The Mama Making Podcast

Avital Norman Nathman | Writer, Author & Activist, Women's Reproductive Rights

• Jessica Lamb, Avital Norman Nathman • Season 3 • Episode 80

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On this week’s episode of The Mama Making Podcast...

We talk with writer, author, and activist Avital Norman Nathman about her book The Good Mother Myth and her upcoming release The Perfect Birth Myth. Avital shares her personal pregnancy and birth experience, including the incredible she encountered with midwifery care, emphasizing her decision to cornerstone the importance of reproductive justice and the need for accessible, supportive care for all mothers.

Jessica and Avital discuss societal pressures surrounding the idea of a “perfect” birth, the impact of quality (or lack of) on maternal care, and the connection between maternal and abortion care.

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Jessica | The Mama Making Podcast (00:01)
Hello everyone. And welcome back to the mama making podcast. If you're new here, I'm your host, Jessica. If you're not new, welcome back today. I am very excited to have Avital Norman Nathman here with us on the podcast. Avital is a writer, author, and activist writing for all the big names, New York times, Rolling Stone vice, a column for Snoop Dogg, which is my personal favorite. just to name a few, she's authored a book.

The Good Mother Myth, redefining motherhood to fit reality, an anthology that gives a platform to diverse voices that are often left out of conversations about parenthood. She's also working on a new book, which we'll definitely dive into. Thank you for being here. I'm so excited to have you.

Avital (00:47)
Thanks for having me, Jessica. I'm excited.

Jessica | The Mama Making Podcast (00:49)
So tell me a little bit about you, your family, what you've got going on, whatever you wanna share. We wanna know more about

Avital (00:56)
Yeah, so I live in Western Massachusetts, in what's called the Pioneer Valley, sweet little area. And I'm married. I've been with my husband now for one to five years. It's been a while. And we have a 17 year old who's going into his senior year of high school. So that's a whole new journey.

Jessica | The Mama Making Podcast (01:12)
That's awesome!

Yeah, for sure.

Avital (01:22)
I live here with them and our dog, Matsubal, and our cat, Baba Ghanoush. And yeah, that's that's that's very

Jessica | The Mama Making Podcast (01:32)
Awesome. Well, I'm so glad to have you here. was just saying before we got on the mic that I've been like deep diving on your Good Mother, the Good Mother myth book. And it's an anthology. So it's many different stories from many different people, yourself included. And there, when I say there's something that you can pull from each story, that's like, that resonates with me or that's exactly how I feel

Avital (01:43)
Yeah.

Mm -hmm.

Jessica | The Mama Making Podcast (02:00)
I didn't know that this is how some other people feel, but I can totally identify with it. So I've been recommending it to all my mom friends. But so I'm excited to have you want to talk a little bit more about the book, how you got started writing about this area of things. Obviously, you have a laundry list of writing credential behind you,

How did you get started writing about motherhood and reproductive rights?

Avital (02:31)
Yeah, so a lot of folks that get into this area tend to do so, whether it's working in the area, writing about it, because of a traumatic event. I had a very, what I call textbook pregnancy and birth. I mean, the pregnancy was demanding on my body, but there wasn't any complications. weren't any hardships. I got pregnant at 25. I gave birth at 26.

It did take me up to a year to get pregnant, but beyond that, there really wasn't anything complicated or difficult. However, about two weeks after I gave birth, so this is back in 2007, I had gone through an OB -GYN office, but I had opted to use their midwives and I had an amazing midwife, Pam Drexler -Lopez, who has now since retired.

but she was phenomenal. I was her only, patient on the ward that day. when I gave birth and we spent a lot of quality time together and I just really appreciated the, the consistency and the care that I received throughout the entire pregnancy. I had moved to this new area when I was six months pregnant. So there was a lot of like leaving my care in another state to come here and not knowing anybody. And so Pam really helped,

made me feel secure and confident in my pregnancy, especially as a young woman. And about two weeks or so after giving birth, I found out that the OB -GYN practice that Pam was a part of was now no longer going to be allowing the midwives hospital permission, right? They weren't going to be allowed to attend births. They could still provide prenatal care, postnatal care, and just regular

gynecological care, but they were no longer allowed to deliver and attend births. And that really upset me because here I had just experienced what that was all about. And the reasoning behind it was something to do with insurance. It doesn't really matter what it was, but the community really came together and said, we need to have some sort of midwifery care connected to this hospital. So instead of

being connected to a OBGYN office, the push started happening to find a way to have midwives connected directly to the hospital itself. It a small local hospital. And probably three weeks postpartum, I hosted about 40 people. There I am just like leaking, still in my mesh underwear that I happened to snag pairs of from the hospital.

Jessica | The Mama Making Podcast (05:13)
Yep

Avital (05:17)
with all of these wonderful folks who were committed to accessible quality birth care, pregnancy and birth care and midwives, right? That good, good handful of midwives, doulas, and even some OB GYNs were there and they all congregated in my, in my living room with my newborn there, to talk about this and to figure it out. And that's what started it for me. It really was, I had just received excellent care.

And I couldn't believe nobody else was going to be allowed to receive such excellent care as well. And so eventually now there's an actual, they took an old house that was on the property, turned it into the Midwifery building. They have a doctor connected to them and midwives have since been allowed to deliver in the hospital there. so providing a space for folks who still want a hospital birth,

don't need any surgical care and so have midwifery care at their convenience. But it took a couple of years to get to that point. And so I had always been involved in reproductive health and reproductive justice. So access to birth control, abortion rights, that had been since I was a teenager. I had been involved in volunteering with Planned Parenthood and local organizations.

And once I became a mother, once I got pregnant and became a mother, it just confirmed for me and it

It just really reinvigorated my commitment that everybody should have the choice, right? I had chosen to become pregnant. In fact, I had worked really hard to become pregnant and I made the choice to have that pregnancy and to become a parent. You know, people are like, if you're a mother, how can you? And I get that a lot, a lot of pushback when I write about especially abortion, like, so glad you were in a good mood the day you found out you were pregnant with your kid. And it's like.

It's not that simple, right? And I knew the difficulties. so I, it just recommitted me to ensuring that everyone has that choice. And so that's just a little bit of my background. So it was just those little personal experiences that really influenced what I was interested in and what I started to research. And then eventually, I mean, we can talk about the Good Mother Myth and how that came, because that was a little bit different.

But just, yeah, I think it was just a natural progression from, you know, in my mind, reproductive justice starts before you want to become pregnant, whether you want to keep the pregnancy or not, and then postpartum for those who want to keep it, that's all part of reproductive justice. And now as I'm going into, or I'm fully seated in perimenopause and headed towards menopause, I feel like that's a part of reproductive justice as well that maybe isn't talked about as much, but that's a whole other topic. yeah, so the full spectrum of reproductive.

reproductive justice.

Jessica | The Mama Making Podcast (08:15)
Yeah. And I think the, the kind of starting of it all is unique in that I think so many of us go through a, a pregnancy period or labor and delivery or postpartum and have had this very impactful experience. mean, it's life changing. We talk about it all the time on the podcast, like this, whether it was good or bad or neutral, it's life changing.

Avital (08:20)
Okay.

Mm hmm. Yeah.

Jessica | The Mama Making Podcast (08:44)
I think coming from this was such an amazing experience and I want others to be able to have that experience, to be able to make the choice is very different from, unfortunately, a lot of the reason people start and that they had a terrible experience and they had trauma that came with it or they had an unfortunate loss or whatever it might be. think it's all, it all counts. It's

Avital (09:12)
Mm -hmm. All valid. No matter how we got here.

Jessica | The Mama Making Podcast (09:14)
Yes, all of it. I think, yes. So I think it's a unique experience to people who aren't like ingrained in the birth and reproductive world that like, you had a great experience. Obviously you want other people to have that as well. So I think it's very interesting that it took such a very quick turnaround to

Avital (09:27)
down.

Yeah.

Jessica | The Mama Making Podcast (09:43)
Because I think in postpartum, you're like so, I know I was, I was just so in the middle of it that I don't know that I could have thought about other people at that moment, except for me and this Chinese human for a short bit of time. But I think it's so incredible that you immediately mobilized and were like, we got to do something about this. I would love to hear a little bit more about that. I mean, I could talk to you forever about your whole life story, but that meeting.

Avital (09:49)
Mm -hmm.

Yeah.

Jessica | The Mama Making Podcast (10:11)
I imagine was just the energy in that room had to be palpable from mothers to practitioners to midwives all over the map, trying to work together to figure out what is the problem? Why is this happening? And reaching a solution and then mobilizing on that. How did that all come to

Avital (10:18)
Mm -hmm.

Yeah, I mean, my part in it honestly was just offering up my space. That was all I could do in the moment. Like you said, I was postpartum. And I'll be honest, I don't even remember the meeting. I just remember opening up my house to these incredible people to let them do their work. And then of course, like as the years progressed, I supported them and helped promote the creation of this as well, of the Midwifery Center at the hospital.

And like I said, wasn't just people came, met at my house, and then like a week later, all was good. It really was a couple of years of figuring out there's a lot of legalities around midwifery. I live in Massachusetts, which is a phenomenal state when you look at maternal health rates and abortion access and things like that. But we're really behind still on full accessible midwifery care.

and we're still pushing to allow for certain types of midwifery care and what does it mean to practice as a midwife and who needs to kind of be above you and like who are you beholden to? Like are you beholden to a doctor? Are you beholden to the hospital and things like that. And so even in this progressive state, and this was again, you know, 17 years ago,

It was a challenge. It was a challenge to find a OBGYN who would stand with these midwives and support them. And because at that point taking on a lot of liability things and so putting their name on the line. it wasn't easy, but there was clearly a need and there was clearly a demand. I had a kind of a cohort of other young mothers with me at the time that had either

Jessica | The Mama Making Podcast (12:08)
Mm -hmm. Yep.

Avital (12:22)
had also given birth in the last couple of months or were about to give birth. And we were fired up. We knew we deserved better care and that the community deserved better care. And so it was such a striking loss to the community. the midwives too, they were like, we're not just gonna stay at this practice to provide just regular gynecological care. you know, we wanna be a part

of prenatal and actually the delivery. So yeah, there were a lot of moving pieces, a lot of people reaching out to folks they knew and a lot of hard work from folks on the ground because that's how it is, right? lot of we did some grassroots fundraising to help purchase the house that eventually is being used and a lot of negotiations with hospital staff that I was not a part of.

But, so really, you know, I did what I could in that time. But it was necessary. They were like, we need a place to meet. Yeah, come to my house. And they were obviously, everyone was very wonderful. And that baby got passed around and everyone got to have some fresh baby love. And that helped too.

Jessica | The Mama Making Podcast (13:36)
yeah. Well, I think it's a good segue to talk a little bit more about the Good Mother myth and how you decided to create that. Because I think something that's so huge in motherhood, I feel that we're all lacking is community. I think we're operating so much in these silos. And I think that's a perfect example of look at all these women and all these different areas of life. Early motherhood, being a practitioner, coming together to make this thing happen.

Avital (13:51)
Mmm.

Go.

Jessica | The Mama Making Podcast (14:06)
How does that kind of connect to the starting of the Good Mother myth?

Avital (14:12)
Yeah, so I, my son was, we'll track back. I was finishing my master's thesis at Wesleyan University in gender studies around December. I think I submitted my final thesis project and then gave birth a couple of weeks later. And then I actually did some revisions while my son was a newborn. And so I...

Jessica | The Mama Making Podcast (14:34)
my god.

Avital (14:41)
just had been writing about these things, you know, for a while and I continued writing about them. back in, so he was born in 2007. So I think 2012, I want to say, Time Magazine came out with a cover and it was the headline, Big Bright Red Letters, Are You Mom Enough? And the cover itself had a woman with

what looked to be like a seven year old standing up on a box nursing her, right? Like they had really made it look like this kid was in like almost, I feel like army fatigues. That probably isn't right. But in my mind, they like really dressed them up to make them look older. And with the idea being that if you're not a certain type of mom, you're not mom enough, you're not good enough. And this was really

A high point in mommy blogs were really huge back then. so people, and like you said, siloed, right? There were mommy blogs for tiger moms and mommy blogs for crunchy moms and mommy blogs for ones who were very helicopter -y and with very little crossover. And so what I saw was this article wasn't there to kind of bring folks together. And here's the crazy part. The article itself, totally fine.

Like I read the article and I was like, okay, they're just talking about like different ways to be moms. And it wasn't that inflammatory, but that cover. And then if you watched any recordings from any of the morning shows or news programs that reported on this cover in that time, all they did was report on the cover, not the actual content of the piece. And so it was super inflammatory and it really made for this, you know, great headline news focus.

But it missed the story. It turned the story into mothers against mothers and what does it mean to be a good mother without talking about the notion that we can't be good mothers if we don't have the support, that we can talk till we're blue in the face about what a mother should be. But if we're not providing folks with the support and the means to become good mothers, then it doesn't really matter, right? And so that, you know,

bookmark that because that's going to be a thread in the perfect birth myth, right? We're not providing the means and support to have these births, not even perfectly. So how can we even kind of come up with this idea of what is a perfect birth? And so I saw that cover, I got upset. I was like, I need to write about this.

While I wrote I was like, okay, but I'm doing the same thing We need more voices and that's when the idea of an anthology came out and I started reaching out to folks and I said Would you be interested in writing an essay to kind of? Break down and dispel this idea of there's one way to be a mother because there's not we know that there's so many different challenges and experiences and backgrounds that we all have and

there's just no, you know, every family is different. Every mother is different. What works for one family isn't going to work for another. What works for one kid isn't going to work for another kid. And so there were, you know, we were living in this kind of world of very binary, very, it has to be like this or that. And so I wanted this book to kind of break through and show that there wasn't. And I love that you said that you kind of,

pulled something from each piece because I wanted, my goal was that anybody anywhere could pick up the book and find at least just one, right? There's over 30 essays, but to find at least one essay that speaks to them in some kind of way that they're like, I'm not alone. And I hope I did that.

Jessica | The Mama Making Podcast (18:34)
Yes. Yeah. Yeah. Yeah. I can, I can assure you that you did. yeah, I feel like it's so interesting because every parent is different. As you said, every mom is different. Every family is different, but I think it also gave permission for me at least that you're not the same mom from beginning to end. You've grown so much. You've learned so much. So each different state, I mean, my son's only two or will be

Avital (18:56)
Mm -hmm.

Jessica | The Mama Making Podcast (19:01)
The mom I was the day I brought him home from the mom I am now is I feel like a different person. So I think it gives validity to the fact that everybody's different. You're different at different times in your life. There were a couple that are popping up in my head where they talked about one mom specifically was a NICU mom. And she was so terrified bringing this baby home.

Avital (19:23)
Mm -hmm.

Jessica | The Mama Making Podcast (19:26)
I identified with that personally. And then by the time I think she was, her daughter was too, well, while she was writing this and the world of difference that it made, but it was all valid at all counted. It was all valid. And I think that throughout the whole book, really like your experience is your own and it's valid and someone else relates to it.

What I loved about it was all these different people coming together to share their experience very vulnerably. that will sure, even if it's just one person that's like, I identify with this and I can feel a little bit better about my experience or what I'm doing or my place in motherhood. think, yeah, I obviously love the book, but I think, each, each experience shared can definitely be,

like resonate with anybody, whether you're a grandmother or a new mom or anywhere in between, feel like just a lot of times I feel like we just need validation. Like I'm just winging it. I don't know what's happening. And it's like, you don't know what's going on either.

Avital (20:26)
Yeah.

For sure. Yeah, exactly. Right. And I think that was one of the troubles. I think there were some amazing mom blogs out there. And I hate that it was almost infantilized with the term mommy blogs. Right. Because there was some great, great reflection and great kind of like internal.

Jessica | The Mama Making Podcast (20:52)
Mm, yeah.

Avital (21:02)
just folks really breaking it down, but that it didn't get the kind of attention or like mainstream attention or focus that they had deserved. And so in the book, what I tried to do, and I didn't want it to be all trauma and I didn't want it to be all heavy stuff. There are some, there's some really intense stories in there and I think they're very important, but then there's also some lighter ones because I think.

We all have, you know, it's not a straight journey. There's a lot of the ups and the downs and we're dipping and we're peeking and there are times where we feel like a really great mom. And then there are times like the next day where we like, you know, totally fucked up. We just did. And so, you know, the article with from the essay from Carla Nauberg, who just wrote about, she doesn't cook. She just doesn't cook.

Jessica | The Mama Making Podcast (21:39)
Yep.

was just thinking about that one. Yeah.

Avital (21:54)
And you know, and I loved that. And it just gave me such permission to be like, I don't have to be that mom that is, you know, and I think we've kind of looped back now where in this like, trad wife is the new thing that's kind of trending. And I think people are getting that. And that's great if you want to go out and cut down your wheat and crush it down and make your bread.

That's fabulous. If you have the privilege and the finances and the time to do that, bless. But it's the idea that, again, the binary, that it has to be one or the other, right? I'm a semi -homemade cooking kind of, Sandra Lee. Like, I'm a Sandra Lee from that kind of a model. But yeah, so it's a spectrum, right?

Jessica | The Mama Making Podcast (22:38)
Yeah.

Yeah, and I think it's so funny, I was thinking of that exact story of it was a funny and very lighthearted story. But at the end of it, like, not at the end, but at some point of it, it was like, you could feel this feeling of like, I'm failing at what I think I'm supposed to do. So I think I think there's something to be taken from from each story. With that said, were there any that

stuck out to you or kind of like sit on your heart a little bit that in this

Avital (23:21)
I mean, so many, you know, I'll admit up front, so many of the folks that wrote were either friends of mine or became really close friends of mine. And so their stories touched me even a little bit more.

I haven't, I'm gonna be honest here, good writer myth. I haven't cracked that book open in a while. And so to like, you know, but there are ones that stand out. TF Charlton, that's not her first name, sorry. I have to make sure that, but I remember that's what we put in the book. It was just about being a black mom in Boston. And it wasn't anything sensational. It was just basically like, this is what my day to day is like.

And I think it was an eye opener for a lot of folks who may not have had close black friends of my experience. Like we can't even talk about being a good mother because I have the weight of being a black mother on me. And what does that mean? Joy Layden's essay about being a trans mom.

Jessica | The Mama Making Podcast (24:12)
Mm -hmm.

Mm.

Avital (24:26)
and coming out later in life and how that impacted her family and stuff. And that was a conversation before there were a lot of conversations about trans parenting and things like that. Yeah, and I still keep in touch with so many of the moms who wrote essays.

Jessica | The Mama Making Podcast (24:40)
Right? Right.

Yeah. I love that. Anything else on the Good Mother myth that you feel like you want to share or is important for people to know about?

Avital (25:00)
I mean, I will say so it's been a little over 10 years since it came out and I still feel that it's relevant. Like, unfortunately, it's not dated. I almost had hoped, you know, in a decade or so it would have been I would have loved almost for it to be irrelevant, but it's not right. Like you're saying you still give it to or you still encourage folks who've just had kids or are pregnant to read it. I hear that all the time, that it's still something

Jessica | The Mama Making Podcast (25:20)
Yeah.

Avital (25:28)
holds merit and holds connection and holds value. And so I appreciate that, but it makes me sad at the same time, if that makes

Jessica | The Mama Making Podcast (25:38)
Yeah, yeah, absolutely. Yeah, I think it's funny that you could almost like take each story and like plug it into an Instagram post. It's like so relevant that you wouldn't even think it was so far in the past, but also so present still. So yeah, so moving from the Good Mother myth, what

Avital (25:48)
Yeah, yeah.

Yeah. Unfortunately.

Jessica | The Mama Making Podcast (26:05)
propelled you to start writing the perfect birth

Avital (26:10)
So the Good Mother Myth had just come out and I at that time was working for Yale School of Public Health, helping them. They had done some incredible research on this idea of group prenatal care. So instead of going for your prenatal care as individual appointments, all of your appointments would be done in a group setting. And that would include getting checked out and things like that.

you would have this kind of the same group, same folks that would go through the entire nine months with you essentially. And there would be a midwife or a doctor there, but you would have that support. You would have this kind of cohort of folks who were going through it. And the research that came out of that they produced from it was incredible. It would be things

lower rates of early birth, lower rates of low birth weight for the babies, higher rates of breastfeeding postpartum, lower rates of immediate new pregnancies afterwards. bigger spaces in between concurrent pregnancies, lower rates of postpartum depression. It was really phenomenal.

And I'm sorry, am I okay because it's showing that I don't have a stable internet connection. Can you hear me?

No, have I? no. I can't hear you.

I can't hear you.

Avital (28:44)
Bye.

I can't hear you.

Jessica | The Mama Making Podcast (28:51)
Okay, can you hear me now? No, that's okay. Sometimes if your internet gets a little wonky, the program will just shut it out and have you log back in, which is probably for the best, a little. no worries. I just not go up. No worries. Okay. So you were talking about the research on cohort prenatal care. Yeah, in the outcome.

Avital (28:52)
now I can't. I'm so sorry about that. It just kicked me off. I don't...

Sure. Yeah, I know just emailed you. was like, I don't know, I'm trying to get back in.

I was like, okay.

the group prenatal care. So amazing research, amazing research, amazing outcomes. And so what they wanted to do was take the data that they had collected and turn it into an actual curriculum. And so I was in charge of helping create that curriculum. And so it really just got me into looking at what is offered to those who are pregnant and giving birth in this country. And so

really connected with Deborah Wage, was a midwife at that time out of Vanderbilt in Nashville. And she both taught and caught babies. didn't teach babies, but she taught other midwives and also OB -GYN residents would come in through her program and stuff. So she taught and caught at Vanderbilt. But she was also an advisor on this program called Expect With Me from the Yale School of Public Health.

And we met a few times at in -person meetings for this project. It was spread all over. There were folks in Nashville, in Minneapolis, because United Health was a part of it as well, and then in New Haven at Yale. And Deb and I were just connected and we started talking about, you

the good mother myth, but I was like, what about this perfect birth myth? Like everyone has this idea and Deb had lots of thought on that, obviously having delivered a lot of babies and seeing what people really wanted. and we were like, we need to talk about like this idea of a perfect birth because we're not even set up as a society to allow for it. Right? So all of these people talking about like, hypnobirthing and breathing and you know, this or that.

all amazing things and all great and I'm sure all have their place, but we're not even set up as a society to support these methods. And so the more research I then did into how insurance plays a role, how state laws play a role, where's the federal role in all of this? then looking at, then so taking it from the large to the tiny and then back again.

how race plays a role, how economics play a role, all of it. And the more we looked into this, the more it was like, we can't even begin to discuss an idea of perfection, which is kind of silly in and of itself. Like we don't talk about being like the perfect heart patient or the perfect diabetic or the perfect cancer patient, right? It's just, it's about getting it done. And obviously those are pathologies and birth is not, but still when we're looking at the medical world, why do we have

Jessica | The Mama Making Podcast (31:49)
Right.

Avital (32:01)
pressure on us to perform in a certain way. right. And especially for a lot of people who felt like birth was happening to them, that they weren't an active participant in their own children's birth. And so we started first just very mildly putting out a survey to folks just to get an idea of what people's birth experiences were. Cause we were like, okay, maybe in our heads, maybe just in

Nashville, this is a very specific thing. Let's really see. And we had almost like within the first month of just asking folks to share our survey, over 2000 people responded, which is white wild. And so we started working on it. We started writing on it. And then life got in the way. And then COVID happened. And I was like, we are doing this book. And so we sent out a revised

Jessica | The Mama Making Podcast (32:43)
Yeah, that's incredible.

Avital (32:56)
survey got a few more hundred responses. And sadly, the data hadn't really changed in terms of like people's experiences, right? COVID kind of did put a of like a kink into it all, but not in the way that really showed a huge difference in the experience. And

We were like, need to we need to do this and we need to get it done. and yeah, that's where we are now. The book is about 90 percent finished. We've done all our interviews. It's just a matter of like cleaning it up and getting it out there. And so the more I researched, the more frustrated I get. But the more I get, the more kind of connected I get to the birth justice world, the more inspired and the more

I'm confident, I feel, that there are people on the ground who are doing the work. They might not be making the headlines, but they are, because the work is, I mean, there's some good stuff happening on the federal and state levels, but the real work, the work that's actually impacting the results and the people and the families is happening at the grassroots level. So.

Jessica | The Mama Making Podcast (34:00)
Mm -hmm.

Yeah. Yeah. I'm very excited for this one. I was prior to having my son, like all I listened to were birth stories and I wanted to know like everything. wanted to hear the hard ones and the sad ones and the beautiful ones, even though I think they all kind of fall under that. But, I think that everyone is like starving to share their story or their experience. And I think just like the first

So many people are going to relate even to the smallest piece of someone else's story. And yeah, I think this is really like meeting a need that isn't being met right now with, mean, we have the podcast, we have amazing resources, but I think there's something to kind of learning a little bit more about this like cohort prenatal care type thing, but then also

of hearing different stories from different places from different people that all kind of melds this one experience as a birthing person.

Avital (35:19)
Yeah.

Yeah, so the structure of the book is very different than the Good Mother Myth. So the Good Mother Myth is an anthology. This book is research and interview driven, but it's still for me, they're still a narrative, they're still narrative because that's important. And so every chapter starts with a birth story. And so it's a birth story that relates to the chapter. And so we start with somebody's story and then we get into why that happened or why something didn't happen.

Jessica | The Mama Making Podcast (35:34)
Okay.

Yeah. Okay.

I love that.

Avital (35:55)
and also little bits of stories kind of interspersed in between, but that was important for me. I didn't want to lose the narrative aspect because you're right. Everyone just wants to share their story. we just want to be heard. And I think that's, an echo that we saw in a lot of the, surveys, you know, people don't love taking surveys, but for some reason, when, you know, we had a lot of, questions where you could pick, like, did you have a doula? Did you have,

pain medication, did you have any of these interventions, whatever, just for statistics. Easy enough, check off, check off, check off. But I was like, how many people are gonna like write their birth stories? And large amount, the majority of people paragraphs. And that the fact that I was trusted with these birth stories is really, you know, I felt really honored. And some of them were

Jessica | The Mama Making Podcast (36:32)
Mm -hmm.

Avital (36:51)
heartbreaking. Some of them were empowering. know, for the, we have a chapter on the impact of white supremacy on birth. And I very consciously in that chapter, I could have easily, I had a number, a number of stories that were traumatic from black moms.

Jessica | The Mama Making Podcast (37:01)
Yeah.

Avital (37:13)
And I could have easily included any of them, but I very specifically included, I started the chapter with a birth story that just resonated with Black Joy of someone who talked about how she was walking with her husband trying to get her labor going and walked through her neighborhood and just got cheered on by her neighbors in a way that was just so familial and supportive and...

I started with it specifically to show that it's possible, to show that when we, because right now, I mean, the headlines are all about how we currently in the US have a maternal health crisis and specifically a black maternal health crisis that black women in particular are the ones most at risk for death, for complications, for postpartum issues. And

Jessica | The Mama Making Podcast (37:54)
Mm

Avital (38:07)
we're inundated and specifically black people are inundated hearing these stories and that promotes fear that promotes uncertainty that promotes just you know, which I think all of those things have a place right in a sense, but I didn't want to be a part of the fear mongering. I wanted to talk about like we are we have issues and we have problems and here's how we can

attack them. But let's look at what's possible. Let's look at like something that we can celebrate. So the stories play a whole kind of, you know, a variety of roles, really.

Jessica | The Mama Making Podcast (38:44)
Yeah, I love that.

Yeah, yeah, I think that creative choice of choosing to like lead with joy in an area that is challenging and scary and daunting. I think will be, I imagine will be very impactful. Yeah.

Avital (39:01)
I hope so. I hope so because, you know, it can take its toll just seeing the reality of what's out there, that it is a real fact that, you know, Black and Indigenous women are just at a higher rate for these things because of policy, because of internal bias, because of the systemic racism in our society. And it leads into medicine. We've known this. There's, there's

and stats and studies that prove it. And so if we can find ways to show the triumphs and, know, and it's also not, there's a lot of women that have lost their lives and whose stories are being shared. And I talk about them in the book as well. But I don't want that to always and only be the face

of this crisis, right? Finding ways to kind of push through. And that's why, so for each chapter, we also have a pushing back section. So like on the chapter on insurance, we talk about the different ways that insurance plays a role in birth. So in my case, I paid $25 back in 2007 to take a test, to show that I, a blood test to show I was pregnant. That's the only thing I, the only copay through the entire pregnancy and birth.

Jessica | The Mama Making Podcast (40:22)
my gosh. It's a world of difference now. Yeah.

Avital (40:23)
and which is wild. And so my husband is employed with the same company, you know, 18 years later. so multiple changes in insurance through the company. And so I called the current company. I was like, hi, I'm not, but if I was pregnant and I wanted a vaginal birth, how much would it cost me out of pocket? Tens of thousands of dollars now. And when I told the person on the phone, was like, when we had

you know, XY insurance, like a 25, they laugh. They were like, that's incredible. That's nobody's reality right now, unless you're paying in, you know, a wild premium. So a world of a difference, a world of difference.

Jessica | The Mama Making Podcast (40:58)
No, no.

Yeah.

Yeah. And I love that there's a portion on insurance. am, if anybody asks me about insurance, I know way more than I should for my place in the world, but it's so impactful on so many birthing decisions that you make. And, I mean, my mom, my mom always talks about how what they paid for my birth was the meal that my dad had the day she delivered me and that everything else was under insurance.

Avital (41:17)
Yeah.

Yeah, it's true.

Ha ha ha!

Jessica | The Mama Making Podcast (41:37)
And, when we got our bills for our son, he had a NICU stay and a transfer, and it was like a whole thing. And it was hundreds of thousands of dollars. And I have good insurance with a healthcare system. So it's so, so different than it used to be. And I think, one, nobody talks about it enough. And two, it's just like, well, that's the, that's the game you play, I guess. And it, it

Avital (41:52)
Yeah. Yeah.

Jessica | The Mama Making Podcast (42:05)
have to be and it shouldn't be.

Avital (42:06)
It doesn't have to be. I mean, it really doesn't have to be. We interviewed a woman who remained anonymous, I met her through... Actually, I'm not going even say how I met her. But she worked in the insurance industry and in maternal care, but in the insurance world.

ended up having a traumatic birth and getting kind of like a whole new education and now works with companies to improve what their offerings are in the maternal world. And she said flat out straight, it's cheaper for women to die.

Jessica | The Mama Making Podcast (42:48)
Wow. that's crazy.

Avital (42:49)
It's cheaper for these companies for women to die because if they're having a traumatic birth, think about all of the financial ramifications, whether that's PT or a hysterectomy or dealing with blood loss, dealing with mental health issues. So it's cheaper in a sense, which is just absolutely shocking to me.

Jessica | The Mama Making Podcast (43:15)
Yeah, absolutely.

Avital (43:17)
But not at the same time. Unfortunately.

Jessica | The Mama Making Podcast (43:19)
Yeah. Yeah. It's that weird juxtaposition of like, my God, that's crazy. But also, yeah, I could see that. Well, I'm so excited for this book. I know you're not supposed to ask an author when to expect the book. Okay. Okay.

Avital (43:25)
Yeah.

soon. I'm hoping soon. I'm hoping soon. I mean, it's it's frustrating in the sense that like some of it's timely, but then the more I think about it, it's not like it's timely and it's not like I don't think if it takes four more years for the book to come out, not you know, I don't want that to happen. But let's say like that's whatever. I unfortunately, I don't think the birth the issues with our birth system right now are going to change in that time. I mean, here are the facts, right?

Jessica | The Mama Making Podcast (43:42)
Yeah.

Yeah.

Unfortunately, yes.

Avital (44:03)
We have the most expensive birth. We have some of the worst outcomes for other similarly resourced countries, like by far. During the pandemic, when other countries actually reduced their rates of maternal mortality, ours went up.

Jessica | The Mama Making Podcast (44:25)
Mm -hmm.

Avital (44:27)
So we're paying the most for the worst outcomes, which, you know, I wrote a piece with Deb for US News and it was like, what other business would be allowed to continue this way? None. If you had a company and you were like, guys, we're failing, 84 % of our mistakes could be avoided.

Right? So 84 % of maternal complications are preventable. It's just that like research has shown that, that it could have been prevented with better prenatal care, with better access, with better just healthcare in general. 84%, 84 % of complications. Like that's a large number. Like if you went into a company and you said, you know, you're doing so poorly, but the majority of your mistakes are preventable.

you would oust that CEO, you would have an overhaul, and yet it's the people at the bottom of the ladder that are doing the fixing. And so it's wild to me. It's absolutely wild that we allow this to continue.

Jessica | The Mama Making Podcast (45:25)
Yep. Yeah.

Yeah. Yeah. Yeah. It's crazy. Yeah. I don't even, I don't even know where to start with it. So the fact that you're even getting started on it is, I think a win to begin

Avital (45:50)
I'm glad. And I don't want, know, there's a lot of doom and gloom in the book. And I don't want it's not like a fear mongering book. That's not my if anything, it's I want it to be empowerment through education. Right. So that's why at the end of each chapter, we have ways that you can push back whether you are pregnant yourself and wanting to find ways to support yourself, whether you love someone who's pregnant, whether you're just like an ally.

And so there's ways that you can fight back on like the federal level, the local level, the personal level. And so we try to find different ways to kind of create a cushion. This book will not tell you how to have a perfect birth. It will not tell you even, know, because there's no solution. watch anyone who's going to tell you that they can promise you that you will have a perfect birth. can't. There's things you can do to mitigate. There's things you can do.

to provide support. But there's nothing that you can do that will say this is exactly what's gonna happen, right? But we do, there's a chapter that talks about the folks who have been pushing back, the ones who have been doing the work, because I think it's so important to highlight those who have been in the trenches, because it's not the politicians, it's not the ones in Congress that are making these laws or not passing legislation that we desperately need.

Jessica | The Mama Making Podcast (46:51)
Right,

Avital (47:11)
It's the people on the ground. It's the people in Miami, Southern Birth Justice Network, who have a traveling midwifery van that goes to the locations where people would either have to take three buses if they can afford it to get to prenatal care. So they just only go every other month or something. So they're not getting the care they need. Instead, these people come to them, right? It's the folks in the Pacific Northwest who have an indigenous collective of care.

Jessica | The Mama Making Podcast (47:17)
Yeah.

Avital (47:39)
because they know their communities and they're providing them culturally competent care, which is really a lack. It's people like Dr. Stephanie Mitchell, a friend of mine in Alabama, who's working to open one of the first freestanding birth centers in an area where it's a maternal healthcare desert. so, you know, hospitals are closing left and right. And so it's those people that are doing the work. And I wanted people to make sure that they knew.

So that they would be, they would leave the book having read it with a sense of hope, a sense of comfort that there are folks that are doing stuff and that there are things that they as an individual can do as well.

Jessica | The Mama Making Podcast (48:13)
Mm -hmm.

Yeah, I love that. So I wanted to talk a little bit about the intersection of maternal care and abortion care. It's kind of a big topic. Do you think we have enough

Avital (48:33)
Sure.

Yeah, I mean, I think really it all boils down to and research has shown that states that have the worst maternal health outcomes and the worst maternal care also have really crappy abortion laws, that there is a connection and that I think there's this myth that if you prevent abortion, you're just going to have great pregnancies and births and it's the complete opposite. states that have

Jessica | The Mama Making Podcast (48:52)
Mm -hmm. Yeah.

Yeah.

Avital (49:05)
most stringent laws, the most stringent barriers to abortion care are losing out and they're losing out in a couple of ways, right? So they're losing out by having providers flee the counties and the states that aren't allowing because they're not able to offer all types of care. And so it's impacting both those who don't want to keep their pregnancy and those that do. So

lack of OB -GYN. So if you need surgical care during pregnancy, depending if you're in a state like Alabama or Arkansas, or a lot of them are in the South, Louisiana. I'm just trying to think off the top of my head areas where they've just, they've done these studies and it's also going to impact if you want to get pregnant, but you can't. So IVF is another one. It's all interconnected. And so I think when people are

that they care about life, they care about mothers, they care about families, they're going about it the wrong way. Banning or restricting abortion isn't going to prevent it, it's going to make it harder for those who want care. I mean, they're even showing now just in the last year since the Dobbs decision that when folks

are less folks are going into OBGYN. They're choosing less people are choosing that path from medical school. So medical school studies are coming out showing, cause there's going to be less states that are allowing, like you've, need to do your rotations. You can't do a full rotation and learn everything you need to know as an OBGYN. If you're not being allowed to learn about abortion care, just, it's not. So people are either opting not to go to those states because then their care will be less than right there, their, experience, their skills.

Jessica | The Mama Making Podcast (50:51)
Mm -hmm.

Avital (50:57)
or they're just choosing not to go into OBGYN practices at all. And so it's a domino effect, right? It's impacting people who don't want to be pregnant, first and foremost, that's obvious, but it's impacting folks who want to give birth because they're now living in maternal care deserts. It's impacting folks who want to try and get pregnant from IBF because now people who are anti -abortion are, well, you you can't have embryos.

It's a whole, it's impacting everybody. And so that's why I'm, know, reproductive justice is for those who don't want to give birth and those who want to give birth. It's so intersectional. You can't talk about one without the other.

Jessica | The Mama Making Podcast (51:42)
Yeah. And I think we've gotten to a point where there's a very like clear picture of who people think are having abortions and who are needing abortion care. And now with so many laws changing and things impacting everyone, people are now seeing, it's my daughter who is going through IVF and can't because of the place they live in, or it's my sister who

Avital (51:50)
Mm -hmm.

Jessica | The Mama Making Podcast (52:11)
pregnant and having a loss and can't get the care she needs because it's.

Avital (52:13)
Mm -hmm.

or you have to travel to another state and with a dead fetus inside of you. it's not, and it's something like one in three folks who get an abortion already have a child. So we're taught, you know, and want to provide the best for their family. So for whatever reason it means that they're getting an abortion, it's there. They already have children to take care of. So whether it's a health reason, whether it's a mental health reason, whether it's a personal reason, like it really shouldn't matter. Economic reason.

It's really, it's frightening. It's really frightening because it's impacting all of

Jessica | The Mama Making Podcast (52:53)
Right. And I think what, I think now people are starting to see the, the intersection of the two where the, the woman who's having a miscarriage and needs the medication to complete that cycle. It's also the same person that needs that medication to have an abortion for whatever reason, as, as you mentioned. So I think, I think now, unfortunately, people are starting to realize that this really affects everyone.

Avital (53:07)
Mm -hmm.

Jessica | The Mama Making Podcast (53:22)
not just people who are looking for abortion care, not just people who... It's affecting people everywhere. And I think that it's just now that people are making this connection, which is crazy. Well, it's crazy that now there's so much happening politically that it's a huge topic of conversation.

Avital (53:38)
Yeah, and it's things. go ahead. Yeah, I was gonna say

Mm -hmm.

Jessica | The Mama Making Podcast (53:50)
But now more people are realizing like, I might be affected by this or my loved one is affected by this. I have a personal frustration where it, with those who, don't care unless it affects them, which is a whole other conversation. But yeah, yeah, that's a whole other conversation.

Avital (54:04)
Right. there's that. Listen, there was a couple of days ago, a North Carolina, someone in North Carolina, a Republican who had like previously been super anti -abortion, mocked women with ads and things like that, said that his wife had an abortion and a new ad and changed it when it's personal. That's what it happens. And what's frustrating is

Jessica | The Mama Making Podcast (54:28)
Mm -hmm.

Avital (54:34)
I think we need to really like revamp the conversation, right? To show how it impacts everyone. So folks that live in states with abortion bans are three times more likely to die during pregnancy, birth, or within that first year postpartum. So that's what maternal health encompasses, pregnancy, birth, first year. Three times more likely. And of course, just like anything maternal health related, black women are

Jessica | The Mama Making Podcast (54:57)
That's so crazy.

Avital (55:04)
the most likely to be impacted. I mentioned Louisiana before. Doctors in Louisiana, because of the restrictions and the fear of being mistaken for providing abortion care in the wake of their state's ban, are performing more C -sections than vaginal deliveries because,

Jessica | The Mama Making Podcast (55:25)
wow.

Avital (55:28)
I mean, it's absolutely wild. It's absolutely wild. So unnecessary procedures are happening because of fear of things going wrong and being labeled, you know, it's an, yeah. So it's impacting.

Absolutely everyone. And it just, it's, frightening. And I, I really fear that, the maternal hair, the maternal care deserts that we're seeing are just going to explode and folks who are at the most risk are not going to be able to access the care they need because specialists are leaving. doctors are leaving and these are areas where also here's where it also relates and intersects. These are also states that have really poor

legislation when it comes to midwifery and where midwives can practice and with who and under what conditions and restrictions. it's, yeah, it's all piled together and you can't talk about one without the other. So we have a chapter in the book. It's called, Pandemics Don't Give a Shit About Birth, something like that. It's not right. Hold on. Wait, what is it? It's,

Yeah, pandemics don't give a shit about perfection. That's it. And it's this idea that our system was so broken that something like a pandemic can come in and make it worse. That something like the Dobbs decision can come in and make birth worse. That our birth system is so fragile and so broken that these events can happen and really just make conditions worse for everybody.

there we go. Yeah, I can hear you

Jessica | The Mama Making Podcast (57:15)
Sorry. There was a, there was a bus passing by and I knew my dogs behind me were going to bark, but, I love that there about this book, that there are different, opportunities for people to either research those and support those who are doing the work, like boots on the ground. think if you don't feel called to being kind of like a quote unquote frontline person or,

Avital (57:20)
Bark.

Jessica | The Mama Making Podcast (57:43)
you're still in that researching phase. think finding the people that are doing the work and supporting them in the ways that you can is helping doing something. I used to work in fundraising and I'm a true believer that every penny counts. If you're able to give $5, that $5 can go somewhere. So whether you can donate your time or donate your talent or your money, whatever you can do, I think

Avital (57:50)
Mm -hmm.

Jessica | The Mama Making Podcast (58:11)
finding the people, whether it's in your area or in your community or in a community far from you, I think that if you feel you aren't called to or can't do the work yourself, finding those people and having a dedicated section to it in your book is incredible.

Avital (58:30)
Yeah, I mean, it can even be as simple as having a discussion, right? So we have a chapter on the birth plan, and I very bravely share my way too long birth plan that I have in a part of the birth plan. was

Don't allow any janitorial staff in while I'm actively delivering. Like what kind of, what was I thinking? I don't know. I pulled something from the internet, right? And I'm like, yeah, that sounds good. And Deb and I talk about it all the time that a lot of providers will have a lot of the things standard as standard of care that you're asking for. But somehow there was, either the provider didn't talk about it, the patient didn't talk about it. And so then there's a lack of trust. There's a lack of knowledge.

And that can impact a birth. And so we talk about it on both ends. We offer tips for providers. Like if y 'all offer these things that you're seeing people come in with birth plans, make it clear, have it be on your website that we do delayed cord clamping, a standard of care, or we allow for free movement, a standard of practice, or make sure you're having that conversation.

During those 15 minutes or whatever it is you have when you're meeting your patient, I know it's difficult, but it prevents a lot of things and it builds up that trust, which we heard from so many people was important. Like there was a lot of, don't know if I trust my provider, but if you find out you're on the same page and you're working towards the same goal, that can just do a lot. And so even if it's just talking to a friend who's a provider of some kind and being like, do your patients know that

XYZ is standard of care. you know what? don't think we do. Like that makes sense that they're coming in armed with binders of what they want to happen. And so it's, you know, it's just, you know, little things like that, but I love your idea. Yes. Donate if you're in a position where the only thing you can do is send a few bucks, like find an organization either in your area. I guarantee you there are people doing the work in your area, even if you don't think there are. There are.

Jessica | The Mama Making Podcast (1:00:18)
Yeah.

Avital (1:00:38)
them and give them money so they can continue their mission because they are the ones that are most impacting and changing the results.

Jessica | The Mama Making Podcast (1:00:46)
Yes, I love that. I'm to be, rehabbing my website and putting kind of a resources page. I'd love to have one that's like activism centered. So if there are, groups that you are like, my God, we need to get this out here. I'd love to have those, to put up on our

Avital (1:00:55)
Yeah, fabulous.

Yeah, I mean, what's wonderful is, especially with like, you know, Instagram wasn't really a thing when we first started writing this book. And seeing so many not just midwives and doulas, but OBGYNs talking about it, it's wonderful. It's really great to see the folks. And I'm hoping that that's helping to break down myths. It's helping to break down barriers to access to information.

Jessica | The Mama Making Podcast (1:01:18)
Mm -hmm. Yeah.

Avital (1:01:31)
So I think it's wonderful. mean, as much as I think social media can be dangerous and really fear monger and show like the bad sides, think there's a lot of, if you know where to look, there's some great information that can help.

Jessica | The Mama Making Podcast (1:01:43)
Yeah. Yeah. Awesome. Well, thank you so much. Like I said, I could talk to you forever. I have a million questions and things to chat about, but in time's sake. Thank you so much for being here. I'm so excited for your new book and we'll be happy to share when it's out. Yeah. Thank you for being here. I've loved chatting with

Avital (1:01:58)
Thank you so much.

Thanks for having me. This is great. I always love talking about, mean, you know, I've talked with all my friends who are actually like doing this and I'm like, I'm just writing a book about this. I just write articles and you guys are doing like the stuff, the work. And they were like, but you know what, without you, like people don't know. So, and same with this podcast. Like this is why we do it is to make sure folks are having these conversations. So thank

Jessica | The Mama Making Podcast (1:02:22)
Yeah, they need people like you.

Yeah, absolutely. Well, thank you for your time. appreciate

Avital (1:02:32)
Thanks so much and I'll definitely be in touch and give you more information when the book is out.

Jessica | The Mama Making Podcast (1:02:35)
Awesome, I would love that. Thank you so much. All right, let me pause this.