Trish invites Nathan Riley, a home birth doctor and holistic gynecologist who advocates for and supports out-of-hospital birth, to The Birth Experience for an important conversation around the passionate call for change in the culture of birth & healthcare.

This conversation explores the limitations of the healthcare system in childbirth, the importance of informed consent, and the impact of unnecessary medical interventions.

Trish and Nathan advocate for a holistic approach to childbirth and empowering women through knowledge and understanding of their rights and options.

They discuss the historical context of obstetrics while sharing personal stories and insights from their careers, aiming to empower listeners to navigate their childbirth experiences with confidence and support. Both of them emphasize the importance of client-centered care in childbirth and how they approach this in their practices for a more positive birth experience.

00:55 Introducing Nathan Riley: The Home Birth OBGYN

05:47 Historical Context of Obstetrics and Gynecology

07:37 Addressing the Challenges of Informed Consent in Childbirth

20:12 The Impact of Medical Interventions

24:08 The Importance of Postpartum Support 

25:45 Exploring the Impact of Communication in Labor and Delivery

26:41 Emergency C-Sections: Perception vs. Reality

29:23 Challenging Conventional Birth Practices 

32:35 The VBAC Lab: Empowering Women Through Education

36:22 Navigating the Healthcare System: Advocacy and Individualized Care

46:12 The Power of Personal Health in Pregnancy and Birth

Connect with Dr. Nathan Riley, OBGYN:

Find Nathan on Instagram: @nathanrileyobgyn

Visit Nathan's website

Listen to Nathan’s podcast The Holistic OBGYN


Join our 5 Days to A Fearless Birth Experience and watch 5 Online Birth Classes FOR FREE!!

Grab a Free Pregnancy/Postpartum Checklist Bundle

Connect w/ Trish:

On Instagram

On Facebook

On YouTube

On Pinterest

On TikTok

For more pregnancy & birth education, subscribe to The Birth Experience on Spotify, Apple Podcasts, or wherever you listen to podcasts.

Next Steps with LNM:

If you are ready to invest in your pregnancy & postpartum journey, you are in the right place. I would love to take your hand and support you in your virtual labor room!

If you are ready to dive into a birth class and have your best and most powerful birth story, then Calm Labor Confident Birth or The VBAC Lab is your next step.

If you have a scheduled cesarean, take our Belly Birth Masterclass and own that experience.

If you are a newly pregnant mama or just had the babe, you want to join our private pregnancy and postpartum membership, Calm Mama Society.

Remember, my advice is not medical advice. Always discuss what you learn with your team. See my Disclaimer here! Also, We make a small commission from some of the links (you don’t pay any more for using our links); however some of the recommendations, we do not earn anything; we love ’em and want you to know about them.


Trish: [00:00:00] My name is Trish Ware and I am obsessed with all things pregnancy and birth and helping you to navigate with the practical and the magical seasons of this journey called motherhood. I'm an all day coffee sipping mama of seven. I've had the amazing privilege of delivering many babies. In my 15 plus year career as a labor and delivery nurse, and as a mama of seven, I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby. 

Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom. of the show notes. 

Hello, everyone. I am so happy to introduce our guest today. You guys are really [00:01:00] going to love this episode. We've got Nathan Riley, who is a home birth OBGYN. So welcome, Nathan. 

Nathan: Thank you. Thank you. 

Trish: So excited. So we're going to be talking about a lot of different things. Like I feel like we're going to cover like I'm, and I'm sure I'm going to have so many questions pop up for you because as a labor nurse, like I don't meet, I've actually had a really awesome conversation with a home birth doctor in North Carolina. 

You may know who I'm talking about. I cannot think of his name right now. 

Nathan: David Hayes. Yeah. 

Trish: Yes. Yes. I had, and we'll get to that in a second. I'll tell you why I talked to him, but go ahead and tell everyone about you and like, how did you end up on that path? 

Nathan: In, in all of our medical training, whether you're a nurse, you're a midwife, you're a doctor, you're a PT, you're an OT, you're respiratory therapy, you work in the NICU, you work in the maternity, work in the operating room, whatever, we're taught that the human being has [00:02:00] these definitive contours, and if we can manipulate the physical anatomy and the physiology, then everything's going to be fine. 

And we're going to live forever and every baby's going to live and every person's going to have the dream birth. And of course, that's not true because the more bursts that you go to, and I know I noticed on your website that you've been, you were a labor and delivery nurse for 16 years. It doesn't take even a whole year to realize just how limited that reductive view of the human body how limited that is in service to childbirth. 

I went in thinking, wow, this is the ultimate curiosity for me as a man. I'm never gonna be pregnant, I'm never gonna have a period, I'm never gonna have a baby, I'm never gonna breastfeed I'm never gonna do those things. And this to me was like the ultimate intellectual curiosity for somebody who's been incentivized to be curious his whole life. 

And then of course very early on I realized, man, the more of this stuff that I do, the worse outcomes we get. So I started peeling those back until I realized I just really don't think it's suitable for me to be in the hospital with tens of thousands of other OBGYNs. I need to find a [00:03:00] different way to do this if I'm going to keep doing it. 

And I started supporting midwives around the country who based on their state needed a supervising doctor, as they call it, or a delegated authority, like those types of things. And I, was really picking up on this whole what we would consider a gambit of attending home births. But truthfully, at the end of the day, what I was being, seeing modeled in midwifery care outside of the hospital and through people like David Hayes and Stu Fishbein and some of these other, rebel people. 

renegade OBs who are now later in their career. What they were modeling was actually like a patient centered approach, right? So the midwives and the outside of the hospital, doctors, et cetera, were doing this in the way that I thought it was supposed to be done. And I just naturally found my way there instead of giving up the whole profession and just doing end of life care, which is my other board specialty. 

I figured let's do home birth, but let's. Let's do it in a way that keeps midwives at the center of the conversation. Actually, the client at the center of the conversation and the next [00:04:00] layer beyond that is the midwife or the doula or the childbirth educator. And then beyond that is me whenever I'm actually needed in order to put this big expensive brain to use. 

And that's working out very well for me. Because informed consent is the nearest and dearest thing to my heart and empowering people with education and support is the only way forward as opposed to throwing more medicine and technology. Guess we can start there. 

Trish: Yeah. It's funny because I start all of my masterclasses or free classes. 

with one statement, which is birth is a natural process. And I, I wouldn't I became a nurse to be a labor nurse. That was it. I didn't want to be a midwife because I had my own children and I wanted, I didn't want my time to be like, yeah. And I knew I wouldn't be a midwife who'd be inducing people and all of that. 

But I started and I can still remember when it, I was like, what the hell is happening here? [00:05:00] And just hearing those desk conversations and we need to get her going because I need to blah blah blah or whatever, and one of my repeating statements inside of my birth classes is nothing out of convenience or curiosity for anyone else besides you. 

I don't think people really understand informed consent because, going to that, because in the system we have, we're just taught that they say it, we do it. And they know, they, they know so much. You know your body, this is your body like, I wanted to start out today actually talking about informed consent, and I'd love to let's just take it wherever you feel like it needs to go. 

Nathan: I think the only starting point is to really understand where abstinence is. TE and Gynecology came from, and I'm not gonna go to the Flexner report in the way that people expect me to go. I'm gonna go back further. And I'm not gonna go back to ancient Sumer, which is what I've done in other conversations. 

I wanna go back to the 1840s where a young surgeon named Jay [00:06:00] Marion Sims, who later became known as the father of Gynecology saw an for himself, which was in Vesco, vaginal and rectovaginal. fistula repairs which in a protracted labor fashion, if a baby gets, is stuck in the canal for too long, of course, we worry about the, the wellbeing of the baby, but also the wellbeing of the mother comes into question because these, pressure on different organs and whatnot can lead to degradation of those tissues and little tunnels, appear between them. 

And with a vesicovaginal fistula, which is a channel that shouldn't be there between the bladder and the vagina, you would have like persistent chronic leakage of urine for the rest of your life. And so there's a lot of morbidity with that. The issue was that we didn't yet have our ethics committees and our institutional review board. 

The Nuremberg trials hadn't even happened. We got a lot of great insights from Nazi medicine, for example. And so this guy saw an opportunity. He started operating on young formerly or actively enslaved women in the [00:07:00] Antebellum South. And Later, he touted that he had found the cure for fistulas, and that may or may not even be true. 

And we can also argue that perhaps the way that this unfolded led to quite a bit of good for humanity. We could argue that. However, at the time, Sims in his own writing argues that they gave complete consent to these procedures, and they were desperate for my help. And so I offered them a solution, and I found the solution. 

Big fucking deal. That's what he would argue. The problem with that argument is that you cannot provide informed consent if you don't also have the right to refuse it. So in a hospital setting, a hundred, whatever, 70 years later, you either have this thing or I fire you is one scenario. If you don't do this, your baby will die is another scenario. 

Or this is just the way we do it. I need you to let me do this thing because you wouldn't have come here for my help if you didn't want [00:08:00] my help. 

Trish: No, it's just, I'm literally tearing up to hear a doctor admit these things. 

Nathan: Yeah. 

Trish: That, it's very unusual. I started Labor Nurse Mama it really was because I am so passionate about women understanding their rights and to have the, like you said, have a choice. 

It's a choice. my students have said to me, you lay it out like a smorgasbord, and then we get to pick and choose, and you support us in what we choose. And if I had a dollar for every time I've heard some of the exact things you've just said, or my students have come to me, yeah, it would be super rich. 

And I remember when I first started, I was like, did he really, or did she really just say that? And the sad thing is, and I call them medwives, the medwives also do that. Those are not the only options. Like, how about I fire your ass? How about that? 

Nathan: we [00:09:00] hear it all the time. And then, When you take that one step further, of course, during J. Marion Sims's work, he wasn't using anesthesia. There wasn't really a ton of anesthesia back then. There was maybe like ether and these types of things. But, maybe to his credit, that was not affordable for experimenting on slave women. 

Fine. I guess we can make that argument. On the other hand, imagine how much pain these young women are in, and we don't even know their names. Like the father of gynecology is given credit for the sacrifice made by these women who, who quite literally, they opened themselves up to traumatization, even if it was going to fix their problem with no anesthesia to do a very intensive vaginal sort of repair. 

So when we look again, we jumped forward 170 years, we would say, Oh my gosh, things were so bad back then. How many times did somebody like me walk into a and force his hand inside of a woman, which is extremely uncomfortable. Let alone painful, let alone maybe reopening some past trauma from their own life. 

They are saying no. Maybe their words are yes, [00:10:00] okay, but their body is saying no. They tense up. They crawl up the 

Trish: bed. I ask the partner. They go up the bed. 

Nathan: Yeah. They crawl up the bed and I just. Follow them and I force my hand inside of them. This is what is happening in hospitals and for people to like, to say, oh, using words like rape and obstetric violence that's not kosher fuck off. 

You have no idea how much pain we are causing in the medical system. And it's not just people like me. It's also people like you. it's 

Trish: all of us. I've had to go back to the beginning of my career And throughout my career I was taught to say that and I didn't even question it. 

I didn't even think about it. I can definitely say and being like someone who has had sexual abuse touch my family and me and just about every woman I know, I know that I've ne I can 100% say that I never forced a cervical exam. 'cause I've never really believed in them all that much. So that's something I ha Yeah. 

Yeah. They [00:11:00] don't . Yeah that's how I always felt. So that I can 100% say, but I can, there's so many different things besides just that one. Like just saying, okay, it's time. Let's get on your back. Let's put your legs up here. I'm going to put, break your bed about never saying, Hey, how do you want to push? 

Do you have a, do you have a thought on how you want to push? , there's just so many layers. This is, I feel like this is going to be such an emotional episode because Another thing about my birth courses is that I do weekly coaching. I have doulas on my team and we meet with my students every week. 

We do what we call it the happy hour. And then part of my classes, we have a membership. It's pregnancy postpartum. And then we meet with our postpartum mamas every Thursday. And then I go live with them throughout the week. And we had just an impromptu live zoom hangout last week. And there were nine of us on there. 

And six had been sexually abused. And part of us talking about that [00:12:00] was the way that doctors can approach that. And it's some of the things that my students tell me, even as a seasoned labor nurse thinking I've heard it all, I'm like, what? Like I just, I don't it's mind boggling, but it's not just a problem in this area. 

It's all over. But I do agree. It's got to change. Like, how do we change it? That what do we do? What do we do to change this? How do we make it where if a woman is saying no or screaming or crawling up the bed, we stop? 

Nathan: worst part of this is that it's not, just for those, 20 to 30 percent of women who experienced some sort of sexual abuse because now we, they didn't have a sexual abuse. 

They had a lovely life up until they arrived at a an institution that advertises safety for birthing women. And then they actually, they then have the experience of rape. So what I [00:13:00] don't want people to take from this conversation is to not go to the hospital when your midwife or your doctor is I'm really concerned. 

I think we need to get there. If our goal is to have a living baby after this, I don't want people to be afraid. So the next question, like you said, is what do we do? I don't have the answer for that yet, but in some ways I feel like, programs like yours, my practice and the way that I've supported midwives and community members through my own programs is modeling what real safety looks like. 

And it, it starts actually with just putting the person you're here to care for at the center, our hospitals have economic boundaries, they have medical legal boundaries, they have administrative boundaries. There are some important. financial reasons for the ways that hospitals work. And we have doctors that are being brought up with without any incentives to appreciate the immeasurable facets of what medicine means, which is allopathic medicine is the only one. 

It's like the only major modality that doesn't recognize [00:14:00] that there is something more important to this person in front of you. than something that can be operated on or something that can be manipulated through pharmaceuticals. It's the only one. Because if I were to ask Trish, you said you have an 18 year old that's your oldest, right? 

If I were to ask you about your birth, you might tell me a good story and I can really glean a lot about who Trish is and where she's been by hearing that story. And of course we've lost storytelling because we have seven minutes with our clients in the prenatal clinics. But as a thought experiment, if I were to sit and just have you unpack, you said you have three kids, right? 

Seven. Oh, my God. You have seven kids. Holy shit. Okay. Yeah. We'd be there for a whole week at around the camp from there. And you'd be telling me every little vivid detail. And there's two parts of that. First, you have to feel safe to tell me and I have to be willing to listen and listening requires presence and nobody is perfect. 

We have three second attention spans. We'd prefer to watch TV than to sit eye to eye, looking into one another's eyes. But if [00:15:00] you were to have that relationship, I could understand everything about your story. And I guarantee that not one time maybe you because you're a labor and delivery nurse, but most people are not going to start or end their story with, and guess what my heart rate was. 

or guess what my white count was or you know what my hemoglobin was after that or guess what the fetal heart tone was it was like 155 isn't that a great no they would be telling me all of these other things over that week that you're telling me about seven different births they would tell me everything about the experience none of which is measurable in the means that my five hundred thousand dollar education taught me to be present with taught me to listen so we have a pickle here we have a philosophical difference in what our clients, these birthing families mean. 

And I use client because you're not a patient if you don't have a disease. These birthing families, what they need and what we were taught to do. And therefore, you shouldn't go to your doctor [00:16:00] unless you need surgery or you have a disease process that needs to be treated, which is a problem. Because health insurance won't pay for most of this. 

So we have this socioeconomic issue. We have a, an equity issue. And then of course, if you thread in some other elements And not just insurance, but we also have this tendency to treat people of different skin color, different creed, different race, different, spiritual beliefs. 

differently from our own. It's just a part of the human experience. But with a hospital system that has for the past, since J. Marion Sims, even before that, we have seen, let's say black women as, inferior to us as white people. It doesn't matter if you agree with that or not. 

It is happening in hospitals. It's an un, it's an unchecked subconscious bias that we have. With that and everything else I've already described, we have an, a leviathan that is moving in this direction. And all that we ask is for it to budge a couple degrees towards east. And we're not going to be [00:17:00] able to do that with just one home birth OB in the country next to maybe Victoria Flores. 

David Hayes is doing some births, Stu Fishbein is doing some births. There's very few of us. So anyways, with all of this being said, I think people are starting to leave the system because they don't feel like. Any longer compelled to try to change the system from within as a physician, I'm very replaceable as a midwife. 

I'm very replaceable as a labor and delivery nurse. I'm definitely replaceable. I've seen it happen over and over. As soon as you put your neck out there, you just get shot at first thing. You're the easy kind of low hanging fruit. And then that keeps everybody else in line. So I don't know what the answer is, but I think modeling what actual. 

patient centered or client centered birth support looks like is, I think we're there. 

Trish: Yeah. And it's funny, like I have said over and over, I think, how they have the baby friendly model. Where is the mom friendly model? We need the mother friendly model because I think even You know, I think a lot of what baby [00:18:00] friendly wants to accomplish, but I have seen some people's rights I can't even explain what I've seen in some of the baby friendly hospitals that happens to the moms. 

And it's wait a minute, stop, hold up for a second here this is her baby. This is hers, not ours, hers, but that's a whole nother conversation. So yeah, there's just so much here and I really wish I don't want my daughters to go through any of this and I would like to hope they wouldn't because they've listened to me on the sidelines for so long, and I love birth. 

But I realized that my voice was way more powerful on this side. Like you said, I always joke that there's probably like America's most wanted labor nurse sign. And because of, my students speak up and I, they will, they're like, Trish, I heard you in my head. And one of my students, [00:19:00] and she was having a birth center birth in Canada. 

And she, her doctor wanted to break her what, or her midwife wanted to break her water. She was in the tub. laboring fine, pretty fast labor for a first baby. And she put her finger up and she said nothing out of curiosity or convenience. And her midwife was like, okay, I won't. And of course her water broke on its own. 

She delivered. She had a beautiful delivery. She went home four hours later. Like why? Like just step back, like step back and let birth happen. Like it's, I do, I am 100 percent like. Obviously, I appreciate your knowledge, I appreciate my knowledge and my ability to step in when I'm needed. I do appreciate that, I appreciate my education, but I also think that a lot of the things that we see when they need us is because of us. 

Nathan: Yeah, so let's Trish, let's talk about that. You and I have seen [00:20:00] every intervention under the sun. You've actually been doing this longer than I. You've probably been a part of a woman's care more times than I have. And when we start to, to look so the question I started asking myself at the the halfway point of residency, did you ever work with residents by any chance? 

So you know how we're like, we get out of med school and we're like, fuck, I'm supposed to be doing the job doctor thing now. Like we're never called doctor before that first day in residency. And we have a white coat that says it there. And we're supposed to start acting like we know what we're doing. 

And we lean on you guys for quite a bit. Now, most of the labor and delivery nurses are doing things based on a protocol that is a part of a package to keep women and babies safe. So nobody's going to argue with the value of having protocols, but the issue is. That you spend that first year or two in residency. 

Intern year is pretty, pretty intense. So you might actually get it in your intern year. I know I was on the right path. But you start to [00:21:00] realize okay, so you start the Pitocin because the contractions are too far apart. Okay. That's easy. Now what? The tracings. Okay. Here's how you do the tracings. 

Okay. C section. Here's how you do a C section. Rupture of membranes, cervical ripening, list them all out. And then after you learn what can be done. A natural question for anybody, labor and delivery nurse, certified nurse midwife, regular midwife, whatever, doctor especially, start asking yourself, which of these interventions is absolutely necessary for this woman to come in, feel taken care of, have her baby, and go home with her baby as soon as possible afterwards. 

That list gets very small. The number of true hemorrhages that I've, managed is maybe like a hundred real hemorrhages. And that sounds like a lot, but when you've done this so many times, a hundred is like a small number, right? We're talking maybe like under, under 5%. I'll just throw that number out. 

How many of those C sections were absolutely [00:22:00] necessary? I don't know. We have this rising c section rate that your, that your community is learning about, that everybody's talking about, but who out there, which OBGYN is raising their hand and saying, I've done a bunch of unnecessary c sections? 

I'm contributing to the problem. And I was able to recognize, I'm not tooting my horn here, but I realized, holy shit, that did not have to end in C section. Oh my God, that one ended in C section and then she lost her uterus. Oh my God, that one went to C section and the baby was nicked with a knife. Oh my God, this one resulted in the baby struggling with transition, right? 

So when you start peeling back these different interventions and you start realizing that, if needed, Pathogen's helpful. Pitocin is helpful. Cervical ripening, maybe fetal heart rate tracing. Maybe that helped us once in a while. But the truth is when you start peeling it back, not only do you guys work less and you actually get more time spending, getting to know the client I get some rest in the call room [00:23:00] and lo and behold. 

A bunch of women's and baby's heads aren't just popping off left and right. In fact, they're actually having a nice, easy transition into motherhood or parenthood for the father, and they're able to go home with their baby and start the hard work, which really is after the fact. But if we've traumatized your abdomen and your uterus and your whole being with these various interventions and not talking to you or educating you or supporting you or putting you like bearing witness to what you're going through the whole time, then that postpartum recovery, when we say we did a good job, bye. 

It actually becomes even harder. So the medical interventions are sometimes beneficial, but more often harmful, it seems, if we can be honest with ourselves and state right now that most of the C sections that you do are probably not indicated. Most of the inductions you're doing aren't indicated. 

Most of these other things aren't indicated. 

Trish: It is such a refreshing conversation. And I went this morning, my son was doing an interview at a new school, and long story short, I ended up in the parking lot. The people did not show up, which was not a good [00:24:00] sign for a new school, but I ended up talking to another mom who was pregnant. 

And I'm sure you're going to understand this, and this is why I do my weekly coaching with my moms. Because I can unpack a birth story and see where it went wrong. When, so that it's not repeated for them. So she had two terrible, this is her, two horrible postpartum hemorrhages. And it was just so horrible and all of this. 

My first questions was tell me about your birth. Were you induced? Yes. And it's I, so we were talking about this current baby and I was like, send me a DM. I would love to talk to you. I said, let's keep you from getting induced this time. And she's like, Oh, really? 

I've already been induced. Like, Don't they have to be induced? no, let's slow back. Let's go back. Because a lot of times when I talk to these moms and why we continued with our postpartum membership, I, as a labor nurse and as a mom, even one of mine is adopted, but a mom of so many [00:25:00] children. 

When I was in my postpartum period, and I'm sure you know this with your wife, she's not hanging out with other moms in that same period because they're all trying, you're trying to nurture your baby. And if you do hang out with another mom, you don't go deep talking about what you're feeling. And you may make some jokes or whatever, but you're tending to your baby. 

So I started the postpartum hangouts because I love my mom so much, and I didn't want them to go. Like I've bonded with them. And. That's how I've, learned so much more about my role as a labor nurse, and about what these moms, and how they're processing what was said to them, how no one's, like you said, no one's communicating to them. 

I had a mom that thought she went back to the OR for a C section. Because she had dilated too much. Who explained anything to her? She wasn't someone who couldn't have comprehended what went on. Just no one talked to her. like you said even my moms who had a picture [00:26:00] perfect birth, 

Nathan: Let's talk about that. 

This is really important for people to appreciate. We're not just talking episiotomies and emergency c sections. By the way, Trish, what was the last, like, how many real emergency c sections do you think you were a part of? 

Trish: Oh. And it 

Nathan: could be a big number. 

Trish: Real, maybe a hundred over the course of 16 years, like really emergent. 


Nathan: how often do you hear, I had to have an emergency c section? Oh, 

Trish: so often, but I do I do think that in that, I think, again, sometimes that's lack of communication because when you have people running in, flipping you over, changing your ID, putting oxygen masks, all those things, but I've also had students who say they had an emergency C section, but it was called and not completed for a couple hours. 

It's it's again back to this lack of communication and, and going back to when I was in nursing school, one of the first [00:27:00] experiences and I can 100 percent say that I did things differently just by nature, but one of the first things I remember is I was in nursing school, and I was at a hospital that they had student nurses. 

The student nurse accidentally opened up the Pitocin instead of the IV fluids to prep the girl for her epidural, which did not end, they were, it didn't, and it was traumatic, all of it. Baby was fine, at least in the labor room. I don't know what happened after, but, The thing that stood out to me a lot is no one was talking to the family. 

No one was talking to the mom. They were all rushing in. And I just hugged the patient's mom was in the room and it was terrifying. The whole situation for me as a nurse or a student, it was terrifying. But I just, held the mom. And I saw that family again later. I didn't, you know how you see a patient somewhere out and you're like, who are you? 

But I knew it, it had to do [00:28:00] something. It was a couple of years later and I saw the patient and her mom and she hugged me and said, I just want to let you know how much it meant to me that like you stood and explained to me like what the nurses were doing. 

I barely knew what they were doing, but she appreciated that. But yes, back to not many. I've seen a lot of very stupid reasons. And I have so many theories and most of the time people don't back me up on this. I'm really happy that you're here because I've talked to they say, is it one in 10 women end up in the OR for failure progress? 

And I call that failure for the staff to do their dang job. I, let's really go back. Like all of these stats out there I think are so inaccurate about all of it. Yeah, you 

Nathan: know let's talk about data for a second. When I was applying for residency, there was this German MFM who continues to haunt my dreams to this day, who I interviewed with, [00:29:00] and she loved that I was, So interested in evidence based medicine, and I thought I knew what that meant, but most people when they hear that term evidence based birth, not to call them out. 

I'm not doing that intentionally. They just got a hell of a name for their program. 

Trish: Yeah, they branded. 

Nathan: Yeah, very well branded. Evidence based medicine, if applied to birth, could look like, if it's published in a peer reviewed journal, then it's relevant. But evidence comes in a variety of forms. 

Trish Ware has 16 years of labor and delivery experience and therefore knows how maybe getting her moved in different positions is going to help facilitate birth. If Trish Ware was compared to a first year out of nursing school nurse, and their statistics were compared, they would look very different. 

And that's not to any discredit to the younger nurse. It's just that they have that experience. But my point here is that peer reviewed literature is one part of the piece [00:30:00] of evidence. Then you have the clinician experience, me attending a vaginal breach versus a, an OB, who's an intern that has never seen a baby come out butt first. 

Big difference there. So clinician experience, peer reviewed, journal, whatever, contributions, and then we also have the client's values, story, perceptions, and whatever. Those three legs comprise the chair that is evidence based medicine. And this is not a knock on evidence based birth, but if we're only interested in the data, we are fucked because we have so much data pouring out of our ass. 

That we can use it to, to support whatever our internal bias is. So we cannot rely entirely on the peer reviewed literature. And of course, there is, the publication industry is rife with issues as we've learned in past years. I won't get into it. But this data thing, as a means of trying to generalize a plan [00:31:00] of care to an individual, is broken as soon as you turn the key, like it doesn't work. 

It is helpful as a guide post when we need really sound insights on a randomized control trial as to what to do with a pharmaceutical or whatever. But there's so many immeasurable facets that are not even taken into account in the medical literature when it comes to childbirth. And given the various variables that play into this experience for both the birth worker as well as the client, we can't rely entirely on that. 

But we see this come through with things like VBAC and trial labor after c section. It's you're not the average, you're a human being. It's not the same. It's not going to dictate, it's not fatalistically dictating what's going to happen to you, but we use this to justify everything around c sections. 

And That really could stop, like that's something we could just stop right now. 

Trish: Yeah, please, that would be so fantastic. I [00:32:00] have a course that's specifically for VBACs. And honestly, it was my DMs on Instagram that first year. So I had the blog for a year and then I turned to Instagram and I just started, I'm pretty outspoken anyway, but I just started Speaking my truth, and I was flooded with women's stories and traumatic birth, specifically moms that have had a C section. 

And in that, I didn't have, I had no plan at all to create a VBAC birth course, which I tell them all the time, you're just like my mom's in comm labor, the VBAC lab, same thing. And I just need to give you extra special care because you're going to navigate a lot of BS. So you're, that's just how it's going to be. 

But I tell them all, you're all just moms wanting to have birth, which is a vaginal birth. That's what we want. But their stories, I had one mom that, which this is completely going [00:33:00] back to our very first topic. I had one mom that was not pushing. She wasn't pushing good. And so they told her if she didn't start pushing good, they were going to do a vacuum. 

And so the nurse laid the vacuum next to her face to show her, like threatening her. She ended up in the, in a cesarean because she couldn't push right. And I was like how did they have you pushing? They did nothing with her. They had her pushing in stirrups, but. that she ended up in a C section. You and I both know she did not need in a C section. 

She wasn't pushing in the time limit, but she also wasn't being helped. No one was helping her with positions or anything. But there, that, all of that led to the birth of the VBAC Lab because I just was so blown away. I also have to say that I also, as a travel nurse, I did mostly travel nurse for the majority. 

I spent a lot of time on the West Coast and Seattle [00:34:00] area when I work, like when I worked in Northern California and in Seattle, like I, that, the very best thing I ever did for myself as a labor nurse was take my first tribal assignment because I realized, holy Shit, the things we were doing, especially on the East Coast. 

That's why I said when we were talking before, like a woman's body is the same. Wow. If she can eat and labor on the West Coast, I bet she could eat and labor on the East Coast. And I learned so much. It was a four week assignment just to get my feet wet. I learned so much and I actually came home and put in my resignation, my job here because I was like, I'm not going to lose my, cause you're right. 

I will lose my license. Not them, and I couldn't do it. I couldn't participate in it anymore. It was horrible the whole yeah And so and then I spent the rest of my career mostly on the west coast, which is better It's still not there, but it is better than the east coast. 

Nathan: It's yeah, I mean [00:35:00] it still has its issues I trained out in California for my residency and fellowship and I had a couple interviews for residency out in New York City and Pittsburgh, New York City, a couple of those little types, not little massive, huge academic programs. 

And I ended up ranking them last, I think, because one of them, I didn't even rank. I won't mention them by name, but that hospital was like, so felt like I was walking into a toxic waste dump. Like it was like, you guys are just. Assholes, like it's just nuts. 

Trish: I did an assignment like that actually in California. 

I felt like I went through a time warp too. Like I was back in the 1940s or 50s. It was insane. 

Nathan: Yeah. Yeah. I want to, since we brought up the VBAC thing, I want to, for people that are listening, I want people to appreciate what I'm saying here, if I may. There's a plain, there's a lot of plain communities around Kentucky where I live and there is a, One of the midwives. 

So I support midwives around the country as I mentioned. [00:36:00] And so I get to hear some really interesting things based on, what's happening in Hawaii versus California versus in Indiana versus New Hampshire, whatever, Florida, Texas. And there's a lot of Amish and Mennonite communities around here in this One midwife with whom I that I support, she called me up and said, there's a disagreement in our practice between the two midwives. 

There's me and there's this other person. I want to support this lady. The my, my partner's not comfortable with it. This lady is in her like 12th pregnancy and she'd had a couple of miscarriages, but she'd otherwise had eight babies before. And the first three pregnancies were C section. We have to check our premises every step of the way when we talk about this. 

But why was that first C section done? Because was it breach? Was it failure to progress? Abnormal fetal heart rate tracing, whatever, probably wasn't necessary. But then, of course, that sets them up in many hospitals for a very limited approach to trial of labor, right? They end up with another C section, scheduled repeat. 

They get another C section, scheduled repeat. The fourth one is preterm. They do a classical incision [00:37:00] on the uterus. Repeat c section, but this is an Amish community that they're going to get more. They're not doing birth control. They're going to get pregnant again. Fifth pregnancy, home birth after three c sections including one vertical. 

Fifth pregnancy, home birth. Sixth pregnancy, home birth. Seventh pregnancy, home birth. You see where I'm going with this. She's now pregnant with her eighth baby. And granted, like I said, she had a lot of pregnancies, some of them were miscarriages, that's a part of the deal. But she'd had four C sections, four home births, and now she's pregnant again, wanting to have a home birth. 

And this midwife calling me, her partner was not comfortable because of the risk of rupture. Now, first off, what data do we actually have of the C section? for a person who's had four home births after four c sections, one of which was a classical. We don't even have a lot of data on a classical incision at risk of rupture. 

[00:38:00] It's like from the 40s or something, the one or two studies that are out there and they've done review articles, but all those review articles do is summarize what was done. This evidence based approach is, yeah, maybe there is an up to 9 percent chance of rupture based on the one study that everybody talks about for a vertical incision on the uterus. 

On the other hand, this person's experience has told us that however she's nourishing herself whatever the circumstances, she is able to have a vaginal birth after c section and her risk should be reasonably considered less because for whatever reason her uterus does not rupture, at least in those four. 

Does it guarantee it's not going to rupture? Of course not. And we counsel based on this possibility that there's still a possibility of rupture and we got to get to the hospital right away. But her story is actually a part of the counseling. It's a part of evidence based birth and I don't hear anybody saying 

Trish: this. 

And that runs the gamut for all of it, whether it's age, all of it. There's no individuality [00:39:00] at all. 

Nathan: Just put a box around them. And then if you go outside the box, the nurse is going to get fired. The doctor might lose his privileges. The client might, their fucking head might explode. I don't know what we expect to happen, but stay in the box and everything will be okay. 

But when you stay in the box, you could even experience trauma at the hands of a nurse and a doctor, even if you have a physiologic or undisturbed or whatever type of birth in the hospital. So this is a real pickle. This is a real pickle that we find ourselves in. And 

Trish: for those of you guys listening. 

Nathan said earlier, we don't want you to be scared. It's about being informed and knowing your power. You really do have the power. And what I've found a lot of the times is that the majority of these doctors and nurses, and I actually have a section where I teach them on communication with their provider. 

And I don't teach them to be like, this is my right. I teach them how to do it the right way without being wishy washy, without being like I'd really [00:40:00] like to try this if that's okay. No, not like that. You have the authority to say how you want to do this. And a lot of the times, The doctor's alright, because they're just not used to people having a thought on it. 

Nathan: Saying no thank you. Yeah. It goes a long way, but it's very hard. 

Trish: Yeah. Yeah. And so that's part of my framework for my classes and, what I show them is that you have to have the knowledge. The knowledge is power. Then you have to have the right mindset. That's the other part, but the third part is being willing to speak up because you can have those other two things. 

But if you're too scared, if you just sit there and say, okay, because you're not willing to say, Hey, no wait, I know that this is not true. Then you're in it. the knowledge and the mindset doesn't matter anymore. They have to have the ability to speak up. And again, this is why I meet with them every week, because they could take my course and be like, hell yeah, I can do it. 

But then six [00:41:00] weeks later, when their doctor has reframed the exact coercion, that I told him was coming, now they're scared. But if we found that if we meet with them every week and we back them up and then, I might have a 12 weeker who hears a 38 weeker going through it right now and how she handled it and then she hears another one and how she handled it and so they figure out, oh wow, I can do this. 

They, their head didn't pop off. Like it actually worked, so that's part of why and I've had a lot of people like, Oh my gosh, that's so much. I don't charge more for my birth classes. Everyone who buys them gets the weekly coaching. We do charge a little more for our, we charge 19 a month for the membership, which is nothing. 

But they have access to doulas and they have access to all the different my, my doulas have way different personalities than me. So they get it from each of us in a different way because Lene, my, the way she speaks up is way different than how Trish would speak [00:42:00] up, so it's really been a powerful part, I think, of my community is for us to actually spend time and break apart these different conversations. 

But through that, like I said in the beginning, I have been blown away. by the things that are said. And I wish I had a copy of I'll ask Emily if I can send you a copy of the letter she sent to the person who did her repeat C section. She wanted to have a V back. I don't remember now exactly the details of why she didn't. 

But, The doctor came, was so awful to her, and he came into her, the, she started bleeding in the PACU. The nurse called her in, and he said something, and I'm probably misquoting this completely, but he said something like, I'm going to have to big, put my big fat effing hand inside Her or something like that. 

Something to that effect, like it was whatever he said, it was so [00:43:00] horrible and traumatizing. But the letter that Emily wrote to this doctor, I, if I would've received a letter like that at all in my career, I would've been devastated, ho. Hopefully it made a difference. I don't know. But I was so proud of her. 

Like she did speak up throughout too, but it was. It wasn't like all the horrible things he did and said, but she really called him out on, Hey, I understand I needed to have a repeat C section, but that was still my birth experience. And you could have made it a joyful, pleasant experience. And it was like, oh my gosh. 

And she the way she wrote it out, like we were all weeping listening to her. But it's, I could just go off on so many tangents, which everybody who listens to my podcast knows we do. That's how we roll. 

Nathan: Yeah. Something I think that it's really important for people to keep in mind is, you know, First off, this this notion that you're, that we [00:44:00] expect women to go in with their dukes up and they're gonna fight the system in birth it's nonsense, especially because so many women have have been gaslit or just not had their voice heard throughout their whole life, and now you're expecting them in the throes of labor with one foot in the astral realm to suddenly now Push back on an authority figure that looks like me. 

So it's so good that you're preparing people from the very beginning. And when I tell people, it's listen, if you can't say no to your husband in a respectful way, that doesn't rupture your relationship when they want to have sex and you're not feeling in the mood, like that might be a good place to start just something right there or friend. 

When I go out, once you got the movies, just no, thank you. I feel like I'm going to, I just feel better staying in today. Like we don't even do that as men, even like we don't really do that. We're not comfortable voicing our. Or declining invitations to do things. The other thing is that there's this notion that you can get a birth plan notarized and that makes it somehow valid. 

It's baloney. Notarization does I 

Trish: don't think I've ever heard of that. 

Nathan: There's a movement now. Get it [00:45:00] notarized. And then it's like a legal contract. It's baloney. It's just a lady at the library saying that the guy who signed it is the guy who he says he is, right? Like I don't know what there's a lot of weird stuff out there. 

Trish: Yeah, that I've not heard. That's the first one. I 

Nathan: do a lot of training programs and whatnot that I'm hearing this because I've taken a lot of courses myself, but I just 

Trish: don't even understand what they think that would accomplish. I don't 

Nathan: know. Like 

Trish: The rude the problem is way bigger than someone knowing you actually signed that document. 

Oh, it's 

Nathan: notarized, dammit. We have to let them watch for four hours. Come on. And the next thing, and we might have to wrap up with this one because I have to go to an appointment, but you had asked before, Trish, what is the best way what can we do about this big problem? And I've said this time and time again, and some people really think it's, a privileged thing to say, but if you can get yourself as healthy as possible, Before pregnancy, at least 6 to 12 months before, and then you have the pregnancy, the likelihood of something [00:46:00] bad happening that's going to require you to lean on an OB GYN or some sort of hospital facility is going to be way below the average. 

Meaning that if you actually do need the hospital, thank God it's there, but you may even feel like less compelled by your providers to do the inductions, to do the, to the NSTs, to do the growth ultrasounds, to do all the stuff, the vaccines, the hepatitis B, the whatever, if you are as healthy as you possibly can be. 

And taking birth out of the conversation, because still 98 plus percent of women are giving birth in the hospitals. That's just going to be a statistic we have to deal with while I am not telling everybody to go out and have a home birth. What I am saying is that. When you end up in the hospital, these doctors and labor and delivery nurses have a very low threshold to intervene. 

And that's going to be things that appear on your blood pressures. It's going to appear in your blood work and your urine, [00:47:00] like all these measurable things we've talked about. And if you are as healthy as possible organically, like your organs work well before you get pregnant, you're moving well. You don't require an epidural perhaps because you've done a lot of hip opening and you've done a lot of breath work and a lot of, Mindset work and whatever. 

I'm not, never going to have a baby. So I can't say I'm an expert in childbirth even, but if you can make yourself as healthy as possible, even take childbirth out of it, the hospital system is going to have to change in order to keep up a market for their services. And they're relying on you to not stay healthy. 

So of course, this is not going to be, it's not possible for every person to go to Whole Foods to get all of their groceries or to buy a CrossFit membership or whatever. That's not even my point. My point is, is that if you have resources. And you want to invest it in your health for the long term, in the health of your baby, do your very best to take care of yourself and make yourself so healthy that the system at large is obsolete. 

That is the most disruptive [00:48:00] thing we can do. It's not Instagram viral posts. It's not podcasting like you and me. It's not birth programs. It's actually taking care of yourself and finding a good guide like you, Trish, to help people really appreciate that you don't need to be afraid of hospitals. You are the one in charge. 

You are the consumer. And if you are a sick person, there is a sick person specialist. Keeper. Yeah. Yeah. If you're a healthy person, you have options and you don't necessarily need to accept all of these protocolized ways of doing things, especially in childbirth, because you are not average. You are way above average and your risks are way below average. 

Trish: Yeah. I love that so much. It's funny because even I, I get questioned about talk about tearing and they people want this big complicate. I'm like, eat healthy, stay hydrated, work on your pelvic floor. Yeah. Yeah. Thank you so much for coming today. Can, I know you've got to go to your appointment, but can you share with everyone where they can find you? 

Nathan: Yeah, the best ways would be Beloved Holistics. [00:49:00] com, which is where you can find my podcast. I've got some offerings there and people can consult with me. It's on a donation basis. If they need to consult with me about anything they can find all of that there. And then of course, Instagram is probably where I'm most active on the social media side. 

That's Nathan Riley of EGYN. So thank you again for having me, Trish. It's a real honor. 

Trish: Thank you. 

Hey, mamas. I hope you enjoyed this episode. Wow. This was a really powerful and validating, so you guys know that what I've been telling you is so important. It's so true. We've got to change the birth culture. We just have to. We don't have a choice. We have to do it for you. We have to do it for your daughters. 

This is so important. Okay, you guys, make sure you leave a review. I want to hear what you guys thought about this episode and leave ideas for future podcast episodes. And as always, I will see you again next Friday. Bye for now. [00:50:00] Bye.