#70 Is Hospital Birth Really the Safest Option? with Dr. Riley

Sarah Lavonne:
Hi, I’m Sarah Lavonne, and I’m so glad you’re here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You as a nurse have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life, both in and outside of work, but don’t expect perfection over here.
We’re just here to have some conversations about anything, birth, work, and life, trying to add some happy to your hour, as we all grow together. By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses.
This episode has been on my hit list for, honestly, since we started, and we started talking about bringing on guests. I was like, “What kind of sexy guests can we bring on, that might be able to just help us think outside the box?”
As you know, here at Bundle Birth Nurses, we like to push the envelope in some ways, while also bringing so much grace and understanding, because we know the system, as well. That is one of the many reasons why I am so excited for this episode, and so excited to bring this expert to the table, and help pour into you as nurses, and as the bundle birth community.
Because today, we’re going to talk about something that, to me, is also very sexy, and that is home birth. And we’re going to bring Dr. Nathan Riley’s experience related to home birth, and the insights as an OB-GYN, to that world. He also has some other things, that I think are going to be really helpful and insightful for us, to just push the envelope a little bit more, and help open our brains to another way of thinking, because as we know, we’re all kind of trained in the same system, and part of what we do here is helping to de-condition our brains, and help to help us think outside of what we just know as normal.
So I am so excited to welcome Dr. Nathan Riley here for this episode. And I would love for you, Dr. Riley, to just give us an introduction, just give us a little bit of your background, assuming that we know nothing about you, so that they are like, “Whoa,” because I think your background, to me, is just so fascinating and super, outside the box.

Dr. Nathan Riley:
Yeah. Okay. Well, Sarah, it’s very, very nice to be here with you. Where do I start? I get asked to do these interviews a lot, and it seems like every time, every year that passes, it goes further and further back.
It’s like, “Why am I such a pesky thorn in the side of the institution?” I think like most doctors, you get good grades on tests and you’re the star student, and blah, blah, blah, as you were, I’m sure. And you get into a position where you look back, and you’re like, “Dang. I guess I kind of chose the wrong path through the woods.”
But most recently, I reconnected with a friend that I had met back on a program called Semester at Sea, when I was in college, and I was re-listening to a book called Confessions of an Economic Hitman. Now, I know that this sounds like a strange place to start, but I went into this Semester at Sea program, which, you’re basically on a ship sailing around the world for four months, and taking college classes, and you stop in various countries.
And you get to really appreciate the impact of this sort of Western ideals, on a variety of different world constructs. I read this book, and the book was all about this economist, whose name’s John Perkins. He goes into meetings with world leaders and convinces them to take big loans, for the purpose of progressing their infrastructure.
These countries become completely unable to pay off these loans, become indebted to the financiers of the World Bank, and the IMF, and then we can leverage some political power from them, and support for different policies … Hang on one second. We have a little visitor.
Yes, baby? Oh, you have a sticker for me? Can I come and get it in a minute? Oh, it’s for my fairy garden? Okay, well …

Sarah Lavonne:
Oh, my goodness. Hi, my love.

Dr. Nathan Riley:
So we have a little visitor here. This is Everly Rosa. She’s, how old are you, Evy?

Sarah Lavonne:
Hi, sweet girl.

Dr. Nathan Riley:
You’re two? Yes, you are.

Sarah Lavonne:
You’re two? I have a niece that’s two.

Dr. Nathan Riley:
Okay, I’ll be right back. Go get Mama, okay? I’ll be right, I’ll be I’m to see her, in a little bit.
All right. So, when I read this book, I realized, “Oh my gosh, the majority of poverty in the world, in our modern world, is caused by US-based policymaking.”
And when leaders didn’t agree to take on these debts, we would send in hitmen and jackals, like the military coups in South America. And this made me very angry. It made me almost averse to this American society as a whole.
So, if you take that little Nathan, and then you put him through medical school, and then, through OB-GYN residency, which I did out in LA near you, and at Kaiser, actually, and then through fellowship, and then, you put them in a big boy position as a doctor, that same little spirit of dissent, it’s not just dissent, it was almost, “I want to push back, and I’m going to hit harder, like you hit me.”
I felt deceived. I felt like my history education was inadequate. I felt like, “I don’t understand anything about the world.” And you then get thrust into a position, where you have an MD on your chest, and you’re expected to learn all of this stuff, and then apply it in a protocolized way, and you’re not seeing the good results. You start to feel like you’re deceived once more.
So we have an American institution, which we call healthcare, that is so focused on the acute comforts of individuals, that we forget about the actual benefit of growth through challenge. And there’s no better allegory for that, than the childbirth experience.
To summarize all of that, I just wasn’t super happy with the highly-interventive, highly-protocolized, hierarchical way that we were taking care of a rite of passage, which is as important in birth as it is in death, as a means of just becoming a little bit more comfortable, in the short end, in the short term, potentially, at the cost of long term detriment to families. I was not comfortable with continuing to do that, and perpetuating this narrative that childbirth is a medical procedure, and pregnancy is a disease, just beckoning pharmaceuticals and surgery at every turn. And so, I became a home birth doctor, which makes me a heretic as an OB-GYN.
But I also don’t really like birth control, and I also don’t really cervical leaps. And I also don’t really like any of the other things I learned to do, which left me in a very, very strange situation, where you can’t work in the system you were nurtured to work in.
And so, you have to start reformulating, “How am I going to change the world? And I think we start with birth.” So that’s who I am.

Sarah Lavonne:
Talk about someone that goes outside of the norm, and what an incredible example to us of, probably an extreme, let’s be clear, because I think a lot of the bundle birth nurses in this community relate to that frustration with the system. And then, also the, “What do I do, and where do I start? And how do I push back, while also having a job, and paying my bills, and also maintaining my love for birth?” And it sounds like that was your resolve.

Dr. Nathan Riley:
So in love with it, and not in love with the way it was being treated.

Sarah Lavonne:
What have you learned from, what was your journey going from the medicalized model, to supporting home births? And especially, I mean, maybe from the jump, your brain was in a different place of being more frustrated with it, and pushing back, and being more critical with what you were learning? I think, I don’t know that everybody that’s listening has that same perspective.
And I know, for me, my journey was very much like, “Okay, okay, okay.” And I didn’t grow up here. I moved here when I was 18. I was in South America prior to that. My story’s a little weird with that, but I was just like, “Okay, I’m learning and yes, and I need to know, and I need to get good grades.”
And it was on this conveyor belt, and it took me getting into practice and going, “Ugh, wait a second, wait a second,” and having various experience that just didn’t sit right in my body, but I also had to learn how to pay attention to my body, and what’s actually going on.
And so, for somebody that’s sort of in that in between, do you have any advice for us, in that in-between? How have you maintained your love for birth, and made some of those changes, while maintaining your integrity? And also, you didn’t leave the system.

Dr. Nathan Riley:
Yeah, yeah.

Sarah Lavonne:
You’re still very much part of it.

Dr. Nathan Riley:
The story that comes to mind is a story I’ve told before, but it’s a very simple one, and it goes directly back to the maternity unit. And bear in mind, OB-GYNs are not just birth doctors. 70% of our training is in gynecology, which is the hysterectomies, the euphorectomies, the clinical stuff.
And then, we spend about 30% of our time, give or take, on the maternity unit, attending births, doing C-sections, doing operative deliveries, all of that, arguing with the nurse around the Pitocin infusion rate, all the stuff that everybody listening already knows.
But the cervical exam is a really, really good way to relate to this story. And I remember, I was a second year resident, maybe, and you have residents, you probably worked with residents when you were in the hospital system.
There was a way of helping to support, that was the language that was used, “We need to make sure the labor is going this direction, and it’s going towards a birth. And of course, if we find any reason why we can’t seem to get the baby out vaginally, we have to go to C-section.” One of those things was the cervical exam.
What I found was, I was expected to wake up every four hours, or just leave the little lounge area, and go and do an exam, because the nurse wasn’t supposed to do that.
You guys, of course, know how to do that, but the doctor needed to do it, so it was in the chart. So we made sure that we were really, really on top of this. And there was one time when I was so utterly exhausted, that I wasn’t even going to wake up from the page.
The nurse pages me, I’m supposed to answer the pager, and go out and check, put my hand where it doesn’t belong. And I was so tired, that I didn’t even think I was going to wake up to the pager.
I put it, actually, on my crotch, because the vibration from the, I’ve put it on Vibrate, and Sound, and I figured that might help. It didn’t wake me up, so I put it on my neck. So somebody comes and knocks on the door, right?
So I put it on my neck next time, and it actually vibrated my vocal cords awake. I’d rush out, and they were like, “Oh, we need to do an exam.” It wasn’t necessarily the nurse, actually, and I’ll get to that, but it was probably one of my superiors, the senior resident or whatever, “What are you doing?” Or one of the attendings.
And I found, I’m being woken up from much-needed, just an hour of rest, and I might have to jump in to do a really, really horrific surgery. So let me just get a little bit of rest. Instead, I’m waking up, I’m going into a room that’s dark, and the couple’s sleeping, the dad’s sleeping on the little bed there.
And the mom’s on this weird mechanical bed, and she’s finally getting some rest, with a peanut ball between her legs. And I’m going to undrape her. She maybe hasn’t even met me before.
And I have a moment to say, “Hey, I’m Dr. Riley. Hey, I’m going to do a little exam. Is that okay?” And before I even get a yes, I’m already pulling the drapes back, I’m already opening the legs.
And they’re like, “Okay, you’re going to do what you have to do.” Maybe they have an epidural, maybe, for God’s sake, they have an epidural, because they don’t have to experience a stranger putting their hand inside of their vagina, which was probably only penetrated, prior to that, by their partner’s genitals.
They have to get situated, and they close their eyes, and they’re kind of bracing for it, and there’s a lot of pressure, and they kind of wince, and their shoulders come up, and they kind of creep up the bed a little bit. “Oh, okay, it’s still four centimeters. All right, well, we’ll check again in four hours.”
And I go and I chart it, and I go and try to get some rest, but then, by then, there’s another exam that has to be done. So this pattern, I realized, was upsetting to the nurses.
It was upsetting to my clients, I say clients, because you’re not sick. You’re not a patient, just by virtue of being pregnant, which took time to change that language.
And I decided on my next shift, I remember this so clearly, “I’m not going to do cervical exams on this shift, and I’m just going to wait and see what happens. And as long as that tracing looks okay, which is not super, it’s not validated at all, anyways.”
But I know you’ve talked a lot about this on your podcast, but it’s the best we have. If the tracing looks fine, and she’s comfortable, then I’m just going to keep my hands free. At first, I got a lot of pushback, and I continued to get pushback. So I started carrying papers around in this big briefcase silken thing, to justify not intervening, data from outside of the United States.
And what I found was, I was getting a higher vaginal birth rate. I was doing less vacuums, I was doing less C-sections. I was doing less Pitocin. We were just being more patient.
The problem was that when you do that sign out at 7:00 a.m., the oncoming team is like, “Well, what was her last exam?” “I don’t know. I didn’t check her”. Uh-oh, go to the principal’s office, get called on. The problem for the administration, I think, in any hospital, is that my outcomes were really, really good.
A potential problem for me as a resident was, I wasn’t getting enough C-sections, and you still do so many C-sections, you don’t have to worry about those numbers, but it was like, “Hey, I went three shifts without doing a C-section.” That became my own metric. And so, the reason I’m telling this story is, even something as dogmatic as checking the cervix can be questioned.
And if somebody says, “That’s how we do it,” well, how did whoever told you, that that’s how we have to do it? When this protocol was made, how did you come to that conclusion? Because if somebody says it improves outcomes, they’re wrong. If somebody says it’s better for the patient, they’re wrong. Somebody says it’s easier for the staff, they’re wrong.
They might say, “Well, you might find a cord.” What’s the chance of finding a cord prolapse? I’ve had maybe two, which is a true emergency.

Sarah Lavonne:
Right.

Dr. Nathan Riley:
But we would see something on the monitor that would tell us, “Oh my gosh, we have to act.” So I’m doing all of these things on a four-hour basis, which is not always four hours, but for the most part, it was pretty routine. Even questioning that led me down a path, where I found that when I keep my hands to myself, and I stay out of the birthing suite, that I get a better outcome.
You start applying, then, that same curiosity to our induction rates, our C-section rates, the high risk, low risk stratification, fetal monitoring, I mean, literally everything. And you start to just unpack this whole dogmatic thing, that every nurse listening, every doctor listening has to, you have to be, if you’re honest with yourself, you have to then realize, that most of the things that we are doing in the hospital are not necessarily beneficial.
And that leads you down a path, where you suddenly then start to maybe be a little bit more comfortable with this notion of home birth. And that’s where it led me.

Sarah Lavonne:
So then what?

Dr. Nathan Riley:
Well, then, you have your own baby coming, and your partner decides to have a home birth, and you have to actually put your money where your mouth is.

Sarah Lavonne:
Yup.

Dr. Nathan Riley:
That is a pretty challenging thing for an OB, as it would be for an L&D nurse, because you’ve seen those emergencies. And we have technologies that can absolutely save moms and babies. Problem is, that in the home birth setting, we have far less of those emergencies.
With that little grain of truth, when we intervene less, which I had learned in the hospital, when I intervene less, I have less likelihood of complication, and a need for a rapid crash C-section in the operating room. When you take that, and you realize that the likelihood of something bad happening is small, it’s not zero, but it is small, you then have to really equip yourself emotionally to stand back. And the role of a masculine person like me in childbirth is to simply hold the container, and bear witness, and let the feminine roar.
But that was the ultimate exercise for me. And when we did that, I’d already been attending home births, it was full throttle. I don’t really necessarily want to support the system anymore. And when it is necessary, we can refer people in. We can transfer them in the middle of their birth. Those are all very, very reasonable options.
But we had a 90-minute labor, from the time that my wife’s waters opened, until the time that Everly Rosa was sleeping on her chest. And that’s a testament to just how magical, and how, even catering to the challenges of this incredible process of having a baby, when we cater to them, we get out of the way, everything just seems to come together. And if it doesn’t, like I said, we can always transfer.
But it’s very, very hard to do that, Sarah, as you and I both know in the hospital, when there’s administrator after administrator, or attending physician, or resident physician, or your more senior nurse, or the hospital policy or whatever, when it’s compelling you to do things a certain way. So it’s a gambit for the individual, but once you see it, and I recommend everybody just go and be a fly on the wall during a home birth. You feel different.
You talk a lot about trauma in our workforce or healthcare workforce, especially in the maternity units. It is not traumatizing to be at a home birth, when you don’t even have to put a pair of gloves on. The baby comes out.
Eventually, the placenta comes out, there’s minimal blood loss, there’s just the right amount of blood loss. You should lose some blood, but you shouldn’t be losing 1,500 MLs. They’re breastfeeding right away.
I just have to clean up the chucks and everything, and we go home. It’s a pretty awesome experience, and that is a very, very different experience for the family, which is what we all signed up to do, is to take care of people, not to serve a very profit-oriented medical system.

Sarah Lavonne:
So I’m thinking about my own bias, right?

Dr. Nathan Riley:
Yeah. Let’s do it.

Sarah Lavonne:
And I want to be very honest about my own bias. I think, especially because for one, I have not been a part of home birth, and I am open to it, but I also, because I take birth coaching clients, I was advised by an attorney that you’re liable if you do and you’re liable if you don’t, because you’re not a doctor, you’re not in charge. It’s like, if something goes wrong, you need to respond, but also, you’re liable if you respond.
I just was like, “You know what? There’s so much need for support in the hospital system, and I feel so comfortable in the hospital, and I feel like I can help navigate that.” And many doulas don’t feel comfortable in the hospital. In fact, they would prefer not to be in the hospital.
So I just was like, “I’m just going to do a hospital birth.” Now, mind you, my bias, when I think about it, and when I talk to other nurses, and what I hear regularly is, “Well, but, what if,” and it’s hard, when you’ve seen scenarios in the hospital that are seemingly normal, and that are, perfectly could have been a home birth. And then, the outcome becomes the baby comes out.
And I remember, one very distinct one that we talked about, and we say, “If this was a home birth, imagine if this was a home birth.” Now mind you, these are the stigmas that exist. And also, because, if we’re honest about our bias, we believe that hospital birth is safer, 100% of the time, and it would be silly. But what if, in those scenarios?
And so, as we’re having this conversation and I want to be open, I also do, I see online, I have home birth doula friends, and I know birthing assistants, and I did one birth center birth. The baby needed some resuscitation. Of course, it ruined it for me, where I was like, “Oh God, that’s too stressful.”

Dr. Nathan Riley:
Sure.

Sarah Lavonne:
I think our bias, very much, we perpetuate the bias, but also, I look online, and I’m like, “It does look pretty magical.” And that is, if we’re honest, that is the birth experience we want, for our patients. And if we’re also honest, there’s no chance that you can have a home birth in the hospital. It’s not a thing.

Dr. Nathan Riley:
No, no, no. Yeah, yeah, it’s not very …

Sarah Lavonne:
That terminology needs to be cut from all of it. And even in patient education, when I’m doing childbirth classes, I want a home birth in the hospital. Well, let’s reorient, and let’s revisit that, because you’re not going to have that same experience.
Now, could we emulate things from that, and could we take some wisdom, and learn from the home birth experience, and try to apply some of those things in the hospital? Sure.
But I just would love your insight on what you would tell someone like me, who’s trying to be open, but my own discomfort of, “But I’ve seen it, and that crash was totally normal, and then, went to, not in the cord, and it would have been a dead baby.” And those are the things we’re saying. How do we navigate that, to have more of an open mind?

Dr. Nathan Riley:
Yeah, I mean, that is the question. I mean, that’s probably the crux of this conversation, is when you have this bias. Because you, like me, we’ve seen how these technologies in the hospital can be applied. But here’s what’s missing, and here’s what we really don’t have the ability to replicate. It’s not the actual birth itself. That’s a huge part of it. But it’s not just that.
In a home birth environment, a midwife, let’s say, in California, a CPM, it’s usually not a certified nurse midwife, and there’s a good reason for that. Because the certified nurse midwife didn’t necessarily, not all CNMs, but didn’t necessarily train through the lens what of what midwifery has always been.
It’s a relationship built with another woman in your tribe, who’s then developing a relationship. You’re developing this relationship over the entirety of the pregnancy. You might have two-hour visits every month, and then, maybe every week, as you enter that 36-week mark, you get to trust this person.
You get to know them, and they get to know you. And that trust is something that we have a very, very hard time implementing, or fostering, when you’re meeting them on the spot at many hospitals, most of which, most of the hospitals in California that people would relate to.
I trained at Kaiser. And it was a great program. But I was probably meeting them for the very first time, when they walked onto the unit. How can we develop that trust, in that moment? That is actually where we probably should be focusing, because that’s probably the best we can do.
But there’s a reason here that this trust, this isn’t just like, “Woo-woo.” This is some pretty heavy neurochemistry that’s happening. So we all know about Oxytocin. Forget about the synthetic stuff. It’s not the same.
Oxytocin is really, really critical, not just in helping the uterus contract. It actually helped the ejaculation on the male’s part. It helped a quivering of the lower part of the uterus bringing sperm up to those fallopian tubes.
This is the love chemical. It’s produced in the paraventricular nucleus, it’s released by the pituitary, it actually is cut from the same big polypeptide as Vasopressin. Vasopressin causes a constriction. Oxytocin is an opening hormone. It’s also a neurotransmitter.
And when we consider what a woman does, when she’s left undisturbed in birth is, there’s a flood of endogenous Oxytocin, this love chemical. And as the amniotic universe is compressing around your baby, and this little light is opening up at the end of the tunnel, sounds a lot like death, by the way, this baby is being pushed and shoved, and there’s this very stressful experience, but the baby’s being flooded by love.
Now, I know I’m sounding a little esoteric here, but when we instead have a stress like, have you ever had a pulmonary embolism, a small bowel obstruction, have you ever had asthma? My wife is standing at the desk at 10 centimeters, and I’m saying, “Guys, we got to get her into a room.”
When those questions start coming, and the unwanted cervical exams, the poorly consented X, Y or Z catecholamines flood, that’s Norepinephrine, Epinephrine, also known as Adrenaline, Noradrenaline, we get a lot of cortisol. And those hormones will suppress the activities of Oxytocin.
So, in an environment where there’s a lot of scary stuff, we are naturally protracting labor. We know this in the mammalian world, you guys have all heard this. The common story is the lioness out on the prairie, right? And they hear grumbling in the brush. So the labor stops, so they can flee and get to a safe place.
It is no different in our brains. And if you are really interested in diving into this further, anybody listening, look into the work of Steven Porges and Sue Carter. Sue Carter is the authority on Oxytocin.
She’s an Indiana University professor, and she’s studied Oxytocin her entire career. Her husband, Steven Porges, developed polyvagal theory, which looks at how the sympathetic and parasympathetic nervous systems, and there’s two limbs to the parasympathetic, the ventral vagal, and the dorsal vagal.
Depending on how the nervous system is operating, we’re going to get either a more seamless experience in birth, or we’re going to get a more contracted, “I need to flee, because I’m afraid,” state of birth. And that catecholamine surge does happen at the moment you’re pushing your baby out, because the steroids, those cortisol, and everything is helpful, to the baby. That’s why we give Betamethasone for preterm babies.
It is helpful in the acute, all of the lights, all of the sounds, the janitors in there, the juggler. We’ve got 15 people from Peds. We’ve got four med students, we have three nursing students, we have two or three L&D nurses. There is a cacophony of scary stuff happening, that is not going to lead to a seamless birth, in most situations.
So we then have to ask, “What are we doing in the hospital environment, that is impacting what I just described? Are we facilitating a rite of passage? Are we hijacking this, causing problems that ultimately lead to those things where we have to save the day?” And that’s not a question I can answer for everybody. And it’s not going to be true for every single client.
It’s going to be true more often than you think, when you start looking at it from a slightly different direction. And that’s why, that home environment, when somebody closes their eyes, maybe even you, Sarah, if you close your eyes and you imagine, what would it be like, as a young baby, or even a mother, giving birth, you’re not thinking about all that stuff that we learned to do, in the name of safety. We’re actually talking about going inward, and letting that roar, like, “The baby’s coming. And you’re inward.” You’re not even in your body anymore. There’s this dissociation, and a baby has come out.
There’s not even a pause for that baby. The baby’s whisked away. We clamp the cord, we dry the baby off, we put the baby under a right light, they put goop in their eyes, we just stick them with needles. That’s not a very, very safe place for an underdeveloped nervous system. And this little baby actually really needs to be honored in a more soft, lit, ambient experience, that comes to you when you close your eyes, and you imagine, what would that scary new place feel like?
Again, all of those implements that we’ve learned can save lives. They can. But I think we’re overly reliant on them, in order to provide short-term comfort, not just to our clients, but to ourselves.
Because we don’t want that bad thing to happen, that dead baby thing. Ooh, that is a tough thing to carry. And then you and your colleagues don’t even have time to decompress. You have to go to the next patient.

Sarah Lavonne:
What I’m seeing here is, it’s like we put value on, and I think that also goes into our training, that everything’s about safety, everything’s about keeping them alive, everything’s about comfort. And it is about appeasing our concerns over liability, our what we’ve been told the policy is, not wanting to get in trouble, get written up. That’s where the nurses are stuck, in between a rock and a hard place.
And I think about, when you describe that, I’m like, “Huh, it’s so lovely.” And then, also, I get kind of pissed off, when I think about the births that we’re doing, and in the hospital. I do think that so much of the culture is shifting, and I want to give credit to those that are listening to this, because you are not the people who are forcing those scenarios.
You are the people who are advocating for, “Leave them alone, no checks, lights are low, calm down. No, we don’t need that,” and slowing down the system, in some ways, but also, how do we navigate the discomfort?
Because my fear is that, and this is what we’re seeing, in fact, I posted a poll yesterday of somebody who was like, “I’m on this over intervening unit, and the culture is bad, and I have such an internal moral injury, every time I’m at these births, and I don’t believe in it, but I want to be a part of it.”
The answer is clearly not home birth for everybody in the entire world. And we also need providers that can nurse the whole midwifery for you. This is like a, you start going layer by layer, it’s like, how do we function in the hospital, without just getting off, when we start to think about this? Because what you described is so beautiful, and I would bet money that our nurses want that. That’s what they’ve seen.
So often, that is something they’re up against, when they’ve been online, and seen the Instagrams. In fact, we had a DM recently, we were all laughing about it as a team, because it’s so true, she’s like, “Y’all lied to me. All the vlogs, and all the YouTube videos, and all the day in the lifes, that is not what it is like.”
The reality is, that it’s a hard place to be. And if you believe in birth for that reason, you quickly get jaded. What do we do?

Dr. Nathan Riley:
Yeah. So we have a big election coming up, right? And a lot of people are voting for what they don’t want, instead of voting for what they want. And you don’t have a lot of good options.
I’m sorry for anybody out there who’s actively looking at this election as, “This is a pivotal time.” We hear all this language, but we’ve become so accustomed to pushing back on what we don’t want, as opposed to creating the ideal of what we do want. So everything I’m saying here is not, “Guys, it’s that easy.”
But we can’t really have a functional conversation around how to change things, or how to even start shifting the media alone’s narrative, let alone all the hospital policies, and the legality and all of that, if we don’t have an idea of what we do want. So let’s peel back the curtain a little bit.
Let’s say a baby does die, and there’s nothing we could have done, at home, in the hospital, whatever. A really, really good example of this is, I was a fourth year resident. A woman came in preterm birth. She had a preterm baby at 32-ish weeks, she was hemorrhaging, I was managing her. Peds staff is running in, I don’t hear a baby crying. What’s going on?
They whisked the baby to the operating room. I get the mom under control, she and I roll over there, and there’s surgeons running into the operating room. What is going on with this baby? And it turns out this baby was born without a trachea. No way to fix that. And it wasn’t picked up in perinatology, doesn’t really matter, but here we are.
This baby’s going to be allowed, allowed, I can talk about that word, “allow.” We’re going to let the baby die. This is the mom’s wishes. “I don’t want this for her.” So they hand her the baby, they take the bag away, and this baby is just taking some fine little gasping breaths, and dies in her arms. There is nothing that could have been done anywhere in the world, as of the time that that happened.
I don’t know if they’ve come up with artificial tracheas or something now, but what happened afterwards is something we can act on. A baby was born 20 minutes prior. A baby is dying, and we’re right here, this is happening. We’re seeing a baby die, and we’re not acting.
But nobody in the room was actually sitting in reverence of this powerful moment. People were counting instruments, people were documenting, people were coming in and out of the door, checking blood pressure, the blankets, all this stuff.
And so, she said, “Can you leave us the fuck alone?” And then you could hear a pin drop. And one by one, everybody filed out, except for me, and somebody like you, the L&D nurse.
So I was the fourth year resident. We had a little powwow afterwards, and I couldn’t take my heart out of what just happened, and I have now two little girls of my own. And trying to appreciate what this family was experiencing in that moment was not something that I was taught in medical school, was not something that was protocolized.
It’s not something some policy administrator, policymaker, whatever, is going to have a little debrief, and we’re going to say, “What could we have done better?” Because it wasn’t there. We don’t learn how to be humans.
In fact, we become dehumanized, even in our training, so much so, that in this moment, you can’t just sit and be still. We could have all held hands in a circle around her, and hummed, and that would have been better than everything everybody else chose to do, because somebody gave them a checklist. And this is the checklist you have to follow.
Every individual in that room could have decided, “You know what? I’m just going to pause, and I’m going to breathe, and I’m going to be grateful that I have two living kids at home.” But they didn’t, and that’s not their fault. It’s because you are a part of a system that has forgotten that we are taking care of human beings here. We’re honoring rites of passage. We are not the purveyors of medical devices.
When we need to do that, we can, and we should. We’re awesome at that. But this moment didn’t call for any of those things. They were left clueless as to what to do, as if they forgot about what it means to be a human being. That’s what I went into medical school for. That’s what you went into nursing school for.
So, using that example, Sarah, I think what we can say, is that you don’t need a protocol. You don’t actually need the medical legal team to give you permission to just be a good human being. There were times when I was a resident, when a woman came in with an all out abruption. I was a first year, I was like an intern, probably within my first couple months. And a woman came in, I had no idea what to do, and the senior residents were running around, and everybody’s doing stuff.
And I noticed the woman had blood on her hands. Nobody was even looking at her. And she was stunned, “What is happening?” So I went to her head, and I just placed my hand on her forehead, and I stroked her hair.
She was sweating, she had blood all over, I had blood all over me, and I gave her a towel, and I just cleaned her fingers, and I said, “We’re going to do everything we can.”
And I think later, it was a second and a fourth year resident, they were going to do a C-section, right? But nobody ever noticed that I did that. And that’s not on them. They were doing what they were taught to do.
But that family got in touch with me later, and the woman said, and I think her baby ended up being fine and everything, but she said, “Thank you so much for helping to clean my hands.”
So, amidst all of the chaos, there is that one little thing that every L&D nurse can do, that is going to just be human to human, woman to woman, mother to mother, or father to mother, where you can just be a good person. You’re not going to get kudos, they’re not going to give you a promotion, you’re not going to get a raise, but who gives a shit?
You’re not going to be sued, either, for being a good human. And what she needed there was not a C-section, what she really needed was just some humanity.
That’s where I think we all can actually just take a little incremental step forward, every single shift. And just remember, this is a really scary thing, because of the way that the media and our politicians, and the OB-GYNS on Instagram talk about this stuff.
They’ve politicized this, and they’ve taken our eye off of the prize, which is building better communities by helping people stay spiritually safe, and emotionally safe, throughout this journey.

Sarah Lavonne:
I’m seeing it come together in my head where, when you compare going back to the home birth thing, but then, I also want to talk about your work in the palliative care space, and how that crosses over for you. I’m very curious about that.
But what I see is this idea of home birth, if we remove, and all of us listening, I encourage you to just take a second, and remove all of your fears, and remove your emotion about it, and think about the beauty and the magic of birth that yes, we have seen at times. And if you haven’t, look for it, because it’s still there.
And then, you look at the, sort of the chaos is what I’m seeing in my head, of the medical system, and the “Do, do, do, do,” that the difference is that human to human interaction, it reminds me of our pause at the door stuff.
We encourage people to just stop and realize who you are, that this is a human being in front of you, and commit to connection, and giving yourself to that moment, and being present in that moment to actually see what’s going on, beyond the bleeding, or the palpating of contractions. If you are palpating contractions, please palpate your contractions.
There’s so much more going on here, that this is a human being in front of you, and the gap that these nurses can fill in that in-between space, because my guess is, not all of us are going to leave the bedside to go be working in home births, but it’s like, what can we take is, is that humanity?
And that seems so simple, but it also is so incredibly challenging, when all you see modeled for you, is the in and the out, the cervical check-in, and, “Did I chart, and you didn’t this, and well, but the room is this,” and the doctor calling you, “I want to see the ears. Call me when you see the ears.” And it’s just this, “Huhhh,” and no wonder our nervous systems are a hot fricking mess.
And so, when you’re in that environment, and also energetically, I am a huge energy person, and that sort of woo-woo side of me, I keep under wraps, for the most part, in many ways, just because we’re trying to bridge a gap here. But also, there’s an energy, there’s a feeling, there’s your vagus nerve, there’s your hormones, that internally, you probably feel, too.
So part of the work for us is paying attention to, getting in touch with our own energy of what we carry into the room, and slowing it down, to a place to see the human. That is so much of the work that we do here at Bundle Birth, is not new to this community, but also, I think, such an interesting and new angle on that, that I love.
And I so appreciate the way that you’re able to describe and sort of bring that life back into a very potentially dead system. And in many ways, what we’re perpetuating is this rigid, non, there’s other sides to a human other than just the medical, safety, physical.
So what can you do, to bring in some of that, the feeling, the emotion, the hormones, that is our physiologic birth class, that helps to really bring it full circle, and make it a lot more holistic, to use a few of your [inaudible 00:41:14] words. Yikes.

Dr. Nathan Riley:
Yeah, yeah, yeah. I mean, these are little things. They can have such an impact. And I think people out there, I think doulas and L&D nurses probably carry the burden of the responsibility here. In many ways, you really can’t expect an OB to do different things. It’s not because of the financial or the administrative pressures, it’s because, they kind of lost sight of this a long, long time ago.
And there were even instances, there was a case of twins that delivered vaginally, when, my first year out of residency, I was in fellowship in UC San Diego. I was just working weekend shifts at Scripps in Encinitas, which is, by the way, one of the best hospitals in California to have a baby, in my opinion. And this lady came in, and she had twins, and I was covering somebody’s practice down there, as well.
And she was like, “Well, I’m a really healthy person, and I don’t really want to be induced,” and I was like, “It’s not induced. I don’t like induction, anyways, that’s more work on me, and all the staff.”

Sarah Lavonne:
Seriously.

Dr. Nathan Riley:
“And then, we have to monitor her, and all this stuff. Your babies are fine.” 39 weeks, 40 weeks, she hits 41 weeks, and she still has di-di twins. They’re growing, she’s got this big old belly.
And then, she’s like, “I’m kind of ready to go into labor now.” I was like, “Well, let’s go drink some red raspberry leaf tea, do some walking, some lunges. Let’s just get things going.” And things did get going. She had her first baby without any issues. And then, the second baby just, dunk, dunk, dunk, came down head first.
It wouldn’t have been a problem if it was butt first, but the baby came down head first, and just chilled there. And we were talking about cervical exams before, there’s nothing about a cervical exam that tells us anything about your labor. If the baby’s still up high, it doesn’t matter what the cervix is, the baby has to come through a big bony structure. So, baby’s high station, ballotable, as we would say.
I was like, “Well, let’s take her back to the labor and delivery room.” Everybody looked at me like, “Seriously?” And I was like, “Yeah, she’s not having a baby for a while.” So we did. I went home, and had dinner, and then they called me.
And by the time I got there, the second baby was out in the nurse’s hands, and I was like, “Oh, good, we have a second baby.” Well, I signed this out to the oncoming hospitalist, and I talked to her about this.
I was like, “We just had twins. The second baby just came first, was yesterday, at 8:00 p.m., or whatever,” and she looked at me like I had three heads. She was like, “You didn’t do an extraction, you didn’t do Pitocin? What’s wrong with you?”
And I was like, “There was no reason to be fired up about that.” But I was a young doctor, and I started questioning myself, and I even called my buddy, Stu Fishbein. I was like, “Stu, here’s what happened.”
He was like, “Well, you’re one of the 0.1% of docs that would have ‘allowed’ 12 hours, or whatever, to pass between them.” But he is like, “But you did the right thing. There was no reason to intervene.”
So we as doctors, we become so indoctrinated with a way to do things, because it has served us well, without the bad outcomes that we’re all so fearful of, that we’re not really going to change with them. Because we have our colleagues, even our colleagues, are pressuring us to perform certain things at certain times, times.
But doulas and L&D nurses, and really, even if you’re a student, there’s so much value for you to just remember, just to close your eyes, remember, like you said, check in with yourself, and feel how privileged it is, that you get to be a part of this experience. Then you walk in, and you just do the human thing. And it will always serve you well.

Sarah Lavonne:
And how simple.

Dr. Nathan Riley:
How simple.

Sarah Lavonne:
Those that are struggling with burnout or struggling with the moral injury, it’s like, remove, I envision just pushing out the outside, and focusing in on that one patient. It’s the starfish story that we share, that it matters to that one.

Dr. Nathan Riley:
What’s that? Tell me that.

Sarah Lavonne:
So it’s one of our stories that we taught, it started with physiologic birth. It just sort of came out, the first time I taught that class. We start with hormones, or whatever, but when you’re looking at a bigger system, and we’re talking about bringing some of those concepts, including understanding the hormones, or understanding all of the bodily structures that fit together, in order to birth the baby without medical intervention, that it feels very overwhelming, when you’re looking at a system, you’re like, “This is not even possible. What? We’re going to have physiologic births?”, when we’re so far from that.
So the story goes, that there’s an old man and his grandson walking on the beach, and they come around this bend, and they come across this beach covered in starfish, stacked high, where they’re just stepping around. It’s just starfish galore.
The little kid reaches down, and grabs a starfish, and throws it back in the water. And the grandpa laughs at him, and is like, “Dude, look at the beach. You’re so cute. But look at the beach covered in starfish. You really think you can make a difference?” And he reaches down, and he grabs another, and he throws it back in the water and says, “It matters for that one.”
So I use that, and that has become so pivotal in our business. Our motion app is actually a starfish icon, with the idea that when you’re looking at the problem, and you’re seeing the beach, and you’re totally overwhelmed that easily, you just go, “Ugh, what difference can I make?”
And instead, that the answer is, “Well, you make a difference for the patient that you’ve been assigned to, the client that you’ve been assigned to.”

Dr. Nathan Riley:
It’s the lady, that I helped her wash her fingers.

Sarah Lavonne:
Yes.

Dr. Nathan Riley:
That was a really, she’s going to forever remember that.

Sarah Lavonne:
Yes. Those moments, when you’re feeling frustrated, or you’re missing the magic, or you’re wishing it could be another way, instead focus on those little, I say, above and beyonds that feel above and beyond, but really should just be the foundation of how we carry ourselves in our practice, and how much more fulfilling that feels, when you know you threw that starfish back in the water, you know you connected, you know that you made a difference in that patient’s life, when they would have been left on the beach. And it begs the question, “How many starfish are we leaving on the beach?”

Dr. Nathan Riley:
Yes.

Sarah Lavonne:
And simply, all we needed to do was pay attention, look down, and go, “Oh. I can do something here,” and reach, and put a little bit of human effort into it to exert yourself, to throw them back in the water, figuratively. So I love that challenge.

Dr. Nathan Riley:
That’s beautiful, yeah. And really, I just read this book about awareness, self-awareness, and it was talking about the world at large. If you’re walking down the street, and you see an empty Pepsi bottle or something, he encourages you to realize that because it came into your awareness, that is your job to pick it up.

Sarah Lavonne:
Ooh.

Dr. Nathan Riley:
I’m using an example, that every single moment of our lives, when we become aware of something that could be done, if we all did that, every time something that needed cleaned, or a spill … I mean, in our household, my wife and I, if we just said, “Oh, Nathan’ll fix it, or Stephanie’ll get it,” if we did that, our house would be a mess. So it’s this conscious effort that, “Hey, you noticed it? Just go and do it.”

Sarah Lavonne:
Ownership.

Dr. Nathan Riley:
Imagine what the world would be like if we just did that, instead of following orders, because we’re afraid of some sort of punitive measures. There’s so much power to just claiming responsibility over your awareness.
As nurses, especially, you guys have every opportunity, every hour of your shift, there’s something that you can just do. It could be the other nurse who just had a hard time, and you bring them a coffee, or you grab their shoulders and say, “Hey, can I give you a little massage?” I know that was probably a really rough one for you.
Or whoever that was bending over, pushing with somebody, and their back and everything’s all twisted like, “Hey, why don’t you go lay down in Room Four? Let me bring you a tea or something. You can do that. I’ll watch your patients. Just take an hour, take a little time off.”
These are easy things that can be done, that have absolutely nothing to do with all of the barriers that people say limit our ability to change the system. It requires human to human, between coworkers, between other staff, between you and your clients.
This is really not that hard, but it’s very, very complicated. It’s very, very hard to maybe enact it, that these are simple little tasks of just being a good human.

Sarah Lavonne:
Yes, preach. I’m here for it. Transitioning, what have you learned from being in the palliative care space. And how does that relate to birth?

Dr. Nathan Riley:
Yeah, actually, a midwife is naturally a pallitivist. A midwife gets to know everything about you, your beliefs, your values, your preferences, your history, where you want to go. They kind of get the whole picture, before they start giving you solutions.
So, in the palliative care space, so my father died of multiple myeloma, excuse me, after about five years of treatment, and I didn’t really know much about palliative care. I did have some kind of peripheral understanding. I thought it was end of life care, but hospice is, for sure, when you’re expected to die, or you’re anticipated that you might die within six months.
Palliative is more of a continuum, and I feel like every person in the world could use a palliative care doctor on their side, because they start with a very, very open-ended conversation. We have a little bit of expertise in every one of the specialties, because we need to understand how we can apply those specialties, and how we can maybe improve in our counseling as to what those specialties might have to offer you, the risks and benefits of different interventions, before we start saying, “This is what we’re going to do.”
It’s the whole captain of the ship sort of motif of the way that we as OB-GYNs are trained. It’s the opposite of that. When my dad passed away, he also started opening up about his existential dread of dying, and what he really wanted to get from chemo, and he decided to go full bore with chemo and all of that.
But eventually, he decided to stop, and it was this palliative care team that didn’t convince him to do anything, but they learned that he was actually afraid of getting more chemo at one point. And they conveyed that to the oncologist, and the oncologist was like, “Yeah, I guess it’s kind of reasonable. We’re on third line now, and he’s withering away.”
My dad was this big, muscly guy, who was a laborer. He had an HVAC company, and I would be his grunt when I was a kid. This is a big, strong, tough human that would come home with cuts all over his hands from duct work, and just a little piece of tape wrapped up on there.
The guy was the sausage finger laborer, blue belt Pittsburgher. But he got to be so sarcopenic, so frail, that I was able to pick him up in his diaper and carry him to the bed, or to the toilet. And that’s hard as a son to see that, but he wasn’t really opening up about who he was, or what he was afraid about. He was just being a tough, “Cancer sucks” kind of guy. And the palliative care team managed to get him to talk about some of these things, and get him to open up.
They were able to build rapport like that, talking about building trust quickly. They have to do it in the first thing that comes out of their mouth, and we have a way of treating people in palliative care, that I thought, watching my dad go through that, I thought, “What if we did that as an OB? What a beautiful way to honor, not death, but birth.” And they’re two sides of the same coin. There’s a lot of similarities here.
So I introduced this idea of going into hospice, and palliative medicine and fellowship, and it was at that point that I was told, I’m not cut out for OB. Obviously, you’re not cut out for this if you want to go and do a specialty that gives up on people. It was that type of language, which I had to just push aside, went and did my fellowship, and improved my communication skills, leaps and bounds, in order to really help appreciate what a person had gone through in their birth, which, many of times people who come to me, they had very traumatic experiences.
And we don’t start throwing data around risk of uterine rupture, and all this bullshit, which, by the way, is based on epidemiological data, that data that is almost not applicable to anybody. But instead, we just say, “What was your birth like? What was your last birth like?”
And you could talk for two hours. They would tell you not about the metrics, not about the things like the vital signs, and infection, and whatever, they weren’t talking about the measurable things. They’re talking about their experience, which is no different from a person who has to make a hard decision around the big C-word, cancer, or whatever it is, that was doing in palliative care.
The other thing it really helped me appreciate it was another tiny little story. There was a woman who, she was Buddhist, she was in the ICU at UCSD, and the nurse called me down frantically, like, “They won’t accept opioids, and she’s clearly in a lot of pain. She’s grimacing.” And I looked at her through the window, and she’s all tight, and you can tell she’s in pain.
But the family came out and saw me, and they said, “Doc, we’re happy you’re here, but she’s Buddhist. If you take her out of this process, she’s going through this … She is suffering, but this is an important part of our tradition.”
And I was like, “God, that sounds crazy, but there’s something there. There’s something to that.” So we didn’t treat her with opioids. She eventually died, and they were so grateful, because she had made it very, very clear, “I do not want to be taken out of my body.”
So when we use these medications, specifically, morphine, fentanyl, those types of things, we actually dissociate you from your body, again, going back to this determination that everybody be comfortable, they saw that as an opportunity for growth, karmically, and that helped me.
It’s not like a cultural appreciation. It’s, “Holy shit, this is something that I would not want for myself, at that time in my life, and I’m going to honor their wishes, because they were very, very, very clear. When they had the capacity for medical decision-making. They had every right to say yes or no to everything.”
The perversion of informed consent in maternity care is probably the number one thing that is traumatizing women and families. But in palliative care, you would never say, “No, you have to have chemo,” or, “No, you have to be intubated. Come here, I’m going to stick this tube down your throat.” We would never do that, but we do sort of coerce people in the maternity units to do things that we would want, because we’re not comfortable with another person’s pain.
So, palliative care really helped me sit and bear witness to a person in pain, and to continue to honor them as human beings, which goes back to the humanity that we’re lacking in modern medicine.

Sarah Lavonne:
Well, and it sounds like, because I’m not a palliative care nurse, I’ve only ever done, so this is not my specialty. But it’s sort of, again, it goes back to this slowing down, and honoring the person in front of you.

Dr. Nathan Riley:
It’s beautiful, yeah.

Sarah Lavonne:
And when you do that, and you’re allowing, for lack of a better word, but you are, you’re allowing them to be fully themself, and be different from you, and make different choices than you would make, and understanding that they are fully capable of making those choices. It’s that autonomy over your body, how much more of a difference and an impact we can make in avoiding trauma in their birth experiences.
And it’s like, there’s nothing better or more successful to me when I work with a client, and they’re like, “I did that. I made that decision, I advocated. I got the birth”-

Dr. Nathan Riley:
But they [inaudible 00:56:51] the worst.

Sarah Lavonne:
… experience that I,” right. It doesn’t always mean that they had a vaginal birth, even. “But I made that choice to have a cesarean birth, and I feel so good.”
And it may be medical, it may not be medical. And ultimately, the goal is them coming out with a healthy birth memory. That is one of also our taglines around here. And so, I love that.
And it’s almost like, that it’s informed consent from another angle, or shared decision making, really, and going back to honoring their experience. There’s this spiritual side to it, that I think is so beautiful. And again, we just lose.

Dr. Nathan Riley:
Yeah. Well, so let me add to that, because you’re on point here, this is really, really important for your listeners, and for the people that are in your programs. Most of the women who were using the words “trauma,” they had a traumatic birth, they’re not talking about somebody doing an unnecessary episiotomy. They’re not talking about having a C-section, where anesthesia wasn’t fully situated yet, right? I’m feeling everything. That is the most horrific thing I could ever imagine.

Sarah Lavonne:
Right.

Dr. Nathan Riley:
The death of a baby is also one of the more horrific things I can ever imagine as a parent. What these women are actually reporting. When you hear their stories, is that even when they had an uncomplicated, unmedicated, undisturbed, use whatever moniker you’d like, they say, “I don’t want to have a hospital birth, because I didn’t feel like I was being treated with respect.”

Sarah Lavonne:
Yup.

Dr. Nathan Riley:
“I don’t feel like they were listening to me. I don’t feel like they were seeing me. I don’t even know if every single person who came in, and saw all of everything I own, I don’t even know if they introduced themselves.”
So it was the lack of the human thing that they thought they would be getting in a maternity space, a maternity unit, that actually was the most traumatic for them. They felt like they were just going down an assembly line. So here again, is where L&D nurses can make this an important experience. And it may not go the way that they want to.
This is not about birth planning. This is about trying to appreciate where this person’s coming from. And if you don’t do that, and you just start acting, because it’s in the best interest of Mom and baby, whatever, however you want to describe it, you end up with a person who feels deeply resentful, and almost hurt, traumatized is the word, but they’re wounded. They feel bad, they feel like they were let down. They feel sometimes raped. They’ve used that word.
They’re not just throwing this word around. They’re feeling, “I feel like, I was really, really harmed. I don’t want to go back in there. I am having a PTSD-like response.” So there are clinics, there’s a perinatal clinic up in Pittsburgh now, The Empowerment Equation, it’s run by Tracey Vogel, who happened to be one of my attendings when I was in medical school, and I was rotating there, and I did an OB anesthesia rotation.
She was an OB anesthesiologist. She did all the epidurals, all the spinals, she was the head honcho, and she left that practice. I mean, she had done it for 30 years. She left it, and started this clinic, where they really just unpack, “What was your experience like in birth?”
And it was usually, given 99% of births are in the hospital, usually in the hospital, and she will tell you that they’re not complaining about the unnecessary episiotomy, they’re complaining that somebody didn’t treat them like a woman who deserves respect. “They didn’t value my autonomy, they didn’t counsel me, they coerced me to do this thing, because they said my baby would die. And I feel deceived.”
So when I told that story originally, I started empathizing with these families. I don’t want you to feel deceived. I want you to be really, really sure of what you want. That’s what I do in my education, as well.
That’s what your nurses can do in their educating, in their support, is helping a person stand on their own two feet, reminding them that they’re safe, making them feel safe, not just having the implements that keep them safe, but making them feel safe.
And more importantly than anything else, do not deceive them. These are adults, these are parents that are going to be making lifelong decisions for their children, and you have to go home and live with the way that you’re treating people.
So in the very least, do it for yourself, because you wouldn’t want to be deceived. You would want to have your wishes not just honored, but even elicited, like, “Hey, I’m really worried about this thing. I’d like to do a gentle exam. Would that be okay? No? Okay, that’s fine. We’ll watch in other ways. Do you need anything right now? Can I get you a cup of tea? Can I get you some ice chips? How can I make you feel a little bit more situated now? I’ll come back in 20 minutes. I want you guys to get situated, get undressed, here’s a drape.” All of that.
We can do that in C-sections, we can do that in vaginal births, we can do that in the triage, and we can do that in the emergency room. We can do that on the street, when we see a pregnant woman, getting up from your chair and letting them sit down.
These are the things that we’re lacking in our society at large, and you would expect that to happen in hospitals. But we’re really missing a lot of those opportunities, I think.

Sarah Lavonne:
Is there anything else that you want to leave with us, maybe, that feels unsettled in your soul, that you want to pour back into these nurses?

Dr. Nathan Riley:
I told a story about a baby that died, and I think we need to get over this notion that a dead person, whether it be a baby or a mom, is the absolute worst possible scenario. I know it seems like it, because we have a war against our own mortality. Look at the anti-aging medicine, and all this other stuff. Nobody wants to even confront this conversation around death, but there’s a lot more to the baby’s journey than merely what the NSTs and the BPPs and everything are saying.
Sometimes, babies contract, and then, we’re getting woo now, but I don’t consider it woo. I think this is real stuff, because I have met my baby in the womb before birth. We need to get over this notion that the worst possible thing that could happen as a mom or baby dies, and that is a tragic, horrible thing. We should try to prevent that in every way that we can.
But we can’t, in doing that, that can’t come at the cost of us realizing that there are certain things that are just ineffable. There’s certain things that we can’t really unpack. The missing trachea, we don’t know why. Sometimes, in our efforts to reduce mortality, we do a lot more harm. And this goes back to the vaginal exam. I rush in, I say, “I have to check your cervix.” I might have traumatized that woman when she had been, let’s say she had been raped, or molested, or whatever.
It doesn’t even have to be that. It could be somebody who’d never had that, and they suddenly feel what it’s like to have a man who has tattoos all over, walking and throwing his white coat down, and shoving his hand inside of her. “Well, we needed to make sure the baby was okay.”
First off, that’s not going to make sure the baby’s okay, let’s be clear, in 99% of cases, but more importantly, in your effort to reduce the likelihood of a baby dying, you have told me by doing that, you have told me that you’re willing to compromise this woman’s, probably physical health, but especially her mental, emotional, and maybe even spiritual well-being.
So again, it’s this acute fix at the cost of some potentially long term issue, that we, by the way, have no means of addressing. We just say, “Oh, get on an antidepressant,” or whatever else, and we wonder why women want a free birth, we wonder why women want a home birth. It’s because you poisoned this culture of humans caring for women.

Sarah Lavonne:
Thank you so much for being here, and pouring into this community, and just offering challenge, but also, just offering your storytelling is so fabulous, and I think it’s always so good for us to just get outside of our environments, and think outside the box. And I know I feel personally challenged of, “I got to slow the heck down.”
Even in my every day. I may not be doing births every day, but just slow it down, and realize there are humans in front of you, and offering the T, I feel like I used to be that person that was much more aware, but it really does take a self-awareness of, who do I want to be?
Do I want to be the person that’s a workaholic that gets a lot done, that’s very efficient and productive, or do I want to be the person that cares for other people? And-

Dr. Nathan Riley:
That’s it.

Sarah Lavonne:
… I know that my values are that, but it will take some effort for me in that. If people want to follow you, if they want more, where can they find you?

Dr. Nathan Riley:
Instagram is pretty popular nowadays. I really don’t like it, but I’ve had to stay active there, because a lot of people find me there. All of the links, Nathan Riley, OB-GYN, belovedolistics.com is my practice website, and then, Born Free Method is really where I’m doing, it’s sort of a complement to what you’re doing, because you’re really, I think, doing a great job of training a new generation of healthcare workers, and people that are starting to question this paradigm.
I have people that are Type 1 diabetics with twins, and they want to have an autonomous birth, even if it means being in the hospital. So we have this support program where people get direct access to me when they’re in the program, for life, and we have this video library and everything else, but if people need me, just reach out.
I do all of my own stuff, so it’s not like some weird admin response, auto-generated, or something. Just reach out. If I can be helpful to anybody, this is what I do. So thank you for having me, and I hope that at least one person hears something here that’s valuable. So thanks again.

Sarah Lavonne:
Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend.
If you want more from us, head to bundlebrithnurses.com, or follow us on Instagram. And as a reminder, all of the links for Dr. Riley are down in the show notes below.
Now it’s your turn, to go and be a little bit more human. Pause at the door, slow it all down. Remember that there’s a human being in front of you.
And remember, that the biggest impact that you can have is on slowing down, and being present with that unique human in front of you. We’ll see you next time.