Stepping Beyond the Medical Paradigm as an OBGYN with Dr. Nathan Riley
Hey birthworkers, how far will you let the hospital system push you? When will you decide to make a better path for yourself and your clients?
In Episode 12 of the Birthworker Podcast, I'm joined by Nathan Riley from Beloved Holistics, who is sharing his insight and experience from supporting moms as an OBGYN both in and out of the hospital system.
In this interview with Nathan, we chat about:
Why hospital OBs are stuck in “golden handcuffs”…
That final straw that made Nathan leave the hospital system…
How to distance your own personal values from the clients you serve…
… and a whole lot more!
Kyleigh Banks: What is your dream with the Indie Birth Institute? What's your dream with that?
Dr. Nathan Riley: We're going to specialize in training midwives and OBs in twins and breech. That's the elevator speech, but really it's going to be a nature-immersive birth experience as well. For anybody, all comers, sort of like what the Farm was when the Farm was the Farm. It's not really doing so hot from a birth standpoint.
And that's my words, they would probably not say that, but their youngest, most promising midwife is leaving because their COVID leanings were just so strict about who could come on the property, you had to have a vaccine record with boosters and masks everywhere. And there's not a lot of autonomy and there's not a lot of open-mindedness it seems, especially as they're caring for women. But the farm will continue being the farm. They just may not have a midwifery program anymore, which is pretty sad.
Kyleigh Banks: Yeah. That'll be cool that you can have that, "Come as you are and learn and give birth." That would be really special, especially for those women who aren't comfortable doing it alone by themselves at home, maybe twins or breech.
Dr. Nathan Riley: Yeah. Right. That's really cool. Yeah. They want to have a space. They want their space to be held, but they don't want interventions. And no matter what, they're going to have interventions in the hospital, but they also don't want to have a free birth because it's a breech and they've heard all this horrible stuff or whatever.
Or even a cephalic baby, honestly, a lot of people aren't ready or don't really want a free birth. A lot of people want to be supported by somebody who's not going to intervene in the other room, just holding space for their process. And so that's what we want to create, it's a very, very unique center that we're going to be opening. There's nothing like this in the world or ever has been, so it's pretty special.
Kyleigh Banks: That's amazing. I am so excited to just watch it come together.
Dr. Nathan Riley: Yeah me too. Soon as we get the money, it's turnkey. So as soon as we get the money, the down payment, we can start doing it. And so it's going to be the home of the Indie Birth midwifery training program. Anybody who wants to apprentice just spends as many months there as they need to in order to catch as many babies or see as many complications or whatever, whatever's important to them.
But I'd also love to have OBGYN residents there where Stu Fischbein and I are both involved in the project. We can train them on how to do breech, how to gauge blood pressures, whatever. You get the OBGYN perspective as well and if you're an OBGYN resident, you've maybe never seen an undisturbed, natural physiologic birth and just how beautiful that can be. So let's give them the opportunity to see it in this type of environment, in a cabin, in the woods in Eastern Kentucky. It's a really, really cool endeavor, so I'm really, really stoked about it.
Kyleigh Banks: Do you have obstetricians reaching out to you just asking you, "What was it like to leave?"
Dr. Nathan Riley: Yeah lots of them all the time. There's so many things that keep you in the system. And we can talk about that on the podcast, but it's complicated. A lot of people are like, "Why don't people wake up?" And it's like, "Well, why don't people wake up to just not asking for permission to do anything?" You don't need anybody's permission to do anything, but we are so indoctrinated into this idea that there's somebody above us that has the answer. And then we just have to pray to the right person, whether it's our doctor, our God, our religious leaders, our politicians, and that doesn't serve you whenever...
The onus is on you to have a baby. Which I know is important to you, given even just the name of your podcast, but there are times to go to a doctor, there are also times where you have to tap in and really ask yourself, "What's important to me?" And that's not something you're used to practicing in general. So a lot of doctors just don't really get it. They're like, "Man, I wish I could do that." I'm like, "You can, right now, you can decide, 'I don't want to work for Kaiser.' You can sacrifice the whole," whatever. They have a really, really great pension plan and that keeps the golden handcuffs on them.
We consider, what does it take to be a doctor? You start in high school, you have to get the best grades. Then you're in college, you have to get the best grades. You have to be taking way more classes, more credits, volunteering more, getting more experience doing whatever, as a scribe in the ED, or you have to volunteer pushing beds around the hospital or whatever, in orderly, or you have to get some experience doing whatever. And you've shown that you're the cream. And then you get a good enough MCAT score and you get chosen to go to med school and then you have to be the cream there. You have to really shine if you want to get into residency, some people don't ever get matched into residency. And then you have to take your licensing exams and those are really hard.
So every step of the way you've shown, "I've got the answer on the test." Well, there's no answer to birth, and there's no answer to death, which is my other specialty. So when you consider that these people have been actually selected by the best system we could come up with, which is taking tests, if there's not an answer to the test, they become clueless. And there's no answer as to how to get out of that system because that's the system you were trained to work in, where there's guidelines and policies and protocols. Kick bucking that trend as the individual is extremely confronting and challenging, that's why most people don't do it, even if they actually deeply intuitively get it and actually are in alignment with it.
So I don't have any advice to anybody out there except that you just need to tap in and say, "What's important to me?" You can either be miserable in the system for the next 40 years of your career, or you can do things the way that you've always wanted to do to them, the mystique of birth that brought you into this space, you can tap back into that. Come and work with me, come and attend home births, reach out to Stu Fischbein. We all did that and it's scary, it's scary out here, but at least it was my decision. And when I care for somebody and I spend 90 minutes with them, that was the way I chose to spend my time in order to honor and bear witness to this incredible process they're going through.
So it's tough out there for all healthcare practitioners. I don't have any ill will towards them. I don't think we need to burn the system down. I think we just need to honor, "What's important to me. How would I want my wife treated? Is it the way that you have been treating women as an OBGYN resident? No? Then do something about it." It's hard, I get it, it's confronting, but in 40 years, whenever you're 70, you're retired, you're going to say, "Damn, I did it my way. And I am the one that did the training. I have the skills and I choose when and when I'm not going to use those skills."
Kyleigh Banks: Yeah. I don't have to report to a system.
Dr. Nathan Riley: Or an insurance company or any of those other pressures.
Kyleigh Banks: I love that you say that the pension is the gold handcuffs because I was thinking that too, it must be the debt and then the money that they're finally making after not making money for many years, I assume, is hard.
Dr. Nathan Riley: And you just want to be left alone. "I just want to buy my house, raise my kids, get my 401k and then die, I suppose" I get that. I understand that because I was also there. And then I realized, you know what? Screw it. Those things aren't important. What's important to me right now is that woman who I went in to see and I was holding space for her having a baby, that she actually felt like there was somebody there that really saw her and really got it. And I don't always do that. I'm not always able to be that person, but when I have the opportunity and there isn't a pressure on me from the system, it sure is a lot easier.
Kyleigh Banks: I'd love to hear what got you into obstetrics in the first place and then maybe what were some of the red flags that you started to see that woke you up to, "Maybe there's a different way."
Dr. Nathan Riley: I think I kind of tapped into that already, but I think it is important to ask, what brings us into obstetric care in the first place? And if you really consider... So the med school training is where it starts. You do two years of book training and you're covering textbook after textbook. It's way more than college. It's not writing papers, it is very, very rigorous library study. You're just studying textbooks for two years. And then in the next two years, you do your rotations where you rotate with, it's a standard thing, neurology, surgery, OBGYN, pediatrics, family medicine, internal medicine, and probably missing one in there, but those are the basic rotations. That's the whole shebang.
And then you have the opportunity to find niches. You want to look at a GI practice, so you do a rotation with them. Or you want to do cardiothoracic surgery, so you do a rotation with them, or whatever. For me, I didn't like anything. I was like, it just is a lot of intervening. It's a lot of surgeries and pharmaceuticals, and it was very weird for me. And it was like, I can have all the answers to the test. Am I just going to be studying for tests my whole life?
And then I saw a baby born, it's so simple, but you're like, Oh my God, there's no procedure for this. This cracks you open. This is wild. And there was the mystique of that, knowing that I'm never going to give birth myself. I'll never have the actual language to talk about what it means to have a baby. And that to me was like, Okay, I'll never have the answer to that test. So this is going to be an ongoing personal experience for me. And if I can get good at trying to see this experience through the eyes of my patients or clients, as I say, because when you're pregnant, you're not sick, you're not a patient, then that will be very rewarding. That would be a very rewarding career path.
And then of course you go to OBGYN residency and 70% of your training is doing GYN surgery, which I didn't like, removing uterus, removing ovaries. And there's a good reason to have GYN surgery don't get me wrong, but it wasn't like what brought me into it. And then becoming really, really good at giving medications and treating every symptom with a new medication until you've got 10 meds on a brand new mom. And I was like, "This isn't fun. This isn't the mystique. I have the answer, but I don't..." I had all the answers so they couldn't kick me out, but I was also questioning it the whole way through.
It was a very good program because the first year you only attend births with a midwife in the hospital, a certified nurse midwife, which is definitely not the same as an independent midwife, like somebody like Maryn Green or Margo Nelson. There's a wide variety and Nicole Morales, Laura Doyle, there's so many midwives, Augustine Colebrook that I'd learned from over the years, but it was still better than the constant need to be doing a cervical exam every four hours. Even if the person's asleep, you wake them up and you stick their hand in their vagina before they even have time to consent to it.
And what I guess I realized is related to, I think, the reason that people get into medicine in the first place, is that a lot of us love having protocols, procedures and people above us to tell us how to do the thing that we train to do. I went to half a million dollars into debt for medical school and I will be paying that off for a long time. And if I'm the one that invested that money and sacrificed 20 years of my life, from high school all the way through finishing fellowship at UC San Diego in hospice and palliative care, if I'm the one that did that work and I have the skills, then why is somebody who's not who I am, who did not go through the training, telling me what I can and can't do? And that comes at the hospital level, from the insurance level, from pharmaceutical companies and your boss, there's always somebody above you that's telling you what you have to do.
And that took the patient, the client, out of the equation. And that was deeply unsettling for me because if any doctor out there imagines, "How would I like my birth to be attended?" You want to be respected. You want to be consented. You want to have some say in this process. We don't have control over birth and we like to think we do. The only person who has any real say is the person you're caring for, and I wasn't seeing that modeled. So for me it was confronting, it was like, "Oh my gosh, I've gone all this way and now I don't like what I'm doing," until I realized, "Oh, I don't have to do it that way. I can actually say, 'Thanks, but I'm okay over here,' and I can start to do things in the way that I do it now."
Kyleigh Banks: I'm sure you've processed that and integrated that into your life, but you make it seem like it was an easy decision and I have a feeling that it might not have been so easy. Did you just step away really quick or was it an ongoing process?
Dr. Nathan Riley: The very last call I did as an OBGYN. So the path was I did four years at Kaiser Los Angeles, so I was a OBGYN basically in Hollywood, which sounds much more luxurious than it actually was, but it was actually a very nice place to train. Very nice people. Everybody's got sunshine and palm trees around, pretty good, compared to, let's say, one of the hospitals in New York city or something where it's ruthless. And you attend, it's a very busy regional referral center, it's Kaiser, they are huge, so 500 plus births during residency.
Then I did a year of fellowship at UC San Diego down in La Jolla. And I worked at Scripps Encinitas as a full-fledged OBGYN up there, attending births, doing surgeries, et cetera, and I gathered more experience and I liked it. And if I was ever going to be an OBGYN in a hospital again, I would hope it'd be at Scripps Encinitas because it was an amazing place. As far as the system is concerned, it was probably the best option I'd found. But then I got recruited out to Kentucky and I was working in a hospital here, Norton Women's and Children's, and it was, again, great experience, great nursing, decent call room, whatever. And I worked and worked and worked. As soon as we got to Kentucky and my wife was pregnant at the time, so it was our first pregnancy.
And it was my very, very last shift, a couple weeks before our baby came, where I was up all night, answering calls, running around, putting things in places, doing exams, all that. And I was like, "Oh my God, I can't keep doing this." And I'm on call all weekend, I'm working all week. And the very, very, I'll never forget it, the very, very last couple hours of that shift, I hadn't yet decided I was leaving, but a woman came in and she had established care with one of the docs and one of the practices that has privileges at this hospital and she had a full blown abruption, meaning there's bleeding all over the bed, and the baby's heart rate was down and we rushed her right back to the operating room. Of course you do a quick consent, introduction, everything else, try to make her feel like, "I know you've never met me, but I'm really worried about you and your baby." And she was like, "Let's go."
So we went to the OR, 37 seconds from skin to baby out. That's what we're trained to do, we're very, very good at C-sections unfortunately, but we saved the baby, we saved the mom. The doctor who was her doctor walked in very casually while I was closing her abdomen and was like, "Hey, how's everything going in here?" And I was like, "I'm done. I'm not doing this anymore." So I was the guy who was in the hospital on backup, whenever people's primary docs couldn't get in. And they wanted to check in, "How's your wife doing or whatever?" And I'm closing up a woman's belly and I was like, "She's good. I'll be done here in a second. I'll meet you outside," or whatever. And I told him the story and I said, "It's been nice to work with you." And then that was my last shift, I just decided there's no way.
So I gave my two weeks and interestingly, the contract, the company that contracted me as a laborist as they call it, the guy who's on call for anything OBGYN-related in the hospital, because these other docs are sleeping at home. Many of them do come in for their patients, but they also can't make it in time, so I'm there as the backup for everybody. And I put in my two weeks, I told them, "I'll do two more weeks of this, but I don't want to do any more than that. I think I'm done with OBGYN." And imagine, again, you've gone your whole life training for this and now you're deciding you don't want to do the thing that you've invested so much of your emotional and mental health into and your finances into.
So that contract, the company that contracted me, actually lost the contract the next week. So I was actually granted freedom, I manifested a job loss for almost everybody there, which was kind of interesting. So I could either sign on with a new company for better pay, actually, but I'd still be doing all the on-call, late night hours, and we had a baby coming in a few weeks, so I made the decision, "I'm done. I'm not going to sign back up." And I just started doing palliative care full-time. And I was in the hospital system again, I was just doing a different role. I was doing palliative care and referring people to hospice and this and that. And we decided mutually to separate as well, because it was not for me, the personality wasn't there for me.
So I did hospice for a year and last September I was caring for a man at the end of his life. And he hadn't seen a face for 18 months because of COVID. And I took my mask off and I connected with him and we talked about his legacy and the wars he was in, he used to play baseball. And you get to know a person and they see your face. It's a person loving them again, and they can't see family, they can't see anybody. Somebody slides a food tray in and creeps out and you're not having any connection after 95 years of life. I took my mask off, of course, and I got fired, somebody reported me and I got fired. And it was like, "The universe is telling me something, it's telling me that I don't belong in the system."
It's a big ego shift whenever you get fired from a job, but I was also, "I should be thanking them. I should be sending them flowers," because it was really more of the same, hospice care was more of the same as what I had been seeing in the system, where it was, "There's an answer, find the drug that meets the diagnosis," or whatever.
And I was pushing back on making people extra sleepy at end of life, and I was like, "What if they don't want that? They look like they're in pain? Well, they don't want to be asleep. They want to grimace. They want to feel this. They want to experience this in the same way that a woman wants to feel birth. They want to connect with the birth. They don't want it to be detached from their baby through an epidural or whatever." And that's not to say, not everybody... Some people want that and that's fine. But I wasn't finding that there was a lot of shared decision making at birth or in death. And that's why I do what I do now, which is very, very, very independent of the system.
Kyleigh Banks: And what do you do now?
Dr. Nathan Riley: Well, I have a holistic practice. I also do part-time palliative care work for a Northern California remote telehealth company, and it's a owned by a dear friend of mine and I can do things there very much the way that I want to, but the vast majority of my time is spent one-on-one with clients or collaborating with midwives. Because I decided I really want to dive back into OBGYN, but the vast majority of my time is taken up by not having a home birth practice of my own. I considered that, I was pricing out how all the stuff I would need to go to people's homes.
And then I realized, "Oh my God, there's all these midwives..." And I think that they just achieved licensure in the state of Kentucky, so there's even more midwives now. "What if I took a step back and I created a platform for them to be able to integrate with me, collaborate with me, without having their patients go to the MFM or the OBGYN down the street that they don't know that doesn't support home birth, that doesn't support shared decision making necessarily," because they weren't modeled that in their training, it's not their fault necessarily.
And so I do that for midwives around the country, is I have this collaborator program for a reasonable fee, you can call on me with any question, "Review these labs, can you order this imaging? Can you order this thing? My patient needs some progesterone supplementation for luteal phase defect because they're struggling with conception. I need these medications ordered because this patient has a history of hemorrhage. Can you order that for me?" And it's been really, really rewarding. So my mission now is to not be an OBGYN, it's to be an OBGYN that has stepped back in order to uphold the midwifery care model of maternity care. And it's been very rewarding and I think that it's going quite well if I must say so.
Kyleigh Banks: Yeah. I feel like I need to make a call to the home birth midwives in my area and just let them know about you, because really I'm talking from experience, the midwife that I had, she had no connection with any OBGYN in the area. So anytime something came up and... Suddenly I had a UTI in early pregnancy and she was like, "I don't have anyone to send you to. I don't know what to do." And no one would take me, no one would give me anything. And in the end I actually had to call around and I ended up lying. And I think I was 17 weeks pregnant and I think I lied and I was like, "I'm 11 weeks pregnant. And so I don't have an OBGYN yet." And just to put a mom in that situation is really fucked up.
Dr. Nathan Riley: Yeah. I will work with almost anybody, there are a couple that I've turned down because I feel like they've come to me because I'm going to help save the day, and that's not an OBGYN's role. Sometimes if you're in the hospital, there are certain things we can do, but just having an OBYGN on your team doesn't mean that some bad things won't happen still. You might have a shoulder dystocia, I can't help you with that. But what if through collaboration, we can help get your patient as healthy as possible through as natural means as possible? And that could be mentally, emotionally, spiritually, or physically. What if we could do that without going to the doctor, that's going to write something in the note or makes somebody you feel bad, you have to lie about what your intuition is telling you about where you want to give birth, if you could avoid that altogether, that's my goal.
And it's been very rewarding for a lot of their clients because they don't have to go into the clinic or the hospital where they are determined to stay out of. But now maybe you do have an infection and we don't want that infection to brew further, so we review the labs together. I'll order the UA, I'll order their culture, "Let's look at the results together and then your patient doesn't even have to lie, doesn't have to go through that process." So sounds like you could have benefited from that collaborative agreement as well. And some states require it, other states, home birth midwives just don't know of any OBGYNs nearby that they can rely on that's going to provide a respectful container for them. And if anybody out there's listening, I'm still accepting collaborators.
Kyleigh Banks: And you also have something going on for the greater world of birth workers where you're going through research and sharing your perspective on that. Is that right?
Dr. Nathan Riley: Yeah. I mean nothing formal, but I do think that there are certain studies, I just posted something on Instagram the other day. It was Netherland study, that as they saw C-section rates rising for, well, for all causes, but especially for an elective C-section for a breech baby. Because ever since 2000, the term breech trial came out and it scared the pants off of every OBGYN out there that, "Oh my gosh, the head's going to get stuck and doomsday is around the corner if the baby's butt first." Well that hasn't ever been the case. Perhaps there is a slight risk of lower Apgar scores when the baby comes out butt first, for example, but this study came out and after one study, across the world, people started offering elective C-section versus vaginal breech. And they've actually, by the way, done a two year followup study on those same people that were in the term breech trial, the same study participants, and the kids had no difference in outcomes, neurodevelopmentally or otherwise at two years out.
So if an apgar score is all that we care about, then I guess the term breech trial was helpful, but it doesn't pan out for the long term outcome that people really care about, which is "My kiddo and I were able to act through our autonomy and have a baby vaginally. And that baby was embodied with all those subtle energetic bodies coming through this tight canal. And I was able to bond immediately with the baby." There's all these other outcomes that nobody considers. We just look at apgar scores, that's it, that's the only thing we care about, healthy mom, healthy baby.
So anyways, the reason I brought that up is that there was Netherland study that showed that as C-section rates have risen for breech babies, they've actually seen a worse maternal outcomes, so women dying from the C-section, pulmonary emboli, sepsis, endometritis, those types of things. So not even just death, but also all these other complications that come with C-sections. So when we weigh risks and benefits of any intervention, we need to consider the whole picture. And with C-section I mentioned neonatal and maternal bonding, but what about the trauma of being strapped down crucifixion style with a sheet two inches in front of your face and your two surgeons are talking about the Super Bowl or something like that? That in and of itself is like, "I'm a freaking person here and you're playing with my guts. Can we just focus on the task? Let alone, I can't see anything and I'm breathing my own exhaust two inches in front of my face, this blue curtain." If you consider all of those metrics, perhaps the risk of C-section may actually outweigh the risk of a vaginal breech birth, but nobody's considering all of that.
So I try to help people understand that in order for a person to make an informed decision, they may decide to have a C-section, that's not my job is to say, "You shouldn't have a C-section," don't get me wrong. But if a person is being coerced into having a C-section without knowing that C-section has incredibly high risks, blood loss, infection rates, decrease mobility afterwards, delayed maternal neonatal bonding, the implications for later, your mortality and morbidity go up dramatically for both mom and baby after you had a first C-section. And it's not just the uterine rupture thing that everybody talks about with the trial of labor after C-section, the TOLAC, it's also that your placenta can grow into the scar, your previous hysterotomy scar. And then you have to have a hysterectomy at your birth and you can't have more kids. The placenta's more likely to be low lying and over the cervix so that you're stuck being faced with another C-section.
And those things, for some reason, aren't as important or whatever, it's just blood loss, it's just, baby's Apgars, it's just the likelihood of NICU admission. And while those things are important, it's not the whole picture. So my whole thing is that if we want to do our job, which is to provide risks, benefits, alternatives, using non-coercive language, and then supporting our clients in doing the thing that feels right to them intuitively, or physically, "That was really hard for my body, I don't want to do that again," then we have to be honest with what the data shows. And we have to be honest with what our experience shows and above all, we need to be able to sit with our patients' decisions and support those decisions, even if it's not what we would do. So that's really my education platform, whether it's through my podcast, through things that I write, interviews that I do like this, that's really what's important to me. And it's a terrible business model, because it's basically saying, "You don't need an OBGYN, so don't come to me."
Kyleigh Banks: Yeah. I think it's a terrible business model, but perfect for just honesty and your soul, I'm sure. I'm sure your soul just thanks you for doing this, instead of having that conversation about the Super Bowl when you're operating on a woman in an emergency situation.
Dr. Nathan Riley: Yeah. So just so over that, it was like, "We are not playing at the park here with our kids. We're not going to catch up. This is a person's birth. Yes, it's a cesarean. Yes, it's dystopic. You must feel that way too. So you're distracting yourself from how weird this is by talking about stuff that I don't care about. I don't care about small talk. Let's just do this. We could do this in 20 minutes. A C-section does not take an hour where you're getting every little bleeder. An hour of chit-chatting is not what I signed up for. Wow. Let's do 20 minutes. Let's do this as quickly as possible so she can be with her baby. And I'm assisting you and I don't think you've even called this right. I don't think you should have done a C-section."
So that cognitive dissonance that we experience, if you're listening and paying attention to how it feels energetically to you, most doctors feel this exact same way. They just got to have these golden handcuffs and other hospital and practice cultures that really prevent them perhaps from listening to their gut, as opposed to just going along with the program, staying in the current.
Kyleigh Banks: As a doula, it's an interesting place to be. I support mostly home births, just because those are the people that find me, but supporting hospital births, it's not something that I want to give up because I want to support these moms, but it's really hard to say, "I'm excited for your hospital birth," because I'm not. Just because what I've seen. It's a weird place. I'm navigating that right now just in my own life.
Dr. Nathan Riley: Yeah. I think there's a lot of truth to what you said, where even if we are fully in support of home birth and we're fully in support of no epidurals and fully in support of vaginal deliveries, or vaginal births, I should say, see there is the habits of delivery, we don't do anything. We just stand there and wait for the baby to come out. But I say except a C-section, I suppose, but I digress. When we start to actually turn ourselves shoulder to shoulder with the system, we start trying to burn the system down, we forget that there's actually a really good reason that we have hospitals and doctors and nurses, there's a good reason we have IVs and medications and surgeries. The problem is that we're over-utilizing those things.
So my whole platform is that there is not a good way to have a baby, so to speak, if you feel most safe at home, or perhaps you feel most safe free birthing, or you feel safer with an elective C-section in the hospital. Wherever you feel most safe, let me give you the full rundown of the risks, benefits, alternatives to that thing, whether it's induction, whether it's medication, whether it's the location of your birth. And if you sit still for 60 seconds and you tune in and you're like, "I thought I wanted a home birth, but I'm too afraid. I don't think my partner's ready, X, Y, or Z. We live too from far from hospital." If you don't feel like that's the right place for you to have a baby, then it's not.
More commonly than not, people are having home births because they don't feel like they resonate with the energy of the hospital. So that's why most people are trying are starting to do that. One exercise for me is, "Why would you want to have a hospital birth?" I have to actually change that language because it's not my decision, it's your decision. And if you're going to have a hospital birth, then let's get excited to have a hospital birth and let's try to keep things... Let's try to get ready for that in any way that we can. So I also am not against that.
If I'm truly an advocate for autonomy, then I need to be able to support whatever it is that you want, even if, it's not something I would do, if you want to chew on glass, sprinkle glass on your salad, that's probably not a good idea to do, I wouldn't recommend that, I wouldn't do that, but hell if that's what you want to do, then that's okay too. It's a strange metaphor, but who's to say that's not right for you. You feel right about it, you have the information, you've got capacity for decision-making, you do whatever is important to you and I'm here to support you in that. And I'll jump in and try to reorganize your informed decision-making process if new information arises. And that takes a big burden off of me, because now you are in charge and I'm here to just support you through information and through space holding.
Kyleigh Banks: I feel like we've been tricked into thinking there's an objective truth in places that objective truth does not exist, which is really intuition, essentially. There's no objective truth there. So I love everything you just said.
Dr. Nathan Riley: Yeah. I think one of the real sticking points for me is that you asked me about what brought me into birth. Well, you see a birth happen, you see a baby emerge into the earth's school and there's something immeasurable about that. It's spiritual, it's emotional, it's mental. Those are things that are hard to quantify. And within the system, we love to focus only on those quantifiable metrics, blood loss, I mentioned them before, blood loss, is mom and baby breathing? Does the mom have an infection? How does the incision look? Is it granulating well? Is it opened up? We need to suture it, whatever. It's just those objectifiable metrics.
But I would also encourage people to consider that you can also measure an experience. You may not think it's measurable, but if a person comes to me five years later and they're in tears describing their first birth, I'd say that's pretty objectifiable. Clearly this has been an emotional burden for you, but unfortunately we don't see that and people aren't asking the question of, "Tell me about your last birth." And when you do, you open up a whole can of worms of, "Oh my gosh, here is the metric." But we don't study that. We're not really interested in the experience. A birth plan is often scoffed at because OBGYN's see it as, "You would never hand a flight plan to a pilot." It's like, "That's not the same thing." We're not driving the birth. We are not the captains of the ship.
But what is important about a birth plan is it tells you what a person's values are. It tells you who they are, it tells you their story, not just, "Here are the pitfalls I don't want to fall into, help me stay out of them." But that's how it's treated, it's like a sushi menu, "We can do that, we can't do that, we can't do that, we can't do that." That's not what this is about, it's actually about building some trust and rapport with this person. And since you don't have the social skills, doctor, midwife, whoever to actually sit with a person and really understand where they're coming from and where they're going, what their purpose is right now, if you can't do that, then you need a piece of paper where they actually have to say, "Hey, dumb, dumb. Here's what I want. Here's what I don't want."
And I'm speaking a little tongue in cheek here, but I've had so many doctors or midwives say, "Oh, birth plan patient, they're going to end up with a C-section." And it's like, "Bro, is that how you would want to be treated if you were having a baby?" And from people like me and you and perhaps many of your listeners, this sounds so silly and so commonsensical, and you want to bash them and you want to say, "Down with the system." It's just they're not trained or incentivized ever to actually get to know this person. And in some ways I just have a lot of compassion for them. Like, oh man, I wish you were happier with the job you were doing because I am so happy with how I spend my time supporting midwives. This is the best job I could have ever imagined. I had no idea that all of that training would've led me here to simply holding space for birth. What a privilege for me to be able to spend my time this way.
Kyleigh Banks: Yeah. You had to go the long way to get there in some funny ways, but that's how the universe works, right?
Dr. Nathan Riley: Yeah.
Kyleigh Banks: You have to sometimes go through some crazy hurdles to finally end up where you are, because you wouldn't be here unless you went through all of that.
Dr. Nathan Riley: Yeah. Right. I'm still on my journey too.
Kyleigh Banks: Yeah, exactly. I love that, the mindset you have is something that is the perfect preparation for birth. I think mindset, in my opinion, mindset is queen in birth. And if you can almost incorporate that throughout your life, even before you're pregnant, wow, it can change your entire birth, which then goes on to change your entire life. So it's really cool to hear your perspective too.
Dr. Nathan Riley: Well, I appreciate that. Thank you. And in the perspectives that you share on your podcast and your social media and whatnot, I don't do every interview, there's a selection process there, but I haven't had too many people reach out that I'm like, "This person doesn't get it. I don't know if this is going to be misconstrued or whatever else." So in some ways it's preaching to the choir.
But another thing I want to emphasize for people that are listening is everybody talks about wanting to make a new world, we all want the world to get better, whatever that means to them. Nobody out there wants to see the world get worse in other words. But if we can't get birth right, how are we going to get anything else right? We're traumatizing our society by not upholding the divine feminine in each and every man and woman. There is a feminine energy that is the water running its course through the mountains, and the masculine is the mountain holding space for that water to do what water does, it erodes, it evolves, it changes the landscape.
The feminine is the power, the creative force behind our entire existence. It is the mountain's job to stand back and to allow that water to ride its course through the gullies, through every little crevasse within the mountains. And the reason that what you're doing is important, is that if we want to actually see the world improve, we need to flip the script a little bit and we actually have to uphold the power of women. And I'm not speaking necessarily cliche that they're quite literally keeping our species alive, but that is a part of it.
The other thing is that we expect men and women to fit into a patriarchal society, which is naturally masculine-dominant. It is forcing the river to go in a direction the river doesn't want to go. So the conversations around birth and whatnot, if we can't uphold that this is not a medical procedure, that this is actually a spiritual process, it merely reflects that our society is devoid of any sort of spiritual concerns. And if we want to see a new world emerge, whether we want to fix the environment, fix whatever, and we can't even get birth right, this is a natural... This is who we are, this is where we all came from, if we can't even get that right, how are we going to actually implement any lasting change in any other part of our society?
Not to mention that when we impose certain things on a birthing woman that leaves her traumatized... I've met so many women who had a natural birth undisturbed birth, healthy mom, healthy baby, they came out of the hospital and they still felt like something didn't feel right about that. What does that mean to how this woman carries that trauma? And I'm using the word trauma intentionally. Because something didn't feel right. I was violated in some way, my rights, the way somebody touched me, they put their hand in my vagina without getting consent. Whatever it was, they see beyond the healthy mom, healthy baby.
So they then finish this birth, they go into the world and they're feeling traumatized by the people that said they were going to take care of them. It's like holding a little kid down and forcing them to get a vaccine, that's traumatizing. And we won't talk about vaccines at all today, but if you're not thoughtful about that, then it's not clear, but I'm telling everybody out there that this is important. Because now we have a whole bunch of women who have never been able to exercise their own autonomy and power and sovereignty, their own intuition, and that means that we are squelching the divine feminine.
So we have traumatized women, we have babies that are traumatized. We have babies that are coming into a space where we don't acknowledge the importance of early childhood years, the importance of the birth experience and how this trauma is going to be gathered up like a big snowball over the years and lead to a society in which nobody feels like you should be able to exercise your autonomy. Nobody has any rights to say, "What happens to me?" And that's a problem. That's a really, really big problem.
So there's a lack of personal responsibility in the world. And I actually think that it's because we have trained everybody to do things based on some higher being, some smarter person that has the answers, and that lack of intuition, that conditioning to not tap into who you are and why you're here, is actually at the heart of every one of our problems, the environmental destruction and everything else. It's all just, like I said, you have babies, you raise your kids, you make your retirement funds, you move to Bermuda and you die. That's, I guess, it. So I'm rambling now, but there's good reason for us to prioritize how we care for women if we want to see a new earth emerge anytime in the near future.
Kyleigh Banks: And you didn't even touch on the whole aspect of a human is being born and they're being brought into the world under this circumstance, and now how can they heal that trauma from their own birth and go on to change this system.
Dr. Nathan Riley: A big ripple effect. Yeah.
Kyleigh Banks: Yeah. And it's such a great point that it just starts with birth.
Dr. Nathan Riley: And if we can't get that right, how can we possibly get corporations to spend their money more wisely or whatever the hell else is important to people out there on Twitter? We can't even get birth right, guys, and we're talking about what the best way to invest in crypto is? Give me a break.
Kyleigh Banks: Yeah. It's that drive to, "I want the test and I want to be told that I'm doing it right and if there's no metric of it's right or wrong, then I don't want to be involved." I did not prepare you to answer this question, but do you have any last practical tips for birth workers to take what you've taught us today and almost help change the birth world, help it be more feminine and less rigid?
Dr. Nathan Riley: I think midwives naturally engage their clients in shared decision making because they don't have all these other powers that are weighing down on them, apart from maybe their state licensure, their state boards or whatever. And I think that in COVID I think we saw something kind of funny happening within even midwifery. I think we saw people, a lot of people, succumbing to fear. And I think that fear does not belong in birth, yet many midwives, doctors and clients of ours have succumbed to the fear of this outside enemy that's coming to get us in this case, a nano-particulate virion.
And without getting into the COVID thing, I think it's important to remember that in order to honor a person's sovereignty and autonomy over what happens to their body, we can't come to them out of a place of fear, because that turns into duress and that turns into coercion. So in other words, if a person feels compelled to have a free birth, because they're afraid of the hospital system, that's not good. If a person feels compelled to have a hospital birth instead of a home birth, because they're afraid of what might happen in a home birth, that's not good.
We need to continue to exercise a distancing of our own personal values and our own sovereignty from that of the person that we're choosing to serve. So that might not make me a lot of friends, but when I hear midwifery conferences requiring N95s and nasal swabs, and everybody's just going along with it, we have to remember the history of midwifery and how you guys lost control over this in the first place. It wasn't your fault. It was a bunch of very rich people, namely the Carnegie Mellons and the Rockefellers of the world that started to actually characterize midwives as dumb, lazy, stupid, and then people didn't want to have births at home anymore. In fact, if you had money, you'd go to the hospital with all these fancy instruments and forceps and all of that.
That was the history of midwifery and that's actually what inspired a lot of midwives to go into this practice, because you don't want to have a systematized way of doing things. Yet, I saw many, many midwives, many older midwives, especially, who were totally nodding along, walking into the conference with the swabs and the masks and everything else. Having said that I don't blame people for doing that, but it didn't just happen in this one instance, it was all over the place. Midwives saying, "I can't take that patient because she won't wear a mask in birth."
I don't think 100 years ago, I don't think a midwife would've turned away a woman who is deeply in need of a midwife or a doula for that matter. And for you to turn them away because they won't wear a mask. If you've got a mask on, triple mask, put your whole self in a giant condom for all I care, but that person needs you. That is what was special about midwifery care. And if you're not willing to take a step back and ask yourself, "What is important to this person? They came to me for help, how can I help them?" Then you're no better than a doctor who's making fun of a birth plan, in my opinion. And people can lash out all the time. I get whipped every single day, I can take it. Hell, I made it through medical training, my ego went out the door a long time ago.
The other thing I think I would say is that many women want to have a home birth. And the key to having a home birth nowadays is to help keep yourself out of the purview of what your midwife's license says. Many midwives won't be able to attend to your birth if you have preeclampsia, if you have poorly controlled diabetes, if you have a placenta that's kicking out, if you had a fourth-degree laceration in your first pregnancy, because that provides a substantial amount of risk in the birth itself. So the licensure boards will say, "Hey, you can't attend that birth midwife because this person has X, Y, or Z."
So the advice I give to midwives and their clients is that you need to take radical responsibility for how you take care of yourself before, during and after pregnancy, to make sure that your soil is as healthy as possible so that you don't develop any of these conditions. And if you want to be able to exercise your true autonomy, then we can't put this in the hands of the licensure boards. You need to make yourself as healthy as possible, move frequently, eat the best type of food.
I just did an interview with Lily Nichols and we talk all about this, but she's a registered dietetic nutritionist, and she wrote the Real Food for Pregnancy, Real Food for Gestational Diabetes. And we talk about this, this is... As well as James Goodlatte of Fit for Birth, if you move, if you exercise in pregnancy and you're eating well and you're sleeping well and doing all the other things for your energetic bodies, the chance of you needing to go to the hospital for your birth is nil. You won't have those things happen, you won't have a big laceration, you won't have stretch marks. You won't even have to worry about how your baby's growing without checking the uterine height all the time, because your body knows how to do this. You just have to go with the right resources.
So if you're determined to keep your client at home or you the client are determined to keep a midwife to have your home birth, it is on you to really live your optimal life. Now is better than ever, whether you're going to get pregnant in the future, you're pregnant now, or you're postpartum, this is critical. And again, "Some other doctor will have a medicine that will prevent that." No, that's not how this works. It's on you. And that's actually the vast majority of one-on-one counseling that I do, is the lifestyle stuff, "Let's get you as healthy as possible and then you're not going to need to go to the hospital. You won't need me ever again."
Kyleigh Banks: You work one-on-one with moms.
Dr. Nathan Riley: I do. Yeah.
Kyleigh Banks: That's phenomenal.
Dr. Nathan Riley: And I call it lifestyle medicine, it's like a buzzword, but we do everything from chakra loading and balancing. I use some biogeometry principles, I use some homeopathic principles, and then the diet, movement, sleep, hydration, the whole lifestyle package. There's not a lot of doctors, I think, that really have an expertise in that field, through personal experience, and having to suffer through my own adrenal fatigue and other medical issues when I was in residency. So what I can say for sure is that if you can get your lifestyle in order, using the resources you have, this isn't rocket science, you don't go broke on this, but if you're using the resources you can to optimize the soil or the temple, as you want to call it, you won't ever need a doctor. Period.
Kyleigh Banks: I look back on my pregnancy and I actually say to myself, I was damn lucky, because I didn't do any of the things to take care of my health and I had a flawless home birth. I look back and I was damn lucky. And I just know if I ever have another, from day one, even now, starting now, I have to change my life. If I want to really remain out of the hospital system, I can't wing it again. I can't just do what I did again. So I really appreciate that you make that a part of your practice.
Dr. Nathan Riley: Well, and don't get me wrong, not everybody has to hire me to ensure that they have a healthy pregnancy. I prefer if I didn't have everybody knocking on my door. I do have a bunch of clients now, and I have space for more, but the bottom line is that your body actually will probably grow a normal, healthy baby and you won't have any of these issues. And I don't want people to be afraid that's going to happen if they don't come and start working with me.
But if you did have, let's say, a perineal laceration's a really great example. If you're afraid of having a perineal laceration, getting your tissues as healthy as possible will make the tissue elastic and it's rich with blood supply and it heals really quickly, everything in the pelvis comes back to normal. Many, many people who develop issues later, like incontinence or back pain or flatulence, that type of thing, it's something that is delayed from the birth all the way down the road, because their health wasn't optimal, but your body, the mom's body will take nutrition from wherever it needs in the body to give it to the baby. So a lot of people have a totally healthy pregnancy and then they find themselves broken mentally, emotionally, spiritually, physically, 10 years later.
So that's the other part of it, is that I can't look into the future for people, but if you're taking care of your body through healthy food, movement, patterns, et cetera, there is a darn good chance that you're investing a little bit of money now into doing that and time into that, is going to pay off dividends for decades later. So of course, I can't say, "Look at where you would be and here you are now," I can't do that. But through all of my experience, this is definitely true. There's been plenty of longitudinal studies that support exercise and eating more protein and fat, for example, in your pregnancy versus big gulps.
So even if people did have a really, really healthy first pregnancy, also, you have to consider the epigenetic programming of the fetus in utero when you're feeding it sugar all day long. And so even if you did have a healthy pregnancy, baby was growing well, that kiddo, if you develop diabetes in your pregnancy has a high chance of developing diabetes early in life, the birth. So there's all these considerations that I guess we won't have time to get into today, but treat your body like a temple. Do whatever is in your power and your resources, and your time, given you may have 10 kids running around, in order to put the right things into your body, move well, sleep well, et cetera.
Kyleigh Banks: Since we skipped the whole intro part, will you just tell everyone again who you are and where they can find you?
Dr. Nathan Riley: Yeah, my name's Nathan Riley. I'm an MD. I'm also a fellow of ACOG, meaning I'm fully board-certified and all that jazz. I'm also a hospice physician. And I practice in Louisville, Kentucky, my practice is completely remote. I've got licenses in a variety of states, I don't need a license in every state to practice to do what I do. But I've got a variety of state licenses just because I'm collecting them. And I have a telehealth practice which is belovedholistics.com.
Also, on my website, you'll find information about my collaborator program, which is really where I'm investing the vast majority of my time. And that is depending on your needs, there's three different levels, but you can either have me as a one-on-one consultant, anytime you need to run anything by me so that you don't have to try to find a doc, like you did. And then at the gold level, I actually have a twice monthly peer review and I'll do all the ordering of meds, labs, imaging, whatever is needed as well, using my license to do that. So for any midwives, birth educators, doulas, anybody in the world of caring for people that would like an open-minded doc who speaks and thinks like me, then you can have me, you can come into my collaborator program and you'll have an MD consultant anytime that you need one.
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.