Episode 7: Informed, Supported, Confident with Dr Catherine Bell, Creator of The Birth Map

Dr Catherine Bell is the creator of the Birth Map, a birth advocate and Managing Director of Maternity Choices Australia. After her own birth experiences left her with questions she didn't have the knowledge to answer, and after listening to countless mothers say they wished they had been better informed, Catherine set out to close that gap.

In this episode Catherine walks us through what the Birth Map is and how it differs from a birth plan, what her PhD research found about what women genuinely need to feel prepared for birth, and why the word consent is failing women in the birth room.

We also hear stories from her research that bring the findings to life — including a woman who moved to a caesarean pathway with almost joy because the decision was fully hers, and what consistently determined whether women in her study felt at peace with their birth or carried it as trauma. It was not what happened, it was how it happened.

Find the Birth Map at birthmap.life. Catherine is also speaking on the panel at the Canberra screening of Allowed to Birth on 16 September at Dendy Cinemas.

What's covered in this episode:

• What the Birth Map is and how it differs from a birth plan
• How to genuinely prepare for birth in a way that builds confidence rather than anxiety
• Why informed consent as it currently operates in the maternity system is failing women and what should replace it
• How to make decisions in labour when time is short and the pressure is on
• What your rights are as a woman navigating the Australian maternity system
• How to advocate for yourself with your care provider
• What Catherine's research found about preventing birth trauma before it happens

CONNECT WITH CATHERINE

birthmap.life

Instagram: @birthmapping

Maternity Choices Australia: maternitychoices.org.au

RESOURCES MENTIONED IN THIS EPISODE

• The Birth Map: a structured decision-making and communication tool for birth preparation. birthmap.life
• The Game of Birth: a visual decision-making tool mapping physiological, medical and caesarean pathways using statistics from the Mother Baby Report
• Realist Evaluation: a research methodology developed by Pawson and Tilley asking what works for whom, in what circumstances and why
• Sensemaking: the process of building understanding of various options before making a decision, drawn from Karl Weick’s work
• Supported Maternal Decision Making: Catherine’s preferred term replacing shared decision making, placing responsibility clearly with the woman
• Matrescence: the developmental and identity transformation of becoming a mother
• The BRAIN acronym: Benefits, Risks, Alternatives, Instinct, Nothing — a decision-making framework used in the Birth Map
• The Bendigo consent case: a landmark Victorian case in which a woman’s lack of consent to vaginal examination was tested in court
• Maternity Choices Australia: working with Catherine to implement the Birth Map approach in Australian maternity services
• Allowed to Birth: The Journey of a Global Midwife — Canberra screening 16 September, Dendy Cinemas. Catherine is on the panel.

Transcript

SPEAKER_00 0:00

This is the Women Who Guide in Me podcast. I've met some unbelievable women along the way, and I can't let them go. I don't want to let them go. Like, I want to keep talking to them and I want to put their voices out there. And that is something that's really beautiful about the journey is you actually get to grow your village of wise women before the babies here. And I think I think that's a really nice experience. After her own birth experiences and after hearing so many women reflect that they didn't feel fully informed or prepared, Catherine became determined to close that gap. What started as a birth plan template grew into a book and ultimately into a PhD where she explored how the birthmap could support women across different models of care. Now having completed that research, Catherine is focused on rolling the birthmap out nationally through Maternity Choices Australia with a long-term vision of taking it globally. You can find Catherine and the birthmap at birthmap.life. I'll link everything in the show notes. In this episode, Catherine shares how her personal experiences shaped the development of the birthmap. Like many women, she entered motherhood expecting continuous supportive care. Instead, she encountered gaps in communication, especially in unexpected or high pressure moments. Although her births were largely positive, she was left with questions about what had happened and what her options really were. Hearing other mothers express the same uncertainty made it clear this wasn't an isolated experience. So the birth map grew from that need for clarity. Rather than a linear checklist style birth plan, it's a flexible visual framework that helps women explore different pathways, prepare for a range of scenarios, and clarify what matters most to them. It also supports shared understanding between the woman and her support team, particularly in moments where clear communication and confident decision making really matter. I'm joining you from Perth, so I would like to acknowledge the Wajaknunga people as the traditional custodians of the land. I pay my respects to elders past and present, and I honour the enduring wisdom and cultural practices of First Nations peoples whose knowledge of birth, nurturing, and community care has been shared across generations. All right, let's get into it. Alright, welcome to the podcast, Catherine Bell. So good to have you on.

SPEAKER_02 2:48

Thanks for having me, Paris. This is really exciting.

SPEAKER_00 2:51

Yeah, and we've already talked a little bit and we've already realized that we've got a pretty cool connection. So um I like to ask people, what drew you to this work, the birth map? How did you discover it?

SPEAKER_02 3:04

Well, it was all a bit of an accident, Paris. I I entered motherhood naive and hopeful, and I honestly thought when I went into the hospital, I would be issued with a midwife and she'd be with me through and through, and it would just be totally on my terms, complete support, this magical experience. And whilst I didn't have a terrible experience, possibly because I have just since discovered that I do not take very long to have babies, they pretty much fall out. So that that's definitely an advantage. Um but what frustrated me was that there were things that did happen that I'm like, what the what was that? I didn't even know that was a thing. So when my first was born, everything went swimmingly, it was beautiful. But in the moments after she was born, they realized that her cord had come away from the placenta and the placenta was still inside, and it just got chaotic and scary. We didn't know what was happening. It turns out everything was fine, but it resulted in a transfer from one hospital to another, and it was dramatic, and we didn't know what we could do. So the next time I was a bit more cleared up and I had this thing called a birth plan. And it was like, I'm gonna birth like this, and then we're gonna have delayed cord clamping. Hey, I'd done my research, I knew what it was all about. And this is this was just as delayed cord clamping was becoming a thing. So now we call it optimal cord clamping, but back then it was delayed because the default was, you know, we got to cut it straight away, otherwise people blow up or something. It was dramatic. And and so I had this, you know, additional thing happening in it that was about the third stage. So it wasn't just about labor because this was starting to become more apparent, and still it was very straightforward, but I just felt like we were processed still. And then when I went into my mum's group, I just repeatedly heard mum say, I wish I had known. Nobody told me about that. Oh, if I'd known that, I would have made a different decision. So I just started documenting it all, and then I learned about doers and I did the doula training, and it was like receiving the knowledge that I should have had upon entering puberty. Like you are now in your fertile stage of life, you need to know this information. And then I did the birth, uh, the um breastfeeding training with ABA, and again, it was like, how do we not get told this? So, of course, now I knew it. Everybody had to know it. You've got to know this information, and so it started as a birth plan template where I just started going, this is just not cutting it. We need to, you know, actually ask some more questions in here. So I just started adding all of those I wish I'd knowns into this birth plan template. And then I accidentally wrote a book. I'm like, whoa, that's a lot of questions. These templates are really letting women down. It's not giving them enough. And so once I realized that there was so much more to it than filling in the blanks on a template, I started using all of the background that I had before becoming mother, which was marine biology and science communication. So I used to study whales. It's still a mammal. They still breastfeed, it's not that much different. So applying that knowledge to a different mammal and bringing in that science communication, I realised I was onto something. And then I very, very boldly sent it to Hannah Darlin, who I'd seen in the newspaper. Like she is a professor of midwifery. How cool is that? Yeah. So I'm like, I'm gonna send this book to Hannah Darlin. Uh, you know, why not? And so I did and said, Do you mind, you know, in your spare time, because I'm sure you're really busy, um, could you just have a look at this and tell me what you think? And she wrote back and said, I think there's a PhD in this, Catherine. Does turn out she tells everybody that minor detail, minor detail. Minor detail. But because I already had a master's and you know, the right background, and my next step was a PhD. I'm like, yeah, you know what? I think I will. But I had just had my final baby. And so I put it off for about three years, and then it just got to the point where I thought, I have to do this PhD. Everywhere I looked, the information, the talk of the town was where is the communication? Why are women not being told? Why is why is this still happening? And so I knew that I was sitting on something that really needed to be evaluated because it did have the potential in this space. So, what really drew me to the birth map was that absolute drive to make it better so that every woman that came after me didn't have to make the bloody thing up as she went along.

SPEAKER_00 8:30

Yeah.

SPEAKER_02 8:30

No need to know basis anymore.

SPEAKER_00 8:33

Yeah. I can just see this like information in your head, just like wanting to get out there. I love it.

SPEAKER_02 8:40

It turns it turns out my birth story. You know how have you heard that the way you're born um says a lot about who you are?

SPEAKER_00 8:48

Oh, yeah. Tracy tells me, Tracy Anderson tells me this.

SPEAKER_02 8:51

So the way I was born, I'm a twin, and my mum tells me that we we were a long birth. It was all of five hours. And the only reason it was that long was because I was trying to see where I was going. She said, You had your chin up, and eventually you put your chin down and out you out you came, and then we practically threw you across the room because Amy was following straight behind. And we've always laughed. That is so typical of you, Catherine. You've always got to analyse everything, see what's going on first. But once you've made up your mind, boom, you're there.

SPEAKER_00 9:26

That's such a cool visual of you flying across the room. Um and with so both Ellen, my wife Ellen and I did the birth mapping exercise with our doula Kylie. And I've got a really clear visual of the difference between a birth plan, which like you think of it like a list, and then the um birth map, which is like a spider web, like this huge map. And it's like if that's not a representation of how women's bodies operate, I don't know what is. It's like the birth plan is like the Western medical model of how we're trying to fit women into this structured approach, like sequential approach, and the birth map is like this network, there's like tentacles reaching out. Like, that's how women's bodies work. Like, so I love that, and we found that so great in um having contingency plans, and um actually, would you mind just like giving a bit of a summary of for those who um haven't heard of the birth map, what is it and how is it different to a birth plan?

SPEAKER_02 10:41

Yeah, it's it that's a really good question because in a nutshell, the birth map evolved from the birth plan. So it as I mentioned before, I did I did start with that birth plan template, and you were so right in the the lift feel of it. It felt very linear and and almost like I'm I'm preparing for one way. Like if I put this down, that's what's going to happen. And so you would hear over and over again the birth plan's gone out the window at the first at the first sign of something going skew if. So the birth map came out of this idea that there are pathways, and we often hear women talk about the birth journey, navigating birth, all these words. I thought, well, if we're gonna do this, we really kind of need a map. And so as I started, because being visual, as I started um writing down or drawing down what I was preparing for with my um fourth baby, I thought that just looks like a map. And so I Googled it, birth map, and I couldn't find anything that was the what I had just done. There were there were some references. So Penny Simpkin had done a roadmap to birth, which was basically a poster that showed those different pathways, but it didn't give that detail of well, what do I do at a particular interaction or junction on that um on that map? What do I do? So if this, then what? Yeah. And then how does my partner use this map to help us in in this journey? And being in a heterosexual relationship um and of a certain age, the um the the phrase men won't ask for directions, but they will read a map um was in my past. And but what so I sort of thought let's try this out. And I found over and over again that the partners were really drawn to the map because it gave them something really tangible to work with so that they could step into the role of being a supporter. So what I was finding with the birth map process, which was structured, so it was it gave a set of how-tos in that here's some questions to ask, here are how the pathways link up and what you can do at a particular point. But it didn't tell you what to do. I worked really hard to make it neutral so that whoever arrived at this map could pour themselves into that landscape, could could absolutely make it on their terms. So the decision maker is ultimately the woman who is taking that journey. It's her body that this is happening to. And the baby, as long as the baby's on the inside, the decisions all belong to the mother. Once the baby is born, though, the the partner can start to make some of those decisions. So it became really apparent to me, particularly after my first experience where we were transferred in a rush, and my partner was there saying, She can't breastfeed if she's in a different hospital to the baby. You have to, you have to take her to the other hospital. And it never like it became apparent that was never going to happen if we hadn't insisted on it. And so the only thing he had to hold on to was that I know Catherine absolutely wants to breastfeed, and she will be devastated if if that can't happen. So he had one thing that he could hold on to, which was you have to get my wife a bed at that hospital, which he managed to do. But there were so many other things that could have happened, such as stop, explain to us what's happening and what are our options because we could see that the baby was actually fine. And that my if I knew now, if I knew then what I know now, I would have said, We're not transferring the baby. This all stops now. Like just give me the baby because she's fine. But we we didn't know that. And the authorities in the room were really worried, so there must have been something to worry about, but there it what there wasn't. So what the birth map would have given him in that moment is that ability to say, I'm now a decision maker for this baby, and we are not consenting to this happening. Well, because I was not in a position to make decisions at that time because I I'm still trying to deal with the placenta that hadn't been birthed yet.

SPEAKER_01 15:17

Yeah.

SPEAKER_02 15:17

So in a nutshell, the birth map is a tool for navigation that helps the partner to be that support that they need to be, so that the woman can just disappear into herself during labour. Because that's what we really want to see. She goes, she goes somewhere only women know about, and it's different for every woman, but she can't go there if she hasn't got that safety around her to just you know dis dis disappear into her soul. Um if you're totally yeah.

SPEAKER_00 15:50

And I for me, like the birth map is like a conversation that starts like pretty early on. Because I think with the birth plan, people are like, okay, this is a product that I'm gonna bring with me into labor or I've given to my care provider. The birth map allows for conversation along the way, like you said, getting your partner across your your values of what you want to happen. But one thing, and I um I saw this come out like when I was reading um your research, like some of the participants said what the birth map allowed them to do, which really resonated, was that they could they knew that even if it was it ended up in an outcome that they weren't that they didn't necessarily want, they knew that they explored every aspect of that pathway. Like, so as an example for me, I was taught like um, and people who have listened to other episodes will know that um my son turned breach at 38 weeks, and my the first option, or the only option I had was cesarean at a hospital in Canberra. But because I did the birth map, I was able to look at what other opportunities I had. And even if, like after, you know, even if I end up having an emergency caesarean, at least I had explored those different options along the way. And I and I think some of the participants found that in in your study as well.

SPEAKER_02 17:26

Yeah, they I they they referred to it as being the difference between an acceptable birth and a traumatic birth.

SPEAKER_01 17:33

Yeah.

SPEAKER_02 17:33

So that that understanding and that feeling seen and heard is what makes a critical dis difference. And the birth map enabled them to be able to do that. Whether it was a an unexpected fast birth, which happened to a couple of the rural mums in the study, or right up to the general anesthetic um emergency um procedure that was how had to happen without consent. Um, but the mother who came through that was like, that was okay.

unknown 18:04

Yeah.

SPEAKER_02 18:04

Because I knew why and I knew what was going to happen.

SPEAKER_00 18:08

Yeah. So let's um sorry, I'm getting ahead of the research here, but let's can you can you take us through so you've you've been invited to do a PhD basically, and what is what is your research? Your research is now testing the efficacy of the birth map.

unknown 18:28

Yeah.

SPEAKER_02 18:28

And the theory behind it.

SPEAKER_00 18:29

Yeah.

SPEAKER_02 18:30

Yeah. Yeah. So we we knew anecdotally that the birth map was working. I was just getting overwhelming feedback from people who were using it through my work as a doula, and then I'd um sharing it with people like Kylie, who was an early adopter of it. She's been using the birth map for a really long time. And I just thought, this is making such a difference. And if I don't evaluate it at and make it evidence, it's just another product on the market. So I I I knew I was onto something that could potentially revolutionize the maternity system. So I set out with the goal with the PhD was to evaluate this as a uh tool that could potentially be embedded within the system, not just as something that happens on the side or complementary to, but how can we get this embedded in the system? So we needed to test it across different models of care and we needed a methodology that acknowledged that every single individual that enters that system comes with a story and a context that is only theirs. There you cannot just do a massive survey and say, hey guys, use the birth map, tell me what you think. Like that would be such naf research. Yeah. So I needed a really juicy methodology, and we came along with realist evaluation, which asks what works for whom, in what circumstance, and why. And that was really crucial because we needed to be able to draw out from those stories what was happening for them in different contexts, what kind of things they were using. So the mechanisms that they had at play. So the birth map was a mechanism that we provided to them. But what else were they using? What else were they drawing on to help them prepare? And then what were the outcomes? But those outcomes measured on her terms. How did she actually feel about what happened? And then looking at what the actual outcomes were, whether whether that's the obstetric outcomes, but also um whether it was an outcome she was generally happy with, was she um feeling negative about it, but breaking it down into different aspects. So based on the hypothesis behind it all, we knew that um with well, it was pretty obvious that this tool was a communication tool and a decision-making tool. But we also wanted to know how was it impacting their experience? So that the hypothesis was that it would facilitate the communication, that it would enhance the experience, and that it would aid maternal decision making. So that was the hypothesis we needed to test.

SPEAKER_01 21:22

Yeah.

SPEAKER_02 21:23

And um, and but it within that understanding what the real nuance, the juice that was coming into it. So we managed to get participants from all across Australia in different models of care. Some had birthed before, some hadn't. Um, some they all had their own context, and they were given a copy of the birth map at around 12 weeks gestation, and told to use it or not. Um pick it up whenever you're ready. Um, because I what I was really interested in was when women would start engaging with this process. And so, of course, this. This is now coming to them from the study, not from their care provider. So the care providers are not aware that the women who are coming to them are in a study, that they've got no idea um what what's going on? It's just an ordinary day at the office for them.

SPEAKER_00 22:16

Yeah, you don't want them to be performing.

SPEAKER_02 22:19

Yeah, so it was um so what yeah, so how because what I wanted to know really was was the book alone going to solve the problem? So could could we, you know, like boom, how awesome would it have been? So uh spoilers, um, it's not. Um but we do have a solution. But so with the we I so I was really hoping that it would be enough if we just empower women, can they navigate this system? And so with with we had women in rural areas, remote areas, um, in regional areas and in the cities, and all from different backgrounds and different um value systems, but they all said they wanted as little intervention or no intervention. But they all had healthy pregnancies at the start. One woman entered the study when at her 20-week ultrasound she discovered that the baby had a heart issue and she needed to change track, and she so she had to go from a home birth to a high-risk situation where she had to travel to receive specialist care for her baby immediately after birth. So she needed to be far away from home to have her baby safely. And at first she thought she'd have no options, that she would just be having to succumb to this, you know, conveyor belt type process. But she saw the study and thought, hey, maybe this is maybe this is the thing that I need. And she found that even within that high-risk situation, she still had a lot of opportunities. There was meaningful questions in there that she could draw out and put into her context, such as, um, what happens if this birth is fast and we're not at the hospital when the when the baby arrives? And the um heart specialist said to her, just get here as quickly as you can. And so that gave her the information that they would they knew that the baby wasn't going to need immediate care, but wouldn't would need emergent care. So get here quickly. So that meant that she knew she could have a little bit more say in how the birth might play out. And um and so she started to relax. And of course, we know a relaxed mum is more likely to birth really well. And so she um she she used the birth map um to navigate a complex system. Other women were um just uh navigating it in yeah, different ways. Everyone had a different story, and so we were able to draw that out.

SPEAKER_00 24:50

I did want to make a point about that um before you keep telling us about the the study, is that if you find yourself like changing models of care because of high risk, you don't then just hand over everything to the care providers, you still have ownership of that birth. And I think I think what I see in in some women is that something doesn't go to plan and they're like, okay, over to you, like over to you now, and um that's where the cascade of things can then happen.

SPEAKER_02 25:23

That's that's exactly right. We women feel like um they're they're somehow um beholden to that pathway, and a lot of that comes from that messaging of um safety, so um not just within the medical system, but culturally, we've been told all that matters is a healthy baby, uh, the good mother just you know sacrifices herself. So um for a lot of women, they they will will hand that responsibility over to the care provider. And Rachel Reed um describes it like holding a big carpet bag, and um that's all your responsibility, and it's heavy, it's a lot to hold. So it's really, really tempting and easy to just go, here, authority, take this, um, take this heavy carpet bag from me and you can hold it. But the reality is, even in that situation, you are still the decision maker. Consent is still required at several steps, and that means you need to understand what is being offered and recommended. So you actually have to keep holding your carpet bag. And so for the woman who came into the high risk from a home birth where she'd been experiencing relationship-based care, one-on-one with a midwife, appointments lasting an hour over several cups of teas, and yeah, absolutely getting to know each other really well. And that's a really intuitive process of getting to know each other. Whenever a recommendation is offered, it's very much understood that a decision is needed, not consent. So we're not starting at the point of assumption of a yes. Whereas in this high-risk situation, suddenly the appointments are a lot shorter, information is coming hard and fast, and that carpet bag just got really, really heavy. And the birth map allowed her to open her carpet bag and start taking the pieces out and looking at them one at a time and saying, now what can I do with this piece? How can I still have me in this story? And where are my options? And how can I still ensure that this is a really gentle and lovely experience, even though I can't be at home anymore? So she needed to engage um a doula to help um with that relationship-based care and some continuity um in the day-to-day, and someone who she knew was going to be a familiar face when she arrived at the hospital. So she had to build a relationship with that lady, and that the birth map allowed her to be able to say, This is what I need. And I and I and these are the bits where I'm stuck. And so between the doula helping her to navigate that system, she now had, if you like, a Sherpa to climb Mount Everest, someone to help her carry that that heavy carpet bag, but whilst she still retained the control over it, she was still the one who knew what was in it and what was going to come in and out of it. She had had the reins, if you like. And so the tenets that came out, so as we pulled all of those bits of information together, the tenets that came out of that were informed, supported, and confident. And they were all intertwined. So the informed part, to become informed, the woman needs to have access to meaningful and contextualized information. It has to be aligned with her values, her understanding. And where she doesn't understand something, she needs the time to be able to process it and ask those questions and make sense of it. So this phrase sense making came about, sort of pulled out of the literature. It's it's a very real process that comes before decision making. And it was very, very relevant in the maternity space, which is first and foremost a wellness journey. It's not a pathological experience in it at its default. So when it does become pathological or more complex, we now need to be able to take on board some understanding of these medicalized terms, and you shouldn't need a degree in medicine to be able to navigate the system. But that doesn't mean that you should remain ignorant. You still need to have a care provider who is skilled at science communication and can take that information and put it into your terms, hear what you understand, and make sure that you know that you are either consenting to something with a full understanding or refusing something with a full understanding, which is why I prefer the phrase decision making rather than consent seeking in in this space, because the consent assumes a yes. It assumes that there's a right path, and it's not always going to be the same for everyone. Intertwined with being able to make sense of things, that means there needs to be relationship-based care. And when women talk about continuity of care, and in and throughout the um the uh participants, they all refer to continuity of care. But what they really meant, so as I'm you're drawing out, what are they really saying? They really meant a relationship-based care. I want to know my care provider, and I want my care provider to know me. I want to know their skills and their limitations. I want them to know what my values are and where I won't consent. And I have the right to decide, even if that results in death or injury, and this is where I might choose to take a risk that you're not comfortable with, but this is where my comfort is. So being able to have a meaningful and respectful conversation. So to be supported was about relationships. And they needed that with their care provider as well as their partner. And when they didn't have a partner, they would like as in the a co-parent of the baby, they would bring in um a mother, a doula, sister, next door neighbor in one case. Um, and the next door neighbor was her backup for her backup, but her her partner was away at the time of uh or you know, about three hours away and on her way when the um the birth was happening. And the woman that she'd had thought would be her her doula wasn't available. So she brought in her backup for a backup. And this is the beauty of having a birth map is that you go, hey, what happens if that person's not available? Ah, so she said at first I was like, oh, you know, she wasn't my first choice, but oh my gosh, she ended up being the ultimate choice. And it was a woman who was able to come in and very quickly digest her map, right? I've got you here, let's do this, hip squeezes. And she said, it actually worked out brilliantly because her partner wasn't um, she she her partner got it, but wasn't ready to sit in that space, and so she was able to observe her partner having um the baby, and she's gone, oh wow, that was phenomenal. And because the pressure had been taken off of her to step into a space she wasn't comfortable in, they were both able to be fully present and themselves for each other. They just all landed so beautifully together, and and they forged a friendship with their neighbor that um they hadn't really realized was, you know, hey, this is one of our people, she's awesome. Like, so yeah, that yeah, what a beautiful, um, you know, woman-filled experience. That yeah, that's so cool. It just kind of really told that story that in the support, women women need female energy in the space, and they're often looking for it, whether it's from their midwife or a doula. Um, but if particularly if you've got a male partner, a lot of the male partners are like, how can I fulfil this very feminine role? And so the birth map can also be a really awesome opportunity for the couple to realize that maybe birth is not the place, and the partner can take a a different role outside of the birthing room and um and still be a loving couple. So being able to have meaningful conversations with your partner and building that relationship is an incredible opportunity for partners to start taking this new journey of going from coupledom into family life together. What does this mean? How are we going to integrate the matrescence that's taking place? And um, and in and for the partner, uh, you know, a patrescence. So per patrescence kind of refers to male, but it could refer to partner as well. Yeah. Because we know the science of co-sleeping, the partner that co-sleeps next to the um breastfeeding dyad will have their hormone, like the male partner's testosterone will will drop. So I don't they I don't think they've studied um female, female partners, yeah, but um, but the science of the testosterone dropping, but the fact that it helps the couples to um become this interwoven dance of of this change that's happening. If you can draw your partner into that dyad and give them a role in that, whether it's bringing the water, changing the nappies, doing some, you know, settling of the baby, but never replacing those essential um, you know, we don't have to share the mother essential parts, you know, breastfeeding and the actual birthing. She has to take that journey herself, and it's hers to own. And we can't can't take that magnificence away from her. Um, so but there are so many wonderful things a partner can can come in in to be involved with, so particularly the male partners that are unsure.

SPEAKER_00 35:05

Yeah, and it's that's so true. And I've been on both the side of the partner and the birthing woman, and it is so different. It is so so different. They much prefer the giving birth partner. Yeah, and and like my daughter is like two and a half now, and she still like when she cries, she cries for her tummy mummy, we call them. Tummy mummy, like, and it's just that's just how it is.

SPEAKER_02 35:38

Like, um it's it's an amazing the science behind it is absolutely incredible, and the more we understand about it, it's like wow, this this matrescence is so powerful and so incredible, but we we don't have have it in the vernacular. So the more so I think page one of the book is um introduces the term matrescence. So in the study, as a quick aside before we get to the third tenant, in the study, the book was um in in um chronological order. So it started with here's an overview of the system, here are the questions to ask, and then how to get ready for beyond the birth. And overwhelmingly, the mums in the study said, I really wish I'd read chapter three um and didn't wait until the baby. So they'd go through and go, Oh, beyond the birth, I'll deal with that on the other side. Um, so now chapter three is chapter one, and it begins with matrescence. You are about to change. And let's know where we're going before we start planning the journey. You really need to know what you're aiming for. And that word matrescence was really powerful for women to be able to understand why they were changing, why they had different um different interests and different passions. And a lot of women report, like, oh yeah, that woman I was before I had my babies, she was awesome. But um, yeah, she's not here anymore. There's this new new woman in in her stead. And it's like a leveling up, but society doesn't talk about it that way. So in the book, it really helps um for partners. There's a whole section in there, and it's only short, but it just lays the foundation for how to stay connected with your partner as you move into this new transition and some some really basic um questions that they might be able to ask each other. So that then builds that support. And then with the information and the support in place, those decisions that then get made can be more confident because they're based on something very tangible and then they're supported. So for the confidence, I refer to supported maternal decision making very, very purposefully to replace shared decision making. In the literature, it was really highlighted that it's so understood that the term shared decision making is a problem. But hey, it's working to our advantage, so you know, let's just not um worry about it.

SPEAKER_01 38:09

Yeah.

SPEAKER_02 38:09

And I was like, how can you put that in a public? That's the inside bit. You're not supposed to say that out loud. But there it is in black and white in the published literature. So I was able to say, Oi guys, you've already acknowledged this is a problem. So let's call it what it really is in the maternity space, and that is supported maternal decision making. The decision belongs to the mother and it needs to be supported. And that's where with that confidence we saw in the um the women in the in that study that did have really good relationships with their care providers.

SPEAKER_01 38:50

When all those tenants came together, I'm informed, I'm supported, and I'm confident, it was so obvious then that these tenants all need to be in place for that effective communication. Otherwise, you're talking to the wall or you're you know, you're not you're just not getting um the crux of where you need to go to be able to make that confident decision. And then it's still made on that tentative, I'm pretty sure this is the right way to go. Yeah.

SPEAKER_02 39:19

We want to be making that step boldly and going, right, next step, let's go.

SPEAKER_00 39:25

Yeah. Yeah. So the informed, supported, confident, the three tenants that came out of the research?

SPEAKER_02 39:35

Yeah. So we we were looking, um, we were so the hypothesis, as I mentioned, was looking specifically at communication um and experience and decision making. Decision making, yeah. And and what we found with the tenants, so the experience part, what made an experience enhanced was very much about the relationship. So that then translated so the theory um moved into relationship over it being um you know just a nice, you know, what are the nice things? It's not candles and and and you know, those things might help, but at the crux of it, relationship. And then for the informed part, it was that sense-making process. So communication was very much about making sense of what was possible. And then when it came to the decision making, what aided decision making was that support and that sense making so that you could make a confident decision, but it needed to happen in advance. So we're not making the decisions in pregnancy, but we're doing the prep work so that as birth unfolds, we can recognize where we are and we can recognize where we can go and say that's the direction we're going. Let's do it. And this meant that women who were accepting interventions were doing it with utter confidence. I know why I want this intervention. I'm saying, yes, I'm giving consent with full understanding of why this is now my best option for this circumstance, and I understand why it's happening and and how I got here. And so for one of the women in the study, um, her labor was just taking a really, really long time. And she she got to a point where she was really assessing what was in the room and she said, actually, we need to go for a cesarean now. Um, she could see you know her, she was starting to get a temperature, she could see, you know, some some something just didn't feel right. So that with that brain acronym, um, the intuition part of her her um thinking, she was starting to tune into that and she said, actually, this baby needs to come out now. Um, she'd been contracting really well, everything had been going beautifully. There was no reason physiologically why this baby shouldn't be out by now. Something else is going on. And when she went in for the cesarean, they discovered that the baby was actually in a semi-transverse lie. It was an ab a genuine obstructed labor. She said, I'm one of that 10 to 15% that they estimate actually needs a cesarean. And because we called it when we called it, the baby wasn't in distress. And I was able to still be with the baby, and we didn't need NICU time. And if we had kept pushing, going, Whoa, just give me more time, give me more time, I can do this, with the total focus on it's vaginal birth, or or you know, and the only emergency cesarean will have is you know, when everything's getting dire. She knew that cesarean was one of the tools in her toolbox, and in that moment she said, This is what I need to do. And she was able to move to that pathway with uh with with almost with joy. And then once she saw the outcome and the the obstetric side of it was explained to her, she said, I knew it. Called it.

SPEAKER_00 42:52

Yeah, such a good example, yeah, yeah, and such a good example of the birth map is birth type agnostic, so it's not how to have a vaginal natural unmedicated whatever birth, it's how to have how to own your birth. And and the I think some people think, and including myself before I did more research and looking into it, if I don't have a unmedicated vaginal worth, I'm gonna be traumatized. But it's actually what mattered to me in the end was being heard and having a go, like and I think that that's did the difference.

SPEAKER_02 43:31

Yeah, and and that's um and that's come out in the literature, including my study, but over and over again, w that's what they find. It's not what happened, it's how it happened that that really matters. Yeah. And um and so in this study, what I found was that women saw themselves as decision makers. So that was one of the um limitations in the study was that because it was self selected, all of the women came to this study already knowing I get to make the decisions. And um the next the next phase is I I would really love to see this embedded in the system because then if the care providers are giving women the birth map, those women that don't already see themselves as decision makers start to realise I have that responsibility. It's a way of saying, You're carrying your own carpet bag, but I can help you do it. We're going to do this together, but you're in charge of the carpet bag. And and so I that's the the vision for me is that we can ultimately get to those women who are more vulnerable because they aren't ready to hold on to that responsibility. So how do we help them hold confidently? But for those women that um did describe being the decision maker, they realized that they weren't passive, passive participants, they weren't a passive passenger in this journey, but they were actually the driver. It didn't mean they needed to be in control, they just needed to have that ownership, as you say, of the journey. I'm I'm holding this journey and it's going to happen on my terms, but I know that there might be detours and we're doing it this way. So no conveyor belts, um, being able to make self-determination along the way. And because the book gives them question prompts, it meant that they were able to see the gaps. So once they had the overview and they could see that map, which um it is quite um one once you see see those pathways clearly, it's not nearly as complicated as it might feel when it's all you know, you know, you only can see the bit that you're shining the torch on. It's like, no, let's just put the spotlight on the whole thing. Look at this. From here you can go to here, and then at this junction point, you still have this option, you still have that option. You can say no to an induction at um at 39 weeks because you've been able to have a um a discussion where you've said, so why am I being offered induction at 39 weeks? It's well, you're having your first baby at 42, what do you think's gonna happen? It's like, well, is there any indication that it's needed? Not really. Um, everything's fine. Is it okay if we wait another week and at the 40-week check-in, let's make that decision there? You might get to 40 weeks and say, you know what, I'm actually good for another week. And you can keep that discussion going. But if you don't know that you can actually question a recommendation and and dig a bit deeper, you you you've got to put it into your own context. If it's just the population level recommend recommendation, it might not be meaningful for that woman. And so she needs to be able to have a meaningful conversation. And if they can start earlier, so with the birth plan, oftentimes, particularly if it's a clinically driven birth plan, you'll be receiving it at about 36 weeks. And we'll discuss this at your 38-week appointment. So you've got like two weeks to get your head around it, and you can have anything you want as long as it's on this page, basically. And in the literature, there are dozens and dozens of examples of these clinically provided birth plan templates, which are really an illusion of choice and an illusion of communication happening. It's very tokenistic. And women often don't have the sense making that needs to sit behind it for it to actually become a meaningful document in at the end. So being able to start those conversations early and hypothetically means that there's no pressure. We're just exploring the different pathways. And one of the other aspects of the book, um, or the or a complimentary tool that goes with the book is the game of birth. Which I you had a play of that with with Kylie.

SPEAKER_01 47:48

Yeah.

SPEAKER_02 47:49

Did you play a black and white version or one with colour?

SPEAKER_00 47:53

Colour. It was like the big material.

SPEAKER_02 47:57

Oh, you've got the mega mega one. And it looks like it looks like a brain that since the study's been completed, the the game got an upgrade, and now all the key decision points are on it. And um there's a there's a purple path for physiology, a green path for the medical pathway, and an orange path for the cesarean pathway. And you can see how they link. And you can say no to induction if it's offered, but it's still available to you. You can still change your mind at any point. Yeah. But once you've said yes to induction, you can't go back to the physiological pathway. And that can be a really useful visual for people who um are trying to get their head around the difference between a physiological vaginal birth and a more medicalized vaginal birth and what that can feel like and look like because the game does change and the statistics change. So as you play the game, you roll a 20-sided dice and it's based on the mother-baby report statistics. So you can get a realistic um sense of what might happen. So once you've chosen induction, there's going to be monitoring happening, you know, more offers of vaginal exams and you know, more people happening. It's going to feel busier. And so you might not be able to slip into labor land as easy. You're also perhaps doubting yourself a little bit more. But if you've chosen induction very consciously and it's a confident decision, you go onto that pathway knowing how you can make that still a really solid journey that's on your terms. And you can see in the in the game, there are spots where you can just sort of ricochet between different interactions before you know the the roll of the dice will say this is actually now an emergency cesarean. Whoa, that's big. It's like this game's horrible, Catherine. I don't feel very comfortable, but you're feeling uncomfortable in a safe space. Let's sit with that discomfort. How is that feeling? What are our options from this point? And so you can play that game and sit in those hypotheticals that might become more complex. And then as your birth unfolds, bloody brilliant if you don't need those hypothetical pathways. If the complex things don't happen, excellent. The birth map wasn't needed because we didn't even look at it because the baby just fell out. Yay! But if you get to if you get to those complicated pathways, you start to see the real power of that birth map.

SPEAKER_00 50:35

Yeah.

SPEAKER_02 50:35

So women were reporting more positive experiences, even in the complexities. And so the real power of having those pathways mapped out hypothetically meant that you could recognize where you were and say, actually, now this is our best option. And one of the key detour points might be the part where you're saying, I now I want that epidural. And you might be getting tired, um, you might be finding um that you know the sensations or the pain or the pressures that you might be feeling because it, you know, it will um interpret differently for everybody. It might be starting to feel too much, and the epidural becomes a temptation for either arrest or it becomes the turning point of saying, we're now going to take this birth towards the cesarean pathway. We'd like to have an in-labour, non-emergency cesarean, because we can see that our statistical likelihood of needing an assisted vaginal delivery, so forceps or um a vacuum, possibly an epesiotomy, starts to become the higher likelihood because we've played the statistical game and we can see at this point that's where our statistics are starting to go. And for some women, choosing the cesarean before it becomes an emergency, as as we heard in the story just before, becomes a much safer pathway than potentially risking a um physically traumatic um like the pelvic damage, fourth degree tears that might come on that pathway, because they can see that statistically they've moved into that part of the map. So I would love to see the statistics or the data collected in a way that is literally mapped out on where the decision points are on the map. If we collected the data based on the the journeys that women were actually taking, we could create a set of statistics that were so much more meaningful when it comes to decision making and so much more meaningful when it comes to looking at policies and procedures and saying, why does this hospital seem to have a high rate of cesarean? Yes. You can start to look at cons context and see, yeah, it's because we are genuinely a hospital that's got a higher proportion of complexities that have been because of um you know no known reasons rather than just too old, too fat, too Asian. That's come up as well. Um some of the other things for induction, um the uh gestational diabetes, um things like that that are on the population level might have a slight risk, but it's um it's like a double of very tiny amount.

SPEAKER_00 53:33

I feel like sometimes the data is used or the statistics used to as a a way to coerce women into a particular pathway that is the least risky path pathway for the care provider as well. Yeah.

SPEAKER_02 53:46

Yeah, yeah, we do hear hear a lot of um and and some of the barriers did come up in some of that did come up in the study. And um and so we were able to see that there were some systemic barriers um and and these are a problem for the care providers as as well. It's not because the care providers wake up in the morning going, How can I terrorize women today?

SPEAKER_00 54:10

Yeah.

SPEAKER_02 54:10

That's not that's not happening.

SPEAKER_00 54:12

Yeah. That's important to note though. Yeah. And I feel like maybe we need to do a part two where we dive into the systemic barriers because I think you know, we've talked about before how the onus is on women to like own the own their birth as a weird way to put it. But there are big systemic forces that um, you know, make them it make it more difficult. Um, so we can dive in uh dive into that maybe another time. But I just wanted to um so I think some things that I'm hearing talking to mothers um or pregnant women is it's really scary looking at all of these different things that could happen. And maybe the easier path is for me to just like go with the flow and like just see how it unfolds. And I don't really want to know all the things that could go wrong. What would you say what would you say to that?

SPEAKER_02 55:14

Yeah, don't do that. Um it and that that's been that has been the biggest um criticism is oh Catherine, you're just gonna scare women, but it's like, no. Um if we don't prepare women, like you would never climb Mount Everest without first doing train other training mountains and um working your way up because not only is there a lack of oxygen at the top, you know, you're going beyond the into what they call the death zone or something. Like you need you need to be prepared, you need support. You you wouldn't just go, you know what, I'm gonna go and uh um get a permit and climb Mount Everest this season. That'd be a great thing. Yeah, you know, I don't know what food to take, I don't know what to pack, I don't have the right clothes. Um, you can't just walk up to the base of Mount Everest and and take a stroll. You have to prepare. If you are preparing for an Olympic event, any kind of sporting event, they do training. You don't just go into it blind and think you're going to not come out injured on the other side. So going with the flow, particularly in a medicalized model where there are known systemic problems, is is like trying to climb Mount Everest without support and preparation. You absolutely need to take the steps to hold that bag of ownership. Going with the flow is like going, no, I'm gonna ignore the carpet bag, not there, not mine. And that assumption that the authority or the you know the care provider is responsible at the end of the day, because if you consent to something, that there's that perception that it relieves the care provider of responsibility. But the recent case down in um Bendigo showed us that when consent is not valid, you can still hold the system to account. But that means having to go through similar to a if if you're uh having to go through court to prove a rape, it's very similar for women. They're the ones that feel like they're on trial, they have to prove that they were not um, you know, that that that it wasn't consent. And and that premise of consent is a real problem within the system. We need a systems change that says, let's support decisions, maternal decisions, rather than let's seek consent. And if you're going with the flow, you're very much at that high risk of that cascade of consent, which means that at every point that something else is offered, you're not in a position to be able to say why, how, what are my alternatives. Because that kind of preparation has to happen before you get to the mountain.

SPEAKER_00 58:07

Yeah. I I totally agree with you. I just wanted to hear you say all of that. Um I I'm totally with you. Uh and the case that you're referring to was the um case of the vaginal examination. Um that there wasn't consent for, um, which I can put some information in the show notes if people are curious about that case. Um uh love love this conversation. And um if people want to hear more uh from Catherine, I'll link everything in the um in the show notes. But also Catherine's going to be on a panel uh in September, September 16, um, allowed to birth a documentary about a global midwife who travels around the world delivering babies. I'll put some more information um about that as well. Um you can you can meet and uh Catherine and hear from her at this this Canberra screening. So super excited to meet you finally in person there as well.

SPEAKER_02 59:08

Yes. I'm very much looking forward to that. It's gonna be awesome. Yep.

SPEAKER_00 59:13

Thanks, heaps, Catherine. No worries, appreciate it. Bye. Thank you so much for listening to the women who guided me. If you haven't already, make sure to follow the show on Spotify or Apple Podcasts so you never miss an episode. You can also find us on Instagram and Facebook for updates and behind-the-scenes moments. For show notes and more information about today's guest, visit our website, you'll find all the details there. If today's conversation resonated with you, please share it with a woman you know who might need. And if there's something you'd like me to explore, a question you want answered, or a wise woman you think I should meet, I'd love to hear from you. You can connect with me anytime on Instagram or through our website. Until next time, thank you.