Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom. of the show notes. 


Nathan: Thank you. Thank you. 


Trish: So excited. So we're going to be talking about a lot of different things. Like I feel like we're going to cover like I'm, and I'm sure I'm going to have so many questions pop up for you because as a labor nurse, like I don't meet, I've actually had a really awesome conversation with a home birth doctor in North Carolina. 


You may know who I'm talking about. I cannot think of his name right now. 


Nathan: David Hayes. Yeah. 


Trish: Yes. Yes. I had, and we'll get to that in a second. I'll tell you why I talked to him, but go ahead and tell everyone about you and like, how did you end up on that path? 


And we're going to live forever and every baby's going to live and every person's going to have the dream birth. And of course, that's not true because the more bursts that you go to, and I know I noticed on your website that you've been, you were a labor and delivery nurse for 16 years. It doesn't take even a whole year to realize just how limited that reductive view of the human body how limited that is in service to childbirth. 


I went in thinking, wow, this is the ultimate curiosity for me as a man. I'm never gonna be pregnant, I'm never gonna have a period, I'm never gonna have a baby, I'm never gonna breastfeed I'm never gonna do those things. And this to me was like the ultimate intellectual curiosity for somebody who's been incentivized to be curious his whole life. 


And I started supporting midwives around the country who based on their state needed a supervising doctor, as they call it, or a delegated authority, like those types of things. And I, was really picking up on this whole what we would consider a gambit of attending home births. But truthfully, at the end of the day, what I was being, seeing modeled in midwifery care outside of the hospital and through people like David Hayes and Stu Fishbein and some of these other, rebel people. 


renegade OBs who are now later in their career. What they were modeling was actually like a patient centered approach, right? So the midwives and the outside of the hospital, doctors, et cetera, were doing this in the way that I thought it was supposed to be done. And I just naturally found my way there instead of giving up the whole profession and just doing end of life care, which is my other board specialty. 


And that's working out very well for me. Because informed consent is the nearest and dearest thing to my heart and empowering people with education and support is the only way forward as opposed to throwing more medicine and technology. Guess we can start there. 


Trish: Yeah. It's funny because I start all of my masterclasses or free classes. 


with one statement, which is birth is a natural process. And I, I wouldn't I became a nurse to be a labor nurse. That was it. I didn't want to be a midwife because I had my own children and I wanted, I didn't want my time to be like, yeah. And I knew I wouldn't be a midwife who'd be inducing people and all of that. 


I don't think people really understand informed consent because, going to that, because in the system we have, we're just taught that they say it, we do it. And they know, they, they know so much. You know your body, this is your body like, I wanted to start out today actually talking about informed consent, and I'd love to let's just take it wherever you feel like it needs to go. 


Nathan: I think the only starting point is to really understand where abstinence is. TE and Gynecology came from, and I'm not gonna go to the Flexner report in the way that people expect me to go. I'm gonna go back further. And I'm not gonna go back to ancient Sumer, which is what I've done in other conversations. 


And with a vesicovaginal fistula, which is a channel that shouldn't be there between the bladder and the vagina, you would have like persistent chronic leakage of urine for the rest of your life. And so there's a lot of morbidity with that. The issue was that we didn't yet have our ethics committees and our institutional review board. 


And we can also argue that perhaps the way that this unfolded led to quite a bit of good for humanity. We could argue that. However, at the time, Sims in his own writing argues that they gave complete consent to these procedures, and they were desperate for my help. And so I offered them a solution, and I found the solution. 


Big fucking deal. That's what he would argue. The problem with that argument is that you cannot provide informed consent if you don't also have the right to refuse it. So in a hospital setting, a hundred, whatever, 70 years later, you either have this thing or I fire you is one scenario. If you don't do this, your baby will die is another scenario. 


Trish: No, it's just, I'm literally tearing up to hear a doctor admit these things. 


Nathan: Yeah. 


Trish: That, it's very unusual. I started Labor Nurse Mama it really was because I am so passionate about women understanding their rights and to have the, like you said, have a choice. 


It's a choice. my students have said to me, you lay it out like a smorgasbord, and then we get to pick and choose, and you support us in what we choose. And if I had a dollar for every time I've heard some of the exact things you've just said, or my students have come to me, yeah, it would be super rich. 


And I remember when I first started, I was like, did he really, or did she really just say that? And the sad thing is, and I call them medwives, the medwives also do that. Those are not the only options. Like, how about I fire your ass? How about that? 


Fine. I guess we can make that argument. On the other hand, imagine how much pain these young women are in, and we don't even know their names. Like the father of gynecology is given credit for the sacrifice made by these women who, who quite literally, they opened themselves up to traumatization, even if it was going to fix their problem with no anesthesia to do a very intensive vaginal sort of repair. 


So when we look again, we jumped forward 170 years, we would say, Oh my gosh, things were so bad back then. How many times did somebody like me walk into a and force his hand inside of a woman, which is extremely uncomfortable. Let alone painful, let alone maybe reopening some past trauma from their own life. 


Trish: bed. I ask the partner. They go up the bed. 


Nathan: Yeah. They crawl up the bed and I just. Follow them and I force my hand inside of them. This is what is happening in hospitals and for people to like, to say, oh, using words like rape and obstetric violence that's not kosher fuck off. 


You have no idea how much pain we are causing in the medical system. And it's not just people like me. It's also people like you. it's 


Trish: all of us. I've had to go back to the beginning of my career And throughout my career I was taught to say that and I didn't even question it. 


I didn't even think about it. I can definitely say and being like someone who has had sexual abuse touch my family and me and just about every woman I know, I know that I've ne I can 100% say that I never forced a cervical exam. 'cause I've never really believed in them all that much. So that's something I ha Yeah. 


Do you have a, do you have a thought on how you want to push? , there's just so many layers. This is, I feel like this is going to be such an emotional episode because Another thing about my birth courses is that I do weekly coaching. I have doulas on my team and we meet with my students every week. 


We do what we call it the happy hour. And then part of my classes, we have a membership. It's pregnancy postpartum. And then we meet with our postpartum mamas every Thursday. And then I go live with them throughout the week. And we had just an impromptu live zoom hangout last week. And there were nine of us on there. 


It's all over. But I do agree. It's got to change. Like, how do we change it? That what do we do? What do we do to change this? How do we make it where if a woman is saying no or screaming or crawling up the bed, we stop? 


Nathan: worst part of this is that it's not, just for those, 20 to 30 percent of women who experienced some sort of sexual abuse because now we, they didn't have a sexual abuse. 


I think we need to get there. If our goal is to have a living baby after this, I don't want people to be afraid. So the next question, like you said, is what do we do? I don't have the answer for that yet, but in some ways I feel like, programs like yours, my practice and the way that I've supported midwives and community members through my own programs is modeling what real safety looks like. 


And it, it starts actually with just putting the person you're here to care for at the center, our hospitals have economic boundaries, they have medical legal boundaries, they have administrative boundaries. There are some important. financial reasons for the ways that hospitals work. And we have doctors that are being brought up with without any incentives to appreciate the immeasurable facets of what medicine means, which is allopathic medicine is the only one. 


If I were to ask you about your birth, you might tell me a good story and I can really glean a lot about who Trish is and where she's been by hearing that story. And of course we've lost storytelling because we have seven minutes with our clients in the prenatal clinics. But as a thought experiment, if I were to sit and just have you unpack, you said you have three kids, right? 


Seven. Oh, my God. You have seven kids. Holy shit. Okay. Yeah. We'd be there for a whole week at around the camp from there. And you'd be telling me every little vivid detail. And there's two parts of that. First, you have to feel safe to tell me and I have to be willing to listen and listening requires presence and nobody is perfect. 


or guess what my white count was or you know what my hemoglobin was after that or guess what the fetal heart tone was it was like 155 isn't that a great no they would be telling me all of these other things over that week that you're telling me about seven different births they would tell me everything about the experience none of which is measurable in the means that my five hundred thousand dollar education taught me to be present with taught me to listen so we have a pickle here we have a philosophical difference in what our clients, these birthing families mean. 


So we have this socioeconomic issue. We have a, an equity issue. And then of course, if you thread in some other elements And not just insurance, but we also have this tendency to treat people of different skin color, different creed, different race, different, spiritual beliefs. 


differently from our own. It's just a part of the human experience. But with a hospital system that has for the past, since J. Marion Sims, even before that, we have seen, let's say black women as, inferior to us as white people. It doesn't matter if you agree with that or not. 


David Hayes is doing some births, Stu Fishbein is doing some births. There's very few of us. So anyways, with all of this being said, I think people are starting to leave the system because they don't feel like. Any longer compelled to try to change the system from within as a physician, I'm very replaceable as a midwife. 


I'm very replaceable as a labor and delivery nurse. I'm definitely replaceable. I've seen it happen over and over. As soon as you put your neck out there, you just get shot at first thing. You're the easy kind of low hanging fruit. And then that keeps everybody else in line. So I don't know what the answer is, but I think modeling what actual. 


patient centered or client centered birth support looks like is, I think we're there. 


And it's wait a minute, stop, hold up for a second here this is her baby. This is hers, not ours, hers, but that's a whole nother conversation. So yeah, there's just so much here and I really wish I don't want my daughters to go through any of this and I would like to hope they wouldn't because they've listened to me on the sidelines for so long, and I love birth. 


And she, her doctor wanted to break her what, or her midwife wanted to break her water. She was in the tub. laboring fine, pretty fast labor for a first baby. And she put her finger up and she said nothing out of curiosity or convenience. And her midwife was like, okay, I won't. And of course her water broke on its own. 


She delivered. She had a beautiful delivery. She went home four hours later. Like why? Like just step back, like step back and let birth happen. Like it's, I do, I am 100 percent like. Obviously, I appreciate your knowledge, I appreciate my knowledge and my ability to step in when I'm needed. I do appreciate that, I appreciate my education, but I also think that a lot of the things that we see when they need us is because of us. 


So you know how we're like, we get out of med school and we're like, fuck, I'm supposed to be doing the job doctor thing now. Like we're never called doctor before that first day in residency. And we have a white coat that says it there. And we're supposed to start acting like we know what we're doing. 


And we lean on you guys for quite a bit. Now, most of the labor and delivery nurses are doing things based on a protocol that is a part of a package to keep women and babies safe. So nobody's going to argue with the value of having protocols, but the issue is. That you spend that first year or two in residency. 


Okay. C section. Here's how you do a C section. Rupture of membranes, cervical ripening, list them all out. And then after you learn what can be done. A natural question for anybody, labor and delivery nurse, certified nurse midwife, regular midwife, whatever, doctor especially, start asking yourself, which of these interventions is absolutely necessary for this woman to come in, feel taken care of, have her baby, and go home with her baby as soon as possible afterwards. 


That list gets very small. The number of true hemorrhages that I've, managed is maybe like a hundred real hemorrhages. And that sounds like a lot, but when you've done this so many times, a hundred is like a small number, right? We're talking maybe like under, under 5%. I'll just throw that number out. 


I'm contributing to the problem. And I was able to recognize, I'm not tooting my horn here, but I realized, holy shit, that did not have to end in C section. Oh my God, that one ended in C section and then she lost her uterus. Oh my God, that one went to C section and the baby was nicked with a knife. Oh my God, this one resulted in the baby struggling with transition, right? 


A bunch of women's and baby's heads aren't just popping off left and right. In fact, they're actually having a nice, easy transition into motherhood or parenthood for the father, and they're able to go home with their baby and start the hard work, which really is after the fact. But if we've traumatized your abdomen and your uterus and your whole being with these various interventions and not talking to you or educating you or supporting you or putting you like bearing witness to what you're going through the whole time, then that postpartum recovery, when we say we did a good job, bye. 


It actually becomes even harder. So the medical interventions are sometimes beneficial, but more often harmful, it seems, if we can be honest with ourselves and state right now that most of the C sections that you do are probably not indicated. Most of the inductions you're doing aren't indicated. 


Most of these other things aren't indicated. 


And I'm sure you're going to understand this, and this is why I do my weekly coaching with my moms. Because I can unpack a birth story and see where it went wrong. When, so that it's not repeated for them. So she had two terrible, this is her, two horrible postpartum hemorrhages. And it was just so horrible and all of this. 


My first questions was tell me about your birth. Were you induced? Yes. And it's I, so we were talking about this current baby and I was like, send me a DM. I would love to talk to you. I said, let's keep you from getting induced this time. And she's like, Oh, really? 


When I was in my postpartum period, and I'm sure you know this with your wife, she's not hanging out with other moms in that same period because they're all trying, you're trying to nurture your baby. And if you do hang out with another mom, you don't go deep talking about what you're feeling. And you may make some jokes or whatever, but you're tending to your baby. 


So I started the postpartum hangouts because I love my mom so much, and I didn't want them to go. Like I've bonded with them. And. That's how I've, learned so much more about my role as a labor nurse, and about what these moms, and how they're processing what was said to them, how no one's, like you said, no one's communicating to them. 


Nathan: Let's talk about that. 


This is really important for people to appreciate. We're not just talking episiotomies and emergency c sections. By the way, Trish, what was the last, like, how many real emergency c sections do you think you were a part of? 


Trish: Oh. And it 


Nathan: could be a big number. 


Trish: Real, maybe a hundred over the course of 16 years, like really emergent. 


And 


Nathan: how often do you hear, I had to have an emergency c section? Oh, 


Trish: so often, but I do I do think that in that, I think, again, sometimes that's lack of communication because when you have people running in, flipping you over, changing your ID, putting oxygen masks, all those things, but I've also had students who say they had an emergency C section, but it was called and not completed for a couple hours. 


The student nurse accidentally opened up the Pitocin instead of the IV fluids to prep the girl for her epidural, which did not end, they were, it didn't, and it was traumatic, all of it. Baby was fine, at least in the labor room. I don't know what happened after, but, The thing that stood out to me a lot is no one was talking to the family. 


No one was talking to the mom. They were all rushing in. And I just hugged the patient's mom was in the room and it was terrifying. The whole situation for me as a nurse or a student, it was terrifying. But I just, held the mom. And I saw that family again later. I didn't, you know how you see a patient somewhere out and you're like, who are you? 


I barely knew what they were doing, but she appreciated that. But yes, back to not many. I've seen a lot of very stupid reasons. And I have so many theories and most of the time people don't back me up on this. I'm really happy that you're here because I've talked to they say, is it one in 10 women end up in the OR for failure progress? 


And I call that failure for the staff to do their dang job. I, let's really go back. Like all of these stats out there I think are so inaccurate about all of it. Yeah, you 


I'm not doing that intentionally. They just got a hell of a name for their program. 


Trish: Yeah, they branded. 


Nathan: Yeah, very well branded. Evidence based medicine, if applied to birth, could look like, if it's published in a peer reviewed journal, then it's relevant. But evidence comes in a variety of forms. 


Trish Ware has 16 years of labor and delivery experience and therefore knows how maybe getting her moved in different positions is going to help facilitate birth. If Trish Ware was compared to a first year out of nursing school nurse, and their statistics were compared, they would look very different. 


Big difference there. So clinician experience, peer reviewed, journal, whatever, contributions, and then we also have the client's values, story, perceptions, and whatever. Those three legs comprise the chair that is evidence based medicine. And this is not a knock on evidence based birth, but if we're only interested in the data, we are fucked because we have so much data pouring out of our ass. 


It is helpful as a guide post when we need really sound insights on a randomized control trial as to what to do with a pharmaceutical or whatever. But there's so many immeasurable facets that are not even taken into account in the medical literature when it comes to childbirth. And given the various variables that play into this experience for both the birth worker as well as the client, we can't rely entirely on that. 


But we see this come through with things like VBAC and trial labor after c section. It's you're not the average, you're a human being. It's not the same. It's not going to dictate, it's not fatalistically dictating what's going to happen to you, but we use this to justify everything around c sections. 


And That really could stop, like that's something we could just stop right now. 


And in that, I didn't have, I had no plan at all to create a VBAC birth course, which I tell them all the time, you're just like my mom's in comm labor, the VBAC lab, same thing. And I just need to give you extra special care because you're going to navigate a lot of BS. So you're, that's just how it's going to be. 


And so the nurse laid the vacuum next to her face to show her, like threatening her. She ended up in the, in a cesarean because she couldn't push right. And I was like how did they have you pushing? They did nothing with her. They had her pushing in stirrups, but. that she ended up in a C section. You and I both know she did not need in a C section. 


She wasn't pushing in the time limit, but she also wasn't being helped. No one was helping her with positions or anything. But there, that, all of that led to the birth of the VBAC Lab because I just was so blown away. I also have to say that I also, as a travel nurse, I did mostly travel nurse for the majority. 


That's why I said when we were talking before, like a woman's body is the same. Wow. If she can eat and labor on the West Coast, I bet she could eat and labor on the East Coast. And I learned so much. It was a four week assignment just to get my feet wet. I learned so much and I actually came home and put in my resignation, my job here because I was like, I'm not going to lose my, cause you're right. 


I will lose my license. Not them, and I couldn't do it. I couldn't participate in it anymore. It was horrible the whole yeah And so and then I spent the rest of my career mostly on the west coast, which is better It's still not there, but it is better than the east coast. 


And I ended up ranking them last, I think, because one of them, I didn't even rank. I won't mention them by name, but that hospital was like, so felt like I was walking into a toxic waste dump. Like it was like, you guys are just. Assholes, like it's just nuts. 


Trish: I did an assignment like that actually in California. 


Nathan: Yeah. Yeah. I want to, since we brought up the VBAC thing, I want to, for people that are listening, I want people to appreciate what I'm saying here, if I may. There's a plain, there's a lot of plain communities around Kentucky where I live and there is a, One of the midwives. 


There's me and there's this other person. I want to support this lady. The my, my partner's not comfortable with it. This lady is in her like 12th pregnancy and she'd had a couple of miscarriages, but she'd otherwise had eight babies before. And the first three pregnancies were C section. We have to check our premises every step of the way when we talk about this. 


But why was that first C section done? Because was it breach? Was it failure to progress? Abnormal fetal heart rate tracing, whatever, probably wasn't necessary. But then, of course, that sets them up in many hospitals for a very limited approach to trial of labor, right? They end up with another C section, scheduled repeat. 


Fifth pregnancy, home birth. Sixth pregnancy, home birth. Seventh pregnancy, home birth. You see where I'm going with this. She's now pregnant with her eighth baby. And granted, like I said, she had a lot of pregnancies, some of them were miscarriages, that's a part of the deal. But she'd had four C sections, four home births, and now she's pregnant again, wanting to have a home birth. 


And this midwife calling me, her partner was not comfortable because of the risk of rupture. Now, first off, what data do we actually have of the C section? for a person who's had four home births after four c sections, one of which was a classical. We don't even have a lot of data on a classical incision at risk of rupture. 


On the other hand, this person's experience has told us that however she's nourishing herself whatever the circumstances, she is able to have a vaginal birth after c section and her risk should be reasonably considered less because for whatever reason her uterus does not rupture, at least in those four. 


Does it guarantee it's not going to rupture? Of course not. And we counsel based on this possibility that there's still a possibility of rupture and we got to get to the hospital right away. But her story is actually a part of the counseling. It's a part of evidence based birth and I don't hear anybody saying 


Trish: this. 


Nathan: Just put a box around them. And then if you go outside the box, the nurse is going to get fired. The doctor might lose his privileges. The client might, their fucking head might explode. I don't know what we expect to happen, but stay in the box and everything will be okay. 


But when you stay in the box, you could even experience trauma at the hands of a nurse and a doctor, even if you have a physiologic or undisturbed or whatever type of birth in the hospital. So this is a real pickle. This is a real pickle that we find ourselves in. And 


Trish: for those of you guys listening. 


Nathan said earlier, we don't want you to be scared. It's about being informed and knowing your power. You really do have the power. And what I've found a lot of the times is that the majority of these doctors and nurses, and I actually have a section where I teach them on communication with their provider. 


Nathan: Saying no thank you. Yeah. It goes a long way, but it's very hard. 


Trish: Yeah. Yeah. And so that's part of my framework for my classes and, what I show them is that you have to have the knowledge. The knowledge is power. Then you have to have the right mindset. That's the other part, but the third part is being willing to speak up because you can have those other two things. 


But if you're too scared, if you just sit there and say, okay, because you're not willing to say, Hey, no wait, I know that this is not true. Then you're in it. the knowledge and the mindset doesn't matter anymore. They have to have the ability to speak up. And again, this is why I meet with them every week, because they could take my course and be like, hell yeah, I can do it. 


They, their head didn't pop off. Like it actually worked, so that's part of why and I've had a lot of people like, Oh my gosh, that's so much. I don't charge more for my birth classes. Everyone who buys them gets the weekly coaching. We do charge a little more for our, we charge 19 a month for the membership, which is nothing. 


But through that, like I said in the beginning, I have been blown away. by the things that are said. And I wish I had a copy of I'll ask Emily if I can send you a copy of the letter she sent to the person who did her repeat C section. She wanted to have a V back. I don't remember now exactly the details of why she didn't. 


But, The doctor came, was so awful to her, and he came into her, the, she started bleeding in the PACU. The nurse called her in, and he said something, and I'm probably misquoting this completely, but he said something like, I'm going to have to big, put my big fat effing hand inside Her or something like that. 


Like she did speak up throughout too, but it was. It wasn't like all the horrible things he did and said, but she really called him out on, Hey, I understand I needed to have a repeat C section, but that was still my birth experience. And you could have made it a joyful, pleasant experience. And it was like, oh my gosh. 


And she the way she wrote it out, like we were all weeping listening to her. But it's, I could just go off on so many tangents, which everybody who listens to my podcast knows we do. That's how we roll. 


So it's so good that you're preparing people from the very beginning. And when I tell people, it's listen, if you can't say no to your husband in a respectful way, that doesn't rupture your relationship when they want to have sex and you're not feeling in the mood, like that might be a good place to start just something right there or friend. 


When I go out, once you got the movies, just no, thank you. I feel like I'm going to, I just feel better staying in today. Like we don't even do that as men, even like we don't really do that. We're not comfortable voicing our. Or declining invitations to do things. The other thing is that there's this notion that you can get a birth plan notarized and that makes it somehow valid. 


It's baloney. Notarization does I 


Trish: don't think I've ever heard of that. 


Trish: Yeah, that I've not heard. That's the first one. I 


Nathan: do a lot of training programs and whatnot that I'm hearing this because I've taken a lot of courses myself, but I just 


Trish: don't even understand what they think that would accomplish. I don't 


Nathan: know. Like 


Trish: The rude the problem is way bigger than someone knowing you actually signed that document. 


Oh, it's 


Meaning that if you actually do need the hospital, thank God it's there, but you may even feel like less compelled by your providers to do the inductions, to do the, to the NSTs, to do the growth ultrasounds, to do all the stuff, the vaccines, the hepatitis B, the whatever, if you are as healthy as you possibly can be. 


And taking birth out of the conversation, because still 98 plus percent of women are giving birth in the hospitals. That's just going to be a statistic we have to deal with while I am not telling everybody to go out and have a home birth. What I am saying is that. When you end up in the hospital, these doctors and labor and delivery nurses have a very low threshold to intervene. 


I'm not, never going to have a baby. So I can't say I'm an expert in childbirth even, but if you can make yourself as healthy as possible, even take childbirth out of it, the hospital system is going to have to change in order to keep up a market for their services. And they're relying on you to not stay healthy. 


So of course, this is not going to be, it's not possible for every person to go to Whole Foods to get all of their groceries or to buy a CrossFit membership or whatever. That's not even my point. My point is, is that if you have resources. And you want to invest it in your health for the long term, in the health of your baby, do your very best to take care of yourself and make yourself so healthy that the system at large is obsolete. 


You are the consumer. And if you are a sick person, there is a sick person specialist. Keeper. Yeah. Yeah. If you're a healthy person, you have options and you don't necessarily need to accept all of these protocolized ways of doing things, especially in childbirth, because you are not average. You are way above average and your risks are way below average. 


Trish: Yeah. I love that so much. It's funny because even I, I get questioned about talk about tearing and they people want this big complicate. I'm like, eat healthy, stay hydrated, work on your pelvic floor. Yeah. Yeah. Thank you so much for coming today. Can, I know you've got to go to your appointment, but can you share with everyone where they can find you? 


That's Nathan Riley of EGYN. So thank you again for having me, Trish. It's a real honor. 


Trish: Thank you. 


Hey, mamas. I hope you enjoyed this episode. Wow. This was a really powerful and validating, so you guys know that what I've been telling you is so important. It's so true. We've got to change the birth culture. We just have to. We don't have a choice. We have to do it for you. We have to do it for your daughters.