EBB 126 – Finding the right provider, and birth in the Dominican Republic with Leiko Hidaka

• Follow Leiko Hidaka on her website, Instagram, and Facebook
• Click here  for the Evidence Based Birth COVID-19 resource page.
• Click here to see EBB’s new Sample Informed Consent Form for Refusal to Separate Birthing Parent and Infant. This document is also available in Spanish.
• For Spanish translations of EBB’s one-page handouts, click here.
• Check out our Spring Sale in the Evidence Based Birth Shop! T-shirts are on sale – buy two, get $10 off your order. Also – we are offering FREE downloads of the e-book version of Babies Are Not Pizzas! 
• The Evidence Based Birth Pro membership is on sale through this Friday, May 1! Click here to get 20% off the monthly or annual term. 

 

Rebecca Dekker: Hi, everyone. Today, I’m so excited to welcome Leiko Hidaka to the Evidence Based Birth® podcast. Before we get started, I have a few important announcements. First, this Monday, on April 27, we released another research update on COVID-19 that you can access on our COVID-19 resource page, evidencebasedbirth.com/covid19.

Rebecca Dekker: In that update, we also addressed a few of the questions that have been submitted by our listeners. These questions are: how accurate are tests for SARS-CoV-2? And what about the accuracy of antibody tests? Should I be worried about being discharged home early from the hospital after giving birth? And which prenatal visits should be face-to-face, which should be virtual or omitted entirely?

Rebecca Dekker: Again, you can access the archives of our newsletter, including the Q&A’s, by going to evidencebasedbirth.com/covid19, and then scrolling to the research update for April 27. On that page, we also have a sample-informed consent form for people who want to refuse newborn separation if they test positive for COVID-19. I’m pleased to announce that that form has also been translated into Spanish and is now available on the resource page as well.

Rebecca Dekker: Speaking of Spanish translations, we recently added some more translations to our one-page handouts that anybody can download. Just go to evidencebasedbirth.com/translations to download those printer-friendly PDFs for free. And speaking of free, from now until May 9, we’ve made the ebook of Babies Are Not Pizzas: They’re Born, Not Delivered free in the Evidence Based Birth shop.

Rebecca Dekker: Just go to evidencebasedbirth.com/shop to get that free download of the ebook. And while you’re there, check out our t-shirts that are on sale right now. We’ve got Waterbirth isn’t just for Mermaids and Babies Are Not Pizzas t-shirts on sale. Finally, we’ve had a lot of new people joining our Evidence Based Birth professional membership this month. We reduced the price, and you can join at the reduced price through Friday, May 1. So there’s just a couple days left to join at that lower price.

Rebecca Dekker: And now let’s get to our interview with Leiko Hidaka. In this interview, Leiko is going to talk about how she helps her clients in the Dominican Republic find the right provider for them. Now, before you listen to the interview, I do want to provide you with a trigger warning, and that trigger warning is that, during this conversation, we will discuss descriptions of obstetric violence.

Rebecca Dekker: Obstetric violence, also sometimes referred to as mistreatment in childbirth, is extremely common in the Dominican Republic. It’s less common in the U.S., where I am located. A recent study by Vedam et al called The Giving Voice to Mothers Study found that 28% of people who gave birth in the hospital in the U.S. described experiencing mistreatment.

Rebecca Dekker: In that same study, they also found that Black women, Hispanic, indigenous and Asian women in the maternity care system were twice as likely as White women to report that a healthcare provider ignored them, refused to answer their request for help or failed to respond to their requests for help in a reasonable amount of time. Families of color were also more likely than White women to report that their physical privacy was violated, and that they were shouted at, scolded, threatened or physically abused by healthcare providers.

Rebecca Dekker: So although some of what Leiko may talk about may shock you, in terms of how pregnant people are treated in her country, obstetric violence or mistreatment in childbirth can happen in other countries as well and it does happen in the U.S. and affects some populations greater than others. As a doula, Leiko is advocating for better care in her country.

Rebecca Dekker: Leiko holds a master’s degree in human settlements and environment. She earned her birth doula certification with DONA International and her childbirth educator certification with the International Childbirth Education Association or ICEA. Leiko is the international coordinator for ICAN, and also leads the local ICAN chapter of the Dominican Republic, where she is a highly respected and passionate leader for women’s autonomy through evidence-based care.

Rebecca Dekker: Leiko became an EBB instructor in 2018, and she teaches classes and workshops for professionals and parents in the Dominican Republic. In 2019, she began collaborating with an American NGO to help establish a freestanding birth center in the Dominican Republic, which would provide high-quality midwifery care and education to any woman who wishes free of cost. Welcome, Leiko, to The Evidence Based Birth podcast.

Leiko Hidaka: Hi. Thank you very much for an invitation.

Rebecca Dekker: So Leiko, can you start by telling us a little bit about how you went from your master’s degree in human settlements and environment to becoming a birth doula?

Leiko Hidaka: Well, I was in my early 30s, and when I came back from my masters, I did it in Chile and I was so excited to make changes in my country. I used to work for the government and I was like, okay, if I can do great things that will help people. But then you realize this takes a long time. And I have been working for the government for over 10 years.

Leiko Hidaka: It just came to that point where you go like, okay, so I’m in my 30s. Is this what I really want to be doing the rest of my life? Am I satisfied with it? Do I feel that I’m useful? And the answer was no. So I got a new job, working for United Nations and I thought, okay, from here I can do it. But after six months, I realized that’s not quite what I was looking for either, and I decided to take a sabbatical.

Leiko Hidaka: In the middle of that, a friend put me in touch with this doula instructor, who wanted to have a workshop and this was going to be her first workshop by herself. She needed help. So I helped her and I was like, “So what’s a doula?” She explained the whole thing to me and she was like, “Why don’t you take the workshop?” And I’m like, “Well, I don’t know. I don’t see that in my profile. I’m not a super sweet person. I don’t think I’m a motherly person. I don’t know how I can be of help to a woman who needs that kind of support.”

Leiko Hidaka: Because in my head, what I had seen, what I had heard of is what most people hear, “Oh, childbirth is painful, and you need to be petting the mama like it’s all going to be fine. Don’t worry. And holding her hand.” And I’m like, I’m not that kind of person. So I took the workshop and after three days sharing with other women who had different reasons to be there, I realized that maybe I could be useful by providing information to people in general, because I learned so much.

Leiko Hidaka: And this was like the breaking point for me, when I was told how much abuse women go through to have their babies. And as a woman, as a human being, I don’t believe that any human being deserves to be mistreated, leave alone any woman. And I’m like, no, they need the information. They need to know they have rights. They need to know they have options.

Leiko Hidaka: So I said I’m going to stay. I’m going to be a doula and I’m going to provide information to moms. So time went by. I was still working at United Nations, so it’s not like I could take clients often. But the instructor, she would call me sometimes like, “Okay. I have a birth, do you want to come?” And I’m like, okay. And a year went by and I saw so much, so many things.

Leiko Hidaka: And the one thing that I remember the most is that at my first birth, she was a second time mom and she arrived with eight centimeters. Imagine what a woman wants to talk to you with eight centimeters, somebody she doesn’t know. So I was just standing there, but I didn’t want to be like a stranger putting pressure on her so I moved away. But I noticed her lips were dry and I offered her some water, and that woman smiled and drank the water.

Leiko Hidaka: And you would think it’s just something silly, but that meant a lot to the mom. And that was my cue like, oh, look at that. I’m actually useful. So eventually, I quit United nations and decided to do this full time. That’s when I started to get trained to become a childbirth educator. I took the exam and all this and all that. Shortly after that, I found Evidence Based Birth and I was like, “Oh my God, this is all the information I need for women to be able to see that things are different. That they don’t need to be afraid.”

Leiko Hidaka: And then when the training opened to become an evidence-based birth instructor, I was like, “Wow, I need to do this.” And that’s when I applied for the scholarship, which I’m very grateful for. And ever since, I have been focusing mainly on workshops for professionals. So far I think it’s having a good impact. A lot of people are opening up to at least listen to new information, and here I am.

Rebecca Dekker: Yeah. And so tell us a little bit more about doula practice in the Dominican Republic. Are there many doulas there? Are there any midwives?

Leiko Hidaka: Right now, there are a good amount of doulas. In terms of like four years ago, there were only like three doulas. Right now, I could say there are like around 10 maybe. It doesn’t sound like much.

Rebecca Dekker: 10 for the whole country?

Leiko Hidaka: As far as I know. These are Dominican doulas that I know. I’m also aware that there are some people, foreign nurse who move here and they may be offering their services. But they’re not in the doula community or like… Because I’ve read a post on Facebook and somebody said, “Oh, I’m a doula,” but it’s not somebody I know and it’s an expat group. So my guess is there must be more people. We don’t have midwives though. Our population is around 11 million people, and 99.9% of birth happens in the hospital, according to the last census, which was a while ago, but still.

Rebecca Dekker: And are midwives not allowed to practice legally in the Dominican Republic?

Leiko Hidaka: Actually, there is a legal limbo there, because I have been through that law and nothing says that midwifery cannot be practiced. What the law says is that somebody who practices medicine without a license can go to jail, but it doesn’t specify what medicine is. And if we talk about a normal birth, tending on a normal birth is not medicine.

Leiko Hidaka: However, many doctors are so afraid because quite a few women want a home birth. And they will be willing to have a home birth with a doctor, except that doctors say, “No, because I could go to jail, or I could get sued if something goes wrong,” and that if something goes wrong, it’s like their excuse for pretty much everything.

Rebecca Dekker: So why do you think there are no midwives in the Dominican Republic?

Leiko Hidaka: I think that it was a powered struggle. Because I was doing research on that and I found this little book from the ’90s which talked about what happened in the ’70s and ’60s. And there used to being midwives in rural areas and the ministry of health tried to formalize them and they would go from being… They were midwives, which in Spanish they were called parteras.

Leiko Hidaka: But if you went and took the training at the ministry of health, you had a new title, which was matrona, which is the same one they use in Spain. However, they didn’t continue with that. That’s what the little book says. And if you ask around, you’ll hear somebody say, “Oh yeah, my dad or my mom was born with a midwife,” Or, “I know somebody here or there.”

Leiko Hidaka: But I have been investigating and I cannot find them. I know there are some in very isolated areas what we would call traditional midwives. And it’s not illegal because when you’ve raised a baby, it actually asks for the signature of the doctor or the midwife. And we’re talking about a legal document.

Rebecca Dekker: Interesting. And you said 99.9% of people give birth in the hospitals with a doctor. What are hospital births like where you live? What are some of the basic statistics of how people give birth?

Leiko Hidaka: Well, right now, in the last survey, our average for C-sections was around 58%. I know that sounds alarming.

Rebecca Dekker: The country’s cesarean rate is 58%?

Leiko Hidaka: Yes. But it’s worse than that. Because that’s 58% for the whole country-wide, but if you break that into public hospitals and private hospitals, in public hospitals it’s around 47%, 48%. But in private hospitals it’s close to 90%.

Rebecca Dekker: And why is that? Why is it that almost like 9 out of 10 people going to a private hospital has a cesarean?

Leiko Hidaka: That was the question that I was asking myself, because you would think that a woman who has access to a private hospital, because she has probably more income, is a more educated woman who can make better choices and who is able to choose a care provider that will more or less be on the same page as she is. But amazingly, that’s not the case.

Leiko Hidaka: We see many women who think they will have a vaginal birth, who think they are being taken care of by somebody who supports their choices. And somehow around week 35, 36, 37, something comes up. And the moment that a mom is told you’re putting your baby’s life at risk, that’s it. She’s not going to argue. She is going to accept usually whatever the doctor tells her.

Rebecca Dekker: And so that happens a lot, being told that your baby’s at risk at the end of pregnancy?

Leiko Hidaka: Oh, yeah. If you ask any doula, she will tell you that happens almost every time, almost.

Rebecca Dekker: Almost 100% of the time, it happens?

Leiko Hidaka: Yeah, you can count. Doulas here know who are the doctors that will not put that pressure on you and you can count them on one hand those doctors. It’s amazing. And then you have the women who are like, okay, I’m going to have a C-section because it’s painless. They’re told it’s painless. I mean, it is painless during the surgery, but nobody tells them what happens after that.

Leiko Hidaka: Nobody asks them, “Are you going to have more children? Do you know how this could affect you?” They don’t have this information. Now, with ICAN, we have been holding meetings and providing this information and explaining to women how it goes, why this may happen. And you run into a bunch of people who will go like, “Oh, I had a first C-section and then I have had two miscarriages at 8 weeks, 10 weeks.”

Leiko Hidaka: And I’m like, “Well, okay. Technically, it’s not a miscarriage, but okay. I get it.” And they don’t know why. And they don’t relate that to the possibility that the C-section scar may be affecting the pregnancy. They were not told these things. Most women who choose to have a C-section are not aware of the risks.

Rebecca Dekker: Okay. So on top of kind of that pressure to have C-sections, what are some of the other struggles that your community is facing?

Leiko Hidaka: Well, the sense of not having options may be one of the most important struggles, because so many women choose care providers based on, oh, this person is very good at what they do. If something goes wrong, they will take care of you. So it’s a culture of fear and decisions are often made based on that fear. Then, you have some women who say like, “Okay, I want to have a birth like this, this or that. I’m going to choose this person to be my care provider.”

Leiko Hidaka: But what they do is that they say, “Okay. So I’m putting my life in your hands.” And they end up giving their choices to somebody else. And it’s a little bit weird and a little bit difficult to explain. The point is not to argue with your care provider. The point is to find a care provider who is willing to talk to you, to discuss things with you; not to argue, but to look for options with you.

Leiko Hidaka: And it is your responsibility as a mom, it’s your pregnancy, it’s your baby, if you want to have things a certain way, to do research, to educate yourself and to find a professional who will support you. And this is not about being pro birth. I say this is about being pro women, pro person, pro human. You want a professional who will not put their degree above your dignity.

Rebecca Dekker: Can you talk a little bit more about abuse? You’d mentioned that word when you were first starting to talk, and I was thinking about obstetric violence and the abuse of women in childbirth. Is that something that you see as a big problem in the Dominican Republic?

Leiko Hidaka: That is a standard.

Rebecca Dekker: So abuse is the standard?

Leiko Hidaka: Yes, it is. And what is even worse is that most people do not perceive it as abuse. It’s just the way it is. That’s just how it goes. “What? My baby with me after birth? Can I do that? Can the baby stay with me?” They don’t know it should be like that. “What? Can I give birth in a different position? I don’t have to lay on my back? What? I don’t need an IV and I can stand up during labor?”

Leiko Hidaka: Most people didn’t know these things. Right now, there are more people who are reading about it and they know in other places they have these options, but they go like, “Yeah, but not in this country, not in this hospital.” They’d be like, “Oh yeah, it would be nice. But that’s just the way it is here.”

Leiko Hidaka: “You get to the ER. They put in an IV. They bring you to the labor room. You lay on your back. They give you possibly on an enema.” Some doctors still do that. They break waters. “They help you a little bit with that thing they put on the drip, that thing.” “Yeah. Okay. Pitocin?” “Yeah.” “And then an epidural so it’s painless. Oh, and they had to help me by pushing the baby from the outside.”

Rebecca Dekker: So they push on your belly while you’re pushing the baby?

Leiko Hidaka: Oh yeah, they do fundal pressure here. I cannot say that I have seen it often, but I have seen it.

Rebecca Dekker: Is there verbal abuse during labor or emotional abuse?

Leiko Hidaka: Yeah. That one is so heartbreaking when you have a care provider who is supporting your desire to have a vaginal birth and this person that you have grown to trust that is really supporting your desire to have a vaginal birth makes some funny comment, which is basically mocking you in a way or another, not necessarily with offensive words.

Rebecca Dekker: But they might mock you while you’re in labor and make fun of you?

Leiko Hidaka: That’s quite normal.

Rebecca Dekker: If you want to have a vaginal birth?

Leiko Hidaka: Yeah, and even in C-sections. And in general, giving birth, I don’t know why we seem to have lost respect for these amazing moments. Not everybody’s like that. Not all doctors are like that. But keeping in mind that if you are going to have a hospital birth, there’s going to be a team of people.

Leiko Hidaka: There’s going to be staff and you can hear nurses talking to doctors about something yesterday or something today or somebody who says, “What? Me? Hell, I’m not going to have a vaginal birth. I’m not going to go through that. Oh my God, look at that.” And we’re talking this in front of a mama who is literally crowning. She’s hearing those things.

Rebecca Dekker: So they’re talking negative about it while the baby’s coming out basically?

Leiko Hidaka: Yeah. On the bright side, most moms forget about it. In my experience, when we talk and we debrief, they don’t remember that part, which is great. But you know how things stick to the back of your head and your subconscious? And that’s just wrong.

Rebecca Dekker: So you hear the way they talk to people during labor, you see how they treat them and you feel like a lot of your clients don’t remember that afterwards? They’ve blocked it out?

Leiko Hidaka: They do, at least for a few months, because they’re in that joy of, “Oh, my baby was born. My baby’s healthy, this and that.” Usually, it’s about a year later. I’ve been doing this for nearly four years. So by now I keep in touch with some of the women that I’ve worked and it’s not so uncommon that they have questions around a year later when their baby is going to turn one and they remember when they went into labor, what they were told to do. And they ask you, “Why was I told to do this if I didn’t need it?” Or, “Why was this done to me if it was not necessary?” Or, “Why did that or this happen? Why did this person say that? What’s with this attitude?” And stuff like that. What they do remember comes out about a year later.

Rebecca Dekker: Wow. And that is when they show up to your ICAN meetings for international cesarean awareness?

Leiko Hidaka: Well, we started our ICAN meetings last year. I did have a couple of moms that they had worked with me. And at first, it was difficult for me to find a balance, because we’re talking about moms. The moms who usually hire me as their doula, they really try to get the best care provider that can support them. So you could pretty much say that all women who have worked with me have had care providers who support vaginal birth. Imagine how difficult it is to find yourself one year later wondering what went wrong; if I chose a care provider who was supposed to be a very good one.

Rebecca Dekker: So you kind of direct them to the best care providers, but even then they start wondering what happened to me in my birth?

Leiko Hidaka: Mm-hmm (affirmative). Yes. They will always ask you, if it’s like an early pregnancy, “So who would you recommend?” And I’m like, ‘”Well, I don’t recommend anybody in particular, but I can give you a list of doctors based on other mothers recommendations. These are the ones that I have had the best reviews about and you can choose from here.” And the part that, again, sometimes we miss is that even though somebody is very good at what they do, if you don’t tell them what you want and how you want them, you’re not making a choice. You’re letting them be the ones to make the decisions.

Rebecca Dekker: So can you talk a little bit about why you think the medical community in the Dominican Republic has resistance to change or to doing things differently and to vaginal birth or unmedicated birth or any of those options?

Leiko Hidaka: I would start with trauma and fear. I think it is similar in the United States, the way that when you’re doing your residency you’re treated basically as something less than a human. And come on, when you’re done with that and you’re finally on OB-GYN, you’ve got four years of baggage of being mistreated, and on top of that, four years of not seeing a normal birth, at least in the DR. When I was in a public hospital for 10 days, I was volunteering and they have residents. And all of the women in this hospital that came in labor, all of them had Pitocin. Why? I don’t know. It didn’t matter if it was a first time, second time, third time mom.

Rebecca Dekker: 100% of them had Pitocin?

Leiko Hidaka: Yes. Oh, hold on. There was one who didn’t because she was preterm. She was like 30 something weeks. But it seems like if you’re a term, they would give you Pitocin. If possible, they will break waters. And they don’t use epidurals in public hospitals here.

Rebecca Dekker: So basically women are made to lie on their backs and have all these things done to them, but they’re not given any pain relief in the public hospitals?

Leiko Hidaka: Nope. And some of them are not allowed to get up and go to the bathroom. So if you say, “I need to go,” they will maybe bring you a bedpan. That was hard to watch and to realize that, if things are difficult for women who can afford a private hospital with a private doctor, it’s beyond inhumane how it is in public hospitals.

Leiko Hidaka: And if you have residents, they all need to learn how to do a vaginal exam. You have a room with five, six beds and you have sometimes two moms in one bed. That’s just wrong. That’s something else. And that’s why I’m so excited about the possibility of this new birth center opening in the DR. There was this American NGO, New Life Birthing Centers.

Leiko Hidaka: They contacted me and we found a place. We rented the place. We have been furnishing and all this. But given the current circumstances, it has been delayed, the opening. And the intention is to make this legal, like to put it on the table; midwifery, here it is.

Rebecca Dekker: Yeah. So tell us more about the birthing center. Where are you in the process of getting that established?

Leiko Hidaka: We got the place. We got the beds, some of the electricity stuff done. We’ve registered the name. We are now in the process of registering New Life Birthing Centers as an NGO in the DR. The idea is to also submit it to the ministry of health. And because there are no legal standards for birthing centers here, chances are that it will fall into the category of a hospital.

Leiko Hidaka: But we’re excited about the possibility that this will be a first step into taking into consideration that we need new rules for something different. The birth center will be located five minutes away from a very big public hospital with a maternity and also a pediatrics hospital, in case there needs to be some transfer done. It will be attended by midwives. There will be a head midwife. She will be living here permanently.

Leiko Hidaka: And it will also be taking students later. The center will be free for anybody and everybody who wants to have midwifery care. And we’re just thrilled about it. Because I’m telling you, right now I have four moms who want a home birth and we don’t have a single midwife in this country that has stood up. Those who may be in rural areas, we don’t know them and they don’t hear from us, and the ones that we were expecting are stuck in their countries because of the virus.

Rebecca Dekker: Yeah. And is that one reason why people are wanting a home birth, because they don’t want to go into the hospitals during the pandemic?

Leiko Hidaka: Actually, yeah. More women seem to be thinking about it now. Some people make tease with the idea, “Oh, I would like a home birth.” But now with what’s going on, they feel more inclined to have a home birth. I heard that, just about three weeks ago, there was a doctor who actually agreed to attend a home birth because she was like, “You know what? I’m not going to put you in the risk of going to the hospital. Sure, let’s do this.” And that was the first time a doctor had a home birth, and she was amazed at how easy it was. And you know what that means? That means that this doctor had never in her life before seen a normal birth. That’s concerning, because she’s not 20, 30 or 40. This woman is in her 50s.

Rebecca Dekker: Yeah. So that is just amazing that you’re planning on opening this birth center. Will the midwives be Dominican or coming from other countries?

Leiko Hidaka: The head midwife will be coming from another country. She’s actually American. But the intention is, in the long wrong, to leave the birth center established and leave Dominican staff running it. They’re also interested in training midwives because I told them there are people interested. I’m studying midwifery and I have another colleague who’s also studying midwifery and they said that’s perfect because what New Life Birthing Centers does is that they establish the birth center. They open it up. They get it running. They train people so that the center can stay in the community and be run by the community.

Rebecca Dekker: Wow. And you said you’re working on studying to become a midwife?

Leiko Hidaka: Yes. It’s a rather weird path for me. I’m 37 and I said I’m going to make it before I turn 50, because we don’t have midwifery schools here. I heard about NARM, but they would require me to go to the States for my practices and that would be a lot of traveling.

Rebecca Dekker: So how are you studying then?

Leiko Hidaka: Well, there was this midwife here, she’s Canadian and she has been my tutor. She’s no longer living here, so we basically Skype and stuff like that. Then, there is all the reading and I sign up for a master’s in obsetrical nurse. It’s not the same, but it’s getting me closer. Because in this country, since we don’t have laws midwifery and I need something that supports my involvement in the field, with this master’s I think I can do that. Plus I’m still getting knowledge and my goal is to apply for the certification with the IRM, International Registry of Midwives, sometime before I’m 50.

Rebecca Dekker: Wow. That’s an amazing goal. I can just imagine like 10 years from now how much will have changed for the butter in the DR. Because you said you see some things changing. You were writing to me, you do see some signs of hope. What are those signs?

Leiko Hidaka: Yes. For once, it’s like women opened their eyes to the fact that they don’t need to be mistreated. They don’t need to accept it and they’re more willing to look for options. It’s a first step. There are more doctors who are now at least saying that they will attend a vaginal birth. They are postponing the time for C-sections.

Leiko Hidaka: Because I remember very clearly how they would schedule C-section at 38 weeks just five years ago. At least now they’re waiting until 39 and 40. It’s not perfect, but it’s a little change. And you can see some hospitals actually have exercise bowls; something silly, but they are allowing women to move. They’re allowing women to get up to go to the bathroom.

Leiko Hidaka: I have heard doctors say, “What? She wants to go to the toilet? No, no, no, no. Because she could give birth there.” And I’m like, “I don’t think she’s not going to notice when the baby is coming out.” But these are tiny little changes. And then you can see some pediatricians who are not in a rush and they will actually let the mom have the baby on her chest while she’s being cleaned up.

Leiko Hidaka: Maybe it’s not the whole golden hour, but it’s better than being separated right away. And you know how we often talk a lot about OB-GYNs? But right now it’s harder to manage what happens to your baby than it is to manage what happens during birth. Because a lot of women know that ideally they want to arrive to the hospital with 8, 9 or even 10 centimeters to reduce the chances of interventions.

Leiko Hidaka: But once your baby is born here, a paedatraecian has to be present. It doesn’t matter if your baby’s healthy or not. For your baby to be born in a hospital, you need an OB-GYN and a pediatrician. As soon as your baby’s out, the pediatrician is the one who makes all of the decisions-

Rebecca Dekker: Including taking the baby away?

Leiko Hidaka: Yes. Because the OB-GYNs that I have worked with, most of them are like, “You can lift the baby a little bit.” And they try because they have learned that the golden hour is important. And the pediatrician may be like, “Sure, let’s put the baby’s cheek to the mamas cheek, like if it was a C-section.” And I’m like, “What’s the rush.”

Leiko Hidaka: “Well, the rush is that the pediatrician has to measure the baby, weight the baby and all this and all that so they can go, so they can leave.” That’s the only reason. It’s so unusual to see unhealthy babies that have a natural reason not to be with their moms. I have not seen any. However, for some reason, pediatricians take them away and you don’t know for how long.

Leiko Hidaka: Because you could have a vaginal birth, you could be healthy, your baby could be healthy, but they will not bring your baby to you until you are in your bedroom. And the hospital may not have bedrooms available, so you’re put in the recovery room. You could spend the whole night there and they’re not going to bring your baby to the recovery room.

Rebecca Dekker: Wow. So there’s like human rights violations happening after the birth as well as during the birth?

Leiko Hidaka: Yeah. At this point, honestly, I would think it’s more difficult to manage the postpartum than the birth itself. Because another positive change is that some hospitals already know what a doula is and they are actually welcoming of us. They open their doors. The nurses are nice to us.

Leiko Hidaka: If they see us, they already know that this mom wants, at least, freedom of movement, no IV, no unnecessary interventions, skin to skin, breastfeeding. They know these things so they act accordingly, and that’s plus. But again, it is possible. The most important thing a mom can choose and decide on for her baby’s birth is a team that will be with her.

Rebecca Dekker: And can you talk a little bit more about that? What are some red flags that you see that might be kind of universal, if you’re helping a client who’s talking about their provider?

Leiko Hidaka: Well, I would say go with your gut. Because you often hear women talk how this care provider, who has been their care provider since they were teenagers, “Oh, he or she is so good and funny and they treat me well,” and they assume that this person is the right person to be there during the birth of their babies. However, I think it’s important to notice that gynecology and obstetrics are not the same.

Leiko Hidaka: A doctor could be an amazing gynecologist, who checks you every, I don’t know, 6 to 12 months. But that doesn’t mean that this person is the right person to be at your baby’s birth. It doesn’t mean that this person will give you what you want. And you can tell when you don’t feel comfortable. If you feel that, don’t panic. But ask yourself, why do you not feel comfortable?

Leiko Hidaka: Do you feel your doctor is not being honest with you? Do you feel there’s stuff that is being held from you? Have you asked questions? And have you gotten straight answers? Or, do you get a maybe, we’ll see? If you pay attention to how you feel, you can usually tell if that person is the right person to be your care provider.

Rebecca Dekker: But you said sometimes people say, “Well, I really like my OB,” but you know as the doula how that OB acts during birth. So what is it that they’re missing? Are they not listening to their gut? Are they just ignoring some of those warning signs?

Leiko Hidaka: Usually, they seem to ignore it. Because when I get a mom who is with a care provider that is known not to be very respectful, I try not to create conflict. I really believe in, and I learned this from you actually, building bridges. So how do you build a bridge between a mom who wants something that is usually very different from what the doctor was taught to do?

Leiko Hidaka: And I tell the moms, “Look, talk to your doctor,” and I give them a list of questions, which has like 40 questions. And I tell her, “Do not bring this list to your doctor. You’re not going to ask the 40 questions. You’re going to choose five, the five that are the most important to you, and you’re going to ask your doctor about those five.” Because with those five, you can get a good sense if you are being taken into consideration, like truly supported, or not.

Rebecca Dekker: And can you give us some examples of those questions?

Leiko Hidaka: Okay. For some moms, it’s highly important to be able to eat and drink. Because they get cranky if they don’t eat, they get headache if they don’t drink something. Of course, you get dehydrated. Most hospitals have a no food and no drink policy. But in this country, the doctor is the one who makes the call, even if that’s a hospital policy, which is nowhere to be found.

Leiko Hidaka: I mean, you can not find this written anywhere, but the doctor can break that. They can tell the nurse, “That’s fine. Let her drink. Let her eat.” If your doctor goes like, “Sure. You could have ice chips or clear juices.” And you ask, “Okay. Could I have nuts, seeds?” And your doctor goes like, “We’ll see.” There’s something weird. Because your doctor could say yes or no, and if they say no, which they have the right to say no because it’s the hospital policy, and you have the right to not like it that he or she says no and change briefly.

Leiko Hidaka: This is something that usually becomes a trap because you think that your doctor will change for you. Because you think something will be different for you with this person that you have already heard how he or she does things. But it’s like, okay, so I give them the list and I’m like, “Ask your doctor at what time do they think you should come into the hospital?”

Leiko Hidaka: “If they tell you to come in as soon as you have a contraction, is that what you want? Do you want to deliver at home? Ask them what do they think about that. Ask them if they have a time limit to wait for labor to become the actual birth?” And with this question, some doctors go, “You have to give birth in six hours after you come into the hospital.” And one mom told me this and I was like, “Okay. How do you feel about it?”

Leiko Hidaka: She was like, “Oh my God. But I have heard that labor could take over 12 hours.” And I was like, “Usually, it does, especially first time moms,” and she was a first time mom. “Well, what if we labor at home and then I arrive when I’m like close?” And I’m like, “If that’s what you want, that’s fine.” I’m your doula. We can do that. We can stay home until things get very intense.”

Leiko Hidaka: But she didn’t want to change doctors. To make the story short, this doctor wanted to perform C-section when she was 37 weeks, for no reason other than she was already effacing at 37 weeks. So I guess it was… I don’t even know the word. It’s not safer. But if you do a C-section, at least you know the time and day, right? And it seems like that has a lot to do with doctors’ decisions to perform C-sections: time, being able to plan.

Rebecca Dekker: Control?

Leiko Hidaka: Yes, because they don’t get paid. Oh, that’s something else. I tried real hard to not forget care providers are human beings too. They have lives too. Yes, they have the right to choose not to work with vaginal birth. They do. But if they do that, they must be honest about it so that the woman has the chance to find another one.

Rebecca Dekker: I know you mentioned, in your email to me, that doctors there are paid the same for a vaginal or cesarean birth?

Leiko Hidaka: Yeah.

Rebecca Dekker: And actually, you would think that would be a good thing. But in your situation, it actually makes them less inclined to want to do a vaginal birth. Is that correct?

Leiko Hidaka: Yes. It’s less than $200 for either a C-section or vaginal birth. And doctors have this belief that labor must be monitored. Many of them do not agree with the moms laboring at home during active labor, which means that they need somebody to be with the mom at the hospital when they arrive. And if it’s them themselves, you get 12 hours, 20 hours, and you’d still going to get paid less than $200 by the insurance.

Rebecca Dekker: But if you do a cesarean?

Leiko Hidaka: Cesareans can done as quickly as 30 minutes but, and this is something I learned recently, they must make it last 45 minutes because that’s tendered and if it lasts less than 45, it can raise certain questions and flags and stuff. But they’re pretty fast with that. So you can get a C-section done, everything done in about an hour, an hour and a half instead of 12 or 20 hours.

Rebecca Dekker: Okay. So there’s that financial incentive and time incentive to do this surgery?

Leiko Hidaka: In private hospitals, yes. Because keep in mind, all of this OB-GYNs and private hospitals, they have their own offices. So 12 hours that you’d spend at a labor, it’s 12 hours that you’re not seeing other patients and they are like, “This is not worth it. I’m losing money.” And they charge. Even if you have insurance and your insurance is going to pay them about $200, they will charge you something. It’s under the table, but everybody knows about it. It’s usually paid in cash or by bank transfer.

Rebecca Dekker: And what is that payment for?

Leiko Hidaka: Their services.

Rebecca Dekker: For a vaginal birth?

Leiko Hidaka: Either.

Rebecca Dekker: Okay. So to get better care you often have to pay that extra fee under the table?

Leiko Hidaka: Well, to feel or to think or to believe that you will get better care, you always have to pay that extra fee.

Rebecca Dekker: Okay. And you talked about changing doctors. Do you find that a lot of your clients do change doctors towards the end of pregnancy?

Leiko Hidaka: They do. And I laugh because I don’t know if it’s a good thing or a bad thing in terms of, how does that speak of me? But I tell moms all the time, “Do not ever make a decision based on fear or the sense that you don’t have options, because that’s my job. I’m going to help you find options.” So I always like… Right now, I know in Santo Domingo, which is where I live, three doctors that you can choose from them.

Leiko Hidaka: If you don’t like one, you can still try the other two. If you don’t like the second one, you’ve got a third one. Usually, by the second one they’re fine. But I have had quite a few clients who changed doctors at 38, 39, 40 weeks. I even had one who changed doctors at 41 weeks because she wanted a VBAC and her doctor did not want to go past 40. She pushed to 41 and he was like, “No, we’re going to go in for a C-section.” So she changed doctors.

Rebecca Dekker: So when they changed doctors, are they able to have good outcomes? Because I know you said even with some of the best or better providers, there’s still difficulties in trauma.

Leiko Hidaka: There are. But something that I have noticed, it feels different for this women when they think that they have true support and that things didn’t work out the way they wanted because of something that they could not have done anything about than when they feel they were caught in the process. You know what I mean?

Rebecca Dekker: Mm-hmm (affirmative).

Leiko Hidaka: So just by having a care provider, who is willing to go with what they want and guide them through what they want, not forcing decisions in you, they feel better. Usually, the ones who change care providers get the outcomes they want in terms of a vaginal birth.

Rebecca Dekker: And the ones who don’t change care providers?

Leiko Hidaka: Say half and half; some of them may get a vaginal birth, some of them may get scared into a C-section. But that’s one of the things that has made me change my own professional policy. I kind of choose my clients, because it’s so much work both for the mom and myself and so emotionally drained to be dealing with somebody who is abusing this mom and this mom doesn’t notice and to guide her through without causing conflict.

Leiko Hidaka: Hey, there’s a doula for every woman. I may not be the one for all women, but I choose… Usually, the women I work with are the women who, first of all, understand that their birth does not depend on anybody. You don’t put your life in somebody else’s hands. You just invite somebody else to provide support, if needed. It’s quite different.

Rebecca Dekker: And I know truth-telling and honesty is one of your qualities, but you also try to do it tactfully as well, like without causing conflict. So that must be a fine line to walk.

Leiko Hidaka: Yeah, it is. Because doctors think, and you can hear this. I have overheard doctors saying that doulas put their clients against them. And I was having this argument with a friend of mine. She’s an OB-GYN. And I actually have worked with patients of hers. And I told her, “You are my friend and you know me and you know how I am, and still I know that you have said this. And the only reason you say this is because when a patient of yours tells you that she wants something different from what you’re suggesting, you know that the reason she has this courage to tell you that is because she has information, information that was provided by the doula. But the doula did not tell her to argue with you. The doula told her to bring the information to you and ask you for options.” So there’s a little bit of, I think, maybe an ego thing.

Leiko Hidaka: Because I tell women, “Please, do not argue with your doctor. Whoever you choose, talk to them. Ask them. I will give you information so that you can learn this, but you have to discuss this with your doctor. And maybe your doctor can give you even further options or even more information.” And then the problem comes when, for some reason, the care provider feels trapped because here, she’s being confronted with information that they can not fight against. It is a fine line, but we’re trying.

Rebecca Dekker: Yeah. And you’re getting a lot of healthcare professionals to attend your Evidence Based Birth classes?

Leiko Hidaka: Well, I wouldn’t say a lot. But there has been a couple of OB-GYNs and a pediatrician. Quite a few doulas. Actually, many doulas.

Rebecca Dekker: Yeah. But I think that’s a good sign that you get any to attend. So thank you so much Leika for sharing your story. Do you have any questions for me?

Leiko Hidaka: I would like to know, I think, more information from an actual mom who has gone through the whole thing and who has felt that fear and who has also felt empowered, as you did. How can I talk to women without making them feel bad or in any way questioned?

Rebecca Dekker: Yeah. So there is a really unique strategy that’s been validated in research that’s called motivational interviewing. Have you heard of that?

Leiko Hidaka: I have not.

Rebecca Dekker: So it’s often abbreviated MI. And motivational interviewing is just like what it sounds: it’s a listening process, where you ask people interview questions and it helps them think about change and access their own internal motivation and ability to take action. So it’s brief and extremely effective. Kind of the underlying premise is that the power for change lives within each individual person.

Rebecca Dekker: So you, as the doula, don’t have the power to change someone’s mind or to make them do some kind of behavior. It’s that person. Do they have the motivation to change? Do they feel like they can change? So motivational interviewing is really about respecting the other person’s autonomy and wanting to understand them, and then partnering with them as they face some kind of decision.

Rebecca Dekker: It also is about drawing out or evoking their wishes, values, goals, strengths and abilities, and having empathy or compassion for people who are struggling with important decisions. So I think there’s a very valid reason why you, as the doula, don’t want to push or pressure someone. When you know that they probably need to switch providers, but they’re reluctant to do so, you can use motivational interviewing techniques.

Rebecca Dekker: And we do have a training on this inside the Evidence Based Birth professional membership, where I kind of go through the techniques. It also can be helpful to think about how giving advice is often very ineffective. So simply saying, “You should do this,” Or, “I recommend that you do this,” does not work, because people don’t like being told what to do. And other tactics that are not very effective include giving lectures or shaming someone, which doulas wouldn’t want to do anyways.

Rebecca Dekker: So you can use motivational interviewing when someone is torn about what to do and they feel stuck, like they can’t move forward. And the more people feel stuck, the more struggle they have and the less likely they are to change. So with these questions that you ask, you’re trying to identify like, how important do they see this problem as being? And how confident do they feel in taking action to face the problem?

Rebecca Dekker: First of all, I would always ask permission before I would start this process, and I would just say, “Do you mind if we talk about your fears related to this provider?” Or you can say like, “I noticed that you seem anxious and you’re upset about what your provider said. Would it be okay if we talked about it?” And then you can start asking some change questions like, “What would you like to see different about your situation?”

Rebecca Dekker: And by asking that question, you’re getting them to think about, “What would I like to see different? If I can imagine myself in a new situation, what would it look like?” And then you can ask, “How important is it to you right now to make this change that you’re thinking about?” And have them rate on a scale of zero to 10; zero it’s not important that I changed providers, 10 it’s extremely important.

Rebecca Dekker: And then you can also ask them like, “How confident are you right now that you could make that change on a scale from zero to 10, zero being not at all confident and 10 being extremely confident?” And then you basically can then move your questions to what they’re struggling with. So if they don’t think it’s important to change, then you can ask them, “Well, why did you choose that number for importance and not a lower number?”

Rebecca Dekker: So if they had said, on a scale of zero to 10, is it important for me to change providers? I’d give it a four. Then, I would say, “Leiko, why did you choose that number for importance and not a lower number? Can you tell me about that?” And you’re trying to get them to talk about like, what makes this important to you? Does that give you an example? So you’re kind of like trying to talk about, is this important?

Rebecca Dekker: And if importance is not an issue, so they already know it’s like a seven, eight, nine or ten. That it’s very important to them. Then, you can move on to confidence. And so confidence would be all about like, how do they anticipate that they have the confidence to do this? And if they don’t feel confident, again, zero to 10, you could say, “Well, why did you choose that number rather than a lower one?”

Rebecca Dekker: So Leiko, you pretend to be pregnant. And I’m going to say, “Leiko, how confident are you right now that you could change providers, on a scale from zero to 10, with zero being not at all confident and 10 being extremely confident?”

Leiko Hidaka: Let’s suppose that I’m 34 weeks. Four.

Rebecca Dekker: A four? Okay. So can you tell me, why did you choose a four rather than a lower number?

Leiko Hidaka: Well, because maybe there could be some care providers that will take me, but I’m not sure at this point, 34 weeks.

Rebecca Dekker: So there might be somebody who could take you? Can you tell me more about that?

Leiko Hidaka: I have heard that there are some doctors that will take me, but I don’t know any.

Rebecca Dekker: Okay. What does this say about your ability to change providers?

Leiko Hidaka: Probably that I have to do research.

Rebecca Dekker: So can you tell me about a time you had to do some research and to make a choice?

Leiko Hidaka: But my concern is time. I’m 34 weeks already in and I don’t know if I have time because I’m still working. Those kind of things.

Rebecca Dekker: Okay. So has there ever been a time where you haven’t had a lot of time to get something done but you were able to get it done?

Leiko Hidaka: Sure. At work. But I just pull all nighters.

Rebecca Dekker: So which of your strengths made it possible for you to succeed at work?

Leiko Hidaka: Being very persistent.

Rebecca Dekker: Okay. And how could you apply that strength to this situation?

Leiko Hidaka: Well, I suppose I could be asking on Facebook or Instagram for recommendations for doctors and scheduling interviews. But to make the time to go to those interviews, I’m not sure about that.

Rebecca Dekker: Okay. Are there any other strengths you could use to navigate the situation that you’ve used in other situations where you didn’t have a lot of time?

Leiko Hidaka: Find somebody to help me. Probably hire a doula.

Rebecca Dekker: Okay. So maybe talk with your doula and get them to get you the contact info of a doctor. So if I had to ask you again, how confident are you that you could make this change on a scale of zero to 10, with zero being not at all confident and 10 being very confident, where would you put yourself now?

Leiko Hidaka: I think I would put it at an eight now.

Rebecca Dekker: Okay. So how ready are you right now to commit to kind of getting a plan out, where we can plan on how you can look for a new provider?

Leiko Hidaka: Definitely ready. I would just post some Facebook, “I need a doula.” Or, “I need a new care provider.”

Rebecca Dekker: So you’re ready right now. Okay. Good. So basically what we were doing is I was trying to evoke your confidence by helping you think back to your strengths and how you’ve handled similar situations in the past. And you can see how your confidence went up from the beginning to the end. And also your readiness was like…

Rebecca Dekker: Whereas before you were like, “Well, I don’t think I can do this.” And by the end you were like, “I’m going to post on Facebook right now.” So that’s just kind of example of… And this is just a small mini lesson. There’s a whole bunch of more techniques you can learn. But it’s definitely something I would encourage you to look into, is to take that class so that you can have some more skills.

Rebecca Dekker: And it’s not about you manipulating someone, it’s really about… When I was talking with you, I was just really trying to find out like, where are you at and where can you find that motivation inside of you? Because I can tell you want to switch, but something’s holding you back.

Leiko Hidaka: Well, it’s like I can totally tell. Because in the moment you feel you have everything against you until you start sorting things out and you realize, okay, this is not really… Yeah, that’s great. It’s not really a problem. There’s something I can do about it. It’s not as hard as I thought. It’s just at the moment when you have to make the decision, you may feel overwhelmed, but by you asking me this question and helping me see what I could do about it, and the fact that those are simple things, then you feel ready to do it.

Rebecca Dekker: Yeah. And the other thing that you got to notice with the motivational interviewing is I didn’t tell you how you could do it. I could have said, “Well, you can post on Facebook and get your friends to give you recommendations. You can ask a doula.” You had to say that for yourself, and I let you say it for yourself. And that I so much more powerful when words come out of your own mouth rather than somebody telling you what to do. Does that make sense?

Leiko Hidaka: This is great. Thank you.

Rebecca Dekker: Awesome. Well, I hope you found this strategy helpful. And those of you who are listening, you can search. There’s lots of resources online for motivational interviewing. And it’s something you can even practice on yourself through journaling and you can also practice with friends and family. Ask their permission, say, “Is it okay if we talk about this and try this strategy?” Before you just do it to somebody. So thank you, Leiko, so much for coming to on the podcast. And we are thrilled about all of the work and change you’re making in the DR.

Leiko Hidaka: Thank you for inviting me. It’s been real fun.

Rebecca Dekker: All right. Thank you, everyone, so much for listening to this interview with Leiko Hidaka. I hope you found it as enlightening as I did, listening to her experiences. If you’d like to follow Leiko, just go to leikohidaka.com. I’ll link to that in the show notes. And you can also follow Leiko on Instagram at embarazoconscienterd and on Facebook at embarazoconscienterd, which stands for conscious pregnancy in the Dominican Republic.

Rebecca Dekker: Don’t forget that the professional membership is available at a reduced rate through this Friday only. Just go to evidencebasedbirth.com/membership to learn more. And I hope people enjoy the free ebook of Babies Are Not Pizzas that is available through May 9. Thanks, everyone, and I’ll see you next week. Bye. Today’s podcast was brought to you by the courses in the Evidence Based Birth professional membership.

Rebecca Dekker: The free materials that we provide to the public at evidencebasedbirth.com are supported by our professional member. Evidence Based Birth professional members get to take continuing education classes on hot topics in the field. We offer more than 20 continuing education contact hours for nurses, doulas, child birth educators, midwives and physicians. To learn how you can become a member, visit ebbirth.com/membership.