S1E07 The Missing Question Mark

This week join Bianca and Meg as they discuss the importance of informed consent in all aspects of health care, including reproductive care. They talk about how fear can be a huge obstacle on collaborating with your health care provider, as well as the systemic barriers that keep us oppressed, quiet and compliant. You will learn valuable tools and scripts to communicate with providers about the decisions and interventions that affect your body, your health and your whole life.

• Everything Below the Waist
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• Grab your spot for the Birth Worker Business School program

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Transcript

Meg: 0:00

When people feel like they don't have autonomy, it feels lonely. It feels degrading, It feels dismissive, and really as though your humanness is really just like, You know what? You're actually just gonna do what I want because it's easier for me as your provider.

Narrator: 0:21

You are listening to the Hot+Brave Podcast with Bianca Sprague from Bebo Mia, where you will hear brave stories, hot topics, and truth bombs that will either light fire to your rage or be the balm you need for your soul.

Bianca: 0:38

Hello everyone and welcome to the Hot+Brave podcast. I'm your host, Bianca Sprague, and I'm joined by the amazing Meg Kant.

Meg: 0:45

Hello.

Bianca: 0:47

the doors to our maternal support practitioner training opened last week, and we are in the throes of all things reproductive health injustice. There are still spots available for the September session, so head over to bebomia.com to find out more. But more importantly, the themes on consent in birth and parenting and just healthcare generally have been coming up cuz our first class is dedicated all about introducing the concept of informed consent, which includes patient autonomy. And this is something we love talking about a lot.. Um, whenever we do our webinars, Meg is like, can I talk about informed consent?

Meg: 1:22

every single time. I'm just like, I wanna do all of the brain: benefits, risk alternatives.

Bianca: 1:29

Um, and so because we're talking about this, it gives space for a lot of the students to share about how many procedures and treatments are happening without a question, they're just being done to folks. And on the flip side, you know, we're also being ignored when we're asking for care. And so how important is that question mark? And when we talk about that, it's like, instead of saying take your clothes off, it's saying, Would you feel comfortable slipping into a gown? And you know, is that important? And the answer is yes. It's very important. Trauma informed care is lacking everywhere in the medical system, but it feels so much worse when it's involved with this vulnerability around our reproductive organs and reproductive care. Um, because it is, it's our labor, it's our birth, it's our bodies, and it's our babies. Um, so we have to teach healthcare practitioners how to care for us in a humane way and in a way that preserves our autonomy and our dignity. So we're gonna be talking about that. We have some tools for how you can, um, either as a patient, access that trauma informed care by teaching it. You know, I'm also gonna hold that. That's really annoying and we shouldn't have to, but this is how we can walk away feeling better when we have to make contact with our medical system. So we have a caveat. Meg? Yes. So what's our caveat?

Meg: 2:47

Our caveat today, we wanna start off by saying that this is, um, a problem, but not on an individual level. It is systemic and it's cultural. It's deeply ingrained in how our medical systems function. So when we're talking about this, we need to hold that all of the people that are working. In, um, healthcare or medical field, they're doing what they were taught. And so if they were not taught trauma informed care, then they're not practicing trauma informed care. And so like really, really, I love, there was a quote from the book that we are using for our October book club. It's called Everything Below the Waist. And it says, feminists have been agitating for decades about how research still mainly happens on male bodies. Even male rats are used more than female rats. But the problem in women's health are not just political or economic, they're ideological and cultural. And so we really just want to, you know, if we pull the everything back, it really is how so many things are intersecting and influencing how healthcare, particular healthcare for people that identify as women, is really, really lacking in bodily autonomy, consent, um, taking our symptoms seriously, like, you know, respecting our requests. And all those things. So...

Bianca: 4:09

you know, all those things. I know the, the research lately, um, was in Canada here, every 22 minutes in Canada, a woman dies from heart related disease, illness, heart attacks, the the works. And, um, yet the article went on to say, despite every two 20, every 22 minutes, a woman dying from this related. You know, illness, there's no research being done, There's no treatments being done, and our symptoms are ignored, which is why we're dying in a rate five to one to men. But always we think of like men, you know, having heart attacks and clutching their chests and you know, all these things. That's what the media shows us, like all of it. And nobody talks about this happening to women. I mean, we could go on attention all the time, but so, you know, we wanna talk about informed consent on both sides of it. That how hard we have to work to have our symptoms taken seriously. And then when we are, for whatever reason, accessing the medical system for care, that there's just, there's no questions, there are just statements being told about us. So first, I think it's great to start with like, what is informed consent before we jump into all the places that make us rage. So Meg? Yeah, just like in our workshops, let's talk about informed consent.

Meg: 5:29

Excellent. So informed consent is getting so either for yourself or if you're working with other people, getting everyone the information so they can make an informed choice. So we wanna have all of the evidence based research and be like, Okay, here are your options. What do you wanna choose? And so within that, what I was mentioning before, we use our brain, so B R A I N. So, benefits, risks, alternatives, intuition, and nothing. So B stand, like for benefits, obviously this is like what are the benefits of doing a certain procedure? What are the risks involved? Is the R are there any alternatives? Is there something different that we can do? I, for intuition, is I think the most underrated one of all of the brain because, um, when we actually connect back to our intuition, a lot of the times people actually know exactly what they want to do or what they feel is best for them. But we have been so severed. From connecting to our intuition that it's really difficult, um, for somebody to be able to actually access that. And so for us, especially as birth workers, this is one thing that makes it so magical is because we might be the first person to ask someone, What do you think is a good choice for you? Like, what, what feels right? And they're like, Oh my gosh, no one's ever asked My parents, you know, told me X, Y, Z. My teachers told me to do this. You know, when I got married, my partner told me to do this. My doctor tells me, And so when we say, what do you think? It can feel terrifying, first of all, usually the like first go-to is like, Ah, oh my gosh. I don't know. And so when we settle in the power, Yeah. Like when we settle into that, I don't know. It's like, okay, great. Let's just think about it for a minute. And when you step back and kind of connect into it, you're like, Wow, I actually feel really strongly that I'm gonna do X, Y, Z. Like, great. Cool. Love that for you. Um, and then N out of the brain is doing nothing. So is this actually something actionable that we need to do something about right now, or is there nothing like, or No. I don't wanna do anything. Um, and so these are, these are all the ways that we can help people to make informed consent. So whether that's for yourself or for your clients

Bianca: 7:44

And the N, I mean, my favorites are the I and the N. Because they're rooted in what you gather from the other, from the other questions. But it is really important to trust your intuition. And it is scary because part of the thing when we are, um, you know, accepting that someone else has guided us through something, it does remove a little of the responsibility from us. So it is really scary taking back our power to be like, I actually don't think I wanna run that test on my baby, even though I'm hearing that there's a 2% chance of, you know, whatever the thing is. But my gut is saying no, You know, that's really scary because if that test could have shown you something. You can also, you can feel the weight of that versus if they did it and it caused harm. You're like, Well, my doctor told me to and they harmed my baby. Um, and so, you know, that, that is a scary thing. So we do wanna hold that following this means you are taking a reclamation of your autonomy and it does leave you to deal with your, with your consequences of it. So I do wanna hold that. That's scary. Yeah. And. It's really fucking sweet , the control of your body because the risk is there the same, and it feels better that you chose it because it's less likely to have the bad outcome, it's less likely. And if it does, it actually lands different because you don't have the feeling of powerlessness that comes with, you know, the victim statement does like absolve you a little bit of, you know, your role in it. Um, but the disenfranchising feeling is, It's agony and it is a source of our rage. It's why we're feeling so mad. Um, and that nothing or no is like you can say no to any of the things that your doctors or nurse, or midwife or whoever your care provider is suggesting. You get to say, no, we, we wanna hold that. Um, the hyper policing for certain populations that no is, um, you know, a luxury that comes with privilege. So we do, we do wanna hold that, that there's a lot of people that, um, the consequences are really great for saying no. So we recognize that and we're sorry for that. And, um, There, it's the no is not the same for every person. Um, and so, you know, we do need to hold that. So let's talk about this missing question mark. We've ran through the brain. You can use it all the time. I would, when you get to the risks part, I would actually flag, um, so for birth workers that you encourage your clients to, to practice this. And for those of you accessing directly to, to care that you remember that if they say the risk, you can say like, What are the other risks? Are you leaving any risks out? Because a lot of the times they'll just share some of the. Big ones. Um, but the other ones, especially if you get a few of the other ones, they can feel really, really terrible. Okay, so let's use our brain with a couple of examples. One, we'll use the epidural, and two, let's use oral birth control. So when we look at the epidural, when people talk about the risks, usually the discussions being had when somebody's made a decision that they're tired or the sensation's too much or they've like, they really. The epidural, which is your flip and choice. And so when the anesthesiologist comes in and they're like, So we're just gonna run through the risks. There's some risks of, you know, it might not work and

Meg: 11:17

you might get a headache.

Bianca: 11:18

Yeah, maybe. But they're like, We'll, we'll let you know. We'll do a couple tests and as long as you don't move, you know, it's pretty safe and, and it doesn't impact the baby A, it does impact the baby, not a judgment of the epidural. But you need the accurate information that it does have an impact. The medication's used in it and there are way more side effects and risks than that, um, that we see all the time. So they don't say you might feel or probably will feel really nauseous. Um, your body will shake from it. You'll get really itchy. Almost everybody does. Your teeth will, will chatter. You'll have to have a catheter. You have to have continuous monitoring. You can no longer eat, you have to stay in bed, um, you have to have an iv. Um, There's risk of paralysis, there's a risk that it doesn't work and so you still have to have all of those things, but all the sensation is still there. Um, like there's a lot of risks. We could, we have pages and pages of notes of the risks and people need to know that because they might be like, Oh wait, I have to have a catheter. My teeth are gonna chatter. I hate being itchy. It like all these things that I actually don't want. Which is also their choice. Or they might be like, I hear all of that and I still would like to do this, but they're going in being like, it doesn't hurt the baby. And the tube is small and it goes in your, in your epidural space and um, you will feel great and you can sleep. Like that happens so infrequently. I don't know my, What is your experience as a birth worker?

Meg: 12:49

A hundred percent. That's what it is. And there's a very, like, quick, like, like you said, there, like a very slight chance of death. Like the, the way that they, you know, they're like, just gonna touch this, touch this, touch this. But everything will be fine. Hopefully. Um, mm-hmm.. Yeah. And so they, they do, the framing of it is, and the, and the thing is too, is that we don't want people to be afraid of choices, you know? So I do understand why we frame things in a way. Especially when somebody's like stressed or nervous in a, like almost a more positive framework. But what happens when we're doing it? When we say like, Oh, like there's this, this, but you get all of these, then we are implying that there is a better choice. And so like a healthcare provider by saying there's like this risk, this risk, but you get all of these great benefits. There's already like an essential being like the epidural is absolutely the best thing to do. Um, so like there's these things but just don't really look at them cuz we're gonna move forward with this. And, um, that really like doesn't make space for people to ask questions, doesn't give them the opportunity to get informed consent. The medical provider has already given kind of their like experience or what they think is the best.

Bianca: 14:09

I think it's very funny when doctors actually share their personal experiences, which I've only ever seen in reproductive health. I've never had my neurologist or a cardiologist or anybody be like, I put this in my mom and it was great. Like nobody has ever said those words to me or with like other people that have gone as a medical advocate. But in reproductive health, the number of people that are. Oh, I did this on my wife or or female doctors that are like Oh, I loved the epidural. It was great. Or like, vacuum was like way easier. It was great. I did that with all three of my kids. And you're like, What is happening?? Meg: Yes. Yes. Well, in one part of informed consent and like, any birth workers listening, that we need to not be, um, attached to the outcomes of what our clients choose. And so immediately by people sharing their experiences and like their inherent like bias towards which one they actually think is preferable, they're taking away that step of informed consent because now they're like, however, like small or marginal, they have showed that they are actually attached to your outcome. And so you also feel as a patient that you want to do what they want you to. Right. And so this is why when we're working with clients, we're not gonna say, You know, I had an epidural and everyone should do it. It was perfect what you're gonna say. These are the risks, these are the benefits. This, what is your intuition telling you? And then, um, allow them to choose. So we need to be able to do things with that like neutral entry point. We influence people whether or not we realize it or we mean to whether it was in our, our intention. These do influence how other people make their choices, for sure. So let's look at the birth control option, which might feel more accessible to some people. So again, what you choose to do is important. I would highly recommend that there's more research done before you just like take an oral birth control, um, or an OBC you might hear them called in the, in the biz . . Um, because we're very quick to prescribe them for everything. Even like, even things that have nothing to do with reproduction or prevention of pregnancy. So some of the things Meg might be headaches. Skin conditions...

Meg: 16:40

depression, even though there's actually, the research is not clear that there's any link between, um, birth control and improving mood. And when people are presented the option of going on birth control, the big things that they hear, right, um, that it reduces your chance, like minimally, I believe, of ovarian cancer. Um, there. What are I trying to even remember what the other things are? Um, there's like a couple of key points, obviously about your period. You know, you're not gonna have your period, it's gonna, or if you do, it's gonna be really regular. But what they lack informing folks on is the, the ways that it impacts our hormones. The ways that it impacts how our body functions, the way that it actually can impact mood, libido, um, hormones, your sex drive, your acne, and all of these things. Because the, our hormones actually do play a huge role in this. And so when we are looking at birth control, just as like this one tool that's going to do this great thing by stopping people from getting pregnant. Yes, AND... We need to take into consideration because this low libido is something that they found in like between anywhere between 12 and 25% of people that were on oral contraceptives. So it's almost a like a double edge sword because you're, you might be taking birth control to not get pregnant, but then you no longer really feel like overly aroused. So maybe you don't wanna have sex. And so like, The selective. right? The selective sharing of the quote unquote important points when we're choosing something doesn't reach all of the buckets that we need to have to make informed choices

Bianca: 18:28

for sure. And, um, the birth control one is a big one. There's really, really great information that Jennifer Block has put together in everything below the waist. The, the tagline is why healthcare needs a feminist revolution, if that needs to mobilize anybody to go buy that book. We're gonna have that in the show notes, and as Meg said, it is our October book club, um, book so that you can read that and come and discuss. So, you know, with birth control, we, we use it as this blanket treatment for so many different things. Um, and then there's not a lot of other information.. Um, and it's, you know, given for, it's almost kind of to me lost a lot of its purpose because, I mean, a lot of my queer friends that have can't get pregnant, they still recommend these things to treat this list, but we are not discussing the risks. Um, I've recently taken Gray, She's like running into a lot of the same issues that I was coerced into having my hysterectomy about, but they've already started at 15 and um, I went in to just get her checked for her physical. And I was like, Don't even bring up birth control. Like, we're not doing that. She's gay, she's not having sex. Like, um, and I, I'm not starting her on this. Like I just wanna flag cuz there's lots of other reasons why she could have these kind of periods. And she was, the doctor was like, There really isn't anything else we can do about it. We don't know why it happens and we don't have anything else besides the birth control pill, but we have options around the birth control pill. And I was like, that's, it's not options, Meg: they're just, it's just the same. Pick your poison , they're just the same with slightly different stuff in them. Um, and so, you know, the, the conversations fall really flat and they're, it's very hard to access solid care. And then, you know, these are just like, we're, it's hard to access the treatments. The whole journey through it is riddled with places of potential trauma and harm coming to us because we're missing these question marks. So there's also a lot of people who are exceptionally harmed by the, the lack of informed consent. And when we look at it, um, with around the assumption pieces that happen, I think it's important to focus here. So I, you know, here's an example for me as a lesbian that, um, I find pelvic ultrasounds to be really, really traumatic. I don't like them. I'm a survivor of sexual abuse. There's like lots of things that I just, I don't like it. I don't like that it's a stranger. They never let me have a support person with me. Everything about it, I just like not here for it, but I have to do them. And so, um, when I go in, When I say I'm very anxious about this, like I need to share with you, I need to do my breathing, Like I need to close my eyes. I usually like quietly cry like this is, I prepare them for how I need to show up as a patient, which is annoying. Um, and the things that have been said to me are like, But you've had a baby. So like this little wand in your vagina shouldn't be a big deal actually. It's not little. It's very big. Yeah. It's a very big wand.

Meg: 21:31

It's a sizeable one.

Bianca: 21:33

with a stranger inserting it into me and wiggling it around. I don't like it in a dark room alone. So, um, and they're always like, But you had a baby, or like, Haven't you had sex before? Or those kinds of things. Like, it's the same experience. So I mean, I, I really wanna hold what happens to queer bodies. Also what happens to fat folks is like so much shit around either they assume they can't do things or as Meg and I were talking about this like menu is, they've decided it's like a, like what are those? When it's like the fixed menu.

Meg: 22:06

Oh yeah, yeah, yeah, yeah. Like you'll eat what I give you, you.

Bianca: 22:11

You'll eat what I give you. And here is your, our starter. Here's your salad, here's your main, and here's your dessert. And that's, that's what we've decided for you. We're really on a food kick with our analogies this week.

Meg: 22:23

We are

Bianca: 22:24

The Bebo Mia team. Um, and so, you know, we're seeing this, this menu that they've decided based on a quick scan of your body, And, and then there's no, they don't give you questions because, um, by having the question mark, you're essentially suggesting that there'd be something else. But by taking it off, you know, put on a gown, get into bed, open your legs, give me your arm, lift up for the monitor. Like, they're just statements and then you, you just get like thrust upon. Like down their stream of, of their tasting experience.

Meg: 23:06

Yeah. And I think, um, one thing that we hear so often from people when they're moving through the medical space is that like when we talk about autonomy, it can kind of like, feel like not rooted in like real experience, right? We hear autonomy and it kind of sounds like, like a word, but we don't like really. Hone in on the actual experience and when people feel like they don't have autonomy, it feels lonely. It feels like degrading. It feels dismissive and really as though your humanness is really just like, You know what? You're actually just gonna do what I want because it's easier for me as your provider. And so,

Bianca: 23:48

Oh yeah, the convenience is there all the time. The positions we're in the temperature of the room, the height of the bed like everything is about a practitioner convenience.

Meg: 23:59

Yeah, so when we're talking about this and we think about what we're doing, how we're being treated, like our procedures, our medical care is around, um, convenience for the provider. And so it's really interesting when we're talking about this convenience factor and how that really plays into care. And when we think back to how people are interacting with birth control, is that it's a convenient. One kind of stop shop. So, Oh, you're having a irregular periods? It's birth control. You don't wanna get pregnant? Birth control. You have acne? Birth control. Are you experiencing depression or anxiety? Birth control. When really, like Bianca just mentioned, they, they don't actually have other option outside of that, so they need this to be the one that we would. And so another thing that I wanted to mention too is regards to care and how certain bodies are receiving more assumed care, like more assumptions about what their body can do and what they can't do. Folks that live in fat bodies and also huge shout out. I live in a fat body, and so you'll hear me throughout this podcast reference that I talk about living in a fat body like I'm tall and I have blue eyes. It's just a fact about me. We are all about body liberation here. So just a side salad on that.

Bianca: 25:16

Woo woo

Meg: 25:19

woo. That something...

Bianca: 25:20

Meg, in fact, today is wearing her all bodies are good bodies sweatshirt.

Meg: 25:23

All bodies are good bodies. Oh my gosh.

Bianca: 25:25

I have a matching one.. Meg: She does. I have a matching sweatshirt with the all bodies are good bodies and it's Haley's favorite sweatshirt. She's stolen it from me and it now lives in her drawer. And she says every time she puts it on, she goes, All bodies are bodies. Because for the first month she wore it. She forgot the good on it. And so she was like, That's a weird thing to put on a sweatshirt. All bodies are bodies. And I was like, It's all bodies are good bodies.

Meg: 25:52

Good bodies.

Bianca: 25:52

Oh, that makes more sense, But we've just stuck with all bodies are bodies sweatshirt.

Meg: 25:57

Um, yes, yes. And so something that happened, somebody actually shared with me. That they went to their healthcare, uh, appointment. And so I, obviously, I'm not a monolith for people that live in fat bodies. Everyone's different. Everyone has different preferences. I had an eating disorder for a really long time, and being weighed is a huge source of anxiety for me. So I always. Like I don't look, I let them know that I'm like, I actually don't wanna know my weight. And honestly, if we don't need to know it, if it's not purposeful for the point of what we're doing today, I actually don't need to be weighed. But somebody shared with me recently that they had gone in to their appointment. They like faced away from the scale. They like hit their eyes because they also knew that this was going to be a point of anxiety for them. And the nurse wrote down the number and then put it on a chart and then showed. And like pointed and under, like pointed to underline it.

Bianca: 26:53

Like we just gonna whisper it,

Meg: 26:55

like we're just gonna whisper this, this, this number that this person's obviously chosen not to look at. And it, this person showed that it was almost like, like a, a repercussion, right? Like this is like, yeah, you, you did this, you weigh this much, you need to come face to face with this like hard truth about who you are and how, you know, morally corrupt. You are living in this fat body. And I just wanna note that that's absolute bullshit, that bodies are gonna land where they land and, um, that, that is just like another thing that you're having to overcome. Like, like regardless, like maybe they don't have chairs that fit people's bodies comfortably. Maybe they don't have a blood pressure cuff that wraps all around their arms. And so in addition to having to navigate the medical system, um, with a lot of assumptions being made about their body, there's also this assumption that your, your body is quote unquote not good. And so you're almost like leaving, having to atone for this. Like, this is where we see people in their appointments talk about like, you know, I, I do, I eat, I like eat really well, You know, I eat chicken, I eat, um, my fruits and my vegetables. I like make sure that I don't overeat. I like don't really have very many sweets and there's this like atonement for the way that you get to show, like your body just shows up in the world. I'm like, oh my gosh. When I came in here in my eating disorder and I was quote unquote, normal weight, I was the most unwell I've been in my whole flipping life, and nobody flagged it. Nobody asks how I was doing emotionally. Nobody gave a shit. All I got was praise. For being like, Wow, you've done so great.

Bianca: 28:36

Oh Meg your disordered eating. You're a champion of disordered eating. Gold star in your chart for you.

Meg: 28:42

You did so good. Your eating disorders doing so well. Your body's getting so much smaller. And I would be like... And Bianca and I joke about this. This is a serious topic, but our coping mechanism, my coping mechanism is to laugh at it now because it was so awful.

Bianca: 29:00

It's so awful and it's so funny about the weight thing. So as I mentioned, we got a new doctor and I went with Gray for her first appointment where she was offered oral birth control. And um, they said, Let's step you out to, to weigh you. And I was like, Well, she actually doesn't need to be weighed. And gray could sense I was getting into my like, My soapbox. I'd taken like one foot on it. I was like looking, and she was kind of this like, mom, like don't. Like, let's, it's whatever. And I was like, No, actually there's, there's no reason for her to be weighed. Like there's, we're we're coming in and she's like, Oh, that's okay. We'll just step out into the hall and we'll weigh you. And the nurse practitioner was like completely ignoring me because like I can tell, we're already gonna go head to head with our smile, our smile talking our smile talk fighting. And she's like, No, no, no, it's okay. And I was like, Gray, you don't have to do this. Like there's, we're not talking about anything to do with your weight. And um, and Gray's like, Oh mom, it's fine. I'll just like weigh myself. I was like, Gray. Um, Gray, could you face the weight from the scale? And she's like, Okay, we'll do it this way. The nurse practitioner and so Gray gets weighed and, um, We're walking back and the nurse, the same thing, like she couldn't not have us know the number and was like, Here's a hint, it's close to your weight. You guys are almost the same, which I haven't been weighed, but it's in my old chart from my surgery. And I was like, What? I'm trying to teach Gray that her weight means fucking nothing about her health or her ability. It is not a measure of anything. I just... I'm doing something different for my 15 year old girl.

Meg: 30:31

Yeah, yeah, yeah.

Bianca: 30:33

And she's like, Here's a hint. I was like, You don't need to hint, like, stop it.

Meg: 30:38

Right?! Like the knowing, it almost feels urgent on the side of the healthcare provider that people get it. They're like, You need to know, and it's like, it's actually not gonna influence how I make my decisions.

Bianca: 30:52

Weight means nothing. It means nothing. Absolutely nothing. Gray would clock as a, as a quote, good weight. But like who knows how she would receive it cuz she might, her friends who are five two might be like, I'm 112 pounds. And then gray's 160 feels giant because that feels so much bigger than 112, even though gray's almost six feet tall. And so I was like, there's so many reasons why I don't want this to be part of the conversation. And Gray is probably quote by the measurements of health being, say, cardiovascular strength. Gray gets winded walking upstairs, but nobody talked about that with her. Nobody asked what she ate. Like nobody asked any of the markers of health. Nobody asked if she smoked, if she tried drugs, if she has tried alcohol, like there was nothing asked.

Meg: 31:40

How she sleeping. Probably didn't get asked, which is like, so huge.

Bianca: 31:43

No, none of these things. They were like, that's great. They were like, You're six feet tall and this weight, and therefore you're, you're good cuz you look good to look at. And I was like, This kid can't walk. I like force her to walk the dog and she'd like "slow down", but we would clock her as healthy and then all of her care would be missing. That and her lack of informed consent could lead to so much more harm.

Meg: 32:09

One of my close friends, oh my gosh, her daughter. So feisty. And, um, her daughter is very little, like, she was like four or five at this doctor's appointment, and the, the nurse at the appointment went to say something to my friend about, you know, what her daughter was eating and she wanted to make sure that she was like getting all of her vegetables because she lives in, in a thicker body. So she's the, my friend says, Oh, we're actually not gonna talk about diet, weight, anything like that in front of her. And then her daughter is like, All bodies are good bodies, Erin. And it's the best story. And every time I wear my, all bodies are good bodies I always end it with: Erin! All bodies are good.

Bianca: 32:55

Erin.

Meg: 32:56

Erin. And so I think that like, it's such a powerful way. That we can be showing our kids like that there is a different way, and especially for folks who identify as women. And so even though Gray rolls her eyes at Bianca and you know, like sees Bianca get on her soapbox, the reality is that she's gonna remember like, okay, I do remember that my mom actually said that this isn't an indicator of health for me. And then my friend's daughter gets to move through the world being like, Oh yeah, no, all bodies are good bodies. Like I don't actually need to know. This is irrelevant.

Bianca: 33:30

And it changes the care.

Meg: 33:31

Yeah, it changes the care. Exactly. Versus when I was growing up and I watched all of the women in my life be on horrific diets, and all of our conversations were based around weight loss or what we're eating or how much we hated our bodies, and so we're writing a different narrative.

Bianca: 33:50

For sure. And, and we can teach these different scripts, so that's why we wanna talk about these scripts with you. I also want a flag that Gray refused to participate in her food and nutrition unit, which is like some course in Ontario here. Um, because she said it's inherently ableist fatphobic, and all food is good food. There's no moral judgment on food. Food is food and whatever your access to, that's what's sustaining your body and that's great and eat with joy, essentially. And so all of her projects, they'd be like, We need you to talk about the whatever beef chart. and Gray would write an essay like the, the length of whatever the assignment was, but it would all be why this was problematic and she refuses to participate in it. needless to say. We got a call from the school about her course credits that she needs for grade nine last year. Um, she's refusing to participate and she was like, I am, I will not sit and hear quote nutrition brought to you by the grain, dairy, and can meet farmers of Canada. So you're correct . I will not, I will not do this. So like we are changing that, that narrative and it is really important to teach our little ones. Advocate for ourselves. You can say no to anything. Hopefully, we really hope you're in a system that you can say no. Um, and there's lots that you can't, but if you can flex that, no, it's a powerful statement. And you know, tell them you need instructions. Tell your care provider again, I'm really, really sorry that you have to do this emotional labor for yourself as a, as a patient. But this is how we're going to survive and maybe even thrive within our medical system. Um, so you need to say, like, you need to tell me before everything. So I recently had a little tiny, little tiny procedure on my shoulders, like a little skin surgery. And the doctor went and washed his hands. Then he asked, no. He said, Can I touch your bra? And you moved it out of the way and tucked a blue pad and went and washed his hands and got his tools. And then he just came back with a scalpel. And I was like, You actually didn't ask me before you touched me with a scalpel, that's a different thing than, can you touch my bra? Versus can you start cutting into my skin? And there was no warning with the freezing. Like it wasn't like, now I'm gonna put the needle in. Do I have your consent ? And then I say yes. And then he is like, Now I'm gonna start cutting. Do I have your consent? Because I saw him pick up the scalpel and I was like, I actually need you to do a test so that I can feel you pushed with the knife gently so I can see if I feel it or not. And he was like, Well, I know you can't feel it. And I was like, I don't know I can't feel it. So, and that's what that conversation looked like. But I, you know, you do have to say, what are the other risks? What are the alternatives? You know, why are you suggesting this for me? Is this what you suggest for everybody? What happens if we do nothing? Um, and then asking questions about the research. So there's a stat that's used very regularly to scare people into getting induced. So induction, for those of you not in reproductive health, is when they use a medication or a procedure to jumpstart the body into labor ahead of it spontaneously going into labor. So there's a stat that at a certain point, at full term, The risk of stillbirth doubles. So it's regularly used in doctor's appointments to say, we're gonna induce you next week. And they're like, Oh, why are you inducing me? And they say, Cause the risk of stillbirth doubles, which is an accurate stat. But Meg, where is the massive flaw in that statement?

Meg: 37:29

Yeah, so the massive flaw is that, yes, the stat does double, but it goes from like a very minimal amount. Something like, what is it? Five out of every 10,000?

Bianca: 37:43

Yeah I think it's, it's 0.2.

Meg: 37:45

Yeah. 0.2%

Bianca: 37:49

doubles to 0.4.

Meg: 37:50

Point four. So that is double, That is statistically correct that that amount has doubled. That's not giving the full picture. Hearing that it goes from 0.2 to 0.4 is very different than hearing that statistic doubles. So we really want to make sure that we're having the whole picture because that does sound scary as like F... as.... As fuck, right?

Bianca: 38:14

Like stands scary as f as fuck.

Meg: 38:18

As F as fuck. Yeah.

Bianca: 38:23

But it does, it's really scary to hear that because you think of like doubling that you were like, it was at, you know, 30% and now it's 60%, but instead of, you know, two of 10,000 and now it's four of 10,000. Which, Yeah, I mean, loss is no joke, obviously. And the risks though, of a lot of the procedures that they would start, have way more likely side effects around mortality and morbidity for both the baby and the birther. Um, by mocking about with, um, you know, Meg used the one stop shop of birth control for all things essentially. Folks with uterus wouldn't like about their lived experience of skin and sleep and weight and, and all of those in the period and cramps and headaches. Um, we have a cascade of intervention, which is the one stop shop for how we birth, which is you come into triage. They muck about a little bit, then they start Pitocin and then the epidural, and then more Pitocin. And then the baby might probably has some sort of distress or doesn't respond well to the all the flood of medications. And then we have vacuum or forceps if the baby's low enough. Otherwise, you go over to the OR for your emergency C-section. And like those tools that were really, really helpful and if they're introduced with a question, people could actually add them to the menu that are really, really great. Pitocin has a really critical purpose. Epidurals are incredible for people that understand, you know, make an informed choice around them. Vacuum, you know, great way to help babies come out that aren't, and have them have pelvic birth.

Forceps: 39:59

a little more risky. But same thing, like all of these things are really, really great. But when we use them all like that for all people walking in, we're actually seeing the worst outcomes in history and, and, you know, we can change that. We can change the course of it and have people pause and, and, you know, engage with what their options are because there's way more options than that. Birth can take a whole bunch of different ways, but that's the most convenient way. It's the most highly managed, It's the most what they believe predictable. Um, and it's, it's so strongly encouraged against by the World Health Organization and by all the governing bodies that are training and regulating our obstetricians and gynecologists, like there all these governing bodies are like, Stop doing this yet all the hospitals just keep doing it.

Meg: 40:55

Yeah. And one thing that makes it a also we wanna hold that makes it can be difficult to have these conversations to say no, to ask the extra questions is first off, um, a lot of us struggle with the idea of being like difficult. We don't wanna be like a difficult patient, and so it's easier to just move along. Somebody actually told me the other day that they had an anesthesiologist say to them when they talked about their birth preferences and they said, Oh, I'm just like planning to like go in, I'm gonna get the epidural and then I'm gonna, you know, just have the baby. As long as we're safe, that's fine. This person, I'm hoping to do some prenatal education. To widen just so they're making informed choices. Um, but the anesthesiologist actually said, Thank you so much. Like most people come in here with like six page birth plans and then get so upset when they don't go right. And I was like, What ? You mean somebody had like questions or requests for how their care happened and you're pissed about it?! Not that this is a surprise.

Bianca: 41:58

Yeah, they are. They.

Meg: 41:59

But so it almost, So there's also this air of authority. When it comes to healthcare professionals, so there's like the idea that a doctor knows best, right? The doctor is going to have all of the information, but if we think about all of the things that doctors are treating versus all of the like possibilities within the medical system, they can't possibly know all of the things. And they also don't live in your body, so they can't know that you have really painful periods, but it's because you have endometriosis or you feel like you have cysts or there's something else going on there, they can't know that. And so this idea that doctors know is best, we really need to like internally kind of come to terms with like, we're actually the, the professional when it comes to our own bodies and we're allowed to ask what we want. They do know lots about medicine and we need to make sure that they're giving us the full picture. So we're making informed choices.

Bianca: 42:57

Yeah. And they, they know as much as they're taught, right? So like they have massive gaps in the information because they're humans. And so like, we don't wanna vilify doctors. We're vilifying the medical system. It's garbage, and it does nothing good for women. And our bodies are just commodified. They just make prescriptions to profit from us. They know the risks, they know the harms. Like, you know, it's not good. And so doctors, like, a lot of them actually do want to help, but they're, they only get what they, what they're taught. So whoever's loud with their prescriptions, like whoever's got a good rep or like sponsors the, the conferences they go to, that's how they learn about those things. And then that's what they, they're just told what the sales pitch for those things, and then they pass that sales pitch on. And so it's just like a giant money making system that's no longer about our healthcare. It's all, you know, retroactive, reactive. It's not preventative medicine. We don't practice preventative medicine. And so you have to work really hard because they also can't share all the things that would matter. And I remember when I was researching for my hysterectomy, which I deeply regret. Um, but I asked a lot of questions. Like, I was like, I'm gonna go in eyes wide open, like, you know, and nobody flagged. I had to go ask people and have somebody else flag it that nobody through all of my intake and at the hospital and meeting anesthesia and talking to my surgeon, nobody said that, like your vagina gets shorter and that might be something that matters to someone. And like there's a lot of things that they were like, Oh, well yeah, of course that happens. But I was like, Nobody said this. It's not on any of the blogs I read. It wasn't until somebody who was straight um, said like, Oh yeah, I did notice like my vagina was way shorter and sex fell way different. And I was like, This feels important. And it never came up one time. And so they, they, they put a, like a value on what's important and what's not important, and you can't decide what is important to people. Um, and, you know, the peace of mind or that information or like, I dunno, Meg and I have so many stories of people that were like, Oh, well of course that is the thing that happens, but that person, the risk felt big enough, or that side effect felt big enough, like even having, um, you know, engaging in treatment and the treatment is too far away. Um, and so now the commute is two buses and it's three hours each way. The treatment might ... Declining of it might be a better option if they're like, Oh, well it's only gonna have this much benefit, but like every, you know, two weeks I have to go see this specialist. Like that is an important piece of information and only you would know that, cuz like Meg said, you're the professional in your body. Only, you know that like there's things, like, there's medications that I'm like, I don't have an allergy per se, but like no medication sits right with me. So like I just have to avoid all prescriptions. And when they're like, Oh, well this antihistamine is actually like, it's, there's no reason why you wouldn't. And I took it and I was rushed to emergency and I was like, My body just doesn't like them. It doesn't make sense. I haven't seen a specialist that's been able to identify it. I just know this about my body. I have to have no intervention and sometimes I have to have a little bit and it goes off the rails and it's really terrible. But like I know this about them and every time I do an intake, they're like allergies to medications. I'm like, I just can't have medications. And they're like, No medications. It's like pretty much. I'm just gonna say dumb medications, so whatever you're suggesting, it's like, it just has to be a no for me. Anything from antibiotics to antihistamines to pain, like narcotics, Like they're just, it's just a pass and anything in between. Um, and so I think that if we get comfortable with that, we can take our power back. And a system that. Actively strips us of our power and our voice.

Meg: 46:48

Yep. That's how, That's part of how we can really, truly take our power back and get more comfortable in making our decisions. I really do... I know we said it at the beginning that it is hard. It's hard to kind of take that back, but how often if something was to happen and you didn't make the decision, how often do you think about, well, what if I had known more? What if I did that, or what if I did this and so this

Bianca: 47:15

ALL-THE-TIME

Meg: 47:19

my whole fucking life.

Bianca: 47:23

my whole fucking life. I'd have a uterus, I'd have a gallbladder, I'd have my labia wouldn't have been ripped off like so many fucking things. Um, but I, yeah, all of that Meg share. Um, we have a wrap up thought that I really, Meg, Meg has a good one that I don't wanna be not captured, um, around like taking the system as it is, as well as taking your practitioners as they are, which we can generally apply to really like, Potential business partners and new roommates, and It's a, it's a good rule of thumb. For life.

Meg: 48:09

Yeah. So it's the idea, and you might have heard this, that when someone shows you who they are the first time, believe them. And so we can think of this when we think of the medical system and the patriarchy, and we deeply want to believe that they're doing what's best for us, despite all the evidence to say otherwise. Right? When we hear other people's birth stories that. Really, like went sideways. Were traumatic. We like, make it okay in our own brains. We have to like collab, like collaborate these thoughts to make it be like, well, no, they didn't know that that would happen. Or, you know, um, mine will be different. Right? There's all of these things that we need to do. But the reality is, is that. These are what's happening. This is what's so and so. We need to believe that while individually all like the healthcare providers are probably lovely, but the system as a whole is showing us over and over and over and over that it actually doesn't care. It's not interested in the wellbeing of women's. Specifically, we've got no research. They just wanna like throw like one hat, like one fits all. Like even the fact that we are the, the people that are ingesting birth control, whereas there is male birth control, but the risk were quote unquote too high. It decreased libido, it impacted their mood. It, you know, made them, um, like it had like issues with, uh, acne and all of the things. But we eat that. Because we've like societally decided that it's fine that women are just gonna eat that and just deal with the consequences

Bianca: 49:49

more than We just eat it. We buy it, we pay them to eat this shit. Yep. Again, if you love your birth control, get on it, girl, But like, fuck.

Meg: 50:01

Yeah. And so we're, we're over here being like, Okay, I'm just going to do the thing that almost, I love that when Jennifer Block says it in everything below the waist, it's almost like a rite of passage to go on the pill. It's like the assumption which you're going to do and get to a certain age, but we're not taking into account that like there's all of these, there's all of these side effects, all of these risks, and yet again, Women are just expected to, to be the ones that are like, You know what, they'll, they'll deal with it, it'll be fine. And then when we try to seek like support or help for when it's not fine, it gets flipped on us. So not only are we like getting. The shit end of the stick. When we have to take it, when we seek treatment, we're, we're shamed. We're like, Well, there's something wrong with your body. Like you, that shouldn't be like, you shouldn't have done that. Or like, This should be fine. Like, Bianca , you should be able to take medication. Well, what the fuck? I can't, So like, let's just move forward. Let's find a different option here. And so there's like so many elements to consider and so. Just taking our own power back, asking the questions, and I also really like, I want to believe, if you could all see me, I want to believe that they are doing what's best for us. I really, life would be easier. I could sleep better at night. I could move through the world a lot easier and less stressed. The reality is, is a number, but they're not. So we do our homework. We like do our research, we ask the questions. We have hard conversations, and this is how we're going to move the needle forward because not only are we doing this for ourselves, but Erin, my friend's daughter's nurse, I guarantee she thought about that the next time she went to talk to a parent about making sure that their, you know, kid that lives in a little bit of a bigger body eats their vegetables. Like all bodies are good bodies, Erin. Like, so these are going to make... I know.

Bianca: 52:05

And it was poor Erin. It's really, Erin is as commodified in the system as everyone else. So Erin, go tell your boss and your policy writer and your local politician and have them hold the wrath of this tiny, beautiful, chubby little human so much. Um, there's, I just quickly wanna add one more thought. I know Meg just did a beautiful wrap up, but, um, it hit me when Meg was talking about when we go in, when we go back to seek treatment for all the shit that comes up from all the crappy care we got or lack of care, um, there's so much room to like blame us cuz we're either fat or we, you know, don't work out or we didn't come in earlier. Or Yeah, didn't take our prenatal vitamins. Like there's always a reason when we're saying like almost all people who take oral birth contraceptions are like getting these things. Or there's a super high rate of this with their heart or this with their anxiety or this with their insomnia or this with their like bowel irritations. And, but yet we, we leave so much room for the individual. Like it was something about them instead of being like, Yeah, this happens to everybody and we don't have any other thing and here's. Some other shit we can throw at you to maybe treat what we've caused. And now we're in this like cascade of quote, support from the medical system. Um, but it's always something you, like, you did, like my friend got an IUD and had, it was like perforating her uterus and they went back in and they were like, Did you rest for the first 36 hours like you were supposed to?

And she was like: 53:38

I literally went from the gurney to my bed as it perforated my uter and bowel, like I didn't move. And they're like, Oh, well we don't see this. And I was like, Look at the stats. We see it all the time. We make it like she did something wrong. This is one of the top risks of it. Like don't make this her problem. Oh, this is a you problem. Yeah, this is a risk of it, but like you guys pass it as like sometimes this might happen, but it doesn't. It won't to you. And then it does. And then they're like, Did you go for a run? She's like, I was just under anesthesia. Of course I didn't do anything. Um, so that we're prime. So no matter what happens, there's so many places. It can be our fault. We need to slow down. We need to stop doing so much. We need to rest more. I was like, Yeah, we'd love to rest more. Circle back to the All the rage episode before this and you can hear why we don't rest. Yeah, because nobody cares. So we have to be our own advocate. Humans with uterus or those who identify as women, the whole bucket of the most harmed by our medical system, um, are, you know, cis women and trans folks. And we, we, this is, this is a tool for how we can survive and, you know, hopefully mitigate some of that rage, that the shit just happens to us and that, you know, we're forced to just endure our medical system. This is a topic we talk a lot about in our maternal support practitioner training. Um, and it's a very healing process. So we, as I said before, we still have spaces available and one of the things we're really proud of is we include mental health support as we go through, because as we learn about. These concepts of informed consent and um, you know, that we could say no, it can bring up a lot of big feelings. So we have a therapist on our staff that does group therapy, um, for our students and our alumni because, you know, these things can feel like a lot of big feelings. I cried twice reading everything below the waist cause I was like, fuck if only I'd known. Um, so that's something we're really, really proud of. And that's all included. And with your tuition, we still have, um, Spots in our September, 2022. If you'd like to join us, we'd love to have you. It's an amazing program. It's a three in one doula training, so you get certified as a fertility, birth and postpartum doula. And we also have the birth Worker business school, which is opening up on October 7th. Very, very excited. It's to pay what you can. We wanna remove the barriers to access support in running your business. So we know you love the skills part, and now we wanna make sure you get clients. Um, so join us for the Birth Worker Business School. It's to pay what you can, you can find out how we structure or pay what you can on our website. It's incredible feminist business education with an amazing, amazing team that puts that together, including Megan. I, So if you like hanging out with us, you can hang out with us more. Um, we have new stickers that just came in. We are really, really excited. We wanna mail those out to all of our listeners. So drop in. Review on Apple podcasts. Give us your five stars. Tell us what you love about us, and we will send you a sticker. And we've got another little surprise that we've included. Thank you, Meli, for your hard work and making those beautiful things. And for Kelly, who's gonna lovingly write your name on all those envelopes. So thank you so much to you. And finally, If you have something that makes you rage, we wanna hear more about it. Write to us at info@bebomia.com and tell us what makes you rage, and we'll share those oncoming future episodes. Thank you so much. For our listeners, thank you Meg, for hanging out and talking about, you know, rage and informed consent.

Meg: 57:21

Love it. Thank you. Thank you everyone. Have a great day.

Bianca: 57:25

Bye y'all!

Narrator: 57:29

Wanna keep hanging out with us? Find out at bebomia.com. Or head over to your favorite social media platform with the handle @bebomiainc. We will see you next time on the Hot+Brave cast.