trauma release formula, a program to eliminate the effects of all kinds of trauma, because so many moms in my practice, have a history of trauma, trauma is very common, and I wanted to help them. And I actually had my own trauma, a lot, quite a number of traumas. And I found a modality that really, like changed my life. So it's gold, and I wanted to share it. So I became a practitioner in that method. And I also, you know, wrote a book on that. So what's the method and, well, it's a certain because you don't heal trauma with therapy, you know, taught that actually triggers that the talking about it triggers that it's trapped energy in the body. So like animals, we learn from animals, they shake it out, you know, if they're running with a tiger or a deer, right, the when the deer gets to safety, they just shake it out and resume being in the parasympathetic calm state. So we still have that reptilian brain. And many people are in this chronic state of stress, you know, and they have trauma. Three out of one out of three women have been sexually abused, you know, there's just any kind of trauma, it could be the loss of a parent, being bullied being adopted, there's so many levels of trauma, but the earliest of the ones are the most significant, you know, even from birth, it's amazing. So so the way to heal it is somatically. And the father of the trauma healing is, you know, Peter Levine, and he's somatic experience. And he's done. You know, he's the father of the research. So there's a certain type of breathwork because I'm very into yoga, I'm a yoga teacher. It's a certain type of breath work that puts a person in the subconscious state, and the trauma just releases out of the body. So it's really really powerful. Saved my life and I I immerse myself in it, so it's called Clarity breathwork yogic kind of form of the rebirthing kind of breathing, it's like taking Ayahuasca without the puking without the Ayahuasca, you really it's very transcendental. And you don't have to think about it know about it, just have to experience it. It shaves years off therapy.

So you mentioned that your own birth experiences led you into the way you practice today as a home birth midwife. Do you want to share a little bit about that?

Yeah, you know, the reason I'm passionate about it is not just because it happened to me. I mean, it happened to me but what's what's really fueling me huge is it's still going on, like people are reaching out to me around the world. You know, I had a lady that came into me from Australia. She read my book She actually flew here to heal her trauma is severe trauma it obstetric violence, which is still going on. It's getting worse 45% According to the stats, but I think it's underreported. So So what happened to me and now I was an OB nurse. So, you know, I was given the royal treatment with my first baby, I was very young, but I was, I was scared. And I was giving birth in the unit where I worked with the doctors I knew. And what happened was just that putting on the hospital gown telling me I can't eat and drink and have to stay, you know, with the IV and continuous monitoring. So already who can leave her like that? But I didn't know you know, doctor kept coming in every hour and putting his hands up me without even telling me and would go out and tell my colleague, she's still four. She's still four. I heard that outside the door. And then And then I heard Hank pit. Now if I wasn't a nurse, I wouldn't have known what that meant. So the nurse, I knew what that meant, though.

What was the phrase what something pit was the first one hang pit hang pit, like a bag of Pitocin hang about a Pitocin. I know what that means, you know, and the thing is working as an obstetric nurse is when I became afraid of birth, because I saw I saw horrendous things. Way more Cesarean birth than I ever imagined. And my hands were tied as a nurse. So I was very frightened of us as Aryan, but I was scared of you know, the outcomes weren't always so great. You know, I was very scared of birth from working in the hospital. So I had fear. And then I wasn't Of course, dilating in that situation. So the nurse comes in my colleague, and she starts putting the injection into the IV, and I'm like, I don't want that. Oh, she said, But honey, you don't want us to zerion Do you? And so no, you know, like when I'm in that state, you know, I'm frightened. No, I don't want us to Darien but then the pit you know, at my Lamaze went out the window, and then I just couldn't cope. And every time I move, no, don't move. Because if you can't get the baby and all this, and then I hear the doctors, they just give her an epidural. And so they're giving me an epidural. And if cause my baby's heart rate to crash, I don't know if it was the epidural or the Pitocin or in combination, whatever. So then I became a stat section. Emergency get the baby out right now, whatever the heart rate was saying, I knew they had minutes to get my baby out. I was in a state now of freaked out. Okay, so now they're reeling me in to the O R. And a stat means that like, right away, right, and so I was in the O R by myself, for 10 minutes, 20 minutes, 30 minutes, 45 minutes over an hour, thinking my baby's gonna be damaged, my baby's gonna be damaged my baby's dead. Like that's, that's basically what I was, you know, going through my head and I went through a trauma. I was in a trauma state, I left my body. That is one of the trauma responses to freeze. And I just left my body and somehow the body the beds took over and I started pushing, because the assistant surgeon hadn't come yet. In an hour over an hour for stats is Aryan and your baby's heart rate, meanwhile, is well no one's monitoring it in the AOR. So I had I left I was gone. I thought I was having a dead baby. And I was I was it I was just done. And so then I started pushing and then then it becomes this whole panic and the doctor screaming get me a vacuum and he cuts a huge a PCR to me down to my anus, rectum, or whatever any vacuums are out. And I she was fine. So that was like they misdiagnosed fetal distress and would have given me an unnecessary cesarean. I was not fine. So look at your baby. I had the classic symptoms of trauma right there. I was afraid to go back to work. That experience made me think okay, a hospital is not safe. You know, that taught me it? You know, for me, it wasn't and and they misdiagnosed something. And I would have had an unnecessary surgery. And it was just a horrific experience. So that fueled my desire because I always was interested as a nurse, you know, do I have to do something with all this I'm seeing I have there has to be a better way. But that sort of fueled my passion to become a midwife. And when I and when someone told me you should be a midwife. I was like, what's that literally, you know, we didn't have Internet back then. And I went to the library and I was like, Ah, I'm home, you know, and then I, I went to midwifery school and then my other babies were, you know, with a midwife. Very, very empowering healing experience, but I hadn't yet healed my trauma. But that was still in me, but it was still very healing to have having midwifery care where it was so different. And I said to my midwife, I said, I believe in this, you know, this whole midwifery philosophy of care and midwifery model of care, but I've, you know, went through hell the last time and I just don't Think I'll be able to handle it. She says, Oh, you'll still be so different and healing and she was right. You know, she, I could wear my own clothes, she let me just walk around. And let me let me I mean, she enabled and encouraged me to just go in the shower, go in the bath, you know, do that. She was like really much, letting my getting out of the way and letting my body do what it needs to do. I knew she was trained to deal with things if necessary, but she, you know, it was like, it was like a night and day experience. And once I experienced that, then I knew viscerally that I could provide this care to other people. Because if this this weekend traumatized when I could do it that I felt viscerally that as a midwife. I could I could help anyone do it, you know, and, and then. So I think that that's really what fueled my my desire to become a midwife. And, and then, you know, the more I was a midwife, the more I heard from women who would come to me, even before social media, right? That their last birth was so traumatic, and the doctor did this or they did that to them. And without her consent, and just horrific, similar experiences. I became also that passionate about helping them heal. And I started researching trauma healing, but but then, you know, we have to prevent this in the first place. You know, like now on social media, you know, when my daughter put me on Instagram, seven, eight years ago, I'm hearing from people around the world, this is still going on, I mean, the stories that I'm hearing, and then I witnessed a story from someone I was helping, she wanted, she wanted me as her midwife coach and her doctor delivery. So this was a family member. And what I saw, I bring her in fully dilated, and she's crowning, and then some Doctor Who is a man sticks his hand in her anus, in her rectum and she says, What are you doing, get out that her out? He goes, I have to check if she's fully dilated, and she's screaming to get out. And he's not getting out and like the baby's crowning. She's, what, wait a second, you can check if someone's dilated, obviously, right, but this was like that sexual assault that sent medical and sexual.

Whoa, I witnessed it. Right. So so this, did he actually intend to indicate he had some special skill where you could check how dilated she was that way? If he's crowding? She's, I'm just saying what did he say? Did he say I can, checking if she's fully dilated? out, get out, get out, you know, pushing. So I'm just saying like, like, I'm hearing this I saw I've, I've seen this. And even the World Health Organization is calling it obstetric violence that is likened to rape for a woman, it because it's involving intimate areas. It's not about you know, the outcome, you know, the baby had shoulder dystocia. It's about how the people how the moms or B and baby being treated, and babies feel trauma to you know, so if they're not handled in a trauma sensitive way, they're born fully conscious, fully aware, and we need to we need to care for them in that way. So anyway, so so I'm very passionate about preventing this in the first place. I just have to go back to this. Yes. He pretending that he could see how dilated she was that way.

I don't know. Who knows. He was just obviously you couldn't I mean, he was blatantly, he was blatantly assaulting her and, and he knew it and everyone else knew. I just I can't, I cannot believe that. So I want to go back to your--  Well, I have a lot of stories to tell you, you wouldn't be able to believe I know.

I was going to just tell you one. Your birth story was interesting and infuriating, in a way, because when Yeah, right? Because when your baby was obviously coming out without any I mean, you even were checked out from the trauma, your baby was coming out. He had the nerve to come in and demand a vacuum and to cut you all the way open. It's like you just had to do something without even telling me. It reminds me of a story I heard heard from a woman she wasn't a client. I just heard her share the story with me. That hurt that happened with her in the hospital, the baby was just coming out and came out without the doctor and he came in and cut in a PCR dummy for the placenta. Okay, for the placenta. Yes, and that's exactly what I feel like happened to and but he could get away with it more because he could pretend she needed to be cut open. But then the same way the doctors checking her cervix through the rectum. It's it's this obsession with having to do something, some sort of control some sort of involvements that they they're unable to be hands off, but it's in reverse tirely wrong in all of these scenarios.

So unfortunately, some people have complained to me about what they call midwives that mid, you know, some l&d nurses or whatever. I don't know how Are they? You know, I could have been a midwife because I wasn't, I was an OB nurse, but I went the opposite direction. But it's not just obstetricians, it's you know, there's some nurses have, you know, can be wonderful. Some can be in on it, you know, very abusive, and some midwives and some midwives, you know, so it's it's not just obstetricians us against them. I know some wonderful obstetricians that I worked with and that I've, you know, worked talk with on online and everything like that. But this is the big deal. This is going on, it's prep. So So where is it coming from? What is what is behind it, it's like any other relationship, there are people who will be ego driven, control driven, abusive, it's like any other relationship that exists in the world, I don't see how that part is surprising because any of those people that are creating abuse, and control issues in a narcissism in personal intimate relationships, of course, they're gonna bring that into their work. And being a doctor in a society that value science more than nature. I mean, that's the perfect storm. Another thing is what I have to work so hard as not as much in my personal home birth practice. I also do shifts in the hospital I love working with the immigrant population, the clinic population and all that, but what I think it also is some people have this mentality that they have, they are the authority, they have authority over me I have no autonomy when I'm when I'm in the hospital. It's they're the boss, not it's like disempowering that people expect to be disempowered. And so, you know, they, you know, like, when people say they let me they don't let me we always say that we always say, but you can't say let they can't let you you have to let them do anything new like, you. You Right, right. You're hiring them. You you have the right to say no, I don't, you know, I don't want this. But like, you know, this, this this routine, doing vaginal exams at 36 weeks, you know, I'm just it's so prevalent. People don't know that they can say no, and certainly in the hospital, they don't know that they can say no, and I and that's how I'm all about like on Instagram, as you know, social media. And a lot of my online work is about empowering moms like I can tell you a beautiful story. Like there was this woman who lived in in a very rural area, and she only had there was one obstetrician in the area. And she she took my online course my guide to pregnancy, birth postpartum. And she was like empowered natural birth and trusting her body and she has all this education. And she came up to you know, she went and made an appointment. She says, I'm do this and whatever. And I would like to have a natural undisturbed physiologic birth. And I want to love my experience, and I wanted to this and lights and work, you know, and all this and he's like, I don't know what you're talking about. He had like an eight 80% C section rate. He says, I don't do natural birth, you know, you're just done. He says, I understand. I understand the concept even know he says, What do you think interventions for you don't want to feel the pit what what, why you want to feel pain, we have the epidural, but she was like, firm and researched and educated. She says, Listen, I just want you to sit in the background and don't touch me the whole time. I don't want any intervention. And I just want you to do it. I've never done that. Right. He's like, What are you paying me for? I'm paying you to do that. Well, it was. The thing is it didn't have to be an argument. It was respectful discussion. And he agreed. He agreed it was outside of your comfort zone for I'm just telling you, you're gonna ask for the epidural. All right.

But he's thinking how do I feel smart? If I'm not doing anything here?

I want you there just in case there's a problem. But I'm having a healthy pregnancy. I'm eating organic, and I'm exercising, I'm doing yoga, you know, whatever it is, anyway, do you know she had the most beautiful birth, the father was brought to tears the mother was brought to tears but he was brought to tears and the staff was brought to tears because they had never witnessed that. Now think of the ripple effect that can have on the way he's going to practice you know, so I think the change comes from when empowered families speak up and educate themselves and speak up so I just love that story. Because you don't have to, you know, it doesn't have to be an argument you have to prepare yourself. But you can have that sort of homeschooling home birth like or whatever you want to call it empowering eautiful sacred birth in the hospital with a physician who knows nothing about it. And if you get you know, what if they don't want if you listen, if they're gonna say no way then you switch, you know, move but she was very she was very lucky that he was willing to sit in the corner and do and do nothing and obviously, he is not going to sit in the same, some other corner away from her thank goodness because if he wasn't in the room, he probably would have had a really hard time keeping his hands Yeah, no, no, he wasn't in the room. No, that's so often. So often what happens is women have this conversation with their doctor and they agree, and then they get in the moment, and something gets a little bit off course, in the labor, like, maybe it's taking a little too long. Maybe the baby has a deceleration in the heart, and they, you know, heartbeat and they want to start an intervention and then, right, so that's called the, you know, the fear of dead baby syndrome, you know, like, so they they first of all that then that's another problem, you know, everybody's escaped, there's it's a litigious environment in the heart, especially in the hospital, they don't want to get sued, and a C section and intervention will prevent them from that. But but so they need an advocate, you know, that's why I say everyone have a tool, or or a doula like support person, you know, because unless there's an emergency, can we have a moment to discuss this privately? When they start, you know, providers will say you want your baby to be dead, that really scare them, you know, some people will give into that scare most most well, because if it's an emergency, if it's a crisis, I love when they call a stat section, and the babies and AP scores are nine, nine. So there's no sense that you know that the baby was they misdiagnosed fetal distress. But I'm just saying that a lot of times things can be talked about, you know, this is taking too long. We want to start Pitocin. So can we have, you know, can we have a discussion? You know, this is an empowered, you know, family now, and they're going to talk with their advocate that doula and she knows that her birth plan, and she's going to help enforce it, and that we would like to just proceed on our own. We would, you know, but yeah, you're right. When in that moment, a lot of people feel disempowered. That's why I'm so big on the preparation that's taken that that's necessary.

Yeah, it's and becoming confident in your own in your own choices coming out, and even in my home birth practice now. So I track my stats. So my transfer rate is not 7%. That means that 93% of families are having their birth in the hat in the home. Right, once they're in labor, and of the 7%. The transfer, the vast majority are first time vaginal birth mothers who have not prepared or who have not have a doula despite my constant urging, right, so now I've made it a requirement. They must prepare, and they must have a dual like support. Yeah, because some people like their mother can be a dual, you know, like if the mother, I have this wonderful family, my practice the mother, the mother had all her babies at home, you know, she's she's, she's a great doula. She knows that she's an obstetric nurse. But she's she's a great though. So So because of that statistic, which is really such a light ball that like people like why do you have to transfer like, you know, the emergencies? Lova. I said, Well, we are the EMTs of birth, you know, we handle most of the emergencies at home, just fine. If we have to call 911 It's probably like a handful of times and 27 years that I've had to actually call 911. But it's mostly non urgent stuck laborers of first time, vaginal birther, but just not progressing who's exhausted and we've tried everything from A to Z that we can. So that lack of preparation and a lack of doula support. So now it's become a requirement.

Great. I love that. We were just talking. We were just talking in our somebody asked us in our q&a Recently, if it's redundant to have a doula at home birth, and we said no way, I would think it's really helpful. Let's talk about obstetric violence occurs, we know that it's happening far too frequently, whatever the statistic is, now, we know it's not happening at home birth, like this. There's there's almost probably a 0%

I know, and the moms, the boss, the families, the boys were coming into their house. Yeah.

Why? Why are women not choosing homebirth?

Well, they are since COVID, I tell you are we're still you know, it used to be 1%. I mean, it was 1% of the population for a while, and then since COVID, it was maybe down to 1.7%, which is it's still it's still a significant population, but still small, you know, whereas whereas that's a significant increase. It's it's an increase but you know, when you look at this, the I love comparing the statistics around the world, right? We're our country, we're at 99 or 98 point something percent, point 3% or whatever 2% of births are occurring in the hospital. Why is it that we our maternal mortality rates are increasing, we have the highest maternal mortality rates among developed countries and even some underdeveloped countries, and our newborn mortality and morbidity is embarrassingly high. So if you look at the countries in the world and I love you know, when Martin Wagner used to compare this, you know, everyone asked him you know, you remember he was a perinatologist he used to had the World Health Organization's maternal child department. And he was very well published in research and he loved midwives. Why do you like midwives? People would ask, Why do you like midwives and out of hospital births. And he says, I look at the stats. He says, if you look at the countries in the world that have the best outcomes, whether it's, you know, Scandinavia, or Holland or Japan, they're having healthy moms and healthy babies, it's the countries where there have, you know, a low risk population goes to the midwives and the high leaving the obstetrician who was really trained in high risk situations, right to treat things and deal with things and diagnose and treat medically in surgery surgically, that then you're then you're serving everybody and you're getting the best outcomes, but when you have in the United States, is that the low risk population is being served majority, by these high risk sort of, you know, the model of care and it's not serving, it's not serving us we're fit, our maternity system is failing. And the midwives are not supported here. And that's a big difference. The midwives are supported in those other countries, the whole system supports the midwifery care model, right, right. In England, for example, you can choose I want to in Canada, even Canada, you choose your home birth, hospital birth, right, it's a Heartland, same thing. And it's all integrated within within the system, but even see, so So a midwife goes to midwifery care and gets all excited about physiologic birth. And then she goes to work for a hospital where they enforce obstetrics, they enforce policies that are outdated and not evidence based. And her hands are tied, because she's got to practice that way. I was very fortunate in my first job as a midwife to work for a hospital where midwifery care was totally encouraged and supported. But it's not all like that. You know, I've also worked in hospitals where I had to really give obstetric care, they were interested in ACOG, they know, you know, immediate cord clamping now that we had no delayed cord clamping here, you know, suction all babies, you know, the Freedman curve, which is outdated, I mean, all these things, you know, I don't have to everybody gets an IV it's like it's crazy. I see how midwives there, it's so hard that you know, they want it they want to do they want to do this work, but their hands are tied.

So what about the mothers, many of our community members talk about how they would love to have a home birth, but they would just maybe like to give birth in a birth center or the hospital the first time around, sort of test out their body, make sure everything is okay, and then choose home birth for subsequent bursts. What do you how do you counsel women on choosing home birth the first time around, we know that the fear of hospital transfer is a big fear. And we know that the fear of an emergency at home is a big fear for women. How do you talk to them about that?

Well, you know, there's no there's not I have an extended informed consent. But But there's no guarantee whether you're in a hospital or you're in a home that you know, but there is there is a lot of evidence about you know, about the safety of home birth, but yeah, we have I like to direct go right at it, you know, this is if there's a trance, you know, in the beginning, you know, where's what's our transfer plan, you know, and these are the reasons why we would transfer, you know, part of my course, is accepting and actually loving what you cannot control because it's happening to you. And it's happening to you for a reason. And it's happening to you by a benevolent divine being, meaning that I get some very spiritual, because otherwise, there's a lot of suffering, because you know, we cannot control what happens, we do our best, but complications happen, and that you know, that are best handled in the hospital. So it's very important to have a doula to go with you. And it used to be that I would go with them too, you know, and it wouldn't be a seamless transfer with my doc with my backup obstetrician, and you know, coming into the hospital, but from the beginning I want I want to cultivate with them a gratitude for life saving medical and surgical care. And it's not an enemy. Intervention is not an enemy, right? Like, sometimes people need IV fluids at home, it's okay, you know, they just get you through to your to your birth, if you're vomiting, the whole labor, and it's been 24 hours. I don't want them to see intervention is evil. It's, I want them to see it as being grateful for this. So it's a shift in a mindset. When it transfers handled in such a supportive way, then it makes a huge difference. And then the mom is appreciative of, you know, at least in my in my experience, but that takes work that takes work through the pregnancy.

In my work in educating couples, we talk so much in the first part of their education about what you can control because you can control so much more than you're led to believe. You can control who you hire, you can control where you're going to give birth, you can control your very physiology. You can control your focus and your thoughts Absolutely, and what you can and then the final lesson is surrender. Right surrender, and that's the ultimate lesson of mothering. Because once you have a baby the rest of your life you are going to be attached to that baby more than you can fathom. And what you are going to have to practice every hour of your life is rest of your life is surrender.

Absolutely. And that's always with birth. That's where my yoga background comes in. And yeah mine to hair care like a boss you know, you can pair you put your dreams you manifest or what you know what how you envision. And then when you're in birth, you surrender. You just have to surrender to however, is.

So an what is sort of your predominant message for a pregnant woman about how to have her best birth experience? How would you counsel her?

Okay, so So I would tell her to prepare like a boss. And the preparation begins in in pregnancy, you know, the mindset shift and developing tools that you can just easily tap into when the going gets tough. And that there's going to help you not just in for birth, but in as a mom and in life, right how to ground yourself at a conscious of how to tap into your joy in your pleasure. And to you know how to trust your body and know that like with billions that billions of women have given birth before you you can too, and we just have to get the modern cultural brain out the way and and I just want women to know that it's so possible, what team do you want to have with you that's going to support you on this journey. There are doctors and midwives that will absolutely support you in the kind of birth that you want. No matter where you plan to give birth, hospital home or birth center, you really need to prepare you need to prepare yourself your mind, educate yourself about what to expect, and educate yourself about how to deal with birth it doesn't go the way you plan because most births don't go the way you plan. And that could just mean that you wanted your kids at the birth and they decide they don't want to be there you're not doing well with them. You know you just like when in the moment. You kind of just have to surrender and be at peace with that. I want women to know that the provider whether it's a midwife or a doctor has nurse has no authority over you nor does the hospital setting you have legally and medically edit medical ethically and legally autonomy over your body. And it's your body, your birth and I encourage you to take back your birth and the responsibility of your health rather than your baby. And rather than just giving it over to institutions that really don't care about you like the way you care about you and your baby. Your lungs know how to breathe your uterus. Your body knows how to give birth. We need to get out of its way.

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Had a mom who was so ashamed at terrible she had a C section because her doctor told her her pelvis was was too small for her nine and a half pound baby and she had a cesarean and her baby was seven pounds. And she was just ashamed that she didn't. I said first of all you were sexually they didn't even give her a trial of labor. You know so you were treated in a way you weren't even giving it a chance right? So we grow through what we go through that you were meant to have that that is how you were meant you and your baby were meant to have that experience. She had a she had a birth with me vaginally nine and a half pounds. She was so ecstatic. She wrote a letter to her doctor saying her pelvis grew.