0:00:07.027,0:00:11.510
Today, I'm going to talk to you,[br]as they said, about birth,

0:00:11.510,0:00:16.521
but I'm going to talk a little bit more[br]about what we know of ourselves as humans:

0:00:18.021,0:00:19.641
home birth.

0:00:20.296,0:00:26.146
Clay Christensen says[br]that disruptive innovation transforms[br]

0:00:26.966,0:00:29.356
a practice or a product

0:00:29.356,0:00:33.246
that has commonly been traditionally[br]

0:00:33.246,0:00:37.796
available only to the privileged few

0:00:37.796,0:00:39.446
and makes it mainstream.

0:00:39.676,0:00:42.496
It makes it so much more[br]affordable and accessible

0:00:42.496,0:00:44.716
that suddenly, everybody's doing it.

0:00:44.876,0:00:47.216
So in North America, we believe

0:00:47.216,0:00:50.816
that the disruptive innovation[br]was hospital birth.

0:00:50.816,0:00:56.996
Isn’t that what made birth safe[br]and accessible to all women?

0:00:56.996,0:00:58.522
A safe birth?

0:00:58.752,0:01:02.802
Well, it turns out[br]that some women don’t agree.

0:01:03.032,0:01:06.232
Some women want to stay[br]in their own homes.

0:01:06.400,0:01:09.500
We’ve exported this idea of hospital birth

0:01:09.500,0:01:14.070
being the way to get safe birth[br]to low-resource countries.

0:01:14.330,0:01:16.130
But even in low-resource countries,

0:01:16.130,0:01:18.480
women aren’t coming [br]in droves to the hospital.

0:01:18.480,0:01:21.560
Why is that? What's going on?

0:01:21.560,0:01:26.810
And is the disruptive innovation[br]hospital birth or is it home birth?

0:01:28.211,0:01:31.511
You’re all familiar[br]with this image, that’s DNA.

0:01:31.731,0:01:34.401
I’m going to talk to you[br]a little bit about the science,

0:01:34.401,0:01:38.231
the physiology of humans[br]and what we’ve come to understand.

0:01:38.231,0:01:39.835
You can see those components[br]

0:01:39.835,0:01:43.765
that are joining from two [br]human beings' genetic information

0:01:43.765,0:01:47.545
to predict what the future will be [br]for this human being.

0:01:47.952,0:01:50.142
It turns out that’s the same[br]kind of linkage

0:01:50.142,0:01:54.072
that happens between the environment[br]and the physiology of birth.

0:01:54.494,0:01:58.694
We’ve learned a lot about it[br]from watching animals.

0:01:59.114,0:02:02.124
Animals in captivity,[br]for some strange reason,

0:02:02.124,0:02:04.564
when they’re outside [br]their familiar environment,

0:02:04.564,0:02:08.444
have a hard time getting pregnant,[br]a hard time staying pregnant,

0:02:08.444,0:02:11.324
a hard time staying healthy[br]while pregnant,

0:02:11.324,0:02:15.714
and a hard time releasing their babies[br]when they feel like they’re being watched,

0:02:15.714,0:02:20.244
when they feel like they cannot get[br]in what position they want,

0:02:20.244,0:02:25.014
they cannot access the comfort measures[br]or the food that they want,

0:02:25.014,0:02:28.241
they’re fearful, anxious or lonely.

0:02:28.502,0:02:31.252
This is Mei Xiang[br]and Lisa is the elephant.

0:02:31.252,0:02:33.942
They both successfully[br]delivered in captivity.

0:02:34.470,0:02:35.720
How did they do it?

0:02:35.720,0:02:37.800
They could get [br]in the position they wanted.

0:02:37.800,0:02:41.840
They were given environments[br]that were so familiar to them.

0:02:42.280,0:02:44.220
Maybe they were still in a zoo,

0:02:44.220,0:02:47.530
but something about it allowed them[br]to do what they had to do,

0:02:47.540,0:02:52.722
and part of that was that the zookeepers[br]and the veterinarians weren’t seen.

0:02:52.722,0:02:55.513
They were behind hidden video cameras.

0:02:55.875,0:02:57.365
So what does that tell us?

0:02:57.365,0:03:03.455
What if every time a young healthy man[br]wanted to run a marathon,

0:03:03.455,0:03:07.302
he was told, "It's okay.[br]We’re not sure you can do it

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and you might have [br]a heart attack in the process.

0:03:09.632,0:03:11.562
So why don’t you come into the hospital?

0:03:11.562,0:03:14.102
You could run your marathon[br]around the hospital.

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But don’t worry, [br]you can bring somebody with you

0:03:17.332,0:03:19.882
and your support or spouse can be there.

0:03:19.882,0:03:22.832
We will monitor you[br]to make sure that you're okay.

0:03:22.832,0:03:26.052
And just in case[br]you do have a heart attack,

0:03:26.052,0:03:29.012
the emergency personnel[br]will be standing right there.

0:03:29.282,0:03:32.112
Just in case you do have a heart attack,

0:03:32.112,0:03:36.522
you'd better not eat, and we probably [br]should restrict your fluids."

0:03:37.678,0:03:41.968
Does that make any sense to what you know[br]about the physiology of sports?

0:03:42.231,0:03:45.511
Do you think that if he didn't[br]believe he could do it,

0:03:45.516,0:03:48.916
he would be able to complete the marathon?

0:03:49.415,0:03:52.965
And what about making love?

0:03:52.965,0:03:55.385
What about making babies?

0:03:55.385,0:03:57.670
Suppose you told this young man

0:03:57.670,0:04:01.520
that he also could have a heart attack[br]when he had an orgasm,

0:04:01.520,0:04:03.010
some people do.

0:04:03.300,0:04:06.030
What if, we weren't so sure[br]about his ability.

0:04:06.030,0:04:09.320
We said, "No worries, [br]come to the hospital!

0:04:09.320,0:04:14.470
We'll give you a nice quiet room.[br]You can bring your spouse.

0:04:15.160,0:04:17.110
We'll just come in from time to time

0:04:17.110,0:04:20.550
check your heart blood pressure[br]and your heart rate

0:04:20.550,0:04:22.890
and make sure that everything is okay."

0:04:23.100,0:04:25.973
Do you think he'd have some sort[br]of performance anxiety?

0:04:25.973,0:04:27.653
(Laughter)

0:04:27.663,0:04:29.123
I think this is what he'd do:

0:04:29.123,0:04:33.923
He'd say, “I know what to do[br]and you guys leave me alone.”

0:04:34.373,0:04:37.245
So, what have we learned[br]about human physiology?

0:04:37.255,0:04:40.665
There're some very cool things[br]that have been discovered now,

0:04:40.665,0:04:43.925
things about when we control birth

0:04:43.925,0:04:46.305
and when babies [br]don't come out of the vagina.

0:04:46.595,0:04:50.175
Guess what? They don't get[br]the beneficial effects

0:04:50.175,0:04:55.385
of the good bacteria living in the vagina[br]that helps them for a long term health.

0:04:55.822,0:05:00.422
What about oxytocin, the hormone of love?[br]Why is it called the hormone of love?

0:05:00.438,0:05:05.618
Well, it's only released [br]in three times in our life,

0:05:05.628,0:05:08.208
three times which are absolutely[br]critical to bonding.

0:05:08.208,0:05:11.328
In fact, it does modulate[br]how attached do we feel.

0:05:11.678,0:05:13.748
It modulates social behavior.

0:05:13.748,0:05:16.618
Oxytocin is only released

0:05:16.618,0:05:19.907
when we make love -[br]when we have orgasm -

0:05:19.907,0:05:23.312
when we have contractions[br]to open up our uteruses

0:05:23.312,0:05:25.092
so that the baby can come out,

0:05:25.092,0:05:27.722
and when we let down our milk[br]so we can feed our babies,

0:05:27.722,0:05:29.772
so our babies can survive.

0:05:30.304,0:05:35.204
Every year, 350,000 women die[br]while pregnant or giving birth.

0:05:35.697,0:05:39.637
2 million newborns die[br]within the first 24 hours of life.

0:05:39.737,0:05:41.277
This is true.

0:05:41.477,0:05:45.527
Is this why we don't recommend[br]home birth to everybody?

0:05:45.677,0:05:47.047
Is it home birth?

0:05:47.047,0:05:51.497
You know, most of these women[br]live in 58 countries.

0:05:51.657,0:05:53.827
They’re low resource countries.

0:05:53.837,0:05:57.537
In these countries, women do not have [br]access to lifesaving techniques.

0:05:57.537,0:06:00.587
They don't have the medications[br]to stop bleeding.

0:06:01.138,0:06:04.278
If they could access it, [br]they can't get there.

0:06:04.798,0:06:07.668
They don't have somebody[br]checking their blood pressure.

0:06:07.898,0:06:12.208
Sometimes they're exposed to conditions[br]which are dangerous for themselves.

0:06:12.318,0:06:14.978
They don't have methods[br]to resuscitate a baby

0:06:14.978,0:06:17.178
that maybe just needs a little help.

0:06:17.360,0:06:21.840
Is that why everybody [br]should deliver in the hospital?

0:06:22.695,0:06:24.025
What does the research say?

0:06:24.025,0:06:28.365
For a long time we had a hard time[br]understanding what it really says.

0:06:28.585,0:06:30.463
Just like what Carzy said this morning,

0:06:30.463,0:06:33.493
you've to ask the right questions[br]in the right way. Guess what?

0:06:33.913,0:06:37.251
We weren't asking the right[br]questions in the right way.

0:06:37.251,0:06:40.981
We were mixing up planned home birth[br]with unplanned home birth.

0:06:41.011,0:06:44.021
When we looked at the difference[br]between home and hospital birth

0:06:44.021,0:06:45.591
we had a lot of cases in there

0:06:45.591,0:06:47.931
where the woman delivered[br]en route to the hospital

0:06:47.931,0:06:49.621
without an attendant, accidentally,

0:06:49.621,0:06:53.581
even in high resource countries[br]where all those things are available.

0:06:53.902,0:06:55.782
And that doesn't tell us the story.

0:06:55.782,0:06:59.592
If we don't know who's attending her,[br]what their skill set is,

0:06:59.592,0:07:03.082
if we don't know if she can change[br]the plan when she is in trouble,

0:07:03.102,0:07:07.112
we don't know what's really[br]dependent on place of birth

0:07:07.112,0:07:12.152
and what is instead dependent[br]on the type of care that she gets.

0:07:12.592,0:07:13.992
What we do know now?

0:07:13.992,0:07:18.992
The good news is that we have[br]15 or 16 really high quality studies.

0:07:19.032,0:07:21.222
We'll never have[br]a randomized control trial,

0:07:21.222,0:07:24.522
because women will not agree[br]to be randomized to home or hospital.

0:07:24.532,0:07:27.222
They have opinions [br]about where they want to deliver.

0:07:27.222,0:07:28.382
And they've tried!

0:07:28.382,0:07:32.602
There was one trial that they tried[br]to run for about 15 years.

0:07:32.682,0:07:34.992
They got 11 women to agree.

0:07:35.143,0:07:36.853
Not big enough to say something.

0:07:37.008,0:07:40.368
So, what we know is that[br]for an essentially healthy woman

0:07:40.368,0:07:42.448
[br]who has attendants with skills,

0:07:42.448,0:07:47.518
and those skilled attendants[br]bring basic equipment and medications

0:07:47.518,0:07:51.178
and they have seamless access[br]to specialized care

0:07:51.178,0:07:53.318
when a complication arrives,

0:07:53.318,0:07:56.448
we actually get healthy mothers and babies

0:07:56.448,0:07:59.719
and they experience less interventions.

0:08:00.677,0:08:01.897
So what's the problem?

0:08:01.897,0:08:06.777
Why don't we all agree that that's[br]the system that we should set up?

0:08:07.226,0:08:08.846
I study attitudes [br]

0:08:08.846,0:08:13.796
and what leads to attitudes [br]among maternity care providers.

0:08:13.896,0:08:17.506
I did this in Canada, [br]a big large national study.

0:08:17.696,0:08:22.646
You can see that midwives, obstetricians[br]and family physicians don't agree.

0:08:23.457,0:08:24.637
Why does that matter?

0:08:24.637,0:08:28.677
Provider’s attitudes matter,[br]because they influence what women choose.

0:08:28.797,0:08:30.947
Women want to do[br]what's best for their bodies.

0:08:30.947,0:08:33.190
They want to be able[br]to believe their providers.

0:08:33.190,0:08:35.807
We know that providers[br]who know more about breastfeeding

0:08:35.807,0:08:37.477
and have education about it,

0:08:37.477,0:08:42.547
their patients will be [br]more successful at breastfeeding.

0:08:42.877,0:08:45.917
We know that women[br]who choose cesarean on demand,

0:08:45.917,0:08:49.387
their providers are more likely[br]to have chosen that for themselves.

0:08:49.447,0:08:51.991
There's something else going on there.

0:08:52.142,0:08:54.822
If we ask the right questions[br]to the right people,

0:08:54.822,0:08:56.342
we might ask the women,

0:08:56.342,0:08:59.522
what happens when they listen[br]to their providers,

0:08:59.522,0:09:02.402
try to access safe care,

0:09:02.402,0:09:06.522
leave their homes and familiar[br]environments, and come in?

0:09:06.712,0:09:08.852
Well, this is what they say,

0:09:09.246,0:09:11.926
“I was told to be quiet and lie down."

0:09:11.926,0:09:14.736
"I was put in a room[br]with women I didn't know.”

0:09:15.299,0:09:17.509
“I didn't know that man.

0:09:17.509,0:09:20.069
He came in and he said to me,

0:09:20.069,0:09:23.509
'Spread your legs like you did[br]when you got pregnant.'”

0:09:25.428,0:09:28.988
“I had to undress in front of strange men.

0:09:28.988,0:09:33.778
They watched me while I got up [br]on the table to have my baby.”

0:09:35.456,0:09:37.516
Women in the Philippines will say...

0:09:37.516,0:09:41.566
Actually a lot of places in the world[br]where women by droves are coming in now,

0:09:41.586,0:09:45.406
- because there're institutional [br]post-policies for institutional birth -

0:09:45.406,0:09:49.296
are overloaded by normal cases

0:09:49.296,0:09:52.456
and don't have enough resources

0:09:52.456,0:09:55.856
to look after the women[br]who really need their care.

0:09:56.026,0:10:01.206
This is a labor ward, and a postpartum[br]ward, and a newborn ward.

0:10:01.516,0:10:05.456
Is that where you would like to be?[br]Does that feel safe to you?

0:10:05.456,0:10:07.256
This woman is an indigenous woman.

0:10:07.256,0:10:09.456
She came in because she believed

0:10:09.456,0:10:12.016
she was going to have[br]a safer birth in the hospital.

0:10:12.016,0:10:15.026
When she got there, [br]they didn't understand her language.

0:10:15.036,0:10:17.806
They didn't believe her[br]that she was really in active labor

0:10:17.806,0:10:19.716
because she had walked from her village.

0:10:19.716,0:10:21.856
So they made her leave.

0:10:21.940,0:10:26.120
Shortly thereafter, she delivered[br]on the grass in front of the hospital.

0:10:26.219,0:10:28.749
Is that safer care?

0:10:29.118,0:10:32.968
If you think this is just happening[br]in low resource countries,

0:10:32.978,0:10:35.518
it's happening all over the world!

0:10:36.491,0:10:38.791
This is North America:

0:10:38.791,0:10:41.988
strangers around, [br]women being told to push.

0:10:42.688,0:10:44.398
One woman said,

0:10:44.398,0:10:48.448
“I was hooked up and trussed.[br]I couldn't move six inches.

0:10:48.848,0:10:52.098
I knew I had to get up to have my baby,[br]but they told me to lie still

0:10:52.098,0:10:54.298
because they couldn't hear[br]my baby's heartbeat.

0:10:54.298,0:10:55.538
I was worried.

0:10:55.538,0:10:58.288
I listened to them,[br]but they didn't listen to me.

0:10:58.588,0:11:01.638
So I closed my eyes[br]and I hid in my music

0:11:01.648,0:11:04.718
while they stood around and watched me.”

0:11:05.058,0:11:08.418
So what is this issue about relocation?

0:11:08.418,0:11:13.108
How are we defining safety?[br]And who gets to define what safety is?

0:11:13.398,0:11:15.588
We know when all [br]of these silly things happen,

0:11:15.588,0:11:18.458
when mammals are not[br]in their familiar environment,

0:11:18.458,0:11:21.958
when they're disturbed,[br]have a loss of privacy and dignity,

0:11:21.958,0:11:25.778
it can affect their ability[br]to care for their own babies.

0:11:27.023,0:11:28.683
Women tell us.

0:11:28.683,0:11:31.775
Tiye, who is some of the women[br]I looked after, told me

0:11:31.775,0:11:33.985
she had a good job in the hospital.

0:11:34.795,0:11:36.005
She was a lab tech.

0:11:36.005,0:11:39.815
She said, "Everybody knows everybody's[br]business ; I don't want them to know mine.

0:11:39.815,0:11:42.115
The white women I work with[br]don't understand me.

0:11:42.115,0:11:45.165
I don't want to be undressed[br]in front of them.”

0:11:45.435,0:11:49.035
We looked after a woman[br]when I was at Yale on faculty.

0:11:49.301,0:11:51.651
Her husband would not tell us[br]what his name was.

0:11:51.661,0:11:53.861
He said his name was Fred.[br]Nobody believed him.

0:11:53.861,0:11:57.651
They said, “Maybe he is undocumented,[br]that's why he doesn't want to tell us."

0:11:57.651,0:11:59.881
It was 2001, October.

0:12:00.241,0:12:02.451
His name was Osama.

0:12:02.451,0:12:06.941
He was afraid if he's told[br]the hospital staff his name,

0:12:06.941,0:12:10.171
that they would not treat his wife well.

0:12:10.464,0:12:13.814
The Hmong women [br]I looked after in California

0:12:13.814,0:12:16.084
were used to having [br]all of their elders around,

0:12:16.084,0:12:17.744
but the hospital had a rule

0:12:17.744,0:12:20.824
that only one person[br]could come with these women.

0:12:21.801,0:12:23.631
This lesbian couple knew

0:12:23.631,0:12:27.341
that if they went to the hospital[br]with their known and beloved donor,

0:12:27.341,0:12:28.751
that it was very likely [br]

0:12:28.751,0:12:32.131
that the hospital staff [br]would hand the baby first to him

0:12:32.131,0:12:35.041
and not to the primary parent.

0:12:35.761,0:12:37.891
Women tell us that when they're home,

0:12:37.891,0:12:41.611
they can get in what position they want,[br]they can use gravity

0:12:41.611,0:12:43.191
and they can still be assured[br]

0:12:43.191,0:12:47.681
that someone will be checking them[br]and their baby's heartbeat.

0:12:49.280,0:12:53.050
So what about babies[br]who are fascinated with technology?

0:12:53.477,0:12:56.147
What about what women say[br]about technology?

0:12:56.337,0:12:58.397
It turns out that they actually don't want

0:12:58.397,0:13:02.402
to reject technology or modern medicine.

0:13:02.692,0:13:06.492
They want access[br]to all those lifesaving techniques.

0:13:06.497,0:13:08.597
They just want to be told the truth.

0:13:09.127,0:13:12.207
All of the things I was telling you about [br]were based on studies

0:13:12.207,0:13:14.987
that we've done where women[br]have told us what they want

0:13:15.017,0:13:18.677
and what's most important to them:[br]comfort, convenience, empowerment.

0:13:18.797,0:13:20.997
This study has just come out.

0:13:20.997,0:13:24.937
About 2000 women[br]answered a very long survey

0:13:24.937,0:13:27.577
about what they thought[br]about their maternity care.

0:13:27.577,0:13:30.187
These were all women[br]who planned hospital births.

0:13:30.337,0:13:32.267
Guess what?[br]They say the same thing.

0:13:32.267,0:13:34.237
They believe they're in charge.

0:13:34.237,0:13:37.407
They believe they're choosing[br]the best options for their baby.

0:13:37.647,0:13:39.377
They just want to be told the truth.

0:13:39.377,0:13:42.527
They want to be told,[br]how does this risk relate to me?

0:13:42.817,0:13:46.397
What if I live in a place[br]that does have those resources?

0:13:46.667,0:13:50.697
What will it be like[br]when I go into the hospital?

0:13:52.033,0:13:53.873
And they also tell us

0:13:53.873,0:13:58.493
that some interventions lead to things[br]that they wouldn't choose

0:13:58.493,0:14:02.533
unless they were very sure[br]that it would save them or their babies.

0:14:03.233,0:14:06.683
40% of women are induced[br]in the United States today.

0:14:06.712,0:14:09.862
We have over 30% C-section rates.

0:14:10.022,0:14:12.312
Do you think the species [br]would have survived

0:14:12.312,0:14:14.922
if that was the needed rate?

0:14:15.125,0:14:17.655
In fact, most countries[br]that have much better outcomes

0:14:17.655,0:14:22.295
than we do in North America,[br]have much lower rates of these things.

0:14:23.178,0:14:25.118
So what about risk?

0:14:25.399,0:14:27.239
Who gets to choose?

0:14:27.239,0:14:29.569
This is a one-in-a-thousand risk.

0:14:29.739,0:14:33.959
When you have skilled attendants at birth

0:14:33.959,0:14:39.679
and access to equipment and personnel[br]when you need it, this is the risk.

0:14:39.779,0:14:43.489
About one per two to three thousands[br]is what loss will look like,

0:14:43.629,0:14:46.639
- not fetal loss, I’m talking[br]about neonatal loss.

0:14:46.639,0:14:49.419
And 50% of stillbirths are unexplained,

0:14:49.419,0:14:51.569
so we don't really know[br]what's going on there.

0:14:51.779,0:14:52.949
So one-in-a-thousand.[br]

0:14:52.949,0:14:57.269
That's about the same risk than that man[br]who wanted to run a marathon,

0:14:57.269,0:15:00.209
would experience of having a heart attack.

0:15:00.499,0:15:02.039
Is that an acceptable risk?

0:15:02.039,0:15:06.009
And what about the risk[br]of loss of dignity, of abuse,

0:15:06.009,0:15:08.149
of disrespectful care?

0:15:08.609,0:15:11.029
How do you define safety?[br]Who should decide?

0:15:11.039,0:15:13.989
Who is most invested and most responsible?

0:15:13.989,0:15:15.749
How much risk is too much

0:15:15.749,0:15:19.189
and whose agenda and whose destiny[br]are you talking about?

0:15:19.829,0:15:22.869
You know what women say?[br]What would your mother say?

0:15:22.869,0:15:26.529
Do you think she was more concerned[br]about you than the doctor?

0:15:26.829,0:15:28.739
Yes, that's what women say:

0:15:28.739,0:15:30.789
''We care about our baby’s health.

0:15:30.789,0:15:33.189
We are offended when people suggest

0:15:33.189,0:15:36.629
that we are choosing home birth[br]or choosing respectful care,

0:15:36.629,0:15:39.979
just for our own convenience[br]or for comfort,

0:15:39.979,0:15:44.489
like it was some sort of cosmetic option.

0:15:44.609,0:15:46.459
We know that if we are not well,

0:15:46.459,0:15:48.469
if we're not treated well,[br]if we're abused,

0:15:48.469,0:15:51.549
if we feel like we had [br]an unnecessary intervention

0:15:51.549,0:15:54.259
or if we're in an environment[br]where we don't feel safe,

0:15:54.259,0:15:57.599
that can affect how we feel[br]about our babies, our future.

0:15:57.837,0:16:00.787
We're concerned[br]about our baby’s health also.

0:16:00.867,0:16:02.417
What about the use antibiotics?

0:16:02.417,0:16:05.397
What about with C-sections[br]or any of these things?

0:16:05.617,0:16:08.497
Absolutely! Give me a C-section[br]if that’s what I really need.

0:16:08.597,0:16:10.037
I want my baby to be healthy.

0:16:10.037,0:16:16.917
I value the advances that modern medicine[br]have brought to high resource countries.''

0:16:17.277,0:16:19.117
That's what they tell us.

0:16:19.117,0:16:21.433
But is anybody listening to women?

0:16:21.503,0:16:24.080
Paula Freire said, “Washing[br]one's hands of the conflict

0:16:24.080,0:16:26.010
between the powerful and the powerless

0:16:26.020,0:16:29.790
means to side with the powerful,[br]not to be neutral.”

0:16:30.000,0:16:32.600
Isn't it time we took a stand?

0:16:32.774,0:16:35.184
Which is the disruptive[br]innovation we await?

0:16:35.314,0:16:38.634
Is it home birth? [br]Is it hospital birth?

0:16:38.864,0:16:42.654
Or is it humanized birth?

0:16:43.416,0:16:45.196
What if all countries took steps

0:16:45.196,0:16:48.596
to facilitate high quality care[br]in all settings?

0:16:48.596,0:16:52.466
And all women were told[br]how to access that care

0:16:52.486,0:16:55.386
wherever they felt safe?

0:16:56.287,0:17:00.637
If the focus was access[br]to safe humanized birth in all settings,

0:17:00.637,0:17:04.090
then we'd prioritize the availability[br]of lifesaving measures and skills

0:17:04.100,0:17:09.590
everywhere and carry them to the places[br]where a woman feels respect, autonomy,

0:17:09.590,0:17:12.552
and the ability to listen[br]to her own body and baby.

0:17:12.642,0:17:15.552
I wrote that down[br]because I wanted to say it all.

0:17:15.552,0:17:17.842
I wanted to be sure[br]I didn't forget to tell you

0:17:17.842,0:17:21.422
that it is about[br]all of those things together.

0:17:22.219,0:17:23.799
We can carry those things to her.

0:17:23.799,0:17:25.749
They might be packaged a bit differently.

0:17:25.749,0:17:28.489
We know most people won't need IVs[br]

0:17:28.489,0:17:30.579
if they're cared for[br]and start out healthy,

0:17:30.579,0:17:32.809
- we're talking about [br]term pregnancies here.

0:17:32.809,0:17:37.819
We could be ready standing by[br]with resuscitation equipment for her baby.

0:17:38.590,0:17:42.130
It doesn’t look like the hospital[br]but it’s got all the same stuff.

0:17:42.410,0:17:46.550
Meanwhile, the woman could get[br]in whatever position she wanted.

0:17:47.270,0:17:51.340
And we could remember[br]that whether or not we're there,

0:17:51.340,0:17:53.410
whether or not [br]the interventions are there,

0:17:53.410,0:17:56.430
a woman will deliver undisturbed

0:17:56.430,0:17:59.250
and will receive her baby[br]and care for her baby,

0:17:59.270,0:18:02.120
because that's what humans do.

0:18:02.300,0:18:05.070
They would receive their babies with joy

0:18:05.085,0:18:08.515
and with the people that they love,[br]with gentleness.

0:18:09.647,0:18:14.417
If we attended them[br]in that respectful way,

0:18:14.417,0:18:16.967
perhaps they would invite us[br]back into their homes

0:18:16.977,0:18:19.838
to help them learn[br]how to care for their babies.

0:18:20.218,0:18:24.398
And their babies [br]would come out alert and healthy,

0:18:24.398,0:18:28.598
ready to receive[br]the wisdom of their grandparents.

0:18:31.490,0:18:34.830
This is what one of my favorite[br]photojournalists said.

0:18:34.900,0:18:36.940
This has been around for a long time.

0:18:37.030,0:18:41.050
I graduated here in 1978

0:18:41.050,0:18:44.060
and I read this book shortly thereafter.

0:18:44.742,0:18:49.072
Suzanne Arme said, “If we hope[br]to create a non-violent world

0:18:49.072,0:18:52.560
where respect and kindness[br]replace fear and hatred,

0:18:52.560,0:18:55.820
we must begin with how we treat[br]each other at the beginning of life,

0:18:55.820,0:18:59.100
for that is where our deepest[br]patterns are set.

0:18:59.110,0:19:03.930
From these roots grow[br]fear and alienation or love and trust.”

0:19:04.150,0:19:05.490
Thank you.

0:19:05.490,0:19:07.040
(Applause)