Transcripts For CSPAN3 After 20240704

Congrats to relations on your new book. Thank you so much. Im so excited for this conversation. Lets dive right in you. You know, im just going to start off sort of what people might end with in an interview, but know, you mention in the book that a lot of pregnancy books on the market are geared toward providing guidance and tips. But yours, however, has a very simple premise. It follows pregnant women at a birthing center, oregon. It is not a selfhelp book, so love to hear your thoughts on. Who this book is for in your mind and what you hope they take away from. I think that this book is for really anyone and i know that that sounds so broad and so vague but i really wanted to to write a book that could be as appealing to people who do not have children who dont want to have children who are maybe not at that phase in their life yet where theyre thinking about it or who maybe have already had their and are in a different kind of later phase. I mean, i was really hoping to write something that spoke to a sort of fundamental Human Experience that in some way, shape or form is all of us are here, but that in many ways remains somewhat taboo or or unspoken about or kind of not spoken about with this like real degree of honesty and any kind of real sort of public way. And i wanted to also have that conversation be framed in the context of other kind of reproductive experiences like abortion or miscarriage or pregnancy loss, which are even more widespread and common. So well, of course, i would hope that people who are navigating some sort of a conception or pregnancy or, you know, birth or postpartum journey, of course, i think that and i hope that the book speaks to them, but i also really hope that its for anyone who has some measure of of interest or curiosity about ultimately how were all here right. Right. I mean and what what timing. Right i mean, considering all of the the state legislation, abortion and reproductive rights, did you imagine that your would land at this kind of it within this storm of stories around abortion and reproductive rights . No, definitely not. I mean, i, i reported on abortion as well, as Maternal Health care, you know, extensively as might be since around 2015. And so i was very much, you know, paying attention to what was happening with abortion legislation and laws specifically and following all of that. So, you know, i think with with the Dobbs Decision and in the lead up to it, i sort of, you know, like many people think who were pretty immersed in the of abortion rights space, i think i had kind seen it coming just because i reported on what happened at the state level. But even with that context, even with that reporting experience, its still came as quite a shock. And then also, you know, could not have anticipated this sort of groundswell, i think, of interest in Maternal Health care and, you know, specifically think in Racial Disparities and inequities in Maternal Health care. That has been very much emerging in a very public way, kind of around the same time. So, yeah, its im really excited to be able to put the book out there. The world at this moment, even. Theres a lot about this moment that is really alarming. Right. Right. I know journalists hate to do this and insert themselves into story, but id love to hear about your birthing first before we dive into the book. My own personal one. Yeah, i dont have any children. Oh, okay. So sorry, i dont have one. Ill take that back. One of the things you highlight in the book and i mean, i guess this is why i was asking that, you know, is how inefficient and ineffective the American Health care system is when it comes to childbirth, especially when compared to other industrialized nations. Talk to me about some of the ways in which the system fails. Yeah, i think that, you know, such a big of complicated question and theres couple of different ways to answer it. That of everything is sort of connected and certainly one of them is cost. I mean ah i think its something, i think its about 111 billion thats spent on maternal care in the us every year and all of our procedures, you know, like how much a vaginal birth in sort of total costs and how much cesarean costs are much more expensive in the u. S. Than they are in some other sort of pure countries. And so were just spending a lot of money and then spending it for outcomes that are also poorer than a lot of those other countries that are spending less. So, you know, the us has some the kind of worst rates of Maternal Mortality, adverse outcomes among poor countries and our seem to be getting worse and we have pretty high rates of interventions, medical interventions, you know caesarean sections and inductions and those sorts of things which then contribute to the costs. And then of course its also related to our insurance and people who are or underinsured or the costs that people incur to navigate the Health Care System. And so, you know, all of those things are related, but there also sort of like so many ways to approach that question, which, you know, something, i tried to do in the book was to bring in a lot, you know, lets consider this avenue of our Maternal Health care system. And lets kind of consider this one and and lets look back into history, see where the roots of this sort of system is right . Mm hmm. Yeah. I mean, you mentioned those issues and. Theyre all compounded for women of color, particularly black women, right . I mean, talk to me the Racial Disparities, not just. Sorry. Talk to me about the disparities. Racially, which, you know, we know the us is not that great compared to industrialized nations, but its even worse for people of color. Yes, absolutely. And the reason that our Maternal Mortality rates are sort of as high as they are are because of those racial. And so if youre sort of, you know, separating out i mean, pretty much, you know, white women, then the rates are going to look even worse. And there are lot of reasons for that. You know, one of them is medical racism. Its the type of treatment and care that people of color and sort of as i mostly focus on in the book, black women experience when they engage with the Health Care System whether theyre taken seriously whether they given the treatment and the sort of attention that they deserve and so theres this sort of little phrase that that one of the doctors who i had encountered in my research talked about which was too much too or too little too late, meaning that patients are either getting certain procedures or sort of more things than they need or more surgical interventions which can create additional complications or theyre theyre being ignored and theyre not having their meet their needs addressed. And so you have that context of kind of the the health care that people are receiving. And then youre also combining that with just whats known as weathering, which is sort of the chronic, the result of the chronic stress existing in america as a person of color or as in this case a black. And the ways that that really have an effect on the body, the ways that that can then manifest in terms of pregnancy and childbirth and. Right. Yeah its a real serious problem. Right. I mean, i actually just did did a piece on weathering and i did a lot of research it. And you know whats interesting to me is that it cuts across socioeconomic class, too. Mm hmm. Right. Yeah. Throughout your book, you also trace the origins of obstetric x into gynecology, which, again, is fraught with racist history. Talk us through the origins. Right. So in the us, you know, kind of in the beginning the early days, midwives were the norm. They were the primary caretakers of people who were pregnant and giving birth. And so midwives tended to be elder women in the community. They tended to, you know, already have had their own children. So they had been through process and they were respected and trusted and they would care for people in their homes. And, you know, that would be true. And, you know, it was different in different types of communities. But that sort of role of the midwife, which kind of loosely comes from like the phrasing of with women. And it was a pretty important and sacred role across communities and it was, you know, knowledge was passed down through generations and it was very much a kind of learn by doing sort of model. And then as medicine in the us more formalized and as there was sort of like a, you know, a quote unquote medical established, it began to emerge in a cohesive. Male physicians started look at childbirth as something that they were interested getting involved in. You know, before it had really been this sort of more insulated kind of to woman thing and they realized that, you know, people are having babies all the time. This is a pretty Good Business opportunity. But then also i think saw some opportunity to apply some of the knowledge that they had learned through medical schooling or training that they had received to apply that to childbirth. You know, once the male physicians got involved, that really set the kind of change in motion. And so then you had male physicians who were entering peoples delivery rooms at home. So really was their bedrooms. And so a midwife might also be present and it was still a home practice. But then especially for middle upper class families, you had that male doctor there who was sort of the man of science. Man of science. And then over time, as they gained more power, there was really a Concerted Campaign to stamp out midwives who were, you know, sort of seen as like these lowly women. And there was, of course, a lot of racism and misogyny and xenophobia that was wrapped up in this really concerted effort to stamp out midwifery and, create sort of, you know, a birth system that was really in the hands of male physicians. Right. And you mention in the the increasingly clinical approach to, childbirth took on a moral political shape, too, right. I it was associated with feminism and progress. Can you explain that . It was its really to learn some of this history because the fight for pain relief, childbirth was such feminist issue for a long time. And so pain and suffering was sort of, you know, part and parcel of childbirth and just this burden that women had to bear and, you know, this is what you have to go through. And so when theyre started to be options for pain relief, that emerged rather that was chloroform or ethers with those earlier methods or, some of the ones that came later, there was actually some some real resistance to it. You know, on the part of the church or even on the part some physicians or communities who were like, no, no. Like childbirth is meant to be really painful. And so when what was called twilight sleep emerged, which was the sort of, you know, anesthetic cocktail that, didnt actually provide pain relief, but it provided like amnesia so that you wouldnt remember exactly what had happened. It pioneered in this clinic in germany. Once american women started finding out about it, they started going to germany and to sort of have this twilight sleep, they didnt remember the pain of childbirth and then went back to the us and were, you know, kind of praising it and passing on the dogma and so then there was like this real feminist where they held meetings in, campaigns to try to convince doctors here that they should be providing this, this twilight sleep. And so that feminist campaign back then was really around pain relief and childbirth and the sort of issues of childbirth have evolved little bit over time. So, you know in the 1970s and eighties, there were some feminist campaigns around. We think that male partners should be allowed in the delivery room instead of having them down the hall in the, quote unquote know start club, pacing around with their cigars or whatever and or, you know, the desire to not be like have everything completely shaved before. And so feminism really has involved in a of the gains that weve made in terms of kind of making childbirth feel like a more, i guess, humane experience. But then at the same time, i think that theres also been some distancing in some cases the feminist movement and childbirth, i think maybe particularly kind of around second wave feminism because there was idea of like were sort of trying to liberate ourselves from only being in this role as as wives and mothers and caretakers. And so, you know, there were sort of other causes that maybe seemed like they were more central to to that particular fight. Right. Right. You know, since book is set in a birthing center, you bring up a lot of, you know, the medicalization of childbirth. Im going to cite a few figures from the book, one in three babies are born via surgery. 52 of women said they received patoka. And at some point during labor, which speeds up labor, 75 got an epidural and i was quite blown away to learn that. At one point doctors were encouraging that every should get a surgical cut the vaginal opening to theoretically make it easier for the baby to though that has been shown to be a problematic. So giving birth in a birthing center, which you describe as almost the exact opposite experience, all of that. Could you walk readers through who might be unfamiliar with actually a birth at a birthing center looks like i really think of a birth as a sort of midpoint between home birth and a hospital birth. And so Birth Centers can there, you know, primarily domain of midwives whether thats a direct entry midwife or whether its a nurse midwife, someone who is a nurse, but then received or earns an additional midwifery credential. And so at a birth center, at least the ones that ive encountered, the ones that ive reported on, they look sort of like almost like a, b and b or something. You know, you walk in usually a lobby with some cute furniture and artwork plants, and then each of the rooms dont really feel that clinical know instead of a hospital bed or like an exam table, theres just going be a normal bed often. And there are, of course, medical supplies that are on hand. But at least in the centers that i was on, theyre sort of tucked away. Birth centers dont do surgeries, so theyre not performing csections. They dont administer epidurals. They rely on other forms of of kind of whats called nonpharmacological pain relief. So that might be Something Like a bath tub because can be can be soothing or some centers have nitrous, which can provide some temporary pain relief. And so people who go to Birth Centers are generally, you know, meeting with midwives on the same cadence that they might go meet with their obgyn, the appointments are typically lasting an hour. So theres you know the clinical stuff can be over in maybe 15 minutes and then the rest of the time can just spent building a relationship between the and the client. And so when you have a homebirth, all of the supplies that are required have to be brought in. And so thats usually a combination of the client supplying things or buying certain things, making sure they have enough towels around. And then its also the midwives bringing their supplies in and so at a birth center, you really have to come with any of your own stuff. That stuff will be on hand of like at a hospital, but also, you know, things that are there to that are tools, right . That people are going to use as part of the birth. So, yeah i think of it as sort of a Halfway Point or a midpoint. And that was part of what inspired to set the birth. The book a birth center was because i was interested to explore well, what is home birth look like . What does Birth Center Birth look like . What does hospital look like . And so i felt like picking that sort of middle option, i guess was was a way to then be able to compare it to those other options. Right. Do we know success rates and safety records, birthing centers . Yeah. So theres, you know, a major, major big study that found the rates are comparable to what you might expect to find at a hospital in terms of mortality. But the rates of are much, much lower and the costs are much, much lower. And theres also a similar study that was conducted around homebirth. And so with safety rates, its a really interesting question because theres theres all of these other factors that go into it. And so, you know, that question of like, is this safe . Something that i know all of the three characters in my book asked its course the question that i asked i think that anyone asks and the answer is yes that it is safe and in many ways it can be better. However, it is sort to achieve optimal safety. There do need to be certain measures that are in place to to promote that safety. And thats things integration with hospital or relationship with the hospital, at least the ability to transfer a client to the hospital in the event theyre able to need it, you know, safety can depend on the ways in which the midwives are trained or the things theyre able to do at a center like at that birth center. Are they able administer pitocin in the event of a postpartum hemorrhage . And so there are you know, its sort of its a little bit challenging all of this to make really blanket statements because our both our Maternal Health care landscape, our midwifery landscape is pretty fragmented in the us. And so, you know, a center might look one way in one place and be very different in another. But i would say for the most part its sort of all of those things are in place like those relationships with doctors in the event you need a transfer, the ability to do certain types of kind of medications, interventions the center as needed then yeah the safety really is comparable right i wanted to come back what you said earlier if like at birthing there is the rate of intervention is much lower. And i wanted to give viewers a sort of example of intervention. I think there was a statistic, the book, about how many women give birth while lying on their back in hospitals versus a birthing center. And i wonder if you can explain that is such an important statistic lying on your back versus being able to walk around. I think when you sort of look at how people before hospital birth was was really the norm of sort of the positions in which people would give birth. What you find is that laying on your back is not really the most common thing you see. And, you know, that could be Something Like if youre looking at artwork, you know, from, you know, antique or ancient artwork from a long time ago or a certain kind of fertility type figurines, like its really common for people to be squatting. Its common for people to be on their hands and knees, maybe on their sides. And so at least for me, growing up, that was through movies or tv. The scenes are always of someone on their back, you know, with their knees up, kind of by their ears, doing whole pushing thing and certainly people like left to their own devices that be what ends up feeling the most comfortable, but that that position is one that is sort of the easiest for you know, in this case lets say the physician or the doctor because they can then be at the foot of the bed and they sort of have like this angle and they have room to maneuver their hands or whatever their tools are. And so for a lot of people in labor, thats not the most comfortable way to be, but thats also, you know, if you have an epidural, thats going to be the position that youre going to be in. And so i think one thing that Birth Centers and sort of home births really try to promote is and lets, you know, lets try to get in this tub or why dont we try being on our hands and knees or why dont you try hanging this cloth over a door and kind of leaning into it, these other positions that can both help to relieve some of the pressure and potentially help kind of move the baby down, right . Yeah. You you write in the book, 2017, one out of every 62 births took place outside the hospital and that number grew somewhat during the pandemic. So know birthing centers and midwives are starting to serve more and more mothers. I wonder if you can to us about how after being sidelined they were able to, you know, come back and do more and more and also how state laws affect their ability to do their jobs right after, you know, kind of picking up almost where i left off earlier when i was talking about some of that history, there was a Concerted Campaign in the u. S. To really stamp out midwives in midwifery, except for a period of time in places where they were the only real providers of health care. And so in that case, and really particularly the thinking of the south, where the majority, the midwives who were referred to as grandma wives, they were taking care of their communities. They had incredible rates of sort of safety and and of health and so you know i read a whole slew of midwifery memoirs the book and referenced some of them. But, you know, the midwives like Margaret Charles smith, ernie logan, who delivered thousands of babies and just remarkable success rates. And so, you know, there were sort of these is communities, these clientele populations that werent willing to serve, you know. They were sort of happy to let midwives continue to be the caretakers for those communities. And then in, for the most part, around the, you know, partly in result as a result of medicare and medicaid. And so that there were more people, you know, poorer people were able to have access to insurance and have greater access. The Health Care System, which was also effect of the Civil Rights Act with with integration, that kind of created the opportunity for states to actually get rid of the practice of midwifery. So they would stop issuing midwifery licenses, which meant that if you were practicing as a midwife without a license, you were kind of like a rogue practitioner and there was a really concerted effort, as i said, to stamp out midwifery. But then around the same time that that was happening, there was also a resurgence of interest in midwifery, but that was predominantly among white kind of middle class women, many of whom were kind of associated with the hippie. So there was a lot of this, you more ideal of more authentic living and getting back to the land and not kind of wanting, you know, the man involved in the birth experience. So there was this resurgence of midwifery around that same time and so when it reemerged it was kind of more of like a white lady thing and that has been the pattern for the past couple of decades. But i also think that really starting to shift and theres a lot of really incredible work thats being done on, you know, black midwifery and community Birth Centers, even Just Community tool organizations or organized that are there. And so, you know, state laws really do have a big impact because. They affect who is able to practice or if people are able to practice at all as midwives. And before i started working on this book, but one of the the sort of stories that i reported that that got me interested in the subject was about alabama women who crossing state lines to give birth with midwives. So at the time, alabama did not allow the practice of direct entry midwifery. So that meant that if you wanted out of hospital birth, you had to go out of state. So most of the people that i interviewed that story, they were going to tennessee, so they were renting cottages over the state border. They were driving hours, they were in labor, many of them in order to make it to the cottage. The midwife could meet them there. And that goes back to sort of the safety i was talking about before, too, you know if youre criminalizing or preventing the practice, midwifery people are going to go to Great Lengths to access it. And then, you know, that creates this whole issue. I think today theres like 13 or 14 states that dont allow the practice of direct entry midwifery, but slowly, you know, every year or so, every couple of more states are changing their laws. And thats really important to making midwifery more accessible, which i think is really important. Right. And in it is inaccessible with medicaid in many places, right . Yeah. A lot of public and private insurance dont any form of of out of hospital midwifery care at least so oregon is i think a little bit unique in that many of the private insurers will cover out of hospital birth or particular practices and then the state public insurance. The medicaid does ostensibly cover it but i know through reporting and speaking with folks at the birth center that the reality of that can be quite challenge. So actually getting having a patient get approved to be eligible for id or actually getting birth center reimbursed. Its not you know, its not like a perfectly smooth or seamless situation, but certainly thats a crucial step in order to make midwifery accessible, because otherwise people have to pay out of pocket. So even if its cheaper terms of total costs than a hospital birth still might be, you know, 3000, 5000, 7,000. Thats a lot money, right . Right. So is that why you chose oregon . Is it legal and covered by medicaid in oregon . That was part of it. I mean, i live in oregon. I live in portland. Certainly that was also part of it. But yeah, i think that i interested in setting the book in a place where Birth Centers and midwifery were fairly accessible and sort of normal like where there were a lot of people who were interested in where there was some history in the state of the practice, where there was the emphasis in place. Because i think one of the points that im trying to make in the book, how i believe through the reporting and research that ive done that one of the ways we can address many of the most entrenched problems that our Maternal Health care is by integrating midwifery more fully into it and by making it more accessible. And i think that in order to sort of consider that, i wanted to make sure that the book was in a place where some version that is, you know, is effect of sort of like this is what could in some measure be striving for right. Talk to me about the three women you pick and you followed for nine months. So my starting point was to out kind of the birth center where i was going to start. So i was drawn to angelous in part because they were busiest birth center in the state at the time. I was trying to figure out where i was going to set the book, and the centers owner just incredibly open and supportive and willing to participate in the project, which was huge. You know, i really needed the full buy in if i was just going to be lurking around in a birth center and sitting in on appointments and just, you know, like sitting in the kitchen while everyones gossiping and drawing, you know, eating snacks and stuff. So i really just kind of needed a place where they were willing let me be very present and angelous was certainly that. And so jennifer, who is the centers owner, she told me to go in for a tour and i went in for a tour. And the person who answered the door checked me in and gave me the tour was jillian, who was one of the characters in the book. And so that day i met jillian, i didnt actually i dont think i learned that she was pregnant on that day. I think we just she gave me this lovely tour and then i, you know, met with jennifer and kind of went on with the day. But then when i found out that jillian, pregnant with her first child and when i found out that she was and an aspiring midwife herself, she had completed Midwifery School into midwifery apprenticeship hours. She just hadnt received her license yet. She hadnt taken the test yet. And i thought that that would be a really great opportunity to consider the history midwifery and what it takes to become a midwife of through her story of learning this and pursuing this as a practice as well. And she also, because shes a midwife and passionate about it, was really excited and kind of invested the project, which was something that i like was important since there was the reporting to take a long time, i was asking so many really intimate questions. You know, i needed people who are excited. And i also thought it was because gillian was, the office manager, she just had a really perspective on the kind of the life and the daily operations of the birth center itself. So that was how i found gillian. And then to find the other characters, i was really doing a combination of sitting in on appointments, so i would shadow midwives throughout their day as. They met with clients and did prenatal and that sort thing, and so i would encounter patients way or clients that way. And then also i asked angelous to sort of pull together a list of maybe a dozen or so people who they thought might be interested in participating in the book. And i contacted of them and did interviews with all of them, and was how i met tanika and think. I knew from our first conversation that i love for her to be a character. She made me laugh so much and i loved the way that her mind had engaged with the pregnancy is an incredibly creative person and she loves sci fi and fantasy books and so she would just make these, i dont know, metaphors, analogies or something or these little jokes that i just thought were so unique. I really appreciated kind of unique voice and perspective, and i was also drawn to her story. Tanika was a nurse. And so she was someone who was very much interested and involved in the medical and had a tremendous amount of respect the profession. But then also had spent so much time reading and doing research and learning about many of the flaws in the system which were things that i wanted to address in the book. And she was very invested in changing those or working for improvement or sort of using her role as a nurse to make sure that that patients like her were really cared. So i thought that that position of sort of one foot in the burn centers space with her own pregnancy experience, but then also one foot in the medical field through her nursing really provided dichotomy that i thought would lend itself to some really interesting kind of explorations. And then my third character, alison, the little bit of an outlier in that she toured on to lose and considered it but ended giving birth at a different birth center. So i actually met alison because i posted i think it was a what to expect forum like one of those pregnancy forums in the portland one early on, maybe even before i had met with angelous i just made a post and said, im a journalist and im working on this book and if anyones interested, you know, feel free to email me and. She was one of the people who reached out and i was immediately drawn to her. I for two reasons. One was that i she had had an abortion experience and a miscarriage experience prior to that pregnancy. And i knew that that would be an opportunity to present abortion and miscarriage or pregnancy loss and pregnancy and birth and all that as all part of the same spectrum, which i mentioned at the beginning, was really important. Me and then also alison, not someone who ever thought of herself a birth center or midwife person. She really had always assumed she would go to a hospital. Everyone and her family and her friends were all, you know, had gone to hospitals to give birth. And so it was a traumatic kind of miscarriage that really changed her thinking and led her down this different alternative path. And so because really took almost a shifting of her view for her to consider midwifery and out of hospital birth, she approached the process of figuring out where to go with such rigor and she was so curious and she was asking a lot questions and she really was tremendously thoughtful about single decision that she made which i thought would make for such a compelling kind of character to follow, because we could talk through each of those decisions and those kind of milestones, right . And its that for all three of them, this was their first child. Mm hmm. Why . What was the thinking behind i wanted to present pregnancy. Birth as something that is the sort of starting point is. This idea in some ways that this is something thats routine and mundane. Right. It looks like millions of babies are born in the us every year you get to a certain in your life and it just seems like everyone you know probably is having babies going through this process and yet at the same time its actually like this really kind of incredible weird, alarming stressful, bizarre to go through to. Theres so much that people dont know. Everyone reacts differently. Your whole body is changing like theres blood going through your body you were used to or like your are bigger. Youre really not. I mean, whatever is right, i mean, its just like this very experience where body is sort of like changing out from under you and you. For some people it feels, i think, great the whole time. I think for a lot of people it really doesnt. And so i think i wanted people who hadnt been pregnant and then given birth before because they were discover growing, they were embarking on this process of discovery like, what am i like as a pregnant person . What my body involve in like, i didnt know about this test or scan, what is this . Because i do think for a lot people, once youve done once, even if subsequent pregnancies are really different, you still kind of know what to like. Youve gone through it and so i really wanted people who were doing it for the time because i just felt like would be this sort of measure of discovery and intense that i wanted the reader to be able to participate in as well. Right, exactly i think being a journalist myself, i was really fascinated by the way you structured the book. Each chapter dedicated to slice of each womans life and then you braided together. Did you always envision the book shaping itself that way or did it happen organically . And also how many hours of recording do you have . Oh, i actually, dont even know. Definitely so many, so many hours and also so reporting notebooks and. So yeah a lot a lot of a lot of material to work through. Right. I, i think the answer to the kind of braiding question is yes and no. I always that i wanted to have both closely reported narratives and a lot of Research Context and you know, statistics and numbers. I knew that i wanted the book to have both of those things, but i think figuring out exactly how they were going to knit together was very much something that i grappled with while writing and then that we, my editor and i were working very closely on during the editing process. And so, you know, when i turned in my first draft and maybe this is like very sort of, you know, journal in the weeds in the first draft, i didnt have them quite as tightly braided because i thinking maybe it would make sense to stay with character the whole time through within each section so that you can kind of really invest the time in that character. But then as we were editing, it really became. That doing that sort more like really aggressively braiding them together would sort of enable you cover a lot of issues, keep the momentum and, kind of the pacing going and i was, you know, in my character selection, as ive probably touched on before, i there were certain topics and themes that i knew were really important that i wanted to explore. I was certainly thinking about who was going to choose as characters with an eye to able to then have it be a somewhat segue into those contextual issues. So yeah, i mean, it was really something that took a lot of time. Make sure that we were doing it in a way that was effective and not, you know, i dont know, disruptive or confusing. So. Right. And i mean, commitment of time and i guess emotional investment at some point to write like following three women for nine months. What that like for you and seeing a seeing birth so up close for all three of them it really felt like such an honor and a privilege. I mean i im used to reporting on really intimate, sensitive things, you know, having reported on abortion and reproductive. For eight years or however long, like im used to being in this reporter position where im asking people who i dont know very well to tell me about whatever is going on and the very things that they maybe havent told people that theyre very close to. So that that was sort of like a muscle, i guess i was used to using. But the Time Commitment was new and so it was a constant sort of navigation of trying to respect their boundaries and trying to make sure that i wasnt being too intrusive or taking up too much of their time because they all worked and they had other families and commitments, but then also trying to make sure that i was getting all of the reporting that i needed and that we were building a relationship and i was so impressed by how much they were all willing to share, like i dont know if i was in the other if i would be that honest. I mean, it was just such a wonderful to sort of be able to have these conversations them and have them be so open and. You know, they all chose to use their first names in the book, which was something that we talked about and. I was if they had wanted to you know, maybe change their name or go by a pseudonym, i was certainly open to that discussion. But i think that in spending so much together and and really being as transparent as i could be about, what my goals were with the project and, what i was hoping to include and all of that i think i hope that everyone was sort of very aware of, of what was going to be included and why and i think each of the characters felt, like, even though they were being incredibly and raw in some ways, that that was because they would have loved to read something that was so vulnerable and raw while they were navigating this. You know, they wanted other people to have the benefit of of of reading this honest accounting of how hard it can be to go through this. Was there anything in the reporting i mean, i think you went in knowing what you wanted wanted these stories to tell you know, tell the Bigger Picture of, childbirth in america today. But is there anything in that reporting process that surprised you . I mean, youve doing this for so long now. I mean . I dont i feel like its probably fine to give, you know, a spoiler, which is that each of the three characters in the book all give birth in a different from where they started or plan to. And that was something i wasnt expecting. So, you know gillian wanted to have a home birth and then alison and nico were both planning a Birth Center Birth. And so during the pregnancy chapters and during that reporting process we all spent a lot of time talking through why they wanted to give birth, where they were planning to, what their concerns were, anxieties were about a potential transfer because transfer is from out of hospital to a hospital for first time. Mothers are pretty common. I dont remember the exact number. I think its something maybe like 16 . So certainly midwives are making sure when theyre talking with clients that theyre being theyre having conversations about the fact that you might end up transferring to the hospital and that might be because you you need more potent pain relief and thats or it might be because theres some sort of a complication that comes up. And so its certainly like the idea of a transfer, something that was on each and every one of the characters minds. But i did not expect that each and every one of them would move locations. You know, even just like statistically speaking, thats not thats not what you would. But not not perfectly kind of normal, i guess. And so it was sort of funny the way that it happens because i was at gillians birth, i was in the birth cottage at her birth, and i think it was maybe after the baby had been born already. And we were just kind of hanging around. And i get a text from tanika who was telling me that she, you know, just kind of was emerging her transfer to the hospital and what had happened there because i texted her a couple of days before to check in and didnt hear back. So i thought, i wonder if, you know, this is. Yeah, because shes in labor. And so just was so surreal to be like in in the room where gillian had just given birth and then find out that could give birth on the same. But it also moved locations. So yeah i think thats really what surprised me the most was just i had known about unpredictability of birth and thats something i engaged with a lot is a theme in the book. But then to really sort of be like in it like that was pretty cool actually. Yeah. And i think i mean the midwives are of course the star of this book in some ways. I mean, i want to talk about their, i guess their working conditions like in terms of wages, terms of being to take breaks. I think were in a period where Frontline Workers are so burned out. So how does that compare to the life of a midwife . So angelas had an interesting in place and i dont i dont actually have a sense of sort of how many other Birth Centers operate on this this sort of schedule or model. But one of the things thats challenging about being a midwife is that when youre on your on, you have to be on call 24 seven. If someone goes into labor, you have to be there. And so affects your life in so many ways. I mean, you know, gillian, as a student would deal with this where she would be, you know she couldnt have a glass of wine at dinner or, like maybe more than one glass of wine. Think it was no one at all . Because if she got called a birth, you had to make sure that, you know, all of her faculties were there or like, you know, its oregon. If someone wants to go on a hike where theyre going to do cell service, thats also not something that you can do if youre on call. And so it is you know, a really sort of intense thing both, you know, actually being at a birth, of course. But then also just the way that in as youre going about the rest of your day to day life, its not like you go into the center. You do during business hours, and then youre just off duty and can chill out. And so the way that angelous addressed that was that they had midwives on believe it was, like a three month on, one month off kind of schedule. And so that every couple of months the midwives would have a full month when they were off. And so that way they could really unplug and, you know, sort of disengage, take that rest time. And so it was also easy to schedule because whenever they had a new client, it would be like, okay well, which month are you do . And so then the midwife issues that were sort of available to them as a care provider, you know, they wouldnt assigning or having a midwife kind of task if they werent going to be on duty during their break. And so i think, you know, you really to be deliberate about figuring out how to give people the rest that they need so they dont burn out. Because i know that burnout like said for any Frontline Worker and certainly for midwives and im sure for obgyns too as well can be a really challenge. So angelas dealt with that with that sort of like full month off schedule based on the midwives. I spoke to they seemed to respond well to and enjoy right is is there. I mean i wonder what it was like to be around midwives who unplugging i was trying to think of the best way to phrase that oh man. I mean midwives, they were super fun to hang out with both when they were at the birth center or, you know sort of when they were unplugging. I mean theres just like this level of sort of. I mean its not its not like a dark humor thats not quite the right thing that i mean but just this ability like i think think being present at so many really intense moments and things that really are life or death, like theyve just seen so much and theyve been, theyve been there through so much. I just think like the sort of types of, of stories that they have just like unbelievable. And i included a few of those little ones in the book, but just sort of, you know, just like the birth Story Library is just kind of endless. And so it was really fun to even just hear a couple of those. You where theyre like rolling out a pallet under dining table so they can take a nap in a tiny, you know, in between contractions or like throwing bloody water out a because they have no place else to put it and it looks like a crime scene just kind of some of the stuff like that was really fun and you know just like all kinds of casual chat about services and and all that good stuff, right . All the fun stuff. And i have one more question before i let you. Are you present in these childrens lives that you followed for nine months. I spent a little bit of time with all of them. I wouldnt say im not like an auntie figure. I dont think. But theyre not attending birthday parties. No. I mean, just to say i wouldnt be invited that i dont receive the pictures about the birthdays. I certainly do. And love getting all of the cute baby photos which i make sure i get somewhat regularly because its really crazy to, especially because, you know, they were all born in almost exactly two years ago. So these arent even like babies anymore, you know, theyre like toddlers. And so, you know, but, you know, people like changes in their lives of which we get into with in the postpartum chapters, but not everything. And so like some folks have moved or changed jobs. So, you know, theyre kind of all have settled into whatever their their sort of rhythm of of parenthood is. And that was certainly something i thought a lot about, like where to draw the line or a sort of where to stop reporting, i guess because i certainly wanted to make sure that we were still in touch, that i would have follow up questions during the writing and the editing process. And i so loved getting to know each and every one of them and felt connected them. So i wasnt i certainly was hoping that our relationships would continue. But then also being mindful that as a new who works, they werent going to spend like 4 hours on the phone with me every anymore either, which was fine. Right. And so yeah, its kind of a strange thing of like, okay, well, i still would to talk on the phone sometimes, but im not to record anymore. Im not going to take anymore. Or maybe we just meet for a casual coffee or something, right . So yeah, kind of shifting into a slightly different mode was felt a little weird not in a bad way, just something to adjust to. Yeah. Well, thank you so much for your time for joining me today. Best of luck with the book and congratulations you so much. Thank you for your questions. Of course. Tathank you very much. Ladies and gentlemen, coming. Our topic