Birth Matters Podcast, Ep 124 - Rachel’s VBA2C: A Black Mother and Advocate’s Path to Doula Work

In this episode, Rachel, a mother of three boys, a doula, and a passionate advocate for maternal health shares her transformative journey through her three pregnancies and births. She details the challenges of her first traumatic C-section, the struggle and acceptance of her second scheduled C-section, and then her victorious vaginal birth after 2 cesareans with her third baby. We discuss the systemic biases and disparities in healthcare, particularly for Black birthing people, and the importance of trusting one's intuition and seeking supportive providers. Rachel's experience led her to become a doula and an advocate, where she continues to support and educate families. This episode is a testament to resilience, empowerment, and the critical need for improved maternal health practices.

Resources:

Interested in getting involved in political action to effect positive change for birthing families in the NYC area? Learn more or join the Movement to Birth Liberation.

Listen to this birth equity podcast with Dr. Neel Shah and this panel on improving Black Maternal Health outcomes.

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Episode Topics:

  • Rachel's Background and Passion for Maternal Health

  • First Birth Experience: Challenges and Lessons

  • Second Birth Experience: Scheduled C-Section

  • Discovering VBAC and Advocacy

  • Third Pregnancy: Seeking a VBAC

  • Finding the Right Support and Provider

  • Achieving a Successful VBAC

  • The Importance of Educating Yourself and Pushing Back

  • Becoming a Doula: A Journey of Advocacy

  • The Impact of Advocacy on Maternal Health

  • Finding Your Voice and Transforming Your Life

  • Challenges in Black Maternal Health

  • The Role of Mental Health in Maternal Care

  • Advice for Expecting Mothers and Doula Clients

  • Conclusion and Future Advocacy Efforts

Interview Transcript

Lisa: Today I have with me Rachel. Hi, Rachel. Welcome.

Rachel: Hi, Lisa. Thank you for having me. Good morning.

Lisa: Good morning. Could you please just start by introducing yourself a little bit more to the listeners?

Rachel's Background and Passion for Maternal Health

Rachel: Okay. So my name is Rachel. I am a wife. I am a mother of three boys. I am a doula.

I am a doula. I'm obsessed with all things maternal health. I have my master's in health administration and you know, I just, I've done all things in this space that honestly contribute to everything that, really promotes advocacy and education for families, for mommies, for, you know, partners, for the community, because I don't think it's just unique to the woman who's having a baby, the birthing family.

Like, I think, so many people are involved in that, you know, aspect. So yeah, all the things that I've done from consultancy to education, yeah, that's kind of like my professional scope and how I entered into this space.

Lisa: I love it. And, time permitting, I'd love to hear more about how you became passionate about moving into birth work and everything. Maybe after we hear a little more about your personal stories. and you live out on Long Island, is that right?

Rachel: Yes. Yes, I do. I live on Long Island.

Lisa: Yeah. Yeah. And most of the guests on my podcast are folks I've worked with directly. But you worked with a wonderful dear friend of mine, Chana, as she was your doula. Although I don't know actually if she was your doula for all three or just one, or you'll let us know that.

First Birth Experience: Challenges and Lessons

Rachel: Yeah. Chana was my doula for my last, I actually did not have a doula prior. My first birth experience, you know, admittedly I just wasn't educated a lot. Like I really didn't think anything of birth other than, Oh, I don't want a c section. That's kind of like the only thing I had in my mind somewhere in the back lingering. My pregnancy was very textbook. It was easy. I didn't have any issues. My provider was amazing.

It was a really easy going pregnancy and then, I went into labor and my water broke and I freaked out. I'm like, oh my gosh, my water broke. I have to get to the hospital and I did, but I was still very much so in the early stages of labor. I was only like a centimeter dilated. There really wasn't much contractions at that point.

But the hospital that I delivered at, you know, they were like, Oh, let's get you an epidural because I also was really nauseous and I was vomiting. And so a lot of things were happening at once. And I got a lot of medication. I got things because my blood pressure was kind of low. I got something for my nausea.

They put me on an epidural. So I went from having this amazing pregnancy to entering a really high stress labor environment very quickly. And 13 hours after that, I developed a fever and I just remember my provider saying, okay, we've given you something to bring the fever down, but it won't go down.

So we're going to have to take the baby because it's becoming like a life issue now. And my mother was in the room with me along with my husband. I remember my mother saying, no, she's fine. And he's like, no, we have to go now. I think at that point, my fever was like 104 and so they rushed me into the O. R. And, you know, I was crying, but I couldn't feel my tears because I was numb from the anesthesia. And I remember gasping because I couldn't breathe. And my husband was like, in that moment, he was like, my wife is going to die. Like, I got so worried because I'm watching you gasping.

The anesthesiologist is giving me oxygen. They're pulling his son out, his first child. And he was like, I didn't know which way to direct my energy, my attention. And that was really traumatic, but I didn't realize how traumatic that was until my second pregnancy. I felt like my body failed. I felt like I failed, you know, and my provider said something that stayed with me and it wasn't meant to be diminishing or, you know, shaming me, but he's like, Oh, you know, you're not meant to have a vaginal birth.

Like you're probably one of those women who would have like, don't worry about like, as if to just,

Lisa: Where is that from? Like, where does it come from?

Rachel: Exactly.

Lisa: And so the reason for your C section was not stalled labor, was it? It sounded like it was because of infection.

Rachel: It was because of infection, but he's like, no, you know, you stalled, you barely got to three centimeters, like, no, you know, but honestly I had a lot of medical intervention so early on, you know, and we know that like epidural sometimes can dampen your contractions and, but I don't have any knowledge of this.

So whatever he told me, I believed and I carried that with me.

Second Birth Experience: Scheduled C-Section

So. My second pregnancy, again, pretty textbook, I knew of VBACs, right? I didn't know much. And again, education is key. I didn't really take the time to consider how I could advocate for myself. I believed everything I was told. I was super compliant.

And so I remember saying, Oh, could I have a VBAC? And you know, he's like, no, no, no, no, no. I was bigger during this time frame in my life as well. So he's like, Oh, your weight and all the things that we know are not evidence based to indicate why you wouldn't be able to have a vaginal birth, and so again, defeated.

I just went along with it, so I had a scheduled C section, and that was fine, you know, I went in there knowing what to expect, and so it wasn't like, my first experience at all. And I remember crying, like I couldn't explain the feeling, but I just remember feeling so defeated. I felt like, you know, I did something wrong.

I didn't understand why I couldn't have had this experience where I got to bond with my baby. Cause that was the other aspect of it, right? You have this C section, you go into recovery. I wasn't able to have skin to skin. I wasn't able, not that you can't with a C section, but for whatever reason, for me, I didn't experience that with my first two labor and delivery experiences.

So I just remember hearing other women share their stories and just feeling like, wow, like I didn't get that. Like, I don't know what it's like to just have that golden hour, that bonding period. And so I kind of, in my mind was like, well, once a C section, always a C section. I'm not having any more kids. I had two C sections. I'm done. It's fine. But there was always this tug, Lisa, for me to want to know more.

Discovering VBAC and Advocacy

And so I decided to go back to school for my masters. And when I did, you know, we had free range to choose for my capstone assignment, whatever topic we wanted to discuss and I immediately chose, you know, C section rates specifically as they pertain to black women and the wealth of knowledge.

Lisa: Because I don't think you've said this yet, right? But you identify as a black woman.

Rachel: Yes, I identify as a black woman.

Lisa: Since people are listening and not seeing you necessarily.

Rachel: That's true, yes. I identify as a black woman. I present as a black woman. I am definitely black. And so, I think I was unaware of the disparities in health care.

And the I guess implicit biases for women of color. And I was introduced to all of that in my research and the statistics and the data. And so that was healing for me. It was sad to see all of these things happening, but it was like, Oh, so it's not me. You know, there were things that I would read and I'm like, I've been told that, you know, and so in so many ways, you realize you gaslight yourself in a way because I'm always like no I couldn't do this and I was told that and I believed it and you hold on to that shame in your body and it just kind of like creates just like this really defeative mindset.

And so I said, I can't know what I know and not try to share this knowledge. And that was kind of like the first time that I said, I want to enter into this space, but more so for advocacy, right? Advocacy work. And so I started, you know, looking around my area for organizations that do anything with maternal health, and I joined one network, the Women's Diversity Network, their education committee.

And so I was entering in that space and doing all that. I'm sorry. That was actually after my third pregnancy. So I'm going to backtrack. I was looking for organizations, but I hadn't joined Women's Diversity Network yet. So I graduated with my master's a week before the lockdown. I remember thinking to myself,

Okay, so I have this master's and now we're in a pandemic.

My background was in healthcare. I worked at a hospital. I worked in an outpatient unit. And so I had always just intended to just use that to just kind of like further my career in a hospital setting, but not maternal health specifically.

But I realized, once I went into my master's program that that's what I wanted to do, like I specifically wanted to work in the maternal health space. And so the pandemic really gave me an opportunity to consider what that would look like outside of the norm, you know, like a brick and mortar position.

And that's when, I don't think I was really thinking about doula work yet, but I started having conversations with people about, you know, education and non profit organizations and just different ways that you can advocate and speak to some of the things that we're seeing happening for women of color in health care.

Third Pregnancy: Seeking a VBAC

And then I got pregnant. I was like, okay, so that kind of derailed my intention from a professional standpoint. But now I'm like, I have this unique opportunity to defend myself, right? Like advocate for myself, establish my own birth autonomy. And, it was really daunting because I remember going to the same provider who delivered my first two.

And, you know, it was like a breakup. I knew going into that appointment that this was not going to be the provider that I stayed with. Like I just knew, I knew that as amazing as he was, we had different viewpoints. And so I remember discussing with him, you know, what I was looking to do. And he said, no, he was like, why would you want to do that?

Like, no. I said, okay. And I, you know, I went through the appointment and I, I think I made a follow up appointment even though I knew I wasn't going to go back and I cried. I cried so hard because it's like this was the provider that I'd been going to since I was like 19. Right?

Lisa: So quite a relationship.

Rachel: Yeah, it was a relationship. And again, there was nothing wrong with the provider. It was more like we had very different viewpoints on birth. He said to me one time, you know, I trust my skillset as a surgeon. I would never really push for a VBAC because like, why? And so for me, I'm just like, but, you're not a surgeon first, you know, you're an OB, so.

Lisa: Except most OBs really, that is their specialty. Their specialty is like high risk and surgery and many of them never, you probably know this, but many listeners may not, like many OBs have never seen a physiologic birth. Like an unmedicated vaginal birth.

Rachel: They look at that as a unicorn. It's like for them, it's like what, unmedicated, like, you know, that is a big deal.

And I, like, I didn't know that, at the time, you know, and so I think for me, the idea of like birth being managed, it's like, Oh, you guys need to be able to control these parameters. And this is not something, it's not a medical condition. It's not an illness. It's not something to be managed.

Finding the Right Support and Provider

So I left that provider. I shopped around. That's when I was looking for a doula at the same time, because I'm like, this is going to be hard. Like, I'm going to advocate for myself, but I need a birth bestie. Like I need someone that's gonna be there affirming me because this is a lot and I did some research, I interviewed a lot of different doulas and something about my doula, Chana, it just, her energy, her intentionality, it was like, she's the one, like, I just knew.

And one of the things that she said to me, unprompted, as I had shared with her, my prior experiences, she was like, you know, I'm not a Black woman. And she was like, and I don't know what it's like to be unheard or not feel seen in that space in your capacity. Right. But she was like, I will advocate for you as much as you need me to advocate for you.

And I get chills thinking about it. And like, sometimes I get worked up because it's like,

Lisa: I just got chills too.

Rachel: Yeah. It's like, I'm over here, like boohoo crying. We're in a pandemic still, you know. The top of 2021 and there's just a lot of unknowns and to have someone say, listen, you're perfectly fine and you're exactly where you need to be.

And if this is the birth that you desire, you can attain it. There's no reason why. And that just unlocked something for me. Like she was like the battery in my back. So. Once I had her, you know, on board supporting me and preparing me for all scenarios, right? Like, yes, your desire is to have, you know, a TOLAC leading to TOLAC is trial of labor after cesarean for those who don't know, she was just like, yeah, let's do all the things. Let's prepare you for this. And let's prepare you for the possibility of a C section, but on your terms, right? Like, a gentle c section, which I did not know. Like, I didn't know that these are things that you can have even if you have a c section.

So she really kind of affirmed me with that. And so coupled with the knowledge that I had from my education and her, I was like, I'm unstoppable. So I found another provider. Things were great. She was like, Oh my gosh, we're going to put you on track for a VBAC and you know, there's no indication why you couldn't try.

You're young, you're healthy. Well, not the young part, but you know, like she just was like, you're in a good space. I think I, at this point I was like 36. So I'm technically an older, woman having pregnancy by, you know,

Lisa: Geriatric pregnancy.

Rachel: Geriatric pregnancy.

Lisa: Ridiculous medical term.

Rachel: Oh yeah. Society's standards are so crazy.

Mm-hmm. So, you know, everything was going great, things looked good. And then when I was around 26, 27 weeks, I went in and I think there were some issues with like some lab work. so I had some questions about that because I had, like, a little bit of a scare where I was experiencing some pain.

And so I went to the hospital because my provider was not able to see me in office and they couldn't find anything. And then me doing some research, I think it was just like C section scar pain that I was experiencing. So I'm trying to explain this to her. Her back is to me. And I remember just sitting on the table and she's like, like she's listening, but not really listening.

And she turns around, doesn't acknowledge anything that I had said, and goes, are you still trying for a VBAC? And I was like, Yes. And she goes, Yeah, okay, so about that, don't gain any more weight. And I'm like, So, first, you don't acknowledge anything that I'm talking about. Like, nothing that I'm sharing with you.

And she said, Yeah, don't gain any more weight, because, you know, I wouldn't want to not be able to offer you this opportunity, you know, and my position in the hospital, like they don't want me to try. And so her whole standpoint to me just changed. Like I felt like I went in there and she was encouraging and all the things.

And then it's like, yeah, no, you know, don't gain any more weight. And I only gained nine pounds at this point in my pregnancy and not that it even matters, but Now I'm like, I'm walking on eggshells because I'm afraid to gain, I'm 27 weeks. So I called Chana and Chana had other clients who had this provider as their provider, and she was like, unfortunately, this is something that she does. Like she does fear monger with weight. It's not you. It's nothing wrong with you. And I was afraid that that would be your experience. And she was like, and if you want to stay with her, again, I will fight for you, I would advocate. She was like, but I want you to consider what she's sharing with you and also where you would be delivering and they're very traditional and they're very strict, and it's possible that they would make it harder for you. So even though she's saying, yeah, you know, there's nothing wrong with you, you can try for a VBAC, it might be difficult.

Lisa: Might be an uphill thing. Yeah.

Rachel: Yeah. And I had to sit with that and consider at this point, I'm entering my third trimester, do I stay? Or do I go? And that was really hard, Lisa, because all my life, super compliant, always doing, you know, the doctor's always right. Like I don't want to be the go against the grain. And I think these are things that go through a lot of our minds when we're dealing with providers is, is it me? Is it them? Should I question this? Should I push back? How much pushing back do I do? And I had to make the decision to leave that provider. And find another provider. And I think, you know, one of the things that I want to express is when you really believe something, right? Be very mindful of who you share that with, because there are people that will encourage you, and there are people that will tell you you're crazy, don't do that, and make you second guess yourself.

And I learned that really early on in my pregnancy to not be like, broadcasting that I was trying for a VBAC. And I remember telling a few people that knew what I was looking to do, that I was trying to change my provider, and they're like, again? Like even in that moment, it was like, okay, Rach, like, this might be where you're going to have to die on this hill here because this is too much. And I'm like, no, I don't feel safe. And I didn't because it wasn't just about the VBAC, it was just feeling like I really was unheard. Like I'm addressing something that I experienced and you didn't even acknowledge that, like you kind of just went into something else.

And so again, everything I did, I always said, well, is it evidence based? And I went and I looked through and I'm like, I'm still justified here. Like, I'm still justified in wanting these things. So Chana helped me look for some providers.

Lisa: May I ask real quick, sorry to interrupt, but how did you learn about VBAC?

Were there specific resources on VBAC or gentle cesarean techniques that you found helpful?

Rachel: Evidence Based Birth was one of the platforms that I think I became so obsessed with. I think using that platform, using a lot of the things that I had come across when I was doing research for my capstone assignment, that's when I learned about VBAC. That's when I learned about, you know, the indications of like, oh, well, 1 VBAC after 1 C section, versus a VBAC after 2 C sections, like the margin of uterine rupture is not that much. Like, it's not like a huge leap. And for me, I'm like, Oh, okay.

Well, so, you know, there's no reason why I can't try. And so that was where the background supporting that, like, allowed me to feel confident in saying that I know you guys think I'm crazy, but there's no reason why I can't. And in other places in the world where this is not even a question, right? Like, it's here that we're making it a big deal, but this is not a big deal.

And so, I eventually was able to find a provider with Chana's help, she gave me a list of providers that have experience with multiple VBACs and, so I found this provider, I went, I spoke with the provider, and that ended up being the provider that I stayed with for the remainder of my pregnancy.

And again, he was very like, listen, there's nothing wrong with you. If you want to try, obviously, I'm not God, like, I can't say that you're definitively going to end up with this, you know, scenario, but we can try. And so, and that was all I needed. I just needed someone to give me a chance, which is still unfortunate because it's like, it's my body.

I shouldn't ask for permission to do this, you know, like I don't have a health condition. There's nothing wrong with me. And one of the things that I kept thinking throughout my whole pregnancy, it was like my mantra, my body's not broken. Because prior to my third pregnancy, I did feel that way. I did feel like I failed.

And again, it's not the c section that made me fail because I think that there's not enough awareness for mothers who deliver via c section. There's always the sense that, Oh, you took the easy way out or, you know, you don't know what birth is like. And it's like, what? That is one of the most phenomenal things that you can go through in terms of just the layers of body that have to be cut open.

So you are a warrior. So in no way is shaming that birth experience, but it was just things were being done to me. And no one was including me in that, you know, it's like, Oh, we're going to do this. We're going to start, you know, cervical check and this and that, and this, and it's just like, you hold onto that, and then you end up taking on, you know, the pain of, well, maybe if I was more, you know, smaller, or maybe my hips, like things that have nothing to do with anything, but you kind of just create this narrative. So, my body is not broken was something that I repeated to myself. And I am a woman of faith.

So just praying and believing God for the birth experience that I desired to have. And just knowing that like, I have to believe me before anyone can believe me, right? Like I have to literally believe that I am capable of doing hard things. And so, I had that third provider, everything looks good. Towards the end, it got a little tricky because I do have a fibroid that, during pregnancy, had gotten bigger. So that was like the only concern, like the position of where the fibroid was. But again, he never made me feel like I was crazy for wanting this. And that was what I needed. And so, at 39 weeks, I went into labor and I literally said, Lisa, I was like, all I want is to not have my water break. I want to be able to labor at home. I want this to not feel emergent.

Achieving a Successful VBAC

And at 39 weeks, my water breaks. And I remember thinking, Oh my God, this is going to be like my first birth experience. And I was freaking out. Like it was like everything, all the calm went out the window and I'm like, no, no, no, no, no, no, no.

This can't be like, it can't happen like this. Like I need it to be different. I don't want it to happen like this. And Chana was the most reassuring anchor that I could have had in that moment aside from my husband because she kept saying look at me, you've already gone so much further than you got with your first. It was steps, it was like we're not gonna talk about what's happening there, we're gonna focus on, look at you. You made it past three centimeters. You said that you didn't even get past that with your first. Look at you. You're feeling contractions. Like, it was just like all the little, like, changing milestones. And she just kept rooting for me and, like, encouraging me. And it was a long labor.

It was a long labor. I think I labored unmedicated, for about 15 hours. I remember saying to her, my goal is to do it as long as I can, because I know the implications of having Pitocin and all the things like that. And so I said, I just want to try. And I did. And I was so proud of myself. And at like hour 15, I was like, okay, I'm tired. I'm tired. I need help. Like, I can't do this anymore. And so I did get a Pitocin drip. And I got an epidural and I was able to rest because at this point I was in the hospital. I labored for maybe five or six hours at home before my contractions got really intense for me. And then I went into the hospital and I only was like two centimeters, which got me in my head a little bit because I'm thinking, again, this is looking very much like my first birth experience. But like I said, Chana was like, no, it's not, it's not like your first experience, it's different. And so, You know, I labored and labored, still unmedicated, you know, they respected all my wishes.

The staff at the facility that I delivered at were amazing. They were absolutely amazing. The nurses were just so encouraging and they wanted to see me experience this too. One of them, I remember saying, you know, you'll be my first VBAC too, like, I've never had a patient have a VBAC after two C sections.

So she's like, we're going to make this happen. You know, like, and so that was so great. The atmosphere felt right. I felt supported. I felt seen, I felt heard, you know,

Lisa: Night and day difference.

Rachel: Yeah. Night and day. I didn't feel rushed. You know, they didn't come in every hour or two asking if they can check me. They let me labor.

They let me labor. And so when I did eventually get to the point where, you know, they're like, okay, well, you know, your water's been broken. It's been some time. We're going to see where you're at. And I think I was at four centimeters. I was like, my body's not broken. I've never gotten past three that was huge for me, like, doesn't matter what happens, like, I know that my body can dilate and like all of these things were being unlocked for me.

I'm like, wow, it was never me. It wasn't me. And that was everything, everything. And so I got my VBAC. after two C sections, I delivered a healthy baby boy, and I just, I couldn't believe it. Like, I couldn't believe that I pushed a baby. Like, I couldn't believe that my body did these things that I've been told it was not able to do.

And Chana's like, you did it, you did it. And I'm like, no, it's you. And she's like, no, no, you did it. You know, I think that was probably one of the highlights of my life. Just being able to say I did something that so many people tried to discourage me from doing and I stayed the course.

And it is possible. It was hard, but it was possible. There were so many things working against me, my age, my race, the climate that we were in, in this country. It's still a pandemic. There were just so many reasons why. Oh, you've had two C sections. Once a C section, always a C section. Why would you take that risk?

You don't care about your baby. That's so selfish. Like all these things, coming from left and right. And I'm like, you know, every C section you have is dangerous too. There's risk of uterine rupture with C sections as well, but they don't speak of that, right? And so I'm like, we can't just speak of the risk here and not the risk there.

Lisa: Totally.

The Importance of Educating Yourself and Pushing Back

Rachel: This is why education is so key because, Lisa, had I not had the experience to research this, not knowing that I would need it for myself, I would have fallen into that trap of like, Oh, I am being selfish. Like, why would I take that risk? You know, went on and had a third C section and been miserable in my heart about that decision, but I always tell people, you have to educate yourself, and there's nothing wrong with pushing back.

There's nothing wrong with going to appointments and saying, hey, so, you know, I was doing some research and, evidence shows, you know, research shows this and this and this, and is this hospital policy or is this evidence based? Because sometimes we're being told we can't do this and we can't do that, and it's really, you know, to protect the facility or to protect the provider and not so much that you can't do it, you know? Because like you said, they don't view birth as a physiological process, they view it as something to be managed,

Lisa: And billed.

Rachel: Yes, yes.

Lisa: And to make lots of money.

Rachel: And billed because, woo! The c section bill versus a vaginal.

Lisa: Oh yeah.

Rachel: Man.

Lisa: Sky rockets.

Becoming a Doula: A Journey of Advocacy

Rachel: So yeah, that was pretty much my birth experiences, which then Chana was like, you have to become a doula. She's like, we need you in this space.

She was like, if you could fight and advocate for yourself this hard, You have, like, we need you in this space. I was like, I don't know. And she was like, you should consider it. And, you know, at the same time, as God would have it, I had a friend send me a link for a few different, doula programs, not even knowing that that was something that I might've been interested in.

She just said, oh, I came across this and I thought of you. Off of the conversations I had with her sharing some of my experiences to help her prepare for her births. And she's like, you'd be really good for this. And I was like, wow, okay. So other people are saying it too. And so, yeah, I decided to enter into the doula program and I actually ended up getting a scholarship for my birth experience.

Like when I shared what led me into this space, I received a partial scholarship, which was helpful. So it's kind of like, okay, well you really should do this. You know, people believe in your story, they believe in you. And so that was two years ago. Going on 2 years. It hasn't been a full 2 years yet, but I've been able to support some families and it's just been an amazing journey and I'm still doing advocacy work.

I've been able to participate with organizations and I did a PSA, a few years ago, supporting, I'm not sure if you're familiar, the Momnibus Act, that they were trying.

Lisa: Yeah, yeah, definitely.

The Impact of Advocacy on Maternal Health

Rachel: Yeah, I, you know, like everywhere and anywhere and anyone who wants to speak of maternal health and just the disparities in healthcare in general, like, I'm like, count me in, but it's been an amazing ride. It's been an amazing journey just being in this space and like, being able to impact other people just because I knew to say no, I knew to push back. And in no way did I consider that like, oh, you know, in me doing this, I'm going to now be able to advocate for that person or support this person.

I wasn't thinking about it at the time. I just knew that I had been told so many things, for so long that were not true. And I was not willing to take that anymore. And that is like the biggest thing that I could have done for myself in life in general, outside of the space as well. and so, yeah, that's, that's my story.

Lisa: That is so amazing. And I'm so in awe of you. So, so fantastic. Thank you so much for sharing all of that. And I do have a couple of questions. But one thing I wanted to just mention and reflect on and see if you have reflections on this is, another woman shared on my podcast, shared her, VBAC story and talked about how finding her voice in advocating for herself was so powerful, just in personal growth and growth as a human and growth as a parent and finding your voice as a parent to then advocate for your kids.

Any thoughts on that aspect?

Finding Your Voice and Transforming Your Life

Rachel: Absolutely. Absolutely. copy and paste everything that she shared. You know, when I think back on how liberated I felt going through that experience, I realized how many other areas of my life I was playing safe, but like, I was so go with the flow, people pleasing, you know, don't push against the grain.

And that was the first time I stood up for myself. And so yes, that did lead to me unlocking, you know, evolving to another level of mom, wife, Rachel as an individual and really just standing up for myself and saying , no, if this doesn't feel right, it's not right.

Trust your gut, there is nothing wrong with standing up and using your voice, you have a voice. Use it. And that's not to say that you doing that means that you're belligerent or angry or you have a voice, use it. Question things. There's nothing wrong with questioning things. So I definitely agree.

It definitely was transformative. For sure.

Lisa: Amazing. Yeah, and in our system, we need more disruption, right? We need disruptors because nothing's ever going to change if we don't advocate and disrupt the way of doing things that needs to change. I mean, American College of Obstetricians and Gynecologists, you know, and I know that like they have said so much needs to change.

Rachel: Yes.

Challenges in Black Maternal Health

Lisa: And I'm curious, in your first pregnancy, were you already aware, before you did your master's work on this and research and everything, were you aware of any of the challenges and the dynamics specifically for Black maternal health?

Rachel: I was not. And you know, I'm so happy that you asked that Lisa, because I think at that time of my life, I was dealing with my privilege.

I was dealing with my economic privilege. I was dealing with the fact that I grew up in, you know, a pretty affluent area. I went to a good school. I had a college degree. I don't think I realized that the things that I learned later on, it's not specific to, oh, you're in an impoverished neighborhood that is, you know, underserved or because you're uneducated.

These are the things that you would experience. You're not afforded the best type of, it has nothing to do with that. You know, some of the things that I dealt with were basically, you're telling me these things, you're giving me standardized care based off of research that is not accurate because of my age, because of my skin color, because I'm this.

And it's not that you're trying to be this way, but you're not considering that there's other evidence to discuss. And I remember even saying, you know, I read this and my provider said, admittedly, I don't know what this new research says, but I know that I would never do that. There was never even the consideration to, well, let me look into it and we can discuss it. We'll circle back. You know, it's just, no, that's not how I do things and I'm comfortable here. So this is how we're going to do it. Not, well, if new studies show, blah, blah, blah, blah, blah, let's. No. And so not having that knowledge or awareness and just trusting that I'm delivering at one of the best hospitals, this and this, everything is going to go great.

And looking back, there were so many instances. I remember, you know, I have high sensitivity to certain narcotics, so I couldn't do well with the oxycodone. I was vomiting even during my recovery. So imagine here's me with a C section and I am trying to brace my midsection from the pain of the sutures and I'm throwing up at the same time.

And they're giving me the oxycodone, which isn't helping, so I'm telling them like, I can't tolerate it. And I remember the nurse saying, Oh, you're one of those. And I'm like what

Lisa: Take that out of your vocabulary nurse!

Rachel: This has nothing to do with trying to prove anything. Like I'm telling you it's making me uncomfortable.

It's making me vomit. I don't want to take it. I could barely hold my baby because I'm so nauseous. I would rather not. Oh, you're one of those, you know. So it's just in the bedside manner in the way that we have no sensitivity, to consider that someone is dealing with something, they're sharing their experience and it's worth you listening.

And so I think a lot of Black women, when they say they don't feel seen or heard, that's part of it. You know, when you're saying that this doesn't feel good, and it's like, oh, you're being dismissed and you'll be fine. You deal with that so much that you don't realize you're dealing with it until you have the contracts.

And so there were just so many moments in my pregnancy and labor and delivery with my third that I was able to reflect back to my first and my second and say, wow, stark difference. Because now my eyes are open because I did have the education and I did learn so much. And I was like, I did experience that.

And I just didn't think that I was in that category of people that would be marginalized or go through some of those systemic issues that we see in health care. So, It's sad for sure.

Lisa: And as you're talking, Rachel, two or three things are coming up for me that I want to point out for listeners.

You just were mentioning the pain of a Black woman being dismissed. We know historically that doctors were, and nurses were trained to think that way, that black people don't feel pain the same way that people of other colors do. And that's just not true. Like we've debunked that entirely and yet it still exists in people's psyches. It lingers in a very powerful way.

And then another thing you were talking about how a former doctor was just like, this is how I do things. Prime example, as you know, of the evidence practice gap that Evidence Based Birth talks about, about how research studies show us that once ACOG or once new formal recommendations are made, new research comes out, that it takes 15 to 20 years for our systems, our hospitals to actually change their practices. You gave a prime example of that about how we get stuck in our ways and the way we were trained to do things. Well, that must be the right way. When no, once we learn better, let's do better. As Maya Angelou wisely said, right?

Rachel: It's scary. And you know, we live in a first world country and we have so much access and resources, but we're not utilizing it in the right way.

Lisa: Oh, that's such a great way to put it.

Rachel: The 11th of all the leading nations of the world. Why are we at the bottom when it comes to maternal health? It's insane to me because, where you have other countries that don't have the resources and they don't have certain things and they don't have access and you could understand why there are disparities and why certain things exist, but it's like, it shouldn't be that way here. So, that is really glaring to me, just the idea that, like, we have all of this stuff, but we just can't find that marriage between what research is showing and just like bridging the gap. And it's giving like my toddler being stubborn. Like, you know, his no's are no's right now, like this quiet, but he's like, no, no. And then he's like.

But I feel like we just don't want to try. And that's where we do have to be disruptors. That's where now you have people that are in this space that are doing this amazing and difficult work that are pushing against the grain because storytelling, having conversations, sharing your experiences, and really questioning what we've always believed to be true, right?

The way things are done here, is the only way we'll get from here to there is the only way we'll progress. So,

Lisa: Yeah. One other thing that I wanted to highlight that you were talking about, in your first pregnancy, talking about coming from a privileged, educated, economically, privileged space, background.

I, just to highlight, you know, in news stories, we've seen how Black women, even celebrities, still aren't listened to when they have a concern. And so just wanted to highlight that for listeners who just might've missed that might not have seen, you know,

Rachel: We've heard, you know, Serena Williams shared her experience.

There's so many celebrities that, you know, you think of them and you're like, well, in no way should they go through anything. I mean, they have all the best and for them to say, no, like, if I didn't push back, like I could have died, you know, I felt something didn't feel right, but I was told, no, it's okay.

Or, you know, whatever the narrative is. I think that it just makes it so clear that, again, it has nothing to do with access, right? Like, it's not just about if you deliver at a better hospital or if you had more money. You know, sometimes people, they don't realize it or maybe they do, but there's implicit bias there.

And, to consider that we go in thinking that we're going to be cared for the same way or that we're going to experience certain things. And you just trust that this person is in this space. They have a vocation for it. They're going to put my best interest 1st. That's how it should be, but that's not always the case.

And so, you know, the same way I don't send my kids to school thinking that the teacher is the sole educator in their lives, like it is a partnership. Like, yes, my kids are getting an education in school, but I supplement that education as well. It's not just, okay, well, you're going there and that's it. No, they're learning every day.

They're learning at home. They're learning other things. I think it's a partnership. I want to share decision making with my provider. I want to go into an office or a meeting or an appointment rather and say, Hey, I came across this. Can we talk about it? One of the things that I remember being so excited about is, you know, when it came to doing my glucose test, I was like, I'm not drinking that.

I was like, I am not drinking that, that's disgusting. And I did some research and lo and behold, I'm like, Oh, there are alternatives, look at that. And I remember going in and saying to my provider, Hey, you know, can we consider like other things? This is what I came across. And the provider was like, sure, this is what you're going to take if you want and do this and do that.

Lisa: And that's an uncommon provider, by the way.

Rachel: Yeah, because most of the time you're like, no, this is what you're going to do and that's that. And I'm like, little things like that make such a big difference because again, you're telling me what to do, but you're not supporting it with why. It's not because, Oh no, this is not safe for you or baby, this is just you saying, this is how it's been done. This is how it's always been done. And so this is what we're going to do. But that can't be enough.

Lisa: It's not, it's not. Yeah, you're so right, Rachel. And another thing that's coming to my mind as you're talking about that is the 3 legged stool that Evidence Based Birth talks about, that when we talk about evidence based care, that's going to actually shift the needle toward better outcomes, not just the studies, it's not just the provider, but it's also your preferences and feeling like you're participating in your care and actually listening to you and your preferences and adapting your care accordingly.

Rachel: Absolutely. I mean, it only makes sense, right? They say the triangle is like one of the strongest shapes, right?

And it's like you consider just how much more power and how much more effective healthcare could be if providers, if facilities really tried to include, you know, the patients, the families in that and getting away from standardized care, like what applies to one may not apply to another.

I've had instances where I'm speaking to fellow mommies and they're like, you know, All the women in my family, we just naturally carry smaller. We have, you know, smaller babies. And one of them in particular, she was like, I can't even tell you how much they were pushing for me to be induced just off the strength of, Oh, your baby's, you know, smaller than normal and this is a concern.

And she's like, I've been telling you guys, I have a history. Like all my babies are small, like there's nothing wrong with me. Like I carry small, my babies are small. And that's crazy because you're pushing induction. The baby's thriving. There's nothing wrong. There's no distress. There's no indication that anything is amiss.

But because, oh, well, you know, normally this and that, whatever it is, you're pushing for that, which could lead to a cascade of interventions, which could lead to something happening that is not in the best favor of this particular person. That is alarming to me. Instead of saying, Oh, well, you know what? If you have a history of having smaller babies, we'll just keep monitoring.

There's nothing wrong with you. We'll see what happens, you know? And if she didn't push back, she would have ended up with an induction that she didn't need, cause she went on to have perfectly normal labor and delivery experiences, nothing wrong with her or the baby at the end of it. But it's just, to me, that is what's so disheartening because like, why won't you listen to me?

Like, I'm telling you this, like, why won't you listen to me? It's just, yeah, it's crazy.

The Role of Mental Health in Maternal Care

Lisa: So what you're sharing, Rachel, is bringing up for me, just mental health and the importance of prioritizing that and being really thoughtful in our choices in pregnancy and in labor, and beyond too, in protecting that, because that's such a huge factor in why we're ranking at the bottom of the developed nations in our maternal health outcomes. And a baby step in that direction that I'm grateful for, but it's only a tiny step, is the Surgeon General's alert about the crisis of maternal mental health.

And so I just hope and pray that over time, our systems will build in better support, better leave policies, better breastfeeding support, better mental health support, all of these things and more respectful care, like let's back up as you're going through this rite of passage, that's a life changing event like no other, like we need to protect the mental health then and just hear people, listen to them.

Rachel: It's so important because you don't realize how one impacts the other. Like when we talk about even just, okay, you had your birth experience now and you go home and you're sitting with that, you're unpacking it. Because in the moment, everything is happening, but as the days go on and you're able to really take time to process this traumatic experience that your body went through, regardless of whether it's vaginal or c section, it's a lot of trauma on your body. Like, you know what I mean? Like, it's just, wow.

Lisa: Yeah, it's a physical trauma for sure.

Rachel: You know, a whole baby. And so you're healing and you're recovering and mentally you're considering what happened, right?

I don't think a lot of people realize the value in us taking time to consider why some women are experiencing postpartum depression. Why some women are experiencing this, like they're just disassociating with certain things. I hear it all the time. I went through it, right? Like my first son, I didn't really bond with until he was like four months. There was just a disconnect. I knew this was my baby. I loved my baby because it was my baby, but there was a disconnect, because of the birth experience I had, because I wasn't able to hold him right away, because I was in the hospital for so long and we were both medicated. It was just really traumatic and I'm healing and I'm not having the opportunity to like heal and bond.

I'm not having the opportunity to really enjoy that first few weeks of life because I'm like, okay, I have to do this. I have to do that. I have appointments, but no one's asking me how I'm doing. How are you? Like, how are you feeling? My breastfeeding journey was even complicated because of that, you know, because I'm on all these medications.

I don't want to give my baby breast milk and I'm trying and then I'm pumping and I'm not doing it right and I have no support and it just became really chaotic. And so, mental health as it pertains to, you know, maternal health is a marriage because we don't talk enough about how it disrupts, it changes, like the chemistry of your brain changes.

Lisa: Physically changes, yeah.

Rachel: It physically changes.

So it's like, why would we not focus on this? Why wouldn't we be more intentional about how we treat or protect people in this space and educate the ones around them, the family members, the partners, to care for them and consider what they're dealing with because it's a big deal. And I think so many of us didn't have that.

We don't think that it's a big deal. And so we have these conversations because my mother didn't have that support. Her mother didn't have that support. They just survived through those experiences, so they may not consider that oh, I need this support here, you know, like as an example.

So yeah.

Lisa: Yeah. Thank you for all of that. You brought up something that was going to ask you about, about your postpartum mental health in following each of your three births, so I appreciate that. Yeah.

And any, any other observations in terms of differences between your postpartum experiences?

Rachel: Oh, yeah.

Lisa: Three journeys?

Rachel: Absolutely. With my first, I was just out of it, you know, again, it was just a lot of trauma, you know, they found out later on that there was an infection, there was something going on with my placenta. So I was admitted for almost six days after I had my first son, obviously with the C section, but also because I was on antibiotics and so was my baby.

So that whole experience was just hard and then transitioning back to home and like trying to figure it out. Not really feeling equipped and not really having the foundation to know that there's a lactation consultant that I could reach out to if I need support here, if this is something that I desire to do.

I just, I felt very lost and I felt like I was drowning in that. And you know, my first son was so colicky and like he was crying all the time and he was this and it was always because he's not eating enough. The breast milk is not enough. You need to give him formula. It means like it was just all these opposing opinions that didn't allow me to establish a sound foundation as a new mommy. Like I just was

Lisa: Trust your intuition, right?

Rachel: I wasn't trusting my intuition. I was just doing everything I was told and trying to figure it out. Whereas with my last son, it wasn't that. It was very like, this is what I'm doing. And he was the only of my three boys that I was able to successfully breastfeed solely.

Like, I mean, obviously there was a formula shortage, so there was an incentive there because it was like, I can't feed my child. There's no formula. We're in a pandemic. But, I was so intentional about doing this and getting this support. I found a lactation consultant, you know. My second son and my third son both experienced oral ties and so learning about that, what that looks like, how that can affect breastfeeding, there's just a whole world of resource and knowledge that I was introduced to because I wanted, I desired to know and I was trying to be better. And I wasn't settling for just someone telling me this.

If you told me this, I would take it and I would go and look into it so that I can learn more, you know, and it changed everything about my mental space because I felt good about the decisions I was making. I didn't feel lost. And not that motherhood is ever a linear journey, but I felt good about what I was doing.

I felt good about my yeses and my nos, and I trusted my gut so much more, which contributed to me being in a better mental space. Whatever I decided to do, it was okay because I took the time to figure it out and consider what this would look like and, you know, what the benefits and the risks were. And that was a game changer because I didn't really do that with my first. With my second, I was grieving the experience of my first that led to my second. So I still was in that space of shame and guilt and not doing enough and being enough. And so, yeah, I can't even speak enough to how much I was able to mature emotionally through that experience that led to a better mental space. And not that it was easier because it wasn't.

It was harder. I'm navigating being a mother of three now and

Lisa: Right. That's a lot.

Rachel: It's a lot. And there were, you know, lots of challenges in that with my last pregnancy or my last postpartum period, but I was just mentally healthier. Like, it was just different.

Conclusion and Future Advocacy Efforts

Lisa: Thank you. So anything else you wanted to share on your advocacy work or your doula work, and I'm happy to share your website or your social handles or anything you'd like to share in the show notes so people can find you.

Rachel: Sure, so my doula page is still under construction, but it's Doula Rach, @doularach.

I, advocacy work, I just get butterflies just even thinking about it because I really enjoy getting on my little soapbox and being a disruptor. So any opportunity that I get to do so I'm more than glad to do so. But, I've had amazing opportunities to work with different organizations that care about maternal health.

They may not necessarily be just maternal health based, but. I participated in a campaign called Autonomy is My Joy with an organization called The Cultural Engagement Lab and they gave me the opportunity to pretty much share my story. And again, it was really encouraging because in them campaigning to promote the Momnibus Act, which is legislation for improvements in maternal health, right? More access and resources and there's just a whole bunch, that that act would do.

Lisa: And one or more of those bills have been passed, I believe, but there's still quite a bit that hasn't. I'll link to information on this.

Rachel: Yes. Yes.

Thank you, Lisa. But more than a few of them have been passed and like, you know, I'm not a lawyer in politics, but like looped into other stuff, which is great. So we're making progress for sure. But to consider that my story was helping move something along, that was powerful. So I've been able to participate in stuff like that.

I function on a few education committees for maternal health on Long Island, wellness workshops, and just really trying to provide support in the form of storytelling, in the form of just resources that people could use. Because one of the things that I learned as well is that, you know, we talk about our experiences, but there are people that stand alongside us that need to be supported as well.

My husband learned so much with this birth experience, and he's like, I wish I had someone to kind of walk me through some of the things that you went through so that I could advocate for you, right? Like, you should be able to advocate for yourself. But in a moment where you can't, I need to advocate for you.

And so I actually created an event, alongside the public health department of Hofstra University, where it was for fathers and it was basically the role of dads, as it pertains to maternal health. And so I had a panel of black fathers speaking to their experiences and how they supported their loved ones during a pregnancy and labor and delivery.

And it was amazing because again, so many people are like, we need more of this. We need more of dads sharing their stories. You know, they're present, they're there. So I've been able to just do a lot of fun things. And of course my doula work is here. I have a client who's actually in early labor, excited for her as well.

But, yeah, it's just amazing how, when you start standing up for yourself, just this world is opened up to you. I never thought I'd enter into this world, but it really just started because I decided to stand up for myself and that allows me to help stand and fill in the gap for other people.

Advice for Expecting Mothers and Doula Clients

Lisa: Amazing. So are there any other things you haven't gotten to share that you would like to share? And, or with your doula clients, say, when you meet a doula client and in speaking to listeners who are expecting a baby, what would be your top words of advice or wisdom that you would share?

Rachel: Top things, words of wisdom, I would say, trust yourself. Your body is able. Education. Education is key. I can't stress that. It's like, underline, underline, underline, you know, anything that you come across that doesn't seem right or that you're not clear on, clarify, educate, ask questions, and if it doesn't feel right, act on that, you know. If that looks like changing a provider, change a provider. If that looks like saying, no, I want to hold off. I want to wait. That's okay too. BRAIN is something that we talk about in the doula space when we're dealing with our clients.

It's an acronym for benefits, risk, alternative, intuition, nothing. And so, you want to use that format when you go into anything that is a discussion between you and your provider. What are the benefits? What are the risks? What are the alternatives to this procedure, this medication or whatever? And then using your intuition with the information that you've amassed to make a decision.

And sometimes that decision leads to you saying, you No, or I'm not going to do anything with that. And that's okay. And so using that as your cheat code to kind of like navigate things that are difficult, I would say, is something that I would encourage new mommies or expecting mommies. And surrounding yourself with people that are going to lift you up.

Community is so important and you're not meant to do this life alone. You're not meant to experience this alone. So, you know, if you're able to join a support group, a postpartum support group, as a first time mommy, because you may not have a lot of mommy friends in your circle. Do that. Do mommy and baby activities.

Like, find your village, your community, that will lift you up and encourage you. Things can get hard and you need your birth bestie. Get a doula. You know, I will always encourage that, get a doula. Chana is one of the most amazing, I still to this day, I call her, I text her, you know, she has become an extension of my family.

It doesn't get any more intimate than a relationship between a doula.

Lisa: True.

Rachel: I mean, it's up close and personal. And if you have the right doula for you, if you find one that you really connect with, that's a lifelong relationship, you know, like she's tethered to me for life. Like she's a mentor in this space now, now that I'm entering doula work, you know, I'm like, Hey, I wanted to pick your brain about this, as a friend, as an encourager.

So get a doula, educate yourself, find your community, use your brain, and trust yourself.

Lisa: Best words of wisdom. Yeah, absolutely. Listen to Rachel, everybody. All right, well, thank you so much, Rachel. It has been such a joy to get to know you. You're such a great communicator. Your story is so powerful, stories are, and I am honored to be in this birth world and this birth work together here locally. I hope you'll stay in touch. I hope you'll keep me posted. If you offer any support groups, including for dads, especially partners, because I get requests all the time for that. And there's just a lack of support for partners and dads.

So, yeah, any of your work that I can help to amplify. I'd love to do that.

Rachel: Definitely keep you posted. There are a few things that I am working on. And so I'm hoping that, you know, for the spring I am able to offer more wellness workshops. So I will definitely keep you posted and I will be sharing things on my page as, you know, everything comes together, but This is

Lisa: And advocacy efforts too, we can, we can join up and talk to our senators and our Congress people, everybody to try to affect change. So thank you so much, Rachel.

Rachel: Thanks for having me.