Latest / MyMaine Birth / 158. MyMaine Birth: Hospital Trauma and the Pull Towards Free Birth, a doctor's honest perspective with Nathan Riley, OBGYN

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158. MyMaine Birth: Hospital Trauma and the Pull Towards Free Birth, a doctor's honest perspective with Nathan Riley, OBGYN · MyMaine Birth

• 0:00
  Dr. Nathan Riley: So, you know, i if we were to now look back at these articles from The Guardian and we hear that people are having a free birth, people need to really appreciate why is this movement taking hold?
• 0:10
  Dr. Nathan Riley: Is it because we have something radically shifting within women, women in circles with other women who have decided we are gonna collectively not do that anymore?
• 0:19
  Dr. Nathan Riley: Unlikely, because we're all siloed off.
• 0:21
  Dr. Nathan Riley: Thanks to, you know, COVID was an obvious example.
• 0:24
  Dr. Nathan Riley: People don't want you talking to each other.
• 0:26
  Dr. Nathan Riley: In fact, we don't even like that women care for other women.
• 0:29
  Dr. Nathan Riley: So we're gonna continue this horizontal violence, this picture of, and and you see it on Facebook, women just tearing other women down for making their own choices.
• 0:36
  Dr. Nathan Riley: That's a part of the deal, unfortunately, in our society.
• 0:39
  Dr. Nathan Riley: Um, so doctors, nurses, everybody else, ask what's happening here.
• 0:44
  Dr. Nathan Riley: And if it's not that, then what is it?
• 0:46
  Dr. Nathan Riley: It's because people don't feel safe in your care.
• 0:48
  Dr. Nathan Riley: And that should be something easy to fix, except that we have two at least two generations now of physicians.
• 0:54
  Dr. Nathan Riley: I'll just speak to the OBG Wayans, being trained in such a way that you're the captain of the ship, the person's experience doesn't matter.
• 1:00
  Dr. Nathan Riley: None of that matters as long as there's a living mother and a living baby after this.
• 1:04
  Dr. Nathan Riley: So it becomes very confronting to the dogma, the indoctrination that many of us have endured, but not you don't have to continue that.
• 1:11
  Dr. Nathan Riley: You could actually take a step back, pause, and be very, very thoughtful and curious about this.
• 1:15
  Dr. Nathan Riley: And when you do, it's almost undeniable that there's actually something to this free birth movement.
• 1:21
  Dr. Nathan Riley: I'm Angela, and I'm a certified birth photographer, experienced duela, childbirth educator, and your host here on the My Main Birth podcast.
• 1:31
  Dr. Nathan Riley: This is a space where we share the real life stories of families and their unique birth experiences in the beautiful state of Maine.
• 1:39
  Dr. Nathan Riley: From our state's biggest hospitals to birth center births and home births, every birth story deserves to be heard and celebrated.
• 1:48
  Dr. Nathan Riley: Whether you're a soon-to-be mom, a seasoned mother, or simply interested in the world of birth, these episodes are for you.
• 1:56
  Dr. Nathan Riley: Hey everyone, welcome to episode 158 of My Main Birth.
• 2:02
  Dr. Nathan Riley: This episode is part of my ongoing series exploring the difference between the powerful idea of free birth, which can be a perfectly fine option for many healthy women, and the specific ideology that was promoted by the company, the Free Birth Society, and its programs.
• 2:20
  Dr. Nathan Riley: Back in late April of 2025, right as more and more stories were coming to light about all of this, Dr.
• 2:27
  Dr. Nathan Riley: Nathan Riley, a board-certified OBGYN and holistic physician, put out an early YouTube live stream addressing the Free Birth Society, the concept of Free Birth, and the questions surrounding it.
• 2:40
  Dr. Nathan Riley: That video was one of the first truly balanced takes on the topic, and a lot of people, including myself, said it felt uniting, like someone was finally speaking with nuance instead of picking a side.
• 2:52
  Dr. Nathan Riley: Today I am honored to have Dr.
• 2:54
  Dr. Nathan Riley: Riley here for a deeper conversation.
• 2:57
  Dr. Nathan Riley: As we wrap up today's episode, I hope you enjoy our new closing song, Walk of the Wild Ones, by Kate Sutherland.
• 3:06
  Dr. Nathan Riley: You can find more of Kate's community songs and deep nature connection work online at katesutherland.ca.
• 3:13
  Dr. Nathan Riley: All right, Dr.
• 3:15
  Dr. Nathan Riley: Nathan Riley, welcome to My Main Birth.
• 3:18
  Dr. Nathan Riley: Glad to be here, Angela.
• 3:20
  Dr. Nathan Riley: Thanks for having me.
• 3:20
  Dr. Nathan Riley: I'm excited for this one.
• 3:22
  Dr. Nathan Riley: To get started, I'm interested in your evolution of consciousness around birth.
• 3:28
  Dr. Nathan Riley: So with a focus on that, would you share a little bit about who you are, how you started out, and what led you to where you are now?
• 3:36
  Dr. Nathan Riley: Sure.
• 3:37
  Dr. Nathan Riley: Well, I was trained as a conventional physician, which for those who don't know, that means you go to college, you get a degree, you go to med school, you get a degree, you go to residency, and then maybe you do fellowship residencies where you focus on obstetrics and gynecology as far as my path is concerned.
• 3:56
  Dr. Nathan Riley: And that's about 70% surgical, 30% uh other stuff.
• 4:02
  Dr. Nathan Riley: Let's just say maternity, maybe.
• 4:04
  Dr. Nathan Riley: That doesn't mean 70% of all of the stuff we do is C-sections.
• 4:08
  Dr. Nathan Riley: We do a lot of other surgery in women's health from hysterectomies to whatever else.
• 4:12
  Dr. Nathan Riley: I was never really interested in the gynecology piece.
• 4:14
  Dr. Nathan Riley: Surgery is kind of fun when you realize that you can do it over and over and over and get a good result.
• 4:20
  Dr. Nathan Riley: Like you realize, whoa, I have this cool skill set.
• 4:23
  Dr. Nathan Riley: Uh, but it wasn't really for me.
• 4:25
  Dr. Nathan Riley: And I guess I should say it wasn't for me, sort of at the end of the at the end of the line.
• 4:30
  Dr. Nathan Riley: I looked back and it was like, I really don't want to be doing that.
• 4:33
  Dr. Nathan Riley: But early in my training, I also had some experience working with some midwives as a resident in the hospital setting.
• 4:39
  Dr. Nathan Riley: And then I met Dr.
• 4:40
  Dr. Nathan Riley: Stu Fishbein when I was about halfway through.
• 4:43
  Dr. Nathan Riley: We went to some home births together, and he really instilled in me a new, uh, a very refreshing take on the whole childbirth thing and what my role might there might be in that.
• 4:53
  Dr. Nathan Riley: And for those who don't know Dr.
• 4:55
  Dr. Nathan Riley: Stu, I I won't tell his story, but when he and I met, he was rounding third base in his career, looking for somebody to take over his practice.
• 5:04
  Dr. Nathan Riley: And so I gravitated towards him because of language around this sort of like art of doing nothing.
• 5:12
  Dr. Nathan Riley: You know, if you're if you're hands off, that's actually earned, you know, not putting your hands on every single step of the way, but it it's sort of like you don't just stop doing all those things and see what happens.
• 5:23
  Dr. Nathan Riley: You one by one systematically look at every single thing that we're doing along the way, from the time a woman gets pregnant all the way through postpartum, which in my world is way beyond six weeks.
• 5:34
  Dr. Nathan Riley: In fact, my wife, my my daughter, uh the youngest, who was born at home, by the way, she just turned four.
• 5:40
  Dr. Nathan Riley: And it was a couple months before that that Stephanie, my wife, said, I feel like I'm finally out of that postpartum period, which is a bigger conversation for a bigger time.
• 5:48
  Dr. Nathan Riley: You know, six weeks is not postpartum, six weeks is the aftermath of birth, and then we have this whole reconstitution thing that happens for maybe years afterwards in the case of my wife.
• 5:58
  Dr. Nathan Riley: So I saw this whole thing, I was able to I've given the privilege to look at this from start to finish and then just start asking, you know, questions and critically thinking about is this necessary?
• 6:10
  Dr. Nathan Riley: And then if I take that away, do I get worse outcomes?
• 6:12
  Dr. Nathan Riley: No.
• 6:13
  Dr. Nathan Riley: Okay, let's move to the next thing, and then the next thing, and the next thing.
• 6:16
  Dr. Nathan Riley: And when you realize is if you're really honest with yourself, most of the things that we do from start to finish are not necessarily useful.
• 6:28
  Dr. Nathan Riley: And then it makes you wonder, how did we get here?
• 6:31
  Dr. Nathan Riley: And that's kind of, I think, that where the crux of our conversation can go, which is who says that you need a surgeon to attend, you know, your birth to make sure that this whole thing unfolds in the way that you wish it will.
• 6:47
  Dr. Nathan Riley: Sometimes that's helpful.
• 6:49
  Dr. Nathan Riley: Other times you may need a surgeon to save your baby's life and you opt not to do that surgery.
• 6:54
  Dr. Nathan Riley: And that's still your prior, your prerogative.
• 6:56
  Dr. Nathan Riley: That's it's a hard thing to talk about, but that is still your prerogative.
• 7:00
  Dr. Nathan Riley: And you know, attorneys working in this space will say if an OBG WAN has a problem with a woman declining a C-section because it's the surgeon's preference, that is not a her issue.
• 7:10
  Dr. Nathan Riley: That is a you doctor, that is a you issue.
• 7:12
  Dr. Nathan Riley: Um, and maybe you need to go get therapy, maybe you need to change professions because uh to say that we believe in reproductive justice from the standpoint of, let's say, birth control or abortion or whatever else it is, a woman has autonomy or they don't, in every step of the way, we're stripping a little bit of that autonomy.
• 7:32
  Dr. Nathan Riley: We're compelling you to do things that aren't necessarily helpful to you and your baby.
• 7:36
  Dr. Nathan Riley: They might be, but they may they they aren't necessarily helpful.
• 7:41
  Dr. Nathan Riley: All the way up until you you have your baby.
• 7:44
  Dr. Nathan Riley: And uh by the time you get to the point where you're in labor, you've you've gone with the preferences of your care team every step of the way.
• 7:54
  Dr. Nathan Riley: And so that would draw into question: do I need a care team?
• 7:57
  Dr. Nathan Riley: Not always, but sometimes it's really, really nice to have somebody there who has experience.
• 8:03
  Dr. Nathan Riley: Not somebody who just did a year of online training, but somebody who's apprenticed with an experienced birth worker, whether it's an OB or a midwife, doesn't matter to me.
• 8:13
  Dr. Nathan Riley: It doesn't even matter how they were trained or what their credentials are.
• 8:15
  Dr. Nathan Riley: Have they done enough of this to see enough bad outcomes in order to demonstrate for you how we can get families out of trouble?
• 8:23
  Dr. Nathan Riley: So I'll leave it at that.
• 8:27
  Dr. Nathan Riley: I guess that's a nice intro.
• 8:28
  Dr. Nathan Riley: Yeah.
• 8:29
  Dr. Nathan Riley: So would you be willing to share about some of the reasons or the births that deeply affected you and contributed to your shift in mindset about birth while you were still in the medical system?
• 8:39
  Dr. Nathan Riley: Yeah.
• 8:39
  Dr. Nathan Riley: Well, frankly, uh unfortunately in our country, headlines don't usually announce totally uncomplicated births.
• 8:49
  Dr. Nathan Riley: And most, I mean, not not just most, but the vast majority of births go off without a hitch.
• 8:57
  Dr. Nathan Riley: Even if you do nothing to prepare, birth just happens.
• 9:02
  Dr. Nathan Riley: In our country, people tend to not be as healthy, and that's partly systemic, it's partly systematic, it's partly poor choices, it's partly socioeconomics.
• 9:13
  Dr. Nathan Riley: There's a whole bunch of reasons.
• 9:15
  Dr. Nathan Riley: There's also a lack of education at times.
• 9:17
  Dr. Nathan Riley: Um, but even so, it's not like because we're in the richest country in the world, we have the best outcomes.
• 9:23
  Dr. Nathan Riley: So, going back to what I had said about all the interventions, this very, very expensive system we have is not producing better outcomes.
• 9:29
  Dr. Nathan Riley: So, who is getting better outcomes?
• 9:30
  Dr. Nathan Riley: At least for, let's say, 85% of women who I would consider low risk.
• 9:34
  Dr. Nathan Riley: Um, and that means that the other 15% do not need C-sections, it means that they might need some extra medical support from a professional and somebody who's maybe a specialist in pathology, like an OMGYN, not necessarily a midwife.
• 9:46
  Dr. Nathan Riley: For those other 85%, I need to get out of the way because there's people that can do this better than me.
• 9:50
  Dr. Nathan Riley: And so back to the newspaper thing, if we had a herald or a courier or something every single week that on Sunday it says, in your county, all of these babies were born, you would see very occasionally a baby that dies or something that goes terribly, you know, wrong.
• 10:06
  Dr. Nathan Riley: Um, but instead, all that we, the only thing we ever hear about when it comes to childbirth in the media is when really, really bad things happen or bad actors are pretending to know things that they don't necessarily have the right to be preaching.
• 10:19
  Dr. Nathan Riley: And we'll talk about that in a second.
• 10:21
  Dr. Nathan Riley: So back to your question.
• 10:23
  Dr. Nathan Riley: Your question is Were there certain instances in which I started shifting my mindset?
• 10:29
  Dr. Nathan Riley: Yeah, it was every single birth where it was like, I don't need to be here.
• 10:33
  Dr. Nathan Riley: It was the 4 a.m.
• 10:34
  Dr. Nathan Riley: call from who knows who, the nurses station or whatever, hey doc, you know, room two.
• 10:40
  Dr. Nathan Riley: Forget about like, you know, Angela Le Ferrier.
• 10:44
  Dr. Nathan Riley: It's room two, the lady in room two, the pre-eclamptic in room two, she needs a cervical exam.
• 10:49
  Dr. Nathan Riley: That wasn't all nurses.
• 10:50
  Dr. Nathan Riley: This is not about LD nurses.
• 10:51
  Dr. Nathan Riley: This is them doing something that has been protocolized, and they're just doing their job and letting us know, hey, they're due for a cervical exam.
• 10:57
  Dr. Nathan Riley: So the first thing I questioned of all those things was this notion that we have to put our hand inside of your vagina and feel around in there for a cervical lip or, you know, whatever.
• 11:10
  Dr. Nathan Riley: Even though the tracing looks fine, even though she's comfortably resting, we have to do it at 4 a.m.
• 11:14
  Dr. Nathan Riley: because that's what the clock says.
• 11:16
  Dr. Nathan Riley: Um, that was the first thing I stopped doing, much to the chagrin of everybody who was attending to my educational process.
• 11:22
  Dr. Nathan Riley: And the bursts that had the most impact were those where I was going against what that protocol would be, knowing we have an operating room.
• 11:31
  Dr. Nathan Riley: If we miss something, we will be able to attend to it.
• 11:35
  Dr. Nathan Riley: But right now she's sleeping, her husband's sleeping, or her partner, and the nurses are all, you know, hanging out, they're all resting at 4 a.m.
• 11:43
  Dr. Nathan Riley: I'm just not gonna do it.
• 11:45
  Dr. Nathan Riley: And I'm not gonna lie about it, I'm not gonna say I checked her and she's the same, because that would be data that now somebody's gonna use against me.
• 11:52
  Dr. Nathan Riley: I just didn't do it because she was sleeping.
• 11:54
  Dr. Nathan Riley: And when those babies started coming out without any issues, right there was it was like, uh-oh.
• 12:01
  Dr. Nathan Riley: I'm halfway in through a four-year residency training program, hundred-hour work weeks, gnarly process.
• 12:07
  Dr. Nathan Riley: And I'm not certain that I'm on a train that I want to stay on for for much longer.
• 12:12
  Dr. Nathan Riley: On the other side of that is when babies die, and everybody, including the parents and anybody who's caring for them, either outside or inside the hospital, they act as if there's some player that didn't act in time.
• 12:26
  Dr. Nathan Riley: We didn't have the right technology, we didn't do this study, um, the whole shoulda, woulda, coulda thing.
• 12:34
  Dr. Nathan Riley: Um that was really interesting to me.
• 12:38
  Dr. Nathan Riley: I as if death is a failure of the medical sciences.
• 12:42
  Dr. Nathan Riley: So those ideas were bouncing around in my head, but after residency, I did a year of fellowship in hospice and palliative medicine, and I sat with death a lot.
• 12:50
  Dr. Nathan Riley: And death for a 95-year-old with heart failure is seen as a failure of the medical sciences.
• 12:55
  Dr. Nathan Riley: If only we had this or that, or if only we had done this sooner, if only he had been compliant with his medicine.
• 13:03
  Dr. Nathan Riley: It was that type of language.
• 13:05
  Dr. Nathan Riley: And that helped me realize, oh my gosh, this thing, this birth thing that seems as ceremonial as a death experience for a loved one.
• 13:16
  Dr. Nathan Riley: Um, it has a lot in common, first off.
• 13:19
  Dr. Nathan Riley: And secondly, when you start to pathologize something that's a natural process, including life at the end of at the end of the road, the 95 road.
• 13:28
  Dr. Nathan Riley: I'm using 95, but it could be at 45, it could be whatever.
• 13:30
  Dr. Nathan Riley: We see death of a human being as a failure.
• 13:33
  Dr. Nathan Riley: And all that we know how to do in response is to throw more technology, more intervention into it.
• 13:38
  Dr. Nathan Riley: And because birth kind of feels like death for a lot of women.
• 13:41
  Dr. Nathan Riley: I haven't been through birth.
• 13:42
  Dr. Nathan Riley: I will never be an expert because I can't give birth.
• 13:44
  Dr. Nathan Riley: But my wife and everybody else I've ever talked to, tens of thousands of women, they say, you know, it felt like I was gonna die.
• 13:50
  Dr. Nathan Riley: I mean, that's not an uncommon phrase.
• 13:52
  Dr. Nathan Riley: I'm sure you've heard that as well.
• 13:53
  Dr. Nathan Riley: So when babies die, that was the other thing that really helped me shift my language and my behavior and my attitude towards childbirth.
• 14:04
  Dr. Nathan Riley: Because even if I did every possible thing that I was taught to do, I mean, I've got pages and pages and pages of notes from lectures and textbooks and this and that.
• 14:13
  Dr. Nathan Riley: I feel like I've read every single pregnancy book on the planet, and I still sometimes won't have the answer.
• 14:18
  Dr. Nathan Riley: That is an opportunity for me to further peel back the layers to appreciate what is this thing to begin with?
• 14:24
  Dr. Nathan Riley: Why are we so afraid of this?
• 14:26
  Dr. Nathan Riley: And if there is an inevitable bad outcome awaiting it in every community where a baby just wasn't fit to get through this process, then how do we reframe our language in order to also appreciate that this is not just a medical procedure, it is not just physiologic birth.
• 14:43
  Dr. Nathan Riley: We can talk about that if you want.
• 14:45
  Dr. Nathan Riley: This is more than a bunch of mechanical processes and chemical reactions that have to take place in order for a life to come in.
• 14:52
  Dr. Nathan Riley: So I could go on and on and on, but when you sit in a room, let's say a home birth, and you feel what the energy is like there, you you can't help, if you're paying attention, if you're present with it, you can't help but start to question any dogma around this experience.
• 15:11
  Dr. Nathan Riley: And if there's any dads listening or doctors listening, remember when your kids came into the world.
• 15:16
  Dr. Nathan Riley: Did that feel like a surgery to you?
• 15:18
  Dr. Nathan Riley: I mean, it maybe even maybe it was a C-section and it did feel like a surgery, but when you held them on your chest, did that feel like, oh, I had an appendix removed?
• 15:26
  Dr. Nathan Riley: Or did it feel like holy smokes, everything has shifted?
• 15:30
  Dr. Nathan Riley: And it's not just your attention and responsibility, it's now a new beginning for every human.
• 15:36
  Dr. Nathan Riley: This is why women feel so empowered.
• 15:38
  Dr. Nathan Riley: Some of them feel like a woman finally, after 35 years and they have their first baby, or they had V-backs after a bunch of C-sections, they feel stronger, like they could conquer the world.
• 15:47
  Dr. Nathan Riley: This is more than just a measurable, outcome-driven process.
• 15:52
  Dr. Nathan Riley: There's something magical here.
• 15:53
  Dr. Nathan Riley: And sometimes it's not really possible to appreciate that until you're sitting in a dimly lit room and a baby emerges and is asleep right on your chest, which is what happened with my wife and I.
• 16:03
  Dr. Nathan Riley: So uh countless births, countless births.
• 16:08
  Dr. Nathan Riley: But what's important is it's not the number of births, it's actually how present and like how much was I paying attention.
• 16:14
  Dr. Nathan Riley: And when you pay attention, you you you start to see through the veil, so to speak.
• 16:18
  Dr. Nathan Riley: Yeah, there's definitely dogma on both sides.
• 16:22
  Dr. Nathan Riley: One of the big things that seems to drive a lot of women toward free birth is a previous traumatic hospital birth.
• 16:29
  Dr. Nathan Riley: What are your thoughts on that?
• 16:31
  Dr. Nathan Riley: I do think that many women, as I mentioned, many women choose to have a free birth because they've been conditioned to be afraid of the hospital.
• 16:40
  Dr. Nathan Riley: And why wouldn't they be?
• 16:41
  Dr. Nathan Riley: You know, we advertise this safety signal, like come to the place that's safe.
• 16:47
  Dr. Nathan Riley: And every doctor, many nurse practitioners, many CNMs, many, many anybody working in this m sort of megalithic industrial complex, this medical industrial complex, is going to see this as this is the only safe way to do it.
• 17:04
  Dr. Nathan Riley: But they don't realize that it's actually there's a there's a stark contrast being between being kept safe and being and feeling safe.
• 17:13
  Dr. Nathan Riley: So if I say, you know, I have to dangle you from your toes over this pit of piranhas in order to protect you from the bears over here on this side, um, the bears can't get you up there.
• 17:27
  Dr. Nathan Riley: Like, okay, I'm being kept safe, but do I feel safe?
• 17:29
  Dr. Nathan Riley: No, because I'm over a pit of piranhas, right?
• 17:32
  Dr. Nathan Riley: People don't realize that.
• 17:33
  Dr. Nathan Riley: And I mean, this is like the same for like arming um teachers in schools.
• 17:38
  Dr. Nathan Riley: Like, we want kids to feel safe in school.
• 17:40
  Dr. Nathan Riley: So we have a bigger problem.
• 17:41
  Dr. Nathan Riley: I'm not uh this is not about gun control, but everybody has presumptions about their lived experience that fall easily into dogma whenever safety becomes an issue.
• 17:52
  Dr. Nathan Riley: So um let's say that 50% of women who have a free birth feel unsafe in the hospital.
• 18:00
  Dr. Nathan Riley: The question for the doctors, and a lot of people circulating these recent Guardian articles, is if you think that that free birth is ridiculous, I do not.
• 18:11
  Dr. Nathan Riley: I think the free birth society has some big issues, and we can talk about that, but um, they are getting hit on so many angles.
• 18:17
  Dr. Nathan Riley: You don't need the good Dr.
• 18:18
  Dr. Nathan Riley: Riley to speak down on the Free Birth Society.
• 18:21
  Dr. Nathan Riley: They they have a big problem on their hands.
• 18:23
  Dr. Nathan Riley: Um But let's say that 50% of women they pursue free birth, and they do that because they had a you know a bad experience in the hospital.
• 18:32
  Dr. Nathan Riley: The question all of the people reading these articles need to ask is why do people feel safe?
• 18:36
  Dr. Nathan Riley: How could you feel unsafe?
• 18:37
  Dr. Nathan Riley: I mean, unsafe.
• 18:38
  Dr. Nathan Riley: Well, how could you feel unsafe in the hospital?
• 18:39
  Dr. Nathan Riley: There's a blood bank, there's an operating room, there's surgical steel, there's IV lines, there's nurses, there's doctors, there's all these great things.
• 18:46
  Dr. Nathan Riley: Why would you want to feel unsafe?
• 18:48
  Dr. Nathan Riley: And it's because th that 50% of people felt like they weren't spoken to, they were touched, they were treated in a way that suggested that they no longer have a voice here.
• 19:00
  Dr. Nathan Riley: And for women especially, I have little girls of my own, they haven't had a voice, they haven't had a seat at the table for quite some time.
• 19:09
  Dr. Nathan Riley: And I'm not saying we need to get rid of all men and all women need to now take over.
• 19:13
  Dr. Nathan Riley: That's also not helpful.
• 19:14
  Dr. Nathan Riley: What we need actually is to appreciate the the, first off, the energetics of the masculine and feminine energy.
• 19:20
  Dr. Nathan Riley: We have a very masculine, energy dominant medical system.
• 19:24
  Dr. Nathan Riley: It doesn't matter if you have breasts and a vulva and you're a doctor.
• 19:28
  Dr. Nathan Riley: It is a hierarchical, patriarchal, paternalistic way of taking care of people.
• 19:33
  Dr. Nathan Riley: And that is fine in an emergency where you know you're bleeding from your head and you're starting to talk about your trip to India 10 years ago while you're hemorrhaging on a in a trauma bay.
• 19:43
  Dr. Nathan Riley: Yeah, we're gonna take over and we're gonna get keep you to life because now Angela can't speak for herself.
• 19:48
  Dr. Nathan Riley: But when a woman and a and a man make love and then they go into a hospital and then they're treated like they're they're uneducated, they're incompetent, and that they just don't know their head from their ass, that makes people feel a certain way.
• 20:02
  Dr. Nathan Riley: And I I have to say this, I know this sounds commonsensical, but I'm hoping somebody listens to this who feels like I'm the worst person in the world.
• 20:09
  Dr. Nathan Riley: And I'm uh and all I'm asking you to do is to be curious about why people don't feel safe in a hospital, the most expensive medical system in the world, probably in the history, probably, probably ever that we will ever see.
• 20:21
  Dr. Nathan Riley: We are spending so much money on a medical system that doesn't serve us, so much so that now to take care of yourself and cancel your insurance premium and not going to the doctor is an act of civil disobedience.
• 20:34
  Dr. Nathan Riley: And when the stakes are high with free birth, now we all we all get our our our nervous systems in a bind.
• 20:42
  Dr. Nathan Riley: Because we in the hospital system know that bad things can happen.
• 20:46
  Dr. Nathan Riley: In fact, way more likely than if you don't get that mole checked.
• 20:51
  Dr. Nathan Riley: And we're we're you know, we're gonna shame people for not wearing sunblock as well.
• 20:54
  Dr. Nathan Riley: So we have to really be honest with ourselves.
• 20:57
  Dr. Nathan Riley: Why would a person not feel safe here?
• 20:59
  Dr. Nathan Riley: Well, I know why.
• 21:01
  Dr. Nathan Riley: It's because when I was in my training, it was modeled to me to do things to the person to keep them safe, but to to to not pay attention to how they actually are feeling in the moment.
• 21:12
  Dr. Nathan Riley: A great example is that routine vaginal exam.
• 21:15
  Dr. Nathan Riley: You walk into the the the um, we call it like a triage, or it's like an emergency room in the maternity unit.
• 21:22
  Dr. Nathan Riley: You walk in, the nurse says, Hey doc, there's a lady in here.
• 21:25
  Dr. Nathan Riley: She seems like she's in a lot of pain.
• 21:26
  Dr. Nathan Riley: She's 39 weeks, here's the blah, blah, blah, blah, blah.
• 21:29
  Dr. Nathan Riley: Um, she's not contracting much on the monitor, but she does look like she's in pain.
• 21:33
  Dr. Nathan Riley: Okay, I assume she's in labor.
• 21:35
  Dr. Nathan Riley: Forget about the monitor, but I'm gonna go and try to build some rapport quickly with her and then offer her the opportunity for me to examine her to see if this is labor or maybe if it's something else.
• 21:46
  Dr. Nathan Riley: What I was modeled was you basically just force their legs open and stick your hand inside.
• 21:52
  Dr. Nathan Riley: You might give a little introduction as you're putting the glove and the lube on, but what if she has a history of rape, sexual abuse, molest.
• 21:59
  Dr. Nathan Riley: Station.
• 22:00
  Dr. Nathan Riley: This might be something that requires a little bit of fine-tuning.
• 22:04
  Dr. Nathan Riley: And if I had a relationship with them, like a midwife does for nine months, and maybe this is the third time I've attended their birth, I know exactly who they are.
• 22:13
  Dr. Nathan Riley: And I go in and I say, I'm just gonna use you an example.
• 22:16
  Dr. Nathan Riley: Angela, I know we've been here before.
• 22:18
  Dr. Nathan Riley: I remember that this was really uncomfortable for you.
• 22:20
  Dr. Nathan Riley: Does this feel like labor?
• 22:21
  Dr. Nathan Riley: You know what?
• 22:23
  Dr. Nathan Riley: It actually feels a little different.
• 22:24
  Dr. Nathan Riley: Okay.
• 22:24
  Dr. Nathan Riley: So maybe we don't need to do the vaginal exam, but I'm a little suspicious you might be in labor, even though it feels a little bit different.
• 22:31
  Dr. Nathan Riley: Why don't we keep you on the monitor for a little bit?
• 22:33
  Dr. Nathan Riley: Have you had any bleeding?
• 22:34
  Dr. Nathan Riley: Have you had any whatever?
• 22:35
  Dr. Nathan Riley: Can I get you something to drink?
• 22:37
  Dr. Nathan Riley: And then we just let you be.
• 22:38
  Dr. Nathan Riley: Maybe we din the lights.
• 22:40
  Dr. Nathan Riley: You know, we make sure your husband or your partner, whoever is next to you.
• 22:44
  Dr. Nathan Riley: If you have kids in the room, make sure that they're occupied.
• 22:46
  Dr. Nathan Riley: Like we can make a person feel a little bit more grounded in our care, but we don't.
• 22:53
  Dr. Nathan Riley: Because we've protocolized everything.
• 22:55
  Dr. Nathan Riley: And let me just I'll end with this.
• 22:57
  Dr. Nathan Riley: Medicine has become standardized.
• 23:00
  Dr. Nathan Riley: It's big, it's expensive, it's powerful, it's technologically far more advanced than it was a hundred years ago.
• 23:05
  Dr. Nathan Riley: Nobody's gonna, you know, doubt, you know, question that.
• 23:08
  Dr. Nathan Riley: But when you standardize a curriculum, let's say, for a group of children who are in second grade, the teacher no longer becomes relevant because you have a list of things that that person needs to be taught.
• 23:19
  Dr. Nathan Riley: And forget about the individual person, the child, and they're in and also forget about the teacher.
• 23:25
  Dr. Nathan Riley: It doesn't really matter because we need every single kid to be treated the same way to get them through third grade and then fourth grade and then fifth grade.
• 23:32
  Dr. Nathan Riley: There it's no different from procedural, or let's say protocolizing everything in the medical system.
• 23:38
  Dr. Nathan Riley: The value of a protocol is that if you are not breathing or you don't have a heart rate, we can go through a list of procedures to try to get you to come back to life.
• 23:47
  Dr. Nathan Riley: That's called CPR.
• 23:49
  Dr. Nathan Riley: Same for a baby, NRP.
• 23:51
  Dr. Nathan Riley: Where it doesn't serve us is when we don't have an emergency outside of pathology, looking at a problem that is not necessarily solved by surgery.
• 24:01
  Dr. Nathan Riley: So now we're in the realm of people caring for people.
• 24:04
  Dr. Nathan Riley: And in order for me to care for Angela or anybody, I need to know who Angela is.
• 24:09
  Dr. Nathan Riley: And you need to know who I am.
• 24:10
  Dr. Nathan Riley: And it's possible that not every single doctor can care for Angela in the same way as as as um as maybe me.
• 24:20
  Dr. Nathan Riley: So these protocols serve us in emergency, but most of the time in childbirth there is no emergency.
• 24:28
  Dr. Nathan Riley: I really feel like that's one of the biggest differences between a woman leaving a birth with trauma or not, is you can have all sorts of complications happen.
• 24:38
  Dr. Nathan Riley: But if you're treated with autonomy and you're able to make your decisions out of the way, you know, you're gonna leave with a different experience, even if things came up that you didn't want.
• 24:45
  Dr. Nathan Riley: That's right.
• 24:46
  Dr. Nathan Riley: That's right.
• 24:47
  Dr. Nathan Riley: Yeah.
• 24:47
  Dr. Nathan Riley: So, so you know, if we were to now look back at these articles from The Guardian and we hear that people are having a free birth, people need to really appreciate why is this movement taking hold?
• 24:58
  Dr. Nathan Riley: Is it because we have something radically shifting within women, women in circles with other women who have decided we are gonna collectively not do that anymore?
• 25:07
  Dr. Nathan Riley: Unlikely, because we're all siloed off.
• 25:09
  Dr. Nathan Riley: Thanks to, you know, COVID was an obvious example.
• 25:12
  Dr. Nathan Riley: People don't want you talking to each other.
• 25:14
  Dr. Nathan Riley: In fact, we don't even like that women care for other women.
• 25:17
  Dr. Nathan Riley: So we're gonna continue this horizontal violence, this picture of, and and you see it on Facebook, women just tearing other women down for making their own choices.
• 25:24
  Dr. Nathan Riley: That's a part of the deal, unfortunately, in our society.
• 25:27
  Dr. Nathan Riley: Um, so doctors, nurses, everybody else, ask what's happening here.
• 25:32
  Dr. Nathan Riley: And if it's not that, then what is it?
• 25:34
  Dr. Nathan Riley: It's because people don't feel safe in your care.
• 25:36
  Dr. Nathan Riley: And that should be something easy to fix, except that we have two at least two generations now of physicians, uh just speak to the OBG Wayans, being trained in such a way that you're the captain of the ship, the person's experience doesn't matter.
• 25:48
  Dr. Nathan Riley: None of that matters as long as there's a living mother and a living baby after this.
• 25:52
  Dr. Nathan Riley: So it becomes very confronting to the dogma, the indoctrination that many of us have endured, but not you don't have to continue that.
• 25:59
  Dr. Nathan Riley: You could actually take a step back, pause, and be very, very thoughtful and curious about this.
• 26:03
  Dr. Nathan Riley: And when you do, it's almost undeniable that there's actually something to this free birth movement.
• 26:09
  Dr. Nathan Riley: Yes, there is definitely something to the free birth movement.
• 26:13
  Dr. Nathan Riley: At the same time, Wapio talks a lot about the difference between ideas and ideology.
• 26:20
  Dr. Nathan Riley: And that feels very relevant here.
• 26:22
  Dr. Nathan Riley: So I'd love to ask you, how do you see the difference between the idea of free birth versus the ideology that was promoted by the company, the Free Birth Society?
• 26:32
  Dr. Nathan Riley: Yeah, in the poor Free Birth Society.
• 26:35
  Dr. Nathan Riley: I I'm not like, I'm not like, oh, let's be gentle on them.
• 26:39
  Dr. Nathan Riley: Uh uh they have dug a they've made a bed and now they have to lay in it.
• 26:42
  Dr. Nathan Riley: Uh I had said this years ago.
• 26:44
  Dr. Nathan Riley: I gave a talk to a bunch of people, and somebody there was also in the Free Birth Society, and they it got back to the owner.
• 26:51
  Dr. Nathan Riley: And um I had said something like, you know, I'm I'm in support of autonomy and people that are that are advocating for free birth to clients who maybe don't understand the difference or or maybe even appreciate why some people go to the hospital, have a midwife, or do it alone in the woods, as an extreme example.
• 27:08
  Dr. Nathan Riley: I said, if you're if you're educating people towards that route and and shaming them for choosing the other options, you might find yourself in legal trouble.
• 27:17
  Dr. Nathan Riley: And here we are.
• 27:18
  Dr. Nathan Riley: So the ideas versus the ideology.
• 27:20
  Dr. Nathan Riley: So the idea of free birth is really, really neat.
• 27:24
  Dr. Nathan Riley: We'll talk about ideas first, then ideology.
• 27:25
  Dr. Nathan Riley: So I what I I don't know if I've said this yet, but if I if it was possible for me to have kids, I think that free birth actually sounds really, really neat.
• 27:32
  Dr. Nathan Riley: And that's probably putting it lightly.
• 27:35
  Dr. Nathan Riley: It sounds really neat.
• 27:36
  Dr. Nathan Riley: Like how how cute of a doctor to say that.
• 27:38
  Dr. Nathan Riley: I think that there is incredible, I have a lot of admiration, let's say, whenever I have friends who have decided I'm gonna go alone on this.
• 27:46
  Dr. Nathan Riley: And they say, before you say anything, I understand that there's risks.
• 27:50
  Dr. Nathan Riley: And before I can say the next thing, they say, even if my baby were to die, I'm willing to take that chance.
• 27:56
  Dr. Nathan Riley: I think it's a low chance, but I'm willing to take that chance.
• 27:59
  Dr. Nathan Riley: When somebody is willing in our in our current society, we're so afraid of death and mortality that it's become a hospital policy, healthy mom, healthy baby.
• 28:08
  Dr. Nathan Riley: We're so afraid of that, even at the end of life.
• 28:10
  Dr. Nathan Riley: You know, get yourself embalmed, get yourself dressed up and prettied up, put in a lead-lined casket inside of a tomb, because heaven forbid, this person actually becomes like a decayed corpse.
• 28:22
  Dr. Nathan Riley: Like everyone that we've ever known becomes, who's died, becomes a dead, decaying corpse going back into Mother Earth to become something new.
• 28:30
  Dr. Nathan Riley: That's really, really, really important for us to appreciate.
• 28:34
  Dr. Nathan Riley: But because we're so afraid of it, and we can thank religions and politicians and everything every which other thing, it's a part of our society to be afraid of death.
• 28:42
  Dr. Nathan Riley: So when a person says, I'm willing to look death in the face and I'm gonna do that thing, I have a heck of a lot of admiration for that.
• 28:50
  Dr. Nathan Riley: Especially when it goes well.
• 28:52
  Dr. Nathan Riley: But what if it doesn't go well?
• 28:54
  Dr. Nathan Riley: Well, then we as a community get around the family and we say, Oh my gosh, what a what a terrible thing to happen.
• 29:01
  Dr. Nathan Riley: So when I'm advocating for free birth, I am not saying babies don't die.
• 29:05
  Dr. Nathan Riley: I'm not saying emergencies don't happen.
• 29:07
  Dr. Nathan Riley: I'm saying because those things are possible, the fact that a person would choose that, and many of them are very intelligent people.
• 29:13
  Dr. Nathan Riley: I haven't met everybody who's had a free birth.
• 29:15
  Dr. Nathan Riley: And a lot of people I know have had free births because somebody didn't get there in time.
• 29:20
  Dr. Nathan Riley: And they're like, holy smokes, it was so wild to be there with just my partner, and we were there by ourselves.
• 29:26
  Dr. Nathan Riley: It was so carnal.
• 29:27
  Dr. Nathan Riley: And I had this once happen at a birth, and I walk in and the baby's just on her chest, and the dad's like, Yeah, we uh I guess things went a little faster than I would than we were expecting.
• 29:35
  Dr. Nathan Riley: I was only 20 minutes away, but that was a free birth.
• 29:38
  Dr. Nathan Riley: That same client in her prior prior birth had a midwife back up and abandoned her because the baby was breached.
• 29:45
  Dr. Nathan Riley: So she had two free births essentially.
• 29:48
  Dr. Nathan Riley: Uh, there was like a doula there taking pictures who for the breach, but so we got some cool photos out of it.
• 29:53
  Dr. Nathan Riley: Um but, anyways, both of those babies are fine.
• 29:56
  Dr. Nathan Riley: And these this is an immovable couple who is still gonna have me at their next birth because it's a hey, just in case, maybe we got lucky twice in a row.
• 30:04
  Dr. Nathan Riley: But the fact that they were able to do that and to talk about the tell the story is not not like we were panicked.
• 30:10
  Dr. Nathan Riley: What we were gonna do is, okay, here's what we're doing.
• 30:12
  Dr. Nathan Riley: In a world that that is really challenged by our own mortality, that is a really, really gutsy thing to do.
• 30:18
  Dr. Nathan Riley: And I love gutsy.
• 30:19
  Dr. Nathan Riley: I really, really love it.
• 30:20
  Dr. Nathan Riley: So those are the ideas.
• 30:22
  Dr. Nathan Riley: The idea is nobody's gonna interfere.
• 30:24
  Dr. Nathan Riley: You get everything that your intuition guides you to, Angela.
• 30:29
  Dr. Nathan Riley: Which nowadays sounds really, really nice with all the mandates and the isolation and the masking and everything we all went through in the COVID moment.
• 30:36
  Dr. Nathan Riley: Man, to just be left alone feels darn good right now.
• 30:39
  Dr. Nathan Riley: But that also means you don't have an ultrasound to detect growth restriction or you know, an renal agenesis or some issue with the brain or whatever.
• 30:48
  Dr. Nathan Riley: You're willing to accept whatever comes.
• 30:50
  Dr. Nathan Riley: And that's there's some beauty there.
• 30:52
  Dr. Nathan Riley: So the idea is nice.
• 30:54
  Dr. Nathan Riley: And and for those listening, I'm sure that they know, we're talking about you're not bringing medications of your own necessarily.
• 31:01
  Dr. Nathan Riley: You don't have a midwife, you don't have anybody.
• 31:03
  Dr. Nathan Riley: You're just waiting to see what happens with the labor, and whatever happens, you're gonna just own the the outcomes of that decision.
• 31:09
  Dr. Nathan Riley: That's what radical responsibility actually means, even in the way the Free Birth Society uses it.
• 31:15
  Dr. Nathan Riley: The way that I would use it and put a subtle twist on that is making that decision and being counseled around the issues that might arise, and then for you to say, you know what, I hear you, I understand it, I appreciate the recommendation, but I'm gonna do it my own way.
• 31:32
  Dr. Nathan Riley: That is what I'm describing.
• 31:34
  Dr. Nathan Riley: Being told all of that stuff, and I'm not here, but somebody who's had zero experience attending burst, who's never who admittedly has never managed an emergency because they quote, don't happen in the home, like bleeding.
• 31:47
  Dr. Nathan Riley: I just show up with a cord clamp.
• 31:48
  Dr. Nathan Riley: Like, are you fucking crazy?
• 31:51
  Dr. Nathan Riley: Why are you even going to burst?
• 31:53
  Dr. Nathan Riley: I thought you were the whole anti-midwife, anti-birth attendant club.
• 31:58
  Dr. Nathan Riley: But that's not I'm not judging that.
• 32:01
  Dr. Nathan Riley: I'm uh listening in for the the the space between the lines.
• 32:05
  Dr. Nathan Riley: And what I heard was bleeding doesn't happen at home, so I don't bring stuff.
• 32:10
  Dr. Nathan Riley: When a person says I've attended X number of births and I've never had a bad outcome, they're either lying about the number of births or they haven't taken enough people in order to see it.
• 32:21
  Dr. Nathan Riley: It's a numbers game.
• 32:22
  Dr. Nathan Riley: And you might be a new midwife who just graduated from whatever program, and 10 births in you have a baby that dies.
• 32:27
  Dr. Nathan Riley: Like that's also the numbers.
• 32:29
  Dr. Nathan Riley: We have no way of predicting it.
• 32:31
  Dr. Nathan Riley: So to say it doesn't happen is uh it ends up revealing just how I don't want to say incompetent, but how um ignorant you are and naive you are, and then charging people a lot of money, bringing them into your circle, shaming them for going outside of your recommendations.
• 32:51
  Dr. Nathan Riley: And then if a bad outcome happens, society doesn't get around this, you know, your your your group, your community doesn't get around that person, we end up doubling down and saying, Well, you didn't do this right.
• 33:02
  Dr. Nathan Riley: That's why it happened.
• 33:03
  Dr. Nathan Riley: And we don't take care of you afterwards.
• 33:05
  Dr. Nathan Riley: This is the ideology piece.
• 33:07
  Dr. Nathan Riley: And when we when we say we're gonna carte blanche throw everything out the window without having any real experience with what with what those things are and what technology and OBGYNs and midwives can do, we end up in a space where the consumer becomes very, very confused.
• 33:23
  Dr. Nathan Riley: And I'll just leave it at that.
• 33:26
  Dr. Nathan Riley: What are your thoughts on the Guardian articles and the podcast coming out and speaking to the nurses and doctors and others who might be hearing about all this for the first time and maybe having the reaction of like, see, free birth is bad.
• 33:43
  Dr. Nathan Riley: Yeah.
• 33:43
  Dr. Nathan Riley: What would you say to that group?
• 33:46
  Dr. Nathan Riley: I think there's two ways to receive this type of information.
• 33:49
  Dr. Nathan Riley: One is we saw it coming, and we've just kept our distance because we don't want to be a part of the downslide that happens whenever this stuff starts to get unveiled.
• 33:59
  Dr. Nathan Riley: Um, it's sort of like the story of Icarus flying too close to the sun.
• 34:02
  Dr. Nathan Riley: I'm just gonna stay on the ground here.
• 34:04
  Dr. Nathan Riley: You guys are doing great, you're making lots of money.
• 34:06
  Dr. Nathan Riley: I don't need any part of that because I can see that this is a ticking time bomb of disaster.
• 34:11
  Dr. Nathan Riley: Um, not least of which for the families that actually really did trust the advice and the community, that support they were getting.
• 34:21
  Dr. Nathan Riley: So because everybody's up in arms, let me just speak to those people who were maybe unintentionally lumping free birth in without a hospital birth.
• 34:31
  Dr. Nathan Riley: Because I think that's actually where our time is best spent.
• 34:34
  Dr. Nathan Riley: So if a if a doctor or a nurse or whoever, I'll just pick on the doctors.
• 34:38
  Dr. Nathan Riley: I don't need to pick on anybody else.
• 34:40
  Dr. Nathan Riley: The OBGNs who were like, see, we told you this is bad.
• 34:43
  Dr. Nathan Riley: Yeah.
• 34:43
  Dr. Nathan Riley: As I already mentioned, be curious about why would a person decide to do this.
• 34:47
  Dr. Nathan Riley: Is it possible that they didn't feel safe with you?
• 34:49
  Dr. Nathan Riley: Is it possible if society were a little bit different, that we treated women a lot differently than we do, that we didn't strip them of their voice and their power and make them feel small for their whole lives, that they wouldn't be doing this?
• 34:58
  Dr. Nathan Riley: It's possible, but that's all conjecture.
• 35:00
  Dr. Nathan Riley: Monday morning morning quarterbacking here.
• 35:02
  Dr. Nathan Riley: I want to make the distinction between a free birth facilitated through an organization like the Free Birth Society, a free birth for a person who's had quite a bit of experience, and this is actually just what they want to do, and all other out-of-hospital births.
• 35:19
  Dr. Nathan Riley: And unfortunately, I think the Guardian Articles didn't do a great job of discerning, or let's say, distinguishing between the free birth experience and the out-of-hospital birth experience.
• 35:32
  Dr. Nathan Riley: So, one thing we haven't talked about is that the Free Birth Society has been against midwives for years now.
• 35:38
  Dr. Nathan Riley: They've been very vocal.
• 35:39
  Dr. Nathan Riley: Midwives are indoctrinated, they've been co-opted, and the word midwife has been co-opted, but not people doing midwifery necessarily.
• 35:45
  Dr. Nathan Riley: And then there's a huge spectrum of midwives.
• 35:48
  Dr. Nathan Riley: Some of the worst ones are also some of the best trained, let's say, the best most credentials.
• 35:55
  Dr. Nathan Riley: And that that that that is the opposite.
• 35:57
  Dr. Nathan Riley: There's also really bad ones that have no credentials at all.
• 35:59
  Dr. Nathan Riley: And it's like, oh my God, I can't believe you hung a shingle.
• 36:02
  Dr. Nathan Riley: On the other hand, your credentials don't necessarily correspond with how great of care you provide.
• 36:06
  Dr. Nathan Riley: And if you're a part of, let's say you're a certified nurse midwife coming out of the medical system, you have a way.
• 36:11
  Dr. Nathan Riley: You're, you're still, you're still a like a person from the medical establishment.
• 36:18
  Dr. Nathan Riley: I I get why sometimes it's harder to do that, to leave and then try to do out-of-hospital birth work.
• 36:23
  Dr. Nathan Riley: But there's also midwives who've attended more births probably than me, um, despite having a, you know, f assembly line in the hospital.
• 36:32
  Dr. Nathan Riley: They've done this for years and years and years.
• 36:34
  Dr. Nathan Riley: They've done breaches, they've done twins, they've done things I could never have conceived of when I was a resident.
• 36:38
  Dr. Nathan Riley: And those are the people I learned from.
• 36:39
  Dr. Nathan Riley: And they don't have any credentials at all.
• 36:41
  Dr. Nathan Riley: They might not have had a license.
• 36:42
  Dr. Nathan Riley: Uh, a licensure doesn't necessarily mean you're safe, it just means you're willing to follow the rules.
• 36:46
  Dr. Nathan Riley: And sometimes the rules serve us and sometimes they don't.
• 36:49
  Dr. Nathan Riley: So I want people to appreciate that there is a very, very important distinction between what has happened with the Free Birth Society and everything else that all let me let me say all of the momentum that has been building around out-of-hospital birth for people like you who are willing to do the work and come at it with some humility and with some honesty and integrity to say, hey, listen, like when I first got out of uh residency and somebody asked me to attend a breach, I said, I can't.
• 37:19
  Dr. Nathan Riley: I've never attended a breach before.
• 37:21
  Dr. Nathan Riley: I have now.
• 37:22
  Dr. Nathan Riley: But I had to go and seek that out.
• 37:24
  Dr. Nathan Riley: And now I might even say, you know, I haven't, I haven't done that many.
• 37:28
  Dr. Nathan Riley: But I did attend my best friends a couple months ago, and that went really, really well.
• 37:32
  Dr. Nathan Riley: And we're getting some mannequins.
• 37:34
  Dr. Nathan Riley: We're gonna be practicing and training and working within our community to reskill, you know, people in this process.
• 37:40
  Dr. Nathan Riley: If you're going through those hoops, that is a really, really good job.
• 37:44
  Dr. Nathan Riley: Like that should be rewarded.
• 37:46
  Dr. Nathan Riley: Um, and unfortunately, you know, the Free Birth Society is because they've been talking about midwives so long.
• 37:52
  Dr. Nathan Riley: What was interesting is they, I don't know when they did, but they started advertising that they're going to train midwives now as authentic midwives.
• 37:59
  Dr. Nathan Riley: They just needed to find a new adjective because traditional, you know, through a granny midwife lineage wasn't enough for them.
• 38:05
  Dr. Nathan Riley: It wasn't enough that, you know, somebody like Christine Lauria, who attends vaginal triplets, uh, who came to one of my past events, um, or or that she's attended, you know, who knows how many births working for Doctors Without Borders.
• 38:19
  Dr. Nathan Riley: Like, forget about that.
• 38:20
  Dr. Nathan Riley: She's also indoctrinated because she uses the term, whatever isn't their term.
• 38:25
  Dr. Nathan Riley: Um, I don't want to keep harping on this because it's so ridiculous.
• 38:29
  Dr. Nathan Riley: It's sort of like saying, no barbers know what they're doing.
• 38:33
  Dr. Nathan Riley: You need to be an authentic barber.
• 38:35
  Dr. Nathan Riley: It's like, do they cut good hair?
• 38:36
  Dr. Nathan Riley: Then they're a barber.
• 38:38
  Dr. Nathan Riley: And yes, there is a barber board and all that.
• 38:40
  Dr. Nathan Riley: I won't even get into that.
• 38:41
  Dr. Nathan Riley: Everything has a permission slip nowadays to do literally anything.
• 38:44
  Dr. Nathan Riley: But the point here is they have they're trying to own the term midwife, which was their original issue with midwifery to begin with.
• 38:54
  Dr. Nathan Riley: So everything's out of integrity with this group.
• 38:56
  Dr. Nathan Riley: Um, we have people who have had babies themselves.
• 38:59
  Dr. Nathan Riley: In fact, I think one of the owners there has like 10 kids, which is great.
• 39:03
  Dr. Nathan Riley: Uh I would trust you with knowing what's happening with your own birth.
• 39:07
  Dr. Nathan Riley: But then you also hear them say a lot of things about hemorrhage and around rogue and around ultrasound and around GBS and antibiotics and God knows what.
• 39:14
  Dr. Nathan Riley: And when you hear them say it, you're like, that's just patently false.
• 39:18
  Dr. Nathan Riley: It's like when people say circumcisions are done without lidocaine.
• 39:21
  Dr. Nathan Riley: I am a huge proponent for no more circumcisions ever.
• 39:24
  Dr. Nathan Riley: But it's not because we don't use lidocaine.
• 39:27
  Dr. Nathan Riley: We use lidocaine every single time.
• 39:29
  Dr. Nathan Riley: So the idea is great.
• 39:32
  Dr. Nathan Riley: The ideology around it and what's being proliferated in the media around Free Birth Society, or from the Free Birth Society, I should say, is more often than not just patently wrong.
• 39:45
  Dr. Nathan Riley: And the hardest part about this for me, Angela, is that they and I have so much in common, but I know what I'm talking about and they don't.
• 39:53
  Dr. Nathan Riley: They're maybe even going on and stealing my language.
• 39:56
  Dr. Nathan Riley: I have no idea.
• 39:56
  Dr. Nathan Riley: I'm not, I'm not accusing them of stealing.
• 39:58
  Dr. Nathan Riley: It's like it's sometimes it just feels like they're making stuff up out of the blue because they found one paper that supports their internal bias.
• 40:04
  Dr. Nathan Riley: But you know who else does that?
• 40:05
  Dr. Nathan Riley: Every OBGN who's trying to coerce you into a C-section.
• 40:09
  Dr. Nathan Riley: So that's my beef.
• 40:10
  Dr. Nathan Riley: That's my beef.
• 40:11
  Dr. Nathan Riley: And I there is no beef.
• 40:12
  Dr. Nathan Riley: There, there, there, there, there's nothing here that I have any ill will towards them.
• 40:17
  Dr. Nathan Riley: I I am just happy that finally at least it took a a guard the guardian papers to at least open the dialogue about it.
• 40:26
  Dr. Nathan Riley: But we need to make sure that we don't let that get away from us, and we need to really be clear that there's there are very highly skilled professionals, and not even professionals, birth workers as a as a lump, who are doing great work, and we cannot allow the system to further isolate women from those options.
• 40:45
  Dr. Nathan Riley: That's going to lead to a very, very, a much bigger problem because midwifery is doing things better.
• 40:49
  Dr. Nathan Riley: And for those 85% of women with low-risk births, so to speak, it's hard to stratify risk, but for those women who are seeking out mid midwives, they're gonna do just fine.
• 40:58
  Dr. Nathan Riley: And the OBJNs need to still be willing to accept those clients when they come in.
• 41:02
  Dr. Nathan Riley: We can't lump all of this together.
• 41:04
  Dr. Nathan Riley: We have a we have a bad actor here, and we need to make sure that that everybody's clear about that.
• 41:09
  Dr. Nathan Riley: Yeah, yeah.
• 41:11
  Dr. Nathan Riley: Thank you for that.
• 41:12
  Dr. Nathan Riley: And I completely agree the demonization of midwives with real skills and experience while simultaneously trying to recreate the definition of midwifery was not okay.
• 41:24
  Dr. Nathan Riley: Yeah, I mean, it was just I don't it's it kind of feels like those conversations maybe within that organization are happening in an echo chamber.
• 41:34
  Dr. Nathan Riley: Like they don't really know what's going on in the world.
• 41:37
  Dr. Nathan Riley: And so maybe there's a way that for us to rehabilitate them, you know.
• 41:41
  Dr. Nathan Riley: Maybe we we do receive them.
• 41:44
  Dr. Nathan Riley: This is this is my optimistic side.
• 41:47
  Dr. Nathan Riley: Maybe there's some way that we receive them back and we say, Are you ready to learn?
• 41:50
  Dr. Nathan Riley: Are you ready to like put your ego aside?
• 41:52
  Dr. Nathan Riley: And I don't know if that'll happen, but I don't want anybody to burn on the cross.
• 41:56
  Dr. Nathan Riley: You know, we or the, you know, like I don't we don't need another witch hunt.
• 42:00
  Dr. Nathan Riley: Um, that's already hard enough for midwives who are getting in trouble in you know, state by state.
• 42:05
  Dr. Nathan Riley: We don't need this to turn into that.
• 42:07
  Dr. Nathan Riley: And actually, it doesn't help for us to just turn all of our attention on the these bad actors.
• 42:11
  Dr. Nathan Riley: There's bad actors in medicine, in midwifery, and in the Freebirth Society.
• 42:15
  Dr. Nathan Riley: We actually need to be able to hold one another accountable through a peer review system so that we can move forward together.
• 42:22
  Dr. Nathan Riley: We can actually build something that actually functions for families.
• 42:26
  Dr. Nathan Riley: Like, what about the families?
• 42:27
  Dr. Nathan Riley: You know, there's families that took this advice and now are going to be mourning the loss of a baby for the rest of their lives.
• 42:32
  Dr. Nathan Riley: Who's gonna take accountability for that?
• 42:34
  Dr. Nathan Riley: Um, it doesn't mean, like I said, it doesn't mean that we could have saved them.
• 42:38
  Dr. Nathan Riley: But to then say, oh, had you woulda, coulda or shoulda done this, that it does make it, you know, now a shame and a blame game.
• 42:47
  Dr. Nathan Riley: And and that's tricky.
• 42:50
  Dr. Nathan Riley: You know, it's hard to punish specific actors without dragging a bunch of other people down with them.
• 42:55
  Dr. Nathan Riley: And I really don't want this to impact midwifery, at least the trend that's been this momentum we've been very hard-pressed to to generate in the first place here in the United States.
• 43:07
  Dr. Nathan Riley: Yeah, and that community accountability piece is is important.
• 43:13
  Dr. Nathan Riley: So now I would love to talk about Maine and the midwifery licensure laws that took effect here in January of 2020.
• 43:23
  Dr. Nathan Riley: There are many, but just to name two of the restrictions, women that are pregnant with twins or a breach baby are now risked out of home birth midwifery care.
• 43:33
  Dr. Nathan Riley: But up until 2019, there are stories of women birthing twins and breach babies with trained, experienced midwives at home.
• 43:42
  Dr. Nathan Riley: And now these women, even if they would want a midwife, they only have the option of either going to the hospital for if you have a breach, it's like automatic cesarean.
• 43:53
  Dr. Nathan Riley: Or if you have twins and you want to deliver vaginally, it has to be in the OR.
• 43:57
  Dr. Nathan Riley: And if the second twin is breached, it's also Automatic cesarean, or they can free birth.
• 44:03
  Dr. Nathan Riley: And these are the options.
• 44:06
  Dr. Nathan Riley: So what are your thoughts for people in situations like this?
• 44:10
  Dr. Nathan Riley: Yeah.
• 44:11
  Dr. Nathan Riley: We we've already established there's some inherent risk in having a baby, right?
• 44:15
  Dr. Nathan Riley: You're not entitled to have a you know Instagram worthy birth in a birth tub with dim lights and all of that.
• 44:21
  Dr. Nathan Riley: You're not entitled to that.
• 44:22
  Dr. Nathan Riley: There are things you can do that can help you fall above the the likelihood uh of the standard, uh the the mean in the United States that you could have that.
• 44:30
  Dr. Nathan Riley: But given that there's no guarantees and it has actually has uh less to do with finances than I think people realize, because there's certain factors that we just don't know how to even predict or prevent.
• 44:40
  Dr. Nathan Riley: So uh when it comes to the breach and the twins thing, there are extra risks.
• 44:47
  Dr. Nathan Riley: So it's inherently uh uh risky, so to speak, to have a baby.
• 44:53
  Dr. Nathan Riley: Um because there's there's there's too many factors out of our control.
• 44:57
  Dr. Nathan Riley: When it comes to the breach and the twins thing, this was a the reason that it is perceived as higher risk, let's just say, is because almost every woman for the past, let's say, hundred uh not hundred years, fifty years, who's had a baby, at least one baby that's butt down, has really not been given adequate counseling and given the opportunity uh to have an alternative to a C-section.
• 45:24
  Dr. Nathan Riley: So if you've got two or more babies in your belly, I mean, uh not to mention a prior C-section, uh, maybe from a breach, if you've got two or more babies in your belly, especially if that first baby is butt down, they're gonna say, we're not gonna do this vaginally.
• 45:39
  Dr. Nathan Riley: And that's a couple fold.
• 45:41
  Dr. Nathan Riley: Originally there was an idea that a baby's head can get trapped.
• 45:44
  Dr. Nathan Riley: I have yet to see that happen, um, even with preterm babies.
• 45:48
  Dr. Nathan Riley: Yes, it probably can happen.
• 45:50
  Dr. Nathan Riley: It's like mechanistically, that does make sense.
• 45:53
  Dr. Nathan Riley: But but even everything that I learned to relieve the head doesn't really address what the head you know gets stuck on.
• 46:00
  Dr. Nathan Riley: The head gets stuck on bony stuff, it doesn't get stuck on the the cervix.
• 46:04
  Dr. Nathan Riley: So when the cervix is the head is trapped, you're supposed to do a cruciate incision, like just cut up the cervix to open up space.
• 46:12
  Dr. Nathan Riley: Like it doesn't work like that.
• 46:13
  Dr. Nathan Riley: So instead we have to actually wonder why is the baby stuck in there?
• 46:16
  Dr. Nathan Riley: Okay, so we're lumping these two categories together.
• 46:20
  Dr. Nathan Riley: And for twins, I'm just gonna we're just gonna use the dichorionic diamniotic twins.
• 46:26
  Dr. Nathan Riley: So it's two sacks, two placenta, it's just two babies growing at the same time.
• 46:30
  Dr. Nathan Riley: And yes, there's more resources that have to go, and yes, they tend to be smaller, and yes, they turn to tend to be preterm.
• 46:35
  Dr. Nathan Riley: But the reason that I clump twins and breach together is because there's a good chance one of those babies in the multiples is gonna be butt down.
• 46:42
  Dr. Nathan Riley: And if that were to happen in a singleton, you'd be whisked away to the operating room.
• 46:47
  Dr. Nathan Riley: So this notion that the baby's head's gonna get stuck is fine, but it's actually not usually the head that we're worried about.
• 46:54
  Dr. Nathan Riley: Some part can get stuck.
• 46:56
  Dr. Nathan Riley: This one arm can be up like this uh or around the the neck like this, or yes, you could get a hyperextended uh neck, but you just, you know, you imagine like I got my my head caught when I was getting into my shirt, and you just rearrange your position of your head relative to the shirt, and your head can come through.
• 47:13
  Dr. Nathan Riley: It's no different with like I can't get my arms in my shirt, like little kids have this happen all the time.
• 47:17
  Dr. Nathan Riley: You just have to reposition the shirt or the body relative to the shirt and then the arms pop through.
• 47:23
  Dr. Nathan Riley: It's no different with this breach thing.
• 47:27
  Dr. Nathan Riley: Let me also say that the vast majority of babies coming out butt first have no problem at all.
• 47:31
  Dr. Nathan Riley: Even those big, chunky term babies have no problem at all.
• 47:34
  Dr. Nathan Riley: Um, if anything, you sometimes just have to like nudge their shoulders to get their head to flex, their chin to flex, and then the baby's out.
• 47:41
  Dr. Nathan Riley: Um, do they have a higher likelihood of needing resuscitation?
• 47:43
  Dr. Nathan Riley: Sure, because we haven't squeezed all the fluids out from a you know baby kind of toothpaste style coming out um head first.
• 47:51
  Dr. Nathan Riley: Um so why did I not learn how to do the maneuvers?
• 47:58
  Dr. Nathan Riley: And therefore, when I graduated from residency, felt like I had no other option but to do C-section.
• 48:02
  Dr. Nathan Riley: It's because we had some some really, really big studies, one in particular around 2000, that demonstrated that babies born by C-section for breach did better than babies who were who were allowed to come out vaginally.
• 48:15
  Dr. Nathan Riley: Since they've done sub-analyses and all of that, they actually found it was pretty much a wash.
• 48:19
  Dr. Nathan Riley: And I won't get into that.
• 48:19
  Dr. Nathan Riley: I've I've done plenty of work on my podcast and whatnot about that.
• 48:23
  Dr. Nathan Riley: And anybody who's come to these twins breach gatherings or worked with breach without borders or Dr.
• 48:27
  Dr. Nathan Riley: Stew, they all, you know, you you'll learn this.
• 48:30
  Dr. Nathan Riley: However, some of those subanalyses found it was a wash because it was in the hands of skilled practitioners.
• 48:37
  Dr. Nathan Riley: So the term breach trial was just one of these studies, and then a bunch of other studies from other countries where they were still training residents, doctors in obstetrics and gynecology how to do maneuvers that would relieve a dystotia, meaning something's caught up in there, usually bone on bone kind of thing.
• 48:52
  Dr. Nathan Riley: What can we do to help that baby fit through?
• 48:54
  Dr. Nathan Riley: Just like helping your kid get their t-shirt on in the morning.
• 48:56
  Dr. Nathan Riley: When we stopped training them to do that, to how to do these maneuvers, we uh basically left them unprepared, doctors.
• 49:04
  Dr. Nathan Riley: And if, you know, roughly three to four percent of babies are breached at term, we're just talking about singletons here, you're leaving basically an automatic three to four percent c-section rate from that alone in our country.
• 49:16
  Dr. Nathan Riley: And that's a big problem because of course it's way higher than that.
• 49:19
  Dr. Nathan Riley: But if we weren't doing so many primary C-sections because we had better skilled physicians and midwives and everything else, that could still do this disappearing art of vaginal breach uh maneuvers and and and birth, we wouldn't we wouldn't have to, you know, chalk, we wouldn't have to put predisposed people to these primary c-sections for breach and all that other stuff.
• 49:40
  Dr. Nathan Riley: So sort of in summary of that point, uh of this point, in the hands of a skilled practitioner, which we no longer have in the United States based on our our accredited you know residency trainings, in the hands of a skilled practitioner, vaginal breach is totally fine.
• 49:58
  Dr. Nathan Riley: But when a baby comes down headfirst and we get shoulder dystocia and whatnot, we know how to relieve that.
• 50:03
  Dr. Nathan Riley: We're not drilling, we're not reviewing how to do it for breach.
• 50:07
  Dr. Nathan Riley: So when people say it's a nor first off, if it's a variation in normal, why do we have to go and do special training for it?
• 50:14
  Dr. Nathan Riley: Is a shoulder dystocia with a cephalic baby a variation of normal?
• 50:18
  Dr. Nathan Riley: Uh no.
• 50:20
  Dr. Nathan Riley: Um it's a pathology, it's something that actually needs to be addressed.
• 50:23
  Dr. Nathan Riley: So to say vaginal breach birth is a variation of normal, yeah, until you have a dystocia, and now we're no longer normal.
• 50:31
  Dr. Nathan Riley: So we need to train in the abnormality.
• 50:33
  Dr. Nathan Riley: Um and because people aren't trained here, there actually is a risk.
• 50:38
  Dr. Nathan Riley: Like there is not good numbers when we do vaginal breach here in the States, and it's because we have a de-skilled obstetrics workforce.
• 50:45
  Dr. Nathan Riley: It's not because it's inherently dangerous necessarily, and maybe even if it is, it's a low, it's a relatively higher risk.
• 50:52
  Dr. Nathan Riley: It's still a low absolute risk that something bad would happen.
• 50:55
  Dr. Nathan Riley: So if you compound that now in the twins conversation, now we're worried about two babies.
• 51:02
  Dr. Nathan Riley: We have a second baby that plinkos down and doesn't know if they're gonna be butt down, head down, transverse, asynclic.
• 51:08
  Dr. Nathan Riley: Like we we have no idea how that baby's gonna go.
• 51:11
  Dr. Nathan Riley: And so we prepare to do a C-section thereafter.
• 51:13
  Dr. Nathan Riley: But again, how does feeling safe impact you know the childbirth experience?
• 51:18
  Dr. Nathan Riley: You know this from your own training.
• 51:19
  Dr. Nathan Riley: When we make people feel safe, childbirth tends to go really well.
• 51:22
  Dr. Nathan Riley: Can you feel safe in an operating room?
• 51:24
  Dr. Nathan Riley: Probably not very safe.
• 51:25
  Dr. Nathan Riley: It's cold, you're naked, you're exposed to everybody, there's 10 people in the room.
• 51:30
  Dr. Nathan Riley: It's a lot.
• 51:31
  Dr. Nathan Riley: It's a lot.
• 51:32
  Dr. Nathan Riley: And so if we were to consider could we do this better, uh it's probably best done in the home.
• 51:38
  Dr. Nathan Riley: Let's keep a person calm, let's train people how to do it, and then if we need surgical intervention, we have it.
• 51:44
  Dr. Nathan Riley: The chances of a second baby in a twins breach needing, you know, emergency, you know, emergency c-section or something to get them out, I've maybe seen that one time.
• 51:54
  Dr. Nathan Riley: It's a risk, but you talk about that risk.
• 51:57
  Dr. Nathan Riley: And we don't say you need a C-section because one baby's butt down, unless we're going to be very honest and say, you need a C-section because I have no idea what I'm doing when it comes to attending a vaginal breach.
• 52:07
  Dr. Nathan Riley: For years now, uh around the world, when countries realize that we have an issue in maternity care, they get all of the the stakeholders at the table when we try to figure out how we can make it better.
• 52:19
  Dr. Nathan Riley: In the case of, let's say, breach, we carte blanche in many states say that midwives cannot attend vaginal breach.
• 52:28
  Dr. Nathan Riley: OBGNs aren't gonna do it anyways because their practice, the hospital, nobody's gonna want them to do it.
• 52:33
  Dr. Nathan Riley: So we have a kiosh, and a woman is now left without options.
• 52:36
  Dr. Nathan Riley: Every other country in the country in the world would hear, huh?
• 52:40
  Dr. Nathan Riley: We've got an issue with breach.
• 52:42
  Dr. Nathan Riley: Let's start training people to do breach, or let's start supporting midwives in how to manage infection or hemorrhage or whatever.
• 52:49
  Dr. Nathan Riley: Let's give them the tools because people are gonna be choosing midwives anyways, at least a small portion of the population.
• 52:55
  Dr. Nathan Riley: In Europe, it's way more.
• 52:56
  Dr. Nathan Riley: But they get everybody at the table and they say, huh, man, midwives who had you know attend births and they they're having some issue with infections.
• 53:04
  Dr. Nathan Riley: Maybe we need to look at, you know, making antibiotics more available, or maybe we should look at how sterility, or whatever, it could be anything.
• 53:13
  Dr. Nathan Riley: What we in the United States say is, oh, we're having bad issues with midwives, midwives must be terrible at this.
• 53:18
  Dr. Nathan Riley: And so there's a it an important thing here for the main legislators or any state for that matter, to consider who is your enemy here.
• 53:27
  Dr. Nathan Riley: Like, is are midwives your enemy, or are midwives somebody who could use your help?
• 53:32
  Dr. Nathan Riley: Because they're gonna be doing this work regardless of your policymaking.
• 53:35
  Dr. Nathan Riley: And we will all continue to do this work with I mean, frankly, Angela, if all of us out of hospital birth workers, the OBs, the midwives, everybody stood up and said, We're done with some, you know, suit in Frankfurt, Kentucky telling us what we can and can't do.
• 53:49
  Dr. Nathan Riley: We're trained, we have the experience, we're the experts, not you, Mr.
• 53:52
  Dr. Nathan Riley: MBA holder or whatever, not you, you know, retired OBG WAN you trained back in the 60s.
• 53:58
  Dr. Nathan Riley: We're the ones doing the work.
• 54:00
  Dr. Nathan Riley: And so, you know, shove it with your license.
• 54:02
  Dr. Nathan Riley: We're gonna keep doing this work.
• 54:03
  Dr. Nathan Riley: Are they gonna jail all hundred thousand of us?
• 54:05
  Dr. Nathan Riley: Probably not.
• 54:07
  Dr. Nathan Riley: But we're all so convinced that there's a permission slip there that grants us this autonomy as practitioners and and and where that energy could go is demanding that they actually um continue to pay for the improvement of out of out of out of hospital birth work.
• 54:23
  Dr. Nathan Riley: That's where Maine's policymakers really should be investing because they don't have any other choice.
• 54:28
  Dr. Nathan Riley: So if they're listening, that's my message to them.
• 54:31
  Dr. Nathan Riley: That's my billboard.
• 54:32
  Dr. Nathan Riley: Yeah.
• 54:33
  Dr. Nathan Riley: It is, it is, yeah.
• 54:37
  Dr. Nathan Riley: So it's like, well, who can I get on my team?
• 54:40
  Dr. Nathan Riley: Yeah.
• 54:40
  Dr. Nathan Riley: A radical birthkeeper, which which is totally fine.
• 54:46
  Dr. Nathan Riley: Uh but like we need like a radical birthkeeper or whatever.
• 54:50
  Dr. Nathan Riley: And I'm not picking on these other terms, but like a radical birthkeeper can say, hey, listen, like I do this in a very different way.
• 54:58
  Dr. Nathan Riley: I do not use medications, I do not do exams, we do not monitor baby's heart rate, but I'm here to support with things that I know how to support.
• 55:06
  Dr. Nathan Riley: That's okay until they get more experience.
• 55:08
  Dr. Nathan Riley: I'm not even saying that that's what's happening.
• 55:09
  Dr. Nathan Riley: I'm saying we all need to just be acting in integrity.
• 55:12
  Dr. Nathan Riley: If I were to say, you know what, Angela, I used to be good at C-sections, come and do it, I'll I'll do your C-section.
• 55:16
  Dr. Nathan Riley: Like, I haven't done a C-section in like seven years.
• 55:19
  Dr. Nathan Riley: Why would I be the good, the right person to do that?
• 55:21
  Dr. Nathan Riley: So, in like in integrity, I have to say, I'm sorry, I can't be working in hospitals anymore.
• 55:27
  Dr. Nathan Riley: I don't have that skill set anymore.
• 55:29
  Dr. Nathan Riley: I chose to neglect it and let it fade away, which is a bit of a pain point at times for me.
• 55:34
  Dr. Nathan Riley: Um, but we all of us practicing out-of-hospital birth work need to be very honest and find a colleague.
• 55:40
  Dr. Nathan Riley: You don't need to be like this lone wolf out there with like a pastel palette on your website advertising in like pictures of you in a field, a meadow with a whole bunch of daisies.
• 55:49
  Dr. Nathan Riley: Like, you don't need to do that in order to impress somebody.
• 55:52
  Dr. Nathan Riley: Just be honest.
• 55:53
  Dr. Nathan Riley: Like, families need us to be honest.
• 55:55
  Dr. Nathan Riley: That's why they left the system in the first place.
• 55:57
  Dr. Nathan Riley: People aren't being honest with them.
• 55:59
  Dr. Nathan Riley: So we have to all be like use this free birth thing as maybe an invitation for us to all dial in our authenticity and our integrity and ask for help when we need it and be okay being out, you know, being okay with the humility that's required to say, I have some deficits in my learning.
• 56:15
  Dr. Nathan Riley: I need to go and learn this, like twins or breach or whatever.
• 56:19
  Dr. Nathan Riley: Go and take an herbalism course, you know, if you don't want to use medications, but do something as opposed to just washing it away as if like bad things don't happen to people in birth.
• 56:27
  Dr. Nathan Riley: And if people don't care if bad things happen, that's the real free birther.
• 56:31
  Dr. Nathan Riley: And that also requires us to give a little reverence because that's some powerful stuff.
• 56:36
  Dr. Nathan Riley: I have met families who have had babies die and they're like, yeah, I made my decision and man, it really sucks, but but here we are.
• 56:42
  Dr. Nathan Riley: This is, I guess, how it was supposed to be.
• 56:44
  Dr. Nathan Riley: Whether that's right or wrong is not my opinion, like or not my prerogative.
• 56:48
  Dr. Nathan Riley: It's it really matters what they what they feel.
• 56:51
  Dr. Nathan Riley: But if but if that were to happen on under my watch, it would have been them deciding this despite my years of experience and my board certifications and all this other stuff.
• 57:00
  Dr. Nathan Riley: And to that I say, like, whatever you want.
• 57:03
  Dr. Nathan Riley: Like, that's you do you.
• 57:05
  Dr. Nathan Riley: Yeah, totally.
• 57:08
  Dr. Nathan Riley: As we wrap it up here, would you want to just share about where people can find you or anything else you might want to share about your programs or things that you do?
• 57:15
  Dr. Nathan Riley: Yeah, Born Free Method is where all of the big stuff is happening.
• 57:19
  Dr. Nathan Riley: I do private consultation at my at my at belovedholistics.com.
• 57:22
  Dr. Nathan Riley: If you don't write want to write anything down, just go to Nathan Riley OBGYN on um Nathan Riley OBGYN on Instagram.
• 57:31
  Dr. Nathan Riley: But Born Free Methods where we have our pregnancy uh support programs, we are coming out with a birth worker-oriented program by the end of the by the end of this coming year, 2026.
• 57:42
  Dr. Nathan Riley: Um, we also have a course coming out for first responders to make sure that people in the community on ambulances and whatnot are able to do all of the things, you know, or at least some of the things related to childbirth in those emergency situations, including, but not limited to NRP, improving them on that.
• 57:58
  Dr. Nathan Riley: So all of the offerings are there at bornfreemethod.com.
• 58:02
  Dr. Nathan Riley: Our twins breach gathering is happening in Austin, Texas in 2026 in November, but it's already sold out.
• 58:07
  Dr. Nathan Riley: So I don't want to give anybody hopes when they hear this.
• 58:09
  Dr. Nathan Riley: But the reason it's sold out is because we're doing something extraordinary with this gathering.
• 58:13
  Dr. Nathan Riley: It's only 100 spots this year to keep it small, intimate, and having like there's some skills that are required.
• 58:21
  Dr. Nathan Riley: You know, like we have these realistic mannequins that cost a lot of money, but you can get multiple, you know, rounds.
• 58:28
  Dr. Nathan Riley: You can you can drill on these things, and it's very realistic compared to what you would expect.
• 58:33
  Dr. Nathan Riley: It's not like one of those CPR dummies.
• 58:35
  Dr. Nathan Riley: Like this feels really, really it feels very real as a doctor.
• 58:39
  Dr. Nathan Riley: The baby's all slippery, it has uh like metal uh appendages covered in the silicon stuff.
• 58:45
  Dr. Nathan Riley: It feels like a real baby, like a seven and a half pound baby.
• 58:48
  Dr. Nathan Riley: And so find these workshops.
• 58:50
  Dr. Nathan Riley: If you, if if you didn't make it, if you're not making it to this one, or maybe you can come to a future one, but Breach Without Borders is hosting events all over.
• 58:57
  Dr. Nathan Riley: You can even reach out to them and they will bring the workshop to you.
• 59:00
  Dr. Nathan Riley: You just have to have a space for them and they'll take care of the rest.
• 59:03
  Dr. Nathan Riley: We gotta keep doing this.
• 59:04
  Dr. Nathan Riley: And there's there's enough for everybody here to get the training they need.
• 59:08
  Dr. Nathan Riley: But if you're not willing to do the training, I'm not gonna, I can't really advocate for you doing this work.
• 59:12
  Dr. Nathan Riley: And if you're not gonna do the training, just tell a person, hey, I didn't do any training, but I'm here to be with you and to maybe pray your hemorrhage away or something.
• 59:20
  Dr. Nathan Riley: Um, I say that a little tongue in cheek.
• 59:21
  Dr. Nathan Riley: I'm not making fun of this.
• 59:23
  Dr. Nathan Riley: We haven't even gotten into the deeply spiritual aspects of childbirth, really.
• 59:27
  Dr. Nathan Riley: But we have to just be honest.
• 59:29
  Dr. Nathan Riley: And if you're honest with yourself, man, I haven't really done any breach training recently.
• 59:33
  Dr. Nathan Riley: Go find a workshop, go to Breach Without Borders, go to Dr.
• 59:35
  Dr. Nathan Riley: Stew, go to me, find it, find it, find a midwife in your community that really, really does it.
• 59:41
  Dr. Nathan Riley: But in the meantime, I'm gonna keep I'm just gonna keep doing me, and we have these great, these great events happening.
• 59:46
  Dr. Nathan Riley: One last thing I wanted to say is it's not just a matter of the skills.
• 59:49
  Dr. Nathan Riley: It there's also Betty Ann Davis lent me this term, the the ultimate dystocia in vaginal breach is fear.
• 59:56
  Dr. Nathan Riley: So you also have to start really meditating on am I afraid if there's a butt coming out?
• 1:00:01
  Dr. Nathan Riley: If so, then the skills and the maneuvers don't really serve you.
• 1:00:05
  Dr. Nathan Riley: You have to also really kind of lean into this and be and recognize that that the way that you speak to your mother, the way that you react in that moment, the way that you set up the room in the ambiance, the relationship that you have with them and they have with one another, all of that is equally important.
• 1:00:21
  Dr. Nathan Riley: And since we talked, since I just touched on relationship, the last thing I'll say is that all of us out of hospital birth workers need to lean in on one another as opposed to continuing to throw stones at one another when one of us makes a mistake.
• 1:00:33
  Dr. Nathan Riley: And I've been the victim and the perpetrator of that.
• 1:00:36
  Dr. Nathan Riley: But I'm also sometimes just a third-party bystander realizing, like, God, midwives are so mean to each other.
• 1:00:41
  Dr. Nathan Riley: And you guys gotta stop that.
• 1:00:42
  Dr. Nathan Riley: So it's my little final moment, uh, my soapbox moment there.
• 1:00:46
  Dr. Nathan Riley: All right, I'll link all of your information in the show notes.
• 1:00:50
  Dr. Nathan Riley: Thank you so much for taking the time to chat with me today.
• 1:00:54
  Dr. Nathan Riley: My pleasure, Angela.
• 1:00:55
  Dr. Nathan Riley: Thanks for having me.
• 1:00:56
  Dr. Nathan Riley: Follow the walk of the wild ones into the woods and the darkness.
• 1:01:06
  Dr. Nathan Riley: Rebirth the ways of the ancient ones whose tracks were washed away in blood.
• 1:01:12
  Dr. Nathan Riley: It falls to us now to open up and taste beyond what we've been fed.
• 1:01:17
  Dr. Nathan Riley: Take up the phoenix for cleansing, change to light and send.
• 1:01:22
  Dr. Nathan Riley: Follow the walk of the ones into the woods and the darkness.
• 1:01:27
  Dr. Nathan Riley: We burn the ways of the ancient ones, whose tracks were washed away.
• 1:01:32
  Dr. Nathan Riley: It falls to us now to open up and taste me on the weapon.
• 1:01:37
  Dr. Nathan Riley: Take up the phoenix and cleansing, change to like the plants.
• 1:01:43
  Dr. Nathan Riley: In darkness, let alone like the way to feed the soil of changing times.
• 1:01:54
  Dr. Nathan Riley: So I said through the unknown, I'll be on the light and yumpy line.
• 1:01:59
  Dr. Nathan Riley: In darkness, let's love like the way to feed the soil of changing times, all of the walk of the wild ones, into the woods and the darkness, remote the ways of the ancient ones whose tracks were washed away.
• 1:02:14
  Dr. Nathan Riley: And taste beyond the fence.
• 1:02:20
  Dr. Nathan Riley: Take up the fitness of the cleansing change to like the plans.
• 1:02:25
  Dr. Nathan Riley: Step a step through the unbilling.
• 1:02:31
  Dr. Nathan Riley: In the darkness, let love the way to feel the soul of changing times.
• 1:02:37
  Dr. Nathan Riley: Step a step through the unlock, be a light, hobby mine.
• 1:02:41
  Dr. Nathan Riley: In the darkness, let love the way to feed the soil of changing times.