Dr. Sterling (00:00:00):

We act like birth is this one-time experience, and I feel that that’s not how human beings and a human life works. That birth story is something that oftentimes our children carry with them. We carry with us, we have to integrate it. We have to take intentional meaning and a process trauma and get help for trauma when that’s necessary.

Dr. Sarah (00:00:27):

The number of women who experience birth trauma are staggering, yet it is not something that is often talked about and women are left without knowing where to turn for support. In this episode, OB/GYN, the founder of Sterling Parents and Mother of three, Dr. Sterling is back to shed light on this very important topic. Not only does she talk about her experience as a doctor, but she also shares her deeply personal journey of healing from birth trauma herself. We talk about why birth is an internal experience, how trauma can occur from both objective threats and subjective experience of feeling unsafe and why so many women minimize their symptoms. Plus, we’ll share medical and psychological perspectives of how trauma is processed and stored in the body and the mind, the power of the stories that we tell ourselves, and actionable strategies that expecting parents can put in place ahead of birth to make them feel safe and empowered reducing their risk of trauma in the first place.

(00:01:30):

I also want to just take a moment to share a trigger warning. If you are pregnant expecting or maybe you’ve experienced birth trauma and the idea of listening to an episode about birth trauma right now, it feels too much for you. Please listen to yourself, trust yourself. You could skip ahead to the next episode or come back to this another time. Just listen to what feels right for you. And if you feel like you can join us for this episode, it is a powerful conversation about self-compassion, finding healing, and learning to rewrite your birth story in a way that supports your mental health and emotional wellbeing.

(00:02:11):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights so you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(00:02:45):

Hello, we have Dr. Sterling back on the podcast today. Welcome. Thank you for coming on the show.

Dr. Sterling (00:02:55):

Oh, I’m so excited to be here. I love my conversations with you always, so this is going to be a good one.

Dr. Sarah (00:03:00):

Yes, yes, I agree. We were just joking before we hit record that we don’t really need to prep for this. We’re just going to go and see where this conversation goes. You can talk about pretty much anything related to parenthood and pregnancy and birth upwards, backwards and sideways. So, yep, from personal experience, you are a mom of three, but also very much deeply from your professional work for people. First of all, if you haven’t listened to our original, our previous episode with Dr. Sterling, go back. We’ll put in the link below and in the show notes to link to that episode. But for people who haven’t listened to that episode or aren’t familiar with Sterling parents and all of the work that you do, let’s just orient them to your quick and dirty.

Dr. Sterling (00:03:54):

I was a regular old OB/GYN until I got pregnant with my first, and I had a really difficult pregnancy, and it really opened my eyes to the gaps in prenatal care in terms of supporting the emotional journey of pregnancy, the stress that is associated with pregnancy and preparing for a baby. And so that opened my eyes. And then my postpartum experience really just that blew the door off the hinges in terms of how I saw our role in a person’s life as they move through the reproductive journey, because postpartum is just this hugely transformative, both physically, mentally, emotionally, this huge and very challenging, difficult time. And you look at the medical healthcare system, it’s just like the support completely drops off, and I found that I just believe that that’s deeply unjust and not okay. So yeah, that spurred me onto an exploration of how do I make it better?

(00:05:03):

How do I solve this problem? It got me looking into the data on what is the impact of stress and anxiety and the emotional journey of pregnancy? What is the impact of that on actual pregnancy outcomes on the developing fetus? What does that do? And we have a lot of data to support that stress anxiety, all of these are impacting our pregnancy outcomes. They’re impacting fetal development, and I think it’s part of the picture of why we have high rates of maternal mortality and morbidity in this country, and the same with infant mortality and morbidity. So I lit a fire under me to really solve the problem and solve it now, and not just chip away at it my whole career, because that was the decision I had to make. Am I going to stay in the healthcare system doing research and kind of slowly chipping away at this problem over the course of my career, or am I going to figure out a way to help the people right now who are pregnant and who need support? And so I decided to leave my clinical practice. I founded an online membership that supports people through the reproductive journey from trying to conceive to pregnancy, to postpartum. That really maps out what are the anxieties, what are the stresses and how do we prevent them, and how do we take evidence-based tools and put it in this membership and improve mental health and just improve wellness as we go through the journey. So that’s what I do now.

Dr. Sarah (00:06:29):

And I mean, we come at this from different angles. I’ve always loved everything that I’ve read that you’ve written. I loved everything that you put out there. I think in part because, how do I say this? You are saying all the things that I’m saying…

Dr. Sterling (00:06:52):

Yeah.

Dr. Sarah (00:06:53):

But from a medical angle versus a psychological angle, and it’s so validating.

Dr. Sterling (00:06:58):

It’s all the same thing. That’s the thing that I think that what’s very clear to me in the data, not only in my field, but in all the fields, we are one organism, our social health, our emotional health, our mental health, our physical health, it’s all one.

(00:07:16):

So it’s about integrating and realizing that no, we cannot separate physical from mental health. It’s the same person. So when things are, if you have relationship issues with either your partner or anybody, you’re having relationship issues in your life that’s going to affect your mental health, that’s going to impact your physical health. It all plays in. So we need to stop dividing up a human being into all of these sections, and we need to start working together to take care of human beings and be more centered on the human being and not on the like, well, this is my lane and I am a doctor, so I only care about physical health. Absolutely not. I care about the human being.

Dr. Sarah (00:08:01):

And I love that. And to take it even a step further, this idea like, yes, we can’t keep fragmenting a person up into these different sections. We have to really look at their whole interconnected network of functionality. The same is true for the family system because when the mother, the parent in the family is doing well, the children can do well, and not always, but when the family system is only as healthy as the healthiest system, it’s an e functioning person in the family, we always, so supporting a maternal mental health or physical health or just whole health supports the child development. It supports the child’s health. It’s all interconnected.

Dr. Sterling (00:08:48):

Exactly. And the perfect example of this is when look at breastfeeding and you have people who are so myopic with breastfeeding, they get so narrow focus, well, the data says this, it’s better, blah, blah, blah. No, you cannot look at outcomes for children in terms of just were they breastfed or not? What does the ecosystem look like for this family? You cannot say that Russ is always best without looking at the ecosystem of the family. Sometimes using formula is the thing that improves the ecosystem.

Dr. Sarah (00:09:24):

Yes. Oh my God. And that’s why I think the episode that we’re specific like this, so we could talk about.

Dr. Sterling (00:09:32):

I know we could go in so many different directions, but I know we have a topic.

Dr. Sarah (00:09:34):

More specifically here. You can just come back over and over and over again. I love it. But what you were saying ties directly into this idea of when you talk about trauma and the impact of trauma on the subsequent health of the whole parent and how that impacts the subsequent health of the entire family system, and then layer onto that, what we do to process that trauma or don’t do to process that trauma can then lead to all kinds of even more kind of entanglement in terms of its impact. Because if a parent doesn’t process their trauma in a way that they’re not processing their trauma, and then there’s this subsequent layer of guilt or shame or avoidance or dissociation, now we’re like, we’re just entrenching ourselves in these secondary, tertiary issues that are still impacting this ecosystem like we’re talking about.

Dr. Sterling (00:10:35):

Exactly.

Dr. Sarah (00:10:36):

And so let’s talk about this, and we’ll probably put a trigger warning at the beginning of this episode, but if you just zoomed in right now and you’re just catching up, we’re going to talk about trauma today and maybe we can even just, when you start talking to people about trauma, how do you help them kind of ground themselves before they go into that kind of headspace?

Dr. Sterling (00:11:01):

Yeah, I mean, first you have to trust the individual. So I tell people, trust yourself. If you’re ready for this conversation, if you dive into it, explore it. But if you are feeling like, you know what, I’m not ready for that. I think that it’s okay to trust that intuition. I think we tend to we’re too, okay, punishing ourselves and thinking that, oh, this is something I should do. But as somebody who has experienced birth trauma and both as a patient, as a human being, giving birth, and also secondary trauma from birth experiences that my patients went through, there are periods where I couldn’t tell the story at first. It was too much of a physiologic reaction that I was having at that time to appropriately tell the story. And I just kept listening to my intuition for, I knew I had to tell my story. I knew that I wanted to heal, and I just had to pay attention to myself and know when that was right for me. I was fortunate enough that I was able to do that. I was able to do that for my own personal birth trauma on my own, for some birth trauma that I experienced as a physician. I got help. I had somebody help me walk through that.

Dr. Sarah (00:12:31):

So in talking about birth trauma, where do you think it’s helpful to orient people also? So when now we’ve established, if you’re still listening, you’re trusting yourself that this is something you can sit here and be with us when we talk about this, but when we think about processing birth trauma, first of all, birth trauma, we maybe could talk a little bit about the definition because it’s not like you have to pass a certain threshold of shit happening to you. Oh, definitely not for you to be kind of earn the title. I think that’s a big thing that a lot of women struggle go with is that this is a subjective experience, and then they’re not sure if the feelings that they’re having are valid or allowed.

Dr. Sterling (00:13:13):

Yeah. Well, let’s start here. First of all, I’m a big believer that when we talk about these things, we need to de-stigmatize, but not normalize. Okay, so this is common. About 30% of people describe their birth as traumatic, and that’s them just saying, Hey, would you describe your birth as traumatic? They say, yes. And then a smaller percentage probably about it looks 10% have true post-traumatic stress disorder as a result of their birth. That number’s probably higher, right? Because we’re not appropriately screening people for PTSD. So what the actual number is may be higher. So this is a common thing. It’s one out of three people very common to describe your birth as traumatic. And part of the reason why we need to destigmatize this is because unfortunately, there’s this belief out there that the birth is going to be the best day of your life, okay?

(00:14:10):

It’s going to be the best day of your life. And when after you give birth, the heavens are going to part and the most radiant love that you ever felt in your entire life is going to shine down on you. And when you’ve heard that narrative your entire life, and then you have a traumatizing birth experience. With my own personal birth trauma, I did not feel, I didn’t feel any love when they put my daughter on my chest. I was coming out of a very, very scary place. And my first thought was, oh wow, she’s really warm. And then my next thought was, well, that was really foolish. I had given birth without an epidural. And I just felt like that was so foolish of me to do that. That was the worst thing I’ve ever been through. And yeah, it’s difficult when you think that that’s supposed to be the best day of your life. The birth of my first daughter was nowhere near the best day of my life. I’ve had births that were, I would say, one of my best days of my life, not the birth with my daughter.

(00:15:13):

It just wasn’t, it was a very difficult day. Obviously, her being here doesn’t say any. It has nothing to do with my love for her. Absolutely not. She’s my girl. She no has nothing to do with that love. So there’s that. And I will say about people who think you need to meet a certain threshold. My own story of birth trauma was in an entirely healthy, perfect appearing birth. Okay? If you watched a videotape of my birth, you would say, that’s what I want. It was there were LED candles, flickering spa music playing. I labored in a tub in a birth center inside of a hospital. And the midwife, my mom, my husband, they all thought that I had fallen asleep. But what had actually happened is that I was in so much pain that I was unable to move. I was unable to speak. I didn’t know who I was, where I was. My entire consciousness was replaced with the experience of pain. And so that I was begging for death. That was the only thing I could do. I just wanted to die. And then when I felt the urge to push, then it was like, okay, I felt like I was pushing out of that. I felt like I was pushing away from death to just get her out as soon as possible. And so that I gave birth in a way that felt very close to death, even though I was not physically close to death.

(00:16:54):

Birth is an internal experience. You have people who have birth trauma from truly, physically very dangerous life-threatening situations. And then you have people like me where everything was perfect. I was perfectly healthy. My life was never in danger. My daughter’s life was never in danger.

Dr. Sarah (00:17:14):

And that I think is so, so important because when we think about what makes something traumatic, it is not necessarily, in fact, I would say it is not the thing that happens to us. It is how we make sense of the thing that happened to us, our ability to trust, our capacity to survive the things that happen to us. And that is a far bigger and our stability to, we’ll talk about this idea of integration, but our ability to integrate, to feel like a whole person, even after something really, really scary happens to us, that’s far more predictive. If we can’t do those things, that is what usually results in this experience of trauma. So when someone goes through, for example, in your situation where from an observer standpoint, there was no quote, objective threat or this objectively scary thing, but your internal experience was terrifying. And I imagine had you not done the work to make sense of that, because the fact that you can tell this coherent story about what happened to you tells me that you have integrated this experience enough to be, it might have been traumatizing at the time, but it may not be something that you’re currently actively traumatized by.

Dr. Sterling (00:18:49):

No, I would not say that I’m currently actively traumatized by it. This is such an evolution. Even two years ago, if I had talked about this, I had integrated a lot. But as it goes, as the years go by and I use this experience more and more, and I’ve created a birth method that is in part informed by this experience.

(00:19:16):

That process of using that, I have really redefined that experience for myself. And I have taken, I felt obviously in the moment, I was in a place of pure vulnerability, no power. And I have then found a lot of empowerment from that experience afterwards, and that has allowed it to exist in my body in a very different way. Whereas in the weeks following that, my body felt very panicky anytime that I thought about it, and I had the feeling of fright and terror and in my body, when anybody would ask me about the actual birth and I felt like I couldn’t even talk about it, it would explode. So it was a process for me to kind of slowly allow that to move through and to experience it in a different, make new meaning from what happened.

Dr. Sarah (00:20:17):

Which is like, I mean, that’s the work, right? So one, we’re saying there is no set of rules that you have to, or set of tick boxes that you have to check in order to qualify for having a traumatic experience.

Dr. Sterling (00:20:34):

Exactly.

Dr. Sarah (00:20:36):

Which I say to validate, right, your experience is real.

Dr. Sterling (00:20:40):

Yes.

Dr. Sarah (00:20:40):

If you have had something that was scary, existentially threatening to you in some way that is real.

Dr. Sterling (00:20:48):

Yeah, my body brain did not know the difference. It didn’t know the difference. That was my experience. And that’s I think a lot of times people with my type of birth trauma that where they were healthy and baby was healthy when they’re talking to other people who had really scary things happen to them where they’re like, well, but I was okay, but the baby was healthy. And that’s really, we minimize our own experiences too much.

Dr. Sarah (00:21:19):

Which is then in direct opposition to the task at hand, which is that second thing is yes, it’s real. Let’s give ourselves permission to acknowledge it and validate it for ourselves and give ourselves permission to have had that experience as trauma, and then also hope giving, because the reality is how we treat trauma is one, it’s a process.

(00:21:43):

There’s no pill that makes it go away. You have to do this difficult and painful and hopefully supported work of telling the story and understanding it and integrating it in a different way because the brain kind, when a traumatic experience happens in the moment, the brain kind of encodes it in these fragmented ways. It’s not like most of our memories that are not traumatic are encoded in a very linear way. You can kind of go back and watch the movie in your mind if something that happened, but when it’s something’s traumatic, it’s usually fragmented. Maybe you’ll get a clip of something, but you don’t usually have a really, really cohesive string of like, I can watch this from beginning to end. In my mind, we quote it in sensory bits and pieces, which can lead to sensory influenced flashback. If you smell something that you smelled back, then you could be flung back into that moment. So there’s a lot of this fragmented is the best way I can think of to describe it. And the work is kind of putting the pieces together and creating some cohesive narrative. And in doing so, you are integrating all of this traumatic stuff together into a whole that you can look at and be separate from.

Dr. Sterling (00:23:01):

Yes. Yes. And this narrative is actually a big part of medicine. So one of the classes that I took in medical school was about narrative medicine, about the importance of the stories we tell ourselves about our health and what has happened to us and our physical bodies. Because we know that these beliefs about our health and about our body and the capabilities of our body, they do impact us. They impact us on a cellular level. So when I look at birth trauma, I’m not just purely looking at this from a perspective of someone’s mental health, so that’s very important, but also saying this is going to inform how their relationship with their body and that relationship with your body is important for your mental health, your emotional health and your physical health.

Dr. Sarah (00:23:51):

And the family system health.

Dr. Sterling (00:23:52):

And the family system and your relational health, right? Because we see, one of the things that breaks my heart into a million pieces is whenever I talk about birth trauma and the importance of integrating your birth story and making intentional meaning from your birth story for yourself that serves you and is good for you, I get messages from women who are in their fifties, they’re in their seventies, and they are telling me their birth stories, and they’ve had nowhere to put it. And this whole time they’ve been thinking, well, my body failed me and this happened. And this is a story they’ve been telling themselves for 30, 40, 50 years. And what is the impact of that story on how you perceive yourself and your body and your health?

(00:24:44):

This is, by the way, why we see you’ll be pregnant and you’ll be in the line at the grocery store, and an older woman will say, oh, I hemorrhage with my two babies. And you’re like, what is going on? Why are you telling me this? Now, that’s unprocessed trauma right there. That is someone who wants, they want to make meaning from what happened to them. And so the way that they’re making meaning is I need to warn other pregnant women that this could happen to you. They really are trying to do a good service in many cases, but it’s just the output. That’s not the right place to do it. Right?

Dr. Sarah (00:25:20):

Don’t ask a pregnant woman to hold your trauma while she’s about to give birth.

Dr. Sterling (00:25:24):

Yeah. It’s just so, but women’s stories, they haven’t been listened to. Nobody. You give birth, and then how many people in the hospital afterwards talk to you about the narrative, talk to you about the story, even though that is going to be, and even do a debrief, because we know how flawed memory is, right? Our memories are incredibly flawed. They’ve done the research on this. If any of you are super nerdy and want to go and learn, do some research on the accuracy of human memory. It is hilarious how inaccurate our memory is, and it’s colored by what comes after and the emotions and all of that. So there’s power in those that time after the hospital of doing a debrief, asking questions, saying, did I understand this right? Because people will come to me with their birth stories, and members of sterling parents will say, Hey, this happened to me.

(00:26:21):

And I say, that just doesn’t sound right. Something’s not correct there. Go back and talk to that doctor or bring your records to another doctor and help them piece together, because the story you’re telling, I’m not saying I don’t believe you. I’m saying something isn’t, the puzzle pieces aren’t fitting together, so I can’t even remember how I got to this, but the power of the narrative doing the debrief, and that’s something that we act like birth is this one-time experience. And I feel that that’s not how human beings and a human life works birth. That birth story is something that oftentimes our children carry with them. We carry with us. We have to integrate it. We have to take intentional meaning and to process trauma and get help for trauma when that’s necessary.

Dr. Sarah (00:27:12):

And so you talked a little bit about debriefing with your medical team or with maybe your partner who is there or a midwife or doula or anything like that. Can you talk a little bit more about maybe what one could do immediately after birth, but also as we’re sort of clearly saying, you might be listening to this and have just given birth and be experiencing something that felt traumatic to you. And if you are, and you’re still with us and you just had this happen, you are solidly strong hats off to you. Yeah, seriously, I have a feeling most people who stuck around this episode maybe are four or five years out from their birth trauma. I can already now to actually listen to this conversation. But my point being, this is something that might be something people are looking at many years later where they don’t have their doctor’s number anymore. There’s nobody that’s going to be able to help them put it back together. So I guess those are two questions. One is for the people who have just given birth or maybe someone who’s anticipating this and wants to have their plan going, what can they do to do this kind of debrief with a team? And then for people who are further out, how can we do something similar but kind of in retrospect?

Dr. Sterling (00:28:25):

Yeah. So the first caveat I want to put here is some birth trauma happens, and there’s the people who were involved did something or made somebody feel unsafe. Their healthcare, whether it’s nurse ob, gn, midwife, whatever. So I don’t want to make anybody feel like they have to do a debrief with someone that made them feel unsafe and they don’t want to talk to.

(00:28:57):

So you have to be careful about that. But a lot of trauma can happen from just not necessarily miscommunication, but no communication. No things happen to people that they don’t understand. Things happen to their body that they understand. They didn’t necessarily consent for all of this. So if you feel comfortable and you have questions with your providers, ask those questions. Ask them before you leave if you can. So you can to your postpartum nurse, I don’t really understand what happened to me. I want to walk through it with my doctor. And when your doctor comes in and sees you, or if another doctor comes and sees you, I don’t understand what happened. I have a lot of questions about how things occurred. Can somebody come and talk to me and do a debrief of what went down? Because one, if you’re able to do it while you’re in the hospital, your doctor’s memory will still be there of the things that happened and what was said, et cetera. If you even a week or two weeks later, if it wasn’t traumatic for them, if something didn’t happen in that experience that was unique in birth for them, they may not remember that could have been one of seven births that they were a part of that day. And the ones that we perceive as going well, sometimes we remember the ones that are really, really happy and we remember that, but mostly remember the negative ones. And we remember the ones where there was a complication.

Dr. Sarah (00:30:46):

The ones that made you scared.

Dr. Sterling (00:30:47):

The ones that made us scared. So those memories get quickly kind of all blend together. So that debrief can be just asking them to walk you through what happened, or it can just be specific questions. If you have questions about what happened, please don’t leave the hospital with them. That is important that you have those answers. And if you feel comfortable, you can ask the nurse. The nurse can. If you don’t want to talk to the doctor, the nurse can review your chart and answer some questions for you. They might not be able to tell you everything, but they can review what was documented. So yeah, it can be hugely powerful. We tend to do it. Now, doctors oftentimes will prompt a debrief when something big has happened, when there was a transfusion or somebody had to go back to the or. We will often be the ones that say, okay, let’s sit down and talk about what happened yesterday. But I think that we don’t do that for everyone because at this point, that’s not standard of care. I think that’s definitely something that we should consider and look into. But if we don’t perceive it to be something that somebody might be traumatized by or we don’t perceive it to be medically complicated, we might not think that this is something the person needs. But if you’re the patient, you feel like you need it, you can ask for that from us.

(00:32:06):

That felt really scary to me. Some things happen that I didn’t understand and I want to understand what happened. No problem. If you have a decent human being as a physician, you’re going to get a good response from that.

Dr. Sarah (00:32:19):

And that makes me think too almost, and we’ll keep going and what can we do after something happens, but I just want to rewind and or kind of go back in time, and are there things people can do to set themselves up that you recommend to reduce the potential risk of, obviously we’re not going to be, if trauma is subjective, we’re not going to necessarily be able to prevent that, but reduce the risk of scarier things happening that we could then become traumatized by.

Dr. Sterling (00:32:51):

So first of all, I think a lot of it needs a lot of this work on reducing birth trauma needs to come from the healthcare provider side and is not on the shoulders of every pregnant individual. That being said, and the things I’m going to share right now, this is not evidence-based stuff that’s been studied. It’s just things that I believe in my heart will help. So one of the things I mentioned that I’m writing a book right now, one of the things that I believe is that we have fears around birth and we’ll have desires around birth things. We don’t want to happen, things we want to happen. And I believe that rather than kind of creating a birth plan where you check boxes, I believe that we need to ask ourselves, and we need to ask people, why do you not want to c-section?

(00:33:43):

Because people say that all the time. Well, I just don’t want to a c-section. Okay, why? What does that mean to you? What are you concerned about? Well, I really don’t like the idea of being strapped to a table, not having control of my body. Okay? There’s some concern about autonomy here. There’s some concern about having control over one’s body, not wanting to feel out of control of your body, being able to communicate that to your healthcare providers, including the nurses on labor and delivery, including your physician, anybody who interacts with you. Listen, one of my concerns about birth is feeling like I don’t have control over my body. That’s going to put your physicians and your nurses into a totally different mindset when they’re interacting with you. This isn’t somebody who’s just afraid of C-section, okay? If you ask a hundred pregnant people, 90% of them are going to say, well, no, no, I just want to give birth vaginally. I don’t want to have a c-section.

Dr. Sarah (00:34:42):

The why is different for everybody.

Dr. Sterling (00:34:44):

Why is different for everybody? And so the first part, this book on birth that I’m creating, this birth method that I’ve created is about what are your whys? What are your core whys? What are your guiding principles? What are your priorities and your values? Because that’s what I want you to communicate to your provider. Because when we’re talking about the actual root of why you don’t want to intervention or why you do want an intervention, then we can actually work together in a collaborative relationship. And it allows your provider to see you as an individual human being, and this is Sarah. This is what Sarah needs to feel comfortable in this birth space, and I’m able to quickly get that information about her. Whereas otherwise, to know that about you, Sarah, without you telling me that’s a relationship that would need to, oftentimes I’d have to know you outside of a doctor’s office to really know that about you.

(00:35:44):

So I want patients to be able to communicate the core of what they are afraid of, the core of what they want in their birth, so that we can make sure that they’re having a birth that’s in alignment with those values and priorities, even if the specifics of how their birth are different. Because so often people will say, well, they wanted this vaginal birth, maybe a low interventional vaginal birth. They wanted that because they assigned to this meaning to that, that’s how I’m going to do a good job. My first job as being a mom is that was what it was for me when I was giving birth for the first time, the reason I wanted to not have an epidural and I wanted a low intervention birth is because I wanted to experience this birth and have this raw experience of motherhood, and this was going to be the thing that was going to usher me into being this incredible mother, blah, blah, blah.

(00:36:37):

All the stories that I told myself, we want to understand those whys because people will say, I wanted this low intervention vaginal birth for these, I wanted this, but I had a C-section, so I failed. But if you pull it back and you say, well, what was the core why? The core why is because you have a guiding principle of safety and wanting the best for your baby. And in this situation, you did it. You made that difficult choice to have a surgery, to have your baby cut out of your body for their health. What beauty is there in that? What an incredible sacrifice. So when we get to the core whys we allow someone to find more alignment in the birth, in the experience, but also afterwards say, wait a second, yes, this is different than I intended, but when I look at my core why’s these guiding principles that was an alignment. I made the right choice for me. And that changes the entire narrative you tell about yourself, your body afterwards.

Dr. Sarah (00:37:46):

Yes. I mean, that is so, so important, and I think it’s the best of intentions, but we are misguiding parents when we’re sending them. You go online and every mommy blog thing is your checklist for your birth plan. Yes. Oh my gosh. And it’s like I get that like sometimes people just need something and they just need something to start with. But what you’re saying to me, not only is you doing the work of reflecting on what is the meaning behind these wishes and communicating that to your provider, not only does that one allow your provider to understand why you want what you want, which then can allow them to prioritize when possible the things that you really need.

Dr. Sterling (00:38:37):

Exactly.

Dr. Sarah (00:38:38):

But it also, it’s like that checklist that you downloaded off of the bump.com might not have everything on it that you can anticipate that might put you in a position that is out of alignment with your why. And so you can get this checklist that you give to your provider thinking, okay, now I’m set. If I can get all these needs met, I’ll be set. But then some curve ball gets thrown your way and there’s 10 new decisions that have to be made that we’re never on that birth plan. And your providers still going to guess. Whereas what you are saying is, if we can understand what is the driver behind what I’m asking for, how do I want to feel and what’s going to make me feel safe and empowered and just cared for, then that is going to allow your provider to make decisions on the fly. And you too,

Dr. Sterling (00:39:36):

When you’re trying to make a decision, and if you don’t know what your values and priorities are, I call them guiding principles. If you haven’t defined that for yourself and thought that through, it’s way more difficult to make that decision like, well, I wanted this low intervention birth, but now they’re saying this. What’s the right decision? If you are informed of what your guiding principles are, it makes those decisions easier. It doesn’t tell you what, you can’t look at somebody’s values and say, oh, well, this is the decision they’re going to make. But it allows them to say, okay, this is what’s important to me. Which choice here feels in alignment with that?

Dr. Sarah (00:40:19):

Or for the provider to be like, listen, you’ve made it really clear to me that you having bodily autonomy in your pregnancy and in your delivery is really important to your ability to feel safe. And we have to make this decision right now. How do I give you bodily autonomy in this move we’re going to make versus how do I check three things off a box or not check three things off a box and try to convince you that I have to do these three things?

Dr. Sterling (00:40:46):

And as a physician, I mean, what’s really beautiful as a physician is if you can understand, because for the most part, we want to meet the needs of our patients. And so often it’s our values and priorities that we have at top of mind. I walk into a delivery room and my values and priorities are what is informing my decisions. What I am going to recommend is based on my value of patient safety. That’s the top of the list. So if I can understand what that patient is valuing, it’s like, okay, how can I meet that need? And also, if I know that that’s what you care about, how can I show you that this is important for that value? Because we don’t, so often physicians will go into that kind of fearmongering and coercion that really oftentimes really sets patients off because the physician is afraid.

(00:41:52):

They’re saying, if you’re making this decision, I’m afraid of X, Y, and Z. They’re coming from a place of fear. And the fear, it’s not for a lot of people, it doesn’t feel, even if they, okay, I’ll do what you want. You’ve told me that I could die. It doesn’t feel good to them even when they make that decision. So it’s like, we don’t need to fear monger. We need to understand what this patient wants. And if we can present a valid position that says, you want this, and I think that this is aligned with this for this reason, and they can say, Hey, you know what? I agree with you, collaboration right there. We’re working as a team to get your needs met.

Dr. Sarah (00:42:34):

So I think that’s so valuable. So getting clear on your guiding principles, which I think, tell me if I’m wrong, but is really like what is it to you that’s going to make you feel safe?

Dr. Sterling (00:42:46):

Yeah, I mean, exactly.

Dr. Sarah (00:42:48):

That’s the thing that leads to the, obviously it’s hard to sit here and say like, well, this could cause trauma and this could cause trauma so subjective. But the reality is, at the end of the day, it’s something that makes us feel really, really, really unsafe. It’s something that is scary threatening profoundly. So it’s like what is the antidote to that is safety. So even though we can navigate things that are truly dangerous, feeling safe and seen throughout that process, held throughout that scary process can really reduce our risk of it being traumatizing.

Dr. Sterling (00:43:24):

And one of the other things that I think is really important when we educate people about birth is walking them through some of the common complications or things that happen in birth that happened all day every day to people who are giving birth and say, okay, if your baby’s heart rate is having some issues, here are some things that might happen in that situation. They might turn you on your side, give you an oxygen mask, somebody might want to check your cervix. Let’s give you a picture of what that might look like so that when that’s happening to you, you can say, wait a second. I’ve been here before. There’s some familiarity with these terms that they’re using, what’s happening. And even one of the things that I help people do, members do who are going through this birth method is say, okay, imagine yourself in a kind of scary situation. What’s your mantra? What’s your home? What do you imagine that when things feel out of control outside of you, how do you feel safe in yourself?

(00:44:36):

And I had a mantra when I went into my second birth because I was like, what am I going to tell myself if this happens again? And I think that it can be really powerful to walk people through. You’re wheeling down in your bed down to the or. What are you telling yourself in that situation? What’s going to make you feel safe even though the things around you? What is an or? Let’s talk about what it looks like in operating room. It’s going to be really bright so that we can see things. It’s going to be cold. And people always talk about how cold the OR is and how scary that is. And I always say we have it at a set temperature because the data shows us that temperature, your risk of infection is lower, so it feels cold, but it’s for you. It’s because we care about you. So some of it is just preparing people that your doctor, if there’s an emergency situation, you’re going to see this robot version of your doctor. We have this huge adrenaline surge and get very, we are like horses with the blinders on, all of a sudden our empathy turns off, everything turns off. It’s this crazy.

Dr. Sarah (00:45:48):

You’re in fight or flight in a trophy while you’re like, you’re going to just fight for this person.

Dr. Sterling (00:45:53):

Listen, that’s one thing almost I kind of miss about medicine is that experience of dropping into fight or flight. It’s so cool. You get super calm and you just know what to do, and it’s just execution. And you feel kind of high because you’re like, we’re going to do this, then we’re going to do this. And you just operate like this machine and your brain is working so quickly. But in order to be like that, you do have to turn off certain aspects of yourself. And so I always try to remind myself to go to the patient, say, I know this is really scary right now, but I’ve got you. I’m going to take care of you and this baby, and we’re going to do this. I always try to remind myself to do that, but you really do have to remind yourself to do it.

(00:46:36):

You are not thinking about feelings. You are a machine. So I tell people that. I say, this is what happens to healthcare providers when there’s an emergency situation. So to you, they look like they’re being really cold and really whatever, but this is them at their, that’s peak. And then after you, your baby and you are safe, then we go and cry in the stairwell and shake and call our moms. Literally, I’ve called my mom after these things just breaking down, but sorry, I’m getting emotional just thinking about it. But in that moment, I am the person I need to be. And afterwards, we kind of, those births, they stay with us forever. I still have dreams about those births. They’re still with me. So it’s not that we don’t care, but we don’t always show it in the moment.

Dr. Sarah (00:47:25):

That’s so helpful to know and makes me think of my own. And I’m curious, your stance on having a doula or somebody who’s in there with you who can kind of be there, because I was lucky. I know it’s a privilege. I was lucky enough to have a doula in my first birth, and it was, the tail end of the birth happened really, really fast. I went from three to nine centimeters in an hour and zero stops in my contractions. And I guess my son right after that had finally, we went, and that was all in the triage room. It was really fast, it was really overwhelming. And then they got me into the delivery room and his heart rate dropped really low. And so they had me get on my hands and knees. They put a mask on me, and they were just buzzing around the room doing all this stuff, and I had no idea what was going on, but my doula was standing. Nobody was talking to me, but my doula was right next to me. She was like, this is what’s going on. Everything is fine. The only thing I need you to do is just breathe and focus on your breath. That’s it. So she told me what was going on, and she told me the one target to hone in on, and that was what I needed.

(00:48:53):

And we were fine. We were okay. It turned around. But I think for me, having that experience of a person just coating with me whose job wasn’t to do, the medical interventions, that kept me able to focus on the only thing I needed to feel safe and in control and just kind of tune out all of the chaos.

Dr. Sterling (00:49:22):

Support people are crucial in birth. That support person can be a partner, it can be a friend, it can be a mom, and it can be a doula, support people when the data tells us that they improve outcomes. So they’re crucial. And the support person is somebody whose only responsibility is supporting you, the birthing person, and doulas. So I’ve had a doula with my first birth. Doulas are an incredible resource. There is one thing that I think is so unfortunate is that there’s this separation between the birth worlds. There’s hospital medical birth, ob GYNs, doctors, some midwives, and then a lot of times there’s doulas and midwives and home birth over here.

(00:50:16):

And there’s this tension that happens between these two worlds because we are looking at the same thing. We have different perspectives, and I think both perspectives are valid, but we’re not communicating, right? We’re not communicating the same way. And I think that when you have a doula who in the ideal setting, your doula is part of the team, they have a good relationship with your labor and delivery nurse. They have a good relationship with your physician, and they’re there for you and you trust them, and they care about your guiding principles. They are being guided by your guiding principles.

(00:50:59):

When some doctors really don’t like doulas. And I think, and I’ve had experiences with phenomenal doulas, and then I’ve had some experiences where I’m like, you are not helping this person. This is not a helpful situation. I’ve had friends who had doulas that were not helpful when they’re being guided by their own values. I had a dear friend who, she had a doula and her doula had a 0% C-section rate, and that was her, she was always touting that. And then my friend needed a C-section, and she left her. She left. And she didn’t want to claim this. She didn’t want any part of it.

Dr. Sarah (00:51:41):

Oh, that’s so hard.

Dr. Sterling (00:51:42):

Isn’t that awful? So when a doula is being guided by their own principles, and they’re not really, it’s about you. You’re at the center of this. And when they have a goal of having a collaborative relationship with your healthcare team from the onset, even if they have to adjust that goal, listen, if a doctor or nurse are doing things that a patient hasn’t consented to and they need to be an advocate because that person, I don’t think that that’s wrong, but I do think that if you walk into a medicalized birth setting as a doula and say, I am going to fight this doctor and this nurse, then we’re breaking the collaborative relationship.

Dr. Sarah (00:52:26):

That makes so much sense. I mean, I was very lucky. I think, oh, God, I don’t even how many births she’s done now, but I think she had done 600 births when I amazing. She was like, I gave birth at NYU in Manhattan, and she knew every single person there. She was beautiful. And that was a big green flag for me when I was looking for doulas. I knew that I wanted to have birth in a hospital. I wanted to have an epidural. That was what I knew, because I knew enough that kind of in the exact same way that you knew how you wanted to feel and that guided you to go all natural. I was like, I know how I want to feel. I want to feel the same thing you wanted. I wanted to feel connected and present. And I knew that if I didn’t have an epidural, I wouldn’t be able to feel connected and present because that’s what I knew about myself. And I was like, I need a doula, can be comfortable with that.

Dr. Sterling (00:53:27):

Right.

Dr. Sarah (00:53:28):

There are other types of interventions that I wanted to reduce the risk of having.

Dr. Sterling (00:53:32):

Exactly.

Dr. Sarah (00:53:33):

And so yeah, I think it’s like when you’re looking for those support people, that’s where I think you’re guiding principles comes back into play because it’s not just communicating with your provider, but if you want to have a support team that’s outside of the medical team, you’ve got, can they understand and be on board with your goals too?

Dr. Sterling (00:53:56):

Exactly. Exactly. And I think that that’s the thing is that if you aren’t, most of us don’t show up into the labor room with these guiding principles clearly defined. And so you default to the values and priorities of the healthcare team oftentimes are what guides it. And you’re like, okay, well, that sounds reasonable. I’ll go along with that because a lot of the time, your values will be aligned with the people who are taking care of you. But it’s helpful to know that if the values aren’t aligned, you can have a conversation that’s actually gets to the root of it. And it’s not just like, well, I don’t want Pitocin. I don’t want Pitocin. Why? You know what I mean? If you already know that, the conversation becomes much easier.

Dr. Sarah (00:54:42):

But I guess I have a question too, because on the one hand, I feel like anything in any extreme is going to be putting people more of a risk for having a traumatic birth. If you are going into birth being like, whatever the doctor says, I don’t want to look at this. I don’t want to deal with that kind of stuff. I don’t want to go there. And then you go in, which is very common, by the way, right? Totally. Because it’s self preservation, it’s making you anxious to think about it. You’re going to avoid it. And so then you go in and then you have, there’s a higher vulnerability to losing that sense of autonomy and control and safety. And then on the other extreme, I think also driven by anxiety, when we get really rigid about our vision of what we want it to be, again, completely in the service of self-preservation of managing that anxiety and that true lack of control that comes with being pregnant, then I also think we put ourselves at a higher risk of potentially putting ourselves in a situation that could ultimately feel traumatizing for us. Because if we have a very narrow vision of what we think will make us feel safe and we’re not comfortable deviating from it, and the reality is, is so many things happen in birth that we aren’t going to be able to control. And so it’s that being ripped from your security blanket of these things.

Dr. Sterling (00:56:03):

Exactly. Because assigned meaning to those things, that’s where we need to break the meaning from the actual specific.

Dr. Sarah (00:56:11):

Yeah.

Dr. Sterling (00:56:12):

We have to break that apart because when we attach meaning to, I’m not going to have an epidural and this is what it means to me, then when we actually feel like we need an epidural, we’re going up against the meaning that we assigned to it and then it feels like we failed and we didn’t do the good job that we were supposed to do, and I was going to do this thing. So if we’re able to, we still care about the meaning of course, but can we detach it from the specific thing so that we can then doesn’t mean, I actually think that when you’re more grounded in the things that really matter, I think that it really can help you have that birth that you dream not so afraid of it going the other way. You’re not so stressed about, oh my God, if I have a C-section, my whole, everything I built up in my head crashes down. And that’s a huge failure. You know what I mean?

Dr. Sarah (00:57:13):

Yeah. Personally, I totally, this is my second birth. I had a vaginal delivery with my son, and I did have that really good experience in birth. And my daughter, my second was breach, and so I had a scheduled C-section, and I had done everything that one can try to do. I was literally hanging upside down off my couch every night trying to get her to flip.

Dr. Sterling (00:57:39):

Oh my gosh. I had a breach baby for a period of time. It is so stressful.

Dr. Sarah (00:57:43):

So many things. I was like, my husband was lighting that mosha by my hose. I was doing acupuncture and chiropractic, all kinds of things because in my head, in my very pregnant, very hormonal, rigid head space, I was like, I had this good experience giving birth to my son. I have to be able to get back to that for this to be okay. And that was really hard because when I had, I remember walking into the hospital on my scheduled C-section date, which was Mother’s Day, and I was like, this is really weird to be walking into my pregnancy because the last time I was doing this, it didn’t feel like this. It was like, but I, and I knew I had already been consciously doing the work of, I know that this is a belief I have to, I’m being rigid about this. I need to be okay with this. I need to let this be okay. And it still took me over a year to really truly integrate and process how painful, not physically, but emotionally painful it was to not have the thing that I thought I needed. And yeah, it’s so difficult. It’s the antidote every time to rigidity is going to be flexibility.

Dr. Sterling (00:59:14):

Yeah.

Dr. Sarah (00:59:14):

It’s moving into that middle space while very hard and maybe not even possible in the moment, but eventually knowing eventually I’m going to work on getting into the middle of this.

Dr. Sterling (00:59:25):

And I think the idea that we’re going to be perfectly flexible and that we’re going to totally get rid of all of the desires, no, let’s not expect that of ourselves. But let’s move ourselves a little bit more to the flexibility side so we can say, yeah, I don’t want a c-section, but I’ve acknowledged that it would be okay if I had it. And I do one thing I just want to say, because I feel like I just want to get this message out to the world. Some of the most beautiful births I’ve been a part of have been C-sections. And I really think we don’t talk enough about how beautiful a c-section can be.

Dr. Sarah (01:00:04):

I would love to, can you come back on another episode and we could just talk about C-sections, because I love that. Think that would be even just for me, I need to have an episode about this, but what I really do, so much new stuff coming out with C-sections and I have so for you.

(01:00:19):

Okay, so then stay tuned and we’ll do the C-section talk. But I guess let’s in closing, because there’s so much, and we’re never going to be able to cover it all, but if someone is listening to this and they’re either about to have a birth and they’re scared of experiencing trauma, or maybe they have just come out of a traumatic experience and they’re still reeling from it, or you’re listening to this, and maybe it’s a year later, maybe it’s 20 years later and you’re listening to this and you’re like, damn, I have to do some work now. I have work to do. Do you have any hopeful messages to kind of ground people in what’s ahead for them?

Dr. Sterling (01:01:10):

You do not have one shot at having an empowering birth. You can have a birth that did not feel empowering, that felt traumatic that you can find immense fulfillment, empowerment after the fact. That was what my first birth was for me, you guys. I felt so silly that I had built this birth into this experience. It was going to be so amazing. And I had heard all these stories about women feeling like they could do anything after they gave birth without medication. And my thought was that was foolish. I felt really, really foolish. And that was, but through the process of saying, okay, what did I learn from this? How is this going to be a positive experience for me? That has transformed that place of feeling very vulnerable, feeling very foolish that I had done this, and now I feel very empowered by that birth, that birth.

(01:02:19):

And obviously I do this work, so it’s very simple for me to do that. But even if you felt voiceless in your birth right, you felt like you weren’t heard. You weren’t seen. Okay, what is the intentional meaning that I can extract from that experience? Well, I’m now a mother. I now have this child, and children oftentimes feel voiceless. They feel like they aren’t heard. That’s what I’m going to root myself into my motherhood. I want my children to always feel heard. And it’s because I felt voiceless in my birth. That is the meaning I’m going to take. That happened to me so that I can be a mother who always makes her always, but asterisk, who makes her children feel heard and seen, and then all of a sudden there’s empowerment there. I have taken something that was really difficult and a traumatizing experience, and it’s made me a better version of myself.

Dr. Sarah (01:03:15):

Yeah, I love that. That’s such a helpful and hopeful message. And you have many opportunities to do this work and there’s resources. You don’t have to do this work alone.

Dr. Sterling (01:03:25):

No, and that’s the other thing, please. The lowest, the lowest threshold to seek support, mental health support. Support from your physician. Our threshold for seeking help is we feel like we have to earn it. Things have to be really bad. We have to earn it, especially as mothers, our threshold needs to be very low threshold to get help, very low threshold.

Dr. Sarah (01:03:58):

And in the show notes, we’ll put some resources as well for where we can go. But if people want to know more about your work and Sterling Parents and your birth method, where can they find you? Where can they connect with you? Where can they get support from you?

Dr. Sterling (01:04:14):

Okay, so on the social medias, I’m @drsterlingobgyn and then Sterling Parents is a membership that reduces the anxieties and stress of pregnancy postpartum, trying to conceive. That’s sterling parents.com. Currently, the Sterling Birth Method is a course that is available inside of that membership, and we’re thinking 2026, it will be a book available for all of it.

Dr. Sarah (01:04:44):

That’s amazing. Well, we’ll have to let everyone know when that book comes out, but thank you.

Dr. Sterling (01:04:50):

Yes. Of love talking with you of I love talking with you too. It’s always the best conversations

Dr. Sarah (01:05:01):

As we were just discussing. Being able to anticipate what’s coming and feeling prepared can significantly reduce our anxiety and stress when you are already in the thick of it. Sometimes it can feel daunting to take that first step, and that is why I advise expecting parents, in addition to creating a birth plan to create a postpartum plan as well. And that’s exactly why I created a mental health postpartum checklist and made it completely free because I want all new and expecting parents to have access to it. This interactive checklist and workbook will walk you through everything you need for establishing your personalized, physical, and emotional support systems throughout your postpartum. You can feel more confident and relaxed knowing you have all your ducks in a row and have a game plan for whatever your new little duckling brings. So to download my Mental Health Postpartum Checklist, go to my website, dr sarahbren.com and click the resources tab. That’s dr sarahbren.com/resources. This is also a great resource to share with any friend you have or family member who’s expecting now. Thanks for listening and don’t be a stranger.