Reclaiming Pregnancy Wellness with Dr. Aviva Romm

Introduction and Welcome

Britta Bushnell: Hello, folks, and welcome to Transformed by Birth, a podcast about the rite of passage of pregnancy, birth, and new parenthood. I'm your host, Britta Bushnell, author, mythologist, childbirth educator, and an all-around deep diver with a side of goofball. I'm so glad you're here. Today we're talking about an integrated approach to wellness during the perinatal period and beyond. So grab your comfy beverage of choice, or take us along for a walk as we connect with midwife, doctor, author, and advocate Dr. Aviva Romm. Before we begin, we start the way we always do by lighting a candle. If you want to join me, please do, or take a breath as I light mine. Today's candle is in honor of wellness.

Wellness. Okay, I love this word, and I also want to scream "gah!" because it's become such a catchphrase word these days, and I kind of wish it weren't. But let's back up and find out what does it actually mean. Well, I went and looked it up in a dictionary, folks. Merriam-Webster's dictionary says, "The quality or state of being in good health, especially as an actively sought goal." Makes sense. Add wellness to pregnancy, and you've got a person who's gestating a human and trying to be in good health. Sounds like a great idea to me, folks. And yet, at times, this idea can be controversial.

So, when in conversation about healthy pregnancy and healthy postpartum, or wellness and pregnancy and postpartum, you're likely going to hear the name of today's guest. Her work has inspired me for years — decades, probably. Sadly, I didn't know of her when I was birthing my children. Fortunately, I am getting to learn from her regarding the midlife passage that is part of my life now. And the good news for those of you birthing and raising young children currently: you have access to her wisdom through her books, podcasts, and online programs.

Dr. Aviva bridges two worlds that often don't speak much to each other, blending 25 years of herbalism and midwifery wisdom and rigorous Yale medical training — that's a pretty rare combo, folks. Most practitioners land up in one camp or the other. This intersection is particularly enticing and interesting to me. And her definition of wellness doesn't seem to be about optimization or hustle-culture wellness — you know, the shiny social media version we're bombarded with. Rather, hers seems to be more about something more grounded: trusting the body, understanding root causes, and having real information rather than fear-based medicine or toxic positivity.

So, a bit more about today's guest. Aviva Romm, M.D., is a world-renowned midwife and herbalist who also happens to be a Yale-trained MD and board-certified family physician with specialties in integrative gynecology, obstetrics, and pediatrics. A longtime home birth pioneer and birth activist, Dr. Romm is keenly committed to patient empowerment and addressing health inequity, racism, sexism, and other biases in medicine, particularly in women's and maternal health. She is the author of the textbook Botanical Medicine for Women's Health, and her latest book, Hormone Intelligence, an instant New York Times bestseller, explores the intersection of the world we live in and women's hormones and health, inviting women into a whole new conversation about our hormones, bodies, and health. Her podcast, articles, books, and online programs are wildly popular and successful, helping women take back their health. She practices medicine in both New York and Massachusetts, and lives in the Berkshires of Western Massachusetts. She's on the board of Every Mother Counts — if you don't know what that is, go look it up. And she's also the mother of four and grandmother of two that she had the privilege to midwife into the world.

When you've been in the realm of birth work for a long time, like I have, there are a few people whose work and name come up over and over again. Today's guest is one of those for me. To say I'm honored to get to have a conversation with Dr. Aviva is an understatement. So welcome. I'm so honored to have you here, thank you for joining me.

Dr. Aviva Romm: Oh my gosh, thank you for that amazing introduction. Introductions are such a special moment because you get to hear reflected back at you other people's view of you, and in such a beautiful way. So it's really such a gift. Thank you for that.

Finding a Shared Thread: Mama Saran

Britta Bushnell: Oh, it's so fun for me, and as I was sharing with you before we hit record, it was really fun for me to find a thread. I felt like I was unwrapping a ball of yarn in really doing my research and exploring, and did not know that one of your midwife mentors was the midwife that I just got to experience a home birth with for my beloved bonus daughter, goddaughter, daughter of my heart, in Georgia. And so I feel I was bursting at the seams when I found that out, because that was such a magical birth experience working with Mama Saran, and she was one of your mentors.

Dr. Aviva Romm: She was my primary midwife mentor, and she is a legend and a legacy and an incredible midwife. So yeah, I feel very gifted to not only have her as a friend for 42 years now, but as my midwife teacher.

Britta Bushnell: Well, I mean, I just felt — I immediately reached out to Alexa and said, "I'm interviewing Aviva tomorrow, can I share this piece?" And she was like, "Yes!" with exclamation points.

Dr. Aviva Romm: I have two interviews — one with Mama Saran and her daughter Leela, and then one with just her daughter Leela, who I was a midwife at her birth when she had her oldest, seven years ago. And then I couldn't get down for the second birth — it was during COVID, or just right after, no real flying time — and so I was there for the birth on Zoom, which was pretty fun, or on FaceTime, excuse me.

Britta Bushnell: Yeah, births by FaceTime — you know, it's a thing these days sometimes. But what a special — I mean, it really did, being there and witnessing this birth, and watching and getting to experience working with Mama Saran, gave me just a hint of what your background must be like in terms of the training and the way that you honor and respect this transition.

Dr. Aviva Romm: Yeah, it was a very unique experience. Well, first, before we even go there, tell me — one thing that stood out to you, is there something that you're like, "Okay, I'm watching a birth goddess in action here" — about Mama Saran?

Britta Bushnell: About Mama Saran? Yeah.

Dr. Aviva Romm: About Mama Saran. Yeah, and your daughter too.

Britta Bushnell: Oh, you know, one of the things — her face, like the way she looked at Alexa while she was birthing, was as if she was witnessing a beloved giving birth. That was profound. She was so in awe herself of what was transpiring, what was happening, the portal that was opening. And I captured some photos in that moment, and you can just see love beaming off of Mama Saran, and it was spectacular. And — it's not my birth story to tell — but I can say that the way she held space and respect for Alexa and her journey, and her autonomy, and what it is that she wanted, and how she was moving, and all of those things was spectacular. It was just awe-inspiring.

Training in Atlanta: Birth Apartheid, Not Just Birth Deserts

Dr. Aviva Romm: She's very skilled at knowing when to hold space, when to move space, when to help the mom move. She's deeply intuitive. So yes, my training was unique and spectacular. There was a collective of African American midwives in Atlanta, and the reason I define it that way rather than being non-descriptive about it is that it was a very intentionally self-descriptive African American collective that served not just the Black community, but was really there to serve the Black community. And this is no small thing in Georgia, where the maternal and infant mortality rates amongst Black mamas and babies is still amongst the highest in the country. It was a time when midwifery was — and actually still is — illegal there, and there are over 180 counties in the state of Georgia now that have no obstetric care. No midwife, no OB, no family doctor, no nurse midwife, nobody.

Britta Bushnell: So many deserts. Yeah, there's so many deserts.

Dr. Aviva Romm: And I would extend that to a term that I learned from Leah Penniman, who is the founder and director of Soul Fire Farm, which really emphasizes farming while Black. And Leah kind of shifted the framework around the term "food deserts" to "food apartheid," and I have extended that to birth. It's not just birth deserts; it's birth apartheid. There is intentional lack of distribution of care and resources, and the midwives in that state continue to hold it down for all the mamas — mamas who do have resources, but also traveling to the places where mamas don't. And, you know, we were illegal — it was no joke to be doing what we were doing there. And these women are incredibly brave. They're both legacy holders and pioneers, and their ability to hold both really deeply traditional practices and modern midwifery is beautiful and profound and meaningful. And that is the tea that I steeped in as a midwife for my apprenticeship, and then my early practice, when they would assist me at births and keep an eye and make sure I felt comfortable.

Britta Bushnell: Amazing, and I also want to just thank you for sharing that reframing — the apartheid rather than just a desert. That it's an intentional restriction that is causing — and yeah, it's important to speak truth to that.

Every Mother Counts

Dr. Aviva Romm: And that's it. It's hence my being on the board of Every Mother Counts, which, of all the accolades and things people can say about me, that's one of the things that I am very proud to say that I'm part of and honored to be a part of. So truly, if you're not familiar with it — you're a birth advocate, you're a mama, you're looking for where to be charitable — it's a great organization.

Britta Bushnell: Would you like to share a one-liner about it, to tantalize people?

Dr. Aviva Romm: I mean, the one-liner is — it was started by supermodel Christy Turlington, who had a complication at her own birth, saw that she was resourced and had access, and realized so many women didn't. So she went back and got a master's degree in public health at Columbia Mailman School, and created — it's a very long one-liner — an organization dedicated to improving access to maternal health care. We are completely dedicated to reducing all maternal mortality, morbidity, and infant mortality that is mostly unnecessary in this country and in the world. So we are deeply involved in grantee partnerships, supporting and helping to get funded and off the ground birthing centers, midwife groups, doula groups all around the world, as well as hospitals that are focusing on improving maternal health in places as disparate as Española, New Mexico, to Tanzania.

Britta Bushnell: Yeah, and because research has shown that access to out-of-hospital care that is supported and legal improves maternal outcomes.

Dr. Aviva Romm: Yes, access to individual midwives who are well-educated for low-risk mothers not only helps improve birth outcomes — and not just birth outcomes in terms of safety of mom and baby, of course that's so important, but also maternal wellness, mama's satisfaction and sense of being supported and respected in her birth experience — but midwifery care can actually help reduce risks for women who would otherwise be high-risk, because we're more attentive to the details. We're more attentive to nutrition, to lifestyle, and these pieces that do help keep mamas healthy and start to even reverse some of the problems that happen when there's lack of access to good nutrition, lack of access to spaces for exercise, higher levels of stress — all the things.

Bridging Midwifery and Medicine

Britta Bushnell: So important. So you have a unique lens because you had this decades-long training and experience in the midwifery model, and then you went to medical school. You had four kids, and then went to medical school — I had two kids and a bonus daughter, and went back to grad school and got my PhD, and that was cuckoo balls, and I can't even imagine medical school. It was a lot. I bet, and I'm sure we could talk about that forever. I want to hear how you bridge these different worlds that are so often seen as separate, as different, and how you see them as integrated, and what difference does that make, or how important do you think it is to have that kind of bridge available to us?

Dr. Aviva Romm: So, kind of referring back to what we were just talking about, about access to midwives, access to out-of-hospital birth — the Western countries that have midwifery care, the UK, Canada, Germany, the list goes on — part of why the maternal mortality and morbidity rates are so low is that midwifery care is seamlessly integrated into the entire maternal health system. Here in the U.S., in so many places, you have midwifery care or the obstetric model, and a lot of women who are seeking a midwife, particularly a home birth midwife, have often had some disenfranchising experience within medical care. They've often felt disrespected, they've often had lack of access, and so they're seeking a model where they feel safe and seen and heard and respected. But part of what happens then is, in many states, if not most states in the United States, when you enter into that model, the medical model now sees you as doing something irresponsible.

Britta Bushnell: Right?

Dr. Aviva Romm: And you can become polarized by that model and by that system. And so what we see happen sometimes is women who are having a home birth, maybe now they're afraid to go to the hospital, or the midwife is afraid to transfer to the hospital when something's going just a little off, and maybe people stay home a little longer, rather than this seamlessly welcoming model — where in the UK they used to have, I don't know if they still do, these kind of ambulance services called the Flying Squad, or the Flying Mobile, dedicated to going to a home birth. If the mom was in labor and needed something that could be done at home, they would do it at home. If not, they would transfer her to the hospital — no judgment, no disrespect. The midwife then came and was part of the birth experience.

So that seamless integration, I think, just on a very strict medical level, reduces so many risks and complications. The other thing is your opening dialogue and your opening conversation with people who have very different backgrounds, very different experiences. There's a lot to learn from each other. There are also times when an OB could lean into a midwife to help facilitate a birth that's maybe going a little slow. And then times when a midwife might need to access something that she can only get through a licensed medical provider — a family doctor who does obstetrics, or an obstetrician. So when those conversations aren't happening, both sides really suffer terribly, and who really suffers is the mom. But also, the care providers have such an extreme level of stress in maternal health, and that translates through the birth experience for everyone.

So I think there's so much we could learn from each other, and there's a tremendous amount that the obstetrics model could learn from midwives that would improve maternal health so dramatically. You mentioned the word wellness — one of the big things that we're seeing in the U.S. right now is almost an epidemic of birth trauma. We know that as many as seven to 15% of women who have given birth in the United States report some level of birth trauma, and a substantial portion of those would actually qualify for a diagnosis of PTSD based on their birth experience. And it's not that they had a C-section, it's not that they were induced, it's not that the baby had something going on — it's how the mother was treated or not treated, integrated or not integrated, respected or not respected, touched kindly or touched unkindly, talked to respectfully or not talked to at all, or talked to disrespectfully, included or excluded. All of this is what seems to be driving that trauma, and it's not things that midwives usually do. Midwives are the solution to that.

Britta Bushnell: It's interesting that we're talking about midwives and the — Western, or the industrial medical complex form of care — conventional obstetrical care — and yet you in yourself bridge those.

Dr. Aviva Romm: Yeah, I say that I'm a midwife who happens to be trained as a doctor. Really, being a midwife informs everything I do — not just how I work with pregnant people, postpartum women, but every woman. And that is literally just the definition of midwife: "with woman." It's really putting the woman at the center of the experience — not your legal concerns, not your fears and worries, not your ego, not your medical degree, not hospital policy. It's putting the woman, her needs, her preferences, and her unique situation at the center of everything. And so, for me, everything ripples from that, in every single thing that I do, even in terms of protocols and the ways that I practice — even when I was practicing in the hospital attending births, and I don't like saying "delivering babies," I don't like saying "catching babies," I say I receive the baby, the mom is the one birthing the baby. But even when I was doing that work in hospital, quote-unquote "delivering babies," I still worked on that midwifery model of care. And even from an intervention perspective, one of the things we know is that yes, we need C-sections, we need inductions, we need fetal monitors, we need all the things. It's the frequency and the routineness with which they're done, sort of the knee-jerk reaction with which they're done, rather than looking at the actual individual person. And we also know that there is a domino effect, an escalating level of interventions that often happens when we're using those technologies prematurely or unnecessarily.

So I try to — I think fundamentally we need a bridge. We need this system to become seamless. So maybe what my experience has to offer, what I've seen, and what I do can be part of that bridge. But in my own work, whether it's through education — I run an online group and program called Mama Pathway — whether it's through my work with Every Mother Counts, whether it's speaking to the House of Representatives over a luncheon at the House in Georgia, talking to them about the maternal crisis that we have there — that's all the different ways that it plays out in real life. And, you know, I just turned 60, Britta, and now I'm looking for the next way that I expand and carry that forward as sort of my primary focus in a way. Not that I'm not going to keep practicing medicine, and my next book is on menopause, but really, shining a light on birth trauma is perhaps one of the most important ways that I can do that, because one, it's really highlighting what's wrong with the model — again, it's not the things, it's how the things are done, it's how the mom is not centered within those things and the family. So it's about helping moms and families to heal from their own birth trauma experiences, but then using those stories to help illustrate for the medical model what really needs to change.

Power, Privilege, and Provider Dynamics

Britta Bushnell: Oh, I love that, and especially coming with your diverse and integrated background to be able to speak to fellow doctors puts you in a pretty unique spot.

Dr. Aviva Romm: It's huge, you know. I was attending the birth of a dear friend some years ago — she was also a celebrity friend — and she had asked me to come and be with her as her doula and friend, and she was in a private hospital. It was right after Christmas, almost nobody was there. She had the full attention of the OB and the staff. And at one point, mama got up out of the bed to go pee — she had a fetal monitor on. When she got up to pee, the monitor was picking up her heartbeat instead of the baby's. So the monitor was reading a rate of about 80 rather than the 130, 140 it had been at. We told the nurse she was getting up to go pee — "I'm telling you, she is on the toilet" — and the OB, who I'm guessing was 20 years older than I am, comes running in the room like a bat out of hell — "We need to get this baby born right now" — and I'm like, "Oh my gosh, what is going on?" And he — the heart tones are — I said, "She's on the toilet, let's get her back into the bed and get the monitor back on the baby, and if we need to get her on her side, we can do that." Of course, immediately she's on the bed, we replace the monitor, and the baby's fine.

And then subsequently she was pushing, and he told her — he said he never does episiotomies, this is just a few years ago — "I never do it, but I hardly ever do it" — episiotomy — and the baby is starting to crown. No sooner does that baby start to stretch mom's perineum than he's got the scissors. And I said, "She really doesn't want an episiotomy." He said, "I think she really needs one." I said, "How about we just give her one more breath and a push and see." And of course, the baby's born over an intact perineum after the next push. But here's the thing: he was a Yale-trained OB/GYN, I'm a Yale-trained doctor. I don't think as a doula I could have done that. I don't think as a home birth midwife coming in with a transport I could have done that, because the respect wouldn't have been there — there would have been a perceived power differential. And I didn't have the perceived power differential, because I'm like, "You're going to play that game, I'm going to play that game right back at you, Mr. Yale-trained." And it all worked out beautifully.

Britta Bushnell: I've experienced that firsthand myself. I'm sure — and if we had a system where there was equality and seamless respect... ideally, nobody would be freaking out when they saw a mom off the monitor, right, at that level. But we could have a very different system, and nobody having to one-up the other, or do their little showmanship game.

I'm — you're making me reflect on a labor I was at many years ago that was with an OB in a hospital, and this mom — I think she pushed for six and a half hours — and the nurses were getting antsy, but the OB was really calm and relaxed about it, and that's a —

Dr. Aviva Romm: — long time.

Britta Bushnell: — was, yeah, it's a long time. And she was checking in with the mom, and the mom was doing great, and checking in on the baby, and the baby was doing fine. Every now and then the baby's variable heart rate would go a little flat, and the OB would go in there and kind of tickle the baby's head, and the baby would — and they'd say, "Fine, baby's fine, baby's fine." And so they just kept going. And I witnessed that, and the power that that OB had to be able to help this mom have a vaginal birth, no episiotomy, no — it was really warm, wonderful, lovely birth.

Dr. Aviva Romm: I want to know why she was pushing for six and a half hours, because that's highly unlikely, atypical. And so usually that only happens when somebody tells somebody to start pushing before they're fully dilated.

Britta Bushnell: That's a very good thing to comment on. Yes, I mean, there are other aspects to what was happening, but I'm using this as one example, because the other thing was being in a hospital with a midwife and having somebody push, and the inability for that provider to be able to say, "Everything is fine, we're doing okay," and have it be respected in the same way that it was at that other birth. There were aspects of them that were kind of similar, but they were treated so differently because of a power dynamic.

Dr. Aviva Romm: What's also interesting too is there's so much wrong with the obstetric model in how it pathologizes normal physiology, and in pathologizing the normal, it creates pathology. At the same time, the obstetricians themselves are under just terrible pressure to have perfect outcomes all the time. When I was in my OB training, one of the adages is: the only C-section you get sued for is the one you didn't do. They're terrified not to have the fetal monitor on, because that is the only thing in a lawsuit that's going to demonstrate baby was still okay until baby wasn't okay. And similarly, they all want fetal scalp pH, because that's another way to demonstrate — so all these interventions that are baked into a very legalized and —

Britta Bushnell: — litigious. Yeah, say —

Dr. Aviva Romm: — litigious society situation. Yes. And so there's so many layers of complexity that happen.

Britta Bushnell: It actually makes me tender for OBs, because it isn't — nobody is operating within a vacuum of entirely self-directed behavior. There's pressures and energies. I borrow the term from my former mentor Clarissa Pinkola Estés — the overculture — that energy of what presses down on us, and not equally — it presses down harder on some people than on others, depending on your intersections of privilege. And yet for OBs, even with a lot of intersecting levels of privilege, there is still fear and pressure.

Dr. Aviva Romm: There's a lot of fear. Yes.

Naming Wellness: What It Actually Means

Britta Bushnell: Yeah, and so even trying to do the best that we can in whatever role we're in, there is an energy of "am I doing this right" that shows up — which I kind of want to use that as a pivot to talk about wellness.

Dr. Aviva Romm: Let's do it.

Britta Bushnell: Because I do think there's intersecting understanding about wellness too. I spoke about in the intro a little bit about how it's become a buzzword and a challenge to even ground what that means, and in the sphere of prenatal, postnatal, and early parenthood, it's talked about in a lot of different ways. What is your take on wellness? How do you define it, and how do you help people locate it?

Dr. Aviva Romm: I'm going to clear my throat first before I answer — some pollen that is getting to me right now. Okay, so when you were talking about wellness early on in our chat, in the intro, I had two thoughts that almost define the problems with wellness for me. One of those is commercialization, commodification, and the other is this culture in which we are a never-ending self-improvement project. And I think if we can just look at the term "wellness" to be "well" — and I believe the etymology, if we go further back, is "wholeness." Wholeness and wellness kind of intersect with each other as etymologic terms and as maybe definitions and goals. But then we look at the problems that we're seeing in the way wellness is presented, and that is generally — or has been — interpreted as high-priced, often-white-women crystals and yoni eggs and spa retreats and very shishy self-care —

Britta Bushnell: The potions and lotions.

Dr. Aviva Romm: — but also this constant drive to perfect and be better, as if we're never already good enough.

Britta Bushnell: I almost feel like we need to take a breath on that one, because I think that was pretty profound and sad.

Dr. Aviva Romm: Yeah, we are never good enough. And I would tack on to that that even though it's not necessarily overtly white women or overtly a certain body type, the tacit messaging under it is still white, thin, blonde, tall, pretty, wealthy, resourced, privileged, and that taints it a lot. And if we can step back from all of that veneer and reclaim the word, reclaim just being well — what does that mean for each of us personally and individually? What does it mean for us collectively? Because the whole is made of the sum of the parts. We can't individually be fully well if our society's not, and society can't be well if the individuals aren't — at a literal level. If people are in poverty, people are struggling, if people are disenfranchised, that leads to all kinds of escalating social problems. If people are depressed, if people are isolated, that leads to escalating social problems. So to me it's like: what does it mean to you to be well? What does it mean to me to be well? What does it mean for a community, a family, a society? And it's just unfortunate when words get co-opted by a movement or a meme, and then we lose the essence of it. And then when you talk about it, you sound like you're part of it, or you're ridiculous. And then add MAHA to it, and it's a whole other conversation of wellness now deeply entwined with a politics that is not about most people being well, and certainly not about most women being well, in my opinion.

Britta Bushnell: Yeah, yeah. Well, I concur with that.

Dr. Aviva Romm: There are complexities there — in the origins of MAHA, it was not created for wellness. It was created to bring a certain demographic of people with certain beliefs into a specific political party. This is well documented, I have those documents. I was invited to be part of that movement — it's not my movement, it's not my political orientation. I don't judge what anyone's is, but that also conflates the conversation around wellness, or nutrition, or herbal medicine, or any of the things that we might talk about.

The "Wellness Bullshit Sandwich" and Disenfranchisement from Medicine

Britta Bushnell: Yeah. So, in your work — first of all, thank you for outlining all of that and bringing it out, because I think these are the conversations we need to be having. I want to be peeling back the layers on where this idea of striving for a particular vision or version of wellness is coming from.

Dr. Aviva Romm: Well, we live in a culture that is very chronically diseased. Half of Americans struggle with cardiometabolic issues, or diabetes — the number of autoimmune conditions that plague women, I mean, the list is long — and we naturally want to be healthy, we naturally want to be well, and we're not necessarily getting that information from our healthcare providers, if we can even access healthcare. So where are we getting it from? We're getting it from people who are speaking — sort of "against the man," as we were in the 60s, the 70s — people who are disenfranchised and dissatisfied with the medical model, offering people another way, and that's very appealing in a culture where people are a little bit tired of experts and all the insulting, dismissive behaviors that also don't provide us with information beyond, "Oh, it must just be stress. Oh, you should exercise more. Oh, you should eat better." But nothing beyond that. So this other way is very appealing, and the thing is, there are lots of kernels of truth within it. Eating better is important for our health. Resting more is important for our health. Reducing stress is important. All these things are true. It just becomes problematic when — in medicine, we call it a bullshit sandwich, when there's a truth, a lie, and a truth — a fact, misinformation, and a fact — so you're kind of biting into the whole thing at the same time, and getting that little bit of truth that gets you to swallow the misinformation. And often the misinformation is what gets you to buy the product that may not be accurate, that you may not really need, or gets you to not buy the medical test and the medical therapy that you really do need.

Britta Bushnell: We see that a lot in the field of birth and postpartum, I think, in part because there's a lot of vulnerability and desire to do well, a deep, deep caring — because it feels so important, there is almost extra susceptibility to those shit sandwiches. And it's not because pregnant people and women are somehow stupid — no, it's because we care so much that we're looking ravenously for something to eat.

Dr. Aviva Romm: There's just such a huge vacuum. There was an episode of The Pit — that show that most everyone's heard of or seen by now — a really devastating episode of a woman who was trying to have a home birth, and she decided to have her birth independently of anyone being there other than her partner. Things went very, very, very wrong. And then there was another episode where a woman came in all yellow, and I said to my husband within two seconds, "They're gonna blame it on turmeric." And they're trying to figure it out, and finally one of the residents said, "Oh, the idiot, she's taking turmeric or something," really pejoratively — and it missed the whole point that people are going outside of the system because they're disenfranchised by, or scared of, the system, or had a bad experience in the system, or heard misinformation even about the system — again, a truth and a misinformation. Because the fact is — and this is very scary — we are one of the only Western countries in the world with an escalating maternal mortality rate. It's not good. So when a woman hears that, and she's being talked down to by her OB/GYN, where does she go? What does she do? And she does feel vulnerable, and it's really easy to go through the other open doorway. So we need two things: that the open doorways are excellent open doorways with great people on the other side or holding the door open, and we need to heal this medical system so it doesn't disenfranchise completely, so that when people do need it, they can get it. Because not everyone's a candidate for a home birth, and not every medical condition that comes up in pregnancy can be treated with "change your diet, get some more exercise, and take some herbs." Sometimes we do need the diabetes medication, or the blood pressure medication, or the induction.

Britta Bushnell: Yes, absolutely, and that's why —

Dr. Aviva Romm: — I went to medical school, Britta. There are so many wonderful home birth midwives, so many wonderful healthcare practitioners offering great things out of the system. But when that woman has to go into the system, when she's scared, when she's vulnerable, when she's tried to do something outside of the system and now has to enter the system, and the system is judging her — I wanted to be able to be on the other side of that door, and I also wanted to have the credential that the system recognized, in order to be able to change the system.

Britta Bushnell: I love that. And as you're speaking about it, I'm looking at the reflection of the ampersand sign behind my shoulder, which is representative to me of that idea — that there are such amazing benefits to out-of-hospital, well-organized, planned out-of-hospital birth, and the tools and what's available in a respectful medical environment or hospital. There's space for both.

Dr. Aviva Romm: I think I'm going to have to get an ampersand.

Britta Bushnell: Get an ampersand. And the importance throughout — I feel like there's this through line, as you're speaking, that is about respect. That wellness is not just personal, it's collective. That how we are treated matters. That it's not just what you put into your mouth, but what you hear and goes into your ears, and how your body feels treated — all of these are part of wellness.

The Weight Carried by Mothers, and Reclaiming "Natural Birth"

Dr. Aviva Romm: Yeah, and let's get our hands in here — for good, healthy food, being able to have the time to prepare it. Half of households in the U.S. are single-mom households — moms doing it alone. How do we support moms in creating wellness for themselves and their children when they barely have a minute? I grew up with a single mom, and I know what it took for her to make lunches the night before.

Britta Bushnell: Me too.

Dr. Aviva Romm: And what it took for her to get dinner on the table, and what it meant for her to have access to a TV dinner or a fast-food dinner just to give her a breather and a break. So how do we create communities? Wellness is a big thing, but I think there are some terms — I sometimes bristle at the pushback that has come around the term "natural birth."

Britta Bushnell: Oh, tell me more about that.

Dr. Aviva Romm: I feel like — so 34% of births in the United States happen via cesarean, and a percentage of those are actually medically necessary. World Health Organization statistics state that if you were to normalize C-section rates — not overly done, but also not underdone, because lack of access to C-sections sometimes makes rates too low in places — we'd really land at about 17%. So we're at double the rate of what the WHO says cesarean sections should ideally be, over which there become diminishing returns of health for mom and baby.

Britta Bushnell: And under which —

Dr. Aviva Romm: We also have problems, yes. And we don't have much of an under-which problem in the United States.

Britta Bushnell: No, we don't, in the —

Dr. Aviva Romm: — in certain pockets, as we talked about, but in general we have an over. So when I talk about how do we prevent unnecessary cesareans, I have to be extremely thoughtful and careful, because I get pushback often — "Mine was necessary, you're talking about someone else." And it's literally never about judgment. I first-assist at C-sections, I think they're really important — it's partly why I went to medical school, did my residency in family medicine with obstetrics — but how do we talk about it so that we're also acknowledging not all of these are necessary? Half of them are probably not. What are we going to do to identify and reduce that problem?

The term "natural birth" for decades has really meant an unmedicated birth where baby is born physiologically. But that tension between the high C-section rate and the normalization of C-section as also another form of "natural" has created this backlash around the term "natural," as if there's some value judgment or —

Britta Bushnell: — hierarchy judgment.

Dr. Aviva Romm: Yeah, as opposed to — this is, whenever possible, healthier for mom and baby, it's a descriptive term — that's now been replaced by "physiologic birth." Like, if we don't say "physiologic birth," we're sort of being judgmental. And I really wish we could reclaim or find a new term that didn't sound also so medicalized. "Physiologic birth" — what does that really mean? I mean, I know what it means — it means birth happening the way the body was originally meant for it to happen. And for some women that's not going to happen, for many, many reasons, and their natural way of birth will need to be a cesarean, right? But the sort of rabid pushback — "we can't say natural birth" — feels a little bit like the wellness word — "we can't say it" — and I wish there was a way to address that more meaningfully, to unhook it. Do you know what I mean by that?

Britta Bushnell: I do. I think the term "natural birth" has gotten to a point where it's become kind of meaningless — it doesn't mean you can't use it in one way and have people understand what it is that you're talking about. I do also like to use the terminology "surgical birth" or "cesarean birth," because I do still see it as birth. There are 34% of people walking around on the streets of the US right now who were born that way.

Dr. Aviva Romm: And mamas should feel really good about it. Mamas should feel so good about allowing that to happen with their bodies — it's like the ultimate — moms will do anything to get our babies born healthy, and we really need to honor that.

Britta Bushnell: Yeah, and at the same time —

Dr. Aviva Romm: — not sort of make it sound like wanting to have a vaginal, unmedicated birth is sort of up there with wellness as some shishy, ridiculous aspiration.

Autonomy and Choice

Britta Bushnell: Yeah, I think for me a huge piece of wellness is autonomy. That feels really important — the ability, the privilege, the access to be able to make choices that feel aligned with my values and my hopes and dreams and wants — including, and I sometimes get some pushback where if somebody chooses an elective cesarean, I want to celebrate that for them.

Dr. Aviva Romm: A hundred percent. And some people are like —

Britta Bushnell: "Wait, what? What are you talking about?"

Dr. Aviva Romm: Yes, all the choices are ours, and we get to make those, hopefully, if we have access to that — based on best education, our best needs, all the circumstances — and if we could just stop polarizing all of these things: polarizing wellness, polarizing difficulties of birth, polarizing home versus hospital —

Britta Bushnell: Yes, as a hierarchy — I mean, I have been present at what I would call traumatic home births, and I have been present at magical hospital births.

Dr. Aviva Romm: Absolutely the same. I've had moms who have come to me over the years who had a traumatic home birth with a midwife — usually something like they needed to transport to the hospital and the midwife didn't go with them, just put them in a car with their partner and sent them, or even being misspoken to or getting wrong information. It can happen anywhere, but it's disproportionately large in the medical model.

Britta Bushnell: Right, and I think it's really an important piece to really prioritize that place of choice and autonomy in our society. And I look at somebody who is making choices about their journey, and I want to get curious about what those choices are about for that person, because I'm not that person, and so my ideas, my values, my choices that I would make for myself actually do not matter.

Ultra-Processed Foods, Weathering, and Intersectionality

Dr. Aviva Romm: A hundred percent. And when you're talking about autonomy and choice, we have to have choices to exert autonomy over. Having choice, having freedom — those are a whole other level of wellness. Not everybody even has those choices. So for me, cultural, social wellness is about making sure that everyone has fair access to choices. And I don't want to minimize — I don't want the conversation about wellness to negate some of the things that wellness talks about, like a healthy, plant-forward diet. The whole conversation around ultra-processed foods has gotten so maligned and politicized and complicated, but when you actually look at the literature, the medical research, we do know that ultra-processed foods contribute to much higher rates of metabolic syndrome, diabetes, heart disease, inflammation. So how can we have these meaningful conversations without them sounding exclusive or judgmental?

We know that — even when we talk about the impacts of weathering and intersectionality — so much of the impact of what's happening, particularly for Black and Brown women in this culture around hypertension, preeclampsia, postpartum depression, all the things — those happen at any socioeconomic level. A woman with a PhD and an MD who happens to be Black, living in Beverly Hills, still has a higher maternal mortality risk than a woman who graduated from high school where I live in Berkshire, Massachusetts. And that has to do with what you were talking about earlier — the overculture, the cultural forces that are literally and physiologically bearing down on people through the form of cortisol, and that can affect our blood pressure, our mood, our immune system, all of those things. And then I'll read an article in the New York Times — "we don't know why hypertension is on the rise in pregnant women" — and I'm like, well, let's look at all the factors that are already well-established that contribute, and who that's happening to, and change that.

Britta Bushnell: Yes. Oh, yeah — so many good pieces here, and how important it is to be thinking about wellness in this broader spectrum, and taking the conversation out of just talking about herbs. Not that herbs aren't an important part of the conversation.

Dr. Aviva Romm: No, it's all a part of it.

Britta Bushnell: It's all a part of it — and just broadening it to talking about socioeconomic and racial inequities and injustices, and really looking at it and teasing some of that apart, and checking in, and also looking at choice — it all feels really important.

Climate Anxiety and Protecting Personal Wellness

Dr. Aviva Romm: And on a personal level, we can do the things too, right? There's a new term I just heard, which was astonishing to me — "climate anxiety." Mamas who are pregnant, who have little kids, worried about the fires, worried about what does this mean, worried about the drugs — what does this mean for me, what does this mean for my child now, what does this mean for my child in a few decades. Economic anxiety. There's so many things that are part of that overculture now that are bearing down on mamas. And how can we insulate ourselves — not detach ourselves, not say we're not caring, we're not doing — but make sure that we are protecting our own individual wellness, our own meditation, our own time in nature, our own time to cook and eat healthy food, our own time, our own joy — to connect with our friends and family and do the things that we love.

Britta Bushnell: Yeah, absolutely. I'm seeing these conversations — both the anxiety you speak of — among family members, among the people that I work with, and frankly, within my own psyche. I refer to my nervous system as pretty porous, meaning that what I take in impacts me. And as somebody who is porous, I have to be very intentional about where and what I take in.

Keeping Your Shield Spinning: Semi-Permeable Membranes

Dr. Aviva Romm: My midwife mentor was Mama Saran, but I had another midwife mentor as well — she's passed away now, her name was Jeannine Parvati Baker.

Britta Bushnell: I have books of hers on my shelf, right down here.

Dr. Aviva Romm: I went and studied with Jeannine and lived out in Utah with her for a while, and we became very close friends. She always stayed a mentor to me in many ways, and she used to say, "Keep your shield spinning" — this image of an Amazon woman, with a shield and a sword, a spear — she would say, "Keep your shield spinning," and I always had this image of like Wonder Woman with her bracelets.

Britta Bushnell: Yeah, you and I are of the same generation, so I know exactly those images.

Dr. Aviva Romm: And then she used to talk about learning to become a "semi-permeable membrane" — so not so porous, but semi-permeable, which are actual membranes around cells, they have docking points, if you will, receptors that allow external things — whether it's hormones or chemicals or nutrients — to enter the cell, immune factors to enter the cell, but it's very selective. It has to be the right key for the right lock, for things to open up, instead of everything just kind of coming in like a sponge.

Britta Bushnell: Right, where it's important to not block everything out in a head-in-the-sand kind of way, but to be self-aware about what is working and not working for your system, and nourishing in ways that make things joyous. I am currently going through a big giant life upheaval in my household that is really challenging, and I haven't spoken about it much publicly.

Dr. Aviva Romm: Do you want to talk about it more?

Britta Bushnell: Well, it's not just mine to talk about, so I can only talk about it kind of in rough sketches. But it's brought — it's like the universe is going, "Here, we're going to test you," and it feels a little bit familiar in the texture of postpartum — that place of, "Oh, I am extra tender, I need to be paying extra attention to what I'm ingesting in a new kind of way." Even what I've always done is kind of pay attention to what negativity comes in — that filter — but now I'm also doing active engagement for joy.

Dr. Aviva Romm: Beautiful.

Britta Bushnell: You know, like, how do I actually fill my joy cup? If I happen to be absolutely obsessed with heated rivalry and it's giving me joy — great, I'm all for it. It's not just filtering out, but allowing in. And when you talked about that semi-permeable membrane, that's kind of the image that started popping into my mind.

Taking a Break from the News

Dr. Aviva Romm: I hear from a lot of women who feel guilty not following the news all the time — like taking a break, they feel bad, like somehow they're demonstrating they don't care, or they're not socially involved, or they're tuning other people's suffering out. And I try to remind people that there was a day and time — I'm sure you remember this — where you got your newspaper in the morning, read your newspaper, and then maybe saw the 6 o'clock news, or if you stayed up late, maybe the 11. Most people had that morning knowing of what's going on in the world, what you need to know, and it wasn't as 3D technicolor as it is now. But even more importantly, there was an intentional manufacture of a disturbing 24-hour news cycle. This wasn't an accident — this feeds the media machine. This is not conspiratorial, this is economic reality. So when somebody says to me, "I'm overwhelmed by this," I say, "How about checking it once a day? Check it in the morning, not in the evening when you're eating dinner, not at the end of the day — unless checking it in the morning is going to set your day off, maybe check it at 3 o'clock in the afternoon when you're jonesing for something to do, or you want that chocolate — the news will give you a little stimulation, and you have your chocolate, and you have that moment to take in what's going on in the world." It's distressing, and it's intended to be distressing. And when I remind women of that, they're like, "Oh right, I'm not shutting the world out by checking once a day." I'm even at a point where my husband is an avid news reader — he was a history and geography teacher — and I'm like, "Babe, if there's something going on in the world that I need to know, can you please let me know, because I don't want to have to read the news every day," and he loves reading the news every day. So if there's something big, that's another thing people can do — take turns, share what you need to know.

Britta Bushnell: Yeah, that's the old grapevine — "have you heard?"

What Gives Hope

Britta Bushnell: So, in light of that, and you just spoke about how so many in this phase of life are in that place of climate anxiety — what gives you hope for women's health and family health and wellbeing?

Dr. Aviva Romm: Conversations like this. Remembering that for all the bad news, there's more good news, we're just not hearing about it. For all the people who are making a mess of things, there are that many more people working towards solutions. And even though we have a lot of crises going on, there are many things that I feel we are able to talk about and approach and address more openly now than, say, 10 years ago, 20 years ago, 30. I think about my mom — she became a single mom in 1970, but women couldn't have their own credit card until 1974. I think, how did she actually pay the bills? Mostly because people paid by cash and check on things back then. I had that same thought recently.

Britta Bushnell: Yeah, I had the same thought. My mom became a single mom in '73, and I was like, wait, how did she do that? How did she buy a house? There are things that are very different than they were in 1950, or 1960, or 1970. There's still a lot of problems, but overall, I see the people doing the good work — the people like us who are doing it in little ways, the people who are doing it in very big ways — and that gives me hope. And I also have hope for the planet. I think nature — I've seen enough over my 60 years to know that there's infinite wisdom and deeper wisdom. I read a definition of hope recently, actually from Jane Goodall — she has a book on hope, and she talked about hope being different than faith. Hope is your belief that things can get better, with action behind it. Because if you didn't believe it, you wouldn't put the action behind it. So hope is optimism married with action.

Dr. Aviva Romm: Action, and that to me is what I believe in.

Britta Bushnell: Yeah, which I actually think is a beautiful thing to bring into conversations about birth and parenthood as well, because faith has a different kind of blind quality to it, and hope involves action.

Dr. Aviva Romm: Yeah, faith can be really beautiful, and I sometimes really admire people who have a religious conviction and a religious community, and they're doing it lightly and beautifully, in all the good ways — there's always that something bigger and higher than yourself to lean into, that feels like that blanket. So I do admire that, but it is also different than hope. For me, I lean into nature and relationship and art and beauty for that inspiration — that bigger sense of something bigger than myself is always, for me, nature — that gives me that restored faith, if you will.

Britta Bushnell: Yeah, I also sometimes think of faith as something that happens in the body, and hope is often something that's more in action and thinking — like, "I'm engaged with it." A deep faith is like a knowingness that feels integrated into the —

Dr. Aviva Romm: — cells, in a different kind. Does that feel true to you on that?

Britta Bushnell: Yeah.

Closing: Where to Find Aviva, and the Closing Question

Britta Bushnell: Okay, so we have to start wrapping up. I want to hear — where do people find more of you, your work, your podcast, your books?

Dr. Aviva Romm: So, Instagram — I'm there answering my comments.

Britta Bushnell: And what's your handle over there?

Dr. Aviva Romm: Dr. Aviva — Dr. Aviva Romm. D-R-A-V-I-V-A-R-O-M-M. That's me, Dr. Aviva Romm. My website — there's tons of free information. There are courses, if you are pregnant or postpartum — there's the Mama Pathway, which is an amazing online experience and community with a support group with me that I run and host and join in. And yeah, those are the biggest ways.

Britta Bushnell: And you also have a podcast.

Dr. Aviva Romm: I do have a podcast. We've been on a hiatus due to a family situation we went through last year — we had a loss in our family, and at that moment, I needed to put — you know, when you were saying, Britta, that you're going through these big changes and it feels tender, and you need to be more tender with yourself, it's like postpartum. My perimenopause, my menopause transition was actually quite easy, but we went through a family loss and trauma last year, and it really took me back. I was also in late menopause, and it deeply affected my sleep. And I needed to give myself grace and say, "I don't have the resources internally to do all of this at once and show up for it," and so I put a few things on pause. Plus I was working on the book, and I needed to make some choices. So the podcast has been on hold, but all the hundreds of episodes are live and they're amazing — it's called On Health for Women, and we will be going live again with that by January of 2027.

Britta Bushnell: Yes, I also have put things on pause for those very same reasons, and I think it's important to model that — as you and I are stepping into this phase of life called, I don't know, elderhood, we're coming into that, and sometimes we have to put pause.

Dr. Aviva Romm: Well, and I sent out an email to my list about it, and the subject line was "Sometimes you have to just let it fall apart," and I must have gotten hundreds of responses to that — thank you for sharing your real life, for putting it out there, thank you for not putting a shiny veneer on things, but really saying that it can fall apart, and it's actually okay. It doesn't really fall apart — it can feel like we're falling, like it's falling apart, because we're so used to holding all the balls that when we put one down it's like, "Ooh, we're failing, we're not doing it." But it was really about just, again, that inner knowing, that listening, touching into that wise woman, and being honest with myself about what I could and couldn't joyfully hold. It wasn't that I couldn't do it — I could have kept pushing — but it didn't feel good anymore. And that's something I think with postpartum, and hopefully we honor — even late pregnancy, any time — that our bandwidth is a little different. As Mama Saran used to say, "You're under construction 24/7" — when you're pregnant, you're building a baby, a human, when you're breastfeeding. We have big emotions, big hormone changes, big feelings. And in menopause, again, perimenopause and menopause — these are powerful inflection points where I think it becomes even more necessary to honor what our actual capacity is, and to honor our right to feel good and well — back to wellness — in what we're doing, and not always push past where we're not feeling that way anymore.

Britta Bushnell: I love that. I love that. I love that, and it almost feels like the answer to my usual last question. But I'm gonna ask you my usual last question, and if you're like, "Yeah, that answer worked for that," okay, we'll just go with it. Which is: what's one thing you feel passionately about that you want new or expectant parents to see, hear, feel, or know during this profound period of their lives?

Dr. Aviva Romm: Ooh — I need to just have one second with that one.

Britta Bushnell: Yeah, please do that.

Dr. Aviva Romm: Okay, I am gonna go with: finding the balance and the inner truth of at once being powerful and autonomous, and having profound agency and doing it yourself, and embracing and welcoming and asking for and accepting help and support. There is absolutely no failure in accepting help and support. In fact, it's probably one of the best things we can do for our overall wellness — is to connect when we need it.

Britta Bushnell: Amen. Or as Clarissa Pinkola Estés says, "and a little woman to that." Thank you so much for joining me. I really appreciate you being here and sharing your wisdom with us. And thank you, listeners, for sharing this time with us. If something shared today impacted, supported, or moved you, please share this episode with a friend. I produce this podcast myself, and your support makes it possible. To show a little love for the podcast and these conversations, please follow, rate, and review. If you'd like to continue the conversation, please join us on Instagram at Transformed by Birth. I look forward to being with you again on the next episode of Transformed by Birth. Now let's gather what we want to take away from this episode with an inhale, and with our exhale, I'll blow out our candle. Until next time, bye, friends.