Transcript of Misconceptions on Midwives & America's Broken Birthing System with Elaine Welteroth

Lemonada. Welcome to That Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton, and today I'm talking to Elaine Weltzeroth. She's a New York Times bestselling author, an award-winning journalist known for her groundbreaking work at the helm of Teen Vogue, and Elaine has been a judge on Project One Way. Since then, She's turned her background as a journalist and a writer, plus her experience as a mom, into passionate advocacy in maternal health, largely through her organization, birth fund, which helps families with access to midwives. Hi.

Hi. How are you?

I'm many things.

Aren't we all?

That's my answer these days. I'm many things. My children are great, so distraught about the world, and everything else falls between those two That is the best answer to the question, How are you?

That I have heard yet. I wish everybody answered it that way.

It's true, though, right? I also feel, since you're also a mom, I have increasingly found myself speaking to myself the way that I speak to my children. Where I'm like, The only way forward is through. The only way through is forward. I'm like, I really find myself giving myself. It's like life lessons for Chelsea from Chelsea.

Yes. I feel like we could write children's books for adults based on how we now speak to ourselves. Honestly, I love that you brought that up. It's the best part of motherhood. The most unexpected bonus of motherhood has been a new relationship to self-talk. Oh, yeah. And self-love because you're so much more cognizant. The way you speak to your kids is the way they speak to themselves and other people. So then you're starting to be more aware of how you speak to yourself and other people in front of them. It just It makes you so much more conscious and gentle. Yes.

Although there are then moments, I did have a moment a couple of years ago where I was in a professional setting, and I did say to someone, Well, that wasn't a good choice. And I was like, Oh, my gosh, I'm so sorry.

I was like, I'm so sorry. I love that.

I was like, Wow, that is what I mean. That was a terrible way to say that. I'm so sorry. So then there are the pitfalls like that.

Right. You're like, I'm so sorry. Or when you say potty, I have to go potty or something. You're like, Oh, my God. I swear I'm a self-respecting adult. This is crazy. Totally.

I'm training for the marathon again. Wow.

Congrats.

Oh, gosh. Well, thank you. But I've realized the only place I would ever give myself pep talks before I became a mom was like, This is a great thing to do for me, was in marathon training. I'm like, You can do it. You can do it. Now, there's other parts of my life where I'm like, I can do it.

I can do it. Yes. I know. Are you in my house? In my mind, I swear this morning, this This morning, I say to my son every single day, he does affirmations like, I am smart. I am kind, I am brave, I am strong, I am loved, and I'm going to have a... And then we do a great day. And this morning, as I was getting ready, I literally, for the first time in my entire life, was like, I did it to myself, and I almost cried. I was like, This is such a beautiful practice that I'm instilling in him, and now I'm borrowing it and realizing how important it is for me, too. I'm so fast moving, but because of these babies, they slow us down just enough to give us little moments of just presence. Totally.

Well, thank you for doing this. All right. We open every episode with something called That Can't Be True. And today, that comes in the form of a pretty unbelievable and disgraceful statistic. The United States has the highest rate of pregnancy-related deaths among high-income countries. We lose over 700 women a year to pregnancy-related complications. The CDC, at least the CDC that historically we've had that's cared about real data, reports that 80% of those deaths, if not more, are preventable. Elaine, why and how is this happening in the United States of America in the 21st century?

That was my exact question when I heard that stat for the first time when I was pregnant. As you can imagine, I was alarmed, both from the perspective of a journalist who felt the need to chase down the answers, but also as a mother who was months away from facing my own birth experience. The other stat I would add here that is very staggering is that Black women are actually dying at three to four times the rate of white women.

And in New York City, it's nine times.

Exactly. And those numbers actually don't really shift much when we're looking at socioeconomic status and things like that. So I couldn't believe that this is the case, and I couldn't believe that we aren't talking about this more. I think that was what was really even more alarming to me. As a journalist, the fact that I did not know this meant that most mothers to be probably don't know this. I think we think of the maternal health crisis as something that's happening elsewhere in other countries. People say third-world countries, which I don't really use that term anymore, but the idea that it's underdeveloped populations that are facing this threat. The reality is that America is the deadliest place to give birth in all of the industrialized countries across the world. For me, as one fired up mother, knowing that there are known data-back solutions that we can be rallying around, that we can be investing in, that we can be waking up women and families to work towards. Then that gave me hope, and it energized me, and it inspired me to start birth fund, specifically because 80% of those deaths can be prevented with midwifery care.

I just happened to someone who struck out of the medical system. I tried to find a doctor that made me feel safe and heard in the context of this maternal crisis, but I couldn't. I went through eight different doctors, and I have access to the best in the country, specifically here in LA. I was shocked by how low the standards of care are for mothers. I pivoted to the path of midwifery care.

You and I have talked about this before. I believe I shared with Before, one of the funniest conversations I've ever had with anyone was when I was trying to raise money to support a startup here in New York City to expand access to midwifery-centered, OB/GYN-supported pregnancy care. I had someone say to me, Could you please tell me a little bit more about this innovation of midwives? I was like, Innovation? I was like, It's probably the oldest profession in the world. Where Where do you think people came from? Like thousands of years ago. By definition, at least some of us came into the world safely or none of us would be here. This episode is sponsored by Betterhelp. Who do you turn to when you need help? A parent, a partner, a friend, maybe the barista or the bartender down the treat. We've all been there. We've all needed help, but none of the above are options for a great licensed therapist. If you're ready to give therapy a try or looking for someone new, or if you have a friend who's looking to give therapy a try, check out Betterhelp. With over 30,000 therapists, Betterhelp can help you find the right match.

It's fully online, and you can pause your subscription whenever that's right for you. As the largest online therapy provider in the world, Betterhelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with Betterhelp. Our listeners get 10% off their first month at betterhelp. Com/cantbetrue. That's betterhelp. Com/cantbetrue. Can we go back to something you said earlier where you said you went through eight doctors, eight doctors before you found the right answer for you. But what was happening in one through eight for you? And then did someone recommend him in Wife, or were you googling, What else can I do? Tell us about that first experience.

Well, the whole thing was so overwhelming. To your point, there's so little we know about what it takes to bring a child into this world, both physiologically and in terms of navigating this system. That's very broken, in my opinion. And so as a journalist, I put my journalist hat on to try to help navigate this maze. And I documented the whole experience in this live series I did called Maternity, T-E-A, like spilling the T.

I almost spit out my coffee when you were saying that. You should be a writer You're so clever.

Those pithy turns of phrases. We need to keep some levity here. I do think we need to spill the tea on all the things because that's really the only way we stay blind and the only way we stay susceptible to being manipulated in the system is if no one's talking about it. I was live broadcasting, here is what I'm facing. I was crowdsourcing advice, frankly, in real-time from my friends, from my digital community. To be clear, Chelsea, I was not even considering midwives. I was fully conditioned to believe that there is one way to give birth in a high-income country, and that is in the hospital with a doctor, and most likely with an epidural and probably a C-section. I was fully conditioned to think of this medicalized birth as the norm.

Well, and I have to just break in rudely for a moment to say I had to have an emergency C-section, I'm so thankful that that exists.

100 %.

For women who need it. Also that there should be a range of options so that pregnant women can decide which are right for each of us and also to have access to emergency care if any of us need it when we need it.

Yes, 100 %. We should know what our options are. We all should have access to those options. And my thing is, I just didn't even know there were other options at all. I kept meeting with doctors that were referred to me by friends or people in the digital community that I was open with about this journey. I just had a range of not great experiences. Because just the way they didn't respect you, they didn't respect your questions, they couldn't answer your questions.

Correct. I'm so sorry.

Yeah. I was very sorry to learn that this was what the standard was because I was told these are the best doctors in LA. Anyway, the example that I can share with you is this was the eighth doctor. This is where I said, Okay, I am officially not built for this system or this system wasn't built for me. A doctor said to me, In the middle of my question, she stood up and said, You have exceeded my 2-3 question max per appointment. I've given you grace, but I need to leave. It was so jarring and There are many ways to communicate that you have to move on. But the way that this was handled was so disrespectful. This was the same doctor who I... She was a little bristled by that point because one of my questions which I think every birthing person should ask their doctor is, what is your intervention rate? Because what we know is that while there are so many mothers like you who need medical intervention, we should reserve doctors attention and energy and hands to deal with those true medical emergencies. But what we know is that childbirth, it's a natural process that doesn't always need medical intervention.

So many of the maternal mortalities are a result of unnecessary medical intervention. I implore anybody who's pregnant or anyone who knows anyone who's pregnant to just ask, What is your intervention rate? Just to get a sense of what their philosophy is. Because a lot of OPs are actually trained to believe that everyone needs something in terms of a medical intervention. This is what the doctor said to me. When I asked the question, she laughed at me for asking the question and said, I don't know what you think this is. You can't just come into a hospital, pop a squat, and have a baby. Everybody needs something. She walked out of the room. After telling me, I had exceeded her 2-3 question max. This was the final breaking point for me. By that point, I walked into her office, a shell of myself. Each of these experiences with these doctors broke something inside of me. I consider myself a fairly confident person and an advocate for women and the issues that I care about. But by that point, my confidence was so broken because it felt like there was something wrong with me or something about me that wasn't worthy enough of good care that my voice shook when I was asking the questions.

I was trembling. I thought, Am I not smiling enough? What is it about me that I cannot earn the attention, care, and trust of my doctor, when I'm in my most vulnerable state, nothing has ever made me feel more vulnerable than being pregnant, especially in America, with the maternal mortality rates being what they are and the traumatic outcomes. Even if you do come through childbirth with a baby, so many women, 50% of mothers, describe their births as traumatic. I didn't want that. And so all I was seeking was connection with a caretaker who I could trust in my most vulnerable hour. And the way that they dismissed my questions, the way that they talked down to me, the way that I was rushed, just made me feel like a number. And that was when I was upright and speaking. I couldn't I didn't trust them with my body when I couldn't speak or when I was... God forbid, I had a medical emergency and I couldn't advocate for myself. So it truly, at the end of that doctor's visit, I cried in my car. I wept in my car.

Were you by yourself?

My husband was with me, thank God, for every single doctor's appointment, and he witnessed it all. Some of it was so crazy to me that I was like, Thank God I have a witness, because I don't know if I would believe that- I would believe myself, yeah. I I think I would believe that these things actually happened to me. But thankfully, from the maternity community, shout out to the maternity community because so many of them referred me to midwifery. They implored me to go take a meeting at Kindred Space LA, which is the only Black female-owned birthing center in all of Southern California. I was very scared and skeptical.

Scared and skeptical because you didn't know anyone who had had midwifery care. You had maybe some like, misconceptions about midwives.

I think that I represent a lot, and I would say the majority of women who either, A, do not know anything or much of anything about midwifery. Also, if you do, what you know is very much framed through stigma. There's this sense that a midwifery is an unsafe or a less safe route. What if something happens? Then there's people who cast judgment on midwifery because of their ignorance. This idea that they maybe are less skilled than doctors, that their practices are less sanitary. I mean, it goes on and on. People throughout history have cast midwives aside as witches. There have literally We've been witch hunts around midwives. It's all by design to create a medicalized model that is set up for profit over patient care. We have all been conditioned to believe that this is the only one true safe norm for how to give birth in this country in particular. So there was a lot of unlearning I needed to do. I proceeded with caution. I had my first meeting with a midwife. The The biggest fear that I had going into this was, I don't know if I can do childbirth without an epidural or access to medical pain relief.

I have only ever seen people do it on television and in movies, screaming It sounds terrible. And I was just like, I'm good. I will take the epidural and just let's just get through it. And that's, again, part of the mindset that we need to shift around birth is we've thought of it as something we just need to Endure. Endure and get over, get past rather than really experience. And certainly, enjoy is not even in our minds. But from that very first conversation with my midwife- And did you click with your first midwife, or did you also have to interview eight? No. Chelsea, moment one was a radically different experience than any of the conversations I'd been having with these doctors in hospital settings. First of all, it was in her birth center with a beautiful garden in the backyard. She had breakfast and tea waiting for me and my husband. We took it out to the garden and we sat and we talked. God, we might have even talked close to 2 hours. She answered all my questions. We got into a deep conversation. She wanted to know everything about my family dynamics, my work dynamics, where my stress comes from, what I'm eating, what my fears are.

I mean, It was so thorough. I felt like this is a person who's truly invested in knowing me so that she can cater her model of care to truly supporting me. That was something I didn't even know existed. I didn't even know that was something we could expect. It felt like a gem. I was like, I had just discovered this gem in a pile of rubble. The experience just immediately reset my nervous system I thought, I want to explore this with this person. But I was very reluctant, and she'll laugh and tell you, I met her in my third trimester, and it wasn't until my 35th week, 36th week, that I finally was like, Okay, I'm going to commit to giving birth with you at home. God help me. Because my whole thing with her was, I love you. I love this model. For me, it feels absolutely right. But I was like, But is there any way you can bring an epidural to my house? That's the one thing. She was like, Yeah, that's the whole thing. We don't do that. You need to make the decision. Then I visited four different emergency backup hospitals because sometimes home births led by midwives, for no fault of either of them, for no fault of the midwife or the mother, sometimes you do need medical intervention, and so you have to do a A hospital transfer.

Like I said, I went to four different hospitals to make sure that no doctors are going to be meeting me for the first time. If there's anything I can do about that, if there's any control I have over this, I don't want a doctor to meet me for the first time under medical duress. I really was very thorough, and it took time to get to a place where I could trust myself, my body, and my midwife enough to let go of a lot of the stereotypes that I had in my mind around what birthing mom I am, what birth experience I'm supposed to have. I also think there's this idea that a midwife and a home birth mom is the mom who's a little crunchy, a little bohemian. She's vegan. She does yoga and meditation every day. Elaine, that's not you? Unfortunately, I wish. I aspire to be that lady, but I'm not. I'm like, I know we don't use the term girl boss anymore, but if we did, that's more of my vibe. I'm like, I'm very efficient. I'm very type A. I'm very much about, let's get the business done. I'm a journalist.

I want to understand everything. And so much about childbirth is about letting go of control and really learning how to trust yourself. And so that process changed my life. And one thing I have to do a little quick call back to the doctor who told me that I could not just walk into a hospital, pop a squat, and have a baby. Everybody needs something. And I went through childbirth at home. I meditated in the shower for probably five hours, completely silent, got to such a place of transcendence that I actually can tell you, and I don't want to sound like this woo- woo woman, but I enjoyed childbirth. I came out of the shower. Eventually, they sat me on the birthing stool, and Within minutes, they were like, the baby's coming. I had this moment where I imagined what that doctor said to me, and I pushed myself off of the birthing stool, and I popped a squat, and I had my nine-pound baby the way women have been having babies since the beginning of time. It was safe and it was empowering, and it was truly the most dignified experience I've ever had. It was really because of those midwives.

Now, this This is not the experience everyone's going to have. I'm not trying to sell anybody here on what to expect from their birth, whether you do it in the hospital or outside of the hospital. What I am here to say is there are options. If you are not receiving the care that feels good in your body, if you are feeling scared and unsafe at the hands of your caretaker, please, please know that you have the agency to explore other options. I am so glad that I did.

Elaine, while you were talking, I was thinking, I mean, that last doctor wasn't wrong. Everyone needs something. You just didn't need what she was offering you.

There you go. There you go. Everyone needs something, and I needed something different.

You needed something different. Also, thankfully, you live in Los Angeles and had your four backup hospitals as someone who has had two friends who started off having home births and then needed to get medical care and then later had other home births. I think they would say they're also really thankful they found the right answers for them and did all the work so that when they needed something more, they got it. When they didn't, they at least knew that it was there.

Yes. Listen, I want to just be so clear. Hopefully, it's already clear, but I want to say for the record, I am not anti-doctor. Birth fund is not anti-doctor. I think there is a There is a place for doctors, doulas, and midwives, and birth workers of all kinds to coexist. To me, the future of birth in this country is hybrid spaces for all of them to coexist within four walls.

Elaine, dare I say, a real system.

That really works.

Not a misnamed amalgamation of different disconnected bits and pieces. Well, we've talked a lot about birth fund. Can you actually just tell us what birth fund does? Clearly, I think we understand why you started it. It's evident. You said you were radicalized by your birth, and not in a political way, the way we often use that verb, but in a way to ensure that any woman anywhere in our country could find the right answer for themselves, Hopefully not the ninth time, but more readily. What is birth fund and what do you do?

I am the founder of birth fund, which was created in response to the maternal mortality crisis. We are a network of funders who are standing in the gaps for families who want access to midwifery care but simply can't afford the out-of-pocket costs. Because in this country, midwifery care is not covered by insurance, we step in and we pay their bills. We pay their medical bill. I think the beauty of how we work is that we are talking directly to the people. Yes, we talk to institutions like Gates and Pivotal. We've been very lucky to receive funding from, and we work with corporations as well. I started with a funding circle. I started with making calls to people from my network, from Serena Williams, who said yes right away and said, Call my husband, I'm in, and he needs to be in, too. He'll love this. We all know what Serena Williams went through with her birth journey. She's arguably one of the strongest women in the world and one of the wealthiest. Even she almost lost her life due to medical neglect. They did not listen to her. They did not respect her enough to give her the that she needed at her critical hour.

Because of that, that's radicalized her, too. There's so many moms in our network, from Kelly Rowland to Carly Claus to Ayesha Curry, LeBron James, Savannah James, John Legend, and Chrissy Tegan, that understand that we need to be doing more to support mothers, and we cannot wait. We cannot afford to wait for lawmakers to do the right thing, for philanthropists to fix this, for doctors and an insurance companies to change the way that their businesses incentivize them to work. I think there's something really empowering about that idea that everybody has influence within their community.

I totally agree. And listening to you, I understand why your mantra is, it's up to us to save us. In our closing minutes, I do want to move to something we call factor fiction, which admittedly is where I throw some things out to you that we're seeing online right now and have you react to them. Feel free to just say fact or fiction, hit a imaginary button on the screen while doing so, or tell us a little bit more about why it's important that we understand that, yes, this is rooted in a fact, or no, this is totally fiction. Okay. All right. Hypnobirthing. First off, what is it? And second, is it something you think people should try?

I definitely think people should explore hypnobirthing hypnobirthing, especially if they have a lot of fear around birth. I am not a hypnobirthing expert, so I don't want to give the wrong definition, but essentially, it is a practice that brings breathwork into the labor and delivery process. I only went through a couple of online classes, and I only did that for my second birth. I did it without having done the technical hypnobirthing training the first time. I can tell you it is the reason why I had that transcended experience I talked about. The breathwork was such a core part of getting to that place of total Zen and being able to ride those waves and to do so in a really peaceful state. So I'm pro-hypnobirthing.

I had never heard of it until I was preparing for this conversation. So also, again, everyone needs to be talking more about whatever it is that has helped us while pregnant and while giving birth. Okay, second, pelvic floor therapy. Is it something you think is helpful? What is it? Worth trying? Did you do it? Feel free to answer any or all of those.

Yeah. I also had not heard about I had a pelvic floor therapy until I was pregnant, and I had been diagnosed with a condition called pubis symphysis dysfunction, which makes it literally feel like your legs are falling off of your body.

Oh, my gosh. I'm so sorry you had that.

Thank you. That sounds terrible. Can you imagine being in that state while also being in these conversations with doctors who are just rushing me through? And I'm like, My legs are falling. And I have a bowling ball that's about to fall out of my body. No, It was not fun, but apparently, one in five women, I learned on Reddit, that one in five women experience SPD. Essentially, it's an overproduction of a necessary hormone that's released into body during pregnancy that loosens things up. But in this case, it's overproducing that hormone, and all the ligaments are way, way, way too loose. Standing up, rolling over in bed, walking, all become excruciating. Oh, my gosh. That was like first trimester before I even got the belly, and it only got worse with the weight of my pregnant belly growing. So all of that to say, having a pelvic floor specialist who could help me deal with the pain and strengthen different muscle groups that I didn't even know that existed, I didn't know I had, was game-changing, truly game-changing. I had SPD in both of my pregnancies, so I really relied on pelvic floor therapy to just help me tighten up all these other muscle groups to help support me.

In my second birth, I did much earlier because I knew more about it. I knew the tools, and it made such a huge difference. I was able to play tennis during my second pregnancy. I was able to continue working.

Were you worried the tennis balls were going to hit your belly or no?

Not at all. I was fearless. By the second pregnancy, oh, please. Nothing because I'm telling you, after you give birth, I'm telling you, after you give birth unmedicated to a nine town baby in your bedroom, there's nothing you can't do. You're just like, I can take on the world from here.

You're like, I got it. Elaina, I love that image of you fiercely playing tennis. And also, just think even the last few minutes highlight much more we all need to be talking about this. I don't have any siblings. I don't have any cousins of my generation. I really, similar to where we started the conversation, relied on my friends for like, What questions should I be asking or what helped you? I was also there reading like what to expect when expecting. I'm like, isn't this what my mom read when she was pregnant with me? Some wisdom truly is always relevant. Sometimes we need updates from science, research, or the ways we've broken down stigma. All right, well, I should pick up tennis.

Let's do a tennis date.

I would love a tennis date, Elaine. Yes, done. You can clobber me, and I will hopefully learn even one thing. I think the admonition to know that if we even positively affect change, save one life, then we've done something that really matters. Elaine, thank you for reminding us of that. Thank you for sharing your work with birth fund, your time with us today.

Thank you, Chelsea.

For anyone listening, you can find Elaine at ElaineWelteroth on Instagram. Thank you for listening. That Can't Be True is a production of Liminata Media and the Clinton Foundation. The show is produced by Katherine Barnes, mixed in sound design by Ivan Kraiev. Kristen Lepore is Senior Director of New Content, and Jackie Danziger is VP of Narrative and Production. Maggie Kraus-Shore is our Managing Director of Partnerships. Executive producers are Jessica Cordeva-Kramer, Stephanie Wittels-Wax, and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Eireantz Kahn, Caroline Lewis, Serge Sbalter, Barry Leroy-Westenberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. If you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that Can't be true with Liminata Premium. Subscribers get exclusive access to bonus content when you subscribe on Apple podcasts. You can also listen ad-free on Amazon Music with your Prime membership. Thanks so much for listening, and see you next week.