[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:07.03,0:00:11.51,Default,,0000,0000,0000,,Today, I'm going to talk to you,\Nas they said, about birth,
Dialogue: 0,0:00:11.51,0:00:16.52,Default,,0000,0000,0000,,but I'm going to talk a little bit more\Nabout what we know of ourselves as humans:
Dialogue: 0,0:00:18.02,0:00:19.64,Default,,0000,0000,0000,,home birth.
Dialogue: 0,0:00:20.30,0:00:26.15,Default,,0000,0000,0000,,Clay Christensen says\Nthat disruptive innovation transforms\N
Dialogue: 0,0:00:26.97,0:00:29.36,Default,,0000,0000,0000,,a practice or a product
Dialogue: 0,0:00:29.36,0:00:33.25,Default,,0000,0000,0000,,that has commonly been traditionally\N
Dialogue: 0,0:00:33.25,0:00:37.80,Default,,0000,0000,0000,,available only to the privileged few
Dialogue: 0,0:00:37.80,0:00:39.45,Default,,0000,0000,0000,,and makes it mainstream.
Dialogue: 0,0:00:39.68,0:00:42.50,Default,,0000,0000,0000,,It makes it so much more\Naffordable and accessible
Dialogue: 0,0:00:42.50,0:00:44.72,Default,,0000,0000,0000,,that suddenly, everybody's doing it.
Dialogue: 0,0:00:44.88,0:00:47.22,Default,,0000,0000,0000,,So in North America, we believe
Dialogue: 0,0:00:47.22,0:00:50.82,Default,,0000,0000,0000,,that the disruptive innovation\Nwas hospital birth.
Dialogue: 0,0:00:50.82,0:00:56.100,Default,,0000,0000,0000,,Isn’t that what made birth safe\Nand accessible to all women?
Dialogue: 0,0:00:56.100,0:00:58.52,Default,,0000,0000,0000,,A safe birth?
Dialogue: 0,0:00:58.75,0:01:02.80,Default,,0000,0000,0000,,Well, it turns out\Nthat some women don’t agree.
Dialogue: 0,0:01:03.03,0:01:06.23,Default,,0000,0000,0000,,Some women want to stay\Nin their own homes.
Dialogue: 0,0:01:06.40,0:01:09.50,Default,,0000,0000,0000,,We’ve exported this idea of hospital birth
Dialogue: 0,0:01:09.50,0:01:14.07,Default,,0000,0000,0000,,being the way to get safe birth\Nto low-resource countries.
Dialogue: 0,0:01:14.33,0:01:16.13,Default,,0000,0000,0000,,But even in low-resource countries,
Dialogue: 0,0:01:16.13,0:01:18.48,Default,,0000,0000,0000,,women aren’t coming \Nin droves to the hospital.
Dialogue: 0,0:01:18.48,0:01:21.56,Default,,0000,0000,0000,,Why is that? What's going on?
Dialogue: 0,0:01:21.56,0:01:26.81,Default,,0000,0000,0000,,And is the disruptive innovation\Nhospital birth or is it home birth?
Dialogue: 0,0:01:28.21,0:01:31.51,Default,,0000,0000,0000,,You’re all familiar\Nwith this image, that’s DNA.
Dialogue: 0,0:01:31.73,0:01:34.40,Default,,0000,0000,0000,,I’m going to talk to you\Na little bit about the science,
Dialogue: 0,0:01:34.40,0:01:38.23,Default,,0000,0000,0000,,the physiology of humans\Nand what we’ve come to understand.
Dialogue: 0,0:01:38.23,0:01:39.84,Default,,0000,0000,0000,,You can see those components\N
Dialogue: 0,0:01:39.84,0:01:43.76,Default,,0000,0000,0000,,that are joining from two \Nhuman beings' genetic information
Dialogue: 0,0:01:43.76,0:01:47.54,Default,,0000,0000,0000,,to predict what the future will be \Nfor this human being.
Dialogue: 0,0:01:47.95,0:01:50.14,Default,,0000,0000,0000,,It turns out that’s the same\Nkind of linkage
Dialogue: 0,0:01:50.14,0:01:54.07,Default,,0000,0000,0000,,that happens between the environment\Nand the physiology of birth.
Dialogue: 0,0:01:54.49,0:01:58.69,Default,,0000,0000,0000,,We’ve learned a lot about it\Nfrom watching animals.
Dialogue: 0,0:01:59.11,0:02:02.12,Default,,0000,0000,0000,,Animals in captivity,\Nfor some strange reason,
Dialogue: 0,0:02:02.12,0:02:04.56,Default,,0000,0000,0000,,when they’re outside \Ntheir familiar environment,
Dialogue: 0,0:02:04.56,0:02:08.44,Default,,0000,0000,0000,,have a hard time getting pregnant,\Na hard time staying pregnant,
Dialogue: 0,0:02:08.44,0:02:11.32,Default,,0000,0000,0000,,a hard time staying healthy\Nwhile pregnant,
Dialogue: 0,0:02:11.32,0:02:15.71,Default,,0000,0000,0000,,and a hard time releasing their babies\Nwhen they feel like they’re being watched,
Dialogue: 0,0:02:15.71,0:02:20.24,Default,,0000,0000,0000,,when they feel like they cannot get\Nin what position they want,
Dialogue: 0,0:02:20.24,0:02:25.01,Default,,0000,0000,0000,,they cannot access the comfort measures\Nor the food that they want,
Dialogue: 0,0:02:25.01,0:02:28.24,Default,,0000,0000,0000,,they’re fearful, anxious or lonely.
Dialogue: 0,0:02:28.50,0:02:31.25,Default,,0000,0000,0000,,This is Mei Xiang\Nand Lisa is the elephant.
Dialogue: 0,0:02:31.25,0:02:33.94,Default,,0000,0000,0000,,They both successfully\Ndelivered in captivity.
Dialogue: 0,0:02:34.47,0:02:35.72,Default,,0000,0000,0000,,How did they do it?
Dialogue: 0,0:02:35.72,0:02:37.80,Default,,0000,0000,0000,,They could get \Nin the position they wanted.
Dialogue: 0,0:02:37.80,0:02:41.84,Default,,0000,0000,0000,,They were given environments\Nthat were so familiar to them.
Dialogue: 0,0:02:42.28,0:02:44.22,Default,,0000,0000,0000,,Maybe they were still in a zoo,
Dialogue: 0,0:02:44.22,0:02:47.53,Default,,0000,0000,0000,,but something about it allowed them\Nto do what they had to do,
Dialogue: 0,0:02:47.54,0:02:52.72,Default,,0000,0000,0000,,and part of that was that the zookeepers\Nand the veterinarians weren’t seen.
Dialogue: 0,0:02:52.72,0:02:55.51,Default,,0000,0000,0000,,They were behind hidden video cameras.
Dialogue: 0,0:02:55.88,0:02:57.36,Default,,0000,0000,0000,,So what does that tell us?
Dialogue: 0,0:02:57.36,0:03:03.46,Default,,0000,0000,0000,,What if every time a young healthy man\Nwanted to run a marathon,
Dialogue: 0,0:03:03.46,0:03:07.30,Default,,0000,0000,0000,,he was told, "It's okay.\NWe’re not sure you can do it
Dialogue: 0,0:03:07.30,0:03:09.63,Default,,0000,0000,0000,,and you might have \Na heart attack in the process.
Dialogue: 0,0:03:09.63,0:03:11.56,Default,,0000,0000,0000,,So why don’t you come into the hospital?
Dialogue: 0,0:03:11.56,0:03:14.10,Default,,0000,0000,0000,,You could run your marathon\Naround the hospital.
Dialogue: 0,0:03:14.10,0:03:17.33,Default,,0000,0000,0000,,But don’t worry, \Nyou can bring somebody with you
Dialogue: 0,0:03:17.33,0:03:19.88,Default,,0000,0000,0000,,and your support or spouse can be there.
Dialogue: 0,0:03:19.88,0:03:22.83,Default,,0000,0000,0000,,We will monitor you\Nto make sure that you're okay.
Dialogue: 0,0:03:22.83,0:03:26.05,Default,,0000,0000,0000,,And just in case\Nyou do have a heart attack,
Dialogue: 0,0:03:26.05,0:03:29.01,Default,,0000,0000,0000,,the emergency personnel\Nwill be standing right there.
Dialogue: 0,0:03:29.28,0:03:32.11,Default,,0000,0000,0000,,Just in case you do have a heart attack,
Dialogue: 0,0:03:32.11,0:03:36.52,Default,,0000,0000,0000,,you'd better not eat, and we probably \Nshould restrict your fluids."
Dialogue: 0,0:03:37.68,0:03:41.97,Default,,0000,0000,0000,,Does that make any sense to what you know\Nabout the physiology of sports?
Dialogue: 0,0:03:42.23,0:03:45.51,Default,,0000,0000,0000,,Do you think that if he didn't\Nbelieve he could do it,
Dialogue: 0,0:03:45.52,0:03:48.92,Default,,0000,0000,0000,,he would be able to complete the marathon?
Dialogue: 0,0:03:49.42,0:03:52.96,Default,,0000,0000,0000,,And what about making love?
Dialogue: 0,0:03:52.96,0:03:55.38,Default,,0000,0000,0000,,What about making babies?
Dialogue: 0,0:03:55.38,0:03:57.67,Default,,0000,0000,0000,,Suppose you told this young man
Dialogue: 0,0:03:57.67,0:04:01.52,Default,,0000,0000,0000,,that he also could have a heart attack\Nwhen he had an orgasm,
Dialogue: 0,0:04:01.52,0:04:03.01,Default,,0000,0000,0000,,some people do.
Dialogue: 0,0:04:03.30,0:04:06.03,Default,,0000,0000,0000,,What if, we weren't so sure\Nabout his ability.
Dialogue: 0,0:04:06.03,0:04:09.32,Default,,0000,0000,0000,,We said, "No worries, \Ncome to the hospital!
Dialogue: 0,0:04:09.32,0:04:14.47,Default,,0000,0000,0000,,We'll give you a nice quiet room.\NYou can bring your spouse.
Dialogue: 0,0:04:15.16,0:04:17.11,Default,,0000,0000,0000,,We'll just come in from time to time
Dialogue: 0,0:04:17.11,0:04:20.55,Default,,0000,0000,0000,,check your heart blood pressure\Nand your heart rate
Dialogue: 0,0:04:20.55,0:04:22.89,Default,,0000,0000,0000,,and make sure that everything is okay."
Dialogue: 0,0:04:23.10,0:04:25.97,Default,,0000,0000,0000,,Do you think he'd have some sort\Nof performance anxiety?
Dialogue: 0,0:04:25.97,0:04:27.65,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:04:27.66,0:04:29.12,Default,,0000,0000,0000,,I think this is what he'd do:
Dialogue: 0,0:04:29.12,0:04:33.92,Default,,0000,0000,0000,,He'd say, “I know what to do\Nand you guys leave me alone.”
Dialogue: 0,0:04:34.37,0:04:37.24,Default,,0000,0000,0000,,So, what have we learned\Nabout human physiology?
Dialogue: 0,0:04:37.26,0:04:40.66,Default,,0000,0000,0000,,There're some very cool things\Nthat have been discovered now,
Dialogue: 0,0:04:40.66,0:04:43.92,Default,,0000,0000,0000,,things about when we control birth
Dialogue: 0,0:04:43.92,0:04:46.30,Default,,0000,0000,0000,,and when babies \Ndon't come out of the vagina.
Dialogue: 0,0:04:46.60,0:04:50.18,Default,,0000,0000,0000,,Guess what? They don't get\Nthe beneficial effects
Dialogue: 0,0:04:50.18,0:04:55.38,Default,,0000,0000,0000,,of the good bacteria living in the vagina\Nthat helps them for a long term health.
Dialogue: 0,0:04:55.82,0:05:00.42,Default,,0000,0000,0000,,What about oxytocin, the hormone of love?\NWhy is it called the hormone of love?
Dialogue: 0,0:05:00.44,0:05:05.62,Default,,0000,0000,0000,,Well, it's only released \Nin three times in our life,
Dialogue: 0,0:05:05.63,0:05:08.21,Default,,0000,0000,0000,,three times which are absolutely\Ncritical to bonding.
Dialogue: 0,0:05:08.21,0:05:11.33,Default,,0000,0000,0000,,In fact, it does modulate\Nhow attached do we feel.
Dialogue: 0,0:05:11.68,0:05:13.75,Default,,0000,0000,0000,,It modulates social behavior.
Dialogue: 0,0:05:13.75,0:05:16.62,Default,,0000,0000,0000,,Oxytocin is only released
Dialogue: 0,0:05:16.62,0:05:19.91,Default,,0000,0000,0000,,when we make love -\Nwhen we have orgasm -
Dialogue: 0,0:05:19.91,0:05:23.31,Default,,0000,0000,0000,,when we have contractions\Nto open up our uteruses
Dialogue: 0,0:05:23.31,0:05:25.09,Default,,0000,0000,0000,,so that the baby can come out,
Dialogue: 0,0:05:25.09,0:05:27.72,Default,,0000,0000,0000,,and when we let down our milk\Nso we can feed our babies,
Dialogue: 0,0:05:27.72,0:05:29.77,Default,,0000,0000,0000,,so our babies can survive.
Dialogue: 0,0:05:30.30,0:05:35.20,Default,,0000,0000,0000,,Every year, 350,000 women die\Nwhile pregnant or giving birth.
Dialogue: 0,0:05:35.70,0:05:39.64,Default,,0000,0000,0000,,2 million newborns die\Nwithin the first 24 hours of life.
Dialogue: 0,0:05:39.74,0:05:41.28,Default,,0000,0000,0000,,This is true.
Dialogue: 0,0:05:41.48,0:05:45.53,Default,,0000,0000,0000,,Is this why we don't recommend\Nhome birth to everybody?
Dialogue: 0,0:05:45.68,0:05:47.05,Default,,0000,0000,0000,,Is it home birth?
Dialogue: 0,0:05:47.05,0:05:51.50,Default,,0000,0000,0000,,You know, most of these women\Nlive in 58 countries.
Dialogue: 0,0:05:51.66,0:05:53.83,Default,,0000,0000,0000,,They’re low resource countries.
Dialogue: 0,0:05:53.84,0:05:57.54,Default,,0000,0000,0000,,In these countries, women do not have \Naccess to lifesaving techniques.
Dialogue: 0,0:05:57.54,0:06:00.59,Default,,0000,0000,0000,,They don't have the medications\Nto stop bleeding.
Dialogue: 0,0:06:01.14,0:06:04.28,Default,,0000,0000,0000,,If they could access it, \Nthey can't get there.
Dialogue: 0,0:06:04.80,0:06:07.67,Default,,0000,0000,0000,,They don't have somebody\Nchecking their blood pressure.
Dialogue: 0,0:06:07.90,0:06:12.21,Default,,0000,0000,0000,,Sometimes they're exposed to conditions\Nwhich are dangerous for themselves.
Dialogue: 0,0:06:12.32,0:06:14.98,Default,,0000,0000,0000,,They don't have methods\Nto resuscitate a baby
Dialogue: 0,0:06:14.98,0:06:17.18,Default,,0000,0000,0000,,that maybe just needs a little help.
Dialogue: 0,0:06:17.36,0:06:21.84,Default,,0000,0000,0000,,Is that why everybody \Nshould deliver in the hospital?
Dialogue: 0,0:06:22.70,0:06:24.02,Default,,0000,0000,0000,,What does the research say?
Dialogue: 0,0:06:24.02,0:06:28.36,Default,,0000,0000,0000,,For a long time we had a hard time\Nunderstanding what it really says.
Dialogue: 0,0:06:28.58,0:06:30.46,Default,,0000,0000,0000,,Just like what Carzy said this morning,
Dialogue: 0,0:06:30.46,0:06:33.49,Default,,0000,0000,0000,,you've to ask the right questions\Nin the right way. Guess what?
Dialogue: 0,0:06:33.91,0:06:37.25,Default,,0000,0000,0000,,We weren't asking the right\Nquestions in the right way.
Dialogue: 0,0:06:37.25,0:06:40.98,Default,,0000,0000,0000,,We were mixing up planned home birth\Nwith unplanned home birth.
Dialogue: 0,0:06:41.01,0:06:44.02,Default,,0000,0000,0000,,When we looked at the difference\Nbetween home and hospital birth
Dialogue: 0,0:06:44.02,0:06:45.59,Default,,0000,0000,0000,,we had a lot of cases in there
Dialogue: 0,0:06:45.59,0:06:47.93,Default,,0000,0000,0000,,where the woman delivered\Nen route to the hospital
Dialogue: 0,0:06:47.93,0:06:49.62,Default,,0000,0000,0000,,without an attendant, accidentally,
Dialogue: 0,0:06:49.62,0:06:53.58,Default,,0000,0000,0000,,even in high resource countries\Nwhere all those things are available.
Dialogue: 0,0:06:53.90,0:06:55.78,Default,,0000,0000,0000,,And that doesn't tell us the story.
Dialogue: 0,0:06:55.78,0:06:59.59,Default,,0000,0000,0000,,If we don't know who's attending her,\Nwhat their skill set is,
Dialogue: 0,0:06:59.59,0:07:03.08,Default,,0000,0000,0000,,if we don't know if she can change\Nthe plan when she is in trouble,
Dialogue: 0,0:07:03.10,0:07:07.11,Default,,0000,0000,0000,,we don't know what's really\Ndependent on place of birth
Dialogue: 0,0:07:07.11,0:07:12.15,Default,,0000,0000,0000,,and what is instead dependent\Non the type of care that she gets.
Dialogue: 0,0:07:12.59,0:07:13.99,Default,,0000,0000,0000,,What we do know now?
Dialogue: 0,0:07:13.99,0:07:18.99,Default,,0000,0000,0000,,The good news is that we have\N15 or 16 really high quality studies.
Dialogue: 0,0:07:19.03,0:07:21.22,Default,,0000,0000,0000,,We'll never have\Na randomized control trial,
Dialogue: 0,0:07:21.22,0:07:24.52,Default,,0000,0000,0000,,because women will not agree\Nto be randomized to home or hospital.
Dialogue: 0,0:07:24.53,0:07:27.22,Default,,0000,0000,0000,,They have opinions \Nabout where they want to deliver.
Dialogue: 0,0:07:27.22,0:07:28.38,Default,,0000,0000,0000,,And they've tried!
Dialogue: 0,0:07:28.38,0:07:32.60,Default,,0000,0000,0000,,There was one trial that they tried\Nto run for about 15 years.
Dialogue: 0,0:07:32.68,0:07:34.99,Default,,0000,0000,0000,,They got 11 women to agree.
Dialogue: 0,0:07:35.14,0:07:36.85,Default,,0000,0000,0000,,Not big enough to say something.
Dialogue: 0,0:07:37.01,0:07:40.37,Default,,0000,0000,0000,,So, what we know is that\Nfor an essentially healthy woman
Dialogue: 0,0:07:40.37,0:07:42.45,Default,,0000,0000,0000,,\Nwho has attendants with skills,
Dialogue: 0,0:07:42.45,0:07:47.52,Default,,0000,0000,0000,,and those skilled attendants\Nbring basic equipment and medications
Dialogue: 0,0:07:47.52,0:07:51.18,Default,,0000,0000,0000,,and they have seamless access\Nto specialized care
Dialogue: 0,0:07:51.18,0:07:53.32,Default,,0000,0000,0000,,when a complication arrives,
Dialogue: 0,0:07:53.32,0:07:56.45,Default,,0000,0000,0000,,we actually get healthy mothers and babies
Dialogue: 0,0:07:56.45,0:07:59.72,Default,,0000,0000,0000,,and they experience less interventions.
Dialogue: 0,0:08:00.68,0:08:01.90,Default,,0000,0000,0000,,So what's the problem?
Dialogue: 0,0:08:01.90,0:08:06.78,Default,,0000,0000,0000,,Why don't we all agree that that's\Nthe system that we should set up?
Dialogue: 0,0:08:07.23,0:08:08.85,Default,,0000,0000,0000,,I study attitudes \N
Dialogue: 0,0:08:08.85,0:08:13.80,Default,,0000,0000,0000,,and what leads to attitudes \Namong maternity care providers.
Dialogue: 0,0:08:13.90,0:08:17.51,Default,,0000,0000,0000,,I did this in Canada, \Na big large national study.
Dialogue: 0,0:08:17.70,0:08:22.65,Default,,0000,0000,0000,,You can see that midwives, obstetricians\Nand family physicians don't agree.
Dialogue: 0,0:08:23.46,0:08:24.64,Default,,0000,0000,0000,,Why does that matter?
Dialogue: 0,0:08:24.64,0:08:28.68,Default,,0000,0000,0000,,Provider’s attitudes matter,\Nbecause they influence what women choose.
Dialogue: 0,0:08:28.80,0:08:30.95,Default,,0000,0000,0000,,Women want to do\Nwhat's best for their bodies.
Dialogue: 0,0:08:30.95,0:08:33.19,Default,,0000,0000,0000,,They want to be able\Nto believe their providers.
Dialogue: 0,0:08:33.19,0:08:35.81,Default,,0000,0000,0000,,We know that providers\Nwho know more about breastfeeding
Dialogue: 0,0:08:35.81,0:08:37.48,Default,,0000,0000,0000,,and have education about it,
Dialogue: 0,0:08:37.48,0:08:42.55,Default,,0000,0000,0000,,their patients will be \Nmore successful at breastfeeding.
Dialogue: 0,0:08:42.88,0:08:45.92,Default,,0000,0000,0000,,We know that women\Nwho choose cesarean on demand,
Dialogue: 0,0:08:45.92,0:08:49.39,Default,,0000,0000,0000,,their providers are more likely\Nto have chosen that for themselves.
Dialogue: 0,0:08:49.45,0:08:51.99,Default,,0000,0000,0000,,There's something else going on there.
Dialogue: 0,0:08:52.14,0:08:54.82,Default,,0000,0000,0000,,If we ask the right questions\Nto the right people,
Dialogue: 0,0:08:54.82,0:08:56.34,Default,,0000,0000,0000,,we might ask the women,
Dialogue: 0,0:08:56.34,0:08:59.52,Default,,0000,0000,0000,,what happens when they listen\Nto their providers,
Dialogue: 0,0:08:59.52,0:09:02.40,Default,,0000,0000,0000,,try to access safe care,
Dialogue: 0,0:09:02.40,0:09:06.52,Default,,0000,0000,0000,,leave their homes and familiar\Nenvironments, and come in?
Dialogue: 0,0:09:06.71,0:09:08.85,Default,,0000,0000,0000,,Well, this is what they say,
Dialogue: 0,0:09:09.25,0:09:11.93,Default,,0000,0000,0000,,“I was told to be quiet and lie down."
Dialogue: 0,0:09:11.93,0:09:14.74,Default,,0000,0000,0000,,"I was put in a room\Nwith women I didn't know.”
Dialogue: 0,0:09:15.30,0:09:17.51,Default,,0000,0000,0000,,“I didn't know that man.
Dialogue: 0,0:09:17.51,0:09:20.07,Default,,0000,0000,0000,,He came in and he said to me,
Dialogue: 0,0:09:20.07,0:09:23.51,Default,,0000,0000,0000,,'Spread your legs like you did\Nwhen you got pregnant.'”
Dialogue: 0,0:09:25.43,0:09:28.99,Default,,0000,0000,0000,,“I had to undress in front of strange men.
Dialogue: 0,0:09:28.99,0:09:33.78,Default,,0000,0000,0000,,They watched me while I got up \Non the table to have my baby.”
Dialogue: 0,0:09:35.46,0:09:37.52,Default,,0000,0000,0000,,Women in the Philippines will say...
Dialogue: 0,0:09:37.52,0:09:41.57,Default,,0000,0000,0000,,Actually a lot of places in the world\Nwhere women by droves are coming in now,
Dialogue: 0,0:09:41.59,0:09:45.41,Default,,0000,0000,0000,,- because there're institutional \Npost-policies for institutional birth -
Dialogue: 0,0:09:45.41,0:09:49.30,Default,,0000,0000,0000,,are overloaded by normal cases
Dialogue: 0,0:09:49.30,0:09:52.46,Default,,0000,0000,0000,,and don't have enough resources
Dialogue: 0,0:09:52.46,0:09:55.86,Default,,0000,0000,0000,,to look after the women\Nwho really need their care.
Dialogue: 0,0:09:56.03,0:10:01.21,Default,,0000,0000,0000,,This is a labor ward, and a postpartum\Nward, and a newborn ward.
Dialogue: 0,0:10:01.52,0:10:05.46,Default,,0000,0000,0000,,Is that where you would like to be?\NDoes that feel safe to you?
Dialogue: 0,0:10:05.46,0:10:07.26,Default,,0000,0000,0000,,This woman is an indigenous woman.
Dialogue: 0,0:10:07.26,0:10:09.46,Default,,0000,0000,0000,,She came in because she believed
Dialogue: 0,0:10:09.46,0:10:12.02,Default,,0000,0000,0000,,she was going to have\Na safer birth in the hospital.
Dialogue: 0,0:10:12.02,0:10:15.03,Default,,0000,0000,0000,,When she got there, \Nthey didn't understand her language.
Dialogue: 0,0:10:15.04,0:10:17.81,Default,,0000,0000,0000,,They didn't believe her\Nthat she was really in active labor
Dialogue: 0,0:10:17.81,0:10:19.72,Default,,0000,0000,0000,,because she had walked from her village.
Dialogue: 0,0:10:19.72,0:10:21.86,Default,,0000,0000,0000,,So they made her leave.
Dialogue: 0,0:10:21.94,0:10:26.12,Default,,0000,0000,0000,,Shortly thereafter, she delivered\Non the grass in front of the hospital.
Dialogue: 0,0:10:26.22,0:10:28.75,Default,,0000,0000,0000,,Is that safer care?
Dialogue: 0,0:10:29.12,0:10:32.97,Default,,0000,0000,0000,,If you think this is just happening\Nin low resource countries,
Dialogue: 0,0:10:32.98,0:10:35.52,Default,,0000,0000,0000,,it's happening all over the world!
Dialogue: 0,0:10:36.49,0:10:38.79,Default,,0000,0000,0000,,This is North America:
Dialogue: 0,0:10:38.79,0:10:41.99,Default,,0000,0000,0000,,strangers around, \Nwomen being told to push.
Dialogue: 0,0:10:42.69,0:10:44.40,Default,,0000,0000,0000,,One woman said,
Dialogue: 0,0:10:44.40,0:10:48.45,Default,,0000,0000,0000,,“I was hooked up and trussed.\NI couldn't move six inches.
Dialogue: 0,0:10:48.85,0:10:52.10,Default,,0000,0000,0000,,I knew I had to get up to have my baby,\Nbut they told me to lie still
Dialogue: 0,0:10:52.10,0:10:54.30,Default,,0000,0000,0000,,because they couldn't hear\Nmy baby's heartbeat.
Dialogue: 0,0:10:54.30,0:10:55.54,Default,,0000,0000,0000,,I was worried.
Dialogue: 0,0:10:55.54,0:10:58.29,Default,,0000,0000,0000,,I listened to them,\Nbut they didn't listen to me.
Dialogue: 0,0:10:58.59,0:11:01.64,Default,,0000,0000,0000,,So I closed my eyes\Nand I hid in my music
Dialogue: 0,0:11:01.65,0:11:04.72,Default,,0000,0000,0000,,while they stood around and watched me.”
Dialogue: 0,0:11:05.06,0:11:08.42,Default,,0000,0000,0000,,So what is this issue about relocation?
Dialogue: 0,0:11:08.42,0:11:13.11,Default,,0000,0000,0000,,How are we defining safety?\NAnd who gets to define what safety is?
Dialogue: 0,0:11:13.40,0:11:15.59,Default,,0000,0000,0000,,We know when all \Nof these silly things happen,
Dialogue: 0,0:11:15.59,0:11:18.46,Default,,0000,0000,0000,,when mammals are not\Nin their familiar environment,
Dialogue: 0,0:11:18.46,0:11:21.96,Default,,0000,0000,0000,,when they're disturbed,\Nhave a loss of privacy and dignity,
Dialogue: 0,0:11:21.96,0:11:25.78,Default,,0000,0000,0000,,it can affect their ability\Nto care for their own babies.
Dialogue: 0,0:11:27.02,0:11:28.68,Default,,0000,0000,0000,,Women tell us.
Dialogue: 0,0:11:28.68,0:11:31.78,Default,,0000,0000,0000,,Tiye, who is some of the women\NI looked after, told me
Dialogue: 0,0:11:31.78,0:11:33.98,Default,,0000,0000,0000,,she had a good job in the hospital.
Dialogue: 0,0:11:34.80,0:11:36.00,Default,,0000,0000,0000,,She was a lab tech.
Dialogue: 0,0:11:36.00,0:11:39.82,Default,,0000,0000,0000,,She said, "Everybody knows everybody's\Nbusiness ; I don't want them to know mine.
Dialogue: 0,0:11:39.82,0:11:42.12,Default,,0000,0000,0000,,The white women I work with\Ndon't understand me.
Dialogue: 0,0:11:42.12,0:11:45.16,Default,,0000,0000,0000,,I don't want to be undressed\Nin front of them.”
Dialogue: 0,0:11:45.44,0:11:49.04,Default,,0000,0000,0000,,We looked after a woman\Nwhen I was at Yale on faculty.
Dialogue: 0,0:11:49.30,0:11:51.65,Default,,0000,0000,0000,,Her husband would not tell us\Nwhat his name was.
Dialogue: 0,0:11:51.66,0:11:53.86,Default,,0000,0000,0000,,He said his name was Fred.\NNobody believed him.
Dialogue: 0,0:11:53.86,0:11:57.65,Default,,0000,0000,0000,,They said, “Maybe he is undocumented,\Nthat's why he doesn't want to tell us."
Dialogue: 0,0:11:57.65,0:11:59.88,Default,,0000,0000,0000,,It was 2001, October.
Dialogue: 0,0:12:00.24,0:12:02.45,Default,,0000,0000,0000,,His name was Osama.
Dialogue: 0,0:12:02.45,0:12:06.94,Default,,0000,0000,0000,,He was afraid if he's told\Nthe hospital staff his name,
Dialogue: 0,0:12:06.94,0:12:10.17,Default,,0000,0000,0000,,that they would not treat his wife well.
Dialogue: 0,0:12:10.46,0:12:13.81,Default,,0000,0000,0000,,The Hmong women \NI looked after in California
Dialogue: 0,0:12:13.81,0:12:16.08,Default,,0000,0000,0000,,were used to having \Nall of their elders around,
Dialogue: 0,0:12:16.08,0:12:17.74,Default,,0000,0000,0000,,but the hospital had a rule
Dialogue: 0,0:12:17.74,0:12:20.82,Default,,0000,0000,0000,,that only one person\Ncould come with these women.
Dialogue: 0,0:12:21.80,0:12:23.63,Default,,0000,0000,0000,,This lesbian couple knew
Dialogue: 0,0:12:23.63,0:12:27.34,Default,,0000,0000,0000,,that if they went to the hospital\Nwith their known and beloved donor,
Dialogue: 0,0:12:27.34,0:12:28.75,Default,,0000,0000,0000,,that it was very likely \N
Dialogue: 0,0:12:28.75,0:12:32.13,Default,,0000,0000,0000,,that the hospital staff \Nwould hand the baby first to him
Dialogue: 0,0:12:32.13,0:12:35.04,Default,,0000,0000,0000,,and not to the primary parent.
Dialogue: 0,0:12:35.76,0:12:37.89,Default,,0000,0000,0000,,Women tell us that when they're home,
Dialogue: 0,0:12:37.89,0:12:41.61,Default,,0000,0000,0000,,they can get in what position they want,\Nthey can use gravity
Dialogue: 0,0:12:41.61,0:12:43.19,Default,,0000,0000,0000,,and they can still be assured\N
Dialogue: 0,0:12:43.19,0:12:47.68,Default,,0000,0000,0000,,that someone will be checking them\Nand their baby's heartbeat.
Dialogue: 0,0:12:49.28,0:12:53.05,Default,,0000,0000,0000,,So what about babies\Nwho are fascinated with technology?
Dialogue: 0,0:12:53.48,0:12:56.15,Default,,0000,0000,0000,,What about what women say\Nabout technology?
Dialogue: 0,0:12:56.34,0:12:58.40,Default,,0000,0000,0000,,It turns out that they actually don't want
Dialogue: 0,0:12:58.40,0:13:02.40,Default,,0000,0000,0000,,to reject technology or modern medicine.
Dialogue: 0,0:13:02.69,0:13:06.49,Default,,0000,0000,0000,,They want access\Nto all those lifesaving techniques.
Dialogue: 0,0:13:06.50,0:13:08.60,Default,,0000,0000,0000,,They just want to be told the truth.
Dialogue: 0,0:13:09.13,0:13:12.21,Default,,0000,0000,0000,,All of the things I was telling you about \Nwere based on studies
Dialogue: 0,0:13:12.21,0:13:14.99,Default,,0000,0000,0000,,that we've done where women\Nhave told us what they want
Dialogue: 0,0:13:15.02,0:13:18.68,Default,,0000,0000,0000,,and what's most important to them:\Ncomfort, convenience, empowerment.
Dialogue: 0,0:13:18.80,0:13:20.100,Default,,0000,0000,0000,,This study has just come out.
Dialogue: 0,0:13:20.100,0:13:24.94,Default,,0000,0000,0000,,About 2000 women\Nanswered a very long survey
Dialogue: 0,0:13:24.94,0:13:27.58,Default,,0000,0000,0000,,about what they thought\Nabout their maternity care.
Dialogue: 0,0:13:27.58,0:13:30.19,Default,,0000,0000,0000,,These were all women\Nwho planned hospital births.
Dialogue: 0,0:13:30.34,0:13:32.27,Default,,0000,0000,0000,,Guess what?\NThey say the same thing.
Dialogue: 0,0:13:32.27,0:13:34.24,Default,,0000,0000,0000,,They believe they're in charge.
Dialogue: 0,0:13:34.24,0:13:37.41,Default,,0000,0000,0000,,They believe they're choosing\Nthe best options for their baby.
Dialogue: 0,0:13:37.65,0:13:39.38,Default,,0000,0000,0000,,They just want to be told the truth.
Dialogue: 0,0:13:39.38,0:13:42.53,Default,,0000,0000,0000,,They want to be told,\Nhow does this risk relate to me?
Dialogue: 0,0:13:42.82,0:13:46.40,Default,,0000,0000,0000,,What if I live in a place\Nthat does have those resources?
Dialogue: 0,0:13:46.67,0:13:50.70,Default,,0000,0000,0000,,What will it be like\Nwhen I go into the hospital?
Dialogue: 0,0:13:52.03,0:13:53.87,Default,,0000,0000,0000,,And they also tell us
Dialogue: 0,0:13:53.87,0:13:58.49,Default,,0000,0000,0000,,that some interventions lead to things\Nthat they wouldn't choose
Dialogue: 0,0:13:58.49,0:14:02.53,Default,,0000,0000,0000,,unless they were very sure\Nthat it would save them or their babies.
Dialogue: 0,0:14:03.23,0:14:06.68,Default,,0000,0000,0000,,40% of women are induced\Nin the United States today.
Dialogue: 0,0:14:06.71,0:14:09.86,Default,,0000,0000,0000,,We have over 30% C-section rates.
Dialogue: 0,0:14:10.02,0:14:12.31,Default,,0000,0000,0000,,Do you think the species \Nwould have survived
Dialogue: 0,0:14:12.31,0:14:14.92,Default,,0000,0000,0000,,if that was the needed rate?
Dialogue: 0,0:14:15.12,0:14:17.66,Default,,0000,0000,0000,,In fact, most countries\Nthat have much better outcomes
Dialogue: 0,0:14:17.66,0:14:22.30,Default,,0000,0000,0000,,than we do in North America,\Nhave much lower rates of these things.
Dialogue: 0,0:14:23.18,0:14:25.12,Default,,0000,0000,0000,,So what about risk?
Dialogue: 0,0:14:25.40,0:14:27.24,Default,,0000,0000,0000,,Who gets to choose?
Dialogue: 0,0:14:27.24,0:14:29.57,Default,,0000,0000,0000,,This is a one-in-a-thousand risk.
Dialogue: 0,0:14:29.74,0:14:33.96,Default,,0000,0000,0000,,When you have skilled attendants at birth
Dialogue: 0,0:14:33.96,0:14:39.68,Default,,0000,0000,0000,,and access to equipment and personnel\Nwhen you need it, this is the risk.
Dialogue: 0,0:14:39.78,0:14:43.49,Default,,0000,0000,0000,,About one per two to three thousands\Nis what loss will look like,
Dialogue: 0,0:14:43.63,0:14:46.64,Default,,0000,0000,0000,,- not fetal loss, I’m talking\Nabout neonatal loss.
Dialogue: 0,0:14:46.64,0:14:49.42,Default,,0000,0000,0000,,And 50% of stillbirths are unexplained,
Dialogue: 0,0:14:49.42,0:14:51.57,Default,,0000,0000,0000,,so we don't really know\Nwhat's going on there.
Dialogue: 0,0:14:51.78,0:14:52.95,Default,,0000,0000,0000,,So one-in-a-thousand.\N
Dialogue: 0,0:14:52.95,0:14:57.27,Default,,0000,0000,0000,,That's about the same risk than that man\Nwho wanted to run a marathon,
Dialogue: 0,0:14:57.27,0:15:00.21,Default,,0000,0000,0000,,would experience of having a heart attack.
Dialogue: 0,0:15:00.50,0:15:02.04,Default,,0000,0000,0000,,Is that an acceptable risk?
Dialogue: 0,0:15:02.04,0:15:06.01,Default,,0000,0000,0000,,And what about the risk\Nof loss of dignity, of abuse,
Dialogue: 0,0:15:06.01,0:15:08.15,Default,,0000,0000,0000,,of disrespectful care?
Dialogue: 0,0:15:08.61,0:15:11.03,Default,,0000,0000,0000,,How do you define safety?\NWho should decide?
Dialogue: 0,0:15:11.04,0:15:13.99,Default,,0000,0000,0000,,Who is most invested and most responsible?
Dialogue: 0,0:15:13.99,0:15:15.75,Default,,0000,0000,0000,,How much risk is too much
Dialogue: 0,0:15:15.75,0:15:19.19,Default,,0000,0000,0000,,and whose agenda and whose destiny\Nare you talking about?
Dialogue: 0,0:15:19.83,0:15:22.87,Default,,0000,0000,0000,,You know what women say?\NWhat would your mother say?
Dialogue: 0,0:15:22.87,0:15:26.53,Default,,0000,0000,0000,,Do you think she was more concerned\Nabout you than the doctor?
Dialogue: 0,0:15:26.83,0:15:28.74,Default,,0000,0000,0000,,Yes, that's what women say:
Dialogue: 0,0:15:28.74,0:15:30.79,Default,,0000,0000,0000,,''We care about our baby’s health.
Dialogue: 0,0:15:30.79,0:15:33.19,Default,,0000,0000,0000,,We are offended when people suggest
Dialogue: 0,0:15:33.19,0:15:36.63,Default,,0000,0000,0000,,that we are choosing home birth\Nor choosing respectful care,
Dialogue: 0,0:15:36.63,0:15:39.98,Default,,0000,0000,0000,,just for our own convenience\Nor for comfort,
Dialogue: 0,0:15:39.98,0:15:44.49,Default,,0000,0000,0000,,like it was some sort of cosmetic option.
Dialogue: 0,0:15:44.61,0:15:46.46,Default,,0000,0000,0000,,We know that if we are not well,
Dialogue: 0,0:15:46.46,0:15:48.47,Default,,0000,0000,0000,,if we're not treated well,\Nif we're abused,
Dialogue: 0,0:15:48.47,0:15:51.55,Default,,0000,0000,0000,,if we feel like we had \Nan unnecessary intervention
Dialogue: 0,0:15:51.55,0:15:54.26,Default,,0000,0000,0000,,or if we're in an environment\Nwhere we don't feel safe,
Dialogue: 0,0:15:54.26,0:15:57.60,Default,,0000,0000,0000,,that can affect how we feel\Nabout our babies, our future.
Dialogue: 0,0:15:57.84,0:16:00.79,Default,,0000,0000,0000,,We're concerned\Nabout our baby’s health also.
Dialogue: 0,0:16:00.87,0:16:02.42,Default,,0000,0000,0000,,What about the use antibiotics?
Dialogue: 0,0:16:02.42,0:16:05.40,Default,,0000,0000,0000,,What about with C-sections\Nor any of these things?
Dialogue: 0,0:16:05.62,0:16:08.50,Default,,0000,0000,0000,,Absolutely! Give me a C-section\Nif that’s what I really need.
Dialogue: 0,0:16:08.60,0:16:10.04,Default,,0000,0000,0000,,I want my baby to be healthy.
Dialogue: 0,0:16:10.04,0:16:16.92,Default,,0000,0000,0000,,I value the advances that modern medicine\Nhave brought to high resource countries.''
Dialogue: 0,0:16:17.28,0:16:19.12,Default,,0000,0000,0000,,That's what they tell us.
Dialogue: 0,0:16:19.12,0:16:21.43,Default,,0000,0000,0000,,But is anybody listening to women?
Dialogue: 0,0:16:21.50,0:16:24.08,Default,,0000,0000,0000,,Paula Freire said, “Washing\None's hands of the conflict
Dialogue: 0,0:16:24.08,0:16:26.01,Default,,0000,0000,0000,,between the powerful and the powerless
Dialogue: 0,0:16:26.02,0:16:29.79,Default,,0000,0000,0000,,means to side with the powerful,\Nnot to be neutral.”
Dialogue: 0,0:16:30.00,0:16:32.60,Default,,0000,0000,0000,,Isn't it time we took a stand?
Dialogue: 0,0:16:32.77,0:16:35.18,Default,,0000,0000,0000,,Which is the disruptive\Ninnovation we await?
Dialogue: 0,0:16:35.31,0:16:38.63,Default,,0000,0000,0000,,Is it home birth? \NIs it hospital birth?
Dialogue: 0,0:16:38.86,0:16:42.65,Default,,0000,0000,0000,,Or is it humanized birth?
Dialogue: 0,0:16:43.42,0:16:45.20,Default,,0000,0000,0000,,What if all countries took steps
Dialogue: 0,0:16:45.20,0:16:48.60,Default,,0000,0000,0000,,to facilitate high quality care\Nin all settings?
Dialogue: 0,0:16:48.60,0:16:52.47,Default,,0000,0000,0000,,And all women were told\Nhow to access that care
Dialogue: 0,0:16:52.49,0:16:55.39,Default,,0000,0000,0000,,wherever they felt safe?
Dialogue: 0,0:16:56.29,0:17:00.64,Default,,0000,0000,0000,,If the focus was access\Nto safe humanized birth in all settings,
Dialogue: 0,0:17:00.64,0:17:04.09,Default,,0000,0000,0000,,then we'd prioritize the availability\Nof lifesaving measures and skills
Dialogue: 0,0:17:04.10,0:17:09.59,Default,,0000,0000,0000,,everywhere and carry them to the places\Nwhere a woman feels respect, autonomy,
Dialogue: 0,0:17:09.59,0:17:12.55,Default,,0000,0000,0000,,and the ability to listen\Nto her own body and baby.
Dialogue: 0,0:17:12.64,0:17:15.55,Default,,0000,0000,0000,,I wrote that down\Nbecause I wanted to say it all.
Dialogue: 0,0:17:15.55,0:17:17.84,Default,,0000,0000,0000,,I wanted to be sure\NI didn't forget to tell you
Dialogue: 0,0:17:17.84,0:17:21.42,Default,,0000,0000,0000,,that it is about\Nall of those things together.
Dialogue: 0,0:17:22.22,0:17:23.80,Default,,0000,0000,0000,,We can carry those things to her.
Dialogue: 0,0:17:23.80,0:17:25.75,Default,,0000,0000,0000,,They might be packaged a bit differently.
Dialogue: 0,0:17:25.75,0:17:28.49,Default,,0000,0000,0000,,We know most people won't need IVs\N
Dialogue: 0,0:17:28.49,0:17:30.58,Default,,0000,0000,0000,,if they're cared for\Nand start out healthy,
Dialogue: 0,0:17:30.58,0:17:32.81,Default,,0000,0000,0000,,- we're talking about \Nterm pregnancies here.
Dialogue: 0,0:17:32.81,0:17:37.82,Default,,0000,0000,0000,,We could be ready standing by\Nwith resuscitation equipment for her baby.
Dialogue: 0,0:17:38.59,0:17:42.13,Default,,0000,0000,0000,,It doesn’t look like the hospital\Nbut it’s got all the same stuff.
Dialogue: 0,0:17:42.41,0:17:46.55,Default,,0000,0000,0000,,Meanwhile, the woman could get\Nin whatever position she wanted.
Dialogue: 0,0:17:47.27,0:17:51.34,Default,,0000,0000,0000,,And we could remember\Nthat whether or not we're there,
Dialogue: 0,0:17:51.34,0:17:53.41,Default,,0000,0000,0000,,whether or not \Nthe interventions are there,
Dialogue: 0,0:17:53.41,0:17:56.43,Default,,0000,0000,0000,,a woman will deliver undisturbed
Dialogue: 0,0:17:56.43,0:17:59.25,Default,,0000,0000,0000,,and will receive her baby\Nand care for her baby,
Dialogue: 0,0:17:59.27,0:18:02.12,Default,,0000,0000,0000,,because that's what humans do.
Dialogue: 0,0:18:02.30,0:18:05.07,Default,,0000,0000,0000,,They would receive their babies with joy
Dialogue: 0,0:18:05.08,0:18:08.52,Default,,0000,0000,0000,,and with the people that they love,\Nwith gentleness.
Dialogue: 0,0:18:09.65,0:18:14.42,Default,,0000,0000,0000,,If we attended them\Nin that respectful way,
Dialogue: 0,0:18:14.42,0:18:16.97,Default,,0000,0000,0000,,perhaps they would invite us\Nback into their homes
Dialogue: 0,0:18:16.98,0:18:19.84,Default,,0000,0000,0000,,to help them learn\Nhow to care for their babies.
Dialogue: 0,0:18:20.22,0:18:24.40,Default,,0000,0000,0000,,And their babies \Nwould come out alert and healthy,
Dialogue: 0,0:18:24.40,0:18:28.60,Default,,0000,0000,0000,,ready to receive\Nthe wisdom of their grandparents.
Dialogue: 0,0:18:31.49,0:18:34.83,Default,,0000,0000,0000,,This is what one of my favorite\Nphotojournalists said.
Dialogue: 0,0:18:34.90,0:18:36.94,Default,,0000,0000,0000,,This has been around for a long time.
Dialogue: 0,0:18:37.03,0:18:41.05,Default,,0000,0000,0000,,I graduated here in 1978
Dialogue: 0,0:18:41.05,0:18:44.06,Default,,0000,0000,0000,,and I read this book shortly thereafter.
Dialogue: 0,0:18:44.74,0:18:49.07,Default,,0000,0000,0000,,Suzanne Arme said, “If we hope\Nto create a non-violent world
Dialogue: 0,0:18:49.07,0:18:52.56,Default,,0000,0000,0000,,where respect and kindness\Nreplace fear and hatred,
Dialogue: 0,0:18:52.56,0:18:55.82,Default,,0000,0000,0000,,we must begin with how we treat\Neach other at the beginning of life,
Dialogue: 0,0:18:55.82,0:18:59.10,Default,,0000,0000,0000,,for that is where our deepest\Npatterns are set.
Dialogue: 0,0:18:59.11,0:19:03.93,Default,,0000,0000,0000,,From these roots grow\Nfear and alienation or love and trust.”
Dialogue: 0,0:19:04.15,0:19:05.49,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:19:05.49,0:19:07.04,Default,,0000,0000,0000,,(Applause)