WEBVTT 00:00:07.027 --> 00:00:11.510 Today, I'm going to talk to you, as they said, about birth, 00:00:11.510 --> 00:00:16.521 but I'm going to talk a little bit more about what we know of ourselves as humans: 00:00:18.021 --> 00:00:19.641 home birth. 00:00:20.296 --> 00:00:26.146 Clay Christensen says that disruptive innovation transforms 00:00:26.966 --> 00:00:29.356 a practice or a product 00:00:29.356 --> 00:00:33.246 that has commonly been traditionally 00:00:33.246 --> 00:00:37.796 available only to the privileged few 00:00:37.796 --> 00:00:39.446 and makes it mainstream. 00:00:39.676 --> 00:00:42.496 It makes it so much more affordable and accessible 00:00:42.496 --> 00:00:44.716 that suddenly, everybody's doing it. 00:00:44.876 --> 00:00:47.216 So in North America, we believe 00:00:47.216 --> 00:00:50.816 that the disruptive innovation was hospital birth. 00:00:50.816 --> 00:00:56.996 Isn’t that what made birth safe and accessible to all women? 00:00:56.996 --> 00:00:58.522 A safe birth? 00:00:58.752 --> 00:01:02.802 Well, it turns out that some women don’t agree. 00:01:03.032 --> 00:01:06.232 Some women want to stay in their own homes. 00:01:06.400 --> 00:01:09.500 We’ve exported this idea of hospital birth 00:01:09.500 --> 00:01:14.070 being the way to get safe birth to low-resource countries. 00:01:14.330 --> 00:01:16.130 But even in low-resource countries, 00:01:16.130 --> 00:01:18.480 women aren’t coming in droves to the hospital. 00:01:18.480 --> 00:01:21.560 Why is that? What's going on? 00:01:21.560 --> 00:01:26.810 And is the disruptive innovation hospital birth or is it home birth? 00:01:28.211 --> 00:01:31.511 You’re all familiar with this image, that’s DNA. 00:01:31.731 --> 00:01:34.401 I’m going to talk to you a little bit about the science, 00:01:34.401 --> 00:01:38.231 the physiology of humans and what we’ve come to understand. 00:01:38.231 --> 00:01:39.835 You can see those components 00:01:39.835 --> 00:01:43.765 that are joining from two human beings' genetic information 00:01:43.765 --> 00:01:47.545 to predict what the future will be for this human being. 00:01:47.952 --> 00:01:50.142 It turns out that’s the same kind of linkage 00:01:50.142 --> 00:01:54.072 that happens between the environment and the physiology of birth. 00:01:54.494 --> 00:01:58.694 We’ve learned a lot about it from watching animals. 00:01:59.114 --> 00:02:02.124 Animals in captivity, for some strange reason, 00:02:02.124 --> 00:02:04.564 when they’re outside their familiar environment, 00:02:04.564 --> 00:02:08.444 have a hard time getting pregnant, a hard time staying pregnant, 00:02:08.444 --> 00:02:11.324 a hard time staying healthy while pregnant, 00:02:11.324 --> 00:02:15.714 and a hard time releasing their babies when they feel like they’re being watched, 00:02:15.714 --> 00:02:20.244 when they feel like they cannot get in what position they want, 00:02:20.244 --> 00:02:25.014 they cannot access the comfort measures or the food that they want, 00:02:25.014 --> 00:02:28.241 they’re fearful, anxious or lonely. 00:02:28.502 --> 00:02:31.252 This is Mei Xiang and Lisa is the elephant. 00:02:31.252 --> 00:02:33.942 They both successfully delivered in captivity. 00:02:34.470 --> 00:02:35.720 How did they do it? 00:02:35.720 --> 00:02:37.800 They could get in the position they wanted. 00:02:37.800 --> 00:02:41.840 They were given environments that were so familiar to them. 00:02:42.280 --> 00:02:44.220 Maybe they were still in a zoo, 00:02:44.220 --> 00:02:47.530 but something about it allowed them to do what they had to do, 00:02:47.540 --> 00:02:52.722 and part of that was that the zookeepers and the veterinarians weren’t seen. 00:02:52.722 --> 00:02:55.513 They were behind hidden video cameras. 00:02:55.875 --> 00:02:57.365 So what does that tell us? 00:02:57.365 --> 00:03:03.455 What if every time a young healthy man wanted to run a marathon, 00:03:03.455 --> 00:03:07.302 he was told, "It's okay. We’re not sure you can do it 00:03:07.302 --> 00:03:09.632 and you might have a heart attack in the process. 00:03:09.632 --> 00:03:11.562 So why don’t you come into the hospital? 00:03:11.562 --> 00:03:14.102 You could run your marathon around the hospital. 00:03:14.102 --> 00:03:17.332 But don’t worry, you can bring somebody with you 00:03:17.332 --> 00:03:19.882 and your support or spouse can be there. 00:03:19.882 --> 00:03:22.832 We will monitor you to make sure that you're okay. 00:03:22.832 --> 00:03:26.052 And just in case you do have a heart attack, 00:03:26.052 --> 00:03:29.012 the emergency personnel will be standing right there. 00:03:29.282 --> 00:03:32.112 Just in case you do have a heart attack, 00:03:32.112 --> 00:03:36.522 you'd better not eat, and we probably should restrict your fluids." 00:03:37.678 --> 00:03:41.968 Does that make any sense to what you know about the physiology of sports? 00:03:42.231 --> 00:03:45.511 Do you think that if he didn't believe he could do it, 00:03:45.516 --> 00:03:48.916 he would be able to complete the marathon? 00:03:49.415 --> 00:03:52.965 And what about making love? 00:03:52.965 --> 00:03:55.385 What about making babies? 00:03:55.385 --> 00:03:57.670 Suppose you told this young man 00:03:57.670 --> 00:04:01.520 that he also could have a heart attack when he had an orgasm, 00:04:01.520 --> 00:04:03.010 some people do. 00:04:03.300 --> 00:04:06.030 What if, we weren't so sure about his ability. 00:04:06.030 --> 00:04:09.320 We said, "No worries, come to the hospital! 00:04:09.320 --> 00:04:14.470 We'll give you a nice quiet room. You can bring your spouse. 00:04:15.160 --> 00:04:17.110 We'll just come in from time to time 00:04:17.110 --> 00:04:20.550 check your heart blood pressure and your heart rate 00:04:20.550 --> 00:04:22.890 and make sure that everything is okay." 00:04:23.100 --> 00:04:25.973 Do you think he'd have some sort of performance anxiety? 00:04:25.973 --> 00:04:27.653 (Laughter) 00:04:27.663 --> 00:04:29.123 I think this is what he'd do: 00:04:29.123 --> 00:04:33.923 He'd say, “I know what to do and you guys leave me alone.” 00:04:34.373 --> 00:04:37.245 So, what have we learned about human physiology? 00:04:37.255 --> 00:04:40.665 There're some very cool things that have been discovered now, 00:04:40.665 --> 00:04:43.925 things about when we control birth 00:04:43.925 --> 00:04:46.305 and when babies don't come out of the vagina. 00:04:46.595 --> 00:04:50.175 Guess what? They don't get the beneficial effects 00:04:50.175 --> 00:04:55.385 of the good bacteria living in the vagina that helps them for a long term health. 00:04:55.822 --> 00:05:00.422 What about oxytocin, the hormone of love? Why is it called the hormone of love? 00:05:00.438 --> 00:05:05.618 Well, it's only released in three times in our life, 00:05:05.628 --> 00:05:08.208 three times which are absolutely critical to bonding. 00:05:08.208 --> 00:05:11.328 In fact, it does modulate how attached do we feel. 00:05:11.678 --> 00:05:13.748 It modulates social behavior. 00:05:13.748 --> 00:05:16.618 Oxytocin is only released 00:05:16.618 --> 00:05:19.907 when we make love - when we have orgasm - 00:05:19.907 --> 00:05:23.312 when we have contractions to open up our uteruses 00:05:23.312 --> 00:05:25.092 so that the baby can come out, 00:05:25.092 --> 00:05:27.722 and when we let down our milk so we can feed our babies, 00:05:27.722 --> 00:05:29.772 so our babies can survive. 00:05:30.304 --> 00:05:35.204 Every year, 350,000 women die while pregnant or giving birth. 00:05:35.697 --> 00:05:39.637 2 million newborns die within the first 24 hours of life. 00:05:39.737 --> 00:05:41.277 This is true. 00:05:41.477 --> 00:05:45.527 Is this why we don't recommend home birth to everybody? 00:05:45.677 --> 00:05:47.047 Is it home birth? 00:05:47.047 --> 00:05:51.497 You know, most of these women live in 58 countries. 00:05:51.657 --> 00:05:53.827 They’re low resource countries. 00:05:53.837 --> 00:05:57.537 In these countries, women do not have access to lifesaving techniques. 00:05:57.537 --> 00:06:00.587 They don't have the medications to stop bleeding. 00:06:01.138 --> 00:06:04.278 If they could access it, they can't get there. 00:06:04.798 --> 00:06:07.668 They don't have somebody checking their blood pressure. 00:06:07.898 --> 00:06:12.208 Sometimes they're exposed to conditions which are dangerous for themselves. 00:06:12.318 --> 00:06:14.978 They don't have methods to resuscitate a baby 00:06:14.978 --> 00:06:17.178 that maybe just needs a little help. 00:06:17.360 --> 00:06:21.840 Is that why everybody should deliver in the hospital? 00:06:22.695 --> 00:06:24.025 What does the research say? 00:06:24.025 --> 00:06:28.365 For a long time we had a hard time understanding what it really says. 00:06:28.585 --> 00:06:30.463 Just like what Carzy said this morning, 00:06:30.463 --> 00:06:33.493 you've to ask the right questions in the right way. Guess what? 00:06:33.913 --> 00:06:37.251 We weren't asking the right questions in the right way. 00:06:37.251 --> 00:06:40.981 We were mixing up planned home birth with unplanned home birth. 00:06:41.011 --> 00:06:44.021 When we looked at the difference between home and hospital birth 00:06:44.021 --> 00:06:45.591 we had a lot of cases in there 00:06:45.591 --> 00:06:47.931 where the woman delivered en route to the hospital 00:06:47.931 --> 00:06:49.621 without an attendant, accidentally, 00:06:49.621 --> 00:06:53.581 even in high resource countries where all those things are available. 00:06:53.902 --> 00:06:55.782 And that doesn't tell us the story. 00:06:55.782 --> 00:06:59.592 If we don't know who's attending her, what their skill set is, 00:06:59.592 --> 00:07:03.082 if we don't know if she can change the plan when she is in trouble, 00:07:03.102 --> 00:07:07.112 we don't know what's really dependent on place of birth 00:07:07.112 --> 00:07:12.152 and what is instead dependent on the type of care that she gets. 00:07:12.592 --> 00:07:13.992 What we do know now? 00:07:13.992 --> 00:07:18.992 The good news is that we have 15 or 16 really high quality studies. 00:07:19.032 --> 00:07:21.222 We'll never have a randomized control trial, 00:07:21.222 --> 00:07:24.522 because women will not agree to be randomized to home or hospital. 00:07:24.532 --> 00:07:27.222 They have opinions about where they want to deliver. 00:07:27.222 --> 00:07:28.382 And they've tried! 00:07:28.382 --> 00:07:32.602 There was one trial that they tried to run for about 15 years. 00:07:32.682 --> 00:07:34.992 They got 11 women to agree. 00:07:35.143 --> 00:07:36.853 Not big enough to say something. 00:07:37.008 --> 00:07:40.368 So, what we know is that for an essentially healthy woman 00:07:40.368 --> 00:07:42.448 who has attendants with skills, 00:07:42.448 --> 00:07:47.518 and those skilled attendants bring basic equipment and medications 00:07:47.518 --> 00:07:51.178 and they have seamless access to specialized care 00:07:51.178 --> 00:07:53.318 when a complication arrives, 00:07:53.318 --> 00:07:56.448 we actually get healthy mothers and babies 00:07:56.448 --> 00:07:59.719 and they experience less interventions. 00:08:00.677 --> 00:08:01.897 So what's the problem? 00:08:01.897 --> 00:08:06.777 Why don't we all agree that that's the system that we should set up? 00:08:07.226 --> 00:08:08.846 I study attitudes 00:08:08.846 --> 00:08:13.796 and what leads to attitudes among maternity care providers. 00:08:13.896 --> 00:08:17.506 I did this in Canada, a big large national study. 00:08:17.696 --> 00:08:22.646 You can see that midwives, obstetricians and family physicians don't agree. 00:08:23.457 --> 00:08:24.637 Why does that matter? 00:08:24.637 --> 00:08:28.677 Provider’s attitudes matter, because they influence what women choose. 00:08:28.797 --> 00:08:30.947 Women want to do what's best for their bodies. 00:08:30.947 --> 00:08:33.190 They want to be able to believe their providers. 00:08:33.190 --> 00:08:35.807 We know that providers who know more about breastfeeding 00:08:35.807 --> 00:08:37.477 and have education about it, 00:08:37.477 --> 00:08:42.547 their patients will be more successful at breastfeeding. 00:08:42.877 --> 00:08:45.917 We know that women who choose cesarean on demand, 00:08:45.917 --> 00:08:49.387 their providers are more likely to have chosen that for themselves. 00:08:49.447 --> 00:08:51.991 There's something else going on there. 00:08:52.142 --> 00:08:54.822 If we ask the right questions to the right people, 00:08:54.822 --> 00:08:56.342 we might ask the women, 00:08:56.342 --> 00:08:59.522 what happens when they listen to their providers, 00:08:59.522 --> 00:09:02.402 try to access safe care, 00:09:02.402 --> 00:09:06.522 leave their homes and familiar environments, and come in? 00:09:06.712 --> 00:09:08.852 Well, this is what they say, 00:09:09.246 --> 00:09:11.926 “I was told to be quiet and lie down." 00:09:11.926 --> 00:09:14.736 "I was put in a room with women I didn't know.” 00:09:15.299 --> 00:09:17.509 “I didn't know that man. 00:09:17.509 --> 00:09:20.069 He came in and he said to me, 00:09:20.069 --> 00:09:23.509 'Spread your legs like you did when you got pregnant.'” 00:09:25.428 --> 00:09:28.988 “I had to undress in front of strange men. 00:09:28.988 --> 00:09:33.778 They watched me while I got up on the table to have my baby.” 00:09:35.456 --> 00:09:37.516 Women in the Philippines will say... 00:09:37.516 --> 00:09:41.566 Actually a lot of places in the world where women by droves are coming in now, 00:09:41.586 --> 00:09:45.406 - because there're institutional post-policies for institutional birth - 00:09:45.406 --> 00:09:49.296 are overloaded by normal cases 00:09:49.296 --> 00:09:52.456 and don't have enough resources 00:09:52.456 --> 00:09:55.856 to look after the women who really need their care. 00:09:56.026 --> 00:10:01.206 This is a labor ward, and a postpartum ward, and a newborn ward. 00:10:01.516 --> 00:10:05.456 Is that where you would like to be? Does that feel safe to you? 00:10:05.456 --> 00:10:07.256 This woman is an indigenous woman. 00:10:07.256 --> 00:10:09.456 She came in because she believed 00:10:09.456 --> 00:10:12.016 she was going to have a safer birth in the hospital. 00:10:12.016 --> 00:10:15.026 When she got there, they didn't understand her language. 00:10:15.036 --> 00:10:17.806 They didn't believe her that she was really in active labor 00:10:17.806 --> 00:10:19.716 because she had walked from her village. 00:10:19.716 --> 00:10:21.856 So they made her leave. 00:10:21.940 --> 00:10:26.120 Shortly thereafter, she delivered on the grass in front of the hospital. 00:10:26.219 --> 00:10:28.749 Is that safer care? 00:10:29.118 --> 00:10:32.968 If you think this is just happening in low resource countries, 00:10:32.978 --> 00:10:35.518 it's happening all over the world! 00:10:36.491 --> 00:10:38.791 This is North America: 00:10:38.791 --> 00:10:41.988 strangers around, women being told to push. 00:10:42.688 --> 00:10:44.398 One woman said, 00:10:44.398 --> 00:10:48.448 “I was hooked up and trussed. I couldn't move six inches. 00:10:48.848 --> 00:10:52.098 I knew I had to get up to have my baby, but they told me to lie still 00:10:52.098 --> 00:10:54.298 because they couldn't hear my baby's heartbeat. 00:10:54.298 --> 00:10:55.538 I was worried. 00:10:55.538 --> 00:10:58.288 I listened to them, but they didn't listen to me. 00:10:58.588 --> 00:11:01.638 So I closed my eyes and I hid in my music 00:11:01.648 --> 00:11:04.718 while they stood around and watched me.” 00:11:05.058 --> 00:11:08.418 So what is this issue about relocation? 00:11:08.418 --> 00:11:13.108 How are we defining safety? And who gets to define what safety is? 00:11:13.398 --> 00:11:15.588 We know when all of these silly things happen, 00:11:15.588 --> 00:11:18.458 when mammals are not in their familiar environment, 00:11:18.458 --> 00:11:21.958 when they're disturbed, have a loss of privacy and dignity, 00:11:21.958 --> 00:11:25.778 it can affect their ability to care for their own babies. 00:11:27.023 --> 00:11:28.683 Women tell us. 00:11:28.683 --> 00:11:31.775 Tiye, who is some of the women I looked after, told me 00:11:31.775 --> 00:11:33.985 she had a good job in the hospital. 00:11:34.795 --> 00:11:36.005 She was a lab tech. 00:11:36.005 --> 00:11:39.815 She said, "Everybody knows everybody's business ; I don't want them to know mine. 00:11:39.815 --> 00:11:42.115 The white women I work with don't understand me. 00:11:42.115 --> 00:11:45.165 I don't want to be undressed in front of them.” 00:11:45.435 --> 00:11:49.035 We looked after a woman when I was at Yale on faculty. 00:11:49.301 --> 00:11:51.651 Her husband would not tell us what his name was. 00:11:51.661 --> 00:11:53.861 He said his name was Fred. Nobody believed him. 00:11:53.861 --> 00:11:57.651 They said, “Maybe he is undocumented, that's why he doesn't want to tell us." 00:11:57.651 --> 00:11:59.881 It was 2001, October. 00:12:00.241 --> 00:12:02.451 His name was Osama. 00:12:02.451 --> 00:12:06.941 He was afraid if he's told the hospital staff his name, 00:12:06.941 --> 00:12:10.171 that they would not treat his wife well. 00:12:10.464 --> 00:12:13.814 The Hmong women I looked after in California 00:12:13.814 --> 00:12:16.084 were used to having all of their elders around, 00:12:16.084 --> 00:12:17.744 but the hospital had a rule 00:12:17.744 --> 00:12:20.824 that only one person could come with these women. 00:12:21.801 --> 00:12:23.631 This lesbian couple knew 00:12:23.631 --> 00:12:27.341 that if they went to the hospital with their known and beloved donor, 00:12:27.341 --> 00:12:28.751 that it was very likely 00:12:28.751 --> 00:12:32.131 that the hospital staff would hand the baby first to him 00:12:32.131 --> 00:12:35.041 and not to the primary parent. 00:12:35.761 --> 00:12:37.891 Women tell us that when they're home, 00:12:37.891 --> 00:12:41.611 they can get in what position they want, they can use gravity 00:12:41.611 --> 00:12:43.191 and they can still be assured 00:12:43.191 --> 00:12:47.681 that someone will be checking them and their baby's heartbeat. 00:12:49.280 --> 00:12:53.050 So what about babies who are fascinated with technology? 00:12:53.477 --> 00:12:56.147 What about what women say about technology? 00:12:56.337 --> 00:12:58.397 It turns out that they actually don't want 00:12:58.397 --> 00:13:02.402 to reject technology or modern medicine. 00:13:02.692 --> 00:13:06.492 They want access to all those lifesaving techniques. 00:13:06.497 --> 00:13:08.597 They just want to be told the truth. 00:13:09.127 --> 00:13:12.207 All of the things I was telling you about were based on studies 00:13:12.207 --> 00:13:14.987 that we've done where women have told us what they want 00:13:15.017 --> 00:13:18.677 and what's most important to them: comfort, convenience, empowerment. 00:13:18.797 --> 00:13:20.997 This study has just come out. 00:13:20.997 --> 00:13:24.937 About 2000 women answered a very long survey 00:13:24.937 --> 00:13:27.577 about what they thought about their maternity care. 00:13:27.577 --> 00:13:30.187 These were all women who planned hospital births. 00:13:30.337 --> 00:13:32.267 Guess what? They say the same thing. 00:13:32.267 --> 00:13:34.237 They believe they're in charge. 00:13:34.237 --> 00:13:37.407 They believe they're choosing the best options for their baby. 00:13:37.647 --> 00:13:39.377 They just want to be told the truth. 00:13:39.377 --> 00:13:42.527 They want to be told, how does this risk relate to me? 00:13:42.817 --> 00:13:46.397 What if I live in a place that does have those resources? 00:13:46.667 --> 00:13:50.697 What will it be like when I go into the hospital? 00:13:52.033 --> 00:13:53.873 And they also tell us 00:13:53.873 --> 00:13:58.493 that some interventions lead to things that they wouldn't choose 00:13:58.493 --> 00:14:02.533 unless they were very sure that it would save them or their babies. 00:14:03.233 --> 00:14:06.683 40% of women are induced in the United States today. 00:14:06.712 --> 00:14:09.862 We have over 30% C-section rates. 00:14:10.022 --> 00:14:12.312 Do you think the species would have survived 00:14:12.312 --> 00:14:14.922 if that was the needed rate? 00:14:15.125 --> 00:14:17.655 In fact, most countries that have much better outcomes 00:14:17.655 --> 00:14:22.295 than we do in North America, have much lower rates of these things. 00:14:23.178 --> 00:14:25.118 So what about risk? 00:14:25.399 --> 00:14:27.239 Who gets to choose? 00:14:27.239 --> 00:14:29.569 This is a one-in-a-thousand risk. 00:14:29.739 --> 00:14:33.959 When you have skilled attendants at birth 00:14:33.959 --> 00:14:39.679 and access to equipment and personnel when you need it, this is the risk. 00:14:39.779 --> 00:14:43.489 About one per two to three thousands is what loss will look like, 00:14:43.629 --> 00:14:46.639 - not fetal loss, I’m talking about neonatal loss. 00:14:46.639 --> 00:14:49.419 And 50% of stillbirths are unexplained, 00:14:49.419 --> 00:14:51.569 so we don't really know what's going on there. 00:14:51.779 --> 00:14:52.949 So one-in-a-thousand. 00:14:52.949 --> 00:14:57.269 That's about the same risk than that man who wanted to run a marathon, 00:14:57.269 --> 00:15:00.209 would experience of having a heart attack. 00:15:00.499 --> 00:15:02.039 Is that an acceptable risk? 00:15:02.039 --> 00:15:06.009 And what about the risk of loss of dignity, of abuse, 00:15:06.009 --> 00:15:08.149 of disrespectful care? 00:15:08.609 --> 00:15:11.029 How do you define safety? Who should decide? 00:15:11.039 --> 00:15:13.989 Who is most invested and most responsible? 00:15:13.989 --> 00:15:15.749 How much risk is too much 00:15:15.749 --> 00:15:19.189 and whose agenda and whose destiny are you talking about? 00:15:19.829 --> 00:15:22.869 You know what women say? What would your mother say? 00:15:22.869 --> 00:15:26.529 Do you think she was more concerned about you than the doctor? 00:15:26.829 --> 00:15:28.739 Yes, that's what women say: 00:15:28.739 --> 00:15:30.789 ''We care about our baby’s health. 00:15:30.789 --> 00:15:33.189 We are offended when people suggest 00:15:33.189 --> 00:15:36.629 that we are choosing home birth or choosing respectful care, 00:15:36.629 --> 00:15:39.979 just for our own convenience or for comfort, 00:15:39.979 --> 00:15:44.489 like it was some sort of cosmetic option. 00:15:44.609 --> 00:15:46.459 We know that if we are not well, 00:15:46.459 --> 00:15:48.469 if we're not treated well, if we're abused, 00:15:48.469 --> 00:15:51.549 if we feel like we had an unnecessary intervention 00:15:51.549 --> 00:15:54.259 or if we're in an environment where we don't feel safe, 00:15:54.259 --> 00:15:57.599 that can affect how we feel about our babies, our future. 00:15:57.837 --> 00:16:00.787 We're concerned about our baby’s health also. 00:16:00.867 --> 00:16:02.417 What about the use antibiotics? 00:16:02.417 --> 00:16:05.397 What about with C-sections or any of these things? 00:16:05.617 --> 00:16:08.497 Absolutely! Give me a C-section if that’s what I really need. 00:16:08.597 --> 00:16:10.037 I want my baby to be healthy. 00:16:10.037 --> 00:16:16.917 I value the advances that modern medicine have brought to high resource countries.'' 00:16:17.277 --> 00:16:19.117 That's what they tell us. 00:16:19.117 --> 00:16:21.433 But is anybody listening to women? 00:16:21.503 --> 00:16:24.080 Paula Freire said, “Washing one's hands of the conflict 00:16:24.080 --> 00:16:26.010 between the powerful and the powerless 00:16:26.020 --> 00:16:29.790 means to side with the powerful, not to be neutral.” 00:16:30.000 --> 00:16:32.600 Isn't it time we took a stand? 00:16:32.774 --> 00:16:35.184 Which is the disruptive innovation we await? 00:16:35.314 --> 00:16:38.634 Is it home birth? Is it hospital birth? 00:16:38.864 --> 00:16:42.654 Or is it humanized birth? 00:16:43.416 --> 00:16:45.196 What if all countries took steps 00:16:45.196 --> 00:16:48.596 to facilitate high quality care in all settings? 00:16:48.596 --> 00:16:52.466 And all women were told how to access that care 00:16:52.486 --> 00:16:55.386 wherever they felt safe? 00:16:56.287 --> 00:17:00.637 If the focus was access to safe humanized birth in all settings, 00:17:00.637 --> 00:17:04.090 then we'd prioritize the availability of lifesaving measures and skills 00:17:04.100 --> 00:17:09.590 everywhere and carry them to the places where a woman feels respect, autonomy, 00:17:09.590 --> 00:17:12.552 and the ability to listen to her own body and baby. 00:17:12.642 --> 00:17:15.552 I wrote that down because I wanted to say it all. 00:17:15.552 --> 00:17:17.842 I wanted to be sure I didn't forget to tell you 00:17:17.842 --> 00:17:21.422 that it is about all of those things together. 00:17:22.219 --> 00:17:23.799 We can carry those things to her. 00:17:23.799 --> 00:17:25.749 They might be packaged a bit differently. 00:17:25.749 --> 00:17:28.489 We know most people won't need IVs 00:17:28.489 --> 00:17:30.579 if they're cared for and start out healthy, 00:17:30.579 --> 00:17:32.809 - we're talking about term pregnancies here. 00:17:32.809 --> 00:17:37.819 We could be ready standing by with resuscitation equipment for her baby. 00:17:38.590 --> 00:17:42.130 It doesn’t look like the hospital but it’s got all the same stuff. 00:17:42.410 --> 00:17:46.550 Meanwhile, the woman could get in whatever position she wanted. 00:17:47.270 --> 00:17:51.340 And we could remember that whether or not we're there, 00:17:51.340 --> 00:17:53.410 whether or not the interventions are there, 00:17:53.410 --> 00:17:56.430 a woman will deliver undisturbed 00:17:56.430 --> 00:17:59.250 and will receive her baby and care for her baby, 00:17:59.270 --> 00:18:02.120 because that's what humans do. 00:18:02.300 --> 00:18:05.070 They would receive their babies with joy 00:18:05.085 --> 00:18:08.515 and with the people that they love, with gentleness. 00:18:09.647 --> 00:18:14.417 If we attended them in that respectful way, 00:18:14.417 --> 00:18:16.967 perhaps they would invite us back into their homes 00:18:16.977 --> 00:18:19.838 to help them learn how to care for their babies. 00:18:20.218 --> 00:18:24.398 And their babies would come out alert and healthy, 00:18:24.398 --> 00:18:28.598 ready to receive the wisdom of their grandparents. 00:18:31.490 --> 00:18:34.830 This is what one of my favorite photojournalists said. 00:18:34.900 --> 00:18:36.940 This has been around for a long time. 00:18:37.030 --> 00:18:41.050 I graduated here in 1978 00:18:41.050 --> 00:18:44.060 and I read this book shortly thereafter. 00:18:44.742 --> 00:18:49.072 Suzanne Arme said, “If we hope to create a non-violent world 00:18:49.072 --> 00:18:52.560 where respect and kindness replace fear and hatred, 00:18:52.560 --> 00:18:55.820 we must begin with how we treat each other at the beginning of life, 00:18:55.820 --> 00:18:59.100 for that is where our deepest patterns are set. 00:18:59.110 --> 00:19:03.930 From these roots grow fear and alienation or love and trust.” 00:19:04.150 --> 00:19:05.490 Thank you. 00:19:05.490 --> 00:19:07.040 (Applause)