You Don’t Need Permission: Birth Advocacy Every Parent Deserves

Introduction and Welcome

Britta: 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 all around deep diver with a side of goofball. I'm so glad you're here.

Today's episode tackles the topic of advocacy. So grab your cup of tea or coffee - I've got mint tea in my mug today - or take us along for a walk as we explore navigating rights and choice on your labor journey with HeHe.

Before we begin, we start the way we always do, by lighting a candle. Today's candle is for all of you, parents navigating what can be a complex system while in the midst of pregnancy, birth and new parenthood. If you want to join me, please do, or just take a breath as I light mine.

In this podcast, I aim to go beyond just sharing information and into the transformative, life changing aspects of this rite of passage. Today's topic may seem like it lands more on the side of information than transformation, but let me tell you, navigating the medical system around labor, birth and new parenthood is a labyrinthian journey all its own.

Learning how to advocate for yourself or for your partner and your baby are actually part of the rite of passage into parenthood, not separate from it. As parents, advocating for your child is going to be part of your life until your child knows how to advocate for themselves, and they will learn how to do that from you.

But learning to advocate for your child and for yourself is more than the words "just advocate for yourself" imply. That's one of the reasons I am thrilled to have with me today, doula, educator, advocate, activist - all these things - HeHe.

HeHe is a leading childbirth educator and maternity care expert, maternity care reform expert, with a master's in human development and over a decade of experience. She empowers families with evidence-based birth preparation, while advocating for informed consent and patient autonomy in birth - so important.

HeHe is also actively involved in legislative efforts to improve women's health policies and expand access to midwifery care. I love this so much. As host of the Birth Lounge podcast, she interviews leading experts to give parents the knowledge they need to navigate birth and postpartum with confidence. And I was so grateful to get to be on the Birth Lounge podcast with HeHe not that long ago.

Welcome HeHe, thank you for joining me.

HeHe: Thank you so much for having me. It truly is an honor. It's super exciting to be with you.

What Advocacy Means

Britta: So I want to dive right in and talk about advocacy. When reading your bio and what's really important and passionate for you, advocacy comes up kind of shining lights. It really seems critical and important to you. So what does it mean to you to talk about advocating for yourself, your baby and your rights in birth?

HeHe: It means finding your voice. It means being able to stand strong and solid and confident in the things that are important to you. I think that this world and this society and the systems that we have in place, particularly in the US, have this way of making us as humans, specifically women, feel as if we don't know best - like we don't know our bodies best. We don't know what's best for us in labor, we don't know what's best for our babies.

And I think that the term gaslighting has kind of been overused, and a lot of times it's misplaced and it's not used correctly. But when you get down to the root cause, or the root meaning of the word gaslighting, you can definitely see how our larger industries in our country do gaslight parents and families, again, particularly women, into believing that they need systems. They need validation outside of themselves. They need machines to let them know that their baby is safe in labor. They need to relinquish control to someone outside of themselves in order to seek the right answer, in order to make the right decision.

And so for me, it is so ingrained in who I am to help parents, but specifically women, regain that control over your voice. What's important to you? What do you want? What is your intuition telling you is the right decision? And then, in addition to that, how do we actually achieve that?

So what are the questions you're asking the provider? How do you say no and decline something that is not aligned to you? How do you say, "I would like to request extra labs. I would like to request a referral. I would like to have a deeper discussion about this before I make my decision. I would like for the room to be cleared and my partner and I to have 10 minutes to just ground ourselves and think about what our decision is before we choose what we're going to do going forward."

And I think a lot of women want that, but they don't know where to find that information. They don't know where to find that education, and they don't know who is out there to help them be able to find their voice and actually use their voice. So for me, that's what advocacy is.

The Challenge of Learning to Advocate

Britta: Yeah, and so much of what you just shared is really critical and important, because there has been an enculturation, especially those raised in female bodies, to stay quiet. I mean, there's not a lot of practice in what it is that you just described. As you spoke about it, I'm thinking, Holy bejeezbus, how many times have we actually learned not to do that? And so saying, "Okay, now here we go. Let's do this for pregnancy, birth and new parenthood" is tough.

HeHe: Yeah, it's really hard, and it's a skill, right? It's a learned skill. Now, I think it would be a lot easier for us if we were raised in a culture that taught children how to advocate for themselves. But you know, a lot of us - I'm a 90s baby, I was born in '91 - and we were taught that children were seen, not heard. We were taught to say yes ma'am and no sir. We were taught that you wore your nice clothes to the doctor's office because they were an authority figure in your life, right? You sat in class and you didn't raise your hand and you didn't ask questions, and you were supposed to be a good girl.

And so so many of us kind of suffer from this good girl syndrome. And if you go into your birth and your labor experience with the goal of not wanting to be "that patient" or cause trouble, or "I don't want the staff to think I'm difficult. I don't want them to not like me," right? It's so hard because - and I struggle to like I don't know how to say this in an eloquent way, so I just kind of say it - but usually you're the one that pays the price for that, and it typically looks like a traumatic birth for you, because you weren't able to actually stand in your truth, and so the system gobbled you up, which unfortunately is the design of the system.

It's not designed to help you have an autonomous birth. It's not designed to have your providers come in and say, "You know, Britta, what would you like? Here are your options. How do you feel about these things?" Now, some providers do that, but it's on their own accord. It's out of training that they have sought out. It's that they have recognized within themselves, "Man, I don't like to treat women as if I'm the authority over them," but that is different than how they are trained.

The system trains them to come in and be the authority, be dominant, use assertive and assumptive language. If I say this confidently, and I say it in a way that I assume that this person is going to do what I say, then they will do what I say.

And I think it can be really hard to face a provider who says, "All right, well, we need to get you scheduled for a 39-week induction," and you have to find the gumption and the confidence to say, "Actually that doesn't feel good to me. I don't want that." And then that provider comes back and says, "I understand, but this is kind of what we do. It's very standard. We don't allow you to go past your due date, and so we are going to get this on the calendar, so when you check out, just ask them what dates are available." And then again, you have to find that confidence to say, "No, I'm not going to do that."

And that is so scary when you've lived a life of being taught to say, "Okay, I guess that's fine with me" when it's really not.

Beyond Education: Embodying Advocacy

Britta: Yeah, and there's when it's really not, but there is also that ingrained energy of that white coat, or of that indoctrination that says they know best, that works against us. So even if we are educated - and you spoke about 39-week induction, so I'm going to put a pin in that, because we're coming back to that - but even if you have education and information and all of that, there is also the unpacking of that indoctrination that needs to be done that involves practice and embodied work.

So beyond education, what do you think folks need to actually start to embody somebody who can advocate for themselves, in part because they are going to also become advocates for their child? I mean, there is that Mama Bear, that Mama lion, or that parent that comes in and roars in service of their child. But that doesn't always necessarily come in riding in hot on a rocket with parenthood, sometimes it has to be developed. How do you encourage folks to develop that?

HeHe: Well, it's exactly what you're saying. It's a slow burn. It's a skill that you have to practice in order to make it something that is automatic in you. So I think the first place that you would start is anywhere else that you want to learn a new skill, right? Surround yourself with people who can model this for you. Surround yourself with people who are already doing it and you can learn. How do they say things? You can learn, well, how are they so confident in this? You can learn, well, what phrases worked for them?

You know, I think having a mentor or a model, and it doesn't necessarily mean one-on-one. It doesn't have to be anybody that you necessarily pay for. If you're like, "I don't want to add another thing to my plate," you can literally get so much from my Instagram for free or my podcast for free that I don't need a single penny of your money. You don't have to pay for this, if you will just surround yourself by people who are strong advocates and also teaching you the skills.

And then that goes into the second piece of practice, and you're not going to walk into your labor and just feel confident to say no to everything and decline all the things. And so it probably is going to start very small. Maybe you start with something super small, like "I am declining getting undressed today in my prenatal appointment. I feel very confident that I don't want a cervical exam. I'm in my second trimester. I feel good about the data saying that it's not necessary. I don't have any personal risk factors. I have no signs of preterm labor. I know that this cervical exam would not change any of the outcomes and or what I'm going to do next in my pregnancy. I feel good in that. So today, my advocacy for myself is, I'm going to keep my pants on."

And when my doctor comes in and says, "Oh, you're not in the hospital gown, how am I supposed to check your cervix?" That is your chance to practice. And listen, it's really hard. And so you may find that in the first couple times - I mean, you guys, I've been doing this for 10 years, and there are still births that I walk out of and like, "Dang it. I should have said this. Like, I wish I had said..." Like, the woulda, coulda, shouldas are universal.

It's not something that you aim to eliminate. It's about reducing and strengthening the skills so that we have fewer woulda, coulda, shoulda. Well, advocacy is a muscle, right? And so you have to think about it as going to the gym.

So every time you speak up for yourself, if you fumble over your words, that is totally okay. Go out to the car and on your drive home, think about what you wished you had said, practice it. And now the next time that you're in that situation, you'll confidently be able to say it, because you have a canned response. And it's so much easier to kind of dig out a canned response than it is to like fill off the cuff.

And as you do it, that muscle will get stronger, your confidence will get higher. You will feel more informed to speak up for yourself. And therefore, you'll be able to work off the cuff. You'll be able to just pull out phrases because you have practiced this for so long.

But I do want to let you know that, like you know, even 10 years in, you're going to have places where you say, "Wow, that was - I did not do a great job there. I could have done way better than that." And so if you're just now learning this, don't go in with the expectation of "I'm going to be able to advocate perfectly and flawlessly." It is not about that. It is about having grace for yourself.

And let me tell you this, when you do do it well, you are going to walk out with your head held high and your shoulders back, and you're like, "Oh my god, that felt so good. I did it. I said no, I didn't have to take off my pants. I didn't have to have a cervical exam. Like I'm the king of the world. I'm the queen of the world, like I can take on anything." And I want you to hang on to that feeling, because it is really important that you remember like "I can do this. I can do hard things, I can sit in the face of adversity and still advocate for myself safely," right?

And if you find that you're not safe when you advocate for yourself, that's not on you, that doesn't mean that you're not safe or that you're doing anything wrong. It means the person that's receiving that message is not in the same place as you and they don't view advocacy as the same thing as you do. And I highly, highly, highly encourage you to change providers.

Learning About Your Provider

Britta: Yeah, that's important information to receive. That's actually one of the things that I love about the practice of self-advocacy during the pregnancy journey is that you actually learn how your provider, your chosen team, responds to you when you speak up for yourself. And that is important info, right? Because it's like, even as you spoke about the not changing into the gown for a meeting with your provider, like I could feel my own like... right, just even in the part. And I mean, I'm not pregnant, I'm not heading into that right now. But it can be that part of us that is so conditioned to be polite.

And I'm even thinking about the ways that I have practiced when I'm getting my teeth cleaned, like, really! Really. I mean, with a dental hygienist just being able to say "I need to spit," right? "I need to spit" is like, how often might we just sit there going, "I'm gurgly, but I... you know, they know what they're doing. They're the expert. They're the professional."

We are an expert-deferring society where we like to defer power to an expert, and becoming a parent is really about coming in and saying, "Wow, I am now the expert in my child. I am the expert in my body." Now does that mean that we are ignoring people who are specialists in this area, who might have some information that as a first-time parent, I might not have? No. But we are the processor. We are the processor of the information for ourselves.

It just means don't override your gut intuition, because someone with letters behind their name or an authoritative title before their name is telling you something different. You're allowed to have different thoughts than the authority figures in your life, and you're allowed to change your mind, ask for a second opinion, decline, accept, request, delay. Say no, thank you. Change providers.

Approaching Advocacy with Curiosity

Britta: I want to dig in a little bit to that politeness, because when you first come into this journey, you can feel really rude. It can feel really combative, like you're a bad person, or as if you asking questions means or insinuates you don't trust your provider.

HeHe: And I've got two things to say about this. First of all, you're allowed to ask questions, and it is not an indicator of how much you trust or love or believe your provider. It literally is just you getting more information so that you can be more informed. I think that your approach does matter a lot.

Lead with curiosity. "I'm curious what this might change later down the road for me. I'm curious what we would do with this result. I'm curious why we're doing a cervical exam at 24 weeks, when I still have 16 to 18 weeks until I have my baby. I'm curious why this might be standard care. Or what if? What if I decline this? What if I decide that I don't want to do this today? Is it an option later? What if I decide that this isn't the right option for my family? Would you be comfortable still giving me care?"

And the second piece of that is, I think it's easier to practice this kind of stuff outside of the labor room, in your prenatal room, and I'll give you two examples. So I am a girl's girl, and I love to be girly, and so I get regular massages and I get my fingernails done. And you know how when you get your nails done, the nail lady always paints one nail and she holds it up and goes, "Do you like the color?"

So many of us bite our tongue and say, "Yeah, it's great" knowing that you hate that freaking color and you're about to have to wear that color on your fingernails for the next two to four weeks. Take the time to say, "Um, actually, that's not what I thought it would look like. Could I choose another color? I'm so sorry."

It's okay to apologize and say, like, "I'm sorry I feel difficult." Don't say "I'm sorry I'm being difficult." That's a different thing.

Britta: Oh, it's so different.

HeHe: And the thing is, like you're paying these people, you're not being difficult. Also, she asked you, she literally set you up to ask your opinion. And you know why? She wants you to like the work that she's doing for you. She wants that when you walk out of her nail salon, she can have pride knowing that you're satisfied. She wants a happy customer.

Same thing with a massage therapist. I used to get massages, and I like really deep pressure. And I think because of my size, I'm an incredibly short and petite person. I'm very tiny. And I think a lot of people look at me and say, "Oh, well, I should take it easy on her, because she's so small. She's very tiny she must be, like, a little fragile." And people used to ask me, or the therapist used to ask me, "How's the pressure?" And I would say, "Yeah, it's good" knowing like, "Honey, I can barely feel you. I'd rather, like, dig... yeah. Like, jump on me. Come on."

I now will say, "You know, could you go a little harder? Or I'd actually like a little bit more firm pressure or firmer if you could," right? It doesn't have to be long. And I also think that practicing not explaining yourself is really helpful. So you don't... you can do this. You can do this at restaurants too.

Britta: Exactly. Yes, I'm sorry. You have no idea, you guys, how many drinks I send back, because I will read over the drink list, and I'll order a mocktail that I think I will like, and then when it comes out, I'm like, "This is disgusting. I do not like this." And after one sip, I'm like, "I also don't want to pay $16 for this." I'm in Boston, so drinks are incredibly expensive, and it's like, "Can I send this back?" And they never get angry. Your server's not angry. They couldn't care less. You want to know why? They want you to be happy.

It is important to them that their patrons in their restaurants are happy with the service that they receive, and that you're not out in the world saying, "Do not order the butterfly mocktail from this restaurant because it is disgusting." They would rather take it back and take it off your bill, make you happy, and then there's no one out in the world bad-mouthing their restaurant, right?

And so you don't have to wait until you are face to face with your OB-GYN, or your midwife, your nurse practitioner, whoever is giving you care, to advocate for yourself. Start small. You could also do this with your children. Start small by recognizing when your child doesn't want to give high fives or hugs. This is something that we often, very commonly force our children to do. Learn how to advocate for your child in that situation. "Oh, they don't really want to give a hug. Would you like to give a high five little Johnny?" And if little Johnny says no, that's your cue to say, "He just doesn't want to today, but we've really appreciated our time with you. I'll give you a hug."

You can model for little Johnny, like "I feel safe to give this person a hug. Little Johnny may not," or you may find, "Oh, mommy's hugging this person. Okay, I'll give this person a hug." Great, but we want to really practice in small places, and it takes conditioning of our own brain to unlearn that speaking up is not rude.

Your presentation matters, so do watch the tone of your voice. Do be intentional about the words that you use. Do be intentional about your body language. Have your shoulders relaxed. Have open arms. Don't have your arms crossed. Don't come with a scowl on your face. Try not to use blaming language. "Well, I know you want me to take this test because you get paid extra for it," right? That's not what our goal is. Our goal is to say, "What data are we getting from this test, and I'm wondering how that will impact my pregnancy, or the decisions that I'll have to make in labor," right? It's curiosity, not blame.

When Advocacy Feels Combative

Britta: Yeah, that's important. And if what's coming up in the moment is more anger or more blame, that's okay too. You know, they say you catch more flies with honey, right? But it isn't that you still didn't do it wrong. You still... it may be an indicator that that provider is not safe for you, right? So if you're continuously feeling like, "Gosh, I am on the defense every time I leave my prenatals, I am angry, or I feel like I was not heard," that is data for you to say, like, "Wow, I do not like this feeling, and it doesn't seem to be a one-time thing. So I don't think it was hormones or that I had a bad day, or that I didn't sleep well the night before, or that I was nervous. I'm continuously feeling like this. I think there might be a misalignment between me and my provider. I don't actually feel safe like I'm feeling heard when things are brought up."

And that's huge, huge information, and so important to be paying attention. So often if we find ourselves combative, we think we've done it wrong, and we're so quick to self-blame. And I think it's really an important part of this conversation to make sure that we're understanding, "Oh, this is information." If I'm being combative, I'm feeling like I have to fight for something, rather than be in a dialog or a creative dance with my provider for my care. And that's a different piece of information for us.

And it also makes me think when we're talking about advocacy in labor, where there is a very unique hormonal cocktail that is moving through your body in a very particular way that can be really influenced by what's happening, how we are with our providers, what's going on, and it can also influence our ability to advocate for ourselves. So can you unpack that piece a little bit? I know you and I have probably a lot of similar thoughts on this, but can you dive in? What about that aspect?

The Safety Component in Birth

HeHe: Totally. Well, you know, I think something that's really helpful is to make this shift in your mindset that your provider should almost be treated like a sexual partner for you, because there is inherent sexuality and sexual safety that comes with birth. This person is going to, if you consent, have access to your genitals, they may even penetrate your body in a same or similar way as your sexual partner, and so the same way that you know you shouldn't have to ask for sexual safety - I understand and recognize that that's not everyone's situation, but in an ideal world, we would not be having to ask our partner to keep us safe or to not violate us sexually.

It's not too much for you to expect a baseline of safety from your provider, and we shouldn't have to fight for that. You shouldn't have to fight for safety. You shouldn't have to fight to not be violated. And if you're feeling unsafe, you're going to enter that place where your nervous system is either in fight, flight, freeze or fawn, and we know that every single one of those work against us in labor. It turns off our labor. It turns off those hormones. We don't want cortisol in labor. It's the opposite of what we want. When your cortisol is going, your oxytocin is not going. Oxytocin is required for labor. It's required for you to feel loved and safe and grounded. We want endorphins, but when you're so stressed out, or you don't feel safe, or your body is feeling threatened, or your mind or your spirit or your soul or your heart is feeling threatened, you cannot relax.

Not only is that going to turn off your labor, but it's probably going to put your nervous system in a place where you start to retreat and you're not sure. "Am I going to be treated differently if I say no to this? Am I allowed to say no to this? Am I going to be abused if I tell them that I don't want this or that I'm requesting this, right? I'm requesting a new nurse." So "Am I going to get a nurse that's going to come in here and bully me because I just told her friend on the unit that I didn't like the care I was getting from her?"

That's a real thing. There are so many anecdotal stories of people in labor who have said "I did advocate for myself, and the repercussions was that I was abused by my medical care team." And so, you know, now we've circled back to the whole like gaslighting ourselves. "Well, maybe I shouldn't have advocated for myself, or maybe I shouldn't have said that, or maybe I did it wrong. Maybe I shouldn't have done this, or I should have done that differently."

And the truth is like no. When we think about the expectations from our partners that keep us safe in a sexual environment, birth inherently has that same thing, and you have to be able to expect that same safety from your providers.

I once heard a doula friend say, you know, "If you don't feel safe pooping in front of this person, then they probably shouldn't be at your birth." And I think so many of us don't even know our providers well enough to, like, let them in the bathroom with us, much less poop in front of them, right? It's like we see them 12, 15, 18 times throughout pregnancy for 10-minute increments, and then we're all of a sudden supposed to just like, be naked and primal in labor with them, and relax with them and let them penetrate our bodies in the most vulnerable part of our body, and we're supposed to just, like, be okay with it. That doesn't line up.

And so I think for you to be able to really unpack the whole idea of being safe in labor, it really requires you to have a provider that you trust and that you genuinely feel safe with.

Now, that's really hard in the US.

Britta: Because... really hard. I think you gotta talk about that.

Limited Provider Options

HeHe: Yes. Now, when you live in a place that's a healthcare desert, or you live in a really rural place... so I live in Boston now, I didn't always live in Boston. I am a Mississippi bred and raised gal, farm gal. My dad was a cow farmer growing up, and providers were far and few between. So if you didn't like your provider, you couldn't just go across the street, like I can in Boston and get another provider.

And so in our country, it's really hard, especially if you're someone who wants to prioritize midwifery care or birth center care. Sometimes you literally don't have the option, because there's no... Do you know that in Buffalo, New York, there's one midwife, one home birth midwife, that serves that entire area? So not only is that limited access, because, well, she has to charge a living wage, so not everybody's going to be able to afford her. She only has limited capacity on her calendar, because there's only one of her, right? And now you're talking about a community that doesn't even have a backup. So if that midwife can't come to your birth. Now, what do you do? Are you transferring to the hospital, or are you birthing your baby without a medical attendant? You know?

And so we have to think about it's not always an option to change providers for everybody. So then what? And this is where that self advocacy really comes in. But on that same token, on the very opposite side of that same coin, it's like, "I don't like this provider. I don't trust them. They have showed me that they're unsafe, and I don't have anybody else that I can see. And HeHe and Britta told me that I need to stay out of fight or flight. So now what? I'm going in feeling like I have to arm myself because I know this person isn't safe. They don't respect my autonomy. They do not show me the consensual care that I know I deserve and I'm worth, but I'm supposed to stay out of fight or flight."

And that's the ugly reality for a lot of people in the US is like we want so desperately - I think, to reference your book - be in that water. We want to be that free flow and feminine. We want to be the yin to the yang. We want to be nice and flexible. It's not always possible in the systems we have now. Sometimes we have to go in the system with our defenses and our guard up, and we have to be in that masculine because we know that our safety depends on it, and that is so inhibitive of the birth process, and we know that. We know that if we want to birth, we need to be in that flow. We need to be the water, and the people around us are the banks. We don't want to be tapping into that masculine energy. But there are so many times where we literally can't tap out, because we will not be safe, right?

Britta: Absolutely, and that brings in sort of the piece of doulas and partners like this isn't just about you. You aren't the only one always. Now there, as you said, there are times when that's just the reality and the truth and that... [puts hand on heart] It's heartbreaking. It is for me as well. It makes me feel really tender.

And there's so much I find put on the shoulders and the backs of those giving birth as their sole responsibility, and I want to say that sometimes if you've got somebody else, whether it's a friend or a partner or a parent or a professional like a doula, who can come in and be more of that banks for you, that can also be something, even if the provider is not being responsive and respectful, because really it's also about being respectful of you as an autonomous individual, person who has rights and feelings and opinions and the right to choices around what's happening to you and in this very patriarchal medical system that we have that has been teaching us about being good patients rather than successful birthing people. There's a clash in there, right?

So you have been a professional doula for over a decade. Talk to me, because one of the things that comes up often when in circles with doulas and other birth professionals is the conversation around advocacy. So we're talking about advocacy. Let's pull in the professional doula. Talk to me about advocacy and doulas.

The Role of Doulas in Advocacy

HeHe: It's a loaded topic, right in its own right. That's our entire role. Our role is to protect your space, not protect you. And I think that's often conflated. People think "I hired a doula, so I'm going to be immune to these things." That's not how a doula works. What we do do, though, is protect your space.

And so I think that being a doula is a really delicate balance of blending that masculine, of holding those banks while also tapping into that feminine to be, that feminine energy that a lot of birthing people need in their experience. So if we think about what birth used to be like, it was a female-only event. There were only women, midwives, elders in the community, your mom, your family members that were women, people who had come before you in having babies and men were sent off. I mean, even in the US, just a couple of decades ago, men weren't really in the birthing room. They'd take you to the hospital. You'd go in, they'd go golf, they'd go drink, they'd do whatever. And you'd call and say, like, "Hey, your baby's been born," right?

Britta: Right. And cigar in the waiting room phase of fatherhood.

HeHe: Yeah. And I think there's a lot of us - I mean, me being one - I want my husband there with me. I look forward to us unfolding as a couple in the birth space, and so I am glad that we've pulled men in. I also am navigating the space of finding that proper female energy for me, because I know that as much as he wants to, it's impossible for him to be everything for me in labor.

And so I think that that's where a doula really comes in, and you have to be very delicate and intentional about your actions as a doula, as a professional, to say, "I'm going to be the protector of this space. I'm going to hold these banks, but not in an aggressive way, not in a disruptive way, not in a domineering way, but in a feminine way that can hold that space. I am a container for safety. I'm not going to let anybody penetrate that bubble of safety, but you're also safe with me, to roar, to cry, to move however you want. There's no judgment here. I'm not thinking about what you should and shouldn't be doing. I'm simply observing you, and I'm filling in the gaps of where the healthcare system falls short, and giving you suggestions on what may be helpful, but there's no influence there. It's just simply, would a birth ball be helpful right now? Do you think moving to the shower might feel better to you? You look uncomfortable in this position. Would you like to move?"

And you can see how I soften my voice. If you're watching on video, I lean into that birthing person, and I say it very calmly to them. I'm a very touchy feely person. Naturally, I love cuddling. I cuddle with my friends, I cuddle with my husband. I cuddle with my dog. I love to cuddle. I'm just a very tactile sensory human, it gives me energy and it makes me feel loved. I love to be touched, and I love to touch other people, and it's also how I express my love. I'm that person that when they laugh, they're like, slapping your leg, or they're squeezing your arm, and that's how you know, like, "Oh, HeHe's comfortable with me, like she's reached out and touched me."

I am always touching my clients with their consent, and it's something that we talk about beforehand, so I will share with them, like, "I'm a big toucher. How do you receive touch?" And I've had clients that say, like, "I'm not a toucher. It makes me very uncomfortable. I don't hold my husband's hand. I don't hold my wife's hand. We don't cuddle. I am not PDA, like that. Please don't touch me." And then I don't, I really don't. If I need to give them a sacrum press, I will say, "Hey, Jane, I'm wondering if a sacrum press might be helpful, because I see that your back labor is really bad. Are you open to me touching your back?" And then Jane has the option to say, "No, thanks. I really don't want to." "Okay, great. Another option would be to sit in a chair with a flat back, and I can push your knees. How does that feel?" "That feels much better to me." "I can also back you up against a wall, put a tennis ball at your sacrum, and nobody has to touch you. You can use your own body weight to get similar pressure on your lower back." We've got different ways to accommodate different people's preferences.

But I think as a professional, especially in the advocacy realm, it is really important that you know your clients, you know their preferences, you know how they want you to advocate for them, and you know your own capacity. So I find that a lot of doulas - that's the missing piece. They spend all this time. They know their clients, they know exactly what they want. They memorize their birth plan. They could rewrite their birth plan from memory if they needed to, but they failed to recognize, "What's my capacity? What are my triggers? Where will I need work in order to show up for this client in a way that they best receive? And where's my ego in all of that?"

What if that client looks you dead in the eyeballs and says, "I need you to get out of here?" Are you going to take that personally? You shouldn't, right? We all know that birth is just like this energetic thing, and it doesn't mean that your energy is off. Sometimes they just need privacy. Sometimes they just need it to be just them. I have been in so many labor rooms where that birthing person has looked at me and their partner and said, "Everyone out. Get out. I don't need anybody. I don't want anybody." And you're talking about the person they made this baby with, and they're like, "Get out," you know? And we didn't do anything wrong.

Now they have just reached a place hormonally, spiritually, on that labyrinth of that birth journey of they need to go within, and everyone else has to clear their space, and that's okay, but you have got to set your ego aside to know it's not about me as the doula. So it's not about you. Give them a hug, squeeze their hand, say "I love you so much. You're doing an amazing job. Call us when you're ready. I'm going to be right outside the door."

We can't help and support our clients to advocate for themselves with their providers, and not include ourselves totally in that permission. That I want to even say permission is the wrong word, invitation to advocate for yourself with me too. That matters, that's included. It's 100% so, so important.

Being a Doula Without Children

Britta: And I'm thinking, oh, there's so many places I want to go. One of the things I'm thinking about is the fact that you have been a doula for over 10 years, and you are pregnant with your first baby as we talk, and one of the things I often hear is from some parents - really resist utilizing a doula who hasn't themselves journeyed through birth, and yet I know so... I mean some of my favorite doulas actually don't have children themselves. Some of them that I use as backup when I do doula work don't have children themselves.

I'm curious about hearing from you as someone who's been doing this for so long, as someone who doesn't yet have children. What advantages do you see as someone who has been a doula, who doesn't have their own kids yet? We're in the "yet" department of that now.

HeHe: Yeah, we are. So for me, you know, I struggle with this. When I first became a doula, and I thought like, "Who's gonna trust me? I haven't had my own kids, what do I know?" And then I quickly realized that it was my superpower. I was unattached to whatever they chose. What did I know? I didn't know any better. I'd never done this. So like, whatever you want to do, I'll do it. I'm happy to support you in whatever you want.

And then that morphed into regardless of my own experiences, I should support this person and what they want, because you're right. What do you know? You know nothing about this person's life or their journey or their motivations for choosing this. Now, as their doula, you're privy to those conversations. A lot of people feel very comfortable sharing that stuff with you, but you don't know any better than they do. I mean, they know them. They know themselves best. They've lived in their bodies for 35 years. They've been making decisions for 35 years. They've made umpteen mistakes, and have all of those scars to show for it, and that informs how they make decisions, what decisions they make, how they show up for themselves, what triggers them, how they retreat, or they fight, flight, freeze or fawn. All of that informs who they are.

And so when I... as we got closer to having our own children, I actually had this identity shift, and I cried so many tears because I was really excited to have my own children, but I was so scared of what that was going to do to me as a doula. Was I truly going to be able to remain so neutral? And when I say neutral, I mean, I don't think anybody could bring me very much that I would be like, "Wow, I have thoughts about that." Very rarely do I ever think like, "Oh, I don't know if that's the right decision." I'm almost always like, "Okay, cool. You feel good in that. Do you have questions about it? Have you looked over these resources? Do you know about the risk?" And it's not like, "Let me tell you the risk." It's, "Do you know about them?" And if they're like, "Yeah, I feel so good about that" I'm like, "Great!" Or "Do you want to know about them?"

Britta: Totally. May not even want to go into the place of knowing.

HeHe: Absolutely, yeah. I have found that it has actually made me even stronger in that, because I have made decisions that other people don't agree with in my pregnancy. And so now, not only have I been the giver of that energy, I've been the receiver of both of those energies, of the judgment energy of, "Oh my God, how could you make that decision? You are a doula, you have a master's degree. You've seen the bad things that can happen from that decision," and I've been the receiver of the energy of "Wow. HeHe, you are just so intuitive. I'm literally so proud of how you're so confident and you feel so informed. It's not the decision I would make for myself, but I want you to know that not only do I support you, but you're safe to make that choice in my care."

I've been the receiver from both of those and so it has made me almost even fiercer in my journey, or my dedication, my commitment to being this neutral, unbiased, unbothered advocate for people who are making these decisions. I mean, I'm literally trying to struggle... I'm struggling. I mean, there are obviously, you know, ones that people could bring to me like, "I murdered my neighbor." I'd be like, "Wow, I have really, that's terrible. I have thoughts about that," you know. But like, as far as individual decisions for you and your baby and your pregnancy, there is... I can't think of one thing right now that someone could bring me. I'd have to really sit with it to be like, "Wow. I have big feelings about that."

There's just nothing. I trust humans so much to know what's best for them when they have all the information. But that's the key right is, do you have all the information to make this decision? You feel informed, you feel confident, and do you feel safe in the choice that you're making? You're not making it because other people are telling you to, right? You're not making it because you're scared of the repercussions, right? You are making it because this genuinely, truly, wholeheartedly, intuitively, feels like the right decision for you. Yes, cool. I am here to back you up, and I won't let anybody stray you away from that decision unless you look me in the eye and say, "I think I want to change my mind." And I'm like, "Girl, let's change! What are we changing our mind to? I'm right there with me. Take my hand. I'm holding your hand. We're doing this together. I'm right here with you. What's our new choice?"

Personal Journey Into Parenthood

Britta: So how are you doing all of that with yourself? Because here you are on this precipice of new parenthood yourself. You are pivoting. You are expanding from a professional in the field to a mom in the field, this is a big threshold moment for you. So if we can get personal for a bit...

HeHe: Oh, yeah, let's dig in.

Britta: What's on the precipice of parenthood for you, that is your edge or your expansion, or your heart opening space?

HeHe: Yeah, I think for me, it really is digging into that idea of making the right choice for my baby, regardless of what the people around me think. I have a wonderful partner who supports me in every single choice. It doesn't mean that we always see eye to eye when I first bring him things. He's in the medical field, so we've had some really tense discussions about "I know the data about this. I've watched it unfold for 10 years," and his initial instinct is to lean into the medical model. Because he's in healthcare.

We have yet to come across a decision where we haven't been able to find a common ground between the two of us and reach something that... reach a decision that makes us both feel super confident.

I also think that you know anytime you're with a partner and their family is very different than your family, or thinks very differently, or they were raised very differently. I am from the south. My husband is from up north. I come from like I say, a very American country cow farm family. My husband comes from a New England family and a very Italian too, super Italian. So you can see that the operations of our family are very different.

I have really had to dig into "I am this baby's mama, and I cannot be concerned with what his family says or my family says. I have to be the one that protects this baby, and I have to be the one that is asking the questions." Now I feel very lucky that not only is he in healthcare, but I also have been doing this work for 10 years, so together, we know the questions to ask.

And I think that some of the decisions that I have made have surprised the people in my life because of what I do, because I'm a doula. So I'll give you an example, and then I'll share a couple of things that I'm not sharing, to keep my own internal peace. But one of the things that I made a decision about, and I feel very confident about it, and it's not evidence based, is that I decided to implement baby aspirin in my pregnancy. I am not AMA. I do not have risk factors. There was no reason for me to do it, but I had this intuitive nudge that I needed to be on baby aspirin to prevent preeclampsia. And there's no preeclampsia in my family. The only risk factor I have is that this is my first baby.

I spoke with all of my close friends who are in the medical field, one of them being an MFM, who I trust wholeheartedly, and I think it's very weird to find an MFM that you know... An MFM, if you're listening, you don't know what that is. It's a maternal fetal medicine specialist, and they deal primarily with high risk births. So they see a lot of births that don't go physiologically, and they are not low risk laborers. And so they're dealing with very medicalized births, and that can sometimes taint, is the word that is coming to my... color. It can color, influence, shade or influence their perception of birth. And my MFM friend has been so supportive of me, and she has just been like, such a great resource for me.

But I went to her and said, "I'm having these like intuitive nudges that I'd like to do this in my pregnancy, and I don't have a reason why, and it's actually not evidence based for me as a human and my individual factors." And she looked me dead in the eyeballs and said, "If you're feeling that intuitive nudge, I think there's something to that. You should lean into it."

So I asked more questions about risk and benefits and when I should stop it according to labor. And, you know, would it be appropriate for me because I'm having a home birth and all these things. And I came to the conclusion that, yes, I did want to do it. It felt like the right thing for me. And I think a lot of people see me make my own butter, and I live a fragrance-free life, and I pay extra to have, you know, like, really clean ingredients, and pretty much everything, and I don't wear a lot of makeup, and I'm that person that sprays vitamin C on my body before I get in a chlorinated pool.

And so I think a lot of people were like, "What? Why would you choose something that is not only big pharma, but is not necessarily, quote unquote, evidence based for you as an individual?" And I think for me, it was just standing in my own voice of "I'm happy to answer that question, but I won't deal with your judgment because I feel confident in it."

Now as a content creator online that I have a lot of eyes on me at this time, I always thought I would be like, super open. I'd be an open book. I would just like, share everything, everything, everything. And I am open and I am an open book, but there are a couple of things that I'm not sharing with my online people, and one of those things is my due date. Now, actually, I haven't shared this with our family, our friends either. Everyone knows that I'm due in November, and that's what my online audience knows as well. That's what our close family and friends know. The only people that know my exact due date are me and my husband, our hospital-based midwife team and our home birth midwife team. And that's it. It's just us two, and then our two midwifery care groups.

And for me, I knew I would do this. I mean, many years ago, I was like, "I'm never telling anybody my due date because I saw it all the pressure on it." You know? It's different being in it. And so you can have this idea of who you think you'll be. And I think that's such a lesson. It's like, that's just like, the precipice of motherhood, right? Is like, "I think I'll be this mom," and then you get there, and you're like, "I am not that lady at all. I thought I'd be chill. I thought I'd be super uptight," and you're the exact opposite.

And so for me, it was really cool to see me really stand in that voice and say, "No, I still feel very confident." I also am not telling exactly what my midwifery care groups are. So online, I get a lot of people who in the New England area, will say, like, "Where are you having your baby?" And I've decided to keep that very private for the time being, and post birth, I'm open to considering sharing that, but right now it feels like sharing my personal medical record. I don't know anyone else that would say, like, "Well, this is where I'm getting medical treatment." It's just very personal.

And so that's one, and then I am not sharing any sort of like vaccine status, of what I've chosen to do in pregnancy, or what we're going to do with our baby, because it's such a charged subject, and I find that through this process, I have found that my decisions I have made influence people just because they love and trust me so much, and I never want that responsibility. And so I have decided that there are certain things I'm not willing to share on the internet because I don't want it to influence your decision. And so I still talk about education around those types of things, the recommendations, why they're recommended, what the risks are, what the benefits are, what the alternatives are, and questions you can ask your provider. But I've decided to keep my personal and my baby person, my baby's personal medical records, private, personally or partly because it's medical records, but partly because I don't want to influence your decision. You shouldn't be making decisions based on what I choose for myself, just because you love and trust me. It's such an honor like I really do recognize that. I mean, I love that I love that you trust me so much that I really want to empower you to make your own decisions. I will give you that education and that information, but I really, really, really stand strong and that you should choose what's best for you regardless of what I chose for yourself, just the same way that I'm choosing what's best for me regardless of what you chose for yourself.

Britta: Yeah, absolutely, and I love how you spoke about the piece of this that is also the flexibility and curiosity about how even your ideas about those things can change, because one of the things that sometimes I'll say the best parent you'll ever be is when you are a fantasy parent before you have children, you know all the answers at that point, because at that point you have got it figured out and and yet, when we are facing things in reality, and we're like, even you speaking about your decision from an intuitive place around baby aspirin, it's like your pre-pregnancy person didn't know that that was something that may come up for you just as your pre your pregnancy person pre motherhood, doesn't know exactly who you will confront in your experience of transforming as a mom, because who knows what's on the other side that is going to bring you to your knees, because the one thing that we know is that this journey brings us to our knees at least once, and likely many times over. And it isn't how do we avoid being brought to our knees, but how do we move through that experience of being humbled, of being tested and keep going with resilience and self care, even when we're like this is hard or I didn't expect this. How often do we hear in this field? "No one ever told me..."

We hear it all the time, and yet we can't. One, we can't always be told everything. And two, we can't always hear everything, even if we have been told. So who you will be when you confront yourself on you know who you will be when you confront yourself on the other side of motherhood is still to be explored, lived, experienced, and that's hard.

HeHe: I think that, Oh, it is hard. It's like, one of the scariest parts, right? It's like, first of all, I don't know how my birth is gonna go. None of us do. My husband doesn't know. My care team doesn't know. Nobody knows, birth will transform you, because it unfolds in a way that is unknown to all of us. The same thing can be said about motherhood, except there is this loss of identity that comes along with it.

So I'm 34 years old. I have 34 years of being this version of myself. Now, of course, over the last 34 years, I've changed many times. You continue to change and evolve and meet different versions of yourself, but I know that I'm saying goodbye to this HeHe. On the other end of it, I'm gonna be a changed human as will my husband and I know that, as will our relationship, and we talked about that in our episode at the birth lounge podcast, is that I had a lot of fear around who will I be after this baby is born, and what will my identity be?

And I have, since recording that podcast, realized that I don't have to know what that answer is. It's not for me to know almost, and that is almost the rite of passage, is being okay with not knowing who I'm going to meet on the other side of that door, but resting in assurance and trusting that whoever she is, she's just as strong as this version of me. She might even be wiser and stronger. She's going to have the same resilience that I have, and she's going to figure it out. It's impossible for me to move through this and not be able to figure it out, because out of 34 years, I've never not figured it out before. So I will figure out whatever comes my way.

And I think that there is a level of resolve and acceptance in that that a lot of people are too scared to get to, right? You don't want to walk in that scary place of like, "Oh, but what will it be like?" It's like. It doesn't matter what it will be like. You know, you'll figure it out. You're strong, you're capable. This baby chose you for a reason. I genuinely believe that this baby chose me, my husband and I were not trying to get pregnant. We had decided we were going to try for a baby later this year, and this baby said "No, right now is the right time, and I'm gonna come and join you guys."

I think that you just have to learn to accept, like, "I can't control everything, and that's okay. That's almost the point" is. It's the point. Wide open and say you don't need to control everything. Be flexible, trust that you will be able to figure it out.

I just did a really intense breath work session, and I thought that I would go into it manifesting my birth. I thought that I was gonna see how my birth played out. But instead, I saw myself as a mom. Oh, I'm gonna cry. And she reached out her hand to me, and just like said, "You're going to be okay, like you make it through this and you're a good mom."

And I think that's a fear of so many of us as first time moms, like, "Am I going to be a good mom?" right? Especially if you don't have a great relationship with your mom or your parents, or maybe you don't have parents at all. Maybe they're not in your life. Maybe you are no contact. Or maybe they passed away before you even knew them, or they passed away when you were a young child, and so now you're kind of walking this journey feeling alone because you don't have that role model for you. You don't have someone to go to.

And so to see me as a mom. And when I first saw her, she was facing away from me, and then she turned her face to me, and I was like, "Oh my God, that's me." And then she turned completely around. She had this baby wrapped on her, and she was baby wearing, and I was like, "Oh my god, it's me as a mom." And it was just so special. And like I say, she reached her hand out, and she was like, "You are gonna be okay. You know the answers, and you're a good mom." And then little HeHe came out. And I was like, "Oh my God, that's me as a little girl like that is crazy." And you know, my big self, my future self, had a conversation with my past self, and it was just so healing.

And I can say that on the outside of that breath work session, I came out with peace and not fear, and I genuinely released the fear. I am not scared of my identity on the other end of this anymore. I don't know who she's gonna be, so it didn't give me answers. I don't want you guys to think I walked out and I'm like, "Oh, I'm gonna be this person, maybe this type of mom. I got all the answers." That's not what... answers aren't the point.

Britta: No, they're not.

HeHe: I just came out of that breath work session, and I was like, "I'm not scared. I'm gonna be okay, and I think I'm gonna be a good mom. Like, I think my kids are gonna grow up and have a good relationship with me. I think they're gonna really feel safe with me, and they're going to feel how much I love them, and I'm going to be able to keep a strong bond with my children as they grow," which I think so many of us people in my age group, we just have this collective experience that our parents were not able to show up for us in the way that we had hoped, and it's partly how they were raised, right? They didn't have good role models, and so many of us 90s babies and late 80s babies are breaking these cycles and trying to show up in a different way than we were parented. And that is so scary because you don't have a guidebook. There is no instruction manual. You don't have anybody modeling this before you, and so it can be really scary to not know if you're making the right decisions or not.

And so on the other end of this, when I came out of that that meditative state, I was like, "I'm gonna be okay. Like, I think I'm making all the right decisions," and it was so healing. It was just really healing. And I still didn't have the answers, and that's okay, I don't need them.

Britta: It's part of the point. It is as a rite of passage, un being out of control and in a space of of the unknown is inherent, not a problem to fix.

HeHe: Yeah, yeah.

Closing & Contact Information

Britta: Oh, HeHe you and I could keep talking, as we experienced when we recorded an episode for your podcast, keep talking and talking and talking. So if folks want to learn more from you, connect with your work. Where do they find you? I mean, you have... you're just a wealth of information and support. So, so what are the best places for folks to connect with you?

HeHe: Oh, thank you so much. Well, thanks for having me, and I appreciate it. You know, I can geek out on these conversations all the time for hours at a time. It never gets old. But if you're looking for free information and education, Instagram is the best place. It's at tranquility by hehe, or the dot birth dot lounge. And also the birth lounge podcast, completely free, two episodes a week, if you are looking for childbirth education that is non biased, non judgmental, evidence based, all the data is linked for you and you're safe to ask questions that are probably taboo in other communities. That is the birth lounge.com, backslash, join

And I genuinely teach you not only what you need to know about planning for your birth, but how do you actually advocate for yourself once you get inside the hospital walls, which I feel like that's where a lot of that slippery slope happens, is you know what your options are. You know what you want, but when your provider comes in with you know, a different idea or saying, like "You're not allowed to do this," a lot of us just don't know where to take that conversation, and that's what I teach you.

Britta: I love that. So I like to end podcasts with one question, and I'd love to hear your response to this, and that's what's one thing that you feel passionately about, that you want new and or expectant parents to see, hear, feel or know during this profound period of their lives?

HeHe: You're allowed. You are allowed to say no, you're allowed to make your own decisions. You're allowed to disagree, you're allowed to request, you're allowed to change providers. You are allowed to make the decisions that feel aligned to you. You are allowed.

Britta: I will double tap on that. HeHe, thank you so so much for joining me. I really appreciate you being here and sharing your heart, your personal journey, your wisdom, your guidance, both here and in the sphere of online spaces, you're doing such a profound service. Thank you so much, 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 that social media world at transformed by birth. I look forward to being with you again on the next episode of transformed by birth.

Now we're going to close with our candle. So let's gather what it is that we want to take away from this episode, from this conversation, breathe that in with an inhale, and I'll blow out the candle on the exhale

Until next time bye, friends.