Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a birth doula, hypnobirthing educator, and pediatric sleep consultant.

Samantha is a birth doula, childbirth educator, and lactation counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Hello, everyone.

Today we have with us Sabrina Ortolano.

She is a birth doula who has been supporting families for nearly 30 years.

She is also the owner of IPSB, Los Angeles' longest running bodywork school, where she's the head instructor for courses on prenatal massage and this history of birth in the United States.

Sabrina's teaching emphasizes how to provide the best care and support for clients navigating major life transitions and milestones with a particular focus on the birth experience and its various nuances.

We are so excited to have you here today with us, Sabrina.

Oh, thank you so much for having me.

I'm so excited to be a part of what you're doing here.

Yeah.

I love your podcast.

It's very cool.

Oh, thank you.

We are, yeah, we're very excited to have you here today and talk about some really cool stuff, I think.

I think we had a conversation a few weeks back, kind of talking about what we might wanna talk about and we all just got so excited and it was so cool that there's so many different things that we can discuss today.

So I'm excited to get into something that I've always been really interested in and kind of dive into that.

So to start us off, we know that birth has changed quite a bit in the United States over the decades, centuries, all of that.

Can you give us kind of a brief rundown of what birth kind of used to look like and kind of how it's changed over the course of the past century or so?

You know, it's interesting.

I think a lot about, I'm 51 this year and my generation is like just on the edges of when things like Twilight birth were common.

And I think it's important to be aware of that because the way that we've approached birth over time in our medical industry in particular can define how some of the underlying currents of how our cultures function.

So for those of you that don't know, Twilight birth was the perspective that like, we don't need to actually, like we have anesthesia, we have all these great things, we don't need to suffer through birth, right?

So what would happen in the like 60s, early 70s, and one of the reasons we had this like back to the back to the earth movement and push against the medicalization of birth was, Twilight birth was really common.

What would happen is the person who's pregnant would check into the hospital, they would get sedated, they would be under rest, tied with restraints to the bed, and they would basically have, the medication they were given was the kind of medication that you would use for like brain surgery, where your body is still able to move and you can respond to things, but you don't remember anything.

So you would sometimes be sedated for three or four days, you'd be lined up in rooms full of other people who were going through similar experiences.

You would have your baby without any awareness of it happening.

And then you'd wake up a few days later and someone would say, this is your kid.

And what we know now around how important things like that golden hour, that first hour after birth, and how it helps you bond to your child and recognize your child and how it helps regulate the baby's breathing and heart rate and all of those things like them being skin to skin contact is so necessary for them being a healthy baby.

But not having that had really poor outcomes.

Like one of the reasons we don't do things like four steps birth anymore, it took a lot of, unfortunately a lot of studying, but oh, it turns out that if you save the 10 minutes, which is about 10 to 15 minutes is all it saved, grabbing onto the baby's head with like tongs basically, and squeezing and pulling them out forcefully, because the parent was sedated and couldn't push, it causes brain damage and our instance of other neurological injuries is higher, right?

It took an entire generation of people having all of these injuries for us to say, oh, maybe that's not a good idea, right?

And if you think about, we have an entire generation of people who were born in Twilight, who have challenges with connecting with their parents, right?

Think about this.

So this is our, this is our boomer generation.

A lot of them had birthed in Twilight.

So the initial connection, and we're also told only poor people breastfeed.

We have bottled formula now, why would you do that?

Don't spoil your child.

Don't hold them all the time because you're spoiling them.

So all of the things we know now about attached parenting and bonding, and even just on a chemical basis, how our bodies react to our children and how we learn their language and how their nuances by holding them and being in that shared kind of chemical bond is so vital for a healthy relationship between parent and child that we sabotage that completely for an entire generation.

And if you look at that as an overarching thing, like I spent a lot of time thinking about this lately.

From an overarching perspective, the differences in the way that the generations communicate and interact, like I'm Gen X.

It's like, okay, yeah, so go outside and I don't wanna see you until the lights come on, right?

There's a lot of running jokes about that, but the lack of a desire to be close to your child is really indicative of the lack of a bond, right?

And it's not that their parents were bad or wrong.

I'm not saying any of those things.

It's that culturally we know better, so we're trying to do a little better, right?

However, there are other challenges involved in all of that.

So each generation has a challenge, but what happened before informs what we're fighting with or struggling with now.

Yeah, I tell people in the childbirth education classes that I teach, you know, it's not that we talk about, you know, the myths and misunderstandings handed down through the ages of childbirth, that we think things are so scary, but when we find out the why, it's just that we didn't know better back then, you know, and that is why the bad things were happening.

And not because anyone was evil or mean, well, I mean, sometimes, but generally, they thought they were helping.

And so they were like, if this amount of intervention helps, let's add more because we're helping.

And really we were inadvertently making this divide between the parent and the child and this disconnect between what's happening with your body and your brain.

And that is not to say that anyone was trying to be bad or mean.

They were trying to save us from what they thought we needed to be saved from, although we didn't all want to be saved.

So.

Well, and it's kind of like an overcorrection too of how bad things used to be.

There used to be nothing anybody could ever do for any sort of pain or saving a baby who did need help coming out.

So it used to be that there were no options.

And then we all of a sudden got all these options and they were like, oh, wait a minute, we have these now and everyone should have them.

And it was almost like a novel thing.

And so it's like the best cool thing out there.

So we all wanna do it.

Well, and if you think about it, the only positive thing that happens in a hospital is childbirth.

Right.

So of course, the desire to have a positive and like it's a human thing.

I wanna be a part of a good happy thing, right?

Of course I wanna be there during like the beginning of their life, but if the perspective is, you know, like it's the old chestnut of like, okay, if the only tool you have in the hammer, everything is nailed, right?

So if you are a medical provider where the only option you have is all of these interventions, because in every other instance, it is completely appropriate to shower these interventions because it helps save lives.

Then of course your perspective is this is the most appropriate thing to do.

Of course, because your underlying understanding of how the world works comes from the perspective of like interventions are good and appropriate.

Birth is the only instance where we're in a quote unquote medical experience where less interventions are actually helpful.

And it's a weird thing.

It's a complete paradigm shift.

And it's not a normal thing for a medical provider.

And especially in our culture, we really are like, you know, I think that my wife had cancer and I am so grateful for all of the care providers, but I also have a really clear understanding that like a medical advocacy is very important.

And there is definitely a culture in American medicine of like the white coat is God and you should not question.

And I think that you shouldn't question out of fear.

You should question out of education, but also like we're responsible for our care that way.

And it is really hard to find a nuanced balance in that.

And except what's helpful and good and what's also understand like I wanna opt out of what's not good for me.

I think that our clients have a hard time with that sometimes when we're speaking with them or even our childbirth education participants that aren't even our clients.

I find myself so often saying, I'm not saying obese or evil.

I'm not saying doctors are bad because every time I tell them things are done for provider preference versus medical necessity sometimes.

Or like, you've got to be on your toes a little bit with this because they may want to do this.

I'm not, just because it's easier for them, more convenient.

And then they think I'm saying, they take that as doctors, you're saying doctors are bad, blah, blah.

No, I'm not.

So in any situation, you should know what's going on with your body and your experience and be able to ask questions without it being an offense.

You're not questioning them, you're asking questions, you know?

And so the attitude behind it can just be from a place of understanding, wanting to understand.

When I don't think that that was really a thing back when women were being, or people were being put under twilight for these situations, there wasn't information.

Well, if you think about it too, like I was born in 1973, that was the year Roe v.

Wade went through.

71 was the first year that a woman could have a bank account without having a male relative sign for them, where their actual name could be on a bank account.

So of course there was no questioning.

Okay, that was culturally not, like we were not autonomous humans.

And in the earlier, like earlier in my lifetime and earlier like 60s and 70s even up to then, the reality was because we were not separate, autonomous creatures, we were children that needed to be cared for.

And also that was a whole cultural perspective.

And however responsible we were for things, we were still like silly little children that needed to be cared for, we were hysterical.

And so that there's a perspective around how we were spoken to and how we were interacted with.

And also, I mean, really it was in 70s before partners were allowed to be at a birth and see what was done to their partner.

Okay, and that's one of the things, like Twilight Birth was part of what caused that uproar because spouses would get their partners home with their child and they would be covered in bruises.

And they wanted to know why.

Why can't I be there to see my child born?

Why can't I be a part of that and support my partner?

The idea that they're a team and they should be able to participate in this major life-changing event that affects both of them was a new concept.

It was always, dad's out there in the waiting room with a cigar, like doing the hard work, right?

Like, we're just in here doing the girls' work, right?

And this whole cultural concept of the like, you know, there's a complete separation and they shouldn't see these dirty things because we have to stay pretty.

You know, this whole thing was just, it's a disadvantage for both partners because the ability to rely on each other and trust each other and support each other is so much stronger when you have been through something that is so profoundly life-changing together.

And it is, yeah.

It makes relationships stronger.

Yeah, I think that it's so hard to even just get that point across to people when we're educating and meeting with our clients.

It's hard to explain how profound that moment is until you have experienced it, how life-changing it is, not just to see your partner do this amazing, powerful, crazy thing that you could never do as a male, but also to watch life come into the world, watch your person become an entirely new person with the birth of this child.

And I try to explain it sometimes, and I don't know how.

It really is just so life-changing, and I really think that everyone needs to have the experience of seeing that happen at least once in their lives, especially partners who do not get to give birth.

Being able to see that and be a part of that is going to set you up for supporting your partner in the postpartum.

Yeah, that connection that turns on.

If you think about back in the day, what it used to look like for partners that were not in the room, not even involved, and then you think about the dynamic at home.

Were the men or the other partner, were they helping rear the children?

Or were they really just the wait till your dad gets home and really the dad's just off at work and the mom's at home caring for these seven children or whatever, and it's like two separate lives ships passing in the night because really he wasn't so involved.

And then you think is how we're evolving of we have some rockstar partners as birth partner.

Like, oh my gosh.

Sometimes I'm just like blindsided with how great they are.

And sometimes we still have partners that are fairly disconnected.

But I would say the tides have shifted quite a bit to where we have ones that really wanna be involved.

And then if you take that and then add when we have partners who wanna help catch their baby and we're the first ones touching their baby, it's like an even higher, even deeper connection.

I went to a birth, dad didn't necessarily plan on catching, but he did.

He wanted to receive his daughter and they did.

And he was like, I wouldn't have been able to do this in a regular hospital room, would I?

I was like, no, they wouldn't have, no.

And he was like, I can't imagine not being the one to have done that.

And then I went to their postpartum followup and the mom was laughing.

She was like, when I feed her, I get her.

Otherwise, she's skin to skin with daddy, right there.

You see that?

And he's just on the bed with her on his chest and I was like, what?

We're just having our moment, you know?

It's like that ownership of, I am now part of this equation and it's not just like the default parent of the mom and she's gonna take care of the house and do all the things.

It's like, he's changing the diapers.

So it might seem so simple, like, oh, it's just the birth.

No, he's the birth.

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Yeah, it makes such a difference.

And it's also the, I was at a birth on Monday, and watching how they depend on each other.

I think this is one of those things, as a doula, learning to be responsible for it, stepping back and helping them foster their relationship, and not trying to swoop in and be the hero in that.

You get this moment where I'm like, oh God, I feel like I've leveled up as a doula, because I'm like, okay, so there's a huge height difference.

And she's more comfortable with my height, because I'm shorter than you.

Like, let's get you on a stool so she can lean on you.

Right?

Because he was like, he was hurt, because she wanted to lean on me, because I was shorter.

And she couldn't express it.

She's just uncomfortable, right?

And she's just like, no, I need her, because she's shorter.

And he was just so, like, there was this moment, I watched him, like his feeling was just good.

You know, and I was like, oh, I'm like, why don't you sit on the stool?

And I'm like, I'm just gonna sit on the couch, and you guys do your thing.

And he felt so, like, engaged.

It was so beautiful that he had the answer.

I was like, let me explain what I'm doing on her back.

Let me explain how to do this with the idea of like, let me help you be the person that she needs in this moment.

It's so cool.

It really is.

Getting to see them, like, we just did a postpartum visit, and getting to see them and like, how he's like really engaged with making sure she's eating and she's comfortable and she has all this stuff and like, like that personal responsibility and that level of partnership is so beautiful.

And it means that they're better equipped to support each other.

I love that so much.

It is.

And you're right.

It not only filters in their care for their child, it filters into their care for their partner because that starts in pregnancy.

You know, are they really making, you know, little changes to their life that you're also having to make just because you're the pregnant one?

Like, are they doing those things with you?

That's really nice.

Do you feel like you have that kind of camaraderie, like somebody else is on my team and doing these things with me?

I know you don't have to breathe, but let's practice breathing techniques so that you know what they're going through and you know how to help coach them before I'm there, you know, or whatever.

You're the one in the moment that's coaching them.

And then that filters into the birth and then that filters into postpartum with the baby, but also with taking care of the partner again, with the feeding, like you're saying and all of that.

And I think that's such a great transition into our next question, which is like, what's been the evolution of the village?

Or I feel like maybe a devolving of the village and maybe it's not an evolution.

You want to touch on that a little bit, like where we've been, where we went to, now where we're going?

So, you know, it's interesting because I was just having a meeting yesterday with one of the people I work with at our school and like, you know, because we're launching our new program next year and we're talking about like, how can we support the community more and like what free workshops can we do to like help the people who are like, my friend's having a baby, what do I do?

Like, how do we do stuff like that, right?

Because the reality is, is like American individualism is not helpful for the family at all.

It just isolates you and makes you feel like you're a failure because you can't keep up with your life.

And the first year postpartum is not something any one person can keep up with.

It's not something any two people can keep up with frankly, especially if you have to earn a living and or, you know, as in the US, which is just insane to me, go back to work six weeks after having a baby.

It's ridiculous.

Like if you had major abdominal surgery, you've made your abdominal surgery, you have any sort of major surgery, six weeks, like you're still on partial duty, can barely do anything.

But how you have a baby where like, you've had a major body event and also are responsible for caring for another human.

Oh, go get out there.

Like it's crazy.

When you have a knee surgery, no one's waking you up every two hours to feed somebody else in the middle of the night either.

I have my knee replaced and I'm like three months of like, don't even talk to me.

I can't.

I was on disability for three months because I could not function.

And it's similar, but no, we just expect you to bounce back and be normal, quote unquote.

It's insane.

And the thing that's challenging about this is we have the, I mean, I feel like social media is no one's friend that way, but the level of privilege involved in being able to afford all of the support, like I had a client at one point who like, she hired me for her pre-needle doula or birth doula.

And like, I saw her every week before doing massage.

So I got to know her really well, but she's an extraordinary amount of privilege.

I'm in Los Angeles.

There's a lot of money here.

And there's also contrasting, a complete contrast in the like resource categories.

And for her in particular, like she had a housekeeper, she had a postpartum doula, she had a night nurse, she had all of this support that was there.

And she had an extraordinary recovery.

She slept when she wanted to sleep.

If she was tired, she had someone making food for her and the house was cared for and someone helped care for the baby and made sure that she was successful at breastfeeding and had all the resources she needed.

And she was, and that's beautiful.

And I love that she had that, but it really highlighted for me how few people have that.

And it's like these days, instead of having your village, especially in the United States, it's you have to pay for your village.

And if you can't pay for a village, you don't get one.

And I hope you know your neighbors and they might sign you up for a meal train.

Like, I mean, it's very few and far between, very rare to have people who know.

And I know in our, spoiler alert, we're gonna have two episodes with Sabrina already.

We were so excited about everything with her.

We planned two right off the bat.

We already have a third in mind.

But we'll dive a little bit deeper into what that looks like.

But in the grand scheme of things, we went from having people take care of people to not really having that because everyone's working and we're busy in the hustle and bustle, to now having to try to pay for it and not everybody can pay for it.

So then we see just the families that don't make it and people that are just run ragged and they're completely empty and their bodies aren't even able to heal because they can't sleep.

They can't do any of these things.

And we talked to a physical therapist, like a child physical therapist and she was talking about how when we fix one thing, for example, having babies sleep on their back instead of their belly.

Well, we fixed one thing, we reduced SIDS, right?

But then now we have flat spots on baby's heads, right?

So it's like, you fix one thing and another thing breaks and then you gotta learn how to fix that thing to deal with it.

And it's kinda like when you take a medication and it has a side effect, so you have to take another medication to help with that side effect.

And it feels like that's what we're doing in our families is we're having to try to fix it, but even having people that are not in your actual village, if you're just paying for the village, it's just not the same.

Yeah, now it's a money exchange situation.

It's not just from the heart, although doulas, we do this for hard work, but we do have to get paid.

We also have to pay for our lives.

Yeah, and we don't have, I mean, for most of us, we're working on building personal connections with our clients, but in the long run, we're not your best friend.

We wanna be your birth boss friend, but we're not your best friend.

We don't know all of the backstory, all of the things that make you you, and we don't always know how to support you in the way that's best without having some additional input.

And I think like just of that idea of the village, like we're talking about like an actual village of people that used to support pregnant women.

They're used to, you go into labor and all of the women came, everybody was there.

And there was somebody there taking care of your older children and cooking for you and cleaning for you and helping throughout your end of pregnancy and birth and postpartum.

And then we turned into, we went through like in the early 1900s, this phase of, no, like pregnancy is dirty, pregnancy is gross.

God forbid anyone has ever had sex and there's proof of it.

And we don't ever talk about it.

And women were expected to be knocked out at the hospital and not have anybody there to support them and then come home to this alien that they birthed, that they don't remember birthing, that they were also kind of ashamed of being pregnant with but also excited for it because that's our sole purpose in life.

And we're solo, there's nobody, you can't ask for help.

Maybe your mom is there, but that's it.

And now we're like kind of getting into this place where like we're starting to understand, yes, there's doulas, we can ask our friends for help.

There's a great app online called Mealtrain.

Everybody can sign up for it.

We have occupational therapists and all these things.

And there's some, I think, advantages to that model.

But I don't think it could ever replace the actual family taking care of you, people who know you, who love you, taking care of you.

Well, and I have to say too, I think to some extent that can be idealized because like I have very challenging relationships with my family.

Like if my family showed up at my birth, that would be a problem.

I think we mean the family you make.

That's your good point.

The family you've chosen.

That's one of the things where I'm like, when I first started attending births, I've been showing up at births now for almost 30 years.

And part of the reason for that is because so many of my close circle were people that came in from different states.

California is full of people who have moved from other states for various reasons.

And so there's not this like infrastructure that's already there.

And like you're very alone a lot of the time because you're just establishing your community.

And so when my friends started having babies, it was like, I don't know, like some of them it was my partner's not safe, my partner's not someone I wanna be around, or the sperm donor is not someone I ever wanna talk to again.

All of those things that happen that are challenging are how do you build that infrastructure and find people that you trust to do those things.

And it's really hard.

Money is a situation there, right?

So people that are going through those hard times and don't have people around for them, how do they pay for that even in birth work, not even postpartum?

Like how do you pay somebody to be with you?

And how do you find that person?

And of course, the internet, it's a lot easier these days in social media and that sort of thing.

It does make it easier to find.

But again, like that's a privilege to be able to afford that.

And luckily there are programs like here in Austin, we have one that's, nobody should birth alone and people donate to that and that is helpful, but it's still not the ideal situation of having that close village of friends and family or friends that you call family around you to do that.

In California here, they just added doula care.

So prenatal visits, birth and a postpartum visit to MediCal so that people who don't have the resource can still get some of the support they need, which I think is extraordinary because the birth outcomes are so low for MediCal supported births a lot of the time.

And I think that that's just so important.

I'm really excited that they did that.

I'm gonna be, one of the things we're going to be offering in our postpartum and doula trainings is a workshop on how to sign yourself up to be a provider for MediCal.

So that, because like I donate time a lot of the time, like I don't see a lot of births these days.

It's more, if you really want me to be there and I'm your person, I will show up, okay?

But I'm not doing it as my main source of income anymore because I have so many other projects.

So I'm like, okay, so when we, when I'm there, it's because you really wanted me there and we just, we'll figure out like what it's gonna cost.

But I have a luxury to be able to do that.

It's definitely like, when birth work was my main thing, I couldn't afford to pay my bills if I didn't have X number of births that paid X amount.

Right?

And it means that I didn't have the luxury to show up for people in the way that I really want to in that way.

And I've created my life in a way that makes that makes that make sense.

But it's, I'm lucky.

I'm really lucky in that.

And I know that.

And it's one of the reasons that, you know, we've had a lot of conversation.

I know we talked about this a little bit when we met because we talked for ever.

I enjoy you guys.

But part of the reason that I'm looking at establishing a massage doula training is to help doulas have more than one stream of revenue so that they can have, when they don't burn out as quickly, it means that you have a little more access to money.

And it means that your life can be a little more stable.

So, I'm like, the years that I was doing this full time, I'm like, I didn't come to my own birthday party.

I missed all the holidays.

You know, I'm like, I was just like, oh, I'd love to do that, but I'm on call for a birth.

And you can't leave your house.

You have to have your kit with you all the time, all of these things.

And it's like, it's beautiful and it's extraordinary life changing work.

And I would never, I have no regrets.

But I also recognize that for me, doing it full time was unsustainable.

And that's where we see a lot of people who get into it and they're so excited.

And then they're like, this is just not sustainable because everyone else in my life is suffering.

And so looking for ways to make this accessible to more people, so they have the support they need and finding ways to make it possible for the practitioners to show up and thrive in this work, not sacrifice all the time.

Because I feel like things that are birth related in particular are expected to have so much sacrifice around them.

Yes.

That I just think it's really unhealthy.

I agree.

We have to find ways to approach this from like, no, we shouldn't have to suffer all the time just because we want to have a family.

Yeah.

You know, it's one of the reasons you see declining birth rates is because the expectation is if you have a baby, you're gonna suffer and you're gonna have less opportunity and less resources and all those things.

That's our memory.

Your career is gonna suffer if you already had one, like glad you worked on it, but sorry, it's gonna taper off here and then you're gonna have a big gap.

Yeah, you're gonna have a big gap on your resume.

I was actually just talking to my 14 year old about this.

She was talking about what she wants to be when she grows up.

And I was like, okay, but you have to think, do you want to have a family?

Do you want to stay home with your kids?

You have to think about whatever realm you get into.

When that time comes and you decide you wanna have children, then you might wanna take four years off to be home with your kids before they start school.

And if you do that, you're gonna have a gap on your resume.

And I'm sorry, but the real world situation is that for women who have a gap on their resume because of staying home, if somebody else applies for that job and they have more recent experience, they get chosen, you know?

Like, my husband was like, Ciarra, this is really far off.

Like, you're really getting into it here.

I was like, I don't care.

She needs to know when she thinks about planning her future that this is something.

And my husband goes, and we're not watching your kids all day, by the way.

So this is so helpful.

And I think, like we already told people, we have another episode coming up.

So we are gonna bring Sabrina back to talk more about this village and the different groups and how this affects different people.

But real quick, in case somebody doesn't listen to the next episode, can you tell people how to find you and what it is you're doing?

You teased a little bit that you have this massage school.

How do people find you online and learn more about what you're doing?

Okay, so the massage school is IPSB.

So it's ipsb.com is our website.

And my email is sabrinatipsb.com.

It's very simple.

We're in the process of moving into a new building.

So next year, 2025, we'll be launching a whole bunch of programs and community mixers and events and things that are gonna be happening.

So, you know, signing up for the newsletter there, we'll get you on the mailing list to make sure that you hear about what's going on with everything.

So yeah, that's the best way to find us.

I love it.

Thank you so much for coming on and sharing all about all this.

I think the history stuff is just so exciting.

Someday I'm gonna have to do a whole series on it.

I've been talking about it since we started this podcast, because I think it's just so interesting.

And so I love that we get to start that conversation.

But thank you for coming on and everybody tune in next week to hear more from Sabrina.

Bye.

Thank you for joining us on Birth, Baby.

Thanks again to Longing for Orpheus for our music.

You can look him up on Spotify.

Remember to leave a review, share and follow wherever you get your podcasts.

See you next week.