07. Informed Consent – with Tatiana Koontz – Episode Transcription

The Birth Re-Imagined Podcast, Episode 07: Informed Consent – with Tatiana Koontz

Elle Kennedy (Introduction): Hi, we’re Elle and Taylor, and we’re here to join you on your journey from pregnancy to birth, postpartum, and beyond! Here on the podcast, you’ll get interviews with birth and parenting professionals, birth stories, and educational episodes to get you feeling confident, supported, and empowered on your journey to and through parenting. Welcome to Birth Re-Imagined.

Due to recording during Covid, it is impossible for us to meet our interviewees in person, which means we don’t always have control over all of our audio elements. In this episode, we had some minor technical difficulties at the end of the episode. Because we want you to receive as much information and takeaways from each episode, we have transcribed the entire episode so that you can read or follow along if the audio becomes difficult for you to understand. We appreciate your continued support and interest, as we strive to give you the best quality content that we can during these unprecedented times. Episode transcription can be found, along with the full episode show notes at ellekennedyphotography.com/podcast.

Elle: Hi, I’m Elle Kennedy, a birth photographer and doula based in Orange County, California.

Taylor: Hi, I’m Dr. Taylor Garcia, a doctor of chiropractic also here in Orange County, California.

Elle: So today we are talking to Tatiana Koontz. Tatiana is a California Medical Board Licensed Midwife, a certified professional midwife, a monitrice, and a postpartum doula. She owns a home birth midwifery practice in San Diego, called Birth Waves Midwifery, and she’s fluent in Spanish. So Tatiana, is there something specific about birth that’s always lit your fire? What are you most passionate about?

Tatiana: Yea, I think that there are a lot of different topics and a lot of things that I’m passionate about in regards to pregnancy and birth, but one of the big ones is definitely informed choice.

Taylor: So a few weeks ago, we talked to Madalyn Morris, and we talked about consent and advocating, but during our interview with her, we really focused on the advocacy aspect. Today we were hoping to talk to you more about consent. Can you remind our listeners what the difference between consent and informed consent is?

Tatiana: Yea, so consent is agreeing to something. Informed consent agreeing to something after receiving education about the risks and benefits to it.

Taylor: Alright – what is so important about informed consent?

Tatiana: So especially in regards to things that go on with our own bodies, a lot of consent happens around pregnancy, procedures, options with testing… I really feel like it’s important because people don’t understand totally what’s happening with their body or what the medical standard of care is for pregnancy-related tests or procedures, so the importance comes from medical providers having more knowledge than the person who is going through the process with their own body.

Taylor: As a chiropractor, this is actually a big deal. We have to deal with informed consent as well, because what we do is not known by most people, so I totally understand that it is definitely about knowing more than the general populace and wanting to be as educational as possible.

Tatiana: Mm-hmm, exactly.

Elle: So how can we seek to become more informed before we’re entering that birth space?

Tatiana: Oh, that’s a really good question. So, when you are pregnant, you and your partner are becoming parents, and it’s important to own that role of being parents, and starting to make choices on behalf of your child, but also on behalf of your body. And so, taking initiative to understand what is happening to your body and picking a provider that can facilitate that discussion is great. But ultimately, you’re also responsible for doing some research on your own time. Each family has their own values, preferences, philosophies, and so not everybody is going to make the same choice. Everybody has different backgrounds. Some people have had different history of experiences, different medical problems in their past that are going to influence their desires and their choices. But just in general, it’s really important to be informed so that you can start making choices right from the get-go.

Elle: I really like that. I know my partner and I decided to take Bradley Method classes before the birth of my first child, and that was a huge thing that they talked about was informed consent, and giving you, you know, a very thorough education on “this is exactly what is going to be happening physiologically during birth and labor.” But then also backing that up with “here are some things that happen” and making sure that everyone felt empowered to say yes or no to these different things. So, for example, the eye cream they use on babies, or the Vitamin K shot they give to newborns – things like that, that if you… if you aren’t informed about them ahead of time, and you don’t understand what it is, you’re more likely to just say “yes, okay, no big deal, you know, that’s your routine, you do it, nurse or OB or midwife, or whoever it is. Go for it.” But knowing what those things are, what they do, what the risks and the benefits of those things are allowed us to make decisions on a case by case basis. So, for instance, the Vitamin K shot. When babies are first born, they don’t have enough Potassium in their system to facilitate blood clotting properly. Am I getting that right?

Taylor: You are.

Tatiana: Mm-hmm.

Elle: Trying to make sure I’m not mixing up my (laughs)

Taylor: No, no!

Elle: My letters and what not. (laughs)

Taylor: You’ve got it right.

Elle: So they don’t have enough potassium in their blood stream to facilitate clotting properly. For most newborns, this isn’t a big deal, because they’re not going to get cut or anything within the first eight or so days of life before their body builds up enough. So for my daughter, we declined the Vitamin K shot. When I had Teddy, however, Teddy was born with a congenital heart defect, and needed open-heart surgery at four days old. That’s before the Vitamin K has enough time to build up in their system, so it was 100% necessary in that case for the Vitamin K shot to be administered. It absolutely made sense for Teddy to get that. So I think that’s a really big part of informed consent. It allows us to make those decisions based on the individual needs of – not just the pregnant person – but also the children themselves.

Tatiana: Right! Exactly! And as a parent, you are the representative or the voice of your child when it comes to medical concerns or procedures, so it’s really important to get used to that in pregnancy. And I actually recently on social media had a conversation over Instagram Stories about just kind of the first basic thing that happens when you get pregnant and go in to your first appointment, either with your doctor or midwife, and that is the initial lab work that they do. And I asked a question and I was just like “How many of you know what was being tested and why? Like, which tests were they taking and drawing your blood for and what was the reasoning behind it?” And pretty much everybody said they had no idea! Like, they remember kind of getting their blood drawn, but they had no idea what tests were being run or why.

Elle: Yea, I feel like that’s pretty normal.

Tatiana: Yea! And I started, like, looking back on that and I’m like, “Why does nobody know what tests are being drawn?” I mean, we talk a lot about different tests during pregnancy, but the bulk of the tests actually happen during those initial appointments – just kind of establishing a base-line and seeing if there is anything that makes the pregnancy higher risk, or if there’s anything they should watch out for. And yea, I really started reflecting on that with my own clients that I work with who are choosing home birth and I was like “You don’t understand what these tests are and what they mean, so let’s slow down, take a step back, and really start talking about what they are.” And you should be able to make a choice of whether we run this test or not because it’s your body, it’s your blood, it’s about your baby.

Taylor: I feel like a lot of that kind of also comes down to the fact that OBs are often not your primary care doctor. So you may have this doctor you’ve built up this lifetime rapport with, and then you have to go to a completely different doctor that’s brand new to you, and try to build up that same rapport. And because you’re already in a very, you know, new time of your life with being pregnant, you know, that step gets missed. Cuz a lot of, you know, family doctors would tell you, “Hey, I’m testing you for this,” because they already know, you know, they know you, and they know what to tell you and what to talk about. Whereas, again, with an OB being a completely new doctor, and people don’t really know what to ask at that initial step. So, that’s kind of a fallacy of the medical community of not immediately saying “Hey, this is what we’re testing for,” because you technically should! That is part of what informed consent is about, and MDs and OBs should be doing that already. So that is kind of a… that is an interesting fact that they don’t talk about that when they draw your blood the first time.

Tatiana: Right, and a lot of it does come down when you… when discussing about informed consent or informed choice, is not only presenting them with what labs are being taken, but giving them the option to consent to or decline to any of them. And it doesn’t have to be an all-or-nothing situation. Like, you can choose “I want these five tests run, and the other ones I decline to,” or “I’m going to do a couple of those tests today, and I can delay other testing until later.” And so, it really is an important thing to be able to start out care on the right foot of making informed choices, and also having a provider that is giving you the care that you want.

Elle: Yea, I really like that. I feel like I came up against that several times in both of my pregnancies of that battle of “Where is the line between what is ‘routine,’ and what is necessary?” Where is it that I can and cannot consent? And I shared about this in the episode where I talked about my own birth story – I went head-to-head with an OB over consent. And I said, you know, “I do not want an IV or a Hep-Lock during labor,” and she was very upset with me, but I held my ground on that one, cuz I did not consent to it. I have really bad panic attacks with needles and I knew if they put an IV or a Hep-Lock in me that my labor was gunna stall because my fight-or-flight instinct was gunna kick in, and I would be in full panic mode, and not able to focus on labor.

Tatiana: Yea, definitely. And that is a huge part of it. It is also questioning “What is routine and why?” You know, just because something is routine or standard of care in the medical community doesn’t mean that that shouldn’t be questioned also. Like, why is that? Generally I think that things that are routine within a care, like even an OB that has a solo practice and private practice, so he is on call – he or she is on call – for their own patients… They are still carrying a huge case-load of, you know, 40, 50 births a month, and that is a lot. And so they have still very short appointment times to be able to make it through, and with that, when there’s decreased interaction time with your clients or patients, that affects the amount of discussions that you can have with them. And I think that’s a huge issue just in health care in general in the US. And just lack of access and lack of conversations happening. But that is a really big part of is, and just the fact that in our health care system, there is a lack of true informed consent. They call it consent, but they don’t actually spend any time going over all of the risks and the benefits. They might highlight one or two before asking for your signature, but they’re not really going over all of them, plus any alternatives, and what are the possible outcomes of declining whatever option they’re presenting you.

Elle: Yea, they’re having you sign something to give your consent. So you’re saying yes to it. You’re agreeing to it. But do you really know what you’re agreeing to? Do you really know the benefits and the risks of what you’re taking on? And that’s something that we have to take back into our own hands and that we have to start taking responsibility for as patients and as parents.

Tatiana: Right, and that’s why I really love… I use more the term informed choice than I do informed consent, because I want to acknowledge that it is a choice, or a decision that they’re making, and it’s not automatically consent. Like, it could be that they’re declining or refusing whatever the option is. And there is something, also, called shared decision-making, which goes along with kind of the choice aspect of… it’s a discussion-based decision and it’s individualized because your provider is taking into account your individual history, your preferences… it can also include your risk tolerance. So, some people, maybe, who have experience loss before don’t have the same perspective of risk as other peoples’ who have never experience a loss before, or complications before. And so all of those things should be individualized when you’re discussing tests, procedures, a plan of care, anything like that.

Elle: Yea, so again, I mean… we… we keep coming back to this. I feel like we keep coming back to this with every guest we have on the show is Individualized Care, and how important it is that every single birthing person is treated as the individual that they are, and not just given generic care.

Tatiana: Yea, and I think that has a lot to do with just, again, it’s standard health care here in the US, there’s just a lot of big practices. So, if you are seeing an OBGYN, you’re probably seeing a practice that could have two, ten, fifty doctors that work within that practice, and so there’s not a lot of continuity in the care that you’re receiving. You’re not seeing the same doctors. And even within some midwifery practices that are like that, too. You could be seeing quite a few midwives throughout your pregnancy, and having to explain your story over and over again, or relying on them to just review your chart before coming in to see you. And there is some loss in the quality of care and individualization that can happen in your care for that. And I think, also, that the better that I get to know my clients, the more those discussions are facilitated, the more we can talk about things, the more it builds trust, and the more that they know I have their, the best care in mind for them and their baby, and also that I value their intuition, because I’ve gotten to know them. So, if they’re feeling that something is off, that is definitely something to take into account also.

Elle: I really like that.

Tatiana: And I think it’s also important to address, too, involving consent, that consent can be withdrawn at any time. Or it can be changed at any time, and just because you consent to something, just like other things in our lives, just because you consent to something doesn’t mean that that is solid and irrevocable. Like, you can withdraw that consent at any time. So, you know, using your IV example, if you did decide to consent to that, but then ultimately decided you didn’t want to go through that, you know, you can say “No, I decline the IV” at any time.

Elle: I think a lot of people actually really struggle with that idea of consent can be revoked, so I’m gunna give, like, a really generic, like, real-world example that will hopefully, like, really illustrate this for people is… Say you are with a partner, and you have this intimacy… this consent for intimacy, whether it’s hugging or kissing or whatever it is, and that’s “normal.” You guys have given consent for that. When you break up, and you’re no longer together, that consent is revoked. That consent has ended. You don’t do those same things with that same person any longer. But that idea translates across the board into every… into anything! You can decide, you know, I’m no longer okay with how somebody talk to me, and you can revoke consent to have conversations with people! You can choose to change how relationships look, but that also translates, like we said, to the medical field. You know, if you’re in labor, you can consent to a vaginal exam, and then have them come in and ask for another one, and say “Nope, we’re done. I don’t want any more of these,” you know, “We’re good now.” That kind of thing. So, it’s… Consent is an ongoing thing. It’s not a one-time decision. It’s a continuous thing that you have to continue to give as time goes on.

Tatiana: Mm-hmm.

Elle: And I think that that’s something that is… that’s an aspect of it that’s kind of overlooked a lot of times.

Tatiana: Yea, definitely. I think timing is a huge part of consent. It also is when and where you’re asking for consent. Are you doing it when somebody is in the middle of a contraction? Are you doing it… Are you asking for additional consent while your fingers are still inside of their vagina doing a cervical exam? Or, you know, are you also – if they say yes – are you waiting for their body to give consent, as well? And a lot of times providers will know what I’m talking about, when you either go to do some kind of vaginal or cervical exam, or place a speculum for like a Pap testing or something like that. You’ll notice that the body can be really tense. And if it’s tense, it’s not giving consent for you to proceed and push forward because if you are pushing forward, you’re going to inflict more pain going forward with that exam. And so it’s important – not only to wait for the person to tell you that they consent to whatever you want to do – but also wait for their body to do it. And it’s just kind of like an IV or blood pressure – you wait for their arm to be available. You wait for, you know, their body to also be ready to proceed. It’s not just what they’re saying. So there’s a lot of different cues to read.

Elle: I am just gunna say… I love you!

(All laugh)

Elle: On the time that we’re recording this, listeners, we have not launched yet. My birth story hasn’t gone out into the world yet. Tatiana doesn’t know my birth story yet, and doesn’t know how… crap, I’m gunna cry…

Taylor: How accurate she’s being

Elle: How… Everything she said… How accurate everything she just said is, and how hard it just hit me… Um… Consent is huge. Consent is so, so, so huge. And you need to find a provider who will respect your verbal consent, but also your bodily consent. It’s so important.

Taylor: People don’t realize that one, like, extra level of bodily consent, that’s not just, you know, the word “Yes. It’s okay.” It’s your body… You know, your mind and your body being ready for that. And as a chiropractor, if we’re adjusting your neck, and you say “Yes,” but you’re still tense as all get-out, we’re not gunna go through with that adjustment, cuz it’s not gunna work. We need that last little relaxation, and a lot of it is trust in your practitioner, trust in what they do. So if someone comes in who’s never had chiropractic, or has only heard bad things about chiropractic, they’re not gunna handle a neck adjustment cuz they’re not gunna, like, trust it.  So, now people don’t realize that last little level of bodily consent, of basically psychological to the body, that people have to give for anything in life.

Tatiana: Yea, and I would say that it is extra important during pregnancy and birth because (1) so many people are going into birth with a history of some kind of trauma. That is just, very common in our society.

Taylor: Unfortunately.

Tatiana: And also… yea, yea… And also, just in typical medical care there’s the authoritative dynamic that a doctor has authority over you and that you are just supposed to be there and submit your body to whatever they want to do to you. And that is definitely not how I approach care. I feel like I’m just kind of a member on their team, and I’m there to guide them. But going along with that – it’s just the acknowledgement and the awareness that it is a very vulnerable state to be in, and a lot of the contact that we’re having with their body is intimate, and can be triggering, and can bring up past trauma. And there’s a responsibility on our part to, as providers, to acknowledge that, and to really model what care should look like, and what they should expect from people that are touching their bodies.

Taylor: Definitely. Especially when it comes to, like you said, the intimacy of, you know, a vaginal exam. And, I mean, it’s… You know, finding a practitioner of any sort that you are comfortable with that – if you have some sort of trauma – that you can discuss about, so that they kind of know what to look for, and know like, if … cuz mistakes happen. So, you know, if you have a practitioner who is going for a vaginal exam – you’ve told them, and they may move in a certain way that just triggers you – to know to back off. To know to that they’ve done something wrong and something needs to be held on pause until you can remember, you know, where you are, what’s going on, and who you’re with. And because of this formula that comes with procedures like birth… an interruption in that formula can be stressful for the doctor, but they need to know hot to adapt and adjust. And some practitioners don’t. They’re just so strict to the formula. They don’t understand that there’s that humanitarian level that basically “Oh, hold on, wait,” you know, there’s a change that has to happen now. And there’s this fallacy in the medical profession where, you know, with all this schooling, and all this knowledge, they have this formula that they follow, and if there’s an error, if there’s a pause in that formula, some doctors can’t adapt, and they need to be able to adapt to when there needs to be a change. And it’s just… It’s a weird thing that in the medical profession that this happens. And, you know, hopefully there’s been, like, there has been some changes in the medical profession. And, you know, this communication, and this consent, and this informed consent has begun to make changes. But still there’s some doctors that just can’t go off the for- go off the script.

Tatiana: Right. And I think that’s an acknowledgement of their lack of exposure to normal physiological birth. They don’t understand all of the mechanisms that are in place. Most of their training has been around very medicalized or very medical-managed births, and so they don’t understand the connections, like Elle was talking about, of being exposed to a needle during her labor could take, you know, her labor totally off track, and ultimately lead to a different outcome. And as a midwife, I definitely understand that, and understand how just one element being off can affect the rest of the care and the rest of the, kind of the rest of the births progress or journey. And I think they just don’t realize all of the smallest of things and how it can just affect… just another person coming in the room, or a word that somebody says when you’re in a really sensitive or vulnerable state, and somebody saying the wrong thing to you, or even just like “Oh wow, this baby has a big head.” I can’t tell you how many times I’ve heard people tell pregnant people that. Or, you know, the ultrasonographer, or the doctor, “Oh, I think this one’s got a big head,” or, you know, “Your partner has a big head, so your baby’s gunna have a big head,” and that gets in their minds because they’re so sensitive and vulnerable that they think, “Oh my goodness, my baby’s gunna have a big head, and I have to push that big head out, and it’s not going to fit.” And so, just even small things like that get embedded and can have just a massive effect on that person’s confidence or on their ability to sink in and really let birth unfold.

Elle: I can’t even tell you how much it bothers me the ultrasound that so many birthing people get, like, a few weeks before their baby is born, and how many people I hear say “Oh my gosh, they’re worried that my baby’s gunna be too big. They said that my baby is already measuring at x weight.” And I always stop and I take a beat and I’m like “Ok, I need you to listen to me right now… This measurements are so inaccurate.”

Taylor: Yup.

Elle: They can be off by as much as three pounds either direction. So when you say, “Oh, you’re 36 weeks, 38 weeks, and your baby’s measuring at 7 pounds. Your baby could be measuring as little as 4 pounds.”

Tatiana: Yea, I actually see it really frequently. Even with sonographers that I trust, I see that they can be just off. When a baby is not able to fit in the whole screen that they’re able to measure, that’s when it becomes more inaccurate. So we’re talking about over halfway of the pregnancy, it’s starts becoming a lot less accurate of being able to do that. And also, the technician who’s taking the measurements. There’s a difference in how people measure – just in technician to technician.

Elle: Yea. I have a friend who gave birth recently, and she was super worried about it. And she came to me, and she was like “Oh my gosh, my baby is measuring at, you know, x weight, and I’m not due for a few more weeks.” And, you know, I told her, I said, “Calm down, it’s okay. Like, it can be wildly off.” And she was… she had a vaginal birth. She’s just fine. The baby measured at just over 8 pounds. Like, not wildly out of, you know, the norm, of what’s a totally normal birth weight. It’s okay!

Taylor: Also, people seem to forget that the birthing body is designed to give birth. It is going to adjust how it needs to give birth. So it doesn’t really matter how big the baby is – the body knows what it needs to do. And, you know, the hormones know how they need to relax the body. It’s all… It’s all pre-programmed in the birthing body to give birth. So weight, head-size, does not really matter as much as people seem to think it does.

Tatiana: Right. Exactly. And it is just a common excuse that doctors give to their patients that ultimately have c-sections and it’s like “Oh, your pelvis is just too small,” and blaming the birthing person. Or “baby is too big,” so blaming genetics, blaming how they grew the baby, blaming whatever… but they just say, “Oh, this is what’s happening, and this is the cause,” when really it could be that baby’s just not in an ideal position. And being told to lay in a bed doesn’t help to facilitate their rotation and their movement through the pelvis to facilitate birth. And it’s just a lot of disconnection, and again, I think a lot of a lack of education of physiological birth from medical providers: nurses and doctors. If they could see what we see in home birth, which is people delivering 10 and 11 and 12 pound babies on their own without any difficulty, then I think that they would have a different perspective on what big babies are and what “big babies” means.

Taylor: We actually watched a video in one of my classes (for the Webster Technique) of a woman giving birth to twins in her bathroom, and one was breeched. And they both came out fine. They both came out healthy. I mean, it was probably a little uncommon, but it was just like… The body knows what to do, and that’s forgotten in the medical community sometimes.

Tatiana: Yea. Breech is just a normal variation of birth. It’s not an emergency by any means, or anything. It’s just the liability has gone up within obstetrics, and that means that they’re not teaching it to OBs that are going through med school, and so the art of delivering breech babies is being lost, and there are so few doctors that are comfortable with it, and have experience with it that it’s a big problem.

Elle: One of the things I remember learning in the Bradley classes we took is: if you think about the classic media portrayal of the woman giving birth, pushing on her back… Who is that convenient for? It’s not physiologically conducive to having a baby. It’s not conducive to the baby itself. The whole time you’re pregnant, they tell you not to lay on your back, because it’s not comfortable and it puts undue pressure on parts of your body and parts of the baby that aren’t great. And yet, that’s how we’re supposed to push? And so I remember my Bradley instructor saying “Who is this good for?” And we realized, the only person it’s convenient for is the person catching the baby.

Tatiana: Mm-hmm.

Elle: Period. It’s the easiest way for them to access catching the baby. But if we look around the world at other cultures who don’t give birth in hospitals, with medical professionals attending, do they give birth like that? No! They don’t! They give birth standing up, squatting down, in all kinds of other positions because that’s what their bodies are telling them to do! And they’re listening to those instincts to birth that baby in the way that feels the best, and is physiologically conducive.

Tatiana: For sure. I mean, if you think about it: when you’re on your back, and you’re delivering, they have great lighting. They have a huge trash bag attached right underneath your butt to catch all poop, all fluids, everything that’s coming out of your body just goes into that trash can. And they’re able to have great visualization, and also to be able to (in their minds) be able to manage the births better, because they think that they are delivering the baby. Where in fact, the birthing person is doing the delivering, and they’re just there to help catch. And I also think that they get away with hiding certain things or doing certain things down there that are kind of “out of sight” without anybody watching, basically.

Elle: So Tatiana, do you have any tips or things that you can tell us about how we can seek informed consent during labor? How can we ask better questions of our providers? How can we make sure we have all the information before making decisions? Things like that.

Tatiana: Ok, so I think what the biggest thing to look for is language: how your provider talks about certain things. Do they use the word allow? “I’m going to allow this,” or “I don’t allow that.” There is no such thing as allowing you to do something with your body. They either support it, or they don’t. But you’re not just allowed to do something. I mean, it’s your body, so you can do whatever you want. I think, also, even when people are – or providers are – giving informed consent, that there can just be a lot of bias in what they’re saying. So even if they’re giving you the options, there’s still ways to sway somebody by the way that you’re talking, by the way that you’re discussing the risks or the benefits. And providers are responsible for staying neutral and providing that true informed consent, and not having it be biased. And one example that I can think of that I thought of recently is how we talk about percentages. I recently… without going into too much detail, had a client whose water broke before she could be in her home-birthing window, and the doctor that was going to be taking over her care, you know, said “Well, we don’t know your GBS status, so you should be induced, and in that case, you’re just going to be treated as positive, because your GBS status is unknown.

Elle: For those of our listeners who don’t know what that is, can you explain?

Tatiana: Sure! So GBS is Group B Strep. It’s a bacteria that is… that is present in the gut of about 30% of pregnant people at any given time. And if babies are exposed to that bacteria, there is a chance that they could get an infection from that bacteria. And so I was just really upset that that was the reason he was giving for an induction – based off of being GBS status unknown because of just the way that the percentages are presented, like “Okay, well, 30% of people are positive at any given time.” Instead of saying, “Well, 70% are negative at any time.” So the majority are negative, but it’s presented as the 30%. Or it’ll say 1-2% of babies that are born to GBS positive birthers will get an infection. So instead of saying 98-99% of babies that are born to a GBS positive person don’t get infections. And I think there’s a lot of, just, bias and influence on the way that things are presented. I also think that people talk about the “consequences” of refusing – I think “refusing” is kind of an interesting word, and I tend to prefer the word “decline.” I think that it sounds like an educated choice in that sense: declining something because you’re educated about it and make that choice rather than “refusing,” which sounds just a little bit more rebellious. And also I think when they talk about the “consequences” of that, it should be the “possible outcomes,” instead of talking about consequences. Like, assuming that there’s a negative response to making that choice. It’s just like, “no, if you choose to decline this test, these are the possible outcomes that come with declining that. This is what could happen if you don’t know.” But that doesn’t need to be necessarily negative.

Elle: Yea, I think our word choice is incredibly important, and I think a lot of providers don’t necessarily think about that when they’re approaching their clients. And I think we need to do a lot of work in that – in figuring out what are our better word choices? You know, what messaging are we sending to our clients? What messaging are they hearing with the choice of words, tone of voice, how we’re approaching things, how we’re choosing to share statistics and information with them?

Tatiana: Yea, exactly. And I think every provider has room for improvement. Even I am, you know, continuously reflecting on how I could be better or how I could provide better information, how I can better empower parents to do the research themselves. I also consider the research options that I present to them and acknowledging that evidence-based material is based off of traditional hospital maternity care and it’s not necessarily outcomes that are based off of physiological birth. So there is a difference there, and acknowledging the resources that I provide is having some level of bias, too. And so, talking to the clients about what evidence-based is, and what is [unintelligible], and just what is my, you know, experience, and what I’ve seen, and letting them know the differences of that. And I think that there also should be an acknowledgment for providers as far as when they give options – acknowledging that some testing can end up providing additional stress that… If you are a provider that is a big proponent for genetic testing – genetic testing isn’t perfect. And so, if somebody comes back with a screening – and there’s also a difference between a person that is screening, and a person that is diagnostic, and I don’t think that is always made clear either… But there are screenings that can come back, and come back with a higher chance of something going on with the baby that is going to change your care plan, it might change your provider, and it’s going to add a whole lot of extra stress during your pregnancy that may or may not even be valid. So I think that there are just a lot of levels of consideration that we should have when consent is given and looking kind of at the holistic picture of its not just getting the data. There are other aspects that come with that, too. So, yea, I feel that as far as choosing a provider, that something you should look for is their language, their ability to spend time and discuss things with you, for consenting to things in labor. The biggest tip that I always give is to ask for a minute. Sometimes that can really help when presented with an option is to ask for a minute. Cuz a lot of times, they’re asking you in the middle of a contraction, you’re usually tired, and going through a lot. You’re not at your best, like, sharpest mental state at that time, and there is that, kind of, authoritarian level that they come in with that is just a different dynamic. And so when you ask them for a minute to discuss your options, you can refuse that kind of energy that is there, and then discuss it with your partner, or whoever is on your team. And then when they come back in the room, you have a more confident answer to give back to them. And I think also just recognizing that you do have power, even within a hospital setting of being able to choose what you do and do not want. And even though something may be standard or routine there, it does not mean that you have to consent to it, and it’s really your choice. It’s your [unintelligible]. There is some responsibility that comes back for choosing to birth in a hospital setting, and you are going to have to fight a little bit more if you are choosing something that is not routine or part of their standard care. So that comes into play as well. And that’s why I encourage people to explore their options while they’re pregnant, and getting educated to really evaluate “Does my provider match up with the type of care that I am seeking?”

Elle: That’s actually one of the huge… one of the reasons I’m a huge proponent of having a birth support person who is not just your partner, but who’s a separate support person. They can kind of help ground you and remind you of, you know, “These were my preferences. I don’t have to give in just because this is a person in, you know, in a position of authority.” I think we’re trained so much to defer to anybody who’s in a position of authority and just “Yes, yes, okay. Whatever you say.” And I think it’s really important if we have that extra person. Have you noticed, since Covid, more people looking towards birthing – either home births or with midwives – because of the lack of allowing birth support persons in hospitals for a long time? I know they’re finally starting to open back up again, but I know for a while they were only offering… or they were only allowing one person, and so most people were having to choose “Do I want my partner there, or do I want a birth support person there?” And I feel like I was seeing a lot of people choosing alternative options so that they had more freedom. Did you notice that as well?

Tatiana: Yea, absolutely! The interest has increased so much because of Covid. A lot of people realizing that a hospital is a place for sick people, and they’re not sick.

Elle: Yea.

Tatiana: And two, they still want to have options, and it’s not only about having a doula or other support person there, but some people don’t want to have to be tested, or don’t want the risk of baby being taken away until they’re test comes back negative. It’s all kinds of stuff going on in the hospital over the last seven months, and I do feel like people are more open to alternatives. That doesn’t mean that all everybody is the best, like, prepared to have a homebirth, because I think there is a different level of preparation that should happen before having a homebirth, and just that awareness. Because many people who are finding a hospital birth don’t do a ton of preparation. They just kind of are ready to show up and be taken care of, and that is not really the way that homebirth works. There is a lot of making your own choices, and choosing what you want, and also a level of having the mindset and the preparation that is important to having a home birth. But yea, I think that has been a good consideration of people who value their birth team, and want their support systems there. And I also have heard some birth workers that have been doing a lot of virtual birth support.

Elle: Yes.

Tatiana: And I think that, you know, doctors and nurses are getting away with a lot more because there isn’t an extra set of education and experienced eyes in the room. You know, doulas provide that level of knowing what’s normal, knowing what’s not, and when parents who, maybe, don’t know any better are there, they’re not gunna get those subtle cues or that subtle pressure, or that manipulation that might be sliding by, and it’s just not the same to be able to support your dream.

Elle: Yea, I totally agree about that. So before we let you go, we have a couple questions we like to ask all of our guests on the show. So first, what is your dream for the birth community?

Tatiana: I would love to see midwifery care be more accessible to all different types of people and all communities, especially minority communities. I would love to see more diverse population of midwives and birth workers, and there be a place for everybody, and it being more equal compared to what it is right now. And I would love for people to be empowered in owning the birth choices that they make, and just see manipulation taken out of birthing rooms. You know, you’re doing the best for your baby, of course everybody is gunna do the best for their baby, so there is a lot of concessions that are made under that guise. And, you know, I don’t think that should be a part of that. So, just people knowing what options they have, and insurance covering all of the options, so that it is more accessible and diverse population of care givers.

Taylor: Yea, that would be great if that could happen! Second question: what is one thing you will do for yourself this coming week?

Tatiana: So something I try to do for myself is plan for some time off, or block time off because I’m on call all of the time for people in their birthing window, and so I try to do things like make a concerted effort to go to the beach one day, or to have a morning where I can sleep in, or different things like that to take care of myself a little extra.

Elle: I love that! I know that Taylor mentioned that when we interviewed her, as well, that one of the things she wanted to do was go to the beach.

Taylor: Heck yea!

(All laugh)

Tatiana: It’s been a crazy summer for beach trips.

Taylor: Ugh, tell me about it!

(Elle and Tatiana laugh)

Elle: So, Tatiana, we wanted to say thank you so much for coming on the podcast and talking with us about consent, and informed consent, and what care should look like. We’re so glad to have you on. Before we go, where can everybody find you to connect with you?

Tatiana: Yea! So my Instagram and Facebook is all Birth Waves Midwifery. My website is birthwavesmidwifery.com and that’s the best way to reach me.

Elle: Awesome! Thank you so much for coming on the show with us today, Tatiana. We loved having you on, and talking about all of this with us!

Tatiana: Yea, thank you for having me! I appreciate it!

Elle: Alright, so we’ll see you next time! Thank you guys, listeners, for joining us, and we’ll see you on the next episode!

Taylor: Bye!
Elle: Bye!

Elle (Outro): Thank you so much for joining us here on Birth Re-Imagined. If you’d like to join our Facebook community, you can find us there at Birth Re-Imagined Family. And if you’d like to join our email list, you can get the link to that on the show notes of this episode. Being a member of our email list gets you access to all our freebies, and makes sure you’re kept in the loop whenever a new episode drops, or we have anything exciting to share. Thanks again, and see you next time!

Cat: (meows)

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