EP 179: Empowering Parents and Birth Workers through Advocacy with Meredith and Alicia of Intentional Birth

In this episode of The Aligned Birth Podcast, Rachael Hutchins interviews experienced doulas Meredith and Alicia to explore the concept of Intentional Birth. They discuss the importance of aligning birth choices with personal values, advocating for oneself during pregnancy and labor, and recognizing physiological needs in birth. The conversation highlights birth hijackers—factors that can undermine confidence and disrupt a positive birth experience—and provides tools for parents to stay informed and empowered.

Key takeaways include:
✔ Intentional birth starts with purpose and self-awareness.
✔ Advocacy begins in prenatal visits and continues through labor.
✔ Understanding birth physiology helps maintain confidence.
✔ Parents should recognize and address birth hijackers.
✔ Collaboration between doulas, midwives, and medical teams strengthens advocacy.

Tune in to gain insights on how to approach birth with knowledge, confidence, and intentionality!

Connect with Meredith and Alicia

Chapters
00:00 Introduction to Intentional Birth
02:16 The Concept of Intentional Birth
05:44 Key Steps for Expecting Parents
11:00 Advocacy for Parents
19:40 Understanding Physiology in Birth
27:56 Identifying Birth Hijackers
33:31 Understanding Birth Hijackers and Intuition
38:23 The Role of Doulas and Birth Workers
42:38 Defining Roles in Birth Advocacy
49:23 Tools for Effective Advocacy
53:30 Training for Doulas: Advocacy and Beyond
01:00:01 Empowering Choices: What Do You Want?

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Chapters

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• 14:07 (Cont.) Untitled Episode

Transcript

Rachael Hutchins (00:01.628)
Hello, hello. You are listening to the Aligned Birth podcast. I am thrilled to be bringing to you today an exciting interview with two gals I connected with last October. And since then, I've just kind of gone all in on all things intentional birth. And I'm so excited to share them with you today. So today I have Meredith and Alicia and their little story, their background or their big story, actually, is that they met as busy.

San Francisco Bay area doulas back in 2015, the bud of a deep friendship that carried them through the birth of Alicia's fourth child and the death of Alicia's husband shortly after. More than a decade of active birth work, serving hundreds of families led them to expand their reach and create intentional birth. They now provide truly honest education, both to birth workers and to families around the world. And they are grateful to see the ripple spreading. Mothers taking personal responsibility.

Partners stepping up as advocates, families being transformed through their own powerful choices and through respectful care. Duelists finding their feet through solid mentorship and loving support, as well as patient advocacy training. Today, they live and work in the same small town in rural Virginia. Welcome Meredith and Alicia.

Alicia (01:20.46)
Thank you for having us, Rachel.

Meredith Nelson (01:20.486)
Thank you, Rachel.

Rachael Hutchins (01:23.461)
What a story ten years together that's amazing you guys have been on quite the journey together

Alicia (01:27.992)
Thanks.

It has been. It's much more than we ever dreamed of, Meredith?

Meredith Nelson (01:36.367)
Definitely, I can't believe it's been that long. It was a slow burn at first, Rachel. It wasn't love at first sight, we love each other. But the best friendship definitely evolved.

Alicia (01:40.11)
you.

Alicia (01:47.192)
Mm-hmm.

Rachael Hutchins (01:48.112)
I can relate to that for sure. And I am inspired by you guys so much and you're hearing about your backgrounds and your journey. And I know that's just like a tiny little, little peek into your history together, but you guys are doing so much and it's so inspiring. So the term intentional birth, love this term. It's something we hear more and more. Can you share what that means to you and why it's such an important concept for birthing families?

Alicia (02:16.494)
Sure, I should just say that Meredith came up with this name. I remember we were out on a hike and trying to think of a name for this new business that we were gonna have and Meredith comes up with a lot of our best ideas. But I think what we're trying to convey is that birth can look a lot of different ways, but that if you're entering into it with intentionality, then the likelihood that you are going to be satisfied with it is so much higher.

And the truth is, whatever parents choose, whether it's an unmedicated physiologic birth or a planned cesarean, that if you do it with intentionality, you will come out on the other side feeling great about the experience that you chose.

Rachael Hutchins (03:01.536)
so true. Yeah, that word intentional. It is so all encompassing. And for our audience, that was Alicia talking. And Meredith, do you have anything to add to that?

Meredith Nelson (03:15.258)
Yeah, unfortunately, we live in a culture in which birth has, I think, well, let's start over. Most families are giving birth inside of the medical system. And the medical system is a wonderful gift with incredible tools to help make birth safer and better. And at the same time,

in order for things to go well in a hospital and for their care to proceed well for large groups of people, right, coming in and out every day, they have systems, they have policies that they have to follow, right? And so it's something like an industrial process, and that sounds like a really negative term, but it's easy to get kind of stuck in this routine care.

cycle that's not personalized. So if you go in with no intentionality, no preparation, no knowledge of your rights and your responsibilities, then you kind of do end up on this kind of conveyor belt and it's easy to have some of your personal needs missed and to receive recommendations that maybe aren't the ideal for your family and your values. So bringing a little bit of intentionality into your pregnancy and your planning process.

can help you find a birth, a birthplace, a birth provider that's more aligned with your needs so that you don't just end up with the routine, but you get what your family really needs.

Rachael Hutchins (04:57.148)
Yes, yes, all of it. Yes, I love it. And all of this is so inspiring and I'm excited to kind of break our conversation down into kind of two main group or categories today. So we're going to talk first about expecting parents and how they can apply this to their preparation, everything you just said, and then also to birth workers, because you guys work with both. Both work is so important. And so we're going to start by talking about

expecting parents. So we're going talk to that group first. So listen up if you're expecting. So what are the key steps to planning an intentional birth? A little bit expand a little bit more on some of the stuff you just said because you delayed it for it. You laid it really well out for us. So if you can expand a little bit more on those key steps.

Alicia (05:44.878)
Well, I think, you it all starts with values. That's where we always like to begin. What are the values of this mother and her partner? What is it that's important to them? What are their deeply held beliefs? And the reason we want to start there is because whenever there is a decision to be made along the way, a mom and her partner can look at their values and see which decision lines up with those values. And...

That way she's making a decision that comes from her and truly from her rather than feeling pressure from anyone else to do a certain thing or make a certain decision. And we're far less likely to have the woulda, coulda, shoulda when we've made a decision that comes from our own intuition that is aligned with our values. And that's why we always start there.

Meredith Nelson (06:38.674)
So maybe we should give a couple of examples, Alicia. A lot of the clients that I work with really value physiology. They really valued kind of trusting their body's process and not interfering with it unless there's a clear necessity to do so. So that's a value that they hold and that they can refer to as they're making decisions. It's also a value that they might choose to consciously, intentionally release at some point if it becomes clear to them.

that another value is going to be served by a decision. For instance, the value of the safety and health of their child, right? And so just knowing what your values are upfront gives you a map.

and a set of guidelines on which to base your informed decisions down the line. So that when the OB comes into the room and says, hey, I'd like to break your water right now, it's going to help speed up your labor and let's move on. Then you can kind of sit back and say, well, how does this align with my values? Well, one of my values is patience with the process. I'm going to, if I choose to accept this recommendation, I'm going to need to intentionally set that value aside in favor of another one. And is that an action I want to take right now?

If you haven't brought your own awareness to your values, then your decisions can feel a lot murkier because you don't have that guideline in place.

Alicia (08:08.139)
And knowing your values also allows you to see if the people taking care of you are people who share those same values. Because if you have one set and they have another, so for instance, maybe your hospital-based midwife, her value is efficiency and technology, but you don't share those same values, then the way that you are going to approach your birth looks so different.

And there may be a way to bridge that gap, but it's also possible that that is a gap that can't be bridged. And in that case, that lets you know that maybe I need to go start hunting for another midwife who is going to be able to support my values.

Rachael Hutchins (08:48.536)
Yeah, so when I took when Hannah and I took your advocacy training back in October We both had been practicing doulas for I ten years for me and seven or so years for her and This approach to the birth planning process was really the first time we had learned about it And it was very impactful for us. It was like an immediate change with there's like a handful of immediate changes We made after doing your training

And we've been in this for a while. And so I just, I really like this approach. It has helped us talk in a more intentional way, like truly when we can focus on values. It's like the top of the birth plan now. And we plant those seeds early on and it's really shaped the whole way our clients are receiving care just by that one simple change. So I love that you guys are talking about values first and that value centered birth planning process and using that as we, we

use some of the phrasing of like as your, it's your North Star. Like that's where if we get lost in the routine care or get caught up in what's happening in the hospital, most of our clients are in the hospital. But for any birth, we still enforce value, know, value centered birth planning, but we're like, it's your North Star. Like we can always come back to that. And then I like how you expanded on that Meredith and saying, you know, if we need to set a value aside in order to prioritize something else, it gives them that.

It's like a reassuring thing. And I think the way the birth planning process has been taught historically is very checking boxes and not thinking about each person's individual values. So it's been a game changer for us. And I think our clients have responded really well to it.

Alicia (10:29.129)
I'm so glad to hear that.

Meredith Nelson (10:29.788)
Love that.

Rachael Hutchins (10:30.896)
Yeah, so thank you for starting there. I think that's a really great like if we're gonna like prioritize one key thing for people to start with is focusing on their values and and finding a provider that's in alignment with those. That's also so important. So I know advocacy is a big part of what you guys are doing and that's what attracted us to learning from you guys and and honestly staying with like your your memberships and doing your classes for our clients and stuff because

The way you guys teach about advocacy, think, has also been a game changer. That was also an immediate change for us or an improvement on how we were doing it before with our birth doula clients. So can we talk a little bit about advocacy and the tips for helping parents advocate for themselves? So speaking right now, because we're going to talk later about birth workers, but speaking to the parents, helping parents advocate for themselves during pregnancy and labor. And I know this is an expansive topic.

but if we can pick the high points.

Meredith Nelson (11:35.676)
Sure, one of our favorite topics. think once you know what you want, Well, and actually before that, part of the most basic part of advocacy, right, is understanding how to get meaningful information.

And so you get to start practicing this prenatally. And that it starts with taking responsibility for your birth, right? It starts with saying, I actually am going to be the one making these decisions. I want to.

I want to have the decisions come from me because I understand that I'm the one living with the outcomes of this birth. And I need to be able to look back on the moment that I chose this course of action or that course of action, knowing that I was in a safe place to choose it and that I was fully informed. That's what reduces birth trauma, which is what we're here for, right? And increases the possibility of birth satisfaction and joy. So take personal responsibility for your birth first.

Say I'm gonna work in collaboration with the people I've hired for the best possible outcome and I'm gonna stay in the driver's seat and then start gathering information and learn how to get meaningful information from your doula from the internet from your care provider and Hiring a doula is a really valuable part of this process because if you hire a doula who understands your values She can help you she can help kind of translate

a lot of the information that's out there and make it more accessible to you, help you understand how it relates to your birth plan, how it fits in with your values. And then you make your plan. We prefer a values-based birth plan. We have a template for that that we share with birth workers in our community. And then you start taking that to your prenatal visits. Every single prenatal visit, ideally, especially if you're working in a large practice.

Meredith Nelson (13:31.782)
You want to be able to walk through this birth plan with every person so that you can do two things. One, express your needs and assess their alignment with your needs. And two, practice advocacy. This is a moment where you get to say, this is my plan. How will you support me? Or what questions or comments do you have about my choice to, let's say, decline

postpartum pitocin. And so that gives you the opportunity to have a conversation with your provider, gather meaningful information from them, understand their perspective, and then either change your decision based on that new information or stand for your choice. And getting that prenatal practice is so valuable in terms of preparing you for the birth room when the stakes are a little bit higher.

Rachael Hutchins (14:26.92)
Yeah, that's awesome. Thank you so much. Did you want to add something, Alicia?

Alicia (14:30.494)
Yes, I just want to say that the reality is that pregnancy and birth are approving grounds for parents. It is their opportunity to learn how to step into this new role of leadership. Even if they've been a great leader at work, you know, or in their personal life, this is completely new because you are now going to be leading your family.

And you're going to be making decisions all along the way that influence your child's life. learning these advocacy tools will serve you well all throughout the life of your child because there are always going to be decisions to be made and some that are going to have a lifelong impact. And so you practicing this, getting good at leading, making your voice heard, communicating well, all of that is going to be needed all along the way.

Rachael Hutchins (15:26.15)
I couldn't agree more. Oops, sorry. Go ahead. Go ahead.

Meredith Nelson (15:29.296)
I think that's absolutely the heart of it. If I could offer one practical tool, this is one that we teach in our advocacy trainings that parents can use prenatally and in birth. Once you've gathered all of the information and you've made your decision. So let's say this family has a, let's say they have a GBS positive diagnosis and they are opting to decline antibiotics for some reason.

and they've gathered all of the information, they understand the risks involved, they understand what their alternatives are and that they're going to be expectantly monitoring this baby. Now that they've made their decision, when someone brings it up to them again, as they will in their birth, they can reply with our tool which we call Own It. This is where you get to own your decision and your personal responsibility and it goes like this. I understand what you're recommending.

I understand why you're recommending it. I'm choosing to decline and I take responsibility for my choice. These are the words that that care provider needs to hear. They need to hear that you got all the information. You understand that there is a small possibility your baby could be very sick or even die. They need to know you get that. They need to understand that you're taking responsibility for your choice to decline.

and that you're grateful for their recommendation and their continued collaboration. So that's a tool that you can use really well in prenatals or in your birth. I understand what you're recommending. I understand why you're recommending it. And I am choosing XYZ and I take responsibility for my choice.

Rachael Hutchins (17:17.34)
That is something we have been, we've already used with our clients. It's so freeing. It's freeing for everybody. And I think as a birthing person, we, you know, kind of there's the authority situation, the dynamic between provider and patient or, you know, birthing person, not patient, but that there's a lot of people, we see a lot of people struggle with when a provider makes a recommendation going against it. Right. And so that is

Freeing it gives them the confidence to do it and the words to do it and providers have responded so well to it and you know, it doesn't create tension because I know that's a that's something you guys teach to is how do we avoid tension? How do we work collaboratively? How do we bring everybody in? and and have that confidence to To make our own decisions and so I love that the own it the own it Phrasing is awesome. Thank you for sharing that. I think all of those tips are incredibly

helpful and I couldn't agree more about how all of this transcends birth. Like I say that all the time because it was my experience too like everything I learned during pregnancy in preparation for my birth with an intentional approach like childbirth education and all the care I saw and doula and all of that it planted these seeds that once I was on the other side I was like it doesn't stop I have to keep doing these things.

And we tell parents that like it's worth spending time learning now getting these tools because it's not just like a one and done. So I like that you guys touched on that too, because I think that helps people see the bigger, hopefully see the bigger picture and how we're really preparing parents to be to parent to it goes beyond the birth. I mean, I use the tools that I teach as a doula and childbirth education for myself. I'll be like in a doctor's office and I'm like.

Meredith Nelson (19:08.25)
Yeah.

Rachael Hutchins (19:10.786)
Bringing out those advocacy tools they apply across the board. So thank you so much. Those are really helpful tips Earlier you mentioned like physiology being a value and I know a phrase that came up in our training and I think you guys use a lot in your in your trainings and teachings is a physiology first approach and it's sort of like regardless of what You're faced with or going through putting physiology first

is always important. So can you tell us a little bit about what that means and how parents can in a society where we are birthing in the hospital a lot and there isn't a lot of interventions and things like that, how we can put physiology first and why it's important.

Alicia (19:56.609)
we should have Meredith do this. She always says it so eloquently.

Meredith Nelson (19:59.314)
Well, just to define physiology, physiology is your body's normal processes without any interference from an outside source. So this is basically how would you birth in the woods? That's a physiologic birth. So when we talk about a physiology first approach, we are upholding physiology as the gold standard.

And that doesn't mean that we never bring in interventions or support or help because they are often desired and needed. But if we, if we focus on preserving and protecting physiology everywhere possible, then things tend to work better for the body and they tend to work better for the bond and for the spirit of, of the family. So the idea is that the more complex you make any system, the more possibility there is for error, right?

So as we've all learned, many people have learned about the cascade of interventions in birth, and this is what we're talking about, right? You add in pitocin. Well, and that means that with the pitocin is going to come continuous fetal monitoring, right? With that continuous fetal monitoring comes an elevated risk of cesarean. And maybe a little bit with pitocin going on, now we're going to have maybe a little bit more intensity in our contractions, elevated chance that you're also going to have.

pain medication like an epidural on board. The epidural comes with its own potential complexities. What's it going to do to the mother's blood pressure? How is the relaxation of the mother's tissues going to impact the baby's position? How is that going to interact with the pitocin that's continuing to be on board in this birth? So we've made the system suddenly very, very complex.

Now all of those interventions might be needed or desired, but we should start from a place of physiology and with intentionality and care, layer in the help that is needed and with continued attention to that physiology. So a physiology for Caesarian might look like we are really paying attention to the mother's nervous system, helping her to feel warm.

Meredith Nelson (22:19.032)
safe, calm, maybe she's got music playing, maybe we even have some dim lighting around her. Maybe she's got her partner just laying his arms on top of her and really trying to help support her nervous system so that her oxytocin can flow for bonding and her prolactin can flow for breastfeeding. Maybe we have delayed cord clamping.

in that caesarean. We have even known of families who have accomplished intact placental delivery in the OR, which means the cord wasn't clamped before the placenta was out. So, I mean, that is focusing on physiology. Let's allow to remain in place as many physiologic landmarks as possible, even while we are doing this, you know, potentially life-saving interference. The same can be said for induction. The same can be said for

using pain medication, we can focus on prioritizing and protecting physiology and only introducing those aids when it's clear that they're needed, either medically or because of the mental spiritual state of the family.

Rachael Hutchins (23:43.08)
That's awesome. Thank you so much. Elisee, do have anything to add?

Alicia (23:48.254)
Just to say that I think, you know, one more example. think, you know, I actually remember being at a birth once and I walked into the wrong room and I knew it instantly because the lights were on, the TV was blaring and there were about 10 people in there. It was a party and I just backed away quietly and left and went back to the room where my client was leaving. And I remember feeling that distinct difference in her room. It was dark and quiet. It was warm.

There were fairy lights everywhere and lovely music and good smells in the air. And I remember that kind of that feeling of, wow, this is infinitely different than the room I just came from.

So for moms who are gonna choose pain medication, it might be easy to just say, let's throw out all that kind of nice environment stuff. Now we don't need it anymore. Let's just hang out with our friends and play games until this baby arrives. The reality is you're still a mammal and your body still operates on physiology. So hormones are still flowing and we can optimize that hormonal flow.

by honoring what physiology needs. And in this case, when it comes to environment, your body still needs the same things, dark, quiet, warmth, a sense of safety and security. So even if you have an epidural on board, you can still add on those physiology promoting environmental factors. So just making that consideration, whatever you're choosing in your birth.

How can I protect physiology? The same environment that I would love to have sex in is the same environment that I will be giving birth in.

Rachael Hutchins (25:31.004)
That is a great comparison and that is what people need to know, you know, and think about that. Like think about where you feel the most comfortable being intimate with your partner and it's not like on a bunch of strangers, a bunch of loud noise and stuff like that. And maybe those elements can get introduced at different times, but for the majority of labor and even in my experience, that calm, quiet, peaceful environment is the best and people enjoy it the best because it's not stimulating their nervous system. Like you said,

And so what I love about this and what I'd like people to take home from that is learning about physiology. Like, and I think a lot of times it does get glazed over and like the hormones of labor, like that's how we teach our birth prep class is we talk a lot about the hormones of labor and we try and simplify it because you can go very deep into it can get very sciencey. But how can we simplify it and then how

can we support those hormones throughout labor to support the physiology? I feel like if you can learn, if parents are new, expecting parents can learn about physiology in this way, it kind of influences the rest of their decision-making and then their confidence. I remember learning about like my birth instructor, my childbirth educator said to me that birth was like my heart beating and my lungs pumping. You know, like it happens on its own.

It doesn't need anyone to tell it to do anything. And so I think that helps people to be like, like I'm not really in control of this, not, you know, to a degree. and so giving them the tools to support that and then kind of going from there. So that's a great, I think foundation foundational place for people to start when they're exploring, learning about birth, regardless of what they choose for their birth, even if they know they, like you said, if they know they want an epidural, how can we support that? so thank you for sharing about that. That's super helpful.

So favorite phrase that I learned from you guys when I trained with you in October was birth hijackers. And another great way of talking about things that come up, because I think that the cascade of interventions is thrown around a lot. Like when we have consults with potential clients, most of them want to avoid the cascade of interventions. But not really understanding what that looks like and how they can actually avoid it.

Rachael Hutchins (27:56.294)
And so you guys have a phrase and do you agree that that's like one of your phrases, birth hijackers? Like, is that something you guys, that's in your class, right? Don't you have a whole section on birth hijackers? So could you touch on what that is and sort of the framework around it a little bit?

Meredith Nelson (28:01.714)
It.

Alicia (28:11.596)
Yeah, of course. Birth hijackers, birth hijackers are things that might hijack your birth during your pregnancy or during the course of your actual birth. So things that might look innocent but can actually have a great big impact. To give you an example, during pregnancy it would be something like end of pregnancy ultrasound.

or so why would that hijack your birth? Well, because if you're finding out that your baby is too big or too small, that will change the course of your provider's recommendations. And what we know about ultrasound in late term pregnancy is that it's highly inaccurate. In fact, so much so that it might be off by one to two pounds in either direction. So that big maybe might actually be two pounds less than you're being told.

And that small baby might be two pounds bigger than you're told. That's a huge range. And that changes everything for you, how you feel about your birth and how your provider feels about your birth and what they're going to recommend. Another example would be an in-office vaginal exam. So you think, well, that's really fairly innocuous, right? My doctor's just gonna give me a vaginal exam at 38 weeks and tell me how dilated I am and how likely I am.

to go into labor? Well, the reality is, yeah, there might be some information provided, but it means almost nothing. I've had clients who've walked around four or five centimeters dilated for weeks, thinking at any moment I'm gonna have my baby, and then instead they're waiting weeks. There are also clients who've been told, man, you are not ready at all. Your cervix is hard and it's high, and this baby's gonna be a few weeks yet, and then they go into labor a day or two later.

And so the way that it hijacks a woman's emotions, that's the trouble with it, is that suddenly she feels like, my gosh, what's wrong with my body? Or why isn't it doing what I think it ought to be doing? And that undermines her sense of confidence. So we want a woman walking into birth, feeling excited, feeling confident and trusting of her body. Anything that's gonna undermine that trust and confidence is a hijacker.

Meredith Nelson (30:34.694)
And we're talking about routine, these routine assessments, not when there's any medical concern, right? So sometimes someone will recommend an ultrasound because of a serious medical concern. Mom has been feeling kicks, you know, to the extent that she should, or there's been some unexpected bleeding, right? That's different than this doctor gives everyone a routine ultrasound starting at 38 weeks every week. That routine late...

pregnancy ultrasound is not evidence-based. We don't have evidence showing that giving that routinely to women improves outcomes. And what we're seeing in our practice, we've seen, we've had a lot of confirmation with this as we've worked with families and practitioners around the country, is that it does cause a lot of anxiety and stress because there's almost always gonna be something they find. Big baby, small baby, low amniotic fluid. What else am I thinking of?

that is a common finding. are the three top ones. But we're not seeing improved outcomes because of these findings because induction for any of those situations is actually not evidence-based in terms of seeing improved outcomes for the large population. So it just ends up causing a lot of stress, often leading to an unnecessary induction.

Alicia (31:36.085)
Yeah.

Meredith Nelson (31:58.974)
and often, which often derails, you know, whatever this family had planned for their birth.

Alicia (32:05.868)
Not only that, but I think feeling stress at the end of your pregnancy is not conducive to all the juicy hormones that you need present for labor to start. So when we're in a state of stress, we are in that sympathetic stress response where we're we're fight or flight, and our body shuts down all of the extra processes, and it's just focused on how do I run away from this predator in front of me?

Because again, we're mammals and so our bodies, even though we are, we're really rational thinking people, our body doesn't always catch up with our brain. So our body is just experiencing a stress response. And it's tough to go into labor when you're in that stress state.

Meredith Nelson (32:51.062)
So I think the key takeaway here with any of these hijackers and there are a few others that we go into in our programs is not that you should decline all of these things. It's that you want to be really intentional and go in with your eyes wide open to where it could lead, right? And understand, ask yourself a question. Do I want this assessment? Is this going to help me make a decision?

or feel more at peace. If I'm not the one wanting this assessment, then I don't need to get it, right? If it's just routine, check the box, care, I could decline that and choose a more personalized route.

Rachael Hutchins (33:31.432)
Absolutely. Yeah, always checking in with yourself. Like we say that like when we know mother's intuition is a data point like it should be considered we should be paying attention to mother's intuition about what's what's being presented how they're feeling and that's something we say a lot too is like it's this there's not a right or wrong here but know your options the eyes wide open component and listen to your gut peer and understanding that so many things are often offered routinely and kind of learning about the reason behind that and connecting with their

provider in a way, in a humanizing way, because I know that's so important to them to understand sort of what the back story is and what's happening there and why it's being offered, you know, can help them come at it a little bit more confidently too. But I think learning about the birth hijackers is so helpful and learning about some of those precautionary things that come up that might lead to more intervention versus actual medical, because I think what we see is a lot of things being recommended that feel like a medical.

need when they're just that precautionary, they're in that precautionary category for using more intervention. So you mentioned your program and you teach about birth hijackers there. So can you share a little bit about what you do for parents expecting parents to help them prepare for birth and beyond?

Alicia (34:55.598)
Well, our goal is to be the most honest and comprehensive childbirth class out there. We really want parents to be able to come and get everything they need. So we call it a one-stop shop. We want them to be prepared for everything that may come up in their pregnancy, every choice and option that they're going to be presented with in their birth, and then afterwards the postpartum as well.

And really our goal is calm, confident parents who recognize the controllables that they can control. And we want them to feel powerful through the process. And we found that when you have good information, when you recognize your place on the team as the leader of the team, mom as the leader of the team, that it makes all the difference in how you show up in your pregnancy and birth and in every interaction with your care provider.

Meredith Nelson (35:49.136)
Yeah, so we follow the physiology first model in that we are coming from a foundation of let's preserve and protect physiology and let's teach you about how birth works and how the environment interacts with it and how your care provider interacts with it. it's everyone's part of this ecology, right? That makes the birth work or not work.

And then we lead you through all of those point by point decisions that you're going to make along the way. And it's kind of cool because we have, there's like 16 hours of on-demand video and then like almost 200 page workbook for parents to work through with lots of easily accessible resources in there. But then we also have a twice monthly, we call it birth power hour, where students in the class can come and ask us their questions.

talk through their particular concerns. And of course, we're not giving medical advice in those sessions, but we're helping people assess their options and the framework of their values and their goals for their birth. It's pretty fun.

Rachael Hutchins (36:59.27)
Yeah, I really, really love this format. We have been sharing it with our clients as well. And the on-demand nature of it is great. Like we just had a client who was decided to do the class kind of later in her pregnancy, and she was able to dive in and like go through all the videos quickly, but then she was able to also join the, monthly live, you know, so she, she could do it at her own pace, but then get you guys live. And I just think that's a really great.

combination of things and I've gone through your course and it is just full. I'm like this is dreamy all the stuff that you guys are offering and the way you talk about birth and and so we've had several people now go through it and just say really wonderful things about it and they're all sort of coming for different reasons and doing different paces and so just just highly recommend people checking it out.

Meredith Nelson (37:56.722)
Thanks Rachel. Yeah and you brought up Rachel that you're having your clients do this. we actually, parents can purchase it on their own but doulas can purchase it at a pretty steep discount on behalf of their clients and license that program and then we give doulas a companion guide or midwives to a companion guide to support their clients and working through the program.

Alicia (37:56.905)
Thanks Rachel.

Rachael Hutchins (37:58.824)
Yeah.

Rachael Hutchins (38:23.568)
Yeah, it's been great. Thank you so much for sharing about it. I hope people check it out. Okay, so we're going to shift gears now. You mentioned doulas and midwives, so like birth workers. So tell me a little bit about how doulas and birth workers, like how do you work alongside them through intentional birth to create a more unified advocacy-driven birth experience.

Alicia (38:50.402)
Well, I think the program, it obviously is going to work best if doulas have some knowledge of what we're up to, because for instance, their clients are going to be learning. We share 24 advocacy tools in our advocacy trainings that doulas and midwives attend. And inside the parent program, parents are going to learn 11 of those. We're going to be reviewing. So it's wonderful if doulas and midwives have a familiarity with it so they know what their clients are.

know already, they know how they're going to utilize those tools, and maybe even so that the doulas and midwives can familiarize themselves with those tools and use them as well. But I think...

All of this advocacy talk can invite conversations. Dulas and midwives can talk with their clients about these things. They can understand how the client is going to show up for themselves. So let's say the client is using the Own It tool at a prenatal visit with her midwife, her home birth midwife. The midwife already has familiarity with this tool and she'll be like, okay, I know, I see what my client's doing, I got it, that's great, she's owning her birth.

So it can work really beautifully if doulas and midwives have had a taste of the program, they've seen what it's all about, and they themselves can use the tools because when you're navigating through the hospital, if you're a doula working at a hospital birth or you're an out of hospital midwife and you're having a transfer to the hospital, these same tools are going to serve you so well because I think it's extremely overwhelming when you have a change of plans like that.

So I guess what I'm trying to say is everybody can learn these tools and it will serve all of them well as they work together.

Meredith Nelson (40:41.488)
I think that just at the very foundation of our program and of our work is establishing tasks and figuring out whose task is what and helping our clients understand whose task is what. And our client's task is to make the decisions, right? It's their task to gather the information and make the decisions. And I think as doulas and as midwives and certainly as care providers, we...

We have the tendency sometimes to take that task on ourselves and feel responsible for the outcomes of a client's decision when that's actually not our task. our tasks as doulas are really clearly defined. Our task is informed choice, protecting and upholding the client's informed choice. But our task is not protecting and upholding the thing they're choosing, right?

And keeping that differentiated in our mind allows us to continue advocating for their right to choose, even when they're choosing something we disagree with. And it allows us to know that we did our task well by advocating for their right to choose, even when they chose, even when their choice actually led to a negative outcome. It also allows us not to impose our own like strong desire for them to have a

gorgeous, goddess, physiologic, vaginal birth on them, right? Because that's not our task. Our task is their right to choose. So just establishing the task so clearly, my role versus your role, is really essential for any of these tools that we're stacking on top of that to work well. We have to know whose responsibility begins where.

Rachael Hutchins (42:32.84)
Mm-hmm.

Rachael Hutchins (42:38.854)
Yeah, that's important. think, you know, people come to us sometimes too. we have to, this, the thing we have to work on most is that they see the dual as the savior or the, the, the, path to all the things they want. And with people like that, we know we have to have those conversations and make sure partner, mom, us knows the roles and tasks that they are responsible for so that everyone can own.

own their role and that's empowering. It might be uncomfortable for them at first but it is empowering so I think that's a good place to start. So what kind of moving into that you know when I did my training over 10 years ago I was really advocacy was sort of like be seen not heard more so than how you guys teach advocacy and

I really align with the way you guys teach it and it's been such a confidence booster for Hannah and I to learn it in the way, because when you have, instead of just like feeling like the doula, it's either advocacy has to be like this aggressive, like takeover, kind of in charge role. It's that collaboration, making sure everyone knows their role, like humanizing everybody, lots of compassion and empathy in how you guys teach advocacy.

And I just think it's the right mix of things for the doula in their role so that they can advocate effectively for the birthing person and actually make a difference and that be a positive feeling and not an icky feeling. And so that's been like a rewiring for me because I just feel like I spent part of my career really in a place of doubt about my role in advocacy. And I felt like the way you guys teach about it has

shifted that for me. So for the duelists out there who struggle with this, what do you think are practical ways that they can advocate within their scope, even knowing we're not speaking for our clients? So how do we advocate?

Meredith Nelson (44:53.862)
That's a big two day long question that we answered advocacy training Rachel. I mean, think to some, we've summarized some of the essentials already, which is like, know what you're advocating for. You're advocating for their right to choose. If you see in any moment of the birth or the pregnancy or the postpartum that their right to choose is not being upheld by the staff, then advocacy means bringing that to everyone's attention, right?

Rachael Hutchins (45:03.174)
Yeah, sure.

Meredith Nelson (45:20.206)
elevating her voice. If she said no, then we then we can stop the room and say she said no, right? We bring it back to her or if she said somewhere on her birth plan, I don't you know, I don't want any fundal massage and someone's going in to do that. Then we can say Rachel she said on her birth plan. She doesn't want a fundal massage, right? We're just bringing it back to what the client has said and making sure they have the opportunity to say yes or no in the moment to something.

So that's really the essence of it. And there should be nothing controversial about that, right? There just shouldn't be because the result of doula staying silent when their clients are not being given informed choice is just trauma. It's trauma for everyone, for us as the witnesses and for the family that's experiencing it. So stepping into our power as birth workers, as advocates is elevating everybody.

And honestly, I actually think it really elevates the staff to the doctors and nurses who are so nervous about the quiet shadow doulas in the corner and what they're saying when they leave the room and how they're operating. When, if we introduce ourselves and make it clear that we're a full member of the team, that we are here supporting our client and that we're going to elevate her voice, they aren't worried about us anymore. They kind of get what we're here for and it's all transparent and they feel like they can talk to us.

and it leaves everybody on a better footing for supporting the client's needs.

Alicia (46:56.312)
The reality is too that doulas don't have a scope of practice, least not legally. We've imposed a scope and each person can do that for themselves.

So for instance, the only thing that we cannot do is give medical advice and act in the capacity of a medical provider. That is definitely outside of anyone's scope who's not a doctor, midwife, or nurse. That said, everything else can be within our scope. We just have to decide what our own scope is. And if you want a way to speak on behalf of your client that feels really comfortable,

You can have them include that in their birth plan. I would like my doula and my partner to speak on my behalf. They're welcome to speak out of my presence about any of my medical care.

Which means the doula and the partner can step out of the room with the provider and have a conversation out of mom's presence. Well, why would it happen out of mom's presence? Well, number one, maybe she's deep in labor land and we don't want to interrupt her. Or perhaps this is an in-depth conversation that she doesn't want to join in. She's tired or maybe it's the provider is feeling a little contentious and we can remove that from mom's presence.

So for whatever reason, you might have a conversation out of her presence, but that can be authorized in the birth plan. So everybody knows clearly this comes from mom. She's made that decision. We can talk about her medical care together. And we also do it by using a tool called, we call elevating the advocate.

Alicia (48:34.452)
So when a mom and her partner first get to the hospital with their doula, ideally the partner is elevating their doula advocate and saying, staff, this is our doula Meredith. She's amazing. We love working with her. We've invited her to our birth to help us have the unmedicated birth we desire and also to be an advocate on our behalf. We're so excited to have you work together with her as our team.

So doing that or doulas can do that for themselves. Hi, I'm Alicia and I'm here today as Sarah's doula and advocate. I'm so excited to work together as a team. So we're really just letting everyone know right from that first introduction, who we are, what we do and why mom has invited us here.

Rachael Hutchins (49:23.688)
Yes, that has been such great. We've used the Elevate the Advocate and talked about this with our parents before labor and they've been doing it. again, boost our confidence, boost their confidence, provide like nurses, everyone, the way it warms things up and takes you out of the shadow. Like you do not need to be in the shadow as the birth worker, as the doula. And again, learning about how to advocate in the birth space. And like you said, Meredith,

two day training to go over all this. And it took every bit of those two days. And it's so, so incredibly important that doulas seek this type of training, regardless of where they started with their training. So, and I know you guys actually do full, also do full birth doula training as well. So you can take them on the whole journey for that too, but the advocacy component specifically.

these little tools that you've mentioned, when you implement them, and I can speak from my own experience, it shifts the dynamic. It gives everyone confidence. And we tell dads, giving them the permission to be guardians of the birth space. Like, that's another thing you guys taught us. And encouraging them to go over that birth plan that they worked on and their values with each person who's going to be in the room. Again, just communication, humanizing, teaching partners to humanize.

Practitioners and nurses so that we all you know are can work together as much as possible and avoid as much tension as possible But that is you know learning how to advocate. It's all that it's not just speaking up But it's an example that you guys taught us and I'd love if you just kind of used it here to Describe it we've been sharing with our clients too when we talk about interventions coming up and decision-making and what it might look like in the first base for the birth worker But the red ball being the power

and and how we can use that like visual aid in the birth space to facilitate keeping mom as the decision maker. Would you guys share just a little bit about that because I think it's a helpful tool for doulas and midwives too I guess.

Meredith Nelson (51:25.382)
Hmm.

Meredith Nelson (51:31.546)
Yeah, so in the advocacy training, we do a few skits to demonstrate this just so that you, so we have a red bouncy, I guess it's a big, what would you call that? It's a ball. red Pilates ball that represents the power and in the skit, you see it passed around, see who's holding the power. So there's a situation where the doctor says, you know, we need to do a

Alicia (51:42.488)
It's a lot of school. Yeah.

Meredith Nelson (51:58.702)
I need to get this placenta out now. We waited too long. And the mom says, do we really have to? And the doctor just takes the ball from her and says, yes, this is the only course of action. So in that situation, when we see that ball just taken from the mom, it's our job as an advocate to hand it back to her and say, is this what you want? Do you consent to this? Or turn to the doctor and say, we do need her consent before we can proceed with this.

and just making sure that ball stays in her hands.

Rachael Hutchins (52:33.319)
Yeah, because it can be a powerful tool for the partner too, because you guys help prepare people even not having a doula present. You know, we talked about that with partners too. Like if there's ever a time we're not there, this is also important that you see it this way too, right? Because there's that one, the example of the nurses asking for dad to help move mom. We see that a lot. Um, and remembering that the power, you know, maybe you should, we're asking her first, getting her consent first, regardless, even if it seems like a harmless thing or, or even if it seems like it's a

an emergency thing, know, when possible, we're just always putting that red ball back in her hands. And I just like the visual. And so we talk about it with our dual team too. There's such a simple way of breaking it down. And again, giving you that confidence, confidence if you're in a moment of like, I'm not quite sure what to do here. It's like, okay, well who's holding the red ball? Let's just start there. That's at least how I see it. Because sometimes, I mean, it's not always clear how we should plug in. And that's a simple way to sort of redirect the energy. And that's why I like it so much. And

Meredith Nelson (53:22.022)
Mm-hmm. Yeah.

Meredith Nelson (53:30.93)
Mm-hmm.

Rachael Hutchins (53:33.064)
So talking about your training a little bit that you do for, cause I guess you technically have two types of ways you work with doulas in regards to training. have the advocacy training and then you do a doula training as well. Do you guys want to share about that for our listeners?

Alicia (53:49.086)
Sure, yeah. The advocacy training, as Meredith said, is two days. And it's pretty intensive, but we're going to build a foundation first of what is advocacy, why do we need it, what are a woman's legal rights, how can we help her understand those, and then we move into teaching the tools of advocacy.

how to get the parents the birth that they want. And the whole second day is spent role playing. Because that is one of the most powerful tools that we've ever found as doulas. It's one thing to say it, it's another thing for parents to embody it and practice it and become and learn the exact words that they need in the moment.

So that's the advocacy training. And our goal is that doulas will walk away being able to go and share this with their clients. So spreading these ripple effects because parents who know how to advocate for themselves will be able to show up powerfully again and again throughout their children's life and throughout their own life.

Meredith Nelson (54:54.096)
Yeah, it is so much fun. We're popping up all over the country. We do only do this in person right now just because of the nature of the embodied work of advocacy. And so you can see on our website where we're going to be.

And then our Dula training is online and we do one cohort per year. So we have another one starting in January, 2026. And it's kind of unique in that every cohort we've done so far has had Dulas ranging from zero years of experience to 20 years of experience. So you're mixing and mingling with some really intentional professionals across the spectrum of experience.

And we're teaching from our model of advocacy and from our model of physiology first. And just a lot of all of the systems and tools and strategies and templates that we wish we had had all along the road. And honestly, with so much respect and love for the people who trained us, we were very inadequately trained for this work. I had a weekend training, Alicia had a weekend training.

And we were trained poorly and in regards to advocacy. I was trained not to speak to staff at all in my original training. And then inadequately in terms of how to make this a sustainable business that we don't burn out from in the average three year doula career span. And then also how to really serve our clients well with.

with true honesty and intentionality and real love and connection with their values and not just checking boxes, one prenatal, two prenatal birth and we're done.

Alicia (56:48.982)
We're trying to address the gaps that we found in our own. I mean, it was so drastic that the first birth that I went to was almost the last birth I ever went to because my experience was so poor and I was so ill equipped to know what to do or what to say or that what I was going to meet. It was great that I knew how to squeeze a hip and wipe a brow, but do the work is infinitely more than that.

Rachael Hutchins (56:49.384)
you

Alicia (57:15.124)
And so rather than a three day weekend training, ours is a year long that starts with a three month intensive. And we're meeting weekly during those three months. And we're talking about the things that are going to allow a doula to build a thriving business. So we're talking about best business practices and how to do this. We're talking about advocacy. We spend two of the 12 weeks on advocacy. And because our goal is to prevent doula burnout.

or reverse it for the do-los who've been in it long enough.

because they're burning out because they don't know how to run the business. Dulas are chronically undercharging. They're chronically underpaid. Not only that, but Dulas are seeing really traumatic things over and over again. Sometimes abuse, they're seeing coercion or manipulation and they don't know what to do with that and they're carrying that. And so it's no wonder that they only last a handful of years and then they say, nah, not for me. So we're losing Dulas.

right when they're hitting their stride, when their knowledge has become deeper, they've gained wisdom and experience, and then they're out of there. What we need is do is who have that knowledge and wisdom and experience, who are staying in the profession and want to continue to stay in it because they are being paid handsomely, because they are witnessing births where parents are powerful advocates and where they themselves are powerful advocates.

So they're doing their very best. They're becoming what we call trauma prevention specialists. So that's our goal, is to develop a whole new generation of Dulas who know how to prevent trauma. Dulas who know how to run a business and who understand physiology and how to protect it and honor it.

Rachael Hutchins (59:07.56)
Yeah, I mean so many things there that I did not have as a brand new baby doula, you know, the length of your training, the, the advocacy component, huge. And that, that the year long support that you guys and the physiology, was the other thing I was gonna say, physiology, advocacy, and the link. Those are the three things that stand out to me as that are so grossly different than any other training out there. So highly recommend it. And

Meredith Nelson (59:11.698)
Thank

Rachael Hutchins (59:37.244)
just respect you guys to the moon and back. But I wanted to ask you if there's one thing you could share with a birthing person or a doula today to move them toward a more intentional birth experience, what would that be?

Meredith Nelson (01:00:01.586)
Such a big question. I'm gonna start. This actually is true for both groups of people, which is that what you want matters and you get to ask yourself what you want.

Alicia (01:00:03.266)
Yes.

Meredith Nelson (01:00:21.97)
and ask if you're a doula, ask your clients what they want. It's just a question that's not being asked. You know, like you don't walk into your prenatal visit with your OB and they sit down and say, tell me what you want. So ask yourself, ask yourself what you want because you matter and you know, you are rooted in your history, your values, your hopes, your dreams. And nobody else knows those

Nobody else has all those connections. So just ask yourself. You might decide to make a choice that's not like your ideal at some point because you feel like it's best for your child or your family and that's completely legitimate. But know what you want and keep your your sights set on that. You really do deserve to have people striving alongside you.

to accomplish your dream.

Rachael Hutchins (01:01:24.53)
Yes, yes, thank you.

Alicia (01:01:26.114)
I would say, yeah, Mersey, thanks. I would say, first of all, doubt your doubts because I think we're so quick to, women for instance, are so quick to say, I can't do this. I don't have a high pain tolerance. These are the stories that we've been fed by our culture. And another story is that birth is so difficult. And so,

I think doubt your doubts. And if you're a birth worker, doubt your doubts that you don't know how to do this and you don't know how to make money doing this. So instead, the antidote to that doubt is curiosity. So stay curious and stay open.

realize that you as a parent don't yet have all the answers and you have an idea of how birth should be, but stay open to the possibility that maybe you'll choose something different. Let me give you an example. So when I started down this path, my husband and I were pretty newlywed and we started talking about birth one day and he asked me what I wanted. And I said, well, I'm gonna give birth in the hospital with an epidural, of course.

And Shane, being a fairly new graduate of chiropractic school, he had other ideas. And he very gently suggested, maybe you just want to learn more. And I took it to heart. And I went down to my local library and I picked up a stack of books from the birth self. And I went home and I started reading. And my mind was completely blown. I had no idea what was possible.

And had Shane not suggested, and had I not been open, I never would be here today. And what I ended up choosing was a home birth with a midwife. And I went on to have three more after that. Stay curious. Realize that what you know about birth is probably very little. And there's a world of knowledge out there. In fact, even Meredith and I are standing here 10 years later, 12 years later.

Alicia (01:03:34.414)
We can say that we will never come to the end of our knowledge seeking when it comes to birth. It's too fast. so recognize that as a parent, you've got a little teeny bit. And there's a whole world of knowledge out there that you can access. So start reading. And start reading things that challenge your current belief system. That's the hardest thing for us to do. But to be a truly critical thinker, we've got to read things from the other side.

at this moment in time we don't agree with or we've never considered before. But read them simply if for no other reason than to gain more strength in your own current position. Start from there. Read for that reason and maybe you'll find, because I tell you what, when I started going to read I'm like, I'm going to prove Shane wrong because we'll see about this. But then I started reading and I recognized like, wow, I am so humbled by what I'm learning.

Rachael Hutchins (01:04:34.088)
That's so beautiful. Yeah. So ask yourself what you want and stay curious. I think those are it's it's guidance for everyone and a way of being. And I do think going through this journey in this way can help people continue that way of being forever and ever. And I just think that's the beauty of this work and just appreciate you guys sharing about that in this way. And I have no doubt that listeners will be inspired and

be curious, you know, I like to say just take like the one next step, right? Like sometimes if we think too far down the road about all the things we have to figure out, it paralyzes people. And I'm like, like you said, start with a book, start with a podcast, start with a one little do. And then before you know it, it's like all these stones have been unturned and you've got this beautiful path. But all along the way, asking yourself what you want. I just think it's great. So can you share with us where

people can learn from you or get your information. Where do you like to direct people to your stuff?

Meredith Nelson (01:05:40.272)
Yeah, you can find everything about us at intentionalbirth.co. You can also find us on Instagram. It's the only place that we actually pay any attention to, even though I think we have other accounts, which is intentional.birth. And yeah, we'd love to connect with anyone.

Rachael Hutchins (01:05:59.602)
Thank you guys so much for your time. I've enjoyed speaking with you and I'm excited to share this conversation with our listeners.

Alicia (01:06:08.856)
Thanks, Rachel.

Meredith Nelson (01:06:10.396)
Thank you, Rachel.