The Fallacy of "Unbiased Maternity Care": An Interview with Author Henci Goer
Are you ready to support your doula clients using the most powerful tool on your belt?
In Episode 8 of the Birthworker Podcast, I'm joined by Henci Goer, author of The Thinking Woman’s Guide to a Better Birth, who shares her insight and experience from being an acknowledged expert on evidence-based maternity care, an award-winning medical writer, and an internationally known speaker.
In this interview with Henci Goer, we chat about:
Understanding the underlying incentives behind commonplace obstetric practices…
How evidence-based decision making has truly turned into decision-based evidence making…
How to maintain transparency with your doula clients without your bias getting in the way…
… and a whole lot more!
Kyleigh Banks: Could you tell us a little bit about who you are and what you do?
Henci Goer: That's not such an easy question to answer, because I don't fall into a nice neat box. But my life's work has been reading, analyzing, and synthesizing the research in order to give people access to what the best evidence says is optimal care. I have a biology degree, which I had at the time when I graduated from college, no idea that I would put this use to it. But that's what I've been doing for the last 35 years or so. And that's been my passion is to help women and care providers help women make informed decisions about their care.
Kyleigh Banks: You said optimal care. Can you explain what optimal care means?
Henci Goer: Yes, that is actually a concept developed by the American College of Nurse-Midwives, and what it basically amounts to is the least intervention that produces the best outcomes given the individual circumstances of the person. And they develop that concept as a way of evaluating maternity care because the way the system is set up is it doesn't make a priority of minimizing intervention.
In other words, two women can emerge from a birth or a delivery. And well, I think my preface sums it up. There is no priority in how the woman experiences it. If you came out alive with a baby in reasonably good shape, what happened between the beginning and the end of that process is irrelevant. The only thing that the conventional medical system pays attention to in terms of experience for what interventions the woman has is, did you do an adequate job of relieving her pain?
So again, I'll repeat. Optimal care is the least amount of intervention that produces the best outcomes given the individual case because obviously, some pregnancies are more complex than others. But even in those cases, you can come out of a difficult labor ending in cesarean delivery, and in one case it couldn't have been avoided, but the woman felt well supported and is feeling sad and maybe frustrated or disappointed, but she is okay. She's feeling positive about her experience and how it unfolded. And in the other case, it could have been avoided. The woman is feeling traumatized. You can fill in the blanks.
Kyleigh Banks: Yeah. Through research that I see and I've read your books, gone to the actual research and looked at it. No research has taken into account the mother's mental wellbeing.
Henci Goer: Well, there are studies of that. Mostly many of them are qualitative studies, but yes, there is a lot of information it's not in the mainstream obstetric research. In the sense that, it's in the midwifery research or it's in the sociology research or it's in a lot of places. You don't find a lot of it in the mainstream journals that obstetricians read. And to be frank, obstetricians discount anything that would appear in something that isn't one of their journals. That's one of the issues.
I think we're going to be covering this ground again, but what I realized fairly early on is that there's a gap. I became interested in childbirth based on the experiential difference between the birth of my first child and the birth of my second child. And that was a powerful enough transforming experience as to what a birth experience could be like that I wanted to give this to other women so that they knew that the experience was important and that the decisions they made would affect that experience. So I trained as a Lamaze teacher, and I was certified as a Lamaze teacher. And that was back in 1980, by the way.
And when I started teaching, I very quickly discovered from my students, what my couples were telling me was that there was a huge gap between what the research said and what they were being told by their doctors. Because I don't think with mainstream Lamaze class, I don't think I had very many women who had midwives. And so that's when I got interested in "Wait a minute, I can read the research." I mean, it's not that difficult, actually. You don't need to have letters after your name. You just need to be a critical thinker in terms of reading critically, you need to have the vocabulary, and you need to understand statistical concepts. It's like what they imply and mean. You don't need to be able to calculate them. And so that became my niche. And even to this day, there are not a lot of people in it. The only other person is evidence-based birth who is very focused on that.
Kyleigh Banks: What a fantastic niche. Yeah. I feel like a lot of women that get into the birth community, they're passion-driven and they're almost spiritually driven. So we need people who have that but also have the numbers brain. And that's exactly who you are.
Henci Goer: Yeah. I sometimes described myself as “the literature lady.” I stroll through the gardens of research, collecting bouquets that I can give to people who that's not their strong suit.
Kyleigh Banks: Yeah. And it's fantastic because you've created many books now that help people who like me and your books just sit on my shelf, and whenever I need them, I can just open them and know that I'm going to get a summary of the research and the research articles linked so I can actually go look for myself if I want to, which is very cool.
Henci Goer: See that, I think, is the key thing. There's so much out there that's opinion. And what I felt was one of the things that I can do, I don't think there's a lot of people who actually track it back to it, the actual study. Much of what pregnant women hear or read about is the opinion level of it. Like, "You should absolutely have an epidural. Why would anybody in their right mind in this day and age go through labor without one?" or "Oh, you really shouldn't have an epidural. I mean, just all sorts of bad things can happen to you. It's really so much better. And you're just a total wimp if you're not interested in natural childbirth." What does she do with that?
I wanted to make sure that everything I said was transparent, that it was open to how I got there and what my source was for how I got there, and what my thought process was. And if you were so inclined, you could, in a lot of cases, go and find that actual material, but at least you had my argument for them, which you could then say, "Hmm, that makes sense to me." or "No, I think ... No, that's just kind of baloney." or "Wow. It's really good to know that, but it hasn't changed my mind about what I think is right for me."
Kyleigh Banks: And it's important to know that, that is okay too. You don't always have to follow the research in birth. That's the magic. That mom's in charge.
Henci Goer: Well, theoretically, and if you actually read what informed consent is, which by the way, I always used informed decision-making because hidden language is very powerful. When you say to someone, this is an informed consent document, in their minds, the intent is for you to consent. I think it's informed decision-making. It is always supposed to be the ultimate choice. There is informed refusal. And it's always supposed to allow the person— because this stretches across medicine, this isn't just about maternity care, to incorporate their values, beliefs, feelings, and individual circumstances. It isn't just about information.
Kyleigh Banks: That's really important. I have a question for you. If the research is there, why doesn't the mainstream medicalized maternity care system know it? Why aren't they practicing if the research is there?
Henci Goer: Because the way people behave is not necessarily based on what's rational. Well, there are two things going on. One is that there are drivers other than what the research says, which are underpinning the system, and we can talk about those. The other problem is actually something that I've watched develop over the years that I've been doing this. When I first got involved in looking at the research, what you found was essentially opinion and studies that contradicted that opinion.
What has happened over the years, the second piece of the problem is there is now a ton of research where the conclusions of that research support what obstetricians want to do. Phil Hall, may his memory be a blessing, was a very progressive obstetrician who coined the phrase “decision-based evidence making.” So that's what you have now, obstetricians are in their bubble. Do we want to start with the drivers, or do we want to continue with an example of what I mean by doctors can now point to the research and say it supports what they're doing, when if you look deeper, it doesn't?
Kyleigh Banks: Let's start there with the evidence being made based on the opinion.
Henci Goer: Decision-based evidence making?
Kyleigh Banks: That's it. Yeah.
Henci Goer: Okay. So anyone who is pregnant at this point and isn't going to a midwife is very likely to find their obstetrician recommending that labor be induced at 39 weeks. That comes from a very large randomized control trial, which took healthy first-time mothers and assigned them. That's what a randomized control trial does, it creates two equal groups by random assignment. You're going to get this treatment or you're going to get that treatment.
And in this treatment, at 39 weeks, you had a routine induction of labor, perfectly healthy women. And the control group got what they called expectant management that didn't necessarily mean that you just waited for labor to start on its own, unless some sort of complication developed. That meant that you probably also would have an induction too, but more down the line. You certainly would have an induction at 41 weeks, because of a whole bunch of literature that I won't go into on that one.
But anyway, so now you've got these two populations. And it turned out that the women who had a routine induction at 39 weeks had a 19% cesarean rate. And the women who had expectant management had a 22% cesarean rate. And it was a very well-conducted trial, nothing wrong with it. So now you have proof that the best thing to do is to induce all women at 39 weeks. And that's being recommended widely.
I won't go into some of the weaknesses of the trial, but I will say this. The women who were entered into that trial were women who would've been eligible for a birth center or home birth. They were very healthy women. They could have had their babies at a birth center or a home birth. We have studies of birth center and home birth outcomes where again, a certain percentage of women will end up needing to be transferred to the hospital and needing to have cesareans or they'll develop a complication very late in pregnancy. That means they need to have a hospital birth. Okay?
Remember, 19% was the low rate in this totally healthy population. Okay? The range in rates, and I have maybe 10 different studies, in women who were planning out-of-hospital births was 8 to 13%. So what that tells you is if that's achievable... And the outcomes were good, obviously, I mean, most of the women who are transferred in labor still end up with a vaginal birth. I mean, they need some Pitocin to help the labor, whatever, but you know. That tells you if that's the achievable rate, then there's something really wrong with your system.
Kyleigh Banks: Yeah. They don't see it that way.
Henci Goer: However, how do you argue with that? This has been my problem, which is it got to be a much deeper problem. When I wrote my very first book, which was published in, I think 1989, I want to say. No, 1995. I think it was still an issue of... So you're hearing these opinions, but here's what the research says. I now have a much deeper problem, which is, so you're hearing your doctor tell you that's what the research says. Here's my analysis of the flaws in the argument. Unfortunately, obstetricians are living in a bubble where this is what they get, which I guess could take this to part two of your question, which is “What are the drivers that have nothing to do with cognitive processes?”
Kyleigh Banks: Yeah. That's definitely one of them. They're living in this bubble, and it's not necessarily their personal fault. It's like that's how the system was built from medical school. And I've had conversations with obstetricians and they all say the same thing, whether or not their cesarean rate is 12% or 35%, they say the same thing that it really started with how they were taught in their medical school, which is a scary thing. People like me think, "Well, how do we change it then?" Because it's so internalized. It's in the system. That's how the system was built.
Henci Goer: It's actually multi-layered. First of all, this is human nature. I mean, yeah, there are some bad actors out there just as there are in any field who really don't care. I mean, they're not good people. But the vast majority of people think they're doing the right thing. So this is about human nature. And this is about being enmeshed in a system that isn't supportive. So I actually was thinking about what you said and I wanted to make sure that I covered them. The first and the biggest one, which you said, is how you're trained in medical school.
One of the problems in obstetrics and gynecology is a surgical specialty. Its premise is that things are going to go wrong and you, the physician, are the person to really keep a tight control so that they don't go wrong. And to proactively introduce whatever you can to control that process that naturally, if you just leave things to do what they want to do, you're going to see disasters. So you have to be right in there in charge making sure that everything goes exactly the way it should, and if it doesn't, jump in there. Okay. So that's problem number one. So that's the underpinning of what you do and how you see yourself as being what pregnancy and birth need to produce healthy outcomes. Okay. So that's huge.
The second thing is the way our system is set up with economic incentives. The best birth from the economic perspective would actually be a scheduled cesarean. And the second best would be a scheduled induction because it generates the most income and the most profit. It enables you to control scheduling. So from both those perspectives, it's really the way to go. Having a woman hanging out in labor and eventually birthing her baby and taking up a bed in the hospital for 24 hours in the labor and delivery unit, that's not good from an economic standpoint. And things like staffing. If you can predict your staffing, that's a huge economic saving. So that's number two, economics.
The third thing is defensive medicine. The belief that if you didn't perform a cesarean, you're much more likely to get sued. And if you did perform the cesarean, you should have done it earlier. That would've prevented the lawsuit. Now, actually, there's some data that's like if you set yourself up, which the obstetric profession has, if you think about it, the exchange between the obstetrician and the woman, the subtext of that is you turn your body over to me and I will guarantee you a healthy baby. That is the subtext. You have to take the drugs I tell you to take, mind the tests I tell you to have. When I say it's time to be induced, agree to that. When I say it's time for a cesarean, agree to that. The subtext of that is you need to do those things because I can give you a healthy baby. Well, what's going to happen if god forbid, it's not a healthy baby. She's going to turn around and say, "It's your fault." Because that was the subtext of the message that you gave her. If you want to know why you are so likely to get sued if there's a problem, look in the mirror.
Kyleigh Banks: That's such a great point. Yeah. Read the subtext, read the words on your forehead.
Henci Goer: If you didn't set yourself up as God, it would be far less of a problem.
Kyleigh Banks: Yeah. I read recently that a midwife can be assisting a birth that has the same negative outcome and she's a lot less likely to get sued by that parent. And that explains perfectly what you just went into.
Henci Goer: Yeah. It doesn't make it zero. I mean, when things go wrong, again, it's very painful. It's human nature. You want to find some reason like, "Well, if we had done this or we hadn't done that, the outcome would've been different." And so that's always there. So now we've got beliefs about the inherent dangers of childbirth. We've got economic incentives. We've got defensive medicine. And the final thing is convenience.
Kyleigh Banks: Yeah.
Henci Goer: First of all, the system is set up in certain ways. At this point, I think the percentage of women who have epidurals in labor is probably, in this country, if you get it down to the women who actually were on the floor laboring, it's probably in the mid 70s to low 80%. So that means you have an intrapartum unit that is set up for everybody to be on an epidural.
Well, if you have someone who isn't ... Well, first of all, you haven't actually been taught how to be helpful to her. Number two, she interrupts your routine because she demands more time. So you have a system that is set up to induce her, to give her an epidural, to keep her in bed, to have her being monitored from a central state. All of this is the convenience of the thing. And also, from both the doctors’ and the nursing staff's standpoint, that is the most efficient, convenient way of running a service.
Okay. Put those all together. This is just a sort of tidbit. I'm reading a study for my next blog post now. And it was a randomized control trial in women who were at high risk to have small for gestational age babies, meaning a baby who is in the lowest 10% that you would expect at whatever that gestational week was. And they had three arms to the trial. They had usual care. They had women who were assigned the Mediterranean diet, which is high in grains and fruits and vegetables, and they gave them walnuts and olive oil, and they had group meetings and they had individual counseling, but they were on the special diet.
The third arm of the trial was mindfulness. And they had specially guided programs. And again, they did it in groups and they had individuals, but it was about mindfulness. Why did they pick those two things? Because one of the things that we know about small for gestational age is that, well, first of all, you are more likely to have an adverse outcome in a small for gestational age baby. I mean, many of them are born healthy, but the odds are higher for morbidity. And there is known that there's a connection between stress. Now, you got the mindfulness, and also sort of inflammatory processes. And the Mediterranean diet is one that reduces inflammation processes.
And also, there is no treatment for small for gestational age. There's no drug they can give you that will help you grow a bigger baby. Great trial, right? Guess what they found? It worked. They had a reduction in small for gestational age, in both arms of the trial in women who were at high risk for it. And then I read the commentary on it. And I realized that you had to read between the lines. What it basically said was this was very expensive and time-consuming, and the system isn't set up to provide it.
Kyleigh Banks: Wow. Wow.
Henci Goer: I mean, they didn't say it that boldly.
Kyleigh Banks: I know. I know. Yeah.
Henci Goer: We don't have a system that meets pregnant women's needs.
Kyleigh Banks: Absolutely. It starts back up those four things you listed. Everything from the bottom, which is convenience. It's not set up. We don't have the staff. We don't have the rooms. We don't have the obstetricians.
Henci Goer: I don't want to name a name because I'm not sure that she was the one who said it, but I remember a long time ago going ... I'm pretty sure that I was at a talk that was being given by a progressive obstetrician. And what she said was "Our prenatal care system is set up to say, are you sick?" So you come in and they weigh you, and they test your urine and they measure your belly, they have some tests you're supposed to take, which are all ways of saying, are you sick? And if the answer to the question is no, then it's like, "Well, come back next month and we'll ask the same questions."
There is nothing in the system about promoting health and wellbeing. It's not set up that way. It's a medical system, and the midwives' model of care, and I'm being very deliberate about that because not all midwives, you have to be careful who you choose as a midwife. But the dice are in your favor, but not necessarily. Okay. But the model of care, which is all about promoting health, I think is one reason why midwives make a difference.
Frankly, I think one of the other elements of that trial is something called the Hawthorne effect, which is when you pay attention to people and they feel looked after and taken care of. So I think if they had just handed someone the diet or said, "Go watch this video on how to do mindfulness meditation," they wouldn't have seen the effect. I think what they were really seeing is in both groups, in addition to the benefits, and by the way, the nice thing about this is there are no harms. There isn't a single drug or treatment that's medical that doesn't have harms as well as benefits. I think they were seeing the Hawthorne effect... And we've seen that all over, the whole centering pregnancy concept with group pregnancy meetings and that informational component in addition to individual time with your care provider, reduces pre-term births.
Kyleigh Banks: Wow. That's really cool. I didn't know that. I need to look into that. That's fabulous. What a great case to create communities in our area, like in our hometowns' communities. And specifically, really communities of people that flow like you and believe things like you. That's really cool.
Henci Goer: Now, I'm not saying, this is the thing about optimal care. This is not about natural childbirth, which everybody wants to layer onto this. This is about the least amount of intervention. Now, you think about disadvantaged communities and the injustices and inequities that you think about. I mean, all pregnant women are disadvantaged by how they are treated in this. And certainly, trans people who are pregnant. Then you can start to layer on top of this, the intersectionality, which makes things even worse. And you can layer on race, and you can layer on age, and you can layer on low-income, and you can layer on all of these things which increase the probability that you are not going to get optimal care in the system.
Kyleigh Banks: And is that rooted in internalized bias?
Henci Goer: Yeah. Bias, assumptions, you name it.
Kyleigh Banks: Yeah.
Henci Goer: Because interestingly enough in this study, as it turned out, because of where it was done and who it was being done with, the vast majority of the participants ... It was actually a Spanish study. The vast majority of participants were white and middle or upper income. So imagine what the rates would have been in a population that had additional stressors.
Kyleigh Banks: Yeah. It's fascinating. Can you talk a little bit about how research is funded and how they find participants, and why that in itself might be a little bit biased if you think it is?
Henci Goer: I don't have a lot of access to that. I can say that a lot of research is funded by drug companies. And also, there isn't much of an incentive to do, because they're terribly expensive to do, to do them right. So there isn't a lot of incentive to fund studies that don't have a connection to something that someone can make money off of.
Kyleigh Banks: Yeah. Yeah.
Henci Goer: And I'll tell you what the classic example of that is. It's this idea that progesterone injections will prevent preterm birth.
Kyleigh Banks: Ooh, tell me more about that.
Henci Goer: Okay. I don't normally get involved with anything, because I'm not a doctor, I'm not a midwife. I'm not even a PhD. I don't get involved with complicated pregnancies. Let's see. How can I give you a short version?
There was a theory that progesterone treatments would reduce preterm births because progesterone and its effects are known to quiet the uterus. And there was a randomized trial, I think it was published in 2003, which found that progesterone injections greatly decreased repeat preterm births. In other words, once you've had a preterm baby, you're at higher risk for having another one. And everybody got all excited about that. Except if you looked at the trial, you would see that when they were developing the trial, they established what sort of the baseline repeat preterm birth rate was, and then they figured out how many people they would need in the trial to reduce it by a particular percentage. It's called a power calculation.
And what they found in the baseline population was that the repeat preterm birth rate was ... I think it was in the low 30% and they said, "Okay. So if our idea is valid, we're going to see a reduction off of that." And when they got the results, they saw the reduction, but it wasn't because they had reduced it from the baseline rate. It turned out that in the control group, the rate was 55%. The rate in the treated group was in the low 30%.
So in effect, their treatment had no effect. But what was published was that we got this amazing decrease. If you read the study, they actually did say that in the study. But man, that was lost in the, "Oh my god, we've cut preterm birth." They went to the FDA. The FDA, I don't know what they were smoking that day. They went to the FDA and said, "Give us preliminary approval," and the FDA looked at it and said, "Okay, you need to conduct a trial, a bigger trial. And yes, we'll give you preliminary approval because there's nothing effective for preterm birth. So yeah, we will."
So when they got the approval ... This was in 2009, the trial was not published until 2019. Yeah. It's like, "Hm, that's interesting." Okay. One of the reasons was they couldn't ... I've written a blog post on this because I've been following this for years. One of the reasons was because they couldn't recruit people, because now that everybody was treated with progesterone injections in these big institutions that would be candidates for running the trial, they were saying, "No-way-José am I going to assign a woman or is she going to agree to have the potential of not getting this treatment."
Anyway, they published it in 2019. Was a very well done trial. And here's where we're getting to the point that you want to make. Oh, I forgot a piece. At the time that the FDA gave approval, if you wanted to give progesterone injections, they were about 30 bucks an injection. Basically, to treat one woman would amount to about $350, except there was a drug company behind this. And the moment that they got the preliminary approval, they came out with Makena, which was a patented version of progesterone, and the treatment jumped to like $35,000. Okay. So now you had these doctors, all of whom were connected to the drug company, running the trial. They did the trial and the trial showed no benefit. You got exactly the same percentages in both the treatment group and the control group.
And then they did this, well, it was spin doctoring by real spin doctors. So they did this dance about "Well, there was this and there was that. We really need to do more research. It really isn't what you think you're seeing." And even after that trial came out showing no benefit, the American College of Obstetricians and Gynecologists and the, oh, what's it called? The subgroup of them that are particularly about perinatologists came out in support after this trial came out.
The FDA then held a hearing and the committee that reviewed the trial almost didn't recommend it. It was nine to seven to recommend withdrawing the drug. One more vote. And that was in 2019, and it still hasn't been resolved, because the drug company is entitled to a hearing and yada yada yada.
Kyleigh Banks: So it's still being prescribed to women?
Henci Goer: You bet it is.
Kyleigh Banks: Oh my goodness. That is a big rabbit hole. And that's just the beginning of it, I assume. I assume something like that happens with thousands of drugs across the world.
Henci Goer: Yeah. But the key point, and I'm sorry it took me so long to get to it is, when you were talking about why is the research the way it is.
Kyleigh Banks: Yeah. That's it.
Henci Goer: The other thing that happens with the research studies is because you are doing them in a system, which is imposing all sorts of interventions that aren't really needed or necessary, how do you tell ... You can't just take one little piece and say, "Well, let's take ..." I'm trying to think of something that would be easy to talk about.
So one of the things about epidurals is you end up needing a whole bunch of other things because you've had an epidural. You need to be on continuous monitoring. You are confined to bed, and being out of bed moving around freely can help the labor progress. You can't eat or drink anything. You're on an IV. You're very likely to get Pitocin. And all of those things have harms connected with them. But if you think and if you look at the studies and you say, "Yeah, but if you have an epidural, it doesn't change the cesarean rate."
Well, even if you don't have the epidural, you are in a system where you're going to have monitoring. You're very likely to have Pitocin. You are not allowed to eat or drink. You're not really allowed to be out of bed. So it's like you are measuring ... You have to change the system in order to see its benefits.
I just thought of another one that might be simpler, which is we know that vaginal birth is harder on the pelvic floor than cesarean delivery. I mean, that's one of the things they keep talking about. However, is it vaginal birth, or is it that she's on her back essentially being told, push, push, push, push, push, push, come on, take a breath and push, and that she is being told to start pushing as soon as she's fully dilated as opposed to waiting until she has a natural urge because the head's descended low enough?
So is it vaginal birth? Or is it the whole system? And she's terrified that she's going to tear and nobody is reassuring her that what she's experiencing is a normal sensation, and just relax, just all of the things that might protect her pelvic floor. I don't disagree that yep, pelvic floor issues can arise from a vaginal birth, but we are not looking at an optimal circumstance for minimizing that possibility.
Kyleigh Banks: Yeah. It's so important to think critically about it, even if it's a well-put-together study, even if it's great research, you have to look at it with a critical eye.
Henci Goer: So you have much of the obstetric research being produced in this echo chamber.
Kyleigh Banks: Tell me about what led you to write your first book, because I think from what I've heard from you, that you wanted to make this information, the research available to women, so they can actually make informed decisions for themselves.
Henci Goer: Well, the first book actually came when I was a Lamaze teacher and I was hearing the women in my classes saying, "Well, of course, you have to have continuous fetal monitoring because otherwise, we won't be able to catch that there's something going wrong with your baby." And I had been curious about the research.
As I was teaching my classes, I wanted to help women make informed decisions when I was talking. So what I realized was "Gee, I'm interested in reading the research and I would really like to have a book on my shelf that would help me with that and summarize the research." So I wrote it, and that was Obstetric Myths Versus Research Realities. And that came out and was well received. So I guess other people also wanted to have that book on their shelf. And then I was thinking, "Well, these pregnant women themselves also need access to this." And so that's how I got involved in writing The Thinking Woman's Guide to a Better Birth.
Kyleigh Banks: What's the difference between those two, if people don't have the two of them?
Henci Goer: Obstetric' Myths was more high level, and Thinking Woman's Guide was actually aimed at pregnant women and had information like, "What do you do with this information?" In terms of making informed choices. Frankly, while there is some sound information in it, I'm surprised it's still selling because that book was published in 1999 and there have been some real changes since then. So that actually is ... I mean, I know we want to talk about the intermediate steps, but that's one of the reasons I'm back to writing books.
Well, maybe we should fill in the blank there. The next thing was I wanted to do a new addition of Obstetric Myths, sort of the more higher level one. And in this case, I partnered with Amy Romano who is a certified nurse midwife and also had a master's in nursing. And we wrote that together and that book was Optimal Care in Childbirth: The Case for a Physiologic Approach. And again, we use that deliberately because sometimes you do need to have the interventions. And that book was published in 2012.
I then wanted to take the newer research that we had done and do the same thing, make it available to pregnant women. And what I decided to do was, everything was on the internet, so I came up with the idea of doing streamed slide lectures. And I set up Childbirth U, as in university, about childbirth issues. And from 2013 to, well, really last year, I struggled to ... I just wasn't getting traction with it, but whatever I tried to do. And my most recent marketing person who I'm still working with said, "We really need to do a focus group and have some people take a look at your lectures and talk about what they want and need." And the message I got back from that is “Great material, not very accessible.”
And so I realized I wanted to go back to writing the book. And here's where it gets interesting. As it turns out, one of my daughters makes her living as an audiobook narrator, and you can look up books by her, her name is Sarah Goer... I'm very proud of her. She's a SAG actress, and this is how she makes her living. She is also entrepreneurial, and she was wanting to start a small press so that she could publish materials that, number one, she'd like to narrate, and number two, that she wanted to see out in the world, but weren't likely to find a traditional publisher with ease. And so she is publishing my first book.
In her previous lifetime when she was trying to make it in Los Angeles, she worked as a writing tutor. So she has worked with me too... and also she's in my demographic for who I want to be speaking to. And she helped me to find the voice to talk to the pregnant women of today. And I really should say pregnant people.
I'm 74 years old, and my language patterns are fixed, but I'm very well aware of the fact that not every person who becomes pregnant is a woman. So I hope that anybody who might be listening to this will forgive and understand that I understand that they have all of the issues that pregnant women face in obtaining humane care, but it is made much more difficult for trans people, people who do not identify with being women. And I hope I found that.
So what I decided to do was to basically take those lectures and transform them into a series of books, but in a very different voice and style, but still with my brand, which is, number one, I'll give you what you need to make an informed decision. I will also be transparent and tell you what it's based on and give you ... There are a couple of chapters that have what I call "the deeper dive," and give you information that many women won't be interested in and won't want, but if you do, it's there.
And most importantly, and I think this is where I'm unique, the last chapter is the takeaway chapter, which says, Okay, you've got all this information, you have your ideas about what you want. How do you implement it in a way ... Like what are the tips, hints, ideas, and strategies for how to maximize the odds of you getting what you want. Including letting you know about some pitfalls that you might not have thought about and strategies for dealing with them.
Kyleigh Banks: Yeah. And the first book is all about pain, is that right? It's going to be a series.
Henci Goer: Right. And that's tricky to talk about because we wanted to ... Again, I didn't want to fall into the extremes of either camp. One being that this is unbearable. You have to have an epidural, don't even try, you'll end up with an epidural, anyway. And at the other end, it's like, if you're in the right space, you won't feel a pain. You'll feel rushes or ... Yes, that is possible for some people.
But I think pregnant people, one of the things ... the first thing on their mind is concern that they'll have a healthy baby. The next thing on the list is how we going to deal with labor pain. So again, the title was a long time coming and went through many iterations so we could get it ... hopefully that it transmits exactly what we wanted it to transmit. And the title is "Labor Pain: What's your strategy?" And the subtitle is "Get the data, make a plan, take charge of your birth." Because I wanted to give women agency.
Kyleigh Banks: Yeah. And you're unusual. You're a unicorn in the maternity care world, because it is so divided, and very few people really, truly try not to bring their biases in. And they're not objective. Like you said, we can't be objective, but we can be transparent. And you're truly transparent. And I see that when I read your books, that I understand your beliefs and I understand your biases, but I don't feel like you're pushing them onto me when I'm reading your books.
Henci Goer: Thank you. You couldn't have said anything better to me. And interestingly, in the process of translating the lecture into the book, it was so helpful to have my daughter's feedback, because she helped me dig out ... I mean, I thought I was really doing a good job, and I was, but she really helped me dig out and reframe and rewrite some of the passages and I'm excited about it's potential.
Kyleigh Banks: And I know it's not geared towards birth workers. You're very specifically talking to ... Will you tell us in your words who you're talking to when you're writing these books?
Henci Goer: So my journey with the book, as we started to discuss where is my voice for this book, for anybody out there who's ever written a book that's non-fiction, or maybe even fiction as well, is you need to find your voice. And what's out there a lot for pregnant women now is "I'm your girlfriend." Or, "I've just been down this path and now I can help you because I have." That's not going to work for me and that's kind of not my brand. On the other hand, I realized that the problem I had come to with the lectures was that I was standing at the podium talking to an audience like a TED Talk, which is all very well, but that wasn't right.
And what we finally got to that really helped me bring in the voice that I wanted was we're sitting at a kitchen table, I'm talking to you, we both have our cups of tea, I am helping you figure out... I'm acting as a resource. I'm helping you figure out what it is that is right for you and what it is that you're wanting. Giving you the information on the pros and cons of all your options that will help you do that. And then helping you process through like, "Okay, so now you have your ideas about that. How are you going to get there?" And creating a no-judgment zone. And also that respects you as an adult who is perfectly capable of making the decision about what's right for her, even if that's not what I would choose. I don't have any sense of like, "Well, I wouldn't choose that for me. So that's got to be wrong for you."
Kyleigh Banks: Yeah. And what are the other books down the line? So this first one is about pain. What other books can we be looking forward to?
Henci Goer: I started work on book two, and that's going to be on induction. My daughter and I thought that we'd sort of... To build the brand, we'd hit the big controversial issues that are forefront in a... Because one of the things we're doing that is new and different is, if you're going to get a book about pregnancy... You're probably going to get one that's soup to nuts, like Penny Simkin's book, Pregnancy, Childbirth And The Newborn, which is a great book. Or Giving Birth with Confidence.
I'm doing something different. These are short books on a single topic. And so it's going to be interesting to see if we can catch the audience who isn't necessarily looking for a single topic book. So we thought we would start with ones where there were a lot of controversies around the issues. And so labor pain was the obvious first one. Induction was the obvious second one. We haven't gotten as far as stating what we would do for a third one, but VBAC is high on the list.
And I still haven't figured out what I ... I mean, the things we've tossed around are the fundamental choice making, like choosing a care provider, choosing the place of birth, and choosing a support team, like the doula research information. I don't know. I think I need to establish the brand first, because most people who... I think those are actually the books I would love to have written first, because if you've chosen your care provider, someone who's in line with what you're thinking and you've chosen the place of birth that feels like the right place for you, three-quarters of your work is done. I mean, you still want to be a full participant and ask questions and have discussions, but you basically set things up the right way.
Kyleigh Banks: That's a really good point. And I mean, it's just the practical world, is that you have to do something that is going to work practically for your brand and for the vision too. And I know, yeah, pain is got to be the first one. So I'm glad you chose that first, because yeah, like you said, right under healthy baby, pain is right there almost at the same... when people think about their upcoming birth. Do you have a potential release date or release season for your book for anyone listening?
Henci Goer: We do. It's later than I thought it would be. However, it is ta-da, August 29th.
Kyleigh Banks: August 29th. Fantastic.
Henci Goer: Yeah. We were hoping to get the book out this spring, but this and that intervened. And then as we looked at the summer where I have plans and my daughter has plans and my marketing person has plans, we just went like, "Okay, let's just give it up and say we'll come out right around Labor Day." Which I guess has the advantage of we can build a launch campaign around Labor Day.
Kyleigh Banks: Yes.
Henci Goer: Can you tell me a little bit more about what you do? I see that you are Autonomy Mommy.
Kyleigh Banks: Yes. So I started as a birth doula. I started in this community right before I conceived, while I was trying to conceive. And what happened is I was listening to birth stories and they just didn't sit right with me. The birth stories I was hearing was was very, "Let me give up my power and someone else is going to make decisions." And I'm not that kind of person. I butt heads with authority. I want to be in charge.
So from day one, I was like home birth. I'm going to have a home birth. And I just went down the rabbit hole and fell in love with birth. And I did have a home birth and I became a doula. Doula transitioned into educating. I love the act of making curriculums and things like that. So doula turned into childbirth educator. I do both. And now it's turning into mentoring doulas, because I also, in that time, created a very successful business. So I'm going to help doulas do what I did and be able to hold space because holding space I think is the foundation.
You can not have a lot of knowledge, but if you have that energy, I think you're a great support person. So the foundation of holding space on top of that, the knowledge and the education and the research, and then on top of that, how to actually make this something sustainable, because people burn out so fast. I know we talked about this on our chat the other day, but it's hard to witness birth. It's hard to witness birth, period, especially when you're witnessing it inside the medical system. So we burn out. It's amazing you've been doing this work for so long and you found a little niche that works for you.
Henci Goer: I see you lighting up in the same way I have and finding that passion. And I also hear that's why I burnt out as a doula, because I was standing by and it was just too hard. I can share this with you. It's so amazing when you find something where you don't just have a job. That's great and that's fine. But you have something that you're giving, that still it is a career. I think that one of the issues that anybody who's involved in birth confronts is burning out because there is just ... it's very intense work, and it can often be very difficult work.
So let me give you a bit of wisdom from my faith tradition. This is from Pirkei Avot, which translates as the wisdom of our fathers. It's a book in the Talmud, and what it says is you are not obliged to complete the work, neither may you depart from it. And I have found over the years that has been a terrific help in terms of like I don't have to do it all. I am not going to be able to fix everything as much as I would like to, but I just need to keep doing what I know how to do to help make the world a better place. That's all.
Kyleigh Banks: That's beautiful. Yeah. I agree. Burnout is definitely a real problem. And even if our passion is serving moms and making the birth community a better place, we can't do that if we burn out. So in some ways, we need to do what serves us first, so we can serve mothers.
Henci Goer: I used to teach the same thing in the postpartum class when I was a Lamaze teacher about how you need to look after yourself. You need to refill the well. If the well is empty, you have nothing to give to others.
Kyleigh Banks: Beautiful. Henci, thank you so much from the bottom of my heart. Thank you. I can never repay you for how beautiful this was. If you told me like two years ago that we would be having this conversation, I'd be like, "Get out of here. There's no way." So just really thank you for gifting your time and for sharing your wisdom and for the books that you wrote. Because part of being a doula is helping moms navigate their options and providing them with the research. But I don't have to do it all, because I can point them to you. And so you're really someone that serves many, many more people than you even realize.
Henci Goer: Thank you. One of the reasons for doing this is exactly for people like you, who can then ... so you are not the ones to say "Yes, but ..." That you can say, "Tell you what, I got a book for you." And that way, you're off the hook... I think this could especially be important for hospital birth educators, where you don't have to do that work. You can say, "Just take a look at this and see if there's anything in there that makes sense to you."
Kyleigh Banks: Yeah. I love that. I first heard of you from my home birth midwife who attended my birth and she told me to get the Obstetrical Myths book and I did that same day. And then after that, of course, you read one and you want to order them all.
Henci Goer: Yeah. Wouldn't have thought of my books as being like popcorn.
Kyleigh Banks: They are. They really are. And I think as I told you that anyone who is my client or who I'm mentoring or teaching, the book that I have them get is The Thinking Woman's Guide, which is really interesting that you're like, "Wait, why are people still getting that?" And the reason is because there's nothing else like it out there. So even though it's 20 years old, there's nothing that's replaced it until your new books come out. So yeah, I'm grateful that I can point people in your direction. It saves me work, but you also do it so well that it's like I don't have to do that work because you did it already.
thank you for listening
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Meet your host, Kyleigh Banks, a side-gig doula turned CEO of a multi-six-figure birth-focused business. Her passion? Teaching birth nerds, like you, how to build an incredibly successful doula business that allows you to quit your day job, stay home with your kids, and most importantly, make a lasting impact on the world.