Podcast: Advocacy, Trauma & Decision Making with Midwife, Illiyin Morrison
Advocacy, Trauma & Decision Making with Midwife, Illiyin Morrison
Season 2, Episode 10
Advocating for yourself (or other people) or knowing how to make decisions can be really difficult when it comes to maternity care.
In this episode I'm joined by birth trauma specialist midwife, Illiyin Morrison to discuss how we can ensure we are advocated for throughout the perinatal period.
Speaking from a trauma informed perspective, listen to this episode for practical decision making tips, a deeper understanding of navigating maternity services and a holistic conversation about birth advocacy.
Please note, no specific traumatic events are discussed in this episode. We discuss trauma with a focus on what may cause it, how to navigate birth after it and what steps could sometimes be taken to minimise the occurrence of it.
TRANSCRIPT
AI GENERATED
I know right now you have no idea what to expect from birth, what it's going to feel like, how it's going to pan out.
And so what you thought was going to be this glowing experience of pregnancy has turned you into a bunch of nerves.
Well, you were in the right place because I am here to hold your hand as you prepare for the birth of your baby through the birth-ed online course, the course that gives you the information you thought you were going to get from your antenatal appointments and didn't.
The birth-ed course opens your eyes to everything you need to navigate your pregnancy and birth choices so you can feel confident, informed and ready to take back control.
Available worldwide for just £40 or $50, sign up now via the link in the show notes.
I'm Megan Rossiter from Birth-Ed, and you are listening to the Birth-Ed podcast.
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Join me for some inspiring, informative, and often challenging conversations with the world's leading women's health experts, from midwives to obstetricians, doulas to activists.
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Ready to meet today's guest?
Hi, everybody.
Welcome back to The birth-ed podcast.
Today's episode is going to be focusing on the topic of advocacy.
I have wanted to do an episode on advocacy for a long time, but it was really important that I had exactly the right voice to have this conversation with.
I think often a lot of the nuance around the idea of advocacy can be lost, and we're left feeling that our options are either to kind of comply and do exactly as we're told, or to just say no and kind of completely disengage from maternity services all together.
If you've listened to the podcast for a while, or you've joined us for a course, you'll hopefully already have seen that Birth-Ed were all about meeting you where you're at, helping you sort the wheat from the chaff and navigate your way through the kind of mysterious world of maternity care, which is unfortunately often more complicated than it first seems.
So I am delighted to be joined today by somebody who is all about the nuance, Illiyin Morrison.
Illiyin is a midwife, a mother, a birth debrief facilitator, author and founder of Mixing Up Motherhood.
Illiyin specializes in supporting families through trauma in the perinatal period and uses her platform to empower women and birthing people to advocate for themselves.
She challenges us to question our own decisions and the systems in which we live our lives and shares her honest and sometimes frank experiences and musings of motherhood.
So, Illiyin, thank you so much for joining me.
No, thank you for having me.
We've been talking about doing this for ages.
And I think it's just the stars haven't quite aligned.
And so I'm glad that we are finally doing it, because like you said, it's an important conversation to have and one that I think many people get a little bit stumped with.
So hopefully by the end of this podcast episode, they'll be feeling a little bit more like, okay, and that's always the end.
Yeah, and it's a hard thing to do, is to advocate for yourself and to kind of understand the importance of that.
So hopefully we'll be able to bring some kind of really practical tips and things that you can kind of implement into your pregnancy or birth and the kind of postnatal period.
So Illiyin, I suppose a lot of your work revolves around working with people kind of once they've had their babies through your kind of debriefing services.
Do you want to just kind of explain a little about kind of how you work at the moment and how this has kind of led to you talking so much about advocacy and supporting women and families to kind of be able to do that in either current or future pregnancies?
Yeah.
So basically, I qualified as a midwife about five years ago, and I remember throughout my training, I'd constantly be told off by a mentor saying, if you stop talking to the women, stop talking to them, you've got this to do, the kind of typical pen pushing bureaucracy.
And it's kind of like, okay, yeah, cool.
But I want to build relationships and I want to really understand people.
And my mom used to say, you're so nosy, you're so nosy.
And I'd be like, no, let's just reframe that.
Let's call it a curiosity.
So I sort of knew that clinical midwifery was kind of not where I was at, particularly because the way in which maternity services are structured and the requirements on clinicians to, I suppose, in some ways, you could kind of call it watch their backs all the time in the context of litigation.
And so I thought that's not the focus of what this is.
And that's definitely not why I came into it.
And then having, when I had my daughter and through what I would sort of describe as quite a traumatic experience, both the birth and the postnatal experience, I would say it kind of was like, what are you doing?
I remember going back to work and being like, I just can't do this.
I can't do this.
I can't partake in this.
Knowing then the things that caused my trauma, I was then basically subjecting other people to unwillingly, which I think is something that's important to note that for a lot of us, we're not doing it because we think that it's the right thing to do.
There's a lack of being trauma-informed, but also practice.
Practice is just we get into bad habits.
We copy people that we know.
We burn out, we're tired, we're stressed, and it all sounds very negative, but the impact of it is that that woman and that family face the repercussions.
And perhaps at the end of the day, as a clinician, I could go home and say, oh, whatever, it's fine.
I'm putting that one to bed onto the next one tomorrow.
But like I say to my clients all the time, you may have one, two, three, four, or five babies and you will remember every single thing that happened.
And so it was like, right, actually, they're going to remember that.
So that led me to thinking, okay, cool, you can't be part of this.
And I suppose you could look at it from a privileged perspective, but I had no idea what I was doing.
But I was like, I'm quitting.
I had one traumatic birth experience and I remember looking at this woman's face and being taken back to my own birth experience and I froze right in that moment.
I couldn't do anything.
And that rendered me essentially useless, but also made me realize that I had some work to do on my own stuff, but that actually I will be remembered by that woman forever.
And that was like, no, you can't be doing that.
So the following day, I quit my job and I was like, I don't know what I'm doing with my life, but I can't do this job anymore.
And so that was February 2020, so right before the pandemic.
And then I, this is a really long-winded way of telling you how I got into this stuff.
But I then started mixing up motherhood in the April of the pandemic, because my husband had gone home.
He'd gone back to Spain.
He was like, I'm going back and I'm coming back.
I said, you're going to get locked down.
You're going to get locked down.
He was like, no, I'm not going to get locked down.
Two days after he arrived, he was locked down and he ended up being in Spain for four months.
And that left me with our daughter, you know, at the time it was about 16 months.
And I was with my parents.
So I was like, oh, I just want to share my musings on motherhood and whatever.
And that led to this work where people were telling me their traumatic birth stories.
And I was like, where do people have to put this stuff?
Like, you know, what are we doing?
And essentially, I said, in October 2020, I was like, why don't I see if I can create a service, essentially a listening service.
And the first couple of weeks, it was one session, two sessions.
And then by November, I had a waiting list of two months.
And that made me realize actually, there were so many people who similarly to me didn't have anywhere to put their experiences.
That felt safe.
And that's the important thing to note, that if the space doesn't feel safe, and it doesn't feel particularly impartial, it can end up doing more harm.
So that is what has got me into doing what I'm doing.
Nearly two years later, I'm still going and very much enjoying it.
Amazing.
And so how has that impacted the kind of information sharing, thoughts, ideas that you're sharing with people who are kind of currently pregnant?
So you're spending all of this time kind of listening to those experiences of trauma, which sometimes come from the kind of physical experience of what happened.
But I'm sure you can share with us that often that's not the kind of only cause of birth trauma or trauma in the perinatal period.
So basically, I mean, I hear traumatic stories or difficult stories day in, day out.
It's meant that I've had to check myself a lot and say, oh gosh, you know, were you doing these things that these people are speaking about?
And can you use the knowledge that you're getting from this to say, hold on, as practitioners, we are causing harm, often unknowingly, like I said, but those things, the comments, the kind of dismissal, the sense of kind of not being centered in their own perinatal experiences and also viewing things from that trauma-informed lens, which means that actually you understand that trauma is not only physical and that a lot of trauma comes from the things that are said or unsaid.
And so that opened up a whole sort of, I would say opened up a broader, broader world from those who had had negative birth experiences, who couldn't quite put their finger on why they felt their experience was negative until someone said, yeah, but did they listen to you?
And it's like, oh yeah, it doesn't have to be, I lost a lot of blood.
It doesn't have to be I had a caesarean.
It doesn't have to be I had a forceps or a ventouse.
It can be that actually I wasn't seen in my experience.
And that has then kind of really given people the validation that I think they really, really needed and deserved.
And so that's that's a lot of what I do.
And so I think as we kind of lean into talking a little bit more about kind of advocacy, I think something that's really important to kind of highlight at this point is that the responsibility should never fall onto the shoulders of the person who is giving birth to make sure they've got all of their options, to make sure that they're being listened to.
But as we kind of stand in the maternity system as it exists today, it does make sense for us to try and kind of reclaim some of that power, where kind of as the kind of standard, all of that power at the moment sits with the maternity system.
So sort of starting with the kind of absolute basics, what do we mean when we talk about advocacy?
Yeah, so advocacy, I suppose being an advocate, which is what we should be as clinicians and what our birth support should be for us as well.
And, you know, it kind of, if I was to put it in, essentially like a bit of a triangle of responsibility, the responsibility goes first on the practitioner, second on the birth support and third on the woman.
So it's like, okay, fine.
That means that the onus cannot sit solely with you, but equally what tends to happen is, it's like, I didn't advocate for myself.
I didn't say all of these things.
I didn't, and, you know, a lot of these thoughts tend to come post-negative experience.
So post-consultant appointment or post-your-birth experience or post-natal experience.
And it's like, hold on, hold on.
One thing that is vital and that we do is that we contextualize those memories and we say, what was that situation?
Who was with me?
How was I feeling within myself?
And was I actually able to advocate for myself?
So once you've done that, it's like, okay, fine.
So if we're speaking about advocacy, it's basically speaking up, being the voice for someone who perhaps doesn't have one.
And that just shows you the triangle.
It means that it can't really all fall on you because you're the person who perhaps needed someone to use their voice.
And so I think that's where we, and one of the sort of, you know, real symptoms of trauma is blame and self-loathing.
And so it's like, you've put it all on yourself and what you should have done, could have done, would have done.
And instead it's, I will actually hold on.
I didn't birth alone.
And so why do I have to take all of the responsibility on my own?
So you didn't sit in that consultant appointment on your own.
You didn't give birth alone.
You weren't in the postnatal period alone.
So why is it suddenly all your fault?
As this is why advocacy is so important and that those who are supposed to be providing that are providing it correctly and that people, when they think about advocacy, they aren't thinking solely on how they advocate for themselves, but also on how they make other people advocate for them too.
That's a really, really important point.
And we've sort of touched on this in all of the conversation that we've had to say for so far, but why is it so hard to advocate for yourself in the current maternity system?
Yeah.
You know, I would say it's actually really hard to advocate for yourself in your life generally, particularly as British people, we are taught to be good from, and to be compliant.
And that really runs so, so deep.
It's not something to be underestimated when it comes to then being in that situation of being confronted with maternity services, which means that when you, you know, if we kind of take it all the way back from school and being a good girl and doing your homework and turning up on time and looking neat and, you know, constantly looking at authority figures to tell us that we are good.
And, you know, that's something that I'm now dealing with with my own children, like, oh, yep.
No, we're not going to be doing all this good, good, good.
Because actually I don't think that serves us in the grand scheme of things and in our wider life.
So when it comes to maternity services, this is a particularly vulnerable time.
And I think all parenting experiences, that, you know, being a parent is a vulnerable position to be in, because you are kind of sort of stuck between a rock and a hard place, and you're like, oh, but I only want the best for my baby.
You know, the healthy baby narrative is strong.
And I also want to be good.
And I don't want to make waves, because if I'm not good, how will people think of me?
And so you're kind of like, oh, man, what do I do here?
And I say to people all the time, I'm like, but why do you want to be good for these strangers?
Like, they're not coming to your house for Christmas.
You don't know them from Adam.
So why do you worry about being good for people who do not matter?
And so the worry about being good leads us into this sense of, like, I have to say yes.
And or I have to say no, which is an important one, because again, it's like, oh, no, no, we don't do that here.
I was, oh, okay, good people don't do that.
Okay, so I'm going to say no to that as well.
And this is what we do.
This is what protocol says.
This is what we would feel is the best thing.
Okay, good people say yes.
Okay, I'm going to say yes.
And so I think that good, that goodness really has people in a bind and can really inhibit the ability to kind of look inwards and say, actually, hold on, what do I want?
And maybe that isn't going to appear good, but does it feel good?
And that's that's sort of where you want to be at.
Yeah, it's so tricky, isn't it?
And, you know, I work with a lot of people kind of anti-natally, and so often those conversations that are coming up are, I don't want to upset my midwife, or I don't want to be difficult, like I don't even know if it's possible.
And I think something that I talk about a lot at the moment is that at the moment, we're kind of everybody's aware, I think now with the news, there is like a huge midwifery crisis.
We are like, hospitals are vastly, vastly understaffed.
And then along with this politeness comes, oh, but they're all working so hard, which, you know, from a kind of personal perspective, like absolutely understand everybody who's working in a system is very pressurized.
It's very difficult place to be working.
However, when we comply and we do things because it is making somebody else's life easier, what we're sort of inadvertently doing is telling the system that they can survive with one midwife for 40 women, or they can survive with one doctor on triage because we are doing things that we don't want to do necessarily in order to make things easier.
So I often think that actually in some ways, by complying because something is making someone else's life easier, we're not actually making their life easier in the long run, because if they have to write in the notes every time, I couldn't do X, Y and Z, because for a good example is the kind of, you have to have a vaginal examination to get through triage.
I always think this is just a good example.
If you were to say no to having a vaginal examination to be four centimeters to make your way through the kind of magic triage of a hospital, then what would have to happen is a midwife would have to stop and look at you and watch you and see how you're behaving and what you're doing and how you're moving and how frequently these surgeries are coming.
And that takes a lot longer than a vaginal examination.
So it would be much easier for everybody that works in the hospital, if you just had an examination and then they could base the decision on that.
Now, in the long term, that's not actually making their lives easier because then that feeds back to the hospital, oh, okay, well, you can get the job done with just one midwife there, so you don't need another one, so we're never gonna fund or put another one in there.
And so when you kind of take a look at it from a kind of bigger picture, that it's not always helpful to everybody anyway, being polite or trying to...
But also when you then look at it from a trauma-informed lens, you say, hold on, you were essentially coerced into doing something that you didn't want to do that may have implications down the line, and you will then look at yourself and be like, why did I say yes to this thing?
And that then adds to your own feelings about yourself, if you're left with a negative feeling, you're thinking, but I said yes, so it's my fault.
If I'd have said no, then that wouldn't have happened.
And it's like, so it's actually a really vicious cycle that doesn't serve anyone.
So it's like, ah, hold on then, I'm not serving anyone.
And then if we look at it from a clinician perspective, what happens is, okay, so then you are four centimeters and you're let through the pearly gates.
But there's no midwives care for you on that side.
So, hmm, then what happens?
You've just done this thing that you didn't want to do to be allowed that thing on that side, but then actually there's no one to look after you on that side.
So then it's like, oh, okay, right, fine.
No one wins.
Yeah.
No one wins.
And so it's sort of like retraining your brain to kind of go, no, I don't need to be, I don't need to be a yes person.
I don't need to be compliant.
And I also don't need to be rude.
Because people think that when you're saying no, you're being rude.
We're taught again, no, we don't say no to people.
No is naughty.
You know, it's that, why is no naughty?
You know, if it was act like toddlers, you know, like my daughter now, she just tells me straight up no.
And I'm like, I bet the people that say no is naughty.
What do they say to their toddlers 24 seven?
No, no, exactly.
You hear it all the time.
Yeah.
And it's like, my daughter, she just says no with her whole chest.
She's like, no, I'm not doing it.
And I'm like, oh, there's a discomfort in me.
It's like, what do you mean you're not doing it?
But with her, it's like, well, I just don't actually want to, you know, I don't want to do that.
That doesn't make sense to me.
And so, you know, we then have to have a whole conversation.
I mean, let's be honest, there are times that I'm like, yeah, you are going to do it.
And then there are other times that it's like, well, tell me why you don't want to do it.
Like, why do you think that you don't have to do it?
And it's the exact same conversations that we need to be having with adults.
You know, why is it that you don't want to do this thing?
Why is it that it feels uncomfortable?
And I say to people, we need to go back to being like toddlers when we are given information, and we can say why, why, why, why, until the cows come home.
And it doesn't matter.
You say why until you are happy with whatever you need to understand.
But instead, we don't say why, because we're like, well, they only want the best for me, or if they're recommending it, then surely it's a good thing.
And I don't want to seem like, you know, I don't want to disrupt the status quo.
Essentially, I don't want to be the one that says no to this thing, or that takes their time and makes them have to explain, and, you know, all of this kind of thing.
So it's, you know, the challenges of advocacy are there, but they aren't impossible to overcome.
But it does start within, we have to kind of, you know, people come late in their pregnancies, and they're like, what do I need to do now?
And it's like, well, actually, this is now something that I want you to apply to the rest of your life.
Ask the questions, get the answers.
Don't feel like you need to comply and teach your children and speak to your partner about the same things.
You know, we don't need to say yes.
And we're not radicalists for saying no.
And I think where that sits uncomfortably with people is that it can feel quite selfish.
And I think there's definitely space to kind of flip, you know, selfish has a very, has very kind of negative connotations with it.
So what it is, is it's centering yourself and your baby in your experience, rather than considering other people that are pregnant at the moment, or the midwives that are working kind of at that moment, you are having this experience, your baby is having this experience, and the two of you are gonna live with the consequences of this experience, literally forever, both the kind of physical and the emotional.
And when you kind of put it in that perspective, it can feel like a heavy responsibility, which we've touched on, and that responsibility absolutely shouldn't be yours.
But sometimes that does give you back just a little bit of kind of confidence and power to be like, oh, okay, I am gonna ask why, because it's my baby that I'm doing this for.
And so I think sometimes centering yourself and your baby and thinking of that as a kind of a positive thing can sometimes make you feel a little bit more kind of powerful in those conversations.
Yeah.
And it's also just like, you know, I think we have to be really wary of the language we use around our own behavior, you know, and the negative connotations that a language has.
So where we're saying we're selfish, it's like, oh gosh, but it's like, am I selfish or am I selfless?
Because all of this is for this person, really.
You know, it's for yourself and your experience, but you are giving of yourself, physically, mentally, emotionally, to this tiny little person that you've got all this responsibility for, and there's a selflessness in it.
And part of that selflessness means that you have to advocate for them.
They are the true voiceless.
And so it's like, actually, hmm, okay.
The responsibility in that triangle is, yes, I have the least responsibility in terms of advocating for myself.
But then we flip it, and that woman goes right to the top because she has the most responsibility when it comes for advocating for her child.
And so actually it's like, am I going to let so-and-so, doctor, midwife, nurse, whatever, make me feel some kind of way that, to such a degree that I could potentially be putting my child in harm's way?
Who matters more?
And it isn't that you aren't necessarily going to put them in harm's way, but it's that you want to understand that you are not putting them in harm's way.
And so that doesn't matter about them thinking, oh yeah, you know, she's so annoying.
She's so irritating.
You know, doesn't matter.
You know, I would be irritating for my child.
You know, it's not a problem.
And I think that's where we need to kind of go, hold on, hold on.
Yes, this is uncomfortable for me.
And that discomfort is not a problem.
We don't have to be comfortable with everything.
When we are trying to challenge norms and challenge our own behaviors, it is sometimes very uncomfortable.
But you will find that this is just the beginning in your pregnancy, because it will be for the rest of your life where you might, your children may put you in uncomfortable situations that you have to go against who you are or the way in which you may manage a situation.
And it's like, well, why not start practicing now?
Yeah, yeah, absolutely agree.
So let's think on a kind of like practical sense.
If somebody is, let's start with kind of thinking about like antenatal appointments.
So conversations that you're having during pregnancy, whether it's recommendations that are coming up, whether they're recommendations that you have absolutely no idea what you think about them or the recommendations that you think you definitely don't want to do.
What are like some practical things that people can do either ahead of, during or after that moment to ensure that they are being heard, advocating for themselves and their babies and kind of making sure they're getting all of the information that they need.
So that first thing that is the why, the why and the what for, but also so it's constantly just be like, okay, until it sits right with you, then it's not right.
And it really doesn't matter.
So we've gone through that whole people pleasing, all of that stuff you don't want to be doing.
But also saying, actually, I'm just going to ask the question.
I'm just going to ask the question, even if it's a stupid question, whatever that means, I'm going to ask the question.
And so one way you can kind of prepare is you write down your questions, and you just say, well, I'm going to go in, I'm going to make sure that I know what I want to ask, and I'm going to ask them.
And perhaps you've got them on a piece of paper or on your phone, and it means that you can just look while you ask the question so you can avoid eye contacts.
All those things that perhaps make you feel uncomfortable, and you're finding ways in which to overcome that discomfort or to work with that discomfort, and you say, cool, or you say your partner, your doula, your friend, whoever's with you, you say, can you just ask that question?
Because I don't really want to ask it, but I really want to know the answer.
Absolutely fine.
Hand it over, say, this is a way in which you can advocate for me, ask the question that I don't want to ask, but need the answer to.
Absolutely fine.
Another thing is kind of recognizing that you do not need justification for your response to things.
So a lot of the time people say to me, okay, but how can I explain why I don't want to do this thing?
And I'll say, well, why don't you want to do it?
I just don't.
So why isn't that enough?
But literally, why isn't I don't want to do it enough?
Why do we then have to feel like we need to come with all the evidence and having done all the research?
When actually we know from experience, a lot of the time that we say, I've done my research and people roll their eyes and they say, oh, Dr.
Google, oh, a Facebook post, or whatever.
So your research is never going to be sufficient anyway.
Let's talk about the egos that are in these spaces and the element of superiority because, yes, these people have studied and they have a lot of knowledge.
And so when you come, I've done my research, and it then has a way of coming back on you and making you feel silly.
So sometimes you don't need to say, oh, I've done research.
You just need to say, no, I don't like the sound of that.
I don't want to do it.
So there's an expertise that I always think is completely underestimated, and it is the expertise that you have lived with this pregnancy since it began, and you've lived in your body for your whole entire life.
And that understanding of how you feel, which for a lot of us still, it does take a lot of practice kind of tapping into.
But that kind of instinct, that feeling, that thing that cannot be quantified, is still really valuable and as valuable as a research study that's published in a journal.
And if that's your reasoning, then that is absolutely as valid if it is the reason for you.
Yeah, exactly.
And I think, you know, when I had my son, when I was pregnant with my son, I was going for an HBAC, the home birth after caesarean section.
And the second time the consultant called me, I said, hi.
And she says, hi, you know, are you still planning to go through with your HBAC?
And I was like, yep.
She goes, you don't really need me to go through anything, do you?
I said, nope.
You know, that kind of like, I'm not, I'm not engaging in this.
I'm not engaging in this conversation because I know what I want to do.
I just want you to tell me how you can facilitate that, you know.
And so sometimes that kind of, yep, nope, it kind of goes, I'm not leaving space for you to kind of show your thoughts and to come to me with your evidence.
I'm just basically telling you, I'm shutting it down.
And that was a really kind of, for me, I was like, you have to say it like that.
You have to be confident in your decision making with yourself, not because you've explained it to anyone, but within yourself, you feel confident.
And when you are dealing with practitioners with that confidence, they might think that you're stupid and it means it doesn't matter because you're confident and they can see that you're essentially immovable in your conviction.
And that's what you want to work towards.
I think just on that, I think it is sometimes helpful.
Well, two things helpful to know.
Number one is that if you don't want to engage in these extra appointments, this, that or the other, every appointment, every single thing, every single conversation that you are having or engaging with during pregnancy is your choice, whether or not to attempt.
So if you have already made a decision, you feel like you have all of the information that you need, and you don't want to attend an appointment or engage in a conversation, you don't have to.
And so sometimes that is something that people might choose to do, to avoid that kind of feeling of being persuaded, even if they felt kind of that they were informed.
But also that within institutions, within trusts, within hospitals, there are sometimes better people to be having conversations with than other people.
So if you find somebody that you feel comfortable talking to, and then you're in a conversation with somebody that you don't feel comfortable talking to, say, just a kind of personal experience, we had an appointment when I was pregnant with my second baby and went for this consultant appointment where within the same sentence, she told me that she had no concerns for my baby, but that she would give me an induction at 38 weeks, to which, from kind of lots of experience, I just knew that there was absolutely no point in even trying to engage in a conversation because she already had an agenda.
She already had an opinion that looked quite immovable.
So I just said, all right, okay, then, well, thanks, bye, and then left.
And my husband looked at me like I was completely insane because he obviously knows me and knows that this is not something that I would just be kind of willy-nilly agreeing to.
But then just went away and was like, right, now I want to have an appointment with this midwife and I want her to put me in touch with a different consultant that I can actually have a conversation with.
And then went away and had a conversation that was actually like incredibly detailed, incredibly in-depth, incredibly nuanced, and was able to kind of come to a decision that I then felt comfortable with.
So if the conversation is like, you're really kind of going up against a brick wall, you can just end it.
You can just say thank you, goodbye, and then try and repeat that conversation with somebody else, whether that is kind of getting a tip for a consultant that might be a little bit more open and kind of women-centered, whether that is kind of finding out there's like a consultant midwife, which tend to be a little bit, they tend to be actually not even a little bit.
Often, they're much, much better at kind of centering choice and experience over kind of protocols.
And sometimes those conversations, you might not actually be speaking to the consultant, you might be speaking to a very junior doctor who doesn't have the kind of experience and confidence to support something that is kind of out of guidelines at the moment.
So it might be a case of actually repeating those conversations or shutting them down completely and going away and asking them to have them with somebody else.
Yeah, exactly.
And I think one thing it's important to note is that where you apply nuance to these situations, it is that different people are going to face different challenges with all of these things.
So if we look at sort of statistically speaking, the experiences and the risks to black women and the risks to brown women and the risks to women of mixed heritage are vastly different.
And it means that the way in which they advocate for themselves and need to advocate for themselves might be slightly different.
And I think it's a real kind of a lot of people find this one a sort of tough pill to swallow because what I've heard, oh, why are we talking about black women's experiences when so many of us have birth trauma and so many of us, but it's like where you can't apply nuance, that is where you'll say so many of us because we're all in the same boat, but we're not all in the same starting point.
And so our advocacy may not look the same.
So for example, there will be and I've worked with these women where they say, you know, if they disengage from services, social services are called.
So that isn't an option to be like, oh, I'm just going to disengage.
So that means that when you're in that appointment, you just can you can just nod.
You know, we can just not like literally, I do this with my husband all the time.
Like I'm acting like I'm listening.
I'm not listening at all.
And, you know, kind of again with that confidence and that like, it's OK.
But actually, I'm going to just tick this box of staying here for my overall safety, well-being, social social experience, I suppose.
And you just nod and then you go to where it's safe for you and you deal with it there.
And you say, right, I've actually got a doula.
I've got an independent midwife.
I've got, you know, people who've had their experiences that I trust and I feel safe with, and I'm going to deal with them.
So it doesn't always have to be, oh, yeah, bye.
I'm ending this conversation because that looks different for different people.
But it can also be this kind of like, I'm just playing this game with you.
You must think that I'm silly.
Like, it's fine, you know, they write in the notes, patient, listened.
You say, yeah, yeah, yeah, yeah.
And you get yourself out of there in a way that feels comfortable, that feels safe, and that feels that you are not at risk of further consequence for certain behaviors.
So I think it's important to note that we aren't all coming at advocacy from the same standpoint and also from the same lived experiences.
And this could be previous experience of birth complications, pregnancy loss, things like that.
We're all coming from different standpoints.
But ultimately, it comes down to the same thing is that I need to be heard.
And that might be from your own lips, or it might be from someone else's.
But ultimately, you need to be heard and you need to be centered and you need to be advocated for.
And I think this is where we're kind of challenged, particularly at the moment, within maternity services, and have been for many, many, many years, that a lot of people don't really understand the importance of true advocacy, and they don't understand necessarily who they are advocating for, and will advocate more for their trusts and their colleagues than for those who are in their care.
Now, this isn't bashing anyone.
This is, like I said at the beginning, practice and habit, and those types of, you know, senses of loyalty will have people saying things that perhaps aren't the right thing, but it's like, okay, well, you know, I've got this sense of loyalty to this doctor or this trust, or I understand that we're understaffed that day, so I'm not going to say yes to that, or, you know, I want to give my colleagues ease, you know, and sometimes when you're advocating for someone, this means that you might not give ease to those who you are working with.
It means that you might end up being a bit of a social pariah of some sort, and people don't want to work with that midwife because she just gives more work, because she gives more choices, because she, you know, makes life difficult.
And that's a really tough position to be in as a practitioner, because you have to go into work with these people every day.
And standing firm in your sort of belief of in women and in your role as a protector of their experiences and a facilitator of their positive experiences, while dealing with the wider picture of staff shortages, increasing induction, increasing caesarean section, increasing intervention, it can be a very difficult position to be in, but it doesn't mean that is any less important and essential.
Yeah, thank you.
That was all very, very amazing insight.
Thanks, Illiyin.
So I think something that definitely needs mentioning is how this might differ or play out in labour, if somebody is actually in labour.
Because we know that in order to actually labour, we need to switch off the neocortex of our brain, which is the thinking part of our brain.
The bit that everybody listening to this is currently got lit up, the bit that is basically in charge of the decision making.
And in order for labour to work, that needs to be shut down.
You need to kind of, I call it going like underwater, you very much kind of go totally inside of yourself, and you cannot think logically, you cannot engage in kind of conversation.
And so how can we ensure that we are still being advocated for in a time when we are so vulnerable and so sort of intellectually switched off, I suppose?
Is there anything that we can do to kind of help protect ourselves when we're like that?
Yeah, so, I mean, it's an interesting one, because we totally do have to switch off.
However, that is sometimes for a lot of people not very comfortable to do.
And this might mean that the labour is longer, that it takes longer to establish because of that inability to switch off, and that you can only really do that when it feels safe and where you feel comfortable and where you are confident in what's happening.
And that's fine as well to go kind of take your time to switch off and look around you and see if you're able to switch off.
And if you're not able to switch off to then look at what is causing you to not be able to switch off and then looking at how you can work.
So it takes sometimes it takes a lot of thinking and you know, the midwife relax, and you're like, I can't relax, I don't trust you.
And that's all right.
You build that and it's fine.
You take your time.
This is a marathon or a sprint.
And, you know, it means that you kind of you still have to.
And my advice was to go into labor thinking, think like you, you know, look around, you can do that and then give yourself that permission to go, okay, now I'm good.
So my labor with my daughter, I don't think I switched off ever.
I never felt safe with the people that were looking after me.
And it meant that I was on high alert.
High alert is a completely different thing.
And in order to get out of that, and I remember the exact moment where the midwife said, oh, you can transfer in for, because I was going for a home birth, you can transfer in for pain relief.
And that was like the first moment that I felt my shoulders dropped, because it meant that I was getting away from her.
And I was getting away from that situation that didn't feel safe, that didn't allow me to relax.
And so sometimes in these labor experiences, we have to be like, how can I get away from this thing that is not allowing me to relax and to kind of really immerse myself in it?
And that sometimes means that you have to say, do you know what, actually, I'd really prefer if you left the room, not because you don't like them or anything, but actually because that's not feeling like it's allowing you to relax.
Would you mind writing your notes at the desk in the front?
We will call if we need anything.
Absolutely fine.
No one's upset.
It's just like you're protecting your space and you're switching off that kind of thinking part of your brain.
Other times, because you sometimes don't even want to have to be making those decisions in labor, you prepare beforehand.
And so you get yourself the adequate birth support, which may be your partner, but also may not be.
For me, with the birth of my son, my husband was not there.
And that was a very active choice that we both made.
He was not the person that I felt could advocate for me in a way that would allow me to be able to switch off.
And I think that everyone has their role, and these are important conversations to have.
For me, it felt way more comfortable knowing that he was looking after our daughter, and that I was going to be able to fully switch off on that front.
And so it was like, right, I had a doula, I had my sister, and they were my safe people that made me be like, okay, you're cool.
You can relax.
To be honest, I'm not a relaxed person.
My doula said to me, I've never known anyone who is this sort of lucid in birth, but I don't trust anyone and I won't do anything.
They're like, close your eyes.
I'm like, why would I want to do that?
But it made me feel comfortable enough to be able to birth my son.
And so sometimes it is that preparation.
It is being able to speak to people, to be like, I need you to be a protector of my space and a protector of my peace.
And that will look different for everyone, but it's an important conversation to be having and a protector of your peace and protector of your space might be that they have to be the ones that are having those kind of uncomfortable conversations where perhaps you aren't gelling with your clinician and they have to say, do you know what, do you mind?
Or that actually they need to check themselves and say, I'm not going to talk to her because I know that she doesn't need me to talk to her.
I'm not going to rub her back in a circular motion that's actually really irritating because I know that she doesn't need me to do that.
You know, where they are the people that are there to hold that space for you.
And so my advice to people, and to Nathalie, is to look at who that person is, who those people are, and choose them accordingly.
So we take romance out of it, and we look at really practical things, like we got shit to do, you know?
Yeah, yeah.
And there was something that you mentioned there that I actually think is a helpful thing, both for pregnancy and in labor, which is to any time a decision is thrown at you, whether it's a kind of expected one or not, taking time away, it's almost always possible, except in like a very, very, very rare emergency situation.
Taking time away from the person who has offered the decision before you offer back an answer.
So it's so, so frequent that you come in 41 week appointment, they say, I'm going to book you in for an induction.
You go, oh, okay.
And then the induction dates booked in, and that's it, you've got it.
And you haven't had 30 seconds to actually consider whether this is a decision you want to accept.
Similarly in, I don't know, say you're on the labor ward, things stall and slow down, and they go, oh, I think, you know, we might like to speed things up with a hormone drip.
They brought it in, it's gone in your hand.
And before you really have understood what it is, you've already said yes to it because it's been recommended.
Now it's very, very, very, very rare that there isn't at least 30 seconds for you to just say, can we just have 30 seconds that I can actually let this settle in my head?
I can consider, do I have any other questions that I want to answer, that I want answered?
Do I, how do I feel about it?
Do I want to say yes?
Do I want to say no?
And depending on when this decision is being made, if it's 32 weeks of pregnancy, you might go, okay, well, we'll go away until our next appointment, and I'll let you know my answer then.
If it's 41 weeks of pregnancy, you might go, okay, well, I'm going to go home and sleep on it.
In my first pregnancy, actually, we had an induction, and a similar thing happened.
The induction was offered, recommended.
And I got to a point where I decided on our own that we were going to accept it, and then said, but first, I'm going to go home, I'm going to have a shower, I'm going to do my washing up, I'm going to eat my dinner and watch Friends, and then I will come back.
And just taking that space away from, whether we like it or not, it feels like those people have power, and it feels like there is a hierarchy in those conversations.
So putting yourself in a place where you feel most comfortable, if it can be out of a hospital, so if you can go home or even sit in a car or on a bench outside the hospital, it takes you out of the place where you feel like the kind of inferior person in those conversations, and really, really puts you in a position where you can feel like you're taking back a bit of that control.
And even in the kind of, we think we need to do an instrumental birth situation, it's still very rare that you can't go, okay, well, can we have 30 seconds where you just wait in the other side of the room and I look face to face with the person that's supporting me and we decide, is this?
Yes, is this?
And I think as well, even in those real emergency situations, you know, having worked on a labor ward, you see there are still things that need to be done within that time.
So, you know, it's kind of like, you still have a moment to just look.
And that's how you want to make sure that the person that's with you knows you and is your person.
Because I knew when I was giving birth to my son, if I looked towards my sister, I knew that she would just tell me.
And it was reassuring, we've got this, it's fine.
And so it's like, even if that's all you've got the space for, you just want to make sure that that is the trusting person that makes you feel safe, that makes you say, you know, I've got you in this, it's fine.
And, you know, like you said, take the time, take the time to be like, okay, cool.
And if they say, well, you know, there's a risk to your baby of, and you say, but okay, am I increasing that risk by?
Because in my work, I get a lot of people who say, you know, they told me that the baby was too small.
And so I needed an induction.
They booked me for an induction the following day.
I'm freaking out thinking, yeah, I need to get this baby out.
They're telling me we need to get the baby out.
And then I had a four day induction.
And it's like, oh, but you said that we needed to get that.
Well, and again, it comes back on the self of like, I said, yes, it's like, but hold on.
If we go back to the contextualizing that kind of thought process, it's like, well, actually, those who advised you probably didn't advise you properly.
Those who consented you certainly did not consent you properly because then you would have known that potentially the induction experience could be four days, which would then have led you to make a different informed decision, perhaps, or the same one, but with you at the helm and you being like, cool, no, this is what I want to do.
So again, from a trauma perspective, it is so much about how you're supported, how you're not supported, what is said to you, what is done to you rather than with you.
And so when I then speak to clients about all of this stuff, it's like constant light bulb moments because they're like, oh my gosh, I'd been telling myself it was all me.
And actually, I now know where I can allocate parts of my story and to whom I can put that on.
And I can also alleviate myself of the burden of responsibility, when actually how could I take responsibility of a situation that was never mine, because it's never given to me to take control of.
So those types of things, you know, it's all just very, very important when we understand the decision-making around pregnancy, birth, postpartum, and, you know, subsequent birth.
Because if I can give one piece of advice to people about subsequent birth, particularly following trauma or a birth that wasn't necessarily a positive birth experience, it's that you have to take accountability in one way, which is like, okay, I saw where I went wrong.
There's not a problem with saying, I didn't do this right last time.
Maybe you didn't know.
Maybe it was just a wrong choice at that time, but it felt right at that time.
Now in a different situation, like maybe that wasn't the right choice.
This time, I want to feel like I'm making the right choices.
How do I do that?
And that means engaging in processes, engaging in your own sort of self, what you want, what your needs are, and really thinking of the memories you want to have of that pregnancy and not about how you think others will remember you.
Yeah, that's amazing.
Thank you.
I mean, we could literally, I'm sure, continue talking all day long, but we're coming to you about an hour.
So I'm going to kind of wrap us up there.
There is one final question that we always ask at the end of the podcast, and it is, if you could gift a pregnant woman or person one thing, what would it be?
The ability to center themselves, which I think has been robbed from women generally, but particularly in birth spaces, like we spoke about that selfishness.
And it's like, actually, now I really, really want to give you the power to put yourself in the middle and everyone else around you.
And yeah, I would give everyone that gift because the power of having that means that regardless of outcomes and modes of birth and things like that, you were just like, but I was in control.
And if we can give anyone a sense of like being in charge of their own experience in whatever way, then it's incredible.
Thank you so much.
So, Illiyin, if people would like to find you, to listen to more of your excellent chat, to book a debrief, where can they access your services and you?
You can find me at mixingupmotherhood.com, so mixing.upmotherhood.com.
You can also find me on my website if you'd like to book a session.
I'm always, I try my best to answer DMs.
So, if you message me and you've got any questions, then come find me.
Also, if you want me to slate your snack choices, you'll find me there as well.
So, yeah, that's where you'll find me.
Thank you very much.
Thank you, Megan.
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