73. Homebirth & Decentralised Obstetric Care | Melanie Jackson, PhD

In this interview we discuss why women choose to birth out of hospitals, modern obstetrics as an industrial conveyor belt, medicalisation of physiological birth, the movement towards decentralisation and much more. 

Dr. Melanie Jackson, PhD is a clinical and research midwife with over 16 years experience caring for women in a homebirthing context. She is also the host of the Great Birth Rebellion, a massively successful podcast exploring topics of out-of-hospital birth and evidence based decentralised obstetrics.

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DISCLAIMER: The content in this podcast is purely for informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast or YouTube channel. Do not make medication changes without first consulting your treating clinician.

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Transcript

Speaker 1: 0:00

Dr Melanie Jackson, phd is a clinical and research midwife with over 16 years experience caring for women in a home birthing context. She's also the host of the Great Birth Rebellion, a massively successful and far-reaching podcast exploring topics of out-of-hospital birth and women-centered care. I brought Melanie on to discuss her work in decentralizing obstetric care in Australia and around the world and our shared goal of helping people become more educated and more informed in their healthcare decisions by highlighting clinical and scientific research that is not emphasized in contemporary treatment guidelines. I thoroughly enjoyed this conversation and I'm looking forward to seeing Melanie present live at the upcoming Regenerate Aubrey Summit on August 3rd. Now on to the podcast. So, mel, you have over 16 years of experience caring for women through childbirth and obviously a very strong academic background too. So tell us about this whole story your journey into where you are currently with regard to your practice with Midwifery, your podcast and everything that you're engaged in.

Speaker 2: 1:18

Yeah, great, yeah. So I'm a private midwife here in Australia and in order to be a private midwife here in Australia and in order to be a private midwife you have to go through a lot more training and education and hours of experience in order to work privately, and so we call ourselves endorsed midwives here in Australia because we have to get an extra little badge from our registration body to say that we could work this way. So for midwives in Australia who want to work in this way, you need to have an additional 5,000 hours of clinical experience, and that's just to qualify for the insurance product that we get. So it's quite a journey. So any midwife who gets into private practice is absolutely dedicated, highly skilled and has additional training on top of the training that we already get throughout through university and when you work in a hospital. So my journey was a little bit more unique. So that's the situation now. But when I entered into private practice, there wasn't any regulation around who could work as a private midwife. So you literally would register and grab a birth kit and start taking clients, open a business which is what I did at the age of 24, became qualified and then ran as fast as I could out of the hospital in order to start working as a private midwife offering women home birth services, and that's what I've been doing for the last 16 years. And then, in the process of doing that, also did my PhD, and the topic was birthing outside the system. I had two of my own children at home and now I train other midwives in how to open their own private practices here in Australia. So that's a very, very quick snapshot of my journey of the last 16 years.

Speaker 2: 3:05

And I started my very first degree was actually in naturopathy, so I was a naturopath before I was a midwife.

Speaker 2: 3:12

And so that philosophical mindset of understanding how powerful the body is at functioning and how capable its physiology is of functioning, so long as it's supported and nourished in the way that will allow it to function its full potential so that's the same idea.

Speaker 2: 3:30

When you're helping a woman to have a baby is you just have to provide or facilitate the circumstance that will allow her body to work to its full capacity.

Speaker 2: 3:41

And that's what I feel like I do as a private midwife, because it's a low intervention model. And that's what I feel like I do as a private midwife, because it's a low intervention model and that's what I was running from when I first started my career is this higher intervention circumstance that on paper doesn't make sense for women to be giving birth in that scenario because it doesn't give them what they need to have their babies. But it also in outcomes didn't make sense either, because we saw so much more intervention, damage to women and babies and trauma that occurred out of the system that I was supposed to be being trained up into. So I was already wired to not appreciate systematic ways of doing things. Because I was a naturopath, I already had a high level of suspicion and I just brought that suspicion into what I was being taught as a midwife, which just made it a really clear path out of that way of working and into private practice.

Speaker 1: 4:40

Yeah, great, it's an interesting background. I did six months of obstetrics and gynecology in my early years as a junior doctor and that was very interesting and I really enjoyed the rotation. But I guess I had an inkling of what you're alluding to in terms of maybe what made you want to leave the system, so to speak. So can you talk to maybe a bit about that PhD and expand a bit more on what you mean about birthing outside the system?

Speaker 2: 5:14

Yeah, so the PhD. Originally, when I started thinking of topics for the PhD, I was thinking about this phenomenon of what we call free birth here in Australia. It's got lots of other different terms, but free birth is a fairly overarching term where women consciously choose to give birth at home but exclude any healthcare providers from the space. So the idea is that, yeah, they're giving birth under their own authority with other people that they've chosen. Some of them might have some skills or understanding about birth. So sometimes people will hire a doula, sort of a professional support person that has seen lots of births before but doesn't have clinical or medical training to assist. If there's an issue, they're simply there as a knowledgeable support person. So that's free birth. And at the time that I was looking into it, sort of Instagram wasn't really a thing. You know, all the social platforms were really new and people weren't using them as they are now, and so it was a really obscure idea of why women would choose to free birth. Particularly in places like Australia, where we have free healthcare, the majority of people, unless they're living very remote, have got access to fairly good services. We've got really great maternity outcomes actually here in Australia compared to some other places in the world.

Speaker 2: 6:41

And so the question is asked is why? Why would women choose this when there's all these other options? And there was a small amount of research in the US and some other smaller studies around the world, but hadn't really it had not at all been looked at here in Australia. So that was the motivation at first is I'd heard about free birth in my work as a private midwife and just it occurred to me that there was a complete gap in the research. So then I proposed this to the uni, and you know, when you want to write a thesis, you have to prove that there's a good reason for this research. So I spent 10,000 words giving them you know an argument for why I should be able to study this, giving them you know an argument for why I should be able to study this. And they said yes.

Speaker 2: 7:26

And so from there it grew to really challenge. I challenged myself to ask why would women birth outside the system? So anything that's not allowed in the system, any decision that's not allowed in the system, was included in my PhD research, and that included women who had risk factors or what would be considered risk factors, but who still chose to give birth at home with a midwife. So I looked at the birth option of free birth, but also the option of having a higher risk home birth and what motivated women to do that. And so what we discovered which is really not brand new information, I mean, but basically that women will always choose the birth space and birthplace and the people that they feel is the best and safest option for them and their baby, so no massive surprises.

Speaker 2: 8:21

The bigger question is is why did women think that being at home without a healthcare provider was the best and safest decision? Because if you said to someone, I free birth because it was the safest option, that is mind blowing to people who are of a mindset that birth is dangerous and that you need an expert and that without the expert, you and your baby would die. That's the message is that birth doesn't work without medical expertise or input, and so women who free birth and who have home births in these higher risk situations have a completely different mindset. And then what we discovered is that their previous experiences of the hospital taught them that the hospital wasn't a safe place to be at, and they were almost forced to, or inspired to, explore other options based on their previous experiences, that was the majority of the women who had actually experienced trauma at the hands of maternity care providers and almost had no other option but to start exploring free birth. The majority of the women, though, wanted to have a midwife with them, but couldn't either couldn't get access to them because there wasn't enough midwives in the area or it was expensive. So that's the other thing with when you choose to birth outside the system, you also choose to relinquish all of the financial benefit of you know, if you want to go to hospital, the government will completely fund that, whereas if you choose options that are outside what's recommended by the government, they'll not extend that kind of financial support.

Speaker 2: 10:03

So women are forced to pay for these more boutique services that better suit their needs, and so I mean, it's obviously it's a hundred thousand words all about this, but that was the thesis, and what we discovered is actually maternity care services don't adequately meet the needs of women. There's other intentions behind a maternity care service, and so women, a certain group of women, these particular women that I studied will pursue birth options that meet their needs, but that also make sense to them. So it makes sense, if you're at home, that birth is going to physiologically function better when you actually know how birth functions. And so women knew these things. They were quite well educated.

Speaker 2: 10:55

When we had a look at the demographic information at that time that I was studying, about 25% of the population had a higher research degree. The group of women that participated in my study 75% were educated to a higher research level, sort of career option or what do you call it degrees so quite a highly educated group. What would you call it? Degrees? So quite a highly educated group. And it just when they explained why why free birth was safer then it kind of made sense. I mean, I personally wouldn't choose free birth, but I can 100 understand why they did, based on their explanations. That's a nutshell.

Speaker 1: 11:48

Yeah, it's such a fascinating glimpse into the many facets of patient decision-making and obviously in the hospital and in general practice every individual is different and you can have a pretty similar clinical situation, but people will make radically different decisions based on all the constellation of personal and family, financial factors and previous experiences that go into it.

Speaker 1: 12:21

So it sounds like that was a really valuable exercise and really understanding. Hey, there's this huge influence on people's decision-making that isn't really factored into maybe mainstream or centralized obstetric care, but was so significant that people would basically make the decision to not have that person at their birth, and that's a pretty huge decision. You made a point about basically being at the hospital as potentially influencing the outcome. It reminds me of Schrodinger's cat, whereas if you're looking at the box or not, it's going to influence what's actually in there. That's a really interesting point, because we kind of think of the process as something static. But what you're basically implying is that the probability of things going more smoothly is actually influenced by where the woman is, and perhaps being at home could potentially facilitate a smoother birth experience and labour than compared to the birth the inpatient ward.

Speaker 2: 13:31

Correct, and some of the things that the women were saying is actually, you know, the hospital says oh, you know, actually, birth is very risky, are you sure you want to give birth at home?

Speaker 2: 13:41

And the women's response to something like that is actually, when I come to hospital, I expose myself to a new collection of risks that I'm not exposed to at home.

Speaker 2: 13:52

So they talked about all the potential medical errors that could occur, the side effects of the interventions that they would definitely be offered in hospital, all of which they wouldn't be exposed to at home, and so there was no suggestion from the women that they had put themselves into a completely safe situation. They acknowledged that there is an element of risk in birth all the time, whether you're at home or whether you're in hospital, and so they just self-selected the type of risk they were willing to expose themselves to. So they decided that it was safer for them to accept the inherent risk of birth in itself and how whatever would unfold and occur for them at home, when they compared it to the risk that they would be opening themselves up to by going to hospital. So it wasn't so much that they yeah, they looked at the whole picture and made a decision about what elements of safety and risk they were willing to accept and they weren't willing to accept the risks offered to them at hospital and they were willing to accept what could unfold for them at home.

Speaker 1: 15:08

Yeah to them at hospital and they were willing to accept what could unfold for them at home. Yeah, that's I mean. Again, coming from seeing what obstetric care is and working in obstetric care myself, I can really see what you're saying in terms of the values of those two parties being quite different. The obstetric team is obviously most concerned about outcome of the baby and the mother on a very medical point of view, but there wasn't kind of, I think, which is talking to what you found in your PhD there wasn't a kind of tick box for the more emotional or other kind of less tangible outcomes. It was very much more of a strictly rigid and tick box type of approach. But clearly that was those things that the obstetric perhaps team weren't prioritizing were so important for the women in their decision making process.

Speaker 2: 16:07

So, yeah, you're right, the philosophical standpoint in obstetrics and in medicine really there's a really big focus on the physical body and a real separation of mind and body connection. And so when obstetrics talks about safety, they're talking about basic outcomes like is the woman still alive and is the baby still alive, and how many days did the baby have to stay in hospital for, and how much blood did the woman lose? They're not asking like are they emotionally intact? Are they psychologically intact? Did we care for them in a culturally appropriate way? And so an obstetric definition of safety is actually it doesn't mimic a maternal definition of safety. And this was another massive sort of disconnection between women said I'm not safe in hospital. And medical people can't understand that because they're saying of course you're safe in hospital, we can give you medicine, we can give you surgery, we can give you stitches, cesareans and forceps and vacuums. How can you be physically safe at home? We don't understand how you could be safe without us. And then women describe the emotional trauma that they that occurred during their births and and what happens to a person when you act in a way that's not in line with the process of gaining adequate consent, for example. And so the stories that the women told me in my PhD were stories that started back in their childhood, of some kind of abuse, for example, that then was mimicked in their childbirth experience. And so then you start and we've got research on this this is not new information about birth trauma that now we know. In Australia, one in three women describe leaving their birth experience with a level of emotional trauma and one in 10 have a diagnosable post-traumatic stress symptoms. And so we have to start asking ourselves if the obstetric care that we're giving women yeah, they're leaving the hospital alive and their babies are alive but if our standard of care is that nobody died, then you have to be wondering. You know that's how we're measuring things. We're measuring physical outcomes, but what we know now is we haven't measured the softer outcomes, like, in particular, if we think about Aboriginal women, for example, that are removed from their families and the land and from their culture and they're flown to Western hospitals, from their families and the land and from their culture, and they're flown to Western hospitals. They wait there until they go into labour, they give birth alone with foreign people that don't respect their culture, and then they fly them back, you know, soon after and wonder why the women and the babies and the communities aren't thriving. And it's because they're too focused on the woman's physical well-being that all the other elements are forgotten. And that doesn't happen at home. The women know that they're going to have cultural and emotional safety when they stay at home, and so it's.

Speaker 2: 19:47

The problem with maternity care is that it's the medical mindset. But childbirth isn't a medical event. It's as physiological as doing a poo and you know we never wonder. You know, yeah, occasionally that doesn't go right, but that's the same as childbirth. It's a physiological process. That's what our bodies were designed to do. You know we menstruate and we bleed and our cycle occurs as it should every month. Sometimes there's pathology in that and then we seek care. It's the same thing with childbirth. Most of the time we physiologically function just fine and there's a small percentage of women who need medical care. You know I'm a home birth midwife. 90% of my clients who plan to give birth at home do give birth at home. There's a 10% portion who need higher acuity care, and so I'm not saying that obstetric care is obsolete and that we don't need it. What I'm saying is it only has a place in complex childbirth. It doesn't have a place in physiological childbirth.

Speaker 1: 20:53

I remember listening to one of your podcasts and you described having an obstetrician present at a low-risk physiological birth is like getting a pediatrician to babysit your child and I chuckled at that analogy because I hadn't obviously thought of it that way, but it does make sense. On the point of these outcomes, or what we're measuring and what standards we're accepting, the breathing it reminds me of an analogy when we're treating metabolic disease and the centralized or the standard mainstream approach to something like insulin resistance and diabetes is one of it's such a low bar. Really we tolerate people climbing really into the danger zone of metabolic health where we have clear data showing risk of stroke, risk of ischemic heart disease starts climbing when that glycated hemoglobin really starts getting above 5.6, 5.7. Yet we're not really giving patients any early warning or effective lifestyle treatments to address that and what you're describing with obstetric care to me sounds like just very much mirroring that approach, just in obstetrics, not in medicine or diabetes.

Speaker 2: 22:19

It's the same problem. The same problem that you're describing is inherent across anything that's been medicalized, and so childbirth has been medicalized. It's been brought under the umbrella of medicine, whereas previously it was under the umbrella of it was in the community. There was a community midwife who went to all the births. She became experienced and wise in birth. It wasn't a medical event, it was just one that you had a wise person at. That midwife had an apprentice and that's how it was taught. And then, once it became a medical event, then you know we have all these problems, the same as what you're describing.

Speaker 1: 23:04

Then, we have all these problems, the same as what you're describing. I'm thinking about maybe a vicious cycle of interventionism, and I mean that in terms of perhaps if there's been multiple generations of women her mother and their grandmother had, say, cesarean sections. Is it setting us up for more intervention down the track? Sections is it setting us up for more intervention down the track? And I'm also thinking of our modern lifestyles and things like vitamin D deficiency, and we know that in severe vitamin D deficiency and even in rickets which is not a problem as much as it was historically there's actually inadequate development of the pelvic bones, so it could potentially lead to a higher likelihood of obstructed labor necessitating something like a cesarean section. So do you think the need for medical intervention in birth and obstetrics has increased or stayed the same, or not so much?

Speaker 2: 24:01

Yeah, well, I think we think of the industrialization of society has profoundly changed our bodies, but I don't think it's happened so fast as what we're seeing with changes in childbirth at the moment. So modern obstetrics is really no older than a few hundred years old, and so, while I think, yes, our bodies are suffering in some way just because of the industrialization of everything and the reduction in the quality of our food and how we're living our lives, birth still works most of the time, and I can only say that because that's what I've witnessed over the last 16 years. People used to say, when I was a student or a very young midwife, like how you know you're going out to births all on your own and you've got like hardly any experience and what gives you the confidence to do this? And the only thing that I could think of is actually, birth actually works most of the time. I have to do very little, even now as a midwife. Only occasionally do I need to offer any midwifery assistance. Most of the time it happens.

Speaker 2: 25:14

So the current message from obstetrics is that women are getting older, fatter and sicker and that's why they need to intervene more. But that's not been what we can see in the research. It's a great story and it perpetuates the myth that they want us to believe. So it's helpful if women believe that their bodies are the problem and that medicine offers a solution. It's helpful if women are frightened of birth because then they believe that they have to go to hospital and seek expert care. If women stopped, if women actually started to say to themselves actually my body's made for this and I can also assist it by creating a circumstance of good nutrition and healthy movement and all these things and sometimes things go wrong in birth, but most of the time they work If women actually believed that the entire maternity care system would have to change and already most modern maternity care systems can't afford for women to have that kind of information because it's disruptive to the whole entire system and the way it's set up.

Speaker 2: 26:36

So, yeah, I do think we're becoming less healthy and that eventually that's going to impact birth like it does everything else in our lives. But I don't think the rate of poor health is to blame for the current increases in things like in interventions. Like we look at maternal stats every few years as overall in Australia and cesarean section rate is gaining by whole percentages every time. Like we're nearly up to 40% of women having cesarean sections. So I don't yeah, I don't buy it that that our poorer health is causing worse outcomes. I think that the possibility is the way we're looking after women isn't right.

Speaker 1: 27:27

Yeah, if we can talk about, maybe that percentage of women that have issues and maybe keeping in mind that some women are going to choose, as you found out in your research, to make a decision to birth at home or do a free birth, and perhaps regardless of what the obstetrician or the obstetric team would say about that risk, and if we're thinking about there's a percentage of women who want to do this, then how can we?

Speaker 1: 28:02

To me, it makes sense that the next step is how can we make this process as safe as possible? Because and to use another analogy people are going to inject heroin regardless of whether or not the drug is legal and regardless of whether or not there are clean needles available. So I think, as a society, then we were faced with a choice you can pretend like it doesn't happen, you can push it under the rug, you can make life difficult for people who are addicted, and maybe their families too, or you can facilitate some degree of safety, which has happened in many countries. So what do you think about that analogy and what can we do to kind of mitigate risk of women who make these choices as fully consenting adults and patients?

Speaker 2: 28:50

Yeah, it is is that if you allowed every woman to choose a midwife and then allowed her to choose where she would like to take that midwife to have her baby, that creates a circumstance of safety for the woman on all safety checks physical, emotional, psychological, cultural, all of them checks physical, emotional, psychological, cultural, all of them. And we know from the research when you do that and where there is a maternity care system that's open to working in that way, women experience the best outcomes. And so why that works is midwives are I don't want to call us experts, because that kind of goes. That discounts the authority and expertise of women but we're trained to care for women under healthy circumstances. So we don't see a pregnancy as an illness. We see it as a life stage. You're having a baby how wonderful, it's, a bit like puberty. You know matrescence is another phase in life. You're having a baby how wonderful, it's a bit like puberty. You know matrescence is another phase in life. You're moving from maiden to mother and we're there on that journey, at the very root of midwifery. It's not to pathologize this situation, and so the only time we need to engage with anybody else and this is where the safety element comes in is having a midwife. Number one is it creates an element of additional safety on top of what the woman's already doing for herself. And then people ask oh, but what if something goes wrong? Yeah, that's why I'm there. If nothing goes wrong, the woman doesn't need me. Actually, the baby will come out, she can pick up her own baby. You know, with very little knowledge, you can work out what to do next If something doesn't go right. That's what I'm there for. If something really doesn't go right and I'm like okay, now I'm out of my scope and I need someone with some specialized tools, a specialized location, some different medication, then we move into hospital.

Speaker 2: 31:07

And the way that works best is if you arrive to hospital and they say welcome, what do you need? How can we help you? Where it doesn't work, where the danger starts to come in, is where there's hostility between the services, and so then a midwife goes. Oh, I really think she needs some help. But if we go to this hospital, that doctor is really hostile, probably is going to report you to your registration body. If you present to hospital in this circumstance, maybe we can try something else, maybe you know. And then, and then everyone's put in danger. The midwife is reluctant to offer transfer, the woman's reluctant to go because there's a reputation that the hospital doesn't treat women well who make these choices. And then when you get to hospital, there's a delay in the type of care that you need and everybody is nervous.

Speaker 2: 31:57

So I've been in that circumstance early in my career where midwives were scared to transfer women to hospital because we knew what we'd be confronted with. It's much, much better now. And so I used to prepare women for transfer like, okay, I'm going to go in there for you, I'm going to fight for you, it's okay, I'm going to do my very best to keep you safe. Now I can really confidently say with the local hospitals in my area, having worked with them for so long is that you're going to be fine, they receive me well, they receive my clients well. Now there's a cohesive way of working. And so, if I haven't remembered entirely what your question was, but we were talking about safety best case scenarios for keeping women safe, and that is allowing women to choose what they believe they need and then having a healthcare service that's open to allowing their choices, and that would include, when we go to hospital, you know going. Okay, you've chosen a home birth, but how can we help you? You need us now, that's okay.

Speaker 1: 33:01

Yeah, no, that's exactly what I was asking and I think it's the crux of patient safety and this idea that there's no external factors that are going to influence that decision.

Speaker 1: 33:13

Because, as you mentioned, there's going to be some percentage of women who need obstetric intervention and you obviously you know that more acutely than I do and I know that having gone through medical training and worked in obstetrics.

Speaker 1: 33:25

So cultivating an environment of acceptance and facilitating of optimal patient care just completely makes sense to me and I myself have seen patients who have had going back all the way to the beginning, who've made decisions to free birth because there wasn't access to home birth midwife in their area, and women who home birth because they had a bad experience at hospital, and I mean even in medicine as a doctor.

Speaker 1: 33:56

If there's a culture in a team and again it's like the different medical teams have different cultures and just different hospitals or different regions have different cultures and it sounds like you've cultivated or you've managed to promote a really healthy culture in your area in the medical team when I was training, if a registrar or a consultant had a reputation of being angry or rude or not really facilitating open communication, a lot of people suffer. The junior doctor suffers because they don't learn as well. But, as you've just alluded to, the patient can suffer because maybe the questions don't get asked at the appropriate time, maybe decisions don't get made by the most experienced person as quickly as they should be made if there's trust and a clear, open relationship between everyone involved.

Speaker 2: 34:50

Yeah, it's exactly right. I mean, you can imagine if you knew that your boss was going to yell at you every time you went to ask a question. You're going to avoid going, you're going to try and solve things yourself with your own inexperienced mind, and this is what happens, and then, like you said, you don't get the full benefit of everyone's knowledge and all of the available services. So if people can just let go of their ego and admit that women are allowed to make a choice that they don't agree with, and then, if it doesn't work, their job is still to help her, even if they think she got herself into this situation. So I've been in lots of situations as a midwife where I've recommended things to women and they've declined that opportunity and they said no, I know what you're saying, but I'm not going to do that. I'm still responsible for caring for her and keeping her as safe as I possibly can within her choice, even if I don't agree with it, and so but that's not the case with everybody. Not everybody can make that distinction.

Speaker 1: 36:03

Yeah, it's really the reason why everyone in this job as clinicians is really in the interest of patients and I really think that we need to do everything possible to make that experience safe. I really think that we need to do everything possible to make that experience safe and, like you said, this hostility between treating teams is just simply only going to be a detriment to that patient care. The next kind of really critical aspect to this whole story in my mind is education, and you've got a podcast, the Great Birth Rebellion, which has quite a massive reach at this point, and I've known lots of patients that I've talked to who have listened to the podcast and it's really shaped their decision-making process. And obviously I have a podcast too, and this is something that I'm critically interested in. But I think that in every situation, more education has been better than less education, and there's no situation where, for some reason, we should be encouraging people to know less about their body, less about birth, than more. So talk to that and talk to your work with your podcast.

Speaker 2: 37:17

Yeah, so the podcast was born out of. Well, basically, I work as a clinical midwife and all of the topics that I started with were the ones that I just feel like I'm always trying to educate my own clients about, and so I thought, wow, wouldn't it be amazing if I didn't have to fully explain this whole thing every single time to every single client? And there was some kind of resource where I could explain it really thoroughly once, give them all the research papers so that I know they've got a full picture of what I know about the topic and then we can discuss it. And so originally I was like, wouldn't that be amazing? If I need that, don't you think other midwives might need that as well? Because part of it is that midwives who are working in a different model to me so I get all the time I want with my clients. There's no time restriction. It's directed by them and by me.

Speaker 2: 38:09

In hospitals, women might go to their appointments and be confronted with a 10 or 15 minute opportunity to sit with a midwife that they may or may not know, or a doctor that they may or may not know and he's unfamiliar with their situation, and so then they don't actually have access to any education, and if they do get information, it's all based on the policies and guidelines that their hospital will offer them. And so the podcast was born out of the interest to give women information that they probably won't get from their hospital care provider not by the fault of the hospital care provider, but by the limitation of time and then also help other midwives out who maybe they're all talking to their clients about the exact same topics that I'm talking to mine about, and and be able to kind of refer to that as another resource. And the idea of the podcast is to give information without telling women what to do, and so what I do is because I have my PhD and I've got access to research papers I can use those to create the episode. I try and do it without any bias, so without trying to give away what I think people should do in certain circumstances, but also still really tapping into the research about, you know, using the research as the basis, and so it's almost a way of bringing people around to what the evidence is saying and also making them aware of what they're likely to get in a maternity care system and how big the gap is between the research and the actual clinical care, and that way, women don't just make the choice that's presented to them through their hospital or their care provider. They actually make a choice based on the information that they've gotten about the topic.

Speaker 2: 40:14

And what you probably find in the podcast and that's why it's called the Great Birth Rebellion is it's not rebellious in a senseless way. It's rebellious against current mainstream messages because the mainstream messages don't match the research, and so it's rebellious because we're using research to inform clinical practice instead of cultural practice. That's currently embedded in maternity care. Some people just do things because that's how our hospital does it, not because the research says it should be done that way. So that's the idea behind the podcast.

Speaker 1: 40:58

It's fundamentally the same thing. That I'm doing really is presenting this alternate set or alternate interpretation of established medical research and biomedical research, and I think the contrast that I draw is this distinction between centralised and decentralised, and in a centralised paradigm, then it's all been funnelled. I think the contrast that I draw is this distinction between centralized and decentralized, and in a centralized paradigm, then it's all been funneled through certain guideline bodies that may be a board of clinicians and not obstetrics, but perhaps other medical specialties like oncology or endocrinology that board of people who decide what the clinical guidelines for the whole country can be conflicted. They can have undisclosed or disclosed conflicts of interest with regard, to, say, pharmaceutical companies. And what you're doing and that's why I really wanted to talk to you, mel is because you're really doing this decentralized approach, using your skills as a researcher and a clinician to critically appraise the research and then coming up with a set of guidelines that is just as evidence-based but is more, in many cases, applicable and relevant to the woman in front of you.

Speaker 2: 42:14

Yeah, well, we know it takes somewhere between 10 and 17 years is the numbers for research to filter down into clinical practice, and so some women are getting the same type of care that that hospital has been offering for 17 years, and it's not evidence based, and then sometimes even the clinicians don't know why they're doing it, and so, yeah, it's just, it's really about empowering women with this new information and, you know, I love, I love the terminology that you use around this with, you know, decentralizing all manner of things, as you are, as I am, in our different relative fields, and I think that the centralization of this stuff is the crux of the problem which I could talk about for days of where the root of all these problems are. Do you want me to talk about it for days?

Speaker 1: 43:15

Only to make the point quickly that that legacy, the legacy treatments, I think women in obstetrics have been the kind of victims of some of the most egregious examples of maybe outdated care and going back to kind of the soaring of the pelvis in shoulder dystocias, and then all the way up to thalidomide, diethylstilbestrol, that was used and had all these transgenerational epigenetic consequences. It's unfortunately obstetricians and women have really had kind of as bum a deal as any patient in medicine with regard to historic treatments. So I think that we really need this critical appraisal of the literature and this open review that you're doing through the podcast to again empower people, empower patients with knowledge.

Speaker 2: 44:10

Yeah, absolutely. I don't know if I have anything to add.

Speaker 1: 44:13

Are there any particular topics that you want to make really quick mention of in terms of some of those episodes that you've done that? You? Think or not, necessarily, I don't know if any.

Speaker 2: 44:24

Yeah, it would be hard to do justice to the episodes, but if it's all right, I'd love to kind of give people a picture of what I don't know if it would be helpful, but just a picture of what maternity care currently is, please, what you're going to be confronted with, because birth is currently set up as an assembly line. It's industrialized birth, and so there's that centralized process that you were referring to, that women and babies. Well, women and families are expected to follow a centralized system, here in Australia at least, and in most developed countries, and if women comply with mainstream services, they're rewarded with access to free maternity care. So if we talk about this assembly line approach to birth, that exists in most government-sanctioned birth institutions, like hospitals in a publicly funded service, the staff are expected to work according to the hospital policies and procedures, as we were talking about, and it's a requirement of their employment and it's a necessity for the service that all the staff comply with these policies, because there's a hospital insurer who will only insure certain activities of the hospital under circumstances. So already the problem here is that the staff are working in servitude to their workplace and their allegiance is to their employer, even though, as midwives, we're supposed to exist in servitude to the women that come under our care. So the very definition of midwifery is to be with women. But what's happened with the industrialization of childbirth, where everyone is expected to attend hospital to have a baby, is that midwifery has also been industrialised and births have become like products of a factory production line, and so midwives find themselves in a position where they're just servicing the production line instead of being free to provide midwifery care to women in a way that sees them as individuals with unique needs.

Speaker 2: 46:43

And so the problems that we see with this type of maternity service delivery is that it's dehumanizing, is that we don't see women or babies as people. We just see them as items and objects to get a baby out of alive and keep the woman alive. You know and I spoke earlier about one in three women leaving their births with birth trauma and I'm not talking about you know people say, oh, yeah, well, of course you know, sometimes they'll have a vaginal tear or some kind of physical trauma. It's not physical trauma that women are leaving their births with. That's lasting, because there's also been research on this, and when women reflect on their birth experiences, about 30% will say that they felt traumatized by something that physically happened to them, but 70% reflect that their trauma relates to the interactions that they had with their care providers. So the problem isn't that women can have physical trauma that happens.

Speaker 2: 47:49

The problem with this factory-style birth approach is that it doesn't treat people like people. It treats them like little baby-making machines, and so the decentralisation of birth would mean dismantling this current system that requires women to attend a facility, and the idea would be to make services match the needs of women, instead of making women fit into a system and a service that doesn't match their needs. So it's this is the problem. It's not that that birth is dangerous and horrific. It's that we're treating, that we're caring for women in dangerous and horrific ways, and so when we talk about decentralising birth, it's just giving women what they actually need in childbirth, instead of sending them through this factory-style birth process that doesn't match the physiological needs of the body or the woman.

Speaker 1: 48:53

Yeah, that's a great point and it really speaks to a systemic issue, and I really want to emphasise that the clinicians working in that system the obstetricians, the hospital midwives they're all well-meaning, and I know it almost doesn't need to be said, but I want to emphasize it because that's something that both you and I believe, which is that everyone is trying to do the best for their patient, but there is handicaps or issues inherent in the system that they're working in that are leading to the outcomes that you described. And so talk about the vision how can this process, this decentralization of birth, how do you see this progressing so that potentially more women can get the care that they want and that they are able to do so in a safe and supportive way?

Speaker 2: 49:51

Yeah Well, my vision would mimic what we know from a lot of research and from historical knowledge of how birth works, and we know that women have the best outcomes when they give birth in a place where they feel safe, where they have a care provider that they've chosen and feel safe with, and where there's some kind of plan and strategy, somebody wise in the space who can help manage complications and assist with what might need to happen next. So my vision would be is that we would start with the demedicalization of birth and start seeing it again as a physiological process that most of the time works well and that is best supervised by midwives or, you know, wise women in the space. This is how it's always been done. Midwifery is the oldest career, you know. It was mentioned in the bible. There was the midwives said they were also rebellious. By the way, you know, pharaoh told them make sure you kill all the baby boys. And the mid midwives said to Pharaoh like, oh, the Israeli women, they just give birth so fast and we never get there. And oh, sorry, we couldn't kill the baby boys. Like, from the beginning of time, midwives have been rebelling against the higher authorities. So you know, always midwives were involved with birth, and it was always an event for women only. Usually the husbands were actually excluded. This was a time where women could get together and help each other have their babies, and so bringing it back into the social frame and out of the medical gaze would be a start.

Speaker 2: 51:41

Reinstating the wisdom of midwifery where again we've centralized midwifery training. We moved it out of an apprenticeship style education and into an academic education. I'm not allowed to call myself a midwife unless I've first got a university degree and I've registered with the appropriate bodies. It's a protected term. Now it's been taken out of the community. And so decentralizing midwifery in itself and trusting women's bodies to function as they should, trusting midwives to be the main carers for women and then trusting that, when and if things don't go right, that we will come and seek help from wise medical people who can help us in the times where it doesn't work.

Speaker 2: 52:29

So I would like to see a demedicalization of birth, a demedicalization of midwifery training, where women can discover a new trust for their bodies and not fear the birth process anymore, and where a medical system is not invested in women feeling fearful about birth. And then it's about allowing women to choose what they want. So, if they want a midwife, that they have access to a midwife. If they want that midwife to stay with them at home, that they have access to that. If they want that midwife to come with them to hospital, that they have access to that.

Speaker 2: 53:05

If the midwife discovers that the woman has a complication and we now need the input of an endocrinologist or a hematologist or an obstetrician, that we can go.

Speaker 2: 53:14

Okay, that's okay, let's go find our next expert that we can go.

Speaker 2: 53:18

Okay, that's okay, let's go find our next expert that we can involve in your care.

Speaker 2: 53:25

And all of that happening respectfully, with the acknowledgement that the woman has some intuitive knowledge inside of her that's going to help keep herself safe, and then that we also, as midwives and obstetric people and medical people, have some knowledge that the woman doesn't have.

Speaker 2: 53:36

And so, together, if she tells us what she knows and what she's feeling and what she can feel in her body, and we tell her what we can the skill that I might have, you know, telling her what her blood pressure is and feeling the position of her baby, and all kinds of things that I can do that maybe she can't check herself then together we can create the best outcome for that woman and baby, in a respectful way, because respectful care is what will reduce the feelings of trauma and will reduce the feelings of powerlessness that women feel and that lead to their birth trauma experiences. So that would be my vision. That would be the utopia of birth as far as I'm concerned. So that would be my vision. That would be the utopia of birth as far as I'm concerned is that we all work together respectfully to give the woman what she needs, rather than her coming to a service that is set up to service the needs of the staff and of an insurer and of the institution.

Speaker 1: 54:34

Yeah, that is a grand vision and it really doesn't throw the baby out with the bathwater and recognizes the role and the advancements that we've had in obstetric care. And you know, I've been in emergency caesareans and when they're needed they're needed and no one is pretending like that isn't the case, isn't the case. So I think that what you're advocating for is really just more nuanced and more considerate and creating a better experience for everyone. I think, and it also fits into a grander picture, I think, of the demedicalization of society and, as a GP, and seeing how many people especially when they get beyond the age of 40, have what I believe to be unnecessary encounters with medical systems and pharmaceutical medications because of lifestyle and in my vision which is part of yours, which is yours fits into is people would only come to the hospital if they have an acute trauma, a traumatic event, motor vehicle accident or severe obstetric postpartum hemorrhage or other kind of complication. So I think we're very much angling towards similar goals, just very much in different ways, but very aligned.

Speaker 2: 55:54

Yeah, and I think it just speaks as well to when you start to medicalize everything and place medical people as the experts in society, you displace people's power and knowledge and you disregard the knowledge of you know, historical knowledge and knowledge that people have. So I think the problem is is that we've encouraged a helplessness in people by setting these kinds of systems up and the health literacy is just becoming, you know, people don't have the health literacy to know what to do next without a GP or without a hospital for birth, like what do we do now? Then you know, for so long we've been told that we need these people and so, yeah, I think across all facets of modern life, we need to respect and encourage other ways of knowing. There's more ways of knowing than the medical way.

Speaker 1: 56:55

Yes, yeah, and what really comes to mind when you just mentioned that is creating dependency in the form of things like a Zen pick People essentially through. And it's worse in the US, to be honest, and they're meant to say well, really, this whole obesity thing, it's got nothing to do with the amount of artificial light you're exposed to, the massive amount of processed food you're eating. Don't worry about that, it's actually not your fault here. Just take this injection. I think that's just another facet of creating dependence on a pharmaceutical in this case, pharmaceutical system. That really disempowers people.

Speaker 1: 57:32

So, um, yeah, that's what, what you're doing with your podcast and um, these educational efforts, I think, are just so important, um, for for people and for for learning. And let's make a quick mention now of um, maybe you can tell us you, you've got a decentralized, uh, agriculture. You, you have a permaculture farm yourself, so you're really, really living this in every kind of facet of life. So tell me quickly about that, and then we're going to talk about some really exciting events that we're both going to be speaking at.

Speaker 2: 58:03

Yeah, awesome. Yes, so we live in the Blue Mountains in New South Wales and the dream has always been to just grow real food and eat real food, because I don't think people really have eaten real food unless you're living in a way where you're growing it yourself and tasting it the minute that it's picked. Things just taste different when you grow them yourself. They feel different, they look different, they smell different. The flavor is insanely good, so much so that when I eat food that I've bought from a shop, I feel sad. I feel sad that people don't know what real food tastes like. Like tomatoes, oh, my gosh, amazing.

Speaker 2: 58:50

So it started when I was a naturopath, just learning about the quality of the soil and how depleted it is, and modern agricultural practices how much they're impacting on how good our food is, and you can no longer just eat a good diet and expect that that's going to translate into a high nutrition and a great microbiome, because our food is so depleted. So we do things like I have goats. I have five goats. Why do I keep goats? Because they poo and they eat my scraps and I can put that poo on my garden and it adds nourishment to the soil and new bacteria and microbiota to the soil and that makes better food. And then when I eat the food, it's covered in all this diversity and that's going to impact on my internal microbiome and my kids. You know we I'm just so invested in good health that I can't not garden and I can't not have my own animals. We have our own chickens for eggs, our own goats for milk. When they're in milk, you know, we use all of their manure for the garden. It's just so golden. You know worms, wormweed for the veggies, and just like I can't not now, knowing all that, I know, and also then how good it tastes.

Speaker 2: 1:00:21

Like I also love to cook and people will eat a salad that I make from my garden and like what did you do with this?

Speaker 2: 1:00:28

I'm like not really much special, it's just this is what real food tastes like. Like our kids will eat beans from the vine and cut a piece of corn off from the stalk and just eat it in the garden. Not all of the food makes it into the house, which I love and so they walk through the garden and they'll pick things and they'll eat things and before they know it, they've eaten all this fresh food at the point of where it was growing, where it's most highly nourishing, and you know it's not this depleted kind of empty, empty calories, so that I mean that's why, that's the passionate reason, why, and that's why in the morning I, you know, get up and go and milk goats, and you know I can't go on many holidays because how many people are going to get up and milk three goats for me? I just really believe in it and I just can't not because it would. I just every time I put something in my mouth I would know that it wasn't the best. Yeah, yeah.

Speaker 2: 1:01:32

So we've worked towards that life and you know people go oh that's really nice for you, you've got five acres, but we can't all do that. Well, yeah, but I didn't start with five acres. That was the, that was the dream. At every house that we've ever been at, the first thing we do is put some soil and manure down and plant some veggies. So that's where it started. And then we had a thousand square meter block and we filled it, filled it to the brim to the edges with veggies and production, and then we went oh gosh, we've really outgrown this. Now we need something more and something bigger, and, you know, with the intention of more food and a better life through that food. So, yeah, the intention has never been big, to be grand and showy, and it's just. I really believe that this is how we should eat.

Speaker 1: 1:02:22

Yeah, and, like I mentioned earlier, it's really you're just manifesting this decentralized agricultural approach. It's just another manifestation of decentralization in your life and it's something that I'm very passionate about in my podcast, Regenerative Health Podcast. That's three pillars there's circadian and quantum biology Maybe we can talk about that a bit more at the conference coming up Ancestral diets, which is necessarily local and regenerative farming, and I think that what we're doing in medicine and health, that is just one facet of how we can hopefully help and heal society. But food is a very, very critical part of that picture. So it's so glad to it's so happy to talk to someone like yourself who's really doing all that as well as in so many aspects of your life. So let's make mention of some of these events that are happening.

Speaker 1: 1:03:16

So, if people have liked what they've heard in our discussion so far, we're hosting an event called Regenerate Albury and it's what I call a decentralized health summit and it's going to be happening in Albury on the 3rd and 4th of August and, mel, you're going to be speaking on Saturday at that event amongst a whole range of other speakers.

Speaker 1: 1:03:40

So we've got Dr Pranayoganathan, who's a gastroenterologist, and he's talking about industrial systems, industrial farming, industrial and pharmaceutical systems and how to, I guess, move past that. We've got Cindy O'Meara, who's talking about a more decentralized and holistic food system, and then we've got a bunch of regenerative farmers who are talking about moving away from chemical agriculture and reliance on industrial chemical inputs in raising our food. And then on the Sunday is about light and health, and that's a topic that I'm very passionate about and we've got I'm talking about artificial light and circadian rhythms and how that can be damaging, and that's another whole discussion of itself. But the birthing experience in a hospital is stark, white, artificial light, and that, I imagine, is the opposite environment that a woman cultivates for herself if she's choosing her birth space.

Speaker 2: 1:04:38

Did you see the episode on melatonin and labor? So there's a whole episode on the Great Birth Rebellion podcast about the impact that melatonin has on oxytocin, which is responsible for contractions, and yet hospitals operate through the day. And, yes, the artificial light and all that. So I mean this. It's so interconnected. I know people might be thinking, oh what, what does a conference with lectures on light and regenerative farming have to do with childbirth? It it's all the same idea, it's the same philosophical background that we're trying to educate people that this centralised way isn't the only way and that maybe it's doing us some damage that we need to come back from. And so how do we come back from that? And so it's such a well-rounded event that I think everybody can get something from. Not just if you're there to hear about birth you will still learn everything else about good health or if you're there to learn from somebody about regenerative farming. I can see it all being connected. So I think it's so amazing, the lineup that you've put together.

Speaker 1: 1:05:50

It's very, very exciting. Tell us quickly what is your topic and what are you going to be talking about, for anyone who might be considering coming.

Speaker 2: 1:05:57

Yeah Well, I'm going to challenge people's ideas about birth locations. We've been so cleverly brainwashed to believe that we must be in hospital to have a safe birth. So I'm going to challenge that concept using current evidence and the knowledge that I have from my research and the research that's already around and available, to make an argument for the opposite and present an idea that still keeps people safe in the same way as medicine believes they should be kept safe, but has way better outcomes long-term on so many other levels of safety. So that's where I'm going to be heading, with sort of targeting my discussion. Amazing, that's going to be a with sort of targeting my discussion.

Speaker 1: 1:06:51

Amazing. That's going to be a great talk. So, again, if people are considering coming, then we've got tickets of a single day just Saturday. We've got double day both days and we've even got a golden ticket which you can join us for a welcome dinner. And for those who are considering, again, it's about a six-hour drive from Sydney and there's plenty of great accommodation options. But if you are in a different part of Australia or you're listening from overseas, then we also have some live stream ticket available and you can watch all 13 sessions of the summit from anywhere. So that information will be in the show notes if you're interested, and then maybe we can just finally talk about the event that you're hosting, mel, because it really seems again that we're both moving the same lines of patient education, people and empowerment through these educational events. So tell us about the Convergence of Rebellious Midwives.

Speaker 2: 1:07:49

Yeah, the Convergence of Rebellious Midwives, also in August, roughly two or three weeks after your event, which is amazing, people can do a full conference tour if they want to. It's being held in Sydney at the Sofitel in Darling Harbour and it's called the Convergence of Rebellious Midwives and it really is an offshoot of the work that I've been doing through the podcast and it's the idea is, if women are only being confronted with one way of learning for their pregnancy, maybe midwives, when they attend conferences, are only getting part of the picture of the story for their education. So this conference aims to just diversify the type of education that midwives can receive for their continuing professional development. It's not stuff that you would learn at a run-of-the-mill in-service through your local hospital or employer. We've got international guests coming to talk about things like breech birth. We've got Kirsten Smalls going to be talking about the use of CTG in pregnancy and birth, which is so widespread, and what we'll realize is actually has absolutely no research basis for the use of.

Speaker 2: 1:09:02

So it's the same idea of the podcast, presenting the research around things, but in a rebellious way that doesn't really fit with current mainstream messaging. And yeah, it's just. You know midwives can claim their professional development points. It's at an amazing venue, the food's going to be incredible because I obviously wouldn't stand for anything less and it's just a time of replenishment education for midwives and really respects the hard work that everyone's doing, because a really big part of maternity care services is not only that women are experiencing trauma, but midwives who know that things aren't quite right in the system are experiencing what we call moral distress. Actually and there's research about this as well is how quickly moral distress can actually wear down the workforce and cause people to leave, and so this conference is for those midwives who just feel like the black sheep and can't understand why they don't fit into the system, and this serves them, but also any midwives. Anybody who's interested really is welcome.

Speaker 2: 1:10:13

We actually only have we've sold over 350 tickets and so there's only kind of 80 or so left, so I would encourage you to get your tickets before the event, um, so that you don't miss out, yeah amazing.

Speaker 1: 1:10:29

Well, yeah, all that information information will be in the show notes. That sounds like a decentralized obstetric conference and I think very, very valuable. In the information you'll be presenting, is there any and maybe some other ways that people can connect with you? Are you still taking on women? Give us some information about how people can interact.

Speaker 2: 1:10:50

Yeah, so taking on clients for me? I would not encourage you to try and my books are mostly full and I'm taking six month break off to travel with my family shortly. But you can find me melanythemidwifecom. If you do want to hire me as your midwife, you can find me there, but just be prepared that I might not be able to take you, MelanieTheMidwifecom. I'm on Instagram at MelanieTheMidwife, and the podcast is the Great Birth Rebellion, also on Instagram. That's where you can find me.

Speaker 1: 1:11:23

Amazing. Well, mel, thank you so much for your time and I look forward to meeting you in person at Regenerate in August.

Speaker 2: 1:11:29

Thanks, max, it's going to be so good. Looking forward to it.