Latest / Arrivals: A Birth Story Podcast / A midwife doula, a C-section, the UK midwifery model of care, and protecting birthing women
Transcript
- Merelise: Before we dive into today's episode, I want to talk to you about something incredibly close to my heart, and that's maternal health. I've spoken a lot about my own experiences on this podcast, especially related to mental health, and how important it is to seek help, whether through therapy or medicine. But we all know that's easier said than done. That's where Mère comes in, a virtual maternal health care clinic serving women from preconception through menopause. Mère was founded by a mom, just like you or me. Who struggled to find the support she needed during her own maternal health journey and wanted to create a better experience for other women. Mère brings together therapists, women's health providers, and pelvic floor specialists who understand the unique challenges women face throughout motherhood. Mère believes women deserve care that looks at the whole picture, not just one symptom or one appointment at a time. Book a free 15-minute phone call today and learn more at Mère-ForEveryChapter.com. That's Mère M-E-R-E dash for every chapter dot com. And then but then I I think let's go into your birth story maybe from there and then we can talk about your work. Does that sound good? Yep. Okay. All right. I'm so excited. Okay. All right. Hello and welcome to the Arrivals Podcast. I'm your host, Merelise Wilson and today I am so excited to have my wonderful doula Charmaine McNeil here with me today. Hi, Charmaine. Hi, thank you for having me. I'm so happy you're here. It's been almost exactly two years since I've seen you. Wow. Which is crazy. I know, time flies. It does fly, because Ford will be two on Wednesday as of recording this. Wow. Which is insane. How does that happen? Time is just going. Getting old. I know. I'm getting we're getting old, our babies are getting older. It's just crazy. I know, I know. Sometimes I see, like, I saw a woman who I was her duela when I first arrived. The kid is nine. I was like, yikes. my gosh, I know. And so, yes, I guess I should also elaborate. So, Charmaine was our wonderful doula with our second son's birth, Ford. And yeah, he'll be two on Wednesday. So it was felt like a just a real stroke of luck meeting you. I don't know if you remember this, you You actually were the second doula I'd hired. Right. Yeah. Cause I hired one and I kind of decided that I didn't. You didn't click with her. Yeah, yeah. It's really important that you click with. I always say that to women: if you don't like me when you interview me, I I'm not the person for you for sure. It doesn't get better. Yes, exactly. And I remember my husband saying, because I'm I'm such a people pleaser. Yeah. And when I didn't really, we went and met, so I'd already hired the other doula, we went and met her, and then I came away just not feeling badly beneficial. But not feeling great. Yeah. And I thought, you know what, it'll be fine. And he was like, Barely's it's the birth of your child. Do you really want someone there that you feel fine about? Yeah. You know? And I was like, okay, that's a good point. Absolutely. Hundred percent. You know, I always say to women, you know, make sure you like the person because they're gonna see you, you know, in your worst state, basically. So Yeah, yeah. So if you can't tell from Charmaine's accent, she is not from the US. And I feel like that's important context for our conversation today. Both because you gave birth to your daughter in the UK, right? That's correct. And then also because you worked as a midwife in the UK for a long time. That is correct. Yeah. Yeah, yeah. So Okay, so a little bit about my birth. I came to motherhood a little bit later than some and so was induced. I unfortunately am not the typical doula in the sense that I did not even contemplate having birth without pain relief. Yeah. and that's because I was a midwife when I knew what I was getting myself into. And so my induction wasn't stress particularly stressful. I managed sort of about for about seventeen hours with nitrous oxide and then decided, okay, I need an epidural. did they induce you with pytosin or they induced Yeah, so the equivalent of cervodil they started off with and then they started with Pitocin, but my daughter didn't seem to tolerate the Pitocin, so she started to have decelerations. And so, My OB was like the lead OB for the trust that I worked for. My Little Claim to Fame is where all the royal babies were born as well. My daughter was delivered and I remember you telling me that. And so he came in and said, Hey, listen, you know, you've been going for a long time, you're not making any progress, let's go and get baby out. And so we did. And so I ended up with a C-section, which went really well. I recovered very quickly. and she's now twenty-four. Wow. So yeah. That might win the record for the shortest. Birth story on the podcast. There wasn't too much to report, really. I mean, you know, I knew what I was getting myself into. And so I kept my room dark. I had very little talking and just kind of hummed through the whole process really. I think a lot of people don't mentally prepare for birth and so when they're faced with induction they don't really know w in which direction to go in. And so, you know There's a I always say there's a there's a beginning, there's a middle part and then there's an end. The middle part is the worst part and you know, you gotta mentally prepare for that. and you know, it's like running a race really. If you don't prepare you can't cope and you know, one of the things that I try to do is to get women to mentally prepare in the middle part. just because, you know, it's a long journey. Inductions take a very long time and it's not you know, people always say, it's gonna be so painful. It is painful but What we have to remember is is is if you stumped your toe, it would hurt for a couple of seconds, but because inductions can go on for days, this is the reason why it becomes so exhausting. And so, you know, I I'm probably gonna offend a lot of doolas when I say an induction is not something you should attempt to do without pain relief and that's just my personal take on things. and so when you take pain relief it's it's easier to cope with, you're more in the moment, and you You know, I can have conversations with women after their birth just because they've remembered everything. But if you're in persistent pain for forty eight hours, you you just don't remember anything because you're just trying to stay alive basically. You know. No, I think that's so valid because I remember I really didn't want to be induced with both of my babies because I wanted to attempt a low intervention, you know, no epidural birth and I knew that being induced would lower the odds of that happening. Absolutely. So you You're an absolute star. thank you. And we got in the shower, and then you decided, yeah, no. I know, I know. I mean, we were talking about it. I was just talking about it with Chris, my husband, the other day, because we were recording Ford's birth story Yeah. And I was saying how the whole just energy change shifted in the room when you got there. And there were so many little things along the way where you just helped that you would probably roll your eyes and say, Well, that's just me doing my job, or that's you know, just standard. But it's just things you don't think about. Like I remember. when so I was group B strep positive and I had to get penicillin. Yeah. And when they gave me the penicillin, they missed the vein. Yep. And so it was just coming into my arm and I had like a vasovagal, horrible reaction to it. And I you weren't there yet, but I called you to kind of tell you what happened. And and you said, Well, it seems like a really strong reaction to the penicillin, even for it being, you know, for them missing the vein. Ask for a different antibiotic this time. And I hadn't even thought about that. And you said, you know, you might not be allergic, it might not be anything, but Just ask for a different antibiotic just in case. And little things like that along the way. And then when you came during my birth and I wasn't really coping well, I remember I said that to you and you said, What do you mean? You're doing it. And I think you were coping really well. I mean, I think what was the funny part was you we decided that we were gonna get you in the shower and then we were about to step into the shower and you raised your leg up to get into the shower and you were like, Yeah no. And we were like, Yeah, okay, maybe not a shower. Let's do something else. Let's do something else, yes. And then we tried. We did fentanyl, which helped for just a minute. Yeah. and then but I think it's in hindsight, it's because I was moving through transition really quickly. We were looking back at our back at our notes and I went from seven centimeters to pushing in 15 minutes. Yep. Yep, yep, yep. It was just And that's what happens with second time babies. Sometimes you just you can't predict, but generally we know some part of that labor is gonna go a lot quicker than the first time around. Yeah. and yeah, and then you just pushed like a crazy person and got him out really quickly. So you were awesome. Well, it was funny. I had that fetal ejection reflex with him. I did not have that with my first, but once you've experienced it, you like you know what people are talking about. I said it feels like you're throwing up, but out of your vagina. Absolutely, absolutely. And people don't realize how important it is to feel that sensation because you I see women even with epidurals on board. sometimes one of the things that I've started asking to do now is to turn the epigeural down closer to the time when they're pushing, so they have some sensation. And the difference in pushing is a Amazing because once they can feel baby moving through their body, it makes it so much easier to push. when you're completely numb, it's really hard to do. I've heard a few people say that recently, and that is so genius. The turning down of the epidural as you get closer, that's so genius to me because for me personally, the most painful part wasn't pushing the baby out. It was it was transition, it was the contractions. So if you can get through that part without the pain and then start to kind of tune your body back in for the pushing that seems kind of like best case scenario. Yeah absolutely. Well they have had some changes with with epidurals recently and I've noticed I think I spoke to an anaestithist at Emri and who said that they're not giving the sort of full dose of drug for the whole hour each hour. They're doing it for 45 minutes. So what you're getting is a lowering of the dose for 15 minutes of each hour, which means that women have more sensation because what I'm finding is women have better movement. able to move them turn themselves, pull themselves up the bed, whereas beforehand you were just kind of numb from the wa from the waist down, you know, and just no kind of sensation at all. So really struggling to push. Yeah. Well, okay. So taking a few steps back, so you gave birth in the UK. Yes. And then you moved to the US. That's correct. And I remember a little bit of this story, but I'd love for you to tell everyone else. You decided not to pursue your midwifery practice in in the US. And remind us or tell me again why that was. Well, basically, the US does not accept medical qualifications from a lot of countries. and it's ironic really that you know, in the UK we Did for a long time have much better outcomes, and so I was told that I would have to start from scratch basically. in fact I was even asked to to do an English exam, which made me laugh because I was like, I speak the Queen's English. Yeah, we we we had it first. Or you guys had it first. I mean so I and then I you know then I kind of worked out it would cost me a quarter of a million dollars to do what I've been doing for 20 years, so I decided I wanted to stay in the birthing world, and so I Had made friends with an OB here and she had said to me, Why don't you be a dueler? And whilst I knew what it was, I didn't kind of I didn't really look into it in depth because we don't need them in the UK, so you know they're not as common, very in fact they're quite rare. and so decided to go down that route, and I think in 2018 I kind of stepped out on my own from kind of working for various companies, and I haven't looked back. It's been an amazing journey. Yeah I meet wonderful people like you. When you say you don't need Doors as much in the UK, what do you mean? So midrify is all very all-encompassing in the UK. So I was a community midwife, so basically I ran my own clinic. and so clients, if let's say for example, you were booking at Emory Johns Creek, you would you would book with me and you would stay with me all the way through your pregnancy. I would take your bloods. The only time you would go into hospital is to get your scans done. and the reason why we decided to to embrace that model of care was is that we had a a lot of immigrants and non English speaking people in the commun in that community who didn't engage well with healthcare professionals. But what we found is is that if they worked with the same people all the time, they worked, they communicated and the uptake of appointments and things like that was much higher. So outcomes were better. And so what we did was we put these satellite clinics in the community where by which, you know, in doctors' offices, local doctors' offices where women went anyway, and so you know they would see the Their primary care physician, and then they would come and see the midwife. and so by the time women were ready to deliver, we knew them well because we booked them from day one. Yeah, and if we were available on the day, we delivered them, and then postpartum we would go and see them at home in the community. We had drop-in clinics, so they would come in, you know, on two or three days a week we'd have a drop-in clinic, so you didn't have to wait for to see your OB, you didn't have to go to an OB, you can just kind of come in and you know get seen, get breastfeeding support, get checked if something was. Wasn't right, get babies weighed, check for jaundice and all that kind of stuff, which was a really I found was an amazing model of care and our outcomes were much, much higher. The uptake of breastfeeding was very high as well. It sounds like a dream. I mean you really said it's like all encompassing. It was it was an amazing model of care. I really enjoyed doing it. And then you get to know, you know, your community and you know, there are all sorts of people, you know, with all sorts of health and medical and personal issues and that kind of stuff, and so we kind of Engaged with local professionals to provide care for women so they didn't have to go and look for a physical therapist or they didn't have to go and look for mental health specialists or anything like that because you know everything came through our our resources. So it was really helpful. That's just huge when you're a new mom to not have to or any when you're a mom, period, new or not, to not have to worry about I I need to see a doctor, I need to see psychiatrist, or I need to see a pelvic floral therapist. Now I've got to go online and Google and figure out and read the reviews and what's the best one for just to already have that like. Like built into the same practice that you were seeing for your OB care is amazing. It really was. I mean, you know, we we found well I was part of the initial group that started the community midwifery, and so we found that the outcomes were much, much better. We had much more engagement, and women seem to enjoy it a lot more. Yeah. How have things changed in the UK since then? So there has been a huge I'm sure everybody's heard there's been a huge change in Government in the last sort of ten years we've had seven prime ministers, and so there has been a lot of underfunding for the NHS, and the reasons behind that I I can't really comment on because I'm not 100% sure. But what we've had is a mass of immigration, and so the NHS was not built to accommodate so many people, and so and then once we also have you know people different cultural differences, different languages, and all that kind of stuff, and those put extra strain on the resources. And so what we're finding is some areas are struggling more than others. Maternity is doing fairly okay, but what we're finding is you know women are dropping through the cracks, whereas beforehand they didn't as much. My hospital where I worked was Queen Charlotte's, so they had a really good community midrify service, but not all hospitals do have that service, and the hospitals that don't have it seem to be struggling. More at the moment. so you know, tests are being missed. I think I heard something on the news recently where by which a number of babies had died due to lack of observation and poor care. I I'm not sure if a particular person was responsible. I kind of half heard the story. but you know, there are there are there are definitely challenges right now with the NHS. You know, even outside of maternity, you know, o orthopaedic surgery is, you know, there are really long waiting lists and you're hearing stories of people dying on waiting lists and things like that now. and you know, it's it's just a kind of s sign of the times really. Yeah. Coming over from the UK to the US, what in kind kind of your observation has been the biggest difference in I guess we'll keep it a little narrow in the in the in women's health care between the US and the UK. I think healthcare here is a little bit disjointed. So for example, if you have a primary care physician in the UK and you're pregnant, your primary care physician is your point of contact. Whereas here, if you've got a problem with a finger, you go to a finger doctor, you've got a toe problem, you go to a toe doctor. So it's really hard to kind of keep things together. When I first came, I had no understanding of healthcare here. I actually did a master's in healthcare administration, so I could kind of get to grips with, you know, how how things funded, why we do things navigate. Absolutely. And I was mind blown. Yeah. You know, as much as universal healthcare is frowned upon, in my mind, it is a better option only because you know you don't go bankrupt trying to pay a bill. Just to give you a little perspective, you don't know this yet, but you're going to find out. I had a little issue with AFib about a month ago. and couldn't figure the doctors couldn't figure out why it happened. but I landed I'd been in hospital for two days and and land got landed with a ten thousand dollar bill and I was like, Jesus, you know. So you know, that does not happen in Europe, which is and even if in some of the European countries like Denmark and the Netherlands and places like that, you do have some pay money to pay but it it won't break the bank. Right. And you know, I it it scares me that you know women you know I'm having clients who especially who are paying out of pocket will say to me, is this blood test necessary? Or do I need to do this or do I need to do that? And women, pregnant women shouldn't have to make those kinds of choices and I find that quite scary. But I think the main thing that I noticed when I first came was one The financial side of things and how women were dictated to. They weren't you weren't kind informed choice almost means something different here. So you sign a generic informed choice when you walk into the hospital and that covers off everything that they choose to do to you when you're in the hospital. you know, and I I find myself having to say to nurses regularly, can you let her know what's happening? Mm-hmm. Can you, you know, can you ask for permission? I had a this is a sad story, I had a client who one twist one twin passed just before she was about to deliver and they kept referring to it to the to the child that had passed as it even though she had a name. And so I had to call the whole team outside and say, Hey, this is her child. Please can you use her name? And you know, they seemed a little bit offended by my comments, but I was a mindful that this poor woman had no idea that this child had passed. Do you know what mean? And so I think the younger generation I find are a little bit more what is the word? They're a little bit more empathetic. I find people that have been in the system for a long time become quite jaded and they this is what we always do, so this is what we're gonna do. Yeah. and we forget that this is a person, that this is their first pregnancy, they have no idea what is coming their way. and you know, we have to inform them. Even talking in in in midwifery speak or obstetric speak, I'm often saying to doctors, Hey, you know, what she actually meant was this, that, and the other. And so, you know, they're talking a month. each other in their obstetric speak and you this poor woman sitting in the room kind of going, what are you guys saying? Right. You know? Inductions I'm just gonna go back to inductions a little bit. Inductions here are all about speed. I think one of the things that I have noticed, especially with all the the recent changes in in healthcare, is that doctors are under a lot of pressure. They have, you know, a short amount of time and they have to deliver certain things and you know, so it makes them come across as being sort of impatient, but they're not. They're just trying to do their jobs. Yeah. And so what I'm I'm finding more and more and more is is that you know they're trying to rush inductions. Now inductions should not be rushed because you're asking your body to do something it's not ready to do. Right. So if you give somebody a drug you have to wait for the body to adjust to that drug. You can't say after two hours, well you're not doing you're not moving quickly enough, let's offer you another drug. This is why how we escalate things and then you end up with a C section. And so for me One of the things I do is I spend an extremely long amount of time trying to educate my clients as to this the need to slow things down. Don't accept that certain things. These are the drugs, this is what they do, this is how long they should be taking, you know, this is what they should not be doing. I mean, the latest thing that I've observed is this that wake breaking of waters really early in labor. shouldn't be done for a number of reasons, really. if you know the head is really really high, you know, baby could come down in an awkward position. I've had several c occasions where, you know, women have forgotten that I've told them not to s to let them break their waters early and they've broken the waters early and babies have come down and they've gotten stuck and they've actually go to C section. they also there's also this movement to be to use a drug called misoprostol or cytotech, which is great for drumming up contractions, but once it's in your system you can't stop it. So if you have cervadil and you're hyperstimulating, they can take it out and slow the contractions down. If you're on Pitocin and Pitocin is causing too many contractions, they can switch it off. Yeah. But once misopristol is in your system, that's it. Right, because that's it's a pill, correct? Absolutely. Yeah. Absolutely. And so it's very good at drumming up contractions, but sometimes it can overstimulate the uterus. And then you know what happens is babies get distressed. Doctors say babies are distressed. Let's go to C-section. Yeah. I think the interesting thing is that in Europe we use it to terminate pregnancies. So when I first heard about using it here, I was a bit stunned because I was like, my God. Yeah. But it's used in a smaller dose, so it's a safer dose. And it's not FDA approved, by the way, for labor. but it again, I'm sure I'm gonna offend loads of people. It's okay, it's a sensitive space. You can't I mean it's hard not to. it is it's a cheaper drug. Yeah. servodil is much more expensive and you have to keep it on under certain temperature and things like that. So in my mind, this is one of the reasons why it's used as of more often. Yeah. I've also seen this movement to do seismic and And the Foley's catheter at the same time. Hmm. Hella painful. Yeah. Hella painful. So for the woman that has chosen to labor without any pain relief, one or the other is gonna cause them a lot of discomfort. Together, they are awful. Yeah. I had it was quite funny now. I mean, we laugh about it now, but I did did have a client who said, no, no, no, it's okay, I'm gonna manage it. And so she had the side checker board, they allowed her to have about four hours. Of side attack, and then they decided to do the balloon. And honestly, her husband called me and I could hear her hollering in the background and she was going, I need an epigol! Yeah, she didn't need an epigewel, she did not, she needed some pain relief, but I wish doctors would not would be honest with women and tell them how uncomfortable those folies catheters are. Yeah, they are awful, yeah. really, really awful. And so I'm not saying don't use them, I'm saying give women an a realistic picture as to what they're they're getting themselves into because Especially for the person that has decided that they do not want any medication or any pain relief. they they feel like they failed. Right. And they haven't failed. Right. It's just that it's so uncomfortable. Right. It's like doing it with one hand tied behind your behind your back. You're at a you know, you're at a disadvantage. Exactly. And so once it's in, you know, it's you can take it out. And that's the other thing that th women are not told that, you know, if it gets really painful, like I had one woman who she was literally screaming and she said to me, Sharm and I can't take it anymore, but I don't Want any pain? I said, so tell them to take it out. Yeah. And she said, you know, the doctors told her they can't take it out. And I Well, why can't they take it out? You know, and so I went down to the hospital and I said, Why can't you take it out? So, well, you know, the purpose of it, you know, if we take it out, it it it loses its effectiveness. And I Yeah, but she's in agony, right? You know, and she's having contractions, which was the purpose. She was not having contractions. she wasn't? No. What was the pain? Just the just the foley in her vagina, you know. And that's the balloon cathy. So here's the thing with the folius catheter, a lot of people don't realize that it does not always cause contractions because it is mechanically opening your cervix, so then there are hormones there. Right. So for a lot of women they have no labor. Right. You know, it's just opening your cervix. Just dilating, yeah. Yeah, absolutely. Absolutely. And so then after you've had the folius catheter, then you then have to go ahead and have pitocin because there are no contractions there. Yeah. You know, for some women will start to contract, but for some women no. Yeah. You know. And these are all the things that, you know, the average pregnant woman doesn't know and shouldn't necessarily have to know. Like this is why it's so wonderful to have a doula. Yeah, absolutely. I mean there was and I think one of the other things too, when I first came I was working with disenfranchised youth and I was a bit stunned at the level of ignorance about their bodies. They had I mean, they'd gotten themselves pregnant, but had no kind of real understanding of what they had committed themselves to. Right. And so when I was working for this nonprofit, I spent a lot of time teaching girls about periods and all these kinds of things. I remember even I used to do a class with both the boys and the girls and just talk about birth control and you know what you can do and what you can't do and you know the risks of getting HIV and all these kinds of things. And you know, some of these kids were absolutely mind-blown and sometimes I feel it's just lack of parenting. Really. Yeah. I I my daughter at the time was about 14, and I remember taking her to one of these classes. I took her because I wanted her to see the reality of life, right? And also as a deterrent. Yeah, that's great breath control. Absolutely. And I remember she was sitting next to this 14-year-old girl, and she sent me a text and she's going, Mom, the girl next to me, she's got a baby. And I Yeah, I know the baby's sitting on my lap. She was like, But It it is amazing how I I feel I felt sad for a lot of these children because the when they started talking to my daughter, they were amazed at how different her life was to their life, you know? And we're just ordinary people. I didn't think that we were anything special, but I just realized that how much more I had to teach these children because things that I assumed, you know, that they knew that Kaya knew, they didn't know. Yeah. You know? And so to this day, you know, and that was ten years ago, some of these kids, I mean, every now and again I would go down to Atlanta and I would say I remember once going to a football game and I heard this person yelling my name from across the stadium. And it was one of these girls and you know I had had such a profound effect on her life, you know, she she Ran across and tell me, Miss Charmaine I went back to school, and you know, and she was just so happy with her life because you know somebody had listened to her and paid attention to her, and it was just so sad that you know, just listening to them could make all the difference in the world for them. Do you know what I mean? I wish I could have stayed working for that nonprofit, but it started to get a little bit dangerous because some of the neighborhoods that I had to go into, and I was like, Yeah, no. So but it was wonderful. I really, really, really enjoyed working with these. kids because I could see them go from being, you know, these little shy girls that didn't know anything about life on their bodies and then suddenly becoming real informed and asking questions and wanting to achieve. Yeah. You know, which was amazing. You I'm reading this book right now called The Body Myth. Right. By Millie Hill. Are you familiar with her? She read the positive birth book. She's wonderful. She's an English woman. Okay. you should read the body myth. It's so fat fascinating. I'm wondering if I've heard about it and don't realize that I know about it. There's so many books. It just came out. okay. And it's about kind of this exactly what you're talking about: this concept of women not knowing anything about our bodies and like where that stems from and why, and just kind of the you know, centuries-long oppression and shame around periods and pregnancy and birth and just female genitalia that has been pervasive in our culture has now led to this. n you know, not knowing lack of information or like it not people not wanting to know about their bodies. Yep. so yeah, a lot of it was c especially in the UK, a lot of it was cultural. Yeah. here it I think it's just history. yeah. and I think again one of the things a a lot of these young girls that I were working with were women of colour who did not engage well with healthcare professionals and so you know, wouldn't show up until they were like showing pregnant. and so, you know If there were any pre-existing conditions or anything like that, then it became a challenge because then you had to kind of work backwards to kind of fix things. which you know can and I I do think that's one of the reasons why the data is so poor for some communities. I think one of the things since I did that, Masters, was is that we do need to break up the data a little bit because somebody like myself and somebody like you, and somebody like these young girls that I work with, their outcomes would be different based on healthcare, because you know, we have health insurance. I'm We do engage well with health professions and we're not afraid, you know, to go to the doctor, whereas, you know, their their demographic is and we understand why. but you know, it does make life a lot harder to kind of care for people with, you know, who have have been chronically ill for years and you know, have, you know, start pregnancy and they're diabetic and you know, they were diabetic even before they became pregnant and you know all the sexually transmitted diseases and all these kinds of things. You know, it's it's it was an education. It definitely was. and I spent a lot of time trying to understand and to to rationalise why why things were happening. Some things I never got an answer for. but It was very interesting to work with these youngsters, you know, w and to see how they would just blossom when they learnt, you know, about themselves and what they could do and what they could achieve and people would believe in them and listen to them and you know, we one of the things that we did do was we put them in touch with like schools and like work programs and things like that, you know, which, you know, kinda gave them opportunity 'cause that, you know, pregnancy did not have to be the end of their lives basically. Something you touched on reminded me, something I wanted to Talk about with you. You know, we know that women are dying at a faster rate than they should be in childbirth, period. But then also black and brown women are three to four times more likely. And you had mentioned some of that fear, you know, that you saw in some of these teenagers of and lack of trust in the medical system. How do you see that coming to light in your work that you do like today with women? I still see it even with the high income. women that I book as as as as doula's And it's it's it's so sad to say, but the common theme for women of colour is Charmaine, I just wanna make this make it out of this alive. Yeah. This is what they they they're coming to me hoping that I would help them to stay alive in this process. It's heartbreaking. It is absolutely heartbreaking. It's especially heartbreaking because I had a client recently who had Help syndrome, which is an advanced stage of pre clampsia. you know, just very, very, very unwell. and I personally felt her care. there was a bit of unconscious bias. I also felt she wasn't a black woman, she was a woman of color, but she she felt that they were overdrugging her. and she was trying to get them to understand that, you know, these drugs are making me feel worse, my blood pressure is ridiculously high. and nobody would listen to her. and there was a conversation had basically when she so decided to. She wanted to self-discharge because she was afraid that they were gonna harm her. And she was told that you made me get out of my bed for this, is what the doctor said to her, and then told her that you're probably gonna end up paralyzed if you don't listen to what I mean, the the horrible, horrible th I was mortified that a doctor could say something like this to her. And it was only because she was a woman of colour, because I'd never seen it happen other otherwise. Yeah. And this poor woman, I mean, a a part of me was a bit scared 'cause I was thinking, my god, I'm gonna have to take on this Right. But you know, was left the hospital because she feared that they were going to harm her. I mean, seriously, in this twenty twenty six this should not be happening. No. This is a big hospital here. Yeah. You know, but it was it was for me it was mind blowing because I've never experienced that before. Yeah. And I I couldn't understand the need for it. and you know, I've ha I've heard the stories, but I've never been Yeah. and so for me it was a real wake up call. You know, I was like, wow, this is what women are talking about. I mean, I have seen incidences like for example, I had a woman who also had preclampsia. This was about seven, eight years ago, and she was being induced, called me and said to me, Hey Charmaine, is a blood pressure of two hundred and ten over a hundred and ten high? And I was like, Absolutely, what's going on? And so I wasn't supposed to go down yet, but I I jumped in my car and I went to the hospital and I felt sorry for the nurse because she was newly qualified and she said to me, I said to her, Are you happy with this pressure? I said, Because her blood pressure's really high, she's looks She doesn't look well, you know, baby looks flat. What's going on? You know? And she said she sent a message via the portal to the doctor. Now, me, I personally, I'd have gone running down the corridor screaming, you know. And so I said, Okay, we need to know being here right now. Yeah. You know, and so I hate to get heavy-handed like that, but sometimes I do. And I have to step out of my doula role because as a doula, we're not supposed to get involved clinically, but I do. Yeah. and I had a doctor say to me the day, I said, said to him, I'm an ex-midwife, and he said, You're never an ex-midwife. He You just in it never goes away. Yeah. And so in the interim, they must have checked her bloods, realized that you know she was preoclamptic, and they came everybody came rushing in and said, you have to have a C-section. And such was my client's distrust of the system, she kind of leaned across to me and she said, Charmaine, do I need to go to a C-section? I Yes you do right now. And so she went to the C-section. and she was fine. But when I went to see her at home, every time I saw her, she would put her head on my shoulder and just cry and say, God, if you weren't there, what would have happened? Yeah. And I've had a few moments like that. Yeah. and you know, and I don't I'm not saying that the system is all bad. I'm just saying that too many times these things are happening too often. Yeah. Why is Obstetric s in the state that it's in, given how much money we spend per capita? capita in healthcare in the US. It shouldn't be so. No. It's disturbing. It is. and, you know, for some lucky women they do have a doula. For some lucky women they do have an OB who will go the extra mile. But you know, you hear the stories all the time about women who die because of, you know, just lack of care. Right. There was a doula stroke doctor who died I think at the beginning of this year. Yes. why did that happen? I know. Do you know what I mean? It should not be happening in US in the USA in 2026. I know. It's disturbing. It is disturbing. You know and People always feel that it's only women of colour, but I have had woman who, you know, she looked just like you. Yeah. Blue eyes. no, not blue eyes. Black eyes. And she called me and she said that she was in her Obi's office and they wanted to induce because her blood pressure was a little bit elevated and there was protein in her urine. Anyway, so got to the hospital, blood pressure was stable, but they decided to go ahead with the induction anyway. So maybe twelve hours in, I said, So what was the pro just out of the blue, something just kind of struck me and I said, Hey, what how many, you know, what was the protein like in your urine when you arrived? And she said, nobody's taken any any urine samples since I've been here. And so I was like, wait a minute, they're inducing you, your blood pressure's stable and nobody's checked your pro your protein. Checked her protein completely normal. But they'd already started an induction. Induction went terribly wrong and she ended up with a C-section. gosh. I mean I mean in the world of me, that's a lawsuit. Yes. Do you know what I mean? Yes. Because P somebody coming in with protein in their urine and elevated blood pressure, those are the two th the main things that you're gonna check. Check their bloods for liver function and all these kinds of different things. Why were these things not checked? Right. Do do you think it's lack of training? Like what is I I d to be quite honest, I cannot put my finger on it. you know, I think part of it is they're under so much duress to deliver, you know, they have so many amounts of women and so much time, you know, some so little time. To look after each woman, and they're kind of banking on the fact that the doctor sent her in saying that she had protein in her urine and her blood pressure is elevated. Let's run with that. Right. But really and truly, you shouldn't run with that. You need to check things yourself. It's just like giving somebody medication. You need to check their name and date of birth before you administer the drug. You need to track the drug. Because even though a doctor told you to do it, if you give it to the wrong person and you give the wrong drug, you should be held responsible. Yes. You know, I've had That when I was training, I had a young woman who was not hypertensive, and I was doing the drug round and she was prescribed a hypertensive drug. So I checked her name, checked her date of birth, and I went, hang on a second here. You don't have high blood pressure. She said no, but she was prescribed a hypertensive drug. So I I went back to the supervisor and to the doctor and I said, Hey, why does she have a hypertensive drug? And it was an error. Had I have given her the drug, I would have been held accountable. Do you know what I mean? Well, and that's why continuity of care is so important. 100%. And that's why that is like a hill I will die on. It's such a problem in the US. And you the way you described the midwifery model of care in the UK, the thing that I kept thinking in my head when you were describing it was continuity of care. Continuity of care. You know your patient. They're not someone you've met an hour ago or a day ago, and you know what is unusual or out of the ordinary in their chart. And it just makes all the difference. A hundred, a hundred percent. And this is why I think ACOG are now saying that then they're now recognizing because they they put out a paper recently recognizing the benefits of doulas. Because there is continuity here, where the only people that see women prenatally during their delivery and postpartum. And so for example, if I came to see you post bottom and you passed a clot the size of a dinner plate, if I was at your delivery, I mean a dinner plate is probably extreme. Maybe a baseball. Yeah, yeah. You know, but if I was at your delivery and and I knew that you didn't pass the lot of blood, then I wouldn't be as freaked out as if I wasn't at your delivery because I know how much blood you lost. Right. You know, even in terms of when women are being sutured vaginally, I always take a look because postpartum when they start to get discomfort, I know exactly where the sutures are. So I can take a look and make sure. Again, this is outside of the doula remit, this is with my midrify hat on. So I think this was but this is what makes me a little bit different. But you know, recognizing, you know, I mean I I was on a on a on a podcast recent not really a podcast, a website recently where they were talking about obstetric drugs and a lot of doolers didn't know what the consequences of some of the drugs that women were getting. I think this is basic. Even if you don't have a clinical background, if you're advising somebody or you're talking to somebody about a particular drug or their induction something. Like that, you need to know what the drugs are and what they do. I mean, you don't have to have like a 100% knowledge of the drug, but you need to be able to say, hey, if you take this drug, you know, it will make you drowsy, yeah. Or if you take this drug, it can make your blood pressure drop, or something like that. even the fact that misoprostol is is also site detect, some people didn't know it was the same drug, and that it's not FDA approved. Right. You know, these are I think basic things that we need to know so that we We're accurately informing our clients. Do you think it's fear of liability that doulas don't want to step into they want to keep that firm line of not being medical? I do think so. Also, I mean, I think doctors are now beginning to recognize that doulas have, you know, are are helpful. Yeah. and so You're not the enemy. No, exactly. Yeah. I mean, I've had maybe th a handful of sort of run-ins with nurses who have probably had issues with doolas before and really gave me a hard time. I mean like a really bad time. I had one client I felt so sorry for her because The the nurse didn't even want to recognize because, like, at the time I only had my UK qualifications. I have subsequently gone ahead and done US qualifications, which was like watching pain dry because I'd done it on the draw. But I did it because I had a nurse who would not accept that I was a midwife from the UK, or would not accept, even though I had all my qualifications on because I carry them around all the time. And so refused to even write on the Yeah. Yeah. And so made everything very uncomfortable for myself and my client. It was absolutely awful. and so the next day I called up a school and said, Hey, can I do this course? so that you know I'd have the US piece of paper, which is an absolute nonsense really, given, you know, my experience. But you know, if it made life easier for my clients I'm prepared to do anything, you know. but yeah, it's it's an interesting battle that we have to find. I I find that every birth that I go to I have to spend a good half an hour in the beginning of the birth trying to convince the team that hey I'm not here to make their life difficult. I'm on their side. My role is to advocate for my clients. Sometimes when I find that they're pushing back a little bit too hard I'll say, Hey, I am a midwife and so that does change the dynamic in the room a little bit. but now I'm finding that I'm working much because people know me now, so people and sometimes they don't really know like you all hear I heard a doctor there recently she said is that that doula from England? And so people are getting to know who I am and so it's making life a lot easier because now they're kind of you know having conversations with my woman and having conversations with me rather than just talking at hers. Yeah. So yeah, it's getting easier as time goes on and you know, absolutely enjoying it still. I haven't reached the point of no return yet. Well I remember when I found your profile and then spoke to you and we decided to you know contract with you. I was like, I feel like I'm getting two for the price of one I'm getting like my own personal midwife and Adula and it definitely gave me that that deeper sense of like you know peace and like that that you had all of that background as well and you're certainly unusual in that way. Yeah absolutely and and a lot of people say that I mean I I have a lot of clients from places like the CDC and places like that because they want somebody technical they want somebody that has you know kind of a deeper knowledge and you know that isn't actually maybe I shouldn't say This That isn't gonna try and fix them with herbs, which you know they do have their place. but it's not my it's not my way of practicing. And so my clients are all very like minded because they do want someone that you know that will say, Hey, the research says they do want somebody that will point them to the research and that you know will give them facts. and you know, we'll tell them, Hey, this is a good idea, however, these are the risks that you're taking. Yeah. And so and that will also Shame them for wanting to have an epidural. I had a client recently who switched just like you from another doula to me because she had said up front, I'm not even thinking about doing it without an epidural And she was kind of shamed into not wanting to wanting to have an epidural. She said to her, you know, you're you're putting yourself in harms where you're better off, you know, without an epidural. And she just didn't even want she didn't, it wasn't on a on her radar. She wanted an epidural and she didn't really care you know, about the consequences, it's what she wanted. And I you know, and I always say, if we are truly giving women informed choices, we mustn't shame them for their choices. Right. You know. Because for some women they do want, you know, completely normal birth, like you did. And you got a normal birth. and for some women, you know, they do want pain relief and so we we need to offer them that choice. Yes. You know, it's our role is not to judge them for their choices, is to support their choices. Right. And And I think what's so important is just understanding your choice, you know, and and making it, may ha not having it made for you. But I remember something that surprised me when we were speaking one day was I think I asked you how many births, like the percentage of births do we attend that have epidurals, because in my mind, I had always assumed that most people contract doulas cause they want to have a low intervention, no epidural birth. And it amazed me and I've learned more since then that obviously it seems so duh now, but doulas are Wonderful for epidural births, for C-section births. Like you guys have incredible value in every kind of birth. Absolutely. I mean I did a C-section recently and it was so funny because Mom was so out of it, she, you know, I had to be answering all the questions because she was completely like not I don't know if it was the drugs or you know, she was just on another planet honestly and I remember one of the twins was really small and so when he came out he was making so much noise. I had to stand up 'cause I couldn't believe that a two pound baby could make so much noise. and so I was able to relate the whole story back to her, what happened, what you know, when it happened, what they look like. I took pictures of them and everything. And it was magical for her because, you know, she said otherwise she wouldn't have seen all of that. Right. You know. So I think people always assume that, yeah, as you said, that, you know, doors are For people who don't want any intervention. And you know, we're available, you know, even when things don't go to plan. You know, we do all kinds of different things, you know, postpartum, prenatal, you know, it's it's different for everybody really. Yeah, and it depends on what you need. And so what I'm finding is supposed to particularly in Georgia's and a lot of people are moving here from California and New York and places like that, and they have no family network. And so this is why doulas are coming in really helpful as well, because they've got nobody to kind of support them. and so especially in the early postpartum period when there's so much going on. Yes. First time moms, at least you'd had one before. Yeah. So you were familiar with kind of commit remember remembering what would have what happened the last time. It's shocking that how much you forget. I mean, I still remember sitting there at two in the morning texting you, you know, saying, like, is this a normal temperature? Like what at what point is a fever a problem? You know, it's it's just crazy how much you forget between babies. You know, it is absolutely. And people don't seem to realize that. I mean, you know, you remember there are some things that you will forever remember. know and I always you know what when I'm training doolas I always say to things like you know mind how you speak to women because they remember things like that yeah no matter how clinically sharp the team was if somebody was abusive to them or you know rude to them they remember things like that and so even in terms of like being responsive you know I always say to women to my to trainees You need to have your phone like attached to you twenty four seven because then when a woman texts you it she needs an answer right now and you know otherwise she's gonna jump on the internet and by the time she calls you back she's spiraling 'cause she's read some story that has completely unrelated to them. Exactly. I know. I always tell people that one of the best perks of having a doula is you don't have to deal with Doctor Google, who's never going to make you feel better. Absolutely, absolutely. Yeah, I know. I can't tell you how many times I've talked women down off a ledge 'cause I've said to them, Now I make them say, I swear I won't I'll not jump on the internet until I've spoken to you. Well speaking of things, I remember that you said to me I have to share the story. I remember th after I had given birth to my son. So I will I will also preface it by saying like I am was a huge Call the Midwife fan. Like watched have watched it for years and years and years, loved it. And so like having an English midwife, I was like, this is so wonderful. And then after I gave birth to Ford, I was holding him on my chest and I was just like in this bubble. I was so happy. And I turned my head and I looked at you and you said, You clever girl. And that's what they anyone who watches Call the Midwife will know. I felt like I was in an episode. Was the b I don't notice how I didn't even try to imitate your accent. But it was the most amazing thing and it still makes me smile whenever I think about it. It was the best. I know. my client that the one that I told you that had a C section, she always says to me things you don't realise what you say. She said, There's so many things that you say at the end of every conversation and I just listen to you all the time. And you don't even realize that it's it's not what we say in the US, you know. And I sometimes I know I do say some Englishisms and I see people staring at me black me, I'm like, they don't understand what I'm talking about. Let me say it again. I love it. Well, what do you think is the hardest part about your job? I think now I'm I I think because I've been in the birthing world for the better part of twenty five years, so I'm finding on call to be harder. But I'm also finding all the changes in regulations really difficult because, you know, I can't keep up with it and it's my job. So for women, you know, it must be, you know, harder. I'm also finding that I'm getting a lot of different personalities. and I think managing expectations, I'm having to change my con contract constantly because somebody's had a different expectation. and so, you know, so that I don't have to deal with it again. Yeah. you know, and I I think people I don't know, it's just the human human beings are are so frustrated by life and so, you know, that gets passed down to me sometimes. And so sometimes I'm I'm you know, I'm always having to do an addendum to a contract or change something because somebody's expectations doesn't meet with what we agreed initially. And I see it more frequent now than I did sort of five years ago. Yeah. So I think life is just generally changing for you know. But it's it's still a wonderful job. you know because I'm I'm now known, you know, to some units, it's much easier to deal with. But Yeah, those those are probably the things that are the most I think the on call, I'm beginning to think, yeah. Please tell me you're in labor and you're not just calling me to ask me a question. I can imagine. On the flip side, what's your favorite thing about your job? I get excited by every birth. Absolutely still. I still get you know, women, you know, think that, you know, when I'm excited they think that it's an act, but I am a hundred percent excited if with every baby still. I can see that. And I think if if if I lose That then I think it's time to quit. Yeah, yeah. Yeah. I've had another doula express the same sentiment. It's like, yeah, if you start to lose that excitement, it's probably time to hang it up. Yeah. Because everything, because it's hard, it's a hard job. It's beautiful, but yeah, that's the reward, right? Yeah, definitely. I mean, and the joy, and you know, just seeing women go from being completely terrified of what they've committed themselves to, and then just blossom into these wonderful mothers, and you know, you get there. And you know, I often say to You are the expert on your baby, so it doesn't matter what I say to you. when you get there, and I go, no, he doesn't like that. he likes this, or he likes that. I'm like, okay, then my job here is done. Yeah, you know. So it's wonderful. Well, I always end every episode by asking my guests to describe birth in three words. Okay. No pressure. I'm lousy at stuff like this. whatever comes to mind, there's no wrong answer. Three words. I can only use one magical really. Yeah. I I think it's magical no matter you know, what type of delivery you have or how you deliver babies. It is absolutely magical. I totally agree. It is the closest thing that we have to magic. Bringing a life from inside your body, breathing essentially underwater to outside breathing air. It's magic. And women rock really, because I mean, you know, we're the only ones that can do this really. I know. Damn right. So yeah. Well you so much for doing this, Charmaine. I really appreciate it. Hey, it was my pleasure. It was good to see you again. It's good to see you too. All right. Well you've been listening to the Arrivals podcast. Until next time. Yay! it was so fun. I could