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Welcome to the Midwifery Wisdom Podcast
This podcast is your go-to resource for practical education, thoughtful insights, and relevant conversations tailored to modern midwives.
Each week, we bring fresh content and engaging guest speakers to explore key themes in midwifery, including:
Advocacy, business, and clinical skills
Self-care and professional growth
Current issues shaping midwifery today
Listen to meaningful stories and essential advice from leading midwives working to elevate care for families across the globe. Gain clarity, encouragement, and actionable guidance to support your business, practice, and personal life.
Wherever you are in your journey, the Midwifery Wisdom Podcast is here to empower you. Together, we strive to make midwifery the gold standard of care worldwide.
Koen Deurloo Edit
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[00:00:00] Hi, welcome Hey. Hi. How are you? Welcome to the podcast. Thank you. It's so great to officially meet you. We spoke maybe two years ago when I was opening a hospital in Bangalore, India- Oh, wow ... that was a collaborative model. Wow. And I'm so happy to have your connection again. You were very busy at that point, but you advised us a little bit about- I'm sorry about that
collaborative relationships. But so great. But you're now in Bangalore? Well, thank you for... Yeah, I, I live in India. Mm-hmm. Ah. Must be really hot now over there, isn't it? No, no. Bangalore is at, um, more than 3,000 feet elevation, and so it's on a plateau, so it's cool. It's lovely. It's like 75 today, 74, something like that.
Ah. It's great. I like that. Yeah. That's better, better than here. Well, is it hot? You're g- you're having a heat wave in, in Europe, I saw, yeah. Yeah, we do. Yeah. Yeah. Well, it's a pleasure to meet you. Thank you so much for agreeing to be- Sure ... on the podcast today. I know you are so busy, so I won't take [00:01:00] very much of your time, but- That's okay
I know people just want to hear about you and what you have pioneered. And so I guess the first question that I would have for you is I read somewhere that one of your clients, one of your patients, actually brought the idea of mother- Yeah ... assisted cesarean to you. Yeah, she did. Would you tell us that story?
Sure. Uh, I think it was almost, uh, 10 years ago, so the mother-assisted C-section has its first anniversary next year. And, um, there was this, uh, pregnant woman, and she was with her doula. And she c- first she went to another hospital, uh, and they... where she asked for a mother-assisted C-section, and they, uh, declined.
And her doula, I know that doula for several years, so we work a lot together. So she said, "We should visit Koen and try to see what he has to say." There she, uh, she, she came over to my hospital, and the doula didn't [00:02:00] prepare me, so I was a little bit surprised when she asked me about mother-assisted C-section.
Because I vaguely heard about it, and I saw some pictures. I, I, I noticed that there's been one in Australia, so I saw a picture how they did it. Um, so but, but I was intrigued by her request, and I was very curious for why would you want to do that. And the, the woman, Camilla was her name, and we still have contact, uh, she could explain really well why mother-assisted C-section would help her.
She had a traumatic experience last time. She almost lost her, her baby. She was in great fear. And she would, uh, she could explain to me if she felt more connected with the C-section, more involved, more proactive, that it would really help her also recover from trauma, and she was... Well, she was pretty convincing So next thing I knew, I was preparing with my colleagues in the operating room with a, with a doll and, and some sheets, and we were [00:03:00] trying to make it work because, no, there wasn't any literature out there.
There wasn't any science or, uh, or, or, or YouTube films, nothing. So we just tried and, and tried, and then eventually we came up with a procedure, the first mother-assisted C-section procedure, and it went real smoothly. And it was such an amazing experience, not only for the mother, because that's, that is our primary goal.
Uh, but, uh, but also for the team. There you ... O- once Camilla lifted out her, her daughter, she ... The whole room went, went silent. Thought, "This is, like, a really nice experience." So, and then it kind of snowballed from there. So it was picked up by national media, and over time with influencers and podcasts. And so, um, I did once a year, or maybe twice I did mother-assisted C-section.
Now I'm getting close to 100 a year. So I, I don't, don't think it's, it's, it's something you should offer everybody. I'm not sure every [00:04:00] woman wants to be involved in their C-section, but for those who will, or those who want it, I think it's a very good option. So this is how it works. So beautiful. Yeah. Yes.
Well, actually- So I'm still grateful It's, it's amazing and, and, and it's so fantastic to speak to one of the pioneers certainly in Europe. I wanted to ask you, because most of our audience are clinical, uh, providers, I wanted to get- Mm-hmm ... a little deeper into what you do differently. You modify the drape, the- Yeah
the, the birthing person has, um, scrubbed in and has sterile gloves on. Yes. What else is modified? How, how did you come up with this process? Uh, well, we tried and tried, and over time we perfected, uh, we make it more perfect or we, uh, improved it. And I'm s- d- I don't think we're still there, but it, it's been improved over the last, uh, years.
So well, first of all, the, the, the preparing of the mother takes a bit more time [00:05:00] than usual cesarean, than normal cesarean. So, and it happens after spinal anesthesia. So blood pressure will go down, and sometimes mothers don't feel well, and sometimes, uh, babies don't feel well, so you shouldn't take too long in preparing the mother.
So we kind of speed things up. So they get the spinal anesthesia, they're in a upright position, they stretch their hands, we disinfect their hands with, uh, with alcohol twice, and then she keeps her hand in front of her, and we'll put her in a supine position with their hands up in the air. I got a lot of pictures on my, on my Insta account if, if, if people wants to see.
Yeah, we'll share some. Mm-hmm. Yeah. So and then I'm going to use, uh, uh, disinfect her belly, but also her chest because we'd like the baby to have skin-to-skin contact after birth, so we disinfect the, the chest as well. That takes a little bit more time, and then we use separate sheets, one going down, one on the sides, and then we'll prepare this gown.
So just a surgical [00:06:00] robe li- like I'm wearing, only we cut it in half like a, like a crop top, and then she gets sterile gloves. So she's like an operating member of the, of the, of the team, just, yeah, she's on the table. So that's how it works. Amazing. It takes- And I'm sure there's quite a bit of preparation before they're even in their surgery to understand their steps.
Uh, yeah, definitely. I, I do feel it has more, uh, reasons to prepare them well. One is to make the procedure go more smoothly, but on the other hand- I notice when women are prepared on what to expect, they have so much more space and room in their heads to really enjoy the moment, because they're not surprised by every step of the way.
They know they have to disinfect their hands, they know they have to lay down, they know it might take some time, they know I will guide them. There are some steps in between where we, uh, slow down during the procedure just to check in on mom. "So are you still okay? Are you still there? Do you want us to move on or you want to take a minute, huh?"
I think one in three, one in two, uh, approximately [00:07:00] are f- are women who are traumatized, so you really got to hold their hand during procedure, really check in on them, yeah, to make it a, a nice experience. So and I think preparation really helps. Yeah, it, it has to be trauma-informed like that because that is who's- Yeah
requesting it primarily, right? Absolutely. Absolutely, yeah. Yeah. Yeah. So, uh, yeah, so this is-- the whole preparation is, is a major, and I usually take an, uh, I have this photo series in which I show every step of the way. I shared some also on my, on my Insta, and just show them how the procedure- Mm-hmm ... is done so they know what to expect.
Mm-hmm. That's so cool. Yeah. As the MAC has scaled in your own hospital, in your own practice, have you relaxed the selection criteria at all? Or is it still fairly strict, and will you explain that? Uh, I haven't changed the selection criteria that much over time. Uh, I've expanded them a little because I-- we did breech, for instance, or twins.
I did a twin last [00:08:00] week. So, uh, it's, it kind of broadens, but the most important part, it needs to be low risk. So there needs to be a good baby, and there needs to be a mother in good health, and, uh, preferably at the term phase, so after 37 weeks. Um, there's, there's some severe of, uh, absolute contraindication.
That's when the placenta is close to the incision, so you can cut- Yeah ... the placenta and then take all the time to get the baby out of b- the baby. So, um, do make ultrasounds, yeah, before, uh, mother's C-sections just to make sure the placenta's not there. Uh, I've noticed over time, at first, a lot of traumatized women came to me, huh, to discuss, uh, their, their wish for mother's C-section, but over time, there were also other mother who said, "Well, I'm not traumatized, but I really Like the way you're treating the C-section, I really want to be part of it.
Is that okay, too?" "Yeah, of course. Of course you can. I'm more than happy." Yeah. So, and I think it's now close to, uh, more than half, I think, is not traumatized. Uh, is just looking for more [00:09:00] involvement or participation in their, in their mother-assisted C-section. We do not offer it routinely. So I think if you offer it routinely to everybody, there might be someone who say, "Well, my doctor's telling me a MAC is an option.
Maybe I should do that." So... And I'm not sure if that's really helping in the outcome. So maybe we, we change over time, but for now, we'll just let the mother decide. So of, of course, we'll make the indication for a C-section. That's, that's the first step. And then secondly, if mothers, um, opt for mother-assisted C-section or ask questions, then we'll discuss it, but we're not offering, uh, many mothers the mother-assisted C-section because, uh, I'm afraid it will kind of mix up our, our, our, our, our participants and maybe...
Well, also, it's not for everyone, I think so, and, and maybe some people felt overruled or felt a little bit pushed into the MAC, and I really don't, don't, don't want to do that. That's very clear and makes a lot of sense. In the same way that home birth is [00:10:00] not for everyone, we should have choices. Yeah.
Absolutely. Yeah. I agree on that. Yeah. Yeah. That's a- Yeah ... very recent discussion I had. Yeah. Yeah. It's not about pro or con, it's just- Right ... what's best for you, what's safe for you, what, what helps you. Right. Yeah. Yeah. Right. And the only real problem globally is reducing choice. I think, yeah, I think with the best intentions, healthcare is also making decisions for women, and I think, um, we should m- more incorporate women in the decision making, yeah, more autonomously.
So I believe- Absolutely. Yeah. I've seen you describe one of your broader goals as putting decision-making authority in the hands of the pregnant person. Yeah. Where- Where it should be. Yeah. So where does that philosophy... Like, how did that happen? Like, what hit the hardest that made you say, "Oh, we're doing this wrong.
I need to do it differently"? Well, not just one thing, several things. So my, the home birth of my own daughters, where I felt that- [00:11:00] Yeah ... home birth is safe where when guided by professionals. We have really expert midwives in Holland, so they're at extremely high level. So... And it wasn't in the hospital, and I was a resident, so I only knew the hospital, and then I still felt safe.
So I noticed, okay, so the hospital is not, is not the only place where you can feel safe. So I think that was an important lesson for me. And also over time- Mm ... I met incredible women who also learned me a lot of things. I remember a woman who I offered to induce m- because she had a severe growth restriction, I thought, and she just said, "No, I don't want to do that."
So she learned how, because I Couldn't see the why in her, and I was just a little bit too young to go search for the why. But eventually I, I, I learned that a why for a mother is also very important because if she agreed with a ind- induction, she wasn't possible to give any home birth. There were other people involved, more monitoring.
So I kinda skipped [00:12:00] that. So those two lessons, home birth and, and the woman who said no, I talk about them in my book as well. So they, they learned me things. So I know there are a couple of more lessons, uh, uh, I've learned. So it's not like this bright moment, so, and all of the sudden I think woman should be the center of our attention, but it gradually increased.
Also with talks with people like you who are just curious. Yeah. down there and- Midwives is- Wire my brain. Yeah. Well- Well, I think, uh, Coen, what's so fascinating about you is that you're open to these messages that come from diverse places. Thank you. What do you think creates that openness? Well, I, I'm not sure.
Maybe I was raised that way by my parents. But I've, I had some really nice, uh, outcomes. So working with birth photographers, for instance, everybo- a, a lot of people thought, "What, what should... Well, why should we allow birth photographers?" But look at this now. We can really explain our story really well about how we take care of women, also in the medical [00:13:00] setting.
So instead of a doctor telling you, "It's safe, and we can be nice to you," I can show you pictures of birth photographers, which really makes you feel, "Oh, the hospital's a nice place. It's a good place as well." So it helps us. And the same with doulas. So, and every time... I, I, I'm curious by myself, so that helps, I think, a bit.
But, uh, every time I notice something, I say, "Oh, this is something we can incorporate, or we can try." And I also made my mistakes. So we tried things and thought, "Oh, this is not, this is not working." But most of the time, it puts people's minds also, because in, in healthcare it's easy to stay at the protocols.
Just, "We've done this for years." Yes. I'm allergic to that phrase, but, well, we've done it. Why should we change? Nobody wants that. Yeah. Mm-hmm. Yeah. We hear that a lot, right? Yeah. And this is, like, one of my primary questions that I think our audience really wants to know is- Mm-hmm ... so many other hospitals are not open to adding MAC to their service.
So many physicians say, like you say, where [00:14:00] you were just quoting, uh, you know, "We... This is how we do it. This is protocol." Yeah. "This is what we use." How do you- Yeah ... how do you kind of, how do you infiltrate those systems and those p- providers' minds? How do you wake them up? Like, what would you say to them?
Well, it's... Well, well, we used to ride horses as well. So if you... Henry Ford says, "If I asked the people what they want, they would say faster horses." So you also have to put the idea in people. So I think healthcare workers are, are really well-motivated. They have the best intentions. So but sometimes you've got to kind of, uh, surprise them a bit with what is possible, and you have to convince them that it's good care.
If they feel it's good care, they're, they're easy to... And most... So I had this, uh, student- ... a very nice student from, from somewhere in Holland, and she, she, she sent an email, and she said, "I'd like to do some research about the MAC because I like that." I said, "Okay. Well, thank you." And she said, she asked the same question, "Why doesn't every hospital offer this?"
I said, "That's a good question." Yeah. [00:15:00] So, and she was really motivated. So she made appointments with like 15 hospitals, went there, called them and said, "Just a question, why don't you do max? Why don't you offer max?" Yeah. So now I got these, I got these great list of excuses. So, and it's not-- They're well-intended, so but they're most- mostly because people don't know.
So a lot of quest- or a lot of reactions were like, "It's, it's unsafe." Well, I got data, it's not unsafe. "It's, it's too expensive." Well, just two pair of gloves and, and a robe. It's like 10 euros. We c- we c- we don't go bankrupt over 10 euros , I can assure you. It- So it takes too long. Well, it's four minutes. So you need, uh, extra staff.
No, it's, uh, no, we don't need extra staff. It's just me and my team. So women don't want it. Well, if you don't ask them, if you don't show them. So I kind of now feel that we need to just, uh, show people that it's working. So, and because their hesitation is not because they don't want women [00:16:00] to have these options, they are afraid of complications or if the care gets worse.
So I, I find that good motivation to be extra careful with new procedures. So it's my job or my my mission just to, to tell them it's safe. So I'm working on data. I'm showing, uh, people's story. Uh, I'm monitoring my outcomes. So, and I'm sh- That's icon- I'm sharing the protocol with everybody. So I talk to a lot of people all over the world who wants to hear the procedure.
So it's for free. So I can, I can help you, can help you with that. So I can send you the protocol just to show how you get women dressed to be prepared for MAC. So it's just out there. And to all the healthcare workers just out there who really want to try, just assemble a team with just three or four people who are really motivated to try.
So, and maybe try five or six or so. Just say to your other colleagues, "We're gonna do a pilot. I don't wanna hear anything. Just five, and then afterwards we'll, we'll [00:17:00] evaluate." And once people see the MAC, that's what I know it's in my own hospital, when they see it, yeah, they're convinced this is good care.
It's safe, good care within the guidelines, you know, operating room with parents who are sometimes healing from trauma. So there's no healthcare worker who- Yeah ... who is not touched by that. That's amazing. That's amazing. Well, I hope that more do pick it up and maybe even share this podcast with someone who wants to add this to their, their repertoire.
I read that you did some subspecialty work, maybe your PhD, in preeclampsia and also- Yes ... specialized ultrasound, and it's made you- Yeah ... work in kind of a high-risk environment. Yep. And also, you have been the secretary of your regional obstetrician gynecology midwife collaborative, I think. Yeah. Yeah. And this is such feels like both ends of the spectrum.
There aren't very many neonatologists, perinatologists who also frequently work with midwives. So I'd love to know more about how that [00:18:00] dichotomy happened, and does it even feel opposite to you? Like h- how did that happen for you? Well, I have broad interests, so this is-- I like to keep, uh, busy, so I do a lot of stuff, so also, uh, besides work, so I like to do that.
So that's just me. Um, well, uh, the, the-- my hospital where I work is, is really a free, open-minded hospital, so... And I was raised and educated by, uh, specialists who had a very good relationship with our midwives. So, and once you have a good relationship and you start listening to each other, then you can learn from each other and listen to each other's stories.
So I was already put in a setting where it was very normal to discuss, uh, healthcare with, uh, with midwives. Amazing. And- Amazing ... for example, we, we-- I, I'm not sure if you're familiar with practice in Holland. Obviously, we do have a lot of home birth, but we treat pregnancy, it's not a disease, so it's just, uh, it's just a state of health.
So you're not going to the doctor immediately when you're pregnant, you're going to our [00:19:00] midwives. We call them first-degree midwives. So they work in centers, uh, across the, across the country, and your first visits and, and monitoring are over there. So, and once something happens, you get a medical indication, then you will be transferred to the hospital, or monitors will be taken over by the hospital, but as long as it's necessary.
So... And over time, we also visit the practices. So I'm, I'm there as well. No white coats, no, no sterile, uh, smell. Just me co- going with, uh, with the midwife discussing the patient. So that works also really well. Get to know your practices. So, but we have a- That's so cool ... unique system in Holland, so that's, uh, it's easy to...
It's more easy, I think, than- That's so cool ... in other countries. Yeah. Well, indeed. I mean, the Netherlands has been a major sort of we put it on a pedestal of how midwifery is treated around the globe. It's like, you know, it's the gold standard. It, you know, most, most women see a midwife first and throughout their pregnancy.
Is that still true? Yes. I [00:20:00] think about 90% of our pregnant, uh, women start their, uh, uh, pregnancy monitoring with their midwives, yeah. And over time- Amazing ... I have to say, about first-timers, so first pregnancy, about 80 to 85% do give birth in the hospital, so there is this pretty large shift. And I think for second or later pregnancies, it's, uh, close to 50%.
So we do see a lot of shifts. Mm-hmm. But still, a lot of care is not medical, it's just physiological, just by- Yeah ... by experts who are trained to look at physiology and not only looking for the absence of pathology, which is different than how- Right. That's such a good clarity ... I was educated. Yeah, yeah.
That's such a good clarity. And midwives in the Netherlands work in all care locations, clinics and birth centers and home and hospital and everywhere, right? Right. Well, so you have the first degree, uh, I am not sure if this is the right word, but for now we call them 1e graad, so it's first degree. It's literally translated.
They work [00:21:00] in, in practices, and they do monitor birth or help women giving birth in the hospital, but only with low risk indications. For, for instance, if you need antibiotic prophylaxis for GBS or you had a bleeding in your last, uh, pregnancy, uh, less than two liters, then your midwife can also monitor your birth in the hospital.
And once, once, once care is guided in the hospital, uh, because you have a medical indication, then you either have a resident, so, uh, obstetrician, uh, who is trained to be a specialist Or clinical midwife, and that's called second degree midwife, so that's a different group of midwives. Wow. Wow. Wow. Okay.
Fascinating. Well, I know that you also are a teacher, and you train both residents and midwives, and I'm curious about what concepts or skills you deliberately teach both groups the same. Well, that's a nice question. So I think always [00:22:00] look for the question behind the question. So be curious about the story, not only by patients or women, but also by healthcare workers.
So, and also be aware of your own feelings. So in Holland we have this discussion sometimes also fueled by social media that women do not want to follow protocol in some options. So, well, and they have several reasons for that. So I train people to ask deeper questions, to ask them why would, wouldn't you, instead of being irritated or angry or, or disappointed But also train them to recognize those feeling because they are fair to have.
So if somebody makes you angry, you can say, "Yeah, well, this is stupid person." But you can also look at yourself, "Why am I angry? What this is triggering me?" So, and that's so for some, uh, healthcare workers is helping them because, uh, you want the, the, the, uh, you want the same outcome. There's no pregnant woman [00:23:00] who want a different outcome than you, so you always find yourself together with them in de-defining the outcome.
But why do they think route A is better than route B? Why? And don't say, "I've, uh, I've studied, so I think B is the best, so you should do B." Well, maybe, maybe there's more to it. Maybe she's been disappointed by previous route B, or maybe she has other goals than you have in mind. So, and the only way to find out is ask her.
So that's why I try to train residents and, and, and interns and midwives and patients as well, or women. So be curious, but also be curious- It's beautiful ... about, uh, the hesitancy of your doctor. So for instance, um, there's also in our country also a lot of discussion over, uh, risks, let's say a VBAC. So one of the risk is that the uterine scar will rupture.
It's one in 200, so that's, uh, uh, approximately one in 200, so that's 99.5% that it doesn't happen. So pregnant women are, "Oh, okay. So that's, that's a very low risk," [00:24:00] some of them. But the healthcare work in my hospital, we do over 3,000 birth. So that's like every month we run to the operating room with a rupture.
So that's a whole different view of the same risk. So you should acknowledge that or acknowledge it. So a woman should know that doctors are not treating the percentage different, but they have a other view with these percentages. So it kind of learn then understand doctors or healthcare workers as well.
So yeah, those are some of my- So smart. So smart. So smart. I was reading that you did a, a joint venture, joint training together with the nurses and the physicians and I think midwives as well, residents, and I wondered what, what exercise or case did you train them on? Like, how did you bring all their roles together?
What was that training like? Uh, over time, uh, also, um, let's go back to the first story, yeah. [00:25:00] The, the Camilla came to me with her, who requests for maternal cesarean because her doula told her, "Koen might understand, he might try to." So, and that's also the culture of my hospital. So a lot of women come to our hospital and try to ask questions about protocol or maybe differ from, from guidelines.
So there has been quite an experience in the hospital, and we also, yeah, we had our discussions, so there was really, uh- necessary to train people because some people felt vulnerable, some people felt irritated or angry, uh, dealing with women who were... So that was the, the basics. So we really needed to do something.
So that's why I developed this, uh, course, uh, giving birth outside the guidelines. Not to promote birth outside the guidelines, but to really give the talk a chance. So ask women why. So I, I have a, a, a paper submitted, which is kind of interesting. After saying this about my own paper, [00:26:00] which is not very, it's not very modest, but I'm sure about- It's okay.
Go for it ... I find it fascinating. I find it fascinating. So, uh, ju- just a little bit. So I had like 65 women identified with, uh, a request from outside the guidelines, and I, I ranked them from one to five. So one is completely inside the guidelines. Five is no guidelines at all, unassisted home birth. So, so one in five didn't come to the hospital, but three, three, uh, two, three, and four came to the, came to the hospital to discuss their levels.
Two was, "I will give birth in the hospital, but not according to protocol." Three, "I will give birth in the hospital, but not with you guys." And four was, "I won't give birth in the hospital, and I won't g- give birth with you guys." So those were the options. And I monitored over the time how it develops. So we put in time in these women.
"So why [00:27:00] would you want that? What's your-- what are you afraid of?" And in Uh, a mean average of two appointments, about 20 minutes. You saw a shift towards one. So the four, grade four, I don't wanna give birth in hospital, a lot of them shifted towards three. They said, "Well, okay, maybe it's not so bad. I didn't know that.
I can give birth in hospital with, uh, with you guys." But the most surprising I thought was I've looked at them, where did you give birth eventually? And half of them gave birth in hospital, so inside the guidelines. So I find that surprising. And I've also looked at which part, so half of them in the hospital, the other half not in hospital, which one has the higher rate of complications?
And you would have thought, well, maybe the outside, but it was the inside. And that made me think once risk is increasing, women change their mind and go off to the hospital, and that's exactly-- Women are not stupid. They have these roles or [00:28:00] they have these fears, so they want to be outside the guideline.
But once their outcome's getting worse or, yeah, the, the, the condition of the baby deteriorates, then they make different, and then they usually get back into the guidelines. So I'm trying to explain to my healthcare, so this is what happens. So eventually we have these women who have requests outside the guidelines, who give birth outside the guidelines.
They have a very low risk of complication. I find that fascinating, which supports also that we're not dealing with, yeah, with, with, with, with dumb people. No, we, we're dealing with motivated- Right ... yeah, caring women who are-- want the best- Right ... for themselves and their, and their babies. So, and they change over time.
And that helps- Yeah ... also because healthcare workers- Right ... are really afraid of, oh, something happens to the baby, and I will be convicted, and so... And I show them this. I say, "No, once there- Right ... is serious warning about the babies, the, the women change their mind. They're not stupid. They just want to- Avoid some risks too.
So hopefully it will be [00:29:00] Yeah. Or, or they just want autonomy and, and the self- Ah ... authority to choose. Absolutely. Yeah. Yeah. Because they are smart. I think so. That's a big part of it. Because they are sovereign, sovereign individuals. That's what I have noticed. Yeah. They are. They're- Yeah. Yeah. I've been saying this for years, that I just, I cannot comprehend the mindset of many of the very indoctrinated hospital workers.
They, they pull what we call in the US the dead baby card. Oh, yeah. Have you heard that phrase? Yeah. Right? Yeah, we have the same. Where it's like, "Oh, if you do that, your baby's gonna die," you know? And I just, I... It just baffles me. I was like, who... In very, very rare exceptions, who would care more than the person in whose body that's happening?
Who would care more about the life of their child than the parents? Now, certainly there are very rare exceptions with folks who have mental health issues or drug abuse, but for the vast majority of about to be parents, they literally care more than you. So how can the [00:30:00] doctor take on this like, "I'm the one that's advocating for this baby" mindset when, when that's fundamentally not true?
Like, it's amazing to me. I love that you did a study to prove that. And a- are people- Yeah, no, I- Did
you get it published? I know it's under, under, under supervision now. So I have to wait. Okay. It's in a Dutch- Okay ... it's in a Dutch, uh, uh, magazine pro- or a Dutch journal probably. Okay. So, but I'll keep you, I'll keep you noticed. Please. Uh, well, I, I also think, but we should... I, I, I, I think you're right. So when we, the dead baby card also, and it kind of, it's not fair to the mom.
So saying, "You make choices that your baby, uh... Which, which jeopardize the baby outcome." So it's not, I don't find it a nice way of a conversation. But also what I'm training also women, okay, but look from the doctor because he sees dead babies once or twice a month. He sees the grief, he sees the running, he sees the panic, he sees the self-blame.
He's, he's, he, he doesn't sleep at [00:31:00] night because he thinks he made s- poor choices. And that's a very, very... I felt that too. I f- That's a very strong motivation to- Mm ... not get close. And it even can Maybe, uh, blur your vision on what is safe, uh, a bit because you are too, maybe- Mm ... you are traumatized as well.
So the dead baby card is- Yeah ... not only to convince people or take away, uh, an autonomy, so but it also tells us something about what happened to this doctor that he is willing to play that card. So, and it's not about- Absolutely ... right or wrong. You should discuss that. You should tell him, "Why are s- why are you so afraid that my baby will...
I, I can, I, I will not make these terrible choices." Huh? And this is the literature that you don't hopefully in here. That's such a, that's such, um, a beautiful reframe. I, I really, really feel your trauma-informed concepts and, and even really adulting. Like, you're, you're, you really have high level of cognitive thought to be in that place being triggered, to be in that [00:32:00] onslaught of, of real pushback against your choice, and still say, "This person must be hurting, otherwise they would be meeting me where I am.
Let me go and find-" Yeah "... out what, what's hurting them." And even for the doctor, the patient-doctor flip, that's such a beautiful reframe, and it's so compassionate, and it's so unusual to come from an OBGYN. I just wanna cheer for you. Like, truly. Thank you. Appreciate it. How did you, how did this happen for you?
Like, I, I mean, I know you had home births with midwives, and so that is a magical thing to have the midwifery model of care and really be seen and heard in midwifery care. There must be other opportunities where you became trauma-informed. You became this really conscious, aware person. Can you, can you name- Well- Like, how do we figure this out together?
Well, yeah. Well, several, uh, several things. So I think looking into care outside the guidelines, so I'm, I'm a listener, so I'm al- always really [00:33:00] curious about, uh, people. Why would you want to think like that? Also, in my personal life, sometimes my daughter, she just roll their eyes, says, "Uh, I don't know why he does that, Dad," they say.
So, "I don't know." I say, "Well, try to think then." So, but they say, "Just stop. Stop it." So, but I'm always curious why do people do as they do. That's just me, and I think over time with birth, with, with re- requests outside the guidelines, I noticed that th- these are not stupid people. These are not, uh, they are not influenced only by social media or disinformation.
It's very easy to say, "Oh, you've read something wrong. Poor you. Let me help you." No, it's much deeper than that. So, and over time, um, when I, I opened up, and I, I've never been disappointed actually, so many times I got a new insight. So, and I thought, "Okay, so this is the way to go." So I got my, my view confirmed over time.
So for, for instance, we had this woman, and she had a intra fetal death, so that terrible, at 20 [00:34:00] weeks. And they were devastated and, well, it was really sad. And, uh, and she also had some self-blame, which I find the hardest part to look at, a mother who is self-blaming. Uh, such a, yeah, such a, such a horrible thing.
And, uh, well, what we usually do, we offer induction, uh, at 20 weeks. So, I, I said- Mm-hmm ... to her from there, "You might want to consider induction." She said, "No. No, I don't want to." Okay, that's okay. So, uh, yeah. "I wanna say goodbye. I wanna take my time." Okay. And instead of a couple of days, she took weeks and weeks, and she was on our list every morning at our morning, uh, briefing, and some people felt a bit uncomfortable.
So she's just walking around there with this... Yeah, with her baby inside who doesn't live anymore. Why? Why? What, what happens? W- will she get sick, or how does the baby look when he comes out? So, well, eventually, after three weeks or so, she, she said, "Okay. I think I'm ready." And she came to the hospital. We induced her, and she gave birth real quick, very easily, and [00:35:00] the baby was born as a beautiful baby.
No, nothing wrong. But she was already... She had processed her grief way more than other women. So instead of hastening- Mm ... to an induction after three days and being traumatized and full of grief, she was already in the next step. So she had her severe grief already there as she was welcoming her baby. She already thought about how to say goodbye.
So I find that very, uh, rewarding and, uh, uh, for her, and I find it... So, uh, I think she took better care of herself, uh, and her, and her, and her grief in waiting. Well, it's not according to guidelines. So it... are these things where you try something, and you agree, and y- I also told them, "I'm not sure how this will work out.
So if you wait three weeks, so we don't do this. So most women just want to stop. So but of course, yeah, your, uh, it's your autonomy. It's your body, so if you want to wait, of course, I'll be happy to help you. You can call me or email me anytime if you, [00:36:00] if you're ready. So but I'm not sure." So she knew that we were not sure.
But eventually, yeah, it, it went there. So, so instead of rushing to the moment, she took a long time to grieve, so and that's also now something which I take with me. So y- you don't need to make decisions immediately. Just take your time. So it can al- also help you, uh, cope with the grief, and I explain this story sometimes.
That's so beautiful. I think that's one of the things that's so special about the midwifery model of care, is that we're willing to meet people where they are- Yeah ... and willing to sometimes really alter procedures, standard of care. And- Yeah ... um, this is what makes the medical model so nervous around the midwifery model of care, is that we will wait for a rupture of membranes, or we will retest labs, or we will sit with someone's grief until they're ready, what have you.
And I, I... It's so inspiring that, that you are bringing this into the medical model of care in the hospital, where I think people need [00:37:00] this even more because they're, they're not normal anymore if they're in a high-risk hospital. They're, they need extra, and it's so inspiring that you're bringing this into that care space.
Do you see your- Yeah ... colleagues starting to follow suit? Are they, are they- Yes, I'm, I'm really happy with my colleagues. So they are very free-minded, so. And I think, uh, so, um, I think the best care, uh, we should offer women is not only guidelines, and that's what most medical healthcare workers are, are, are, are offering.
So this is the guideline. But there's more to that. There's also the woman. So what's important? Which risk is she willing to take? A 45-year-old woman with an IVF procedure with her last time, her last option for a living baby is something different than, I don't know, 20-year-olds in their third pregnancy with the same choices, let's say breech birth.
So they make different choices because their life is different. They, they, they, they are, they aren't willing to take some risk or they are willing to take other [00:38:00] risk. So we should take that into account, and that's something which sometimes is forgotten, that risks are not just- Yeah ... risks, they're also how they influence your life.
So how much weight do you put- Yeah ... on that risk? Um, and of course, don't forget the doctor. Yeah. So the doctor also have their motivation to offer you care based on their own experience. So, and I'm trying to... You don't have to change that, but you should be aware of that, that you are sometimes... When I have a s- severe complication during surgery, my next surgeries, I, I'll be extra careful.
It's, I, I, you, you just, y- it's just like it is. So like everybody, every, if you, if you, if you, uh, if you made a mistake, you're extra careful not making the mistake again or... So, and the fourth is also- Yeah, it's human nature ... fourth, the logistic- Yeah. Yeah, it is. And the, the fourth is also the, the logistics of your hospital.
So we have a small country. Uh, you can't go far away from, from a hospital in our country. So home birth is safe because there's a hospital, uh, almost in your backyard. So that, that really [00:39:00] helps us, yeah, promoting home births. Let's not forget that. Um, so and the fourth, so the guidelines and the protocols, the woman and her wishes and her motivation, autonomy, but also the experiences of the doctor and of course the logistics of your country.
Those combined, that's good care. There should we be. We should not forget, not one of the circles should win. It should be combined to good care. This was my TED Talk. It's so beautiful and so exciting that... Yeah, basically- Just kidding. Just kidding ... thank you for, for including us, and so inspiring. No, I- Thank you
I think everyone wants to come to this TED Talk in our audience. Uh, people, people want to know more about so much, and we could go on and on. But I guess I would just wrap up with the last question I have for you- Sure ... which is really a request for you to speak to our audience, which is made up of midwives and midwifery students, nurses, doctors, doulas, other birth workers, and some parents.
But mostly a, a provider audience. And I would just [00:40:00] say we have such a problem in the US, in India, in the UK, many places in the world, we have such a problem with integrating midwifery care in a sustainable, healthy way. And it seems like you are really, while you're pioneering lots of things, you are also regularly working with midwives, doing visits even in their clinic, building collaboration, requesting them to call you with complications, being backup.
How can we build this in other areas? What's your strongest advice for our listeners? Oh, that's, that's a good question. I think, well, of course, you, you should recognize and confirm that you're all working on the same goal, so there is no other goal than a healthy mother, a healthy family, a healthy outcome, but also a good experience, huh?
Uh, those combined is an outcome, and if you identify the, the shared outcome, it usually makes it easier to work on that because you can agree on that. And [00:41:00] what I'd noticed just on a low level, just, um, work together, so like we did in our practices, it really helped me seeing how midwives work, how they talk to their clients, how their practices are organized.
And also when I meet them at the hospital or they send me a text message, "Well, hey, Colin, would you like to think with me just a small question?" So it really lowers the threshold, so very low threshold communication helps a lot, uh, because it's easy to, to think for somebody else, "Oh, he must be doing this because he wants to go home at 5:00," or, I don't know, "He's just following protocol," or, "This is just a money thing."
But it's, it gets more difficult when you know someone, huh? So, uh, and, and most of the health workers are very motivated, so you got to know them. So I think that really helps also in our region. Got to know each other, you got to communicate a lot, you got to communicate on a low threshold, and you got to confirm that you work on the same goal.
I think those are the most important part to start, start [00:42:00] with. And I'm not... Yeah, and I think- Yeah. Agreeable ... yeah, people must be open to this. So g- like with the MAC or the doulas or the birth photographers or, I don't know, a lot of things, so I only work with, with motivated people at first. So because you have this big group of people, there are always this little group who s- never agree on anything, so they, they just want to stay the same all the time.
So that's okay. You're good. So we're, we're not gonna work with you. Then there's this big group who is willing to change but is not front runner, and then there's the front runners. You should get them And start doing pilots because you have your success stories, and your success stories will help you convince the, the big mouse say, "Oh, this is good care.
Oh, look what they're doing." And they are easily convinced. So you're never gonna convince all of them, but that's okay. If they're still small, that's okay. Got them in my own hospital, too. That's fine. So they also help you keep focused. So whenever something's wrong, they call me, say, "What did you do?" And so, uh, you're right.
So I swear I should have done that or I should have organized that better. [00:43:00] So you need them, but you shouldn't, yeah, pioneer with them. So, and maybe- Got it ... in your region also, find the pioneers like yourself, right? People who really want to change and let them go making little success stories. So, and share those success stories, so be part of, of a movement of change.
Uh, I think that will work. Yeah. I, I love that you worked with birth photographers and midwives, of course. Mm-hmm. I always worked with birth photographers, too. I had one on staff since, I don't know, 2008, 2006, something like that. Oh, really? Mm-hmm. Because like you said, when you can tell a story, like a picture says a thousand words, right?
Yeah. It's so easy to communicate when you have the imagery. So yeah, I think working with birth photographers is one of the best goals that midwives can have because then they can share more. They can share, you can tell the story, but also it also helps me ... A lot of healthcare workers find it nice to see themselves work, focused, caring.
Mm. So they're, so, uh, some of my birth photographers, they say, "I make some [00:44:00] pictures of your staff." And they just- Sent the picture and said, "Oh, I made a picture of you. Just you were happened to be there, so you'd like to have it?" So they have this really nice professional picture of them working, very caring or focused.
So yeah, yeah, that's, that's a good thing. So birth photographers are smart people. So that also helps, yeah. So, and then you feel part of a whole story, yeah, like a team, yeah, we're all working on this, this, this, this, this big event, yeah, for this, uh, for these parents. So, and that's, th- and that what birth photographers support really well.
Well, you got to train them, so I train them on the operating room, and, uh, we give lectures to them as well. So you need to know what to do and where to stand, and not to touch any instruments. But once you train them, and it's not a big job, so, uh, yeah, then, then you got them working for you inside your team.
So getting their expertise. Same with doulas, exactly the same. They got their own expertise, expertise we don't have. They know the parents really, really well. They invested a lot in their relationship. They know their fears, their worries, their, their, their [00:45:00] anxieties, their goals, their, their life quality, and we don't have the time.
So once a doula is there, and we train them how to behave in a, a operating room, and how to... which is the way to communicate with us or, and show them what happens in emergency, uh, settings, they can really be, uh, supportive in the whole team because they add that extra value of care, the patient experience.
So in which we can't because we don't have staff or time, or I can perform a C-section also, I try of course, but also comfort the women the same as a doula can. Yeah. Because they're separate professions. And actually- Yeah ... you, you really- Absolutely ... should stay in your own profession, right? We need, we need everyone.
We need everyone. Yes. Yes. Oh, so beautiful. Yeah, and that's what we also, uh- Koen, thank you ... yeah I really, really appreciate that. Uh, you're welcome You're welcome. So it was nice talking to you. I loved your questions. And then finish what you were gonna say. Go ahead. You were gonna say something, go ahead.
Well, about 50 years ago there was this report in Holland, uh, because there [00:46:00] seemed to be a relatively high, uh, neonatal morbidity and mortality. So there was, there was big fuss about of course, because we think we're a very well-developed country. Uh, so, uh, it should be safer with us. And they, uh, they, they, they came with a report and some recommendation, and one of the recommendation was, "Don't leave a woman giving birth alone.
Don't do it. It's improved outcome if you help her." We don't have the staff, we don't have the time, so... And then there's the doula. So it was already there 10 years ago that we really should implement doulas. So instead of people saying, "Oh, I don't want a doula," why not, uh, train them? Yeah. They d- they don't do what I like.
Well, train them, help them. Help them recognize so, so they can be part of the team. So that's what I'm working on now a lot with, with several doula academies to see how we can implement them, not by being under my supervision, no, but understanding the system and bringing their own expertise to help the whole team in the outcome.
So we'll start with the first training, I think, [00:47:00] uh, in October. So- That's exciting. Yeah. This is, like, the same thing that e- the, I think the same concept echoes in all of the professions, that so much of the fear or the lack of, of collaboration is because they just don't know, right? The doulas- Yeah Learning about why emergencies happen, how those decisions get made, how movement has to happen, helps them be actually a better support for their clients.
And the same thing with the physicians. Absolutely. I think the physicians not understanding what happens at a home birth, what happens in midwifery care, how the care is, why these things happen. Suddenly they're like, "Oh, well that does make sense." Like you're saying, introducing the MAC. And it's like, "Actually, this is good care."
Yeah. And so building these bridges so that we stop being these siloed care, like, islands will change everything. One thing I used to do was after I had an interaction with a provider, a nurse, midwife, doctor at the hospital, as a home birth midwife, I would always send them a handwritten note and send food because they're up all night or they're [00:48:00] on call.
They're busy. And so we'd send fruit baskets or we'd send platters of things. I love that. That's nice. Because, like, the way to someone's heart is through their stomach, right? So we feed them when they're hungry. Yeah. And And hopefully they remember us well. That's so considerate, yeah. You know? Nice. Maybe I gonna steal that.
Well, what happened was when I first opened, um, a center in that area, we... They would take out our IVs. They were done in the field. They're not clean. They would just reevaluate everything. We were just totally not trusted. But as we built this actual personal relationship, every transfer, every consult, they got something from us, a handwritten note, a basket of fruit, what have you, they started to be like, "Oh, these people can't be that bad."
Mm-hmm. "They care about us. They're being nice." Yeah. "They're feeding us." That's it. And so by the end of, of five years, not only did they leave our IVs in, but they took our diagnosis so that woman would go back for cesarean without another evaluation. They would be like, "Well, if the midwives think she needs a cesarean, she definitely does," you know?
So it was, like, this real [00:49:00] trust-building change that happened because of that personal relationship. Nothing changed in our care. Our care was the same. What happened was we were included. They trusted us more. Yeah. And so building those bridges where we can trust each other is so, so important. And I am so grateful to hear this example of you and what you're building in your community.
Thank you so much for being the change- Oh ... that we're all looking for. Thanks. Thank you. So fantastic. Yeah. A real pleasure. Great summary. Thank you for being, uh, on this call today. Thank you for doing what you're doing in the world, and you've got some pretty raving fans over here at Midwifery Wisdom, so- Well, I'm easy approachable
we'd love to, we'd love to get you to talk. Yeah, you're so approachable. We'd love to get you to speak at one of our conferences, and we just would love to continue to, to spread your, your work. Oh. Thank you. Well, Cohen, thank you so much. Have a wonderful day, and, uh, appreciate you taking time out of your busy schedule.
Oh, yeah. Thank you again. Oh, well, thank you for inviting me. Love to talk.