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On today’s podcast, we will be talking with Brooklynn and Hoang Pham. Brooklynn and Hoang currently live in Davis, California, and are the parents to Marvel, who turned seven months last December. Brooklynn is the senior managing director of Teach For America in Sacramento, and Hoang is finishing up his final year of law school at UC Davis School of Law. They took the Evidence Based Birth® Childbirth class with EBB instructor, Shalin Butterworth, and are here to share their birth story.

Content Warning: We will be talking about maternal mortality and racism.

We will talk about Brooklynn’s and Hoang’s empowering experience when they attended the Evidence Based Birth® Childbirth class and how it prepared them to feel ready for their powerful and miraculous birth with their doula and EBB instructor, Shalin. We also talk about the significantly high rates of maternal mortality among Black and Brown individuals and racism in birth work. 

Resources

Hoang and Brooklyn’s YouTube: https://www.youtube.com/channel/UCOBNp5cuEQpBDY3-3Bnl6eQ/
Instagram: @_hoangpham Twitter: @_hoangpham

Birthplace Lab: You can explore the maps at https://www.birthplacelab.org/maps/. There is a How To video with tips on using the interactive maps: https://www.birthplacelab.org/how-to-explore-the-maps/. Visit BirthPlaceLab.org to learn about your state’s score!

Research References:
Balde, M. D., Nasiri, K., Mehrtash, H., et al. (2020). Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey. BMJ Glob Health. 2020 Nov;5(Suppl 2):e003564. Click here.
 
Bohren, M. A., Berger, B. O., Munthe-Kaas, H., et al. (2019). Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012449. Click here.
 
Bohren, M. A., Hofmeyr, G. J., Sakala, C., et al. (2017). Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766. Click here.
 
Vedam, S., Stoll, K., MacDorman, M., et al. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS One. 2018 Feb 21;13(2):e0192523. Click here.

Transcript

Rebecca Dekker:
Hi everyone, on today’s podcast we’re going to talk with Brooklynn and Hoang Pham about their powerful and miraculous hospital birth story.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD, and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence based information into the hands of families and professionals around the world. As a reminder this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi everyone, today I’m so excited to welcome Brooklynn and Hoang to the Evidence Based Birth® Podcast. Brooklynn and Hoang Pham currently live in Davis, California, and are the parents to Marvel, who turns seven months last December. Brooklynn is the senior managing director of Teach For America in Sacramento, and Hoang is finishing up his final year of law school at UC Davis School of Law. They took the Evidence Based Birth® Childbirth class with EBB instructor, Shalin Butterworth, and are here to share their birth story, which they told me was powerful and miraculous. So I can’t wait to hear how everything went. Welcome Hoang and Brooklynn to the Evidence Based Birth® Podcast.

Brooklynn Pham:
Thank you so much, Rebecca.

Hoang Pham:
Thanks.

Brooklynn Pham:
Thanks for having us.

Hoang Pham:
We’re excited to be here.

Rebecca Dekker:
So tell me, how did you find out about the Evidence Based Birth® Childbirth Class? How did you get introduced to EBB?

Brooklynn Pham:
So we have midwives that we had been routinely seeing at Sutter Davis, and we were just inquiring about different opportunities to learn more about the experience and ways to just prepare us for having our first baby, and one of our midwives, Jen, mentioned Evidence Based Birth® instructors and classes, and sent us a link to a few different resources and so we were able to contact those resources and got in contact with Shalin Butterworth, who became our Evidence Based Birth® instructor, and we started going to classes with her.

Rebecca Dekker:
And this was a first child for both of you, correct?

Brooklynn Pham:
Yeah.

Rebecca Dekker:
So what were your thoughts and feelings going into educating yourself, how are you feeling about meeting your baby and going through childbirth and everything before you took the class?

Brooklynn Pham:
Gosh. I think the first class she asked a question around what are your experiences or what are your thoughts about even labor, and the first word that came to mind for me with every question was pain. Pain, pain, pain, pain, pain. That’s what I was preparing myself for. And so that’s what I initially thought the birthing experience would be, just a lot of pain, just a lot of exhaustion and pain, and so I had only been thinking about that, I wasn’t even really thinking about the 10 months leading up to having the baby. I was just thinking about the actual labor. So my associations were really negative, I would say.

Rebecca Dekker:
What about you, Hoang?

Hoang Pham:
Yeah. I’m trying to think back to what I was thinking. I remember being very ill informed, just not knowing anything. All of my experiences with understanding what labor was like was from television. So the car ride to the hospital, you know, was like-

Rebecca Dekker:
Rushing to get there in time.

Hoang Pham:
Yeah. The five seconds that it takes for the baby to come out, the yelling, the loudness. That was what I was thinking about. I wanted to know more about what is this actually like, and what can I do as a partner to help support my wife in going through this experience. And I remember even on that first class that we went to with Shalin, Shalin did a really good job of just including everybody that was there, all the partners that were there, we all had a role in understanding what the labor experience was like, all the different stages of labor, and the things that we could do to help support our partners in having a good and positive experience with birth. And this is before Shalin became our doula, this was just the first class that we had with her for our EBB class, and I think that first impression that we had with her was just this warm, welcoming experience that everyone had a part to play in supporting the birthing person, and I really loved that.

Obviously a lot of that information I learned that first day is information that I just did not know at all from anywhere else, because most people growing up in America, like I said, your experience with birth, if you’ve never had gone through it or gone through it with somebody else, is primarily from media. And so to me it was just like okay, this is just supposed to happen. We’re supposed to rush to the hospital at some point, I’m supposed to drive fast in a car, and by the time we get there you just have the baby, and the baby cries, and we move on.

Rebecca Dekker:
Just like the movies.

Hoang Pham:
Yeah.

Rebecca Dekker:
It really is amazing how little awareness most people have, or education about just the basic bodily function of birth and labor and everything. And I’ve met a lot of people when I teach college classes who are just like, “Why weren’t we taught this in high school even?” This just seems like basic information that we should all know about how human bodies work.

Brooklynn Pham:
Absolutely.

Rebecca Dekker:
So what was your experience like taking the class? You said you got to the first live session and you had just learned stages of labor and then you went through the next five or six weeks together, what was that experience like?

Brooklynn Pham:
Gosh, it was so empowering. I felt like with every session I was feeling more connected to my baby, to my body, and to Hoang as my partner in preparing for this, just because I went into it thinking that it was also all on me, and I had to do things to get my brain, my body, my spirit ready, but it was so much more about our partnership and the role that he and I both played in getting our baby here, so with every session I just felt more empowered. I felt like it was a space where I was finding my voice and finding my unique value added ness in this world. I know that seems real deep, but that’s what the experience was for me, and by the end of the sessions that we had, I felt ready. I felt like a different person, just ready to be a mom and ready to go into labor and have our baby.

Rebecca Dekker:
And you weren’t as terrified anymore of the experience?

Brooklynn Pham:
No. I had Marvel at 42 weeks and a day, so by that time I was really ready.

Rebecca Dekker:
This can’t happen soon enough.

Brooklynn Pham:
Yeah. But I wasn’t scared anymore. I was more eager and excited.

Rebecca Dekker:
Okay, wow. We’ll have to hear about that 42 weeks in a little bit. What about you, Hoang, what was your experience like?

Hoang Pham:
I felt the same. I think for me, I learned about a lot of things that I could do, and I thought that was really empowering. So Brooklynn in using the word empowering, I think that really describes what the EBB class was like for us. I learned about acupressure points that I had no idea at all that these points even existed, and who knew that you could stimulate labor by pushing on these points, so don’t do it before 36 weeks, I don’t remember what the number of weeks were, but don’t do that. So I was just like okay, that’s really cool. Who knew that there’s these things about our body that works in very peculiar and really cool ways that you could actually help with labor. You can help induce labor by using these points, there’s certain things you can do with your body that would help position the baby in a more-

Rebecca Dekker:
More optimal position, yeah.

Hoang Pham:
Yeah, that was a good word for that. I think knowing those things was really helpful for me, because then I could decide, okay well how can I help Brooklynn when she actually is in labor? In going through the class, you kind of get those ideas cemented in your mind that this is doable, and it’s a long journey but it’s a doable one because you have all these resources and tools that will help you as you go through that journey, so even before we, I think the class, maybe it was at the end of April, your due date was April 30th, and we ended the class in March, so there was almost a month and a half between the time the class ended and the time that the baby was actually due, and I remember thinking okay, this is awesome information, and then it kind of slowly faded away after a couple weeks of the class being over, and then once things started speeding up again, we were like okay it’s week 40, or week 39, 38, I was like I had questions about what to do or what we could do and what did we do? We opened up our EBB book and started reading again, going back to the information.

I thought that was really, really helpful to have that as a resource, just to know what is going on right now with her body, what should we be thinking about? What could we be doing? What do we need to be considering, especially if these things are happening, and I think every time that we had a question, even when we met with our midwives on a weekly basis, we could go back and reference some evidence that would support some decisions that we want to make, whether it was getting a vaginal exam or not, other things that they would recommend for her to do. So it’s really helpful to go back to the information.

One thing we told Shalin I think is a sentiment that we both share is that EBB, the class itself, was an investment for us as a couple. Now that we have this information, we store our information in a special place where next baby comes, we’ll have it all right there, but now that we have this information, it’s like you’ll always be empowered to know what this process is like and to have a good birthing experience, which is something that I know that Brooklynn wanted, and I wanted too.

Brooklynn Pham:
And we’ve recommended it too to so many friends and family members because of how valuable it was for us. We felt like we had a responsibility to share information with others.

Rebecca Dekker:
Oh that makes me so happy. Thank you for spreading the word with your friends and family.

Hoang Pham:
Thank you for doing this.

Brooklynn Pham:
Right. Thank you for putting this together.

Hoang Pham:
This is an aside, but I’ll be honest, we had no idea what to do. This is December, it was like week 20 of being pregnant, and we were just like, are we late for classes? Do we need to start figuring out what to do? Because we just had no idea. All the information we got was from the hospital. So that was the extent of what we knew to do and our midwife was like you should definitely take a birthing class, there’s one that’s offered through the hospital, and then there’s others like Evidence Based Birth®. And we’re like let’s check out Evidence Based Birth® and see what that’s all about. And I think just the availability of what you give and provide in information for mothers and dads just to go through this experience together is so valuable. Like Brooklynn said, it’s very empowering because again, most of us don’t know any of this information and this is our first time going through this experience.

Rebecca Dekker:
It’s interesting that you called it an investment because I was thinking about, it’s both with education and with doula support are two things that will go on if you have more children to affect your future births, because you have this education you can continue to go back to this information. But then also having a doula, some people are like, “I pay for a doula, it’s just for that one birth. It doesn’t help with my other births.” But it actually does, because if the doula can lower your risks of certain things happening in your first birth, then that goes on to make your subsequent births less complicated too, if that makes sense.

Brooklynn Pham:
Absolutely.

Rebecca Dekker:
Yeah.

Brooklynn Pham:
Absolutely, that’s what we were really thinking, like this is an investment not just for this baby, but for our family. Our future family, for kids to come.

Rebecca Dekker:
Yeah.

Hoang Pham:
I’m going to share just one more story, just before we move onto the next part.

Rebecca Dekker:
Okay.

Hoang Pham:
I think we’re moving into the next part would be like what was your birthing experience, what was the actual birthing experience like. So before that, in February, my law school, the Women’s Law Association hosted a doctor who came in and talked about birthing rates for Black and Indigenous mothers in the United States, and the one thing, so I was sitting in there, this was after the first session with Shalin in the EBB class, I was sitting in a lunchtime session to talk with the doctor, thinking it’s 50 minutes long, the whole time you have 10 minutes at the end to ask questions, and the whole time there was never a mention of doulas or midwives, the whole time.

Rebecca Dekker:
And they were talking about poor outcomes, bad outcomes for Black and Indigenous mothers, but not mentioning midwives or doulas as a solution?

Hoang Pham:
Yes. Not mentioning them as a solution. So I was sitting in the back like I think I have some information I want to share, and I’m one of the few, I’m one of the only men in the room, and also one of the only men that asked a question. So I asked this question, I was like, “So, what do you think about doulas and midwives and their role in improving outcomes for Black and Indigenous mothers?” And the doctor was like, “Yeah, they’re both really important.” I don’t remember what else she said, but I remember her not really answering the question, not really discussing what midwives and doulas actually do. So she kind of didn’t really respond to my question, other people then started following up and asking more about midwives and doulas, but I found that really interesting to think about. Okay, I’m in this space, this educational space, this institution that is bringing doctors who come in and talk about these disparate outcomes for Black and indigenous women, and yet there’s these solutions that have been proven to improve outcomes for Black and Indigenous women, but yet they’re not discussed about.

And then I remember at the end, when I was walking out, some of the organizers went up to her afterwards like, “I don’t want you to feel like Hoang was pushing you to think differently about what we need to do to improve these outcomes, just wanted to let you know his wife is pregnant, she’s having a baby.” And I thought that was funny because I was like if I hadn’t started thinking about births in the way that the EBB class made me start thinking about it, I would have not even asked those questions about midwives and doulas as options, because I do think you made this point in your videos, but I know Shalin does as well when she was working with us, that midwives and doulas tend to be this, there seems to be a hierarchy in the medical field when it comes to knowledge, and it seems to start with medical doctors, MDs, and then it kind of goes down from there, and if you don’t hold certain degrees, your opinion is somewhat less valued-

Rebecca Dekker:
It’s marginalized, yeah. You don’t have as much power or authority.

Hoang Pham:
Right. And in California, midwives still have to get, I think the law states that midwives, decision wise, they still have to get confirmation from a MD to make decisions in the hospital. So it’s just interesting to think about, when you start thinking about change, when you start thinking about the way we frame narratives around birthing, how do we change those narratives around what actually supports healthy outcomes for mothers?

Anyways. Sorry.

Rebecca Dekker:
No, I’m so proud of you, Hoang, for speaking up and just using your voice in that setting. And I think it’s cool. It just shows you even just a little bit of education, like one class session, and you already felt like I know more than this doctor does actually about solutions, and if you hadn’t had that class, having a wife who’s Black and pregnant and you’re sitting there just listening to these horrifying statistics that could have been really disempowering and scary if you didn’t know that there are actually solutions for this problem.

Brooklynn Pham:
Yes.

Hoang Pham:
I think that’s one of the things I started feeling was like all right you’re telling me that Black moms die at a higher rate than any other moms when going through labor? That makes me scared, because I don’t want my wife to die. And even a couple days before that, there was a story that I read in an article about this dad in LA at Cedar Sinai Hospital, and his wife died in childbirth, Black family, and for me it’s more than just knowing this information, but it’s also about saving lives, making sure my wife lives. So yeah, it was scary-

Rebecca Dekker:
It’s extremely personal for you. Yeah.

Hoang Pham:
And I think those questions that I asked, I think I was really just wanting to know what else can we do outside of just knowing what causes death, like what are the preventative steps that we can take? What are the things that we know that can help with creating a better experience for our laboring mothers. So the EBB class helped me with that information and it pushed me to think about, I know this is not all the information that’s out there. You haven’t even said midwife or doula yet, and I know-

Rebecca Dekker:
We’ve spent an hour together and the proven solutions you haven’t mentioned. And I just love how you spoke up, because I’m sure everybody else was like yeah, he’s right, why aren’t we talking about solutions that are affordable and pretty easy to administer.

So tell me about the end of your pregnancy. What kind of birth were you planning? It sounds like you hired Shalin to also be your doula, and was this during the start of the pandemic? Had everything locked down in California? What was going on?

Brooklynn Pham:
Yeah. So as we were nearing the end of my pregnancy, we already hired Shalin as our doula and the world locked down. So we were thinking, what’s going to happen if Shalin cannot go into the hospital with us? What then do we do? So we started just having a plan B, what to do if just Hoang and I, or maybe even just me, we didn’t know, would be in the room by myself. So Shalin, in an additional session with us to practice some of the comfort measures and some of the things that we can try in the event that she was not there and that Hoang would be needing to hold it down in the room without her. And we also talked about the option of having her FaceTime in during labor, so that she could kind of coach and be a champion for Hoang as he was in the room just with me.

But yeah, we had no idea what to expect. We were just kind of playing it by ear and experimenting with different options. The option of her being there, not being there, FaceTiming in, not FaceTiming in, me being by myself. In some hospital settings at that time just the woman was by herself in labor, so we were kind of preparing for all of those cases, but because of our class, we wrote a letter to the hospital and basically asked or demanded that our doula be considered a practitioner and be in the room with us, and that was not granted. However, we did get a call from the hospital asking what are the ways we can support you in preparing for this, what do you need from us, what supports was your doula going to provide that we can also think about providing, be it lighting, be it massage, be it different things, what techniques can we use? Which was also very empowering to get a phone call from a hospital asking what can we do a couple weeks out away from you being here. And I don’t think we would have written that letter if we didn’t have that course that you taught about advocacy and just the important role we play in making sure that our needs are taken care of.

But yeah, so we were preparing for all different kinds of scenarios of baby entering into the world, yeah.

Rebecca Dekker:
And what was your birth plan? Other than having a doula, what were you hoping for your birth?

Brooklynn Pham:
Yeah, I wanted unmedicated birth, and I wanted to be able to have my baby in any position that felt comfortable in the moment. I did not want, what were some other things that I put on my plan? I feel like it was so extensive.

Hoang Pham:
Yeah there’s like the-

Brooklynn Pham:
And then it became really simple.

Hoang Pham:
The vaccinations after the baby comes out.

Brooklynn Pham:
Yes.

Hoang Pham:
We didn’t want any vaccinations. I think we were okay with the Vitamin D shot?

Brooklynn Pham:
Vitamin K.

Hoang Pham:
But no hepatitis B, I think. And then we wanted the baby not to be wiped down, to keep the stuff-

Rebecca Dekker:
So you had a baby plan too as well as the birth plan. You kind of created a baby plan.

Hoang Pham:
I guess that’s going into the baby plan now.

Rebecca Dekker:
But it all kind of goes together because it’s all happening around the same time. So you were hoping unmedicated, in the hospital, and you were hoping that your doula could help you with that.

Hoang Pham:
Also there was an option for being in a tub, like a water birth, and I think with COVID they said you couldn’t have a water birth anymore, but you could still get in the tub.

Brooklynn Pham:
Yeah.

Rebecca Dekker:
So you were hoping to utilize the tub while you were in labor?

Brooklynn Pham:
Yeah. You could use the tub but you couldn’t have your baby in there.

Rebecca Dekker:
Yeah. Okay. So tell us about as you approached your due date and then went past it, what happened then?

Hoang Pham:
We got a lot of phone calls and text messages.

Rebecca Dekker:
From family?

Brooklynn Pham:
Yes.

Hoang Pham:
A lot.

Brooklynn Pham:
Everybody wanted to know what was wrong, like what is going on, something must be wrong because your due date has passed and baby’s not here.

And that freaked me out.

Hoang Pham:
I was also taking finals at that time, it was finals week for me.

Brooklynn Pham:
There was a lot going on. So we had a checkup I think at 41 weeks, and then at 42 weeks. So 41 week appointment came and baby was fine. At that point, at the hospital we were at we then returned back to the OBGYN instead of our midwife, because I think after 40 weeks I think they bring back the doctor because it seems like a unique case or something, I didn’t quite understand. Even though it’s normal for your first baby to be born after 40 wees, so I saw the doctor again, which I had not seen since being told that I was pregnant, since being confirmed that I was pregnant, 40 weeks before, however many weeks before, so she said everything is fine, so she checked fluids, made sure baby had enough room and fluids in there and it was confirmed that everything was fine, still considered a normal pregnancy, and I was sent home and another appointment was made to return in a week.

At that point, the doctor asked if she could do a cervical exam, and I declined. And she then recommended that I get one when I return if baby’s not here in another week. So that’s what we did, I went back at 42 weeks. Baby still had great heart rate, plenty of room, it was just real comfortable I guess. And at that point, they recommended that I be induced, because it was at 42 weeks. So I did have a cervical exam then, and was three centimeters dilated, and they said that they would give it another day, but then come back in the next day, essentially. So they were like baby is coming, but yeah. So baby didn’t come the next day, and that’s when I was induced with pitocin.

Rebecca Dekker:
Okay. So you showed up at the hospital, was it early in the morning for an induction? Or what happened?

Brooklynn Pham:
I showed up-

Hoang Pham:
It was like two in the afternoon.

Brooklynn Pham:
-around two in the afternoon.

Rebecca Dekker:
Oh in the afternoon? Okay.

Hoang Pham:
Yeah.

Brooklynn Pham:
And our doula was still recommended, because I told her that I still wanted, an induction was what I wanted to avoid, I wanted to try some other natural methods first, so breast pumped for, gosh, maybe an hour or so to see if my contractions would start from the pumping. I think I did some exercises.

Hoang Pham:
We did everything that you could possibly try to do.

Brooklynn Pham:
I even took misoprostol I think.

Hoang Pham:
Yeah, misoprostol.

Rebecca Dekker:
From your provider?

Brooklynn Pham:
Mm-hmm (affirmative). Yes. To see if-

Rebecca Dekker:
If that would just start things?

Brooklynn Pham:
Yeah. It wouldn’t start. So the last resort was-

Rebecca Dekker:
Pitocin.

Brooklynn Pham:
Pitocin. Started pitocin around I think midnight. So we had been there for a good 10 hours?

Hoang Pham:
Yeah.

Brooklynn Pham:
Wow. 10 hours.

Hoang Pham:
It was, yeah.

Brooklynn Pham:
Started the induction at that time.

Hoang Pham:
Do you remember everything after that?

Brooklynn Pham:
I do.

Rebecca Dekker:
So what happened next?

Hoang Pham:
Well there were a couple things that I remember that I don’t know if she found out. Like, so we stopped breast pumping at 10. We decided on pitocin at that time. At 10:30, they came in, they said, “We have to start an IV so we can start the pitocin.” They come back at 11 and they try to insert the IV, but they couldn’t get it in any of her veins. So they poked her six or seven times, which is really, really hard. It was like an hour of just poking. I remember just sitting there like I want this to end. I want the baby to come out, I don’t want her to get poked anymore-

Brooklynn Pham:
This was not the plan.

Hoang Pham:
I want the baby to come out. So they finally inserted the IV in the probably least optimal place, which was in the eye of her elbow, which is really hard for her to move, but that was just the only place they could enter an IV. So they finally started pitocin around 12 or 12:30 and then every 30 minutes they would come back in and increase the pitocin. So from 12:30 all the way to 7:00 in the morning, they did that. So we went through the night, we tried to get some sleep, but that was really hard to do. By 7:00 in the morning, that was when she went into active labor.

Brooklynn Pham:
I remember it was at 19, like the level was-

Hoang Pham:
19 millimeters.

Brooklynn Pham:
Yeah. And I think I started to feel contractions around like 17, and was thinking okay they’re not going to increase it any more than this, because I already feel it, but they continued to increase it until it sounds like 7:00 AM.

Hoang Pham:
Yeah, it was at 7:00 AM, and they kept it there. They kept it at 19, and when I started counting the five minutes, one minute long contractions, and then it was getting closer, three minutes, one minute long contractions, I called Shalin, said, “Shalin, it’s go time.”

Brooklynn Pham:
We’re in active labor.

Rebecca Dekker:
Yay.

Hoang Pham:
Shalin’s on FaceTime on my laptop in the room, and she’s coaching me through everything, because Brooklynn is doing her thing, and I’m like what do I do? And I’m trying to remember everything I learned in the last six months, so from there, she gave birth at 10:15 AM, or 10:11 AM, and I think from 7:00 to 10:11, it was really cool just to have Shalin in my ear like, “Hey, Hoang, you should help, remember give her water. After every contraction, water, do you want water? Do you want some coconut water? Do you need something to eat?” And then she goes through the contraction again. I think there was a point where Brooklynn was like, “I don’t know if I can do this.”

Brooklynn Pham:
Oh yeah. There was a point where I asked for, I said I need some relief, and the midwife that was there, she knew that I did not want medication.

Hoang Pham:
Jessica.

Brooklynn Pham:
Jessica, yes. She knew I didn’t want medication, and so she was like, “Okay, let’s get you into a bathtub.” And there wasn’t a bathtub in that room, so we had to walk into another room, but yeah, that for her signaled let’s do something different-

Rebecca Dekker:
Not necessarily let’s get an epidural, but let’s do the next comfort measure that you need, that was your wish.

Brooklynn Pham:
Yes.

Rebecca Dekker:
Okay. So you did get in the tub, you were able to get in the tub?

Brooklynn Pham:
Yeah. For about 20 minutes. But I was strapped with the monitor for the baby’s heart rate, and underwater it was just moving around too much, so they couldn’t monitor her anymore so I had to get out. So I think I was in there for about 20 minutes, but by the time I got out they looked at the water and I had membranes hanging from me, so they were like oh, baby is coming. So Jessica checked and baby’s head was there. So as soon as I got out of the tub, baby had already dropped and crowned, or I was-

Rebecca Dekker:
Yeah, so you saying, “I need relief, I’m not sure I can do this.” Was basically transition, and then you were able to spend transition in the tub, and then you got out and baby was coming.

Brooklynn Pham:
Yeah.

Hoang Pham:
Yeah. There was a moment before that that was pretty funny. It was just me and Brooklyn in the room, so the nurse, Kristin, who was awesome, and Jessica the midwife who is also awesome, they both had to tend to other patients in the hospital. And so there was a moment around 8:00 where it was just me and Brooklynn and Shalin in the room, and Brooklynn was going through a really intense wave, and after the wave was over she literally said, “I think the baby’s coming. I think the baby’s coming.” And Shalin was like, “Hoang, Brooklynn says the baby’s coming, go into the hallway and tell somebody that the baby is coming.” Because I was like I don’t know what to do, is the baby coming or not? Is she just going through another intense one? And I’m like okay Shalin, this is what you would do and this is what you’re telling me to do, I’m going to go do it.

So I run into the hallway, it’s like a quiet hallway, and there’s a bunch of nurses at the nurses station, I was like, “Excuse me, I think the baby’s coming.” And they’re like, “Okay, we’ll send somebody in, thank you.” So I run back in, I’m like, “Okay someone’s coming.” And that’s kind of when they started getting the tub ready for her and we were able to get into the other room where the tub was, because in the room we were at there was no tub, so we had to switch rooms kind of midway through everything. But yeah. Otherwise I would have-

Rebecca Dekker:
Excuse me.

Hoang Pham:
Yeah. Because I would be like, how do you talk to nurses in a really quiet hallway? I don’t want to sound like I’m-

Brooklynn Pham:
Needy.

Hoang Pham:
Yeah, or-

Rebecca Dekker:
Help, help. I love it. I wonder, too, if they were surprised it happened so quickly, because you said your contractions didn’t really start until around 7:00 and the baby came at 10:00, that’s pretty fast for an induction for a first time parent.

Brooklynn Pham:
Yes. Yeah. I don’t think anybody anticipated it being that fast. I think I remember them saying that, that it was like this was really quick, because when I got out of the tub they were shocked that there were membranes hanging from me. They’re like oh there’s a head, okay. She’s here.

Hoang Pham:
I remember I was just standing on, I don’t know, there was a couple people in the room, I didn’t want to be in their way so I was just standing, I was holding Brooklynn’s hand actually, that’s what I was doing. So I was holding her hand, and Shalin, we brought the laptop over and Shalin was still there with us, and Jessica, our midwife, was like, “Baby is coming, head is crowning, do you want to see?” And I was like sure, I’ll come over and look.

And sure enough, there’s a head with a bunch of hair. So I am holding her hands and Shalin was like, “And Hoang, did you want to go catch the baby?” And in my mind, we had planned on, like I wanted to catch the baby. I talked to Shalin about it, we practiced with Shalin, and she told me how it would go and this is how you would do it. So I had practiced everything already with Shalin.

But in my mind, I was like we’ve been in the hospital for almost 24 hours, I just want the baby to come out safely. I don’t want to catch the baby, I’m fine with just the baby coming out, and I’ll be really happy. But Shalin was the one who reminded me, she was like, “Hey I know you wanted to catch the baby, do you still want to catch the baby?” And Brooklynn’s head was down at this point like this, she’s still holding my hands, and she was just like this, like go catch the baby.

Brooklynn Pham:
I motioned him away.

Hoang Pham:
And I was like okay, I’m going to catch the baby. So I walk around to the other side, if it wasn’t for Shalin reminding me that that’s what I wanted to do, I wouldn’t have asked Brooklynn because I didn’t want to bother her, and in my mind I was just thinking all I want to do is just have the baby come out safely.

Rebecca Dekker:
But Shalin knew you didn’t really want to miss that opportunity.

Hoang Pham:
Yeah. She was like, “Do you want to go catch the baby?” I’m really glad that she said that, because it was such a beautiful experience, just being able to hold the baby for the first time.

Brooklynn Pham:
And pass her to me.

Hoang Pham:
And pass her to Brooklynn. So I went and caught the baby, Brooklynn gave birth on hands and knees and I caught the head and turned her around and Jessica the midwife was just supporting me the whole time, like good, perfect, turn the baby, and I turned her and handed her to Brooklynn and that’s it. That’s what happened.

Rebecca Dekker:
That’s amazing. What made it feel so powerful and miraculous to both of you?

Brooklynn Pham:
Wow.

Hoang Pham:
I could say it, or do you want to go?

Brooklynn Pham:
Are you ready?

Hoang Pham:
I’m ready. I know exactly what was powerful.

Brooklynn Pham:
Okay I need some thinking time, go for it.

Hoang Pham:
Okay. So there was a point when I literally thought my eardrums were going to blow. I literally thought I was like, this is the loudest I ever heard anybody ever. Shalin described it as a roar and in the background, as Brooklynn was going through her contractions, I heard Shalin say, “Wow, that was so powerful. Oh my gosh. What a powerful way to bring your baby into this world.” And I remember just the word power kept sticking in my mind every single time Brooklynn went through a contraction, because I was thinking it takes a very powerful woman to go through this experience. I don’t even know, I just know that my hands were about to break, and my ear drums were about to blow. And I was just thinking, the moment, I’ve never experienced anything like that ever before. I felt so powerful because of how she was responding to each wave. And I remember just thinking like wow, this is the most beautiful, powerful moment I’ve ever experienced in my entire life. Never heard anybody this loud before, it was like a lions roar.

She sings, so it’s like this beautiful noise of I don’t know, opera level pitched noise that was going throughout-

Rebecca Dekker:
Opera volume, opera level roaring.

Hoang Pham:
I was like this is so powerful. And again, that was reinforced by Shalin telling Brooklynn after each wave, she was like, “Wow, Brooklynn, so powerful. Keep going, you’ve got this.” Our nurse and our midwife would say the same thing, and I remember just thinking like yeah, this moment, if there was a word to describe what this is like and how this actually feels, this feels powerful. Yeah. That was what made it powerful for me, because I just remember watching you just like, again, no one’s every squeezed my hand that hard in my entire life. As a young boy I used to run across the street and my mom and dad would grab me and da-da-da. But never have I ever had anybody squeeze my hand that hard, and never have I had anybody scream in my ear that hard. But I was right there next to her. Yeah, it was so powerful. By the time the baby came I was like wow, she did it.

She went through, I don’t know, everything I saw her go through, the attempts to start contractions with breast pumping, the misoprostol, checking into the hospital at two PM, the pricking to just get an IV started, the seven hours of increasing pitocin before she finally got into active labor, and then finally going through active labor. That all played around in my mind, and I was just thinking coming to this point of her in the final moments of her waves to be able to get our baby out, wow. That was powerful. Could I do that? I would never. She asked me after, she was like, “Would you ever want to go through that experience?” I was like no I wouldn’t. I would gladly take the other side again.

Brooklynn Pham:
Do some role reversal.

Hoang Pham:
Yeah.

Brooklynn Pham:
Yeah, for me, I think the miraculous part is after all of the planning and all of the decisions that we made together about the way that we wanted to have our baby, one it was so empowering for most of those things to remain true throughout, but I feel like the miraculous part is the intuitiveness and the spirit just kickstarts, I feel like in labor for all the planning, those things help, but there is a just miraculous way that your body responds and works as a woman without thinking. I was like completely surprised, shocked, proud of myself and just how my body just responded and was ready, was ready even though I was so exhausted, so worn out, my body was ready, and to me I just think that is totally out of this world miraculous for a woman’s body to be ready to go through that even after being so exhausted and worn out and just tired. Yeah, there’s something just miraculous I think about a woman’s body that I felt so grateful to experience and I could do anything. I could fly. There’s nothing that I can’t do anymore.

Rebecca Dekker:
How cool it is to start off parenthood with such a feeling of empowerment.

Brooklynn Pham:
Yes. Absolutely. Yeah. And I think as a Black woman too to start off, there was something one of our midwives, during the experience about my identity as a Black woman, I think that my role in this country and in society is to I’m off work to make sure that I’m getting myself ready and giving myself permission to do that and I was not giving myself permission to do that because of the identities that I hold as an employee, as a person that’s working really hard for things outside of my family and my relationship and she just encouraged me to take time off and even the decision to say, “Work, I need you to press pause right now, I need to focus on my child and my family.” There were many steps that I feel like prepared me for the empowerment of going into labor and having the baby and just being like a strong Black woman who feels capable of doing all these things but choosing what to prioritize and my identities, I have choice.

I’m important enough to give myself permission to choose, so I feel like yeah, going into motherhood, I’m starting with that mindset, and feeling unapologetic about it, which is awesome.

Rebecca Dekker:
You were in control of all your decisions, all along the way, and the care you received, what interventions you agreed to, all of that.

Brooklynn Pham:
Yes.

Rebecca Dekker:
So I want to make sure we have time to answer your questions, because I know you two submitted some really good questions to me ahead of time.

So what was your first question for me, how can I help you?

Brooklynn Pham:
Yeah. So our first question is how can we ensure women, particularly low income Black and Indigenous women, gain access to high quality, pre natal care, including the Evidence Based Birth® Courses and Resources, and doula services?

Rebecca Dekker:
Yeah, I’ve thought about this a lot when I received your question. One thing we’ve known for a long time is that we really desperately need more Black and Indigenous doulas and midwives and childbirth educators. They are currently very underrepresented in these professions, and there’s a lot of reasons for that, primarily having to do with racism. Also, for many years, most doula trainings, childbirth educator trainings, and midwifery educational programs were and still are mostly run and directed and taught by white doulas, white childbirth educators, and white midwives. This creates what we call racially discordant or non congruent experiences for people who might want to go into those professions who are Black and Indigenous.

Thankfully there are now a variety of trainings that are becoming more and more available that are taught and led by Black and Indigenous birth workers. We’ve interviewed several founders on the podcast of people who are training doulas and midwives who are particularly leading Black led organizations and I really see that as one of the big solutions because I think that we know that many Black families often feel more comfortable and have better experiences when they’re taught by someone who looks like them and has had similar experiences as them in the healthcare system.
So one of the things that we’ve done for several years now at EBB is we’ve had scholarships and sliding scale fees in place to recruit more Black and Brown birth workers into our instructor programs, so that we can have a thriving group of excellent Black and Brown EBB instructors. And one of our primary goals for 2021 is to grow that group even more. So growing the number of available EBB instructors who are Black, Hispanic, Asian, Indigenous, LGBTQ, that’s one of our top priorities here.

But that’s only half of the issue. The other half of the equation has to do with funding. So I had a conversation with Dr. Sayida Peprah who’s a consultant and a speaker and a psychologist and doula and I’ve hired her to meet with me monthly to discuss anti racism issues and to consult with me on that. So I actually brought your question to her. And she really thought that it all comes back to funding, that funders, donors, philanthropists, need to fund scholarships or provide grants for these kinds of things, for Black and Indigenous families to have doula care, to have childbirth education. She suggested that they could have partnerships with organizations that are providing these services. For example, if a Black or Indigenous led group is able to be paid to doula these clients, or they’re able to pay an EBB instructor who’s Black or Latino or Indigenous to teach their clients, because the EBB instructors, just like everyone else, they have to make a living and we can’t expect them to work for free, so the main cost for that would just be paying for their time to teach the classes.

And Dr. Sayida basically said people with money need to pay for these things. Instructors need to be paid, these non profits that are on the ground need to be paid, and she said a couple million from one or two philanthropists would completely change the game, because how many parents and families could get childbirth education or doula services with that money. Or she said, think about getting healthcare organizations to pay for it.

What if insurance companies, what if hospitals were like we’re going to pay for these families who need it most to get this education or to get this doula support.

So I think that’s kind of the two halves of that equation, one is making sure we have representation in these fields, and supporting the groups that are working on that, that are training Black and Indigenous and Brown doulas and midwives and childbirth educators. And then also pressing for more donors to fund the non profits on the ground that are providing the services. So that was what my thoughts were on that question.

Brooklynn Pham:
Thank you, Rebecca. Yeah, I hear you say representation and funding were the two most biggest ways that we can have an impact, and my sister is a midwife too, and she became a midwife while I was pregnant, and she didn’t live in the same city as me, but the ability for me to call and ask her questions and get her expertise as a Black woman was invaluable. So yeah, you would hope that all Black and Indigenous families have that access.

Rebecca Dekker:
Exactly. What else did you want to talk about?

Hoang Pham:
Yeah, the second question we had was are there good examples of states that have policies that support outcomes that demonstrate having holistic care for women of color improve the birthing experience and healthy births?

Rebecca Dekker:
Probably the most important study we have on this was published in 2018 by a team of experts including Saraswathi Vedam and others. And it was called the access and integration maternity care mapping study, which is kind of a long name, but the point of this study was to find out if integrating midwives into the maternity care system, which goes back to your conversation with that doctor, if that actually changes health outcomes. So they were looking at integration of all types of midwives including certified nurse midwives, certified midwives, and certified professional midwives. All of these midwives, what they have in common is that they all follow the midwives model of care which is a holistic, family centered model that has demonstrated excellent outcomes in every type of birth setting.

So what this research team did is they had a huge interdisciplinary team that developed a scoring system which scores each state on criteria about their laws and regulations, whether or not their laws and regulations support midwifery care, or limit midwifery, including the ability for midwives to prescribe medicine, how can families access midwifery, is it included in insurance coverage, and how is the ability to make smooth transfers to advanced medical care when needed, for example if you’re planning a home birth and you need to transfer to the hospital from a midwife to a doctor model.

So this was the first research on this subject in the United States. They basically found that states that have higher midwifery integration scores where there’s better integration of midwives, were associated with improved outcomes for mothers and babies even when taking into account the impact of race. So having increased access to midwifery care is linked with higher rates of breastfeeding, lower rates of medical interventions, higher rates of vaginal birth after cesarean, and importantly, lower rates of newborn death, including race specific newborn death. They also looked specifically at race specific pregnancy outcomes by the midwifery integration scores, and they found that sadly, in states where more Black babies are born, think of the southeastern United States, integration of midwives is lower. Then states where there’s fewer Black babies are born, we have more access to midwifery care.

Hoang Pham:
Wow.

Rebecca Dekker:
And access to midwives and the density of midwives is just significantly lower in states where more Black babies are born. And the states with the most Black births have the highest rates of newborn death, but they found that New York state has a very high density of Black births, but they have one of the lowest rates of newborn death in the United States and they have in the top quartile of scores for midwifery integration.

So going back to your question, are there any examples of states that have good policies that impact care? New York state is a good example of a state that more so than most states has policies that support midwifery care, which is then associated with improved outcomes for families of color. In contrast, you can use like North Carolina, Alabama, and Mississippi as examples of states where there is a very high percentage of Black births, high rates of newborn death, and very, very low midwifery integration scores, where there’s extremely low rates of midwives and midwives being integrated into the system.

Hoang Pham:
Wow.

Rebecca Dekker:
So basically the research from this study, which was a very powerful study, shows that the higher score, the more the state integrates midwives, the fewer racial health disparities we see. So I’ll send you the link, but their website is called birthplacelab.org, and if you click on the maps tab you can explore the maps and there’s a tutorial on how to use the maps so basically you can make the maps different colors and it will show you how integrated the midwives are in the different states and you can layer it by different outcomes like cesarean rate, or newborn death rate, or breastfeeding rate, and you can kind of see how it all fits together.

Brooklynn Pham:
Wow. That’s incredible.

Hoang Pham:
That’s such good information.

Brooklynn Pham:
Thank you for sharing that.

Rebecca Dekker:
Yeah.

Brooklynn Pham:
It was birthlab.org?

Hoang Pham:
Yeah.

Rebecca Dekker:
Birthplacelab.org. That’s a research team that’s been doing a lot of studies on not only midwifery integration, but also mistreatment in childbirth and other experiences of racism in childbirth and other things. So they’re putting out a lot of fascinating research, you can explore on their website.

Brooklynn Pham:
So last question is what is the research regarding partner support in healthy birthing outcomes?

Rebecca Dekker:
So there is a lot of research on this showing that partner support improves outcomes both for the birthing people and babies, and helps with having positive childbirth experiences. We have more than 26 randomized control trials that have tested the effects of having someone continuously stay with you during labor, on more than 15,000 people who have given birth. And overall, people who receive support are more likely to have a vaginal birth, they’re less likely to have pain medication, they’re less likely to have negative feelings about their birth experience and they’re less likely to have cesareans. In addition, their labors are shorter and their babies are less likely to have complications.

So this is why it’s so important to have someone by your side all the time. And it was one reason it was so upsetting at the beginning of the pandemic to see hospitals just unilaterally say you can’t have any support person, much less a doula. Because it’s a safety issue. Your safety outcomes are going to be a lot worse without a partner, and the best results in the research occurs when you have a trained doula there as part of the team. And that is someone who’s not a staff member at the hospital, and not part of your social network. So when the hospital called you and was like, “What can we do to kind of replace the doula?” Literally they can’t. They can do their best to make it a better experience, but it’s the doula’s presence, the person that’s not a staff member at the hospital who makes the better outcomes. Does that make sense?

Brooklynn Pham:
Yes.

Rebecca Dekker:
But we don’t have any research on virtual doula support, at least not at the time we’re recording this, but it was really cool to hear how some of the things that Shalin would have done in the room, she was still kind of able to do over FaceTime, which I don’t think it’s a replacement for being in person, but it definitely helps. It’s better than nothing, if that makes sense.

Brooklynn Pham:
Yeah. Yeah. I could say that her voice definitely helped.

Rebecca Dekker:
Yeah. It sounds like she set the tone for the room. When she was giving you compliments and affirmations, the rest of the team kind of was like oh yeah you’re right. You know?

Brooklynn Pham:
Yes.

Hoang Pham:
Yes, she certainly set the tone for the room.

Rebecca Dekker:
And that’s the other thing too. We found another research study was sponsored by the World Health Organization, published just in 2020 by Balde et al, and they were looking at around the world, does having a labor companion reduce the risk of mistreatment, and they found that having somebody there to support you, a companion, either your partner or somebody else lowers your risk of all kinds of mistreatment. Sad to say, but there are countries around the world where physical abuse can happen in labor. Being beaten, slapped, kicked or physically restrained. So they found that you’re less likely to experience physical abuse and you’re less likely to have a non consented vaginal exam, you’re less likely to be ignored when you voice a concern, and you don’t need as much medical pain relief because you have that companion with you.
So I thought that was an interesting research study, and that was from low income and middle income countries, but I thought it was an important study, just having that third party kind of there as a witness changes how people interact with you as the client, if that makes sense.

Brooklynn Pham:
Yes.

Hoang Pham:
Yes it does.

Brooklynn Pham:
Yeah. Absolutely.

Hoang Pham:
Thank you so much, Rebecca.

Rebecca Dekker:
Yeah, thank you Hoang and Brooklynn. It was so wonderful getting to meet you and hear your birth story and we look forward to sharing your story with the world.

Brooklynn Pham:
Yeah. If there’s anything else that we can help with, we now see ourselves with advocates and champions for EBB, please don’t hesitate to let us know. This has been such a transformational experience for us. We are forever just grateful.

Rebecca Dekker:
I know that you actually have been talking about online about your experience with doula support. Do you have a YouTube channel, or Twitter, or somewhere where people can follow to hear from you?

Brooklynn Pham:
Yeah. We started one. We have one video right now with the plans of making more. Our YouTube is …

Hoang Pham:
Learn, Love, Liberate.

Brooklynn Pham:
We hope that it continues, but we’ll definitely message you the link.

Rebecca Dekker:
Well there’s at least one cool video on there, I know because I watched it. So if anybody out there is listening, and their partner is on the fence about hiring a doula, I think it would be a good video to show your partner.

Brooklynn Pham:
Yeah, thank you. We’re so happy you watched. That’s awesome.

Hoang Pham:
Yeah. We’re planning to do more. In the video we mentioned making a video about midwives, but we have not done that yet. But I think our goal is to be able to spread this information because we found how useful it was for us, I think the question about funding was huge for us because we’re thinking how do we get access to these services and these resources to everybody. Our thinking was, I think one thing you mentioned was having this being a part of your healthcare, your healthcare plan and your insurance plan, is to be able to have them pay for a doula, or have them pay for an Evidence Based Birth® class. So we’re thinking about where is this going to take us next, and certainly think this journey has been sparked by a lot of what we’ve learned from you. So thank you so much.

Rebecca Dekker:
That’s so inspirational to hear that you want to keep doing the work and keep advocating for other families. I would encourage you to visit our birth justice page at evidencebasedbirth.com/birthjustice. We have a list of national and local non profits that are led by Black, Brown, and Indigenous folks. They’re the ones that, if you’re looking for and you’re able to find people who are interested in funding, I get frustrated and sad sometimes when I see people in the news talking about these big donations being given to these big organizations but it’s actually these small organizations that are on the ground that are literally saving lives, changing lives every day that need support and they’re not getting enough support from philanthropists.

Brooklynn Pham:
Yeah.

Rebecca Dekker:
So if you could spread the awareness of those organizations, that would be super helpful.

Hoang Pham:
We will, yes.

Brooklynn Pham:
Yes, we definitely will.

Hoang Pham:
Thanks for letting us know about that. And thanks for all of the amazing work that you’re doing. I feel like every time that you share something, it resonates so much with what we think things need to, what we think needs to happen. So just again, thank you so much, Rebecca. It’s been awesome talking to you.

Rebecca Dekker:
You’re welcome.

This podcast episode was brought to you by the book Babies Are Not Pizzas, They’re Born, Not Delivered. Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence based care. In this book you’ll learn about this history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizza is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Get your copy today and make sure to email me after you read it to let me know your thoughts.

Listening to this podcast is an Australian College of Midwives CPD Recognised Activity.

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