Birth Wisdom from a Midwife

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Why does our birth culture treat low-risk women like high-risk patients? And how does that impact birth outcomes? Schuyler Grant, host of Commune's 21-day program Empowered Birth talks with midwife Elizabeth Bachner on how to navigate the pressures of the modern medical system and make even a hospital birth more homey.

To learn more about the Empowered Birth course and to take the program completely free from August 12-September 1, go to onecommune.com/birth.

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Schuyler VO: Hi, I'm Schuyler Grant and welcome to Commune, where each week we explore the ideas and practices that bring us together and help us to live healthy purpose-filled lives.

I'm taking over the mic from Jeff for a few weeks because I've curated a brand new kind of Commune course. It's a 21-day deep dive into pregnancy, childbirth, and early postpartum called Empowered Birth. We're offering the course for free to mamas, and mamas-to-be, and their partners, and other support team from August 12th to September 1st. If that sounds like your jam, just go to onecommune.com/birth to sign up.

This week and next, I'm inviting two experts from the course onto the podcast. Today I'm going to be talking to Elizabeth Bachner. She's a home birth and birthing center midwife. And next week I'm going to sit down with obstetrician, Suzanne Gilberg-Lenz. I'm super excited to have a conversation with both of them about what empowerment throughout the baby making journey means to them and to give all of you some actionable tips about how to navigate the wacky world of the birthing industry.

Last week on the podcast if you were listening, I shared some birth stories including my own birth and the birth of a few of my daughters, all of which happened at home. So you might imagine that I'm an advocate of home birth, but that's not entirely true. I'm an advocate of a woman being informed about all the ways that she can safely and healthily grow, and birth, and raise a baby. And then that woman making an empowered decision to have that baby wherever she is most comfortable because all the science, as well as our intuition, tells us that one of the most crucial elements for a positive birth outcome is the woman's sense of safety and security while she is laboring. And let me be clear, when I say positive birth, I do not mean a baby being born the way the mama has envisioned. a home birth that ends in a C-section can absolutely be a positive birth because a positive birth experience, an empowered birth, in my mind, is one that has five key components.

These are, one, you have the knowledge and confidence to ask questions from your support team and to keep asking questions until you are satisfied with the answers. Even as you understand that this is a process that you can't fully control. Number two, you have a strong sense of your own agency throughout the process. You have been able to act on your own choices even if things don't go according to plan. Number three, you have felt safe physically and emotionally. Four, you have been able to reach out for help and you have felt deeply connected to your caregivers, your partner, your family, and your friends. And finally, that this process has been a deepening of your self-awareness. That growing your baby has happened in tandem with growing yourself. In short, and empowered birth is not a state of being. It is a state of inquiry and expansion.

Elizabeth Bachner is a midwife, doula, and the owner and director of Graceful Birthing Centers. She is an outspoken advocate for women's health. She also has her own podcast, Big Birth Junkie, which explores birth stories. And as you know, I'm a big fan of birth stories. You can find out more about her at gracefull.com and on social at GraceFullBirth. She also has a book coming out quite soon, Birth Planning: All the Questions You Need to Ask. And once again, if you want to see Elizabeth and our new Commune course, Empowered Birth, go to onecommune.com. That's O-N-E commune.com/birth to sign up. Here's Elizabeth.

Schuyler: Thank you for coming in, Elizabeth.

Elizabeth: Oh my God, thank you so much for having me. You know I love you and love what you're doing. It's amazing.

Schuyler: Thank you so much. You were the cherry on top of our birth course Sunday. Really. We'd wrapped all of our experts, and then we just knew there was one piece missing and someone recommended you and you came in and at the end of the day we all high-fived and we were like, "That's exactly who we needed." So thank you.

Elizabeth: You're very welcome.

Schuyler: Oh, the love fest.

Elizabeth: Oxytocin. Oh my God, we're gonna have a baby right here in the podcast studio.

Schuyler: So actually that's a great segue. Oxytocin, what led you... Give me your story. What led you to be an oxytocin inducer?

Elizabeth: It's kind of crazy and I'm going to tell this story and every time I tell it now, 15 years later, I'm always like, "Is that how it happened?"

Elizabeth: I was kind of minding my own business, going forward with what I thought my life should look like and next steps. And I was a licensed acupuncturist and I'm like, "Okay, time to get married, time to have kids, check that box." And I kept having dreams and in the dreams my arms would be outstretched and the babies would be born into my hands and I would look up and go, "I don't know what to do. Literally, I don't know what to do." And it wasn't just one night, it was night after night after night.

Elizabeth: So there were a group of acupuncturists and they were all becoming doulas. And I was like, "What's this doula thing? I have no idea what it is, but I might as well do it because I need these dreams to stop so I can go get married and have babies."

Schuyler: Do the thing.

Elizabeth: Do the thing, right? So I go and I become a doula from this place of I'm getting these dreams, I want them to stop. And we are sitting on the hill of Topanga and, I know, I tell this story and I'm like, "What?" So we're sitting on the hills of Topanga and everyone's going around sharing why they want to become a doula, and it's the usual answers like, "I love babies," or "I've had a terrible birth and I want other people to have better births." And you get to me and I'm like, "So I keep having these dumb dreams. They're repetitive. They won't stop so I figure I'll become a doula."

Elizabeth: And so Anna Verwaal is leading the circle and you might know of her from the Business of Being Born, and she's got this long dark hair and she turns to me and she is like, "You have received the calling," and I am like, "The calling for what?"

Schuyler: Oh no. 

Elizabeth: She's like, "You've received the calling to become a midwife." And I was like, "Hell no. Like why would anybody birth their baby outside of a hospital with this midwife person out by a tree?" Because actually, I was the person who thought it was a crazy idea because I didn't know how to think for myself. You know, I believed the propaganda. I thought you got the white male doctor who told you what to do in the hospital with the drugs and then you went home with the baby and lived happily ever after in a fantasy. That's it.

Schuyler: Right, and you were waiting for that to happen to you, not to have any part in that process.

Elizabeth: Exactly. Exactly. And so, you know, birthing babies is what it's all about and birthing babies is just the tip of the iceberg, which is why I love the course you've created. You're getting people to question, you're getting people to ask. You're getting people to know they have choice. And that's what excites me about this course.

Schuyler: Yeah, and to me what's so exciting is that you, and this is something we've talked about before, you can have a hospital birth that is fully empowered-

Elizabeth: Absolutely.

Schuyler: ... and what is shifting in our culture is that women are starting to ask for what they want, which might well be a hospital, but it's not the hospital that they see on TV and it's actually their experience in a hospital or a birthing center or maybe at home. So tell me, because I've been in a hospital, honestly probably three times in my entire life... Outline for me, since you've seen all parts of the birth world, what that difference looks like and how women, when they're really looking at their options, how they can evaluate or start to untangle what feels right for them.

Elizabeth: So the first thing that I want pregnant people to know is that there is a difference between low risk childbirth and high risk childbirth. There's a straight up difference that I didn't even know existed as a low risk expert. So low risk childbirth and high risk childbirth is defined by your community, by your care providers, and a lot by the hospital. So people need to know that Ob-Gyn doctors, they're amazing surgeons. They're incredible surgeons, but they are not taught how to work with low risk unmedicated pregnant people in a hospital environment, meaning they don't know how to help somebody get into position. They are not taught that if the labor stalls, it could be because of the baby's head. It could because of the pregnant person's position. It might not mean that there's a problem and we need to go straight to C-section.

Elizabeth: And I'm not saying that they're bad people, I'm just saying they're not educated in that, and so going into this, you have to know who is your care provider and what is their education.

Schuyler: If you're a woman and you really don't have any intention of having a baby at home, because that doesn't sound like an appealing idea to you-

Elizabeth: Correct.

Schuyler: ... but you want to have a low intervention or ideally a non-intervention birth at a hospital or a birthing center if there is one in your vicinity, lucky you, I assume that there are Obs that are operating from a midwifery mindset.

Elizabeth: Yes and no. So each person comes into birth for their own reasons, and I just want to say straight up, it's very rare to have a misogynist, someone who hates women, and that's why they're an Ob. I mean you've got to imagine back in the day there's this spark of like, "I love this idea of birth and that's why they got into it."

Elizabeth: But the training that they get is part of the problem because their training is, first of all, I think a lot of doctors have PTSD that they don't know about because they're seeing emergency after emergency after emergency and they're exhausted, so that's not being addressed. They're being taught surgery. They're being taught how to manage-

Schuyler: Crisis.

Elizabeth: ... and crisis, thank you, and high risk. And you know the moment a pregnant person gets an epidural, which is not a bad thing, but the moment they get an epidural, they become high risk and we need people who can manage that. It's not a bad, it's just that's high risk. That's an area of specialty I don't have and I want someone who knows how to do that. Once we start an induction process by using Pitocin, a drug to augment it, you become high risk. Not a bad, but you need to understand that.

Elizabeth: And I think what's been happening in a mental place is that epidurals and Pitocin inductions have become the norm as opposed to, "You know what? Your body knows how to do this. It knows how to communicate . It knows how to communicate from low risk to high risk." So if you get an Ob-Gyn who knows how to sit on their hands more, who is up to date in evidence-based care, and I just want to say evidence-based care changes all the time, and there's a lot of communities out... There is a lot of hospitals with old protocols that are not evidenced-based care. There's a lot of doctors who haven't upped their knowledge and they don't know what the new evidence-based care is. And so they're practicing in these old ways. I mean I've heard of doctors who are like, "You can't eat and drink in labor because, you know, it's-

Schuyler: Oh yeah, that's still out there for sure.

Elizabeth: ... so you don't want to be eating and drinking in labor if you're high risk and you really have a high chance of having a C-section. That's a really bad idea, but if you're low risk and you're going into this from this place of low risk, and you're coming into it with letting your body do what it knows how to do, you can work with a care provider that's going to allow you to eat and drink.

Elizabeth: But the other thing that people don't understand, there's no education around this, is this is like you're not going to want a roast beef dinner.

Schuyler: No, you're not.

Elizabeth: When you've got surges moving through your body. But, yeah, I'm looking at your face right now-

Schuyler: Worse than ever.

Elizabeth: Right? It's like a disgusting idea. You're just like, "Oh, I'm just going to want a cracker. I'm going to want a protein bar. I want a couple bites of something." Your body's going to tell you what it needs. And that education of the body's going to tell somebody what they need, and we work in relationship with that. And relationship means boundaries, conversation. You know, there's a relationship that happens with both people. And when you establish that relationship, you're establishing safety, you know?

Schuyler: 100% and-

Elizabeth: It's not just like, "Oh, go ahead, eat whatever you want." It's like, "No, no, no. You're low risk, great, your body will tell you what to eat."

Schuyler: So let's back up a little bit because I don't think everybody who's listening, and even in my mind, I don't have a really clear understanding of the pregnant woman who is low risk versus high risk. I mean obviously some things clearly jump out, but if we go to the Ob and we're three or four months pregnant and we're shopping around and we're talking to an Ob and we're talking to a midwife, how are they going to establish that?

Elizabeth: Ask them. Everybody does it differently, so at Graceful Birthing, we've got protocols in place where we give everyone a risk assessment and we've got things that are just, you can't birth with us. It's state law. So it's state law you can't birth with us outside of a hospital before 37 weeks, after 42 weeks and you can't do breeches, you can't do twins. My medical board license tells me that.

Elizabeth: So then we assess risk at every prenatal. We assess risk during labor. We give it a score. We're doing critical thinking and we'll explain that to people, even postpartum. So you want to ask your care provider, how do you determine if I'm low risk or high risk? How do you do that assessment? And what you might get is, "Oh, we don't."

Schuyler: So if you're at a hospital, there might not be any differentiation because by virtue of being at the hospital you're just all put in the same soup.

Elizabeth: Exactly. Exactly, and if you are with a doctor who doesn't have any additional training, you know, I think this and we can ask somebody else later, but the default is everybody's high risk. We're going to treat everybody like high risk. I am pretty sure they're not differentiating between low and high risk and how you approach birth differently from those two different places?

Schuyler: Interesting. I'll have to ask Suzanne next week.

Elizabeth: Yes and by the way-

Schuyler: I won't tell her it's coming.

Elizabeth: ... don't tell her, but she's an amazing person.

Schuyler: She is.

Elizabeth: She can speak to it more generally, about the training of the OB's.

Schuyler: Yeah. Cool. I'll ask her.

Elizabeth: Yeah.

Schuyler: So let me just ask you a personal question, just in this vein. So when I was pregnant, every time I develop, and I'm probably going get the terminology wrong, but I had elevated blood pressure, natal elevated... What's it called? It's like, my blood pressure went up every time I was pregnant. So, it seemed like that was a thing. Nina actually, in this course, speaks to that and she says, "It's no big deal. Don't freak out. You just treat that by eating smart and it's going to resolve itself and if it doesn't and it continues to elevate, then it's a thing."

Elizabeth: Correct. So, elevated blood pressure, are you having elevated blood pressure on its own, white coat syndrome? Meaning every time you walk through the door and somebody with a white coat takes your blood pressure, it just goes up and at home it doesn't. So, it's like, I'll give someone a blood pressure cuff, take it at home.

Schuyler: But I did. I had elevated blood pressure. So, did that make me high-risk? Certainly, it didn't according to my midwives, but it seemed like a very-

Elizabeth: No, it doesn't automatically make you high-risk. There's grades in between. So, I would give you a risk number of a one. Okay. We're going to recommend herbs for you. We're going to recommend dietary changes. We're going to look at that and make sure we're okay. Then if it gets a lot higher, I'm going to consult with someone with a license higher than mine. Do you need to be on medication? Wow. It's really high. You have to be medicated. You're not low-risk anymore. We have someone with a license higher going, "Nope, you're doing great. It's kind of borderline, but stay in communication with me. Great. We're going to birth outside of the hospital."

Elizabeth: So, you as a home birth and birthing center midwife, who is that person you're consulting with? Is it an OB-

Schuyler: OBGYN.

Elizabeth: ... that you have a relationship with?

Schuyler: Exactly. Yeah.

Elizabeth: So, we're doing it in relationship to keep pregnant people safe outside of a hospital. It's not isolated. It's in relationship and then, for other people who have high blood pressure, that could be a sign that they're going towards something called Preeclampsia. So you're testing the blood, you're testing the urine, you are asking other questions to make sure you don't have that. Because if you get Preeclampsia, that's bad. You got to be at a hospital.

Schuyler: Right. You're glad to be in a hospital.

Elizabeth: You're really glad to be there.

Schuyler: Yeah, you're super psyched for modern medicine.

Elizabeth: Exactly and a water birth might not be an option because you need to play it safer.

Schuyler: Right. In LA, we're really lucky. We're in this quite progressive birth culture. I moved here from New York four years ago and in New York the choices are very stark.

Elizabeth: It's really hard because there's not good relationships happening between doctors in the 

hospital and the midwives. It's a lot of-

Schuyler: And there's no freestanding birth centers. There's no birth centers really.

Elizabeth: Right. So the choices then become polarized. They become oppositional and they're not working in relationship just to help the community. There's an incredible community up in Maine, where the home birth midwives and the doctors in the hospital all work together and they've got great births in the hospital, outside of the hospital. It's wonderful.

Schuyler: Right and it's all supportive with good outcomes.

Elizabeth: Exactly.

Schuyler: So my question is, if you live in a place like New York or maybe somewhere way, way out in the country where you really have two options that don't have a nice middle ground, like a freestanding birth center or a midwife who has a great relationship with a backup doctor. So that leaves you feeling like, "Oh, I like this idea of having a no intervention birth, ideally. I want all of that. That all makes sense to me intuitively. But being at home just doesn't make... It just doesn't logistically make sense or my husband just won't go for it or my girlfriend won't go for it." How does one create the best possible sense of a home birth in your nervous system in a hospital setting?

Elizabeth: Right, great question. Right. I think it's got a lot to do with expectations and you've got to do it before you walk through that door in labor. You have to find out, who is your care provider? If your care provider says to you... You're going to go, "We have a whole bunch of questions." Your care provider says to you, "Oh sweetheart, don't worry about it," and is dismissive, you know you need to get another care provider.

Elizabeth: If you get someone who looks at you and said, "Hey, you know what? Not my area of expertise. I do high-risk. That's what I got going on. Better at surgery." You're going to go, "Great. That's clear. Now I know I want to hire an advocate. Now I know I want to hire a doula." You want someone in that room who has an expertise in low-risk childbirth to work with everybody in that room.

Elizabeth: You need to find out beforehand. What are some of the protocols? If my water breaks, how long before I'm going to be induced? At how many weeks pregnant do you want me to be induced to have the baby come out? You need to find out where their boundaries are, so you know what you're working with before you walk through that door. Because it's very different than just going, "Oh, I'm going to be fine. Everyone in my family has fast labors." And then you end up in a hospital with a doctor who was just like, "Oh no, everyone gets induced at 41 weeks in my practice and if the water's broken, we give you 12 hours and then, a cesarean birth and you're like, "What? What? What?" And then, [inaudible 00:16:43] is like, "Look at my body's going, what? what? what?"

Schuyler: Yeah, your shoulders are really tight.

Elizabeth: Right. Baby's not going to-

Schuyler: There's no baby coming out.

Elizabeth: But if you know that beforehand, you're like, "Okay, and this is what I got to work with." It might not be perfect, but at least know what you're working with and what you're getting into and can start working towards that. Also, I'm going to give a little doula tip here. So the nervous system, when you relax the nervous system, in order for the hormones to work, we're going to need a dark room. We need it dark, we need it quiet, we need someone unobserved, right? And usually one door in and one door out. What is the one place, when almost everybody's home and every hospital that is dark, warm and one door in, one door out?

Schuyler: The bathroom.

Elizabeth: Yes. Yay, you got it!

Schuyler: Ding, ding, ding, ding, ding.

Elizabeth: The bathroom. So everybody listening here, whether you're the pregnant person or the partner or the doula, if you are walking into a hospital and it's like bright lights and you're like, "Oh my God, I'm nervous and I'm scared." All you got to do is just suggest to the pregnant person, "Don't you have to go to the bathroom?" What pregnant person is going to say no in labor, right? You go into the bathroom, you sit on that toilet, you do your breaths, you connect back in, you got headphones on, maybe. So that you're just listening to your music. You got someone else answering all the questions and you come back into yourself, the bathroom. Go to the bathroom.

Schuyler: So maybe key is find out if there is a private bathroom that you could go into that nobody else is going to be knocking on the door at.

Elizabeth: Midwives will knock on the door, but everyone else is going to stay away.

Schuyler: Right, but if you have your own private bathroom though, which may not be the case in every hospital room.

Elizabeth: Not in every hospital, but I do know that even in the hospitals that have the community bathrooms, there's always a bathroom down the hall in labor delivery that's kind of private.

Schuyler: Good to know. Good tip.

Elizabeth: Try to find that.

Schuyler: And then, vibe it out with a disco ball and [inaudible 00:18:41] like-

Elizabeth: Depending on your style. They're not going to let you spend that much time in there. But also, you have to remember, so bright lights can inhibit the hormones in the body from going into labor. So what can we do? We can get them to turn down the lights. We can get them to dim the lights, right? If you have a private room, hopefully you'll be able to do that also. Then Amazon these days, they've got great electric candles. They have great little fairy lights that operate with battery. You can put those on in the room and that can help just kind of give it a little bit more of an ambiance.

Elizabeth: I would say most hospitals these days are going to let you bring in your own music, right? I am a big fan of the over the head earphones because these give messages to people that say, "Don't talk to me." You got those little earbuds and nobody knows whether you have them in or not. You're talking to yourself.

Schuyler: Right, but if you have a helmet on.

Elizabeth: Right?

Schuyler: Right.

Elizabeth: Go to Marshall's, TJ Maxx, Target, buy a pair for, I don't know, 15 bucks and you put them on over your head and you're listening to your music. How are they going to tell you to take those off, right? They're asking you questions, you want your partner, you want your doula, you want someone else in the room to answer them for you, just point to that out of the person and go back into your space.

Schuyler: So, can we even rewind a little bit further internally for people who are listening, who really don't know anything about the cascade of physiological shifts that happen for childbirth, and could you speak to that a little bit, so that all of this place making makes sense?

Elizabeth: Yeah. So, there are hormones in the body that actually get the uterus to contract. The number one hormone for that is oxytocin. Oxytocin, we release it during orgasm. We release it at dinner parties where the red wine is flowing. That honeymoon stage with a partner and you fall in love. It's called the love drug. That gets contractions going and it's been scientifically proven, trust creates oxytocin, oxytocin creates trust. I'm not talking about blind trust, I'm talking about trusting that your body will communicate to your care provider if it goes from low-risk to high-risk. Trusting in your care 

provider, trusting who's in that room that you'll be safe. That's going to create the oxytocin.

Elizabeth: Then we've got the endorphins. Endorphins are natures opiates. So it's like, the nature magnificence that's created us isn't just going, "Here's a contraction. Good luck. Have at it." Right? It's like, "No, no, no. Your body's going to also have something called endorphins, that's going to meet you there." And some people don't like the endorphin feeling because it's tingly and you don't care so much and you could feel out of control. But you're supposed to feel a little loosey goosey from the endorphins to help with the surges in the body.

Elizabeth: So how do we get that to come into the body, to work in the body? The pregnant person has to feel safe, and that's different for everybody. But at a very basic level, we're all mammals. So mama bear, where does she give birth?

Schuyler: In the cave.

Elizabeth: Right, she's in the cave, she's not out in the field,

Schuyler: which is where our internal stories and what makes us as women. What makes us feel comfortable gets very complicated, because what makes us as a mammal feel safe and able to do the biggest opening that we will ever do in our, in our lifetime-

Elizabeth: Do the biggest opening spiritually, mentally, emotionally-

Schuyler: And physically.

Elizabeth: ... and physically.

Schuyler: Yeah, the whole gamut.

Schuyler: The whole thing, that's all so deep and hardwired. And that is this cascade of chemicals that you're talking about and this whole neurological play. Then we've got all of our cultural programming, which is huge too. So, which is why a home birth or even a birthing center isn't the right place for some women because that wouldn't make them feel safe.

Elizabeth: Correct.

Schuyler: So the important thing is that you're in the place that makes you mentally, that makes sense to you, given the stories in your head that makes you drop in, and then how do you hack that-

Elizabeth: Yay, yes.

Schuyler: ... so that you, that your mammalian brain can also drop in, because those are in many of us ... in all of us, let's be honest, are operating side by side and for some of us it's maybe ... they maybe are in a little bit more alignment, but we're all living in our head and in our gut. And so, I think a big part of it is the hack.

Elizabeth: Right, so the hack I believe towards empowerment is about education and choice.

Schuyler: Absolutely.

Elizabeth: Right? So, it's-

Elizabeth: Which leads to trust, which leads to the love drug of Oxytocin, right? Which is why we all do this anyway. But, but going back, it's like the education, it's, it's knowing, "Oh, you mean I could choose a birthing center, because I'm low risk, instead of a hospital?" Great, so you go tour that birthing center and you go, "Hell to the no. That's not my place. I'm a hospital person." And you own that with your truth and your confidence?

Schuyler: Right.

Elizabeth: That right there is going to have more Oxytocin and a better chance of opening up to birth your baby than going, "Well, I'm low risk and I saw an Instagram the candles in the water and I really should be doing a birth center birth, but I'm ... the scared is being pushed away." That's more chance of a transport. 

Schuyler: Yeah, active choice. It's all information leading to active choice.

Elizabeth: Right, and the challenge that we're having is we're not educating pregnant people about the questions to ask so they can know what their choices are, which is what you're doing in this video.

Schuyler: Yes, and guess what people? On day seven of week one, you give us a list of questions-

Elizabeth: I sure do.

Schuyler: ... to ask your midwife and Susanne gives us a list of questions to ask your OB, your prospective OB as you're interviewing people and grilling them, lovingly. A big question that comes up with a lot of women that I speak to who are even contemplating the idea of a birthing center, or a home birth is insurance.

Elizabeth: Oh yeah.

Schuyler: Yeah. So can you speak to that a little bit?

Elizabeth: I think that's a whole other podcast, but I'll try. I just wanna say for the record that I really know what's going on in California well. I don't know what's going on nationally, so I can speak from this place, but the biggest challenge is that there's no differentiation between low risk and high risk childbirth in most states. Like Washington state, they got it plugged in. Alaska, they got it plugged in. But if you're not differentiating from the two the norm becomes a hospital.

Schuyler: What does a hospital do?

Elizabeth: It works with high risk. It knows about high risk, but it doesn't know about low risks. So when we have a pregnant person who's like, ",,Hey insurance, I'm gonna birth outside of the hospital and I'm low risk and I'm going to save you a ton of money because I'm going to birth at the center and then I'm going to go home four hours after I give birth. I'm not going to have two overnight stays." It's like they don't know what to do with that because they don't have any-

Schuyler: Right, there's no paradigm.

Elizabeth: There's no paradigm for that. They have it over in the UK. They've got it in Australia. They're saving tons of money for healthcare because they're encouraging low risk people to birth in either low risk facilities with low risk protocols or at home. They're saving a ton of money. It doesn't happen here, so we gotta fight to explain. We got to educate first.

Schuyler: Right, okay. So let's ... so, you're pregnant and you're not ready to fight. You just want to have your baby and you want your insurance to pay for it. So, so how do you go about it the best you can?

Elizabeth: The best you can is that accredited birthing centers are actually, which is what we are, we're actually making inroads and the hospitals are hospitals. And the insurances are starting to go, oh, are you going to birth within an accredited birthing center? Okay. That we know how to pay for. You know, there's pockets of insurances who know about that. There are also health savings plans, I mean, health share plans that you can get into. It's not health insurance, it's health share. And so they will choose to actually pay for an out of hospital birth at home, or a birthing center. So that can be another alternative. And that's the best we can do. I've been fighting insurance for about seven years, nine years now, and we're finally in-network with Blue Shield with Anthem, and we're working on other ones to make it affordable.

Schuyler: Mine were all covered in New York. Actually, I had my first daughter in Connecticut and the other two were born in New York.

Elizabeth: I think Connecticut is one of those good places, and New York has kind of figured out the code also, but it's not-

Schuyler: So, it's just state by state.

Elizabeth: It's state by state, but we're doing better and we're educating the insurances, and I think they're starting to understand they can save money by supporting low risk people to birth outside of the hospital.

Schuyler: Right, interesting. So really the ... you just have to figure it out state by state with your care provider, and that's just what it comes down to. And at a certain point, you are faced with possibly making the decision that you're going to have to fund it, if it's not covered. And then usually I assume as a midwife there's payment plans and...

Elizabeth: ...there's all of that. But the other thing is also starting to wrap your head around, and this is where insurance doesn't get this part, you're not paying for an outcome. You're not paying the money to have an out of hospital birth. You're paying for midwifery care, and you're paying for my expertise. And we are all hoping and praying and doing the work for it to be out of the hospital, but if you go from low risk to high risk, we're going to be with you as we transport to the hospital and you're still getting midwifery care, which also includes postpartum care for six weeks for both you and the baby.

You're paying to have more than five minutes at every prenatal, and insurance doesn't understand that. So you're paying for that extra time and you're paying to be seen and heard. And at some point, fingers crossed, I've got both fingers crossed, we're going to get insurance to understand that if it starts to pay for the pregnant person to be seen and heard, we're going to lower the the rates of C-section. We're going to lower the rates of infant mortality, of maternal mortality. And I just want to bring this little piece in here right now is that people of color are dying at a rate of three to four times that of white people specifically because they're not being seen and heard by their care provider and insurance is not paying care providers to see and here people. It is a conundrum and if we can start making the changes for people of color that way, everybody is going to benefit.

Schuyler Right? And insurers will save money?

Elizabeth: Mm-hmm (affirmative).

Schuyler ... for that better holistic outcome? Exactly. Yeah. 

Schuyler: So how do you then ... well now lucky us, in California who do have backup from institutions, but around the country, how do we start to fill that gap? How do we start to reach out and and create support networks for people who don't have access to a broad spectrum of care?

Elizabeth: I think the starting place is knowing what questions to ask of your care provider, and it starts simply by going, "Am I low risk or high risk?" And figuring that out, and then knowing what support you need if you're low risk. There is great doula organizations, and the word doula is that the ... The job of doula is becoming more prevalent and people are recognizing that and honoring that doulas are amazing of what they can advocate for and educate with. I think it's about getting the right childbirth education class, so you know what your choices are. I think it's about asking your doctor, asking the hospital, and and holding them to evidence based care protocols that differentiate between low and high risk. I think it's about calling up your insurance and saying, "I want you to pay for my low risk care provider. My OBGYN is not an expert at low risk. How do you expect me to have a low risk birth that's going to save you money?"

Elizabeth: You know, I think we got to start talking about those things and yeah.

Schuyler: So, let me ask you one last thing, Elizabeth. I sort of have my intuitive feeling of what an empowered birth is. In a few sentences for you, and you're an expert, I'm a lay person, what for you in the fortune cookie spiel, what for you is an empowered birth?

Elizabeth: An empowered birth comes not only from knowing what questions to ask before you go into labor, but it's also being seen and heard with any of the questions that you've got going on from this course, from a list, or from inside of yourself, ask your questions. It's so important.

Schuyler: Boom. I agree. Oh my gosh.

Elizabeth: So back [crosstalk 00:10:09].

Schuyler: Oh my God, we're back where we started. Thank you, Elizabeth.

Elizabeth: Oh.

Schuyler: It's such an honor to have you a part of this project, and I look forward to being on the path of labor and delivery and babies with you.

Elizabeth: Oh, me too.

Schuyler VO: Our hope with this course is not so much that you arrive at a state of empowerment, but that you embody the power to ask questions of your partner. As Elizabeth said, ask questions of your extended family, of your wider culture and most importantly, ask questions of yourself. We know so much more than we think we do, ladies. Sometimes we need to just get out of the head and into the wisdom of the heart, the wisdom of the gut, the belly. This process is not a process of arriving somewhere. It's a process of being fully engaged in a conversation that both your heart and your mind want for this pregnancy, for this labor and delivery, for this new baby. By doing so, you arrive as a mother who's able to embody the ever changing vortex of parenthood, whether this is your first or your fifth baby. So please join the journey into empowerment at onecommune.com/birth. That's one, O-N-E, commune.com/birth. It's free from August 12th to September 1st and free is good.

Thanks for joining us on the Commune Podcast. I'm Schuyler Grant and I'll see you next week.