Content warning: Obstetric violence/birth trauma is discussed in this post.
Spoiler alert: There are Fleishman spoilers in this post.

In December, a respected friend/colleague tagged me on a social post and asked me if I’d been watching FX Hulu’s Fleishman Is in Trouble, saying it should be required watching for birth professionals. While on holiday break visiting family in Texas, I immediately decided to watch. It quickly drew me in and proved to be some deeply compelling and complicated storytelling about triple-crisis intersection: midlife, mental health & relationship.

Before I get into the details of analyzing the birth elements of this show, I fully acknowledge that I generally encourage pregnant folks to seek out the more positive, empowering birth stories in preparation for giving birth. This is because scary ones generally don’t lead to a sense of calm but instead increase anxiety for many. It’s true that, because of the huge mind-body connection, it’s important to feel as relaxed as possible in labor strategically because of the physiology of the birthing process. So if you know me and my work, you might feel like this writing is out of character, out of left field. However, because this is a popular show and because you might have already watched the birth-related episodes, I felt compelled to write about it and help anyone here who’s watching navigate how realistic (or not) this show might be in its portrayal of birth in NYC hospitals. If you’re pregnant, you may or may not want to read all of this; you can always skip past the scary stuff and to the more constructive pieces toward the end.

Let me cut to the birth-related point: Episodes 3 and 7 are must-watch episodes for anyone who’s thinking about becoming pregnant, trying to become pregnant, loves someone who is pregnant, or is in the general biosphere of someone expecting a baby. (Note I left off anyone who IS pregnant as, once again, I very much hesitate to increase anxiety/stress for those currently pregnant! I’ll leave it to you to decide.) Including birth workers. Though for experienced birth workers, it’s preaching to the choir; we just think it’s important how show reveals the unfortunate-but-true way too many birthing people are (mal-)treated. (I should add that you’ll more fully appreciate the episodes if you watch the entire series.)

Let’s parse this out. Below is a transcript of the two segments with my commentary in italics (labeled with my name, Lisa). If you’re able to actually watch these show segments, if you haven’t already, it will be easier to follow and appreciate the commentary. If you haven’t watched, the series centers around the end of Toby’s and Rachel’s marriage and Rachel’s subsequent disappearance/abandonment of their two older kids. Toby is a doctor at the hospital where the below flashbacks occur and where Rachel is giving birth to their first baby in these scenes.

Again, if you’re not interested in getting into all the nitty gritty weeds with me, feel like it might be too anxiety-producing, or you don’t want spoilers: skip down past the script & commentary (search for “Strategies for You”), where toward the end I’ll go over some strategies to get respectful, customized, family-centered care and avoid feeling deeply violated as is demonstrated in this all-too-true-to-reality story.

Episode 3 - Toby’s perspective (26:16-32:49)

Narrator: Five months later, Rachel was admitted to the hospital with high blood pressure. She was given Pitocin for an induction, but 14 hours in, she hadn't progressed beyond two centimeters.

Toby: Just try to picture dilation, okay? Open waters. Open fields. Sunrise.

Rachel: Shut up. Please, just shut up. Uh, who is he? Who... Sorry, who are you? Who are you?

Dr. Romalino: I'm Dr. Romalino.

Lisa’s thought: Already off to not a great start. He should have used her name, not only told her his, shown some kind of interest in her as a human.

Toby: Sorry, where's... Where's Dr. Goldberg?

Dr. Romalino: Dr. Goldberg is in Hawaii for the week.

Rachel: No. No. I-I want my regular doctor.

Toby: Yeah, it's okay. Hi, I'm Dr. Fleishman. I'm a... I'm a resident up on gastro.

Dr. Romalino: Nice to meet you. I'm who you got.

Lisa’s response: Really, doc? You’re already treating her like a child and showing no empathy. “I’m who you got.” A little kindness, please? At the very least, acknowledge her disappointment. Let her know you’ve heard her and you care — especially when you’re about to be all up in her stuff in her most vulnerable state. Yes, it’s an unfortunate truth that if this labor is already in progress and her doctor is in Hawaii, she won’t be able to have her doctor as she’s requesting. But that doesn’t mean she should be treated this way.

Dr. Romalino: Can I see her chart?

Rachel: Do you have absolutely no pull here? You work here. [to her husband, Toby] ( knock on door )

Toby’s residents: We heard you were here. ( quietly )

Rachel: Away. (Rachel mouths the word to Toby to get them to leave.)

Toby: Yeah. Yeah. Sure. Hey. Guys, hi. Thank you so much for coming. Um, yeah, here. Come over here. This is not exactly the laugh riot that they promised us.

Resident 2: This is how it goes. You remember the OB, with the, uh...

Resident 1: Husband who was the dancer?

Toby: Oh, yes. Uh, "and all that jazz." Listen... I gotta go, but hey, listen, really, thank you so much for this.

Resident 1: Good luck. Thank you.

Resident 1: Bye.

Rachel: (breathing heavily, in a panic) Get him away from me! (doctor raises both hands up by his head and backs away from her)

Lisa’s thoughts: We later learned that the OB artificially ruptured her membranes without consent (I’ll add a theory to this when told from Rachel’s perspective). I wish I could say this doesn’t actually happen in real life, and yet it absolutely happens ALL the time. Either that or the provider brisquely says, “I’m going to break your water(s),” immediately before or as they’re doing it. Neither approach is abiding by the legal requirement of getting the patient’s informed consent, and yet it happens routinely in NYC (and I’m sure plenty of other U.S.) hospitals.

Toby: What... What... What happened?

Rachel: He did something! Get him out!

Dr. Romalino: Okay, I think we might need to get psych in here.

Toby: What... What did you do? What happened?

Dr. Romalino: Are you planning on being a baby, or delivering a baby? (he says, standing over her bed and looking down)

Lisa’s thoughts: This line provokes me to turn into a swearing sailor. It is NEVER okay to treat a birthing woman/person like a child, and yet it’s another way of wielding power that we see happen constantly with many providers both in labor and in pregnancy, too — often more subtle ways, but sometimes not. (Sidenote - I found it surprising that this wasn’t included in Rachel’s perspective but was from Toby’s.)

Toby: Hold on a minute. That's not how you talk to a patient.

Rachel: What? A patient? What...

Narrator: Toby later found out what had happened. The doctor had intentionally ruptured her membrane / broken her water without her consent. Anyone could have predicted the rest. (Cut to the OR where Rachel has just had a cesarean birth)

( baby fusses )

Toby: Okay. Thank you. Okay. Is it okay? The head. Yes, of course. Yeah. Thank you so much. Hi, honey.

Narrator: He understood then that this wasn't just a bad delivery. She was hurt. That night, he wanted to kill the doctor for what he'd done to Rachel, but someone had to watch the baby.

Nurse: You should hold her.

Rachel: How can I hold the baby when I can't feel my legs? (Nurse looks at Toby, who comes to take baby and bring her to Rachel)

Toby: You really should hold her now.

Rachel: Okay. Give her to me. Okay.

Toby: Okay. (Toby hands her the baby; Rachel looks disengaged and almost anxious while holding baby.) (Cut to their living room.)

Narrator: Toby waited for things to get back to normal. His family visited, excited to meet the new baby, but Rachel felt compelled to tell each visitor about the birth.

Rachel: Well, our usual doctor was in Hawaii, of course. And so, I'm propped there, I'm writhing in pain, when this guy... He takes his hands and he tells me he's only gonna examine me, but the minute Toby leaves the room, he starts to examine me, but he's not... He's not really examining me. Like, he's doing something. Like, it... Like, it hurts, you know?

Visitor: Don’t tell me he was removing the membrane.

Lisa’s comment: The correct term would either be stripping/sweeping or rupturing, depending on what she meant. In the 2nd version, it seemed to hurt a lot more than just rupturing hurts for most people, so it seemed to me like he was likely trying to manually thin the cervix or sweeping the membranes to “help” labor progress.

Rachel: Yes! And then he broke my water. Not... Not a word to me. Nothing. Terrible.

Visitor: That's terrible.

Rachel: No, it was. It was terrible. And then, while his hands were up inside me, I kicked the doctor, and he went flying across the room to the wall.

Narrator: It wasn't true. Toby wanted to ask her why she said it, but she seemed too delicate. She was wearing the same pair of sweatpants since she'd gotten home, so he let it be.

(Cut to park, where Toby is handing a cup of coffee to Rachel, who’s sitting in Central Park on a bench next to cooing baby in a stroller)

Toby: Here you go. Hi, honey. Mm! God, what a nice thing to see you two in the middle of the day.

(Rachel looks over to another bench and sees 3 moms with their strollers and babies)

Rachel: They were in my prenatal yoga.

Toby: You want to go over?

Rachel: Where'd they learn to play with their babies like that? They didn't teach us that in the class.

Narrator: Something was very wrong.

(cut to pediatrician visit)( baby fussing )

Rachel: She's not smiling yet, and the... The book said that at six weeks...

Pediatrician: Well, smiling's an imitative behavior. So, you have to be smiled at in order to smile back. Are you smiling at her?

Toby: Yeah. Yeah. ( muffled sob )

Pediatrician: Have you talked to someone?

Toby: Yeah, I know. I keep telling her.

Pediatrician: You have to take care of yourself here, Rachel. It's like they say on the airplane... In an emergency, you secure your own oxygen mask before you secure the children's. You can't help them if you can't breathe yourself.

(cut to waiting room)

Toby: Hey.

Rachel: ( sobbing ) I ruined her.

Toby: No. Stop that. Stop that. Don't... Honey, don't say that. Seriously. This is normal. Like, a lot of mothers go through this. (Looks over to a bulletin board that has a couple of support group signs, including a pregnancy & postpartum as well as a survivor support group) You know, you a... You actually should go.

Rachel: You know how I feel about therapy.

Toby: I do know. Rachel, that is like... It's so archaic, honey.

Rachel: It's for rich people...

Both: …who don't even realize they don't have problems.

Toby: Yes, I know. I know. But you... can you just try it?

Rachel: God. Fine. Fine. I'll go, okay? God, you're like the Gestapo.

Toby: No, I'm... I'm not. That's not really how the Gestapo worked, honey.

Narrator: He knew what was happening to her wasn't in her control, and he didn't blame her. But she was really missing out.

Toby: (rocking baby in a stroller in his office at the hospital) Shh, shh, shh, shh, shh. Shh, shh, shh. (Rachel comes in.) Hey. How was it?

Rachel: Fine. I don't love sharing in groups, but yeah, it was fine. Whatever. ( sighs ) No, I-I'm not talking about it. If you're gonna make me go there and talk about it and then I have to talk to you about talking about it, you can kill me now.

Toby: Hm. Okay. Well, I'm just... happy to hear it worked. You can go again Thursday.

Lisa: As if that wasn’t bad enough, that was only from Toby’s perspective. Then in episode 7, we see and hear it from Rachel’s perspective.

Episode 7 “Me-Time” - Rachel’s Perspective (12:30-25:48)

Narrator: It was true. She was great. ( Rachel sighs ) And then she wasn't.

Lisa’s thought: Before we even launch into Rachel’s perspective of the events surrounding her first baby’s birth: the narrator might have a blindspot here when she says this, or maybe she’s just repeating what Rachel told her. However, it was just revealed that Rachel carries the weight of grief of having lost her own single mother at a young age. A wave of grief seems to come over Rachel when Toby’s mother tells her it’s sad and too young to lose your mother. She goes to the restroom, sheds some tears, then Toby asks her if she’s okay and she says she’s great. This scene happens just before the birthing segment, just after sharing this part of her history with her (at the time, future) in-laws. Our relationship with our parents, stress or strife or loss, can play a profound part in our mental health and emotions going through the metamorphosis into parenthood. While she might have been “great” in some ways, she still carried this deep burden of loss with her for years and into parenthood.

Nurse: I don't know. If you're not progressing, if it were me, I'd talk to the doctor about pulling the plug on this induction. Right?

Toby: No, I think we should take a second and... And catch our breath, okay?

Nurse: Tell him you'll stay in the hospital. Just tell him you'll do what he says. (Knock on door)

Lisa’s comment: It also sounds like perhaps Rachel had said she wanted to go home but they convinced her to stay. The nurse seems to be trying to warn her that this doctor wields power if you don’t “play nice” (like we women are trained from birth to do, sadly).

(Two of Toby’s residents come to the door with gift-candy and balloons)

Resident 2: Hello in there!

Resident 1: We heard you were here!

Rachel: Get them away.

Toby: Yeah. Hi, guys. Hey. Come with me. Yeah.

(Toby leaves room and OB comes in)

Rachel: Um, did you hear from Dr. Goldberg?

Doctor: I told you. I'm covering. I've done this at least five or six times before.

Lisa’s comment: She has every right to request the covering doctor be in communication with her own doctor who knows her, her medical history and her preferences much better than this doctor. If that wasn’t possible, then he should have more compassionately explained why it wasn’t possible. “I told you” is curt and condescending, once again. In his next statement, he seems to (maybe?) be trying to make a joke, and sometimes levity can be helpful. However, it seems to me what he’s really saying is, “I’m the authority and you’re the child,” given the way he led with, “I told you.”

Rachel: Okay. I... Um... ( clears throat, looks to the door nervously ) My husband is... Is, um, gonna, um... D-Do you think that maybe we should stop the induction? Because my... My blood pressure is... is lower now, I'm not progressing, I'm exhausted from the Stadol. Um, it made me hallucinate all night last night. I didn't want the epidural yet.

Lisa’s comment: This is written so interestingly. What I find intriguing is that it almost seems to me as if Rachel interprets what the nurse said differently from how I’m almost sure it was intended. When a hospital worker says, “pull the plug on the induction” they usually mean giving up on it and moving to cesarean. It sounds like Rachel’s instead asking the doctor to stop the induction and pain meds to see if her body might take over and progress labor on its own or maybe she might get a break for a bit. She also points out the fact that she hadn’t wanted the epidural yet (perhaps she felt coerced into this, which is also common) and hated the side effects of the narcotic pain med Stadol she’d been given, too. But it’s unclear to me if she’s communicating she simply wants a break from everything, a pause (I’d say it’s that’s definitely it if she hadn’t said, “I’m not progressing”), or if she’s requesting a cesarean. Either way, she doesn’t feel heard because he does neither and then does an unconsented (illegal, harmful) vaginal exam.

Doctor: Let's just see what's going on in there, and then, if you're still not progressing, we'll talk. ( Monitor beeping, starts vaginal/pelvic exam )

Rachel: Ow! ( Gasps ) Ow! Ow! Ow! I-I-Is this... Is this just supposed to be a... Ow! This is not an exam.

Doctor: There is some leakage here.

Rachel: Ow! Ow!

Doctor: Get me the hook.

Rachel: What is he doing?! What are you doing?! ( Gasping ) Ow! Ow! Fսck! What the fսck are you doing to me?! Stop it!

Toby: Hey, hey, hey! What the hell is going on in here?!

Rachel: ( sobbing ) Stop it!

Lisa’s comments: So what should have gone differently here? The doctor was under a legal and ethical obligation to go over the potential risks and benefits of what he thought should be done. He should have given her time to think about it or to discuss it with her husband if she wanted. It should have been her choice to provide her informed consent or informed refusal…or he could have shown a little creativity and sensitivity in discussing various options of courses of action (or inaction) for her to consider. It was never, ever his place to decide for her and especially not his place to put his fingers up her vagina without even asking or explaining what he was going to do before doing it. Serious, irreparable harm was done. There’s no way her labor could progress after this violence was done to her.

( sobbing fades; cut to OR )

Doctor: Scalpel.

Narrator: There she was, paralyzed... Literally paralyzed... Splayed out like she'd been crucified. Everything in her told her to get up and run, to make a break for it. But she couldn't. Any power she ever thought she had was suddenly gone.

Toby: You're doing great, honey, okay? ( indistinct conversations echoing; she slowly looks around, keeps looking at the clock, closes her eyes )

Toby: You're almost there.

(Baby cries as camera slowly pans up and out in a circular direction over Rachel to the point that, ultimately, she’s viewed upside-down pose with her arms spread out, a visual demonstration of the narrated crucifixion/martyr description.)

Toby: Oh, my God! It's... It's a girl! Rachel! Rachel, it's a girl!

Narrator: It was the worst day of her life. ( Baby coos )

(cut to postpartum hospital room)

Toby: I think you should hold the baby.

Rachel: I still can't feel my legs. It's not safe. What if I have to run?

Lisa’s comment: She is clearly in fight or flight mode, a deeply unfortunate state to be in when one has just become a mother/parent.

Rachel: Okay. Give her to me.

Toby: You want to go to Mommy now? Okay. Okay, honey. Okay. Your mommy.

Narrator: Rachel looked down and knew that the baby knew what she was thinking. ( Baby coos ) She knew... and would never forgive her.

(cut to Rachel in a wheelchair with a nurse pushing her through the hallway being discharged, with Toby to her side walking and carrying gifts, balloons, and a duffle bag)

Narrator: This was Rachel's introduction to motherhood. ( man on P.A. speaking indistinctly )

[omitted scenes: Toby encourages Rachel to go to therapy but she’s unwilling, then she reaches out to a mom group and ends up feeling rejected]

(cut to pediatrician office waiting room)

Rachel: I ruined her.

Toby: No, no. Don't say that. This is normal. A lot of mothers go through this, honey.

(Rachel & Toby look over at the bulletin board and she see the survivor support group sign. She goes to the survivor group.)

Survivor group leader: Please, come in. Welcome, dear. ( Indistinct conversations )

Participant: I kept trying to explain it to my mother, but I couldn't.

Narrator: She knew she hadn't been raped, but when she saw that sign, she knew that inside that room would be people who understood what she'd been through...Far more than the people in a postpartum depression support group would.

Leader: Would you like to share anything with the group? ( Rachel breathes sharply…Stifled sob…Breathes sharply…Sobs uncontrollably; the group forms a circle around her and lay on hands of comfort )

(cut to Rachel coming into Toby’s office where he’s been caring for baby)

Toby: Hey. How was it?

Rachel: It was fine. It was good.

Toby: You wanna talk about it?

Rachel: Cannot do any more talking.

Toby: Now, there's my wife. (chuckles)

Narrator: For a while, the world seemed to have some light in it again.

(cut to Rachel getting on an elevator at the hospital)

Rachel: But then, one day, on the way to her group... ( button clicks, the OB who assaulted her gets on the elevator and it’s just the two of them ) ( Rachel breathing sharply ) She had four floors to say to him, "Look what you did. Look what you did to a perfectly good person!" ( Elevator bell dings ) But she didn't say anything. What was it that he'd seen in her that would make him think that she would tolerate that?! (Beep) How had he looked at her... at Rachel... And thought, "Now, there's someone I can victimize"? (Doors open, elevator bell dings, beep) She wasn't a victim! (Thud) She was Rachel f***ing Fleishman!

[Lisa’s endnote: In response to that moment of crisis in the elevator seeing the OB, Rachel never goes back to any support group or therapy. Instead, she throws herself entirely into her work and she grows harsher and harder until her relationships and entire world falls apart and she experiences a profound mental health crisis 12 years later.]

******end transcript******

Good for Rachel for knowing instinctively the survivor group was for her. (I do want to point out, though, that a postpartum support group is often full of folks who’ve experienced birth trauma and feel they are survivors, too. Rachel just had no way of knowing that, seeing as how she was a first-time mom.)

Whew. Tough stuff. Consider taking a few deep breaths and/or stretch or shake it out for a moment if reading this amped up your nervous system.

How on earth can obstetric violence actually happen IRL?

We doulas/birth workers know, and too many of our clients know, too, that the obstetric violence that’s portrayed in these two episodes of this series is real. We know it happens all too frequently. We’re constantly trying to figure out how to help our clients navigate away from certain obstetricians and/or midwives who we’ve seen time and time again do things to their clients without the process of informed consent and dignified care. (Did you know that informed consent has been a legal requirement for over 100 years in the U.S.? I talk about this legal concept toward the end of Episode 84 of the BIRTH MATTERS podcast as well as specific self-advocacy strategies.)

The U.S. ranks at the bottom of the developed nations in terms of maternity mortality, and the rates are 3-4x worse for Black birth givers, as well as worse for Brown and indigenous birthing people. What gets less press (I suspect because it’s local and not national) is that the rates of maternal mortality are ~9x worse for those who are Black and birthing in NYC.

As you read that last paragraph and if you’re white and/or have a good deal of privilege, please know these concerns absolutely also apply to you. Please don’t assume you get a free pass to a great birth — too many people I’ve worked with hire a less-than-ideal provider and stick with them and seem to unconsciously rationalize, “I’ll be the exception,” and then regret it later. (Of course, in a hospital setting the choice of provider isn’t always within our control for the actual big day, as was the case for Rachel Fleishman.)

A major reason for these terrible outcomes is that our hospital system (aka Medical Industrial Complex or “MIC”) lacks customized, patient-centered care. Instead, the system is set up to default to routine care that treats everyone as if they’ve had a high-risk, complicated pregnancy, which is not the vast majority of birthgivers. Even for those who have complicated pregnancies, individualized care is still best. Patient-centered care means listening to, trusting, and honoring someone’s intuition and preferences. Giving them a sense of bodily autonomy, agency, & dignity. This kind of care is shown to lead to better physical as well as mental health outcomes.

How on earth can this lack of consent & obstetric violence happen in real life, you might wonder? It’s complicated and multi-layered. Here are just a few thoughts:

Power dynamics. Many doctors report having felt entirely powerless in medical school and residency, so there can be an understandably human, psychological, yet highly unfortunate tendency to overcompensate and wield power over others once they’re practicing — even if they don’t admit or realize it consciously. This is reinforced by our “doctor knows best” highly patriarchal, paternalistic medical system (Medical Industrial Complex or MIC)…which leads me to the next point:
Misogyny & Racism. The MIC was designed by and for men and has a history of putting women/female bodies last. This is highly evident in medical literature, diagrams, standards and studies. In the U.S., women’s bodies and Black bodies have historically been perceived as objects for the taking and doing with as one likes, including a dark history of experimentation on Black bodies. Even when an OB identifies as female, they still went through a highly paternalistic, patriarchal, colonized medical training that can’t help, at least to some degree, indoctrinating them with this kind of thinking and approach to care.
Overmedicalization of Birth. (aka Misogyny, part 2) Did you know that most obstetricians & RNs never once witness a physiologic, unmedicated, non-medically-managed birth across their time in medical/nursing school or residency (and often beyond)? Research shows that overmedicalizing birth (aka using interventions routinely/unnecessarily) significantly worsens outcomes. We need to trust the birthing person, their bodily autonomy, wisdom, and intuition more.
Impatience. The desire for efficiency (as well as even need due to unfortunate aspects of our healthcare system) & the sense of “this is just the way we do things”…aka routine care. This also partly stems from a lack of healthy work-life balance in the medical field so they’re often exhausted and burned out. (Providing patient-centered care does take a bit of extra energy and time.) We need to examine our entire U.S. healthcare system and address the often underresourced, overcrowded hospitals the system creates that both contribute to this burnout and necessitate an assembly-line approach that prevents staff from being able to provide compassionate, individualized care.
Trauma. Doctors and nurses also experience all too much trauma across their career that can cause them to have compassion fatigue, and again, patient-centered care requires extra patience and energy.

Strategies for you to have the kind of birth experience you want to sing about from the mountaintops

Educate yourself (early!)
- One excellent starting point is an Evidence Based Birth Savvy Birth 101 workshop (if we’re not offering one soon, you may also find other folks teaching it here), which only takes an hour of your time. This helps folks earlier on in the process of trying to conceive or earlier in pregnancy to start thinking through choices that need to be made early on like your care provider and birth setting, and how to receive family-centered care.
- A couple of books I recommend to help you navigate this: 1) Your Birth Plan* and 2) Your Medical Mind* (not directly pregnancy-related, but still could be useful) — here’s my full book recommendation list* for the perinatal journey
- A more comprehensive birth class taken in 2nd or 3rd trimester should include specific self-advocacy strategies for anyone birthing in a hospital environment where those might be useful or necessary.
Hire a doula to have a patient advocate & witness, someone who can also help provide you with anticipatory guidance so that you can stay calm and prepare for things that might come up and have more time to strategize. (However, PSA from my fellow doulas and I: please understand that your doula cannot fully protect you from a not-great provider. We have the least power in the birthing room. Too many birthing people think that their doula is somehow protection against a harmful provider. We can often help, yes, but we certainly cannot wave a magic wand and make everything go blissfully if there’s a provider who regularly causes harm and who has the most power in the room.)
Choose out-of-hospital care (a freestanding birthing center or homebirth, if this feels like a good fit for you and if available where you live), which is ideal for those hoping for an unmedicated, physiologic birth and who have uncomplicated pregnancies. If you prefer the hospital setting, consider hiring a hospital midwife, if available where you live.

Now, I don’t want to be a reductionist here and give the impression that doing the above things is any kind of guarantee. Of course it’s no guarante, BUT it certainly bodes well for you to feel heard and respected (rather than unheard and even violated) and therefore have that much more positive of an experience because you’ve been all the more mindful and strategic in your decisions.

Finally, I’d like to leave you with these thoughts from respected maternal/reproductive justice advocate and Harvard-educated OB, Dr. Neel Shah (shared in an interview on this Sakara Life podcast, ep. 52, Oct 2021):

“I was trained in a big academic medical system where you have a really sharp focus on safety. What that means and the way you start to think about that is that peoples’ experience is a secondary luxury that you get to after you’ve secured them. And I think that a lot of people have adopted that. Nobody would give birth under fluorescent light in a johnny [i.e. hospital gown] tethered to a bunch of wires unless they thought that was safer somehow.

One of the things we’re starting to learn increasingly with the maternal mortality crisis in our country where there are these really stark racial inequities is that it’s not about customer satisfaction; it’s about dignity. That’s the right word for it. And that actually attending to people’s lived and embodied experiences is the way that you make them safe…we hear that over and over in the stories of Black women in particular. But really anybody who’s giving birth and it doesn’t turn out the way they want to. Where they express concerns or expectations that just aren’t attended to in a timely way or at all.

I think part of the challenge is that there’s something very black & white about mortality or an injury in childbirth. But the whole system is really tuned to this idea that the goal is to survive childbirth. That’s like the floor of what people deserve. We haven’t really defined well the ceiling, but that’s what we should be aiming for, is an empowering experience…Customer satisfaction could be a luxury, but dignity is a human right.

Maternal health is a bellwether for the health of society as a whole. If moms are unwell, society is unwell. And what you start to see is that almost every type of social injustice shows up in the outcomes of moms across the country, whether it’s racism, gender inequity, geographic inequity (when we look at the plight of rural Americans), even generational inequity shows up in this whole enterprise of starting and building your family.

Every system is perfectly designed to get the results that it gets. So if we have a system that’s producing inequities in maternal mortality, really high c-section rates, all the statistics that keep showing up in the headlines, it’s designed to do that. So the thinking about how to address it means [to] fundamentally redesign. The other thing that I strongly believe is that a bad system will beat a good person every time.”

Resources

Take action:

Share your story of obstetric violence with Birth Monopoly, who’s compiling a geography-based resource (for birthing families OR birth workers)
Irth app - a space for Black & brown folks to share reviews of prenatal, birthing, postpartum and pediatric providers

Birth in Rape Culture (Birth Monopoly)

What Is Obstetric Violence? / Obstetric Violence map / Have You Experienced Obstetric Violence?: Share Your Story (for birthgivers OR birth workers) (Birth Monopoly)

Birth Allowed Radio Podcasts:

The Future of Maternal Care (Oct 2021 interview with Dr. Neel Shah on the Sakara Life podcast ep 52)

Like a Mother (Angela Garbes)*

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Exposing the Silence project

Breaking the Silence campaign FB

Invisible wounds: obstetric violence in the United States (Farah Diaz-Tello, J.D.)

Father of Gynecology Who Experimented on Slaves No Longer on Pedestal in NYC (NPR)

Fleishman Is in Trouble Gets Painfully Real About Consent Violations in Pregnancy (Romper)

How Fleishman Is in Trouble Ditches the Cliches of the Female Midlife Crisis (New Yorker)

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