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Who delivered your baby? | Ashley Greenwald Tragash | TEDxUniversityofNevada
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Translator: Madison Shirley Reviewer: Hélène Vernet
There is a difference between something that you do
and something that is done for you.
My phone rings at two in the afternoon: it's Mike.
"Erin's contractions have started coming every three to five minutes,
and we're ready to head to the hospital," he says.
I hurry to meet them,
just in time to wheel Erin up to Labor and Delivery.
The room is a rush with nurses,
and Erin stands next to the hospital bed, clutching onto my hand.
She's working hard through the contractions.
As a contraction breaks,
Erin has just enough time to whisper to me,
"Ashley, I don't know if I can do this,"
(Laughter)
before the next one comes over her.
I gently take her face with both of my hands,
look her straight in the eye, and say,
"You are already doing this.
Mike and I are right here with you, we both know you can do this."
In the past six years,
I have had the extreme pleasure to witness over a hundred babies being born.
I am a doctor, but I'm not a medical one.
I'm a behavioral psychologist,
and a very passionate doula that studies the behavior of birth.
You may be thinking, "What is a doula?"
and you're not alone in that thought.
A doula is a trained childbirth professional
that provides physical and emotional support to women,
either at home or in the hospital.
Unfortunately, only about five percent of women in the U.S. use doulas today.
So, join me for a moment on a journey of making a person.
Pregnancy is miraculous.
It's romantic, it's spiritual.
Women's bodies grow and change,
and they get to eat all the ice cream they want with no shame.
(Laughter)
It is downright amazing
that a woman's body knows how to grow a baby.
But somehow when it comes to giving birth to that baby,
our society no longer trusts women.
Instead, we insist that an expert take control and deliver the baby.
Why is this?
Historically, women gave birth in a squatting position,
surrounded by other women.
Birth is not easy, nor has it ever been, but women were well supported.
They moved, ate, drank, danced, swayed
and stayed in upright positions.
But most importantly, they trusted their intuition.
They knew how to give birth.
Midwives or experienced medical birth professionals,
oversaw almost all birth.
And birth usually occurred in the home setting.
So, what has changed and why does it matter?
Let's consider the question "Who delivered your baby?"
A seemingly harmless question that is commonly asked to women.
Someone other than the woman herself delivered her baby.
Think about that for a moment.
The power of birth has been taken away from the woman,
her intuition interrupted.
And her birth experience has been put into the hands of medical personnel.
Of course, when we consider why birth practices have evolved over time
the simple response is safety.
I hear this statement all the time,
"What matters most is a healthy mom and a healthy baby."
But what exactly do we mean by "healthy"?
Birth is not only physical,
but it is extremely emotional for everyone involved.
Consider that you may not remember
your first day of work at your current job.
You may not even remember the day that you graduated high school.
But for both mothers and fathers,
you'll certainly always remember the day that your baby was born.
And you will remember it in detail.
Consider too, that everything in nature has a purpose.
When we interfere with a woman's ability to give birth to her baby,
we very well may be interfering
with her ability and confidence to raise that baby.
So when we ask ourselves: "What is most important about birth?"
we need to consider not just the physical, but also the emotional.
Let me back up and share the rest of Erin and Mike's birth story.
When I first met the two of them,
we were sitting around a table at a coffee shop.
"Tell me why you want to hire a doula," I asked.
Erin shyly looked at me and said,
"I want to have a better birth experience than my previous two births."
As she elaborated, I quickly learned
that she had wanted to have a natural birth for both of her babies.
Both times she went to the hospital, was forced to lay in bed against her will,
and was given no other options for support or pain relief.
With no choices, Erin didn't think she could make it through the process,
not the first time, nor the second.
Both times, she left feeling disempowered,
discouraged,
and dissatisfied.
Like many women sadly do,
she used the word "traumatic" to describe her birth.
Erin's husband, Mike, went on to explain that following both births,
Erin had suffered from significant postpartum depression,
and he couldn't bear to see his wife go through that again.
They needed to do it differently this time.
Fast forward five months:
beeping machines surround them,
nurses are coming quickly in and out of the hospital room.
"Ashley, I don't know if I can do this."
Erin is softly crying now, and her body is trembling.
I know that look of despair quite well and I know it means that she is so close.
"You are already doing this.
Mike and I are right here with you. We both know you can do this."
Not more than ten minutes later, Erin has an extreme urge to push.
Erin is standing on one side of the narrow hospital bed,
and I'm standing directly across from her on the other.
Erin reaches up and puts her arms around my neck, and I embrace her body in a hug.
She buries her face into my shoulder.
With the help of gravity and just two strong pushes,
Erin roars her baby into the combined hands
of her loving husband and her nurse midwife
who had been standing beside her, patiently waiting.
The baby is passed up to Erin and placed on the bed before her.
She cries out, "Oh my god, I did it."
"It's a boy!
I did it!"
When I spoke with Erin after the birth,
the only word she could find to describe the experience was "perfect".
Following two previous traumatic births,
and significant stints of postpartum depression,
this empowered couple had delivered their baby exactly as they had wished.
As is with Erin and Mike, it's not unusual for a family to say to me,
"I couldn't have done it without you,"
but really, Erin did all of the work.
All I did was provide physical and emotional guidance.
So yes, I may have rubbed her back. And yes, I may have held her hand.
But really, my most important role was to be a calm presence,
and to remind her of her own ability to deliver her baby.
Animals in the wild deliver their own babies all the time.
Imagine an elephant, perhaps giving birth.
The elephant seeks shelter and support away from unknown animals.
In this protected environment, the animal allows her body to give birth,
just like she would allow any other physiological process.
We might say that she instinctively knows what to do.
Imagine now that we take that pregnant elephant
and we treat her the way that we treat humans during labor.
The elephant goes into labor, is instructed to go to the hospital,
(Laughter)
is told to lay flat on her back in a labor bed,
has an IV with fluids,
contraction monitor strapped to her belly,
nurses coming in and out doing blood samples, cervical exams.
This sounds so bizarre and hilarious
when I think about an elephant having a cervical exam.
But this is exactly how 95% of women in the U.S. give birth today.
Because the routine practices of the medical model
interfere with this natural process,
this elephant would likely require pain management, an epidural,
because she can't move to help her body feel better;
labor augmentation drugs such as Pitocin,
because she is filled with fight or flight adrenaline that interferes
with the natural production of oxytocin, or the labor hormone.
And quite possibly surgery to deliver her calf,
because she can no longer effectively feel her body to push.
Now I know that we're talking about elephants,
and that may not be a perfect metaphor for humans,
but imagine if that human had happened upon an elephant in the wild.
The human would most certainly hang back, quietly observe,
and only intervene if absolutely necessary.
So I ask you, why should we treat humans any different?
Because the medical model takes the approach of birth as pathological
and something that needs to be medically managed.
Couples rely on medical expertise to deliver their baby.
Doctors become authority figures.
The natural process is interfered with.
Women don't trust their bodies, and partners go in underprepared,
resulting in doctors delivering babies instead of mothers.
Think about this:
Women are instructed to go nine months without ingesting certain food chemicals
and without taking medication.
But somehow, in the final moments before her baby is born,
it is okay for a woman to routinely load up
on heavy narcotics and artificial hormones,
all of which have significant side effects for mom and baby.
This chain of medicalized behaviors in the U.S.
has contributed to the dramatic increase
in the number of Caesarean section births in our country.
Worse than that, the U.S. maternal mortality rate is steadily climbing,
and is amongst the highest of all other developed nations.
If we want to improve our maternity practices,
we need to put an end to the over-medicalization of childbirth.
Women should be taught
that there are other options to pain relief,
rather than the routine use of an epidural.
Evidence-based strategies for reducing pain and enhancing coping in labor
such as movement,
massage,
meditation,
hydrotherapy,
should be regularly used and supported in hospitals.
Medical intervention should be saved for medical necessity.
Finally, we need to change the way in which our society views birth.
Birth should be seen as a dance between mom and baby,
requiring movement and an environment that supports that type of behavior.
Imagine what birth could look like if we thought of birth
from the perspective of accomplishment and empowerment,
rather than pain and suffering, and something that requires medication.
So, why does all of this matter?
My intention today is not to convince you
that doctors are bad or that hospitals are scary,
because we all know that modern medicine certainly saves lives during childbirth.
My intention today is not to convince you to have a natural childbirth
because I firmly believe that women should have a choice.
My intention today is to share with you the idea that childbirth matters,
physically and emotionally.
And we should be encouraging women to be active participants in their births.
Whether a woman delivers her baby through a Caesarean section,
or with or without pain medication,
she should walk away from the experience just like Erin, saying, "I did it!"
I've had the good fortune to study childbirth in the U.S. and abroad.
And I'm here today to tell you that we can practice safe childbirth,
under medical guidance,
while promoting healthier moms and healthier babies.
In the United States alone, over 10,000 women will give birth today.
Let me ask you a question:
Who should deliver those babies?
(Applause)
(Cheering)
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