The Power Dynamics Inside Maternity Care with Cristen Pascucci

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 human rights in childbirth. So grab your comfy beverage of choice or take us along for a walk as we connect with human rights and childbirth advocate Cristen Pascucci — did I get that right? Cristen Pascucci, got it — before we begin. We start the way we always do, by lighting a candle. If you want to join me, please do, or just take a breath as I light mine. Today's candle is in honor of bodily autonomy. Your body is your own. It seems like that should go without saying. But in the context of birth, in this country, it still needs to be said loudly and clearly. You own your body, not your doctor, not the hospital, not the state. You, and you have human rights in childbirth, real, legal, protected rights, and knowing that — knowing and knowing them — could transform your birth experience. It's not like you become pregnant and your rights go poof and suddenly disappear, although in some places, that statement seems to become rather more complicated, even if it shouldn't. My guest today is Cristen Pascucci, an advocate for human rights and childbirth and the founder of Birth Monopoly. With a background in public affairs, Cristen has led multiple consumer-based advocacy campaigns to bring awareness about birth trauma and institutional mistreatment in maternity care into the media. She teaches birth and health care workers about their patients' human rights. And she's currently working on a documentary film about obstetric violence and the state-sanctioned suppression of midwifery in the US. I know Cristen's work through Birth Monopoly, and I wanted to have this conversation now, because, as the saying goes, knowledge is power. Folks, understanding your rights, knowing what to look for, and recognizing what respectful, ethical care actually looks like, can profoundly impact how you navigate birth. And we're living in a particular moment where this — not where this — knowledge matters more than ever. Restrictions on reproductive rights are impacting not just abortion access, but birth outcomes, treatment in hospitals, and whether human rights are actually respected during labor and delivery. So this is the person I want to have some of these conversations with, and I'm so grateful you're here. Thank you for joining me, Cristen. I'm happy you're here.

Cristen Pascucci: I'm happy to be here. Thanks. Yeah, thank you.

The Corporatization of Birth: How Big Health Systems Are Reshaping Maternity Care

Britta Bushnell: So I kind of — that was a mouthful of an intro, and I kind of want to bounce it back over to you and ask you to give us kind of a like — I've been in this field for over 25 years. I've watched kind of an arc of change, of shift, of evolution, and yeah, what is — was the opposite of evolution, devolution — like, yeah. And and shifts and changes, improvements and not improvements happen. And I'm curious if you could kind of give us an overview of what is going on in the realm of birth today, and how it has changed, and how it may currently still be changing in ways that matter to folks who are navigating this realm right now. I know it's a big one.

Cristen Pascucci: So the first thing that comes to mind is that over — over the time that I've been involved in birth work, which is about 13 years — I have seen, I've seen some systems change. As far as — how do you say this like — so I've watched the — the swallowing up of smaller practices into like, corporation. Let me put it this way: corporations have been taking over birth in the US for decades, right? But it has gotten like, so much worse now. Like, I've watched it go from like, okay, you know, there's five major health systems in the US to like, oh, now three major health systems in the US are like — you know — own basically the majority of birth. And it's, it's gotten so — you know, my organization is Birth Monopoly, and it's really crazy, because I feel like when I started calling it Birth Monopoly, that was more than 10 years ago. I've actually watched things get worse in that time in a lot of ways. One of those ways is that it feels like even more of a monopoly now than it used to be. And that is really intimidating, because there are a lot of other factors, like patient education and health, health worker education, public policy, legal rights, and the way that our rights are treated in the court system. There are, you know, there are whole kind of like schools of thoughts and concepts that we've seen — like shared decision making, you know, has sort of — you know — came in as an idea, and then trauma-informed care. And the thing is, is that, like, a lot of these things are almost irrelevant in the context of, like, well, we're just in corporate healthcare now. Like, no one cares about any of that stuff.

Britta Bushnell: And I need — I need you to help unpack that just a little bit. Why — why, in a more corporate-based system, do those things matter less? I'm curious. Like, like, spell it out for my listeners.

Cristen Pascucci: So, like, you know, like, 10 to 12 years ago, I could say, like, oh, we're working with a number of community-based, you know, clinics or healthcare facilities, or, you know, labor and delivery units or whatever, where these are — like I said — community-based, they're local. The people who work there are local. They are serving people in their communities. They don't have like a boss of a boss of a boss of a boss of a boss who's actually in —

Britta Bushnell: DC. In a corporate building somewhere, very disenfranchised from the folks on —

Cristen Pascucci: — the ground. Yes. So you might have like, you know, maybe like a physician there or a nurse there say, hey, you know what, we need to do better with — we need a refresher on patient rights. We believe that also, some of the evidence in birth is not — we're not implementing best practices, right? Because some —

Britta Bushnell: Some of — some of best practices, it feels like it can take years, if not decades, to update what's actually happening connected to new research. Yes. Unless it's super supportive to how things run in a hospital, then somehow it magically happens very, very quickly. You know, I'm looking at you, ARRIVE study. Yeah, it takes —

Cristen Pascucci: 20 years for something to be implemented, if it's patient-positive, if it's actually — birth should be less restrictive. Because, like, a really simple example would be eating during labor.

Britta Bushnell: Good one. Okay.

Cristen Pascucci: Example. We've known for many, many years that not only is it not unsafe, it's beneficial to eat during labor, if that's what you want to do.

Britta Bushnell: And that's — the research has — that's not you and I saying that. The research is talking about that, saying this, look, this matters. And yet what we see in practice doesn't show that happening.

Cristen Pascucci: Right, right. And so, and then, even in places where — so that — so then, like, say, a local birth worker comes to me and says, we're really trying to get our hospital to change their policy on eating and drinking in labor. It would, you know, it takes months, years, you know, all kinds of advocacy. They want to see, you know, research. They want an expert to lobby them, you know, all of these things, for something that is really obvious and really well-documented and actually really well-known. However, like you sort of said — you referenced the ARRIVE study earlier — but then, if something comes out that leans more towards a patient restriction, it's like, instantaneously adapted. Does that make sense? Yeah. It's like, oh, this thing came out that cast doubt on, you know, the safety of water birth. Water birth will be shut down by the weekend in those facilities. In the same facilities that will not allow people to eat, even though — you know — everyone who knows anything, as far as current evidence, knows that that's a best practice.

Britta Bushnell: So, so, and that's what — when you're saying that even though we've brought in terms and understanding like trauma-informed and shared decision making, or informed consent, or, you know, the various different ideas of centering patients — that in this monopolization of health care that is occurring kind of in this rapid way, rapid pace, that those things aren't helping as much as we would like to think that they are. In part, because we're not in a relationship face to face with the provider in our town who has decision-making power themselves, but it's trickling up. Trickle up — can you trickle up? It's, it's, it's coming from above in corporate boardrooms, and there's other things that are being protected there.

Profit, Liability, and the Business Logic Behind Institutional Birth

Cristen Pascucci: Yeah, I mean, it comes down to — I think, you know — it's all about profit, lower liability — and liability is money, I mean, like, that's what we're talking about when we use the word liability — and higher volume, right? Like, really basic business concepts. You're applying business concepts to something that is not really a business-friendly field, childbirth. It just isn't. It doesn't, it doesn't fit neatly into an institutional framework.

Britta Bushnell: But, yeah, it's like purely one, especially one built on pathology. Yeah, yeah, because healthcare is mostly based on pathology — on, how do you fix what is broken? Yeah, and birth can be a tricky one to mold and form into a system that's built for that, although it seems to have succeeded pretty well in trying to do that.

Cristen Pascucci: Yeah. Yeah, right. So it's like, you know, look at it as, like, you know, preventive care versus emergency care, right? You know —

Britta Bushnell: Good example. Yes, we throw all —

Cristen Pascucci: — kinds of money at — and then we wouldn't, we wouldn't need 80% of that emergency care if we just invested in the preventive care. But we're not going to. We're going to put $0 towards preventive and then put all the dollars towards the emergency, and then you have more emergencies. When it happens, yeah, so there is more pathology. Yeah.

Britta Bushnell: So, so, in this more monopolization trend that you've been seeing, matched with this trend of — of some — some positive things, but they're bumping into each other. Am I getting that right? They're bumping into each other in a way that isn't creating the change that we're hoping for.

Cristen Pascucci: Yeah. I mean, it's like, the more corporate we go, the less human rights is even anywhere in the picture. There is no financial incentive for human — like, it's basically like, hey, do you want to do the right thing or not? Like, you're either a person who wants to do the right thing because that is who you are, or it's more important that you get paid money for something. And you know, this — to me — seems like a really tough barrier, because I know it sounds horrible to say, and probably super cynical and like all these things, but I mean, all I can say is — you know — this is from experience. It's just from years and years of doing it. And I hate to say that out loud, but it's just true. There's no reason for hospitals to respect human rights more. It just isn't.

Supporting Clients and the Power of Birth Workers to Navigate a Broken System

Britta Bushnell: So I'm — I'm curious, because we can — I know, and I imagine you know — that birth workers, people, professionals in this field, we can spiral. We know how to spiral. We know how to find our way into the depths of despair about the system. We also navigate — those of us that work with families navigate with the individuals who are having hope and desire and expectation and looking for ways to — asking for ways to help them navigate these systems — that also can make us spiral. And so when we are — we're sort of talking about that overlay of what's happening in birth — then how do we support clients who are navigating birth and understanding what is happening in the system? And maybe, you know, I mean, having choice is something that is — gosh — what I want for my clients. I want them to have the choice to pick location and and provider and choice of care team and emotional support and physical supports and relational supports. Like, I want all of that for my clientele, and yet they don't all have access to all of those things. Yeah. So how do you — how do we help them?

Cristen Pascucci: Yeah, well, I mean, this is why I teach a human and legal rights in childbirth course, because if no one else is going to be educated about it, birth workers like doulas and childbirth educators have to be — have to be educated about it. And that's something I say in the course, is that you know you may not — you may not, as a birth worker — even realize the amount of power and like the value that you're bringing. It is very likely that, having learned this information, you are the most knowledgeable in the whole room, possibly the building, about this topic — about what your client is owed, you know, what the legal framework is, what a human rights framework looks like, how you can navigate it, you know, some ways to respond, some ways to prepare, you know. And and and then I would say, on top of that is, you know, that education layer is super — is super important. I mean, you know, like, sort of that saying of, if you don't know your rights, you don't have any. And then on top of that is the community layer, I think, which is birth workers collaborating with each other, working together, informing each other, being on the same page about what is going on in different facilities. You know, here's what's happening here, here's what's happening over here. What are we going to do about it? Like, you know, how can we get together so that this isn't just like one doula and one client?

Britta Bushnell: Actually, I want to jump in, because I actually would say that in 25 years of being in this field, that's a place I've seen improvement — is birth professionals speaking out more collectively, to one another, to communities of other doulas, other childbirth educators, and saying, hey, this happened, and this is not a one-off. You all need to know about this. And that — I didn't see that happening 25 years ago in the way that I do.

Cristen Pascucci: Now listen, I hope I've had something to do with that, because I've been preaching that for years. And I hope so too.

Britta Bushnell: I think — you know — give yourself a pat —

Cristen Pascucci: — on the back, on it. Yeah, yeah. I mean, it's — and I mean, I can't remember if it's in the updated version of the course, but I remember the last — in the old version, I had a whole section on it, you know. And it was — you know, in a system where the patients or clients and birth workers are often, like, at the low end of the hierarchy, you do have power in ways that you may not even be aware of. And let's, like, really get into that and talk about that and lean into it. Because I think one of the ways that doulas and other birth workers have power is they have the trust of their clients in a way that, you know, a physician might not or a nurse might not — who you are —

Britta Bushnell: A different type of trust, yeah, even just more of a relationship, typically.

Cristen Pascucci: Yes, actually, relationship is probably a better word there.

Britta Bushnell: Yes, because they may trust their provider — medical provider — for particular things, but they have more of an emotional relationship with others. Yeah.

Cristen Pascucci: Yeah, which also translates into just factual information. You know, a doula might know — like, you're having a lot of trouble with your partner right now. And, you know, you know things that are not going to come out to —

Britta Bushnell: — matter. Yes, yes. They might not come out, and they matter, but they aren't going to — you're not going to pick up on that through a vaginal exam. Yeah, right. It's a different kind of information. Yeah, and that different kind of information matters. And I'm — I'm thinking of, as you're talking about this, I'm also thinking about how — I don't, I don't think it's equal across locations and across identities. So racial identities and sexual identities and like, there's — I mean, we just have seen come out in the last couple of months, some of these videos of people being — you know — forcibly where their human rights are being abused, violated in ways that make it look like it's okay from the powers that be. Yeah, and yet there — it's still a violation.

Birth Trauma, Reframing, and Holding Space for Complex Emotions

Cristen Pascucci: Yeah, I mean, this is — like, this is one of the, like, you know, really difficult parts of all of this, is that so much of that abuse is so normalized. People don't even know what they're seeing, and they don't even know what they're experiencing. You know, so many — and I'm sure you've had a lot of experience with this — is people reinterpreting things that happened to them. You know, what did they — doulas used to say back in the day — reframing? I remember hearing that quite a bit and getting into arguments with people about the idea of, like, my job is to help them reframe their birth in a positive way. And hearing people say that, and then me, from a patient perspective, going, absolutely not. I would — I feel, from a patient perspective, that is completely unethical. I absolutely do not want you consciously reframing, helping me or influencing me to reframe my birth in a positive way, unless I have explicitly asked you to do that. Right.

Britta Bushnell: And generally, if that desire comes out, it's typically further down the road. It's not usually right in that — I mean, and I'm gonna, I'm gonna flip it and say, I've seen it true in the inverse as well, where it's the — I have sometimes referred to it as the fruit basket response, where right after a particularly traumatic birth, the parent is like, oh, my God, thank God for my team. I'm going to send them a fruit basket, or I'm — you know — I mean, that's kind of where I come in with the fruit basket idea. But it's like, I want to thank them and shower praise on them, and they're in that place where — where a doula or a witness of the birth may be like, holy but Jesus like, yeah, yeah, that that was a storm created, yeah, not, not responded to. Yes. And, and it takes — but, but it's not our job to be like, you just had a traumatic birth. And can we — can we — you know, I need you to see what actually really happened, because they're in a trauma response of, thank God I'm alive, thank God my baby's alive. And it may be six months, a year, longer, until they start going, huh. I find it with clients who come back to me for a second baby, they start unpacking —

Cristen Pascucci: Yeah, absolutely, yep.

Britta Bushnell: — start unpacking those births too, where they're like, I'm thinking about this in a different way, like, yeah. Because it isn't our job to tell a client when to move on, or how to, or when to put a positive spin on it, or when to unpack it, because they may need to — they need to come to those on their own.

Cristen Pascucci: Yeah, I don't think it's anybody's job, right? Like, I — to me, that — and I probably have, like, a personal emotional response to that too, like, I do feel really, really strongly about giving people their own space to process whatever is happening and to stay very far away from manipulating their perspective or their feelings, in either way, you know, like giving them the space. Now, that doesn't mean that I think that you shouldn't be honest and you shouldn't be factual. And that is also something — you know — they've had lots of conversations with Elizabeth where they're — you know — similar to what you said. They're like, oh, my God, it was, it was horrifying. It was traumatic. Like it was traumatic for me. I'm sure it was, had to be traumatic for them. And, you know, whatever. And they are not giving me the impression at all that they found that traumatic, you know. And, and actually, you know, I've had friends with me, like, I've had friends go through this, you know, and, um, I have said, you know, just from, like, in a very, kind of neutral, clinical way, these are risk factors for trauma, you know, this happened. So just something to be aware of. Do you know what I mean? Like, this is something that happened in your birth, okay? So that is something that you know could be considered traumatic by some people. So that's just something to be aware of down the road. Because — and we also know, like, trauma is self-defined. Trauma hits different people different ways. Something that is traumatic to me may not be to you and vice versa. Um, so — but I think it's like, it is factual to say, you know, um, a near — you know — an event where — where there was a threat of death, or, you know, there was a significant risk to someone's health or well-being. I mean, that is, that is within the definition of traumatic. And that doesn't mean it is a traumatic birth. It just means that this is a risk factor — like, this might be, this could be traumatic for you. And I think there's, you know, nothing wrong. I mean, I feel like that's informative to tell people.

Britta Bushnell: I probably — the way I would probably do that is to acknowledge and validate what it is that they are expressing is true in the moment. Like, yeah, it totally makes sense to me that right now you're feeling so grateful that you are well and your baby is well, and you're feeling some gratitude about that, and that makes so much sense. And sometimes feelings about what happened can shift and change over time. And I want you to know that I'm — I'm here, or that it — it makes sense if, if at some point you start thinking about it in a different way, that doesn't mean that you're doing it wrong. Like, I might not try and, and point directly to the thing, but speak — I would probably speak kind of more generally about the possibility of their arc, of their emotional journey. That's probably — how my — that's how I would do it. Yeah, yeah.

Cristen Pascucci: Well, like I said, that's something I've done with friends, where there's a relationship there. And and it's also — this is something I'm talking to all the time, right? Exactly — a random person that I'm like, hey, by the way, it's — but we talked a month ago last time, just want to let you know, right? Yeah, just kind of like, dropping that in, like, by the way, you know, this is a thing. And there's no shame. Like, you know, I mean, this is, like, another aspect of it is, I think a lot of people feel shame and or guilt for expressing that they might — maybe traumatized isn't the word — but just, you know, have doubts about what happened in their birth, or they don't have just 100% positive feelings and gratitude about it, right? And it's totally okay, like you can feel 1000 different feelings about what happened in your birth, and those feelings might change month to month for the next three years.

Britta Bushnell: You know, I have a — I have an ampersand over my shoulder and "and" sign on purpose, because I think that speaks to exactly what you're talking about — the, the, you kind of sometimes messy feeling of emotional bedfellows that don't feel like they make sense together, and yet we often can feel them at the same time. And and that aspect in childbirth, really — I mean, I feel like birth brings that up in a way that few experiences can, where it's like, oh my gosh, I am feeling grateful and absolutely filled with doubt and shame and or self-loathing or other-loathing — saying rage — all at the same time. And yeah, that's big. And that helps me kind of want to pivot into talking about these aspects in regard to the transformative process of this journey. Because part of what we are talking about is we're talking about a process that is huge, in a system that is, you know, created for profit, for health care, for pathology, for, you know, all of that. And and it's also a really big rite of passage in our lives when we become a parent. So we're navigating these physical and social and medical journeys while simultaneously totally being rebuilt. Yeah, it's like — I know your laughter just made me — I kind of felt it in that moment.

Cristen Pascucci: I just — it's funny, because, like, at the time, I had no idea. Yeah.

Cristen's Personal Birth Journey: From Patronizing Care to Firing Her Provider the Day Before Labor

Britta Bushnell: So — so I'm curious, because — did your birth journey help bring you into this work? Like, that's what I thought. So what — you want to tell us a little bit about your transformative journey and like, how — how human rights in childbirth play in, like, what's the thread that weaves human rights in childbirth and birth as a transformative journey together?

Cristen Pascucci: Yeah, well, um, I gotta go back to the beginning for this one. Um, I mean, I grew up in a conservative religious community in the South, in a red state, and human rights was not a concept I grew up with. If anything, if I ever heard it, it was derogatory. When I got pregnant, I was — I think I was 30 years old. And first of all, I knew nothing about birth or pregnancy or babies, nothing. So I came in —

Britta Bushnell: — as more common than we realize.

Cristen Pascucci: Okay, I don't know.

Britta Bushnell: Yeah, I mean, just because so — so little conversation occurs in our overculture around physiology and birth reproductive processes.

Cristen Pascucci: Yeah, yeah. Um, so when I — I'm trying to think of how I can, like, sum this up best. While I was pregnant and I started seeing care providers, I just remember being like, very taken aback by — I mean, their tone is kind of the best way I can describe it — like, it was just like, a very like — I just felt like I was constantly, like, getting patted on the head and just being like, honey, don't worry about it, like, we're gonna take care of everything. And I was like, I'm so confused. Like, I'm literally asking you a direct question. Why are you not answering my question? You know? Like, it was so strange.

Britta Bushnell: It sounds so patronizing.

Cristen Pascucci: Yeah, yeah. Like, and also like, they were not — yeah — they just, like, were not interested in me participating in this process at all.

Britta Bushnell: Sweetie, and you've got — you — energy. Don't, don't worry your pretty little —

Cristen Pascucci: — head. 100%. And it was very odd, because I was — I mean, it was — I was 30 years old, like, I was a successful professional, you know, respected. Like, it was just so strange to be treated that way. And then, um, one of my — one of my biggest, like, musts for my birth was having my son immediately come to me. I was like, look, I don't care what happens in there. This is the only thing that really matters to me — is I want to make sure that he comes directly to my chest, that I am the first person to hold him. And, um, again, I sort of hit up against this really strange — unable to get a direct answer about this. I could not wrap my head around like, I don't understand why we can't have a plan for that to make sure this happens. Like, are we speaking the same language, you know? And that was so strange to —

Britta Bushnell: — me. And you weren't speaking the same language. Let's just be clear, right? Because I actually think that's part of it — is that it is like we're speaking two different languages. There's the clinical language and there's the language of desire and want, and —

Cristen Pascucci: Will. I guess they looked at it as the desire and want. And I was saying, this is a must. Does that make sense? Like, I was like, I don't understand why you keep acting like this is like, a cutesy little thing that you may or may not let me do. You don't have the authority to tell me whether or not I can hold my own child. Like, I don't know where you're getting this weird perspective. This is my baby, and I'm telling you, you need to help make sure the plan is in place that I get to hold my baby. And they clearly did not have that perspective. And again, I was just so surprised that they didn't have that perspective, because it seemed so obvious to me. And it was just like, it was just very odd, like I — you know — just felt like we were not communicating.

Britta Bushnell: And you knew that in the moment, that that professional —

Cristen Pascucci: — communicator. Like, I was a professional communicator. Like, you felt — to communicate.

Britta Bushnell: You felt it in that moment, like, this is not working.

Cristen Pascucci: Yes. Like, in a way that, if I were in a meeting with someone in a business setting, I would not let them walk out the door. Does that make sense? Yeah. Like — I love that, you know. And and also, I should say — you know — I worked with lawyers my entire — like from — I think — 20 years old to 30 years old or whatever. So, like, I also had, like, almost like a contractual view. Like, I don't know if that makes any sense.

Britta Bushnell: Yeah. Like, you understood how to talk about the parties and what it is they're needing and wanting from the relationship. Yes. Like —

Cristen Pascucci: — these are the expectations. This is what you're going to do, what I'm going to do. We agree on this, right? Okay, everyone's on the same page, agreement. What's next? And it was, like, very clear to me that this was — there — they were not meshing, you know. Um, and then when — so I go through — and I'll leave out a whole bunch of the story, but to kind of fast forward to the very end of my pregnancy, when my provider switched things up on me. And again, where we had had a clear plan, and she and I — I felt like we were on the same page. I finally found someone who I was like, absolutely, we're clicking. She's clearly communicating with me. This feels good. And then it was like, at the very end, she switched everything up. And I was like, what — am I crazy? I know what we talked about. This was not it. And yeah, I ended up firing her at the very end of my pregnancy and switching providers that day, and then I gave birth the very next day.

Britta Bushnell: Okay, wait — I feel like we need to put an extra beat on that one for a second, because a lot of people tell me it's too late.

Cristen Pascucci: Yeah, it always feels too late. Um, you have free will, however — like, it's actually not —

Britta Bushnell: Well, I mean, and it might be too late for some people who don't have another option covered by their insurance, or ability to pay out of pocket, and all of those kinds of access-based —

Cristen Pascucci: — not possible. Yeah, until you explore the barriers, you don't — you know, right? Just from the perspective of, like, is that a possibility? Yes, it is a possibility, right, until you kind of get into it. And like, I am so lucky to have found another provider. Like, that was totally like, you know, magical and providential and all the things.

Britta Bushnell: And you did it the day before you actually gave birth. Yeah. Which, which is inspiring, and I think important for people to say — that if you've got a red flag warning going off in your nervous system, and it feels like it's too late — it can be a good thing to look into what your options might actually be.

Cristen Pascucci: Yeah, and like, that wasn't the first red flag. I did ignore multiple red flags up until that moment. I'm actually really grateful that she came down as hard as she did on me, because otherwise I probably wouldn't have just let it slide, and then I would have not fired her, and I would have ended up in the birth room getting very fucked over. I am really glad that her true colors came out when they did, because otherwise I would not have had an out. You know.

Britta Bushnell: Grateful for her to push you over that edge, and for you to be able to have the wherewithal. Because I think that's also an important piece where you said, this is my — this is my end line here, this is my final straw.

Cristen Pascucci: Yes, yes. And, of course, a huge part of that was the people I had around me, which, again, like, I'm not that smart — like, I could not have planned it the way it happened. It just happened that way that I had, like, the perfect people around me at that moment, or, you know, in those hours, and or contacting me or picking up the phone at the right time, that it, you know, things turned out better than I could have ever planned. But again, had I paid more attention to those red flags leading up to that, you know, it might not have been such a, you know, an emergency on that day. But you know, also, with the benefit of hindsight, I didn't know what the red flags were. You know, I — how would you ever know, except your nervous —

Britta Bushnell: — system knew at the end, when it was finally crossed, right. And that — so, whatever. Yeah. I mean, I don't — I don't know that I'm a huge fan of the woulda coulda shouldas, but — because I do think there's a time when we get to the other side and we're like, wow. I mean, as you said, not that everything needs to become something that we're grateful for. That's also toxic positivity, bullshit that I don't buy into. And your journey of transformation involved this particular path.

Cristen Pascucci: Yeah, yeah, yeah, totally.

Britta Bushnell: And part of that was ignoring some of those other red flags and getting to that point where you crossed — where one final one was crossed — that your nervous system said, nope, don't —

Cristen Pascucci: — exactly. And like, I think there's really something there though, because those red flags feel the same no matter what context you're in. So later, I explained it to people like, okay, so have you ever, like, had a boyfriend, and you one day, you can just tell something's off, and you say, you know, is something going on? I feel like, you know, you're acting a little different. And he's like, no, everything's fine. What do you mean? I'm fine. There's nothing to talk about. And you're like, oh no. Then something's definitely off. But then they, like, talk you into not thinking anything's off. But you're like, I still feel like there's something off. And then, but they talk you out of it, and then everything goes back to normal again. And then it's maybe a month later, and you're like, this dude's acting funny, you know? Or maybe you say, I love you. And they say, aha, you too, okay? And then they hang up, and you're like, uh, wait a minute, something's off, right? That it's sort of like that feeling where you let someone, kind of, like, talk you out of it, but, like, it almost always comes up again, and you know something's off, you know. Something is not quite clicking.

Britta Bushnell: I think that's a fabulous analogy, because I do think we know, and we tell ourselves a story inside our mind to make it make sense.

Cristen Pascucci: Yeah, and in, like, in both of those scenarios, it's like — literally, I'm like, in denial at this point, right? Like, I don't want to break up with him. I don't want to find out that he's cheating on me. I don't want to —

Britta Bushnell: — find a new provider at the 11th hour. Exactly.

Cristen Pascucci: — like, you don't want to think those things. And you're like, hoping against hope that that is not the case. But unfortunately, like, the benefit of life experience is that you're right 100% of the time. Like, maybe you keep dating that guy for two years before you find out, absolutely, 100,000,000%, he has been cheating on you the whole time. Or, you know, whatever the thing is. Or, you know, maybe he bit down and dug in and, you know, whatever, and then one day — say, you know what, I'm leaving you, I don't want to be here, I never did, and I tried, but it didn't work. It's like — you're always right, like you just are, even if you're able to stall it and procrastinate it and, you know, whatever. And that's true in, like, every area of life.

Britta Bushnell: So it makes me want to, like, lean into my microphone and, like, whisper into the listener's ear: if you are feeling and noticing little things that you're like, I don't know, I don't know, that doesn't feel quite right — listen to Cristen. She's saying, you are right. Listen to your body, it knows. And what can you then do about that?

Cristen Pascucci: Yeah, yeah. I just — I feel like that is such a hard lesson that I have learned over and over and over and over in my life, is that listening to those — paying attention to those red flags — and instead of having the, like, reflexive response of covering them up, or, you know, kind of dismissing them, or finding ways to reason yourself out of them. It's just like prolonging the inevitable, really.

Britta Bushnell: And it's hard, it is hard, and it's tender. It makes me kind of teary as we're talking about it, because it's — it's a very tender experience. And I think it is part of what occurs and what comes really to a head in this transformative time, where — things — part of what makes birth and and new parenthood so transformative is how important so much of it feels. It feels so important, and so it's raw. It's on the edge, it's big, it's a big thing. And so it's tender to have to just, like — love feels like a big thing, right? That's part of why I think your analogy is so spot on, because our desire for love, our desire to do well, they come head to head with our, our, like, wait, but I'm feeling something. Yeah, yeah.

Cristen Pascucci: And navigating other people, you know? I mean, these are all about your relationships. Relationships, yeah. And, you know, one of the things that comes up for me when you say that is, like, having to admit to yourself that someone would mistreat you is really hard. I mean, yeah. Like, there's so much, like, kind of shame in there for me when I think about, you know, wow, that person had so little respect for me that they did this. And in my mind, we have a great relationship. I think we have mutual respect, and we're on the same page, and we've communicated. And and I'm talking about both of these types of relationships here.

Britta Bushnell: Both — I can, I can feel them as you're talking —

Cristen Pascucci: — about them. Yeah. And you're like, oh my God, the whole time, this is who they really were. Ouch. Like, that's ouch, you know. Oof. That's an awful feeling.

From Deferring to Authority to Embodying Your Own: Cristen's Path to Advocacy

Britta Bushnell: So — so back to that transformative piece. So, so coming face to face with your ouch. That day before you gave birth, you switched. And what — what happened next? How did you end up in this work?

Cristen Pascucci: Um, I mean, it was that whole experience that I afterwards was just like, what in the hell was that? What? And it was also like, people's responses to — my — to what happened. It was not like, oh, my God, good for you, I'm so glad you switched. Most people were like, you did what? Do you mean? Why would you do that? Really? Oh. Like, it was a very — I felt judged. Like, wow, that was very high-maintenance of you. And that was kind of astonishing. Like, I was just like, what? Do you mean — you have someone lying to your face, you're saying that you would go ahead and pay them thousands of dollars and let them get up in your vagina? Like, I don't — is that what you're — you're saying that's what I should have done? Like, I know. Like, no, not doing that. Like, but I was really surprised at how many people were just sort of like, oh, really? Not — I don't know.

Britta Bushnell: Like — which I bet really put the whole thing in a cultural landscape, kind of, where you looked at it almost anthropologically, I'm guessing. Like, to have that be the mirror back to this very real experience for you probably activated sort of that anthropological — what is going on here — that that is the response. You know?

Cristen Pascucci: It just — it kept, for me, it really keeps coming back to value. Like, how people value you as an individual, but also as a pregnant person. And I just was getting these contrasts over and over and over, throughout pregnancy and then with what happened with the birth, and then after birth, like sharing that story. And it was just really shocking to me. I don't know, you know, my perspective was — like you said before — about like, this being so big, and, you know, I looked at this as, like, the single most important thing I had done in my entire life up to this date, you know. And to me, it was like this — if you're ever gonna pull out all the stops, it's now. Like, this is when you do it. This is the most important thing. This is not a time to kind of pussyfoot around things. And, you know, you know — hope it all goes well, but kind of like, not really prepare as much as you can. And, you know, maybe that's my OCD talking, but yeah. And so then for me, I'm thinking like, I value this experience — like, this is the most valued experience in my entire existence, up till now. And other people around me are not valuing it the same way I am. And I feel like I'm like, you know, dragging them kicking and screaming to value it as much as I do — including, you know, after the fact. And actually, I'm remembering the decision moment when my friend, who was with me on that day that I switched providers, and she was the one who was like, so are you going to switch? And I was like, I don't know. Um, I just — I feel like it'd be really rude. Like, how am I going to tell the other one? And she, like, kind of put it in perspective for me, and essentially said: you — all the decisions you've made up until this point have been about the safety, well-being, and like, out of love for your baby. Are you now telling me that you are going to make a decision based on the feelings of your provider? And I was like, okay. Yes.

Britta Bushnell: Now what a — what a wise friend, to be able to present it in a way that was holding the version of who you are that they knew you to be — that one who has put values and acknowledgement on what has been really important — and hold the mirror up against what not making the decision was. I mean, that is, that is a friend. Shout out to that friend, who's able to hold that in that. Because I do think there's, there's a power in — in, in a time when we feel great vulnerability — to have somebody who can remind us who we are.

Cristen Pascucci: Yeah, yeah, totally, yep. And that was like, yeah. It was like, is mature Cristen gonna make this decision, or is little girl Cristen going to make this decision? Yeah. Is mother Cristen going to make this decision?

Britta Bushnell: Yeah. Which is, you know, archetypally speaking, what was being birthed through this whole process was Mother Cristen. Yeah, not just your baby. Yeah, you were being birthed from a younger, more innocent version of yourself into — alright — who you're going to be in this way, in this form.

Cristen Pascucci: Yeah, yeah, and someone who defers to authority —

Britta Bushnell: Rather, someone acknowledging your own authority.

Cristen Pascucci: Exactly, yeah, yeah. And I feel like that was just kind of thrust on to me — that was never, like, explained to me. We don't have those cultural, like, rites anymore, you know, for that to be something that would even be in my, you know, conscious mind. Yeah, and every bit of parenthood has been pretty much that still with it to this day, 14 years later. Yeah, yeah. I mean, which —

Britta Bushnell: Which, I think, is actually a really important point to kind of highlight — is that often, when people are like, I don't understand how birth is a rite of passage, or how — how becoming a parent is — you know — how do my sleepless nights in pregnancy or my labor journey or early postpartum map onto me being changed as a parent? And you just gave an example of the fact that you have needed to face and confront — and we all do in parenthood — people in positions of quote-unquote authority that we have to find out who we are in the face of those.

Cristen Pascucci: Oh yeah. I mean, going from, like, the abstract concept to the embodiment of — to go right back to the beginning of this podcast — you own your body. You own your body. You are — you are the legal authority on your body. You are, you know, sort of like the sovereign person when it comes to yourself. And you are the expert on you. I mean, I mean, I might have said those things before, but this was like, really, this whole process has required me to embody that, because it is challenged. It was not challenged before I gave birth. I could say those things in theory, because nothing was pushing on me otherwise. But this was people, one after another, coming up to me and saying, I'm the authority over you. You're not the authority over you and your fetus, your baby, your newborn, your baby, your toddler, your child. And having to go, oh shit, no, sorry. I actually am the authority, and I'm gonna have to fight you on that, damn it. I don't want to. I don't like conflict. I really wish you could just leave me alone. But if you're not going to leave me alone, then I am going to have to stand up to you. Kind of my process.

Britta Bushnell: Yeah. I mean, that's a transformation of going from intellectual understanding to embodied wisdom — is a journey that matters. And it sounds like this was — I know that I own my body to — oh, oh — owning my body means I'm actually standing up, and I have to, to acknowledge this when it is actually challenged. That is a different kind of knowing. Big time. Okay, we — I — we could keep talking for hours, and I know we are running short on time, and I want to kind of just come, come into, kind of some of the end things that I like to ask about. And you — you do work in support of human rights in childbirth and and in dismantling the monopoly. How do people connect with your work? What is it that you offer that can support families, support professionals? Like — give us that whole okay?

Cristen's Know Your Rights Course and Birth Monopoly Resources

Cristen Pascucci: Well, I love teaching people about legal and human rights in childbirth — both. I love teaching parents and I love teaching birth workers and medical providers as well. And I have — I have my — my signature course is Know Your Rights: Legal and Human Rights in Childbirth, for birth professionals and advocates. And I, it's funny, I just always come back to that. Like, anytime someone's like, Cristen, how do we — I just want to be like, just take my course. Like, it's literally in this course. This thing has — I've, you know, revised it multiple times, and I think it's as good as it's ever been. And it is just an absolute must for anybody who's working in the birth space. And not only have I had parents take that, but also mostly it is doulas. And then I would say next group is nurses, and then there are physicians and midwives as well. But that is, you know — to use the word transformative — I've just had so many, but especially nurses, say this was really transformative. And and —

Britta Bushnell: Sometimes you've had parents take it too.

Cristen Pascucci: Yeah, and they're usually advocates, like people do not just walk off the street and go, hey, I'm gonna learn about my legal and human rights in childbirth. I actually do have a parent class that I offer just to birth workers so that they can use it with their clients, like to walk them through it, and it's like a very simple, like, 30-minute thing, just to introduce some concepts to get their conversation flowing about those same things. And I love teaching, you know, not just the online course, but I do teach that in person as well. And I think that I love doing that. It's so fulfilling to get in a room full of people — generally they work together, you know, either in the same facility or in the same community — and then to be able to, like, you know, for them to learn all that information, but then also digest it and talk about it and plan about it right in real time. Is, is awesome. So I love doing that. I love that.

Britta Bushnell: And then people can reach your — I mean, Birth Monopoly — is it .org? I'm trying to remember what — what's the website?

Cristen Pascucci: Well, I actually — I'm sure it's either one, but yeah, I'm like, I —

Britta Bushnell: I think I've gotten there both ways. So that's why you saw the crinkled look on my face, like, wait a minute, did I get that right? And then that's also your Instagram and your socials and all of that too, right?

Cristen Pascucci: Yeah, mostly — mostly Instagram, I would say, at this moment in time. Yeah, but yep, everything else I think is at my website. Okay, excellent. But yeah, yeah.

Closing Question: What Do You Want Expectant Parents to See, Hear, Feel, or Know?

Britta Bushnell: So I like to end with the same question every time, and the question that I like to end with is: what's one thing that you feel passionately about that you want new or expectant parents to see, hear, feel, or know during this profound period of their lives?

Cristen Pascucci: Man, I have two different answers. That's perfect.

Britta Bushnell: I love people who break the rules. We've just been talking about breaking rules. So I want to get both of them.

Cristen Pascucci: The first thing — like, the second you started talking, what immediately came to mind was: you know what respect feels like. And like, lean into that. If you know what —

Britta Bushnell: I love that answer. Okay, keep going. Sorry — I'm just having a visceral response to that answer.

Cristen Pascucci: If you know what it feels like, you know what the absence of it feels like as well. And like, really, like, lean into that. I will put a caveat on that. I don't think I did know what respect in healthcare looked like until I actually switched providers at the very end of my pregnancy. Got this wonderful midwife who treated me completely differently than I had been treated before, even when I thought I was being respected. It was a different feeling in my body, and it was very illuminating, because then I realized, oh, my God, my entire life, I have never been treated with actual respect over my, you know, my health care. But the second thing that occurs to me is, similarly, in the sort of — like, you don't know when you don't know — is like, the fact that a human rights framework exists for birth. That people have the right to their own bodies, to autonomy, to respect and to dignity and to consent and to refusal. The fact that — it isn't true that you just throw yourself in a system and you get on a conveyor belt and you just kind of lay there like a bug on your back, and they do whatever they want to you. You still do own your body in those — in that context — even though, you know, there are many ways in which that will be challenged. But if you aren't oriented to the fact that you do deserve to be treated in that way, it's just really easy to not be treated in that way, like — it — the default setting, learning will be not treated in that way. And so I am very passionate about people, and especially women, owning and standing on the idea that they deserve great care and they deserve to be treated with respect. One of the things that I find really triggering that has been said to me — and I'll close on this thought — over all of these years, is that women — birthing people — should lower their expectations when it comes to maternity care. And I just absolutely, wholeheartedly reject the idea that we should lower our expectations. They are already really low, and we are treated as such. And that is the thing that I want people to, I guess, sort of embrace — is: have high expectations. Go for it. Manifest. That actually — editor, take that out. I don't want to use that word.

Britta Bushnell: So Chris, pause. Cut out the word manifest. We're going to pick that one back up.

Cristen Pascucci: Okay, um, do I — imagine one, yeah, yes. Imagine those high expectations, and go out and find that, as — as you know, as good as you can, as close as you can get. Go after that, and don't, don't settle.

Britta Bushnell: Nice. So you're leaving us with — you know what respect feels like, go for it, and don't lower your expectations. Know what you want. Yeah? Yeah, yeah.

Outro

Britta Bushnell: Thank you, Cristen. 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 Cristen — with all this wisdom and guidance — thank you so much for joining us. And with our exhale, I'm going to blow out our candle. Until next time, bye, friends.