Autonomy may not be the first thing you think about when you think of pregnancy or birth. Taking agency and ownership of your body can have a profound impact on your confidence and your satisfaction with your birth experience. This episode explores autonomy as it relates to many aspects of your pregnancy and parenting journey. We cover working with your care provider and participating in the discussion. How autonomy can help you navigate current restrictive policies due to COVID-19. Plus, the value in trusting your intuition.
Thank you to Deb Flashenberg for sharing so much valuable information in this episode.
Deb Flashenberg, CD(DONA), LCCE, E-RYT 500, RPYT, Director of the Prenatal Yoga Center located in New York City. Drawing on her experience as a prenatal yoga teacher, labor support doula, childbirth educator, and mother, Deb hopes to support the pregnant person with functional yoga asana to create a functional birth and ease into parenthood feeling empowered and honored on this sacred journey of birth and beyond.
Transcript and Resources
Vanessa: Today on the podcast I have Deb Flashenberg, the director of the Prenatal Yoga Center located in New York. Deb is also a prenatal yoga teacher, a labor support doula, a childbirth educator, and she hosts the podcast Yoga|Birth|Babies. Deb, thank you for joining me. I know I really summarized your bio. You wear a lot of hats and have quite a few credentials. Is there anything you want to add?
Deb: No, I think you got it covered. I do have a lot of hats and I dive as much into the yoga world as the birth world. I try to intertwine them. One of my favorite things is teaching teachers how to teach pregnant and postpartum populations. We’re going to talk about autonomy today, but that’s actually really where I found how important it is to talk about autonomy is with the teacher trainees. So they know how to impart that with the students. So that’s one of my favorite things is to teach other teachers.
What is Autonomy?
Vanessa: Thank you for all you do for the birth community and all of that teaching. It’s powerful when you can teach teachers and then think about all the students that they have and you really get to make a big impact. I brought you you’re on the podcast today to talk about autonomy and in the pre-chat, I was telling you, I don’t think that that’s a word that I have brought up on the podcast. I’ve talked a lot about informed consent and the importance of getting educated. Can you break down what autonomy is and how it relates to pregnancy and birth?
Deb: I see it as it’s taking agency and ownership over your body, and it’s about being asked about what’s being done instead of, here’s my body do your thing. It’s also about being part of the decision making or at least the discussion. Oftentimes we can put ourselves in the hands of the care provider and not really take ownership of what’s happening. We’ll be like, oh, sure, you told me to do this. I will do this. Instead of stepping back and taking a break and saying, why are we doing this? You know, it’s easy to be the “good patient”. As women, we are brought up to be a good girl and not rocking the boat. I just define it as an opportunity to really take ownership as opposed to giving yourself to the situation.
Vanessa: That’s a good way to define it. One thing I would add is, a lot of times a care provider, whether it’s doctor or midwife, they’re in a position of authority and can be intimidating. I myself have been in a position where I’m going into a prenatal appointment saying here are the three questions I want to ask. You get in the appointment and it’s intimidating. Especially if your questions aren’t getting the attention that you want, or you’re not getting the answers that you want, or they’re getting brushed off. It can be really hard.
Deb: I remember during my first pregnancy and I was with a midwife and she never wore the white coat, her whole place was very cozy and I really felt comfortable with her. But then she started having me go to her assistant for most of the appointments. And I was like, that’s, that’s not what I want. I want to be with her. And it took me so many times I had to draft in my mind what I wanted to say to her. I mean, this isn’t a typical doctor where you’re in and out, there’s a white coat. It can feel very sterile. As the midwife in a casual, a cozy atmosphere, and yet I was still so nervous to speak with her. You’re 100% right when people are in a position of authority, it’s easy to give your autonomy and agency away.
Vanessa: Until you’re in that room and face to face with somebody, it’s hard to know exactly how comfortable you’re going to be bringing that kind of stuff up.
Deb: I completely agree. And I feel like during pregnancy and birth is the time that people really need to take that agency over their body. There have actually been studies that compared people that were getting induced and people that had education about it and people that didn’t. They showed that even though maybe induction wasn’t what the people wanted when they were involved in the decision making when they had education behind it, they felt better about their birth, more satisfied about their birth.
I think that also comes back to pregnancy and birth is such a huge part of one’s life. And even, if someone is not like a birth junkie like us, it’s going to make an impact. Every single person I meet knows what I do. I end up hearing their birth stories. I was talking to my husband’s grandmother, this was before she died and she was in her nineties and she told me her birth stories in her nineties. You know, they make an impact on us.
If we can at all, have somebody feel better about, or more satisfied or let’s even lower the bar to not traumatized at birth, then that I think can impact their lives and how they share their birth with their children. Pregnancy and birth is a really important time to start to grab that voice. And many of us don’t naturally flex that muscle of ownership over our experience in our body.
Vanessa: You don’t see research questions on how people feel about their birth afterward. It is medical statistics, what was the rate of this, or how many people had this outcome. It is pretty rare that you see any results on how people reflect back on their birth, whether it was a positive experience or a negative experience.
Deb: Listening to Mothers is a survey that breaks down and talks about people’s satisfaction with their birth. It’s all perceived satisfaction. If you also start to dive into some of the birth trauma that comes again back to how people are perceived, how they’re treated during their birth. That comes back to the whole just experience. There was one article I read that compared how women felt about their birth to being more traumatizing, higher levels of postpartum depression to post-traumatic stress disorders. More people related to that postpartum than people did to 9-11. This is a whole other conversation about what’s happening in our birth culture. If people are coming out of birth traumatized, they’re feeling disrespected, they’re feeling shame, they’re feeling traumatized. Literally words like barbaric were used in this study. Then if we can back that up a little bit with education and autonomy, maybe we can take that trauma away.
How to Find Autonomy
Vanessa: Let’s talk about how you find autonomy. What are some things that you do to make yourself more empowered and be more involved in all the decisions and getting educated?
Deb: I think it’s so multi parted, so let’s break it down. I think education is one. I’m going to put that on the table for one second, but we’ll definitely talk about the importance of education. I think about the prenatal yoga classes that we do, we put autonomy out there even then. A lot of yoga classes, kind of like a doctor, you go in and there is a leader and you’re following what the leader says. Like a teacher-student situation or a doctor-patient situation. What we’re trying to do in this methodology that I teach is that we want them to make decisions. I’m always saying, it’s your body, it’s your practice. It’s your birth. I’ll do poses and give them options.’
I remember we had one woman, she used to come to the studio for, it was her third child. She came with all three and it was Tuesday night. And she would set up her mat in the corner and take a nap. She’s like, this is my practice. My practice right now is not putting my kids to sleep. My practice right now is taking care of myself and taking a nap. And I’m giving them the opportunity to take ownership. They’re like, I don’t need to do downward dog. I need to take a nap. Where the stakes are low flexing, that muscle of what if I don’t do exactly what’s being said? What if I have to make my own decisions? We also talk about in our childbirth classes, the acronym BRAIN (benefits, risks, alternatives, intuition, and doing nothing). I interweave that as a theme into class and say, if we’re doing something, think about it. Is it working for you? What are the benefits of it? The risks? Some of the alternatives you can do? What’s your intuition tell you to do? And what if you didn’t do it? We’re trying to create this space for them to explore, really taking that ownership on the yoga mat, where the stakes are low. If they can get used to doing that on the mat, they can take that courage and that confidence and that ownership for when the stakes are higher. When they’re having to talk to a care provider. When they’re having to even talk to their partner or in-laws, and it comes to being a parent.
I also think education, if you are feeling undereducated and someone’s talking at you, how are you going to feel like you have the voice to oppose, or even say, let’s break this down and talk about it more? I think the more education someone can get, the more confidence they’re going to feel. It doesn’t mean that their birth is going to go exactly how they envisioned. I mean, birth rarely does, but if they have that confidence and that education, they can be part of the conversation more, they can at least be in the discussion. They may not be able to make medical decisions because that is why they have a care provider. And they may not understand some of the medical decisions, but at least they’re in the discussion.
Working with Your Care Provider
Vanessa: I’m a huge proponent of working with your care provider throughout your whole pregnancy. You should be an integral part of getting educated and helping to make these decisions. It’s really a two-way street.
Deb: I love what you just said. I also think people forget, they hire that care provider. They’re working for you. I love OBGYNs, I love midwives and nurses. We also have to keep in mind, these are people. They have a lot of education, but they have been hired and they can be fired. Someone can choose a different care provider. They should be part of the team, not necessarily heading the team. I think for somebody that feels like they have some sense of autonomy, if you’re working with a care provider that’s not the right fit that you’re not really comfortable with, you’re going to be a lot more comfortable finding somebody else. That is a whole other topic, making sure you have the right fit. I’ve told my students, you’re not going to go head to head with your care provider and change the way they practice. You can change to a different practice though. They don’t have to stick with that person. And if they do, because I know sometimes there are limitations. In New York City, we have a ton of care providers, but if you’re in a more rural place or you have less opportunity I always think of having a doula can help or having your partner be really supportive and educated. We also don’t want to have the birthing person have to start getting into that kind of thinking brain during labor. Hopefully, the birth team is stepping in. Knowing that you’re with the person, with the team, that’s going to support you, I think is really important.
Vanessa: That support piece is huge. Definitely. In the past, I’ve recommended that you take your partner with you to prenatal appointments if that’s possible. Sometimes just having someone there, so you maybe feel a little less intimidated or you have someone to help you speak up if you need that nudge or just having that support next to you.
Deb: Especially if you do get nervous. I remember I had abdominal surgery years ago, I had a hernia and I had to take notes with me because I was nervous and my husband had to stay home with the kids. My friend came with me. This particular doctor, I felt I was very intimidated by. We had a little look. She’s like if you feel like you need me to remind you to ask her questions and she did, she’s like Debra, are any other questions you want to ask? Yes. Yes, I do. Because she knew she couldn’t ask the questions for me, but I was so intimidated.
I was in this gown, which is another thing when you’re speaking with the care provider, if you don’t have to be in a gown, you’re going to be far more confident in your clothes than a paper gown. Here I am, the best of us can feel really small at times. There are so many hospital policies or policies that just your doctor has, your appointment comes up and you have to put that gown on every time. I mean, sometimes I don’t think it hurts to ask, is this necessary? Or, can I not do this? Can we do something different? There’s a midwife, Tanya Wills, here in New York and she always talks about who wears the pants. Meaning you’re going to feel more comfortable to able to push back if you’re in your own clothes.
If you’re hitting your 36, 37, 38-week checkup, and you don’t want a vaginal exam, don’t get undressed. Keep your clothes on. Think about who wears the pants? If you’re going to feel better in your clothes, then making yourself feel diminished in a gown. Not saying there’s not a place for it. There certainly is. I guess just finding a comfort level with yourself, making sure that you can kind of hold your own.
Vanessa: You don’t want to clash with your care provider. It’s not about questioning everything that they’re doing. This is somebody who I’m sure has a lot of experience and they bring a lot of expertise to the table. That’s what we’re talking about with working with them. And they’re on your side and on your team. I get quite a few emails from listeners of the podcast that say they are not thrilled with their care provider, but they don’t know how late in their pregnancy can they switch. My stance on that is always any time is a good time to switch if you’re unhappy with your provider. Definitely I think it can be a little bit easier earlier on.
Changing Care Providers
Deb: I asked my doctor this and he was really forward about when to switch and why to switch. He says after 23 weeks, it’s a lot harder to switch. And I asked, why is that? He said because of insurance. They don’t get paid as much after 23 weeks. I guess there is a certain amount of visits you do. I don’t totally understand the billing, but he was really honest. After 23 weeks, it’s not as much of an incentive to take someone new. Now, if they’re not taking insurance, that might be a different situation.
I’m with you. If someone’s really not feeling supported because let’s take a step back from that. You know what happens if you go into a birth and you’re feeling apprehensive about the care you’re going to get your body’s going to react to that. We know the hormones of labor. If there’s a lot of anxiety and adrenaline, how well is the body going to produce oxytocin and how functional is that birth going to go? It really is important to make sure your care provider is part of your team so that you can really be open and vulnerable and get out of that thinking brain. Instead of trying to labor in the back of your mind. There’s animosity or there is a feeling of they’re going to tell me I don’t want to do something I don’t want.
The Value of a Doula
Deb: That’s why I think a doula is incredibly helpful. If you can’t switch, if you’re stuck for whatever reason. The doula doesn’t come in with a sword and a cape to fix everything, but they can just help hold the space a little bit.
My experience when I was taking birth work, we were left alone a little bit more by the hospital staff because the doula was there. I would say if you’re having a hard time with your care provider, try to switch to someone you feel really aligns with the support you want. If you can’t switch, have a really strong support team, whether that just be your partner, if you are partnered, whether it be a doula and your partner. Or, even try to have a frank conversation with your care provider about how can we work better together. Hopefully, they would be receptive to that.
Birth Changes Due to COVID-19
Vanessa: With the current situation going on with COVID-19 I know that it can be a little more challenging when you can’t bring your partner into an appointment or your doula has to be virtual.
Deb: That is harder. I have not done doula work virtually, but the ones I know that are still are able to support their client by making recommendations, maybe encouraging the partner. If the partner is there to help make recommendations.
I did have a conversation with a student, not that long ago, she gave birth right at the start of COVID. This was during that one week in New York City where partners weren’t allowed, which is devastating.
She said, what was really helpful for her was going in with knowledge and education that gave her the confidence to help navigate the hospital. She also said she felt competent to push back a little bit because they wanted to do full-time monitoring and she wanted to have intermittent monitoring. And the nurse was like, we’re just so busy, I really need you to have full-time monitoring. And she’s like, no, I really need to have intermittent monitoring.
She really stood up for herself, which is amazing because she was in labor by herself. And, she said something that I thought was just so beautiful. She said I was by myself but you know what made me feel really good? I had my baby. I wasn’t really, by myself, I had a really small team.
It’s hard. We’re in a crazy time where we can’t bring as many people in. If you’re feeling restricted again that comes back to the confidence and education and knowledge. And then, also maybe picking your battles. I don’t know if that would be if that’s helpful. But yeah, for, for my student that had that, like the intermittent monitoring was really important to her and she really stuck with that and, and they, and they honored that.
Vanessa: Yeah. I want to be careful saying pick your battles. You’re not going to get anywhere if you’re butting heads on every single thing. There are some things that may seem really important in the beginning and then you get in that situation and you think maybe this wasn’t quite as big of a deal as I thought it would be, or maybe your viewpoint changes.
Deb: I’m not trying to concede on everything, but more highlighting what you said. Especially if you’re already overwhelmed by the situation not every single thing you’re kind of picking at and saying, you know, I want this, I want this, I want this. So that’s what I meant by picking your battles. I, wasn’t trying to say like throw up your hands and be like, okay, do what you want with me.
Vanessa: When you have people that are doing prenatal yoga with you and, and talking about how that can help with autonomy, for somebody who isn’t very well versed in yoga, or who doesn’t practice it regularly, how can they get involved with a yoga practice? Do you have tips for what kind of class to seek out?
Deb: If they are pregnant, and they haven’t done yoga, I highly recommend that they start with a prenatal yoga class, and make sure the person’s certified. Then they will slowly start to learn the basics.
Yoga is such a great opportunity to get to know your body, which is changing daily. I literally had a student at 21 weeks this morning say, I popped, I’m different than I was two weeks ago, I’m hitting things with my belly. It’s just a great opportunity to get to know your body.
Start with making sure that you have a class that is tailored to prenatal and then use it as an opportunity to explore. We use it so deeply to not just explore how your body moves, but even exploring how your body responds to discomfort. And that’s one of the things I think is so important about a prenatal class. It’s giving me the opportunity to notice I am uncomfortable and what’s helping me. Maybe I’m finding my breath. Maybe I’m making a sound. While everyone is having the same practice, each person can personalize how they respond to that pose and how they respond to a challenge of that pose. It’s such a great rich ground for self-exploration.
Getting back to, if they’ve never done yoga, definitely find a teacher that knows what they’re doing, make sure they’re certified. Hopefully, that teacher gives the opportunity to have some space. When we’re on all fours, after we do some standing pose on each side that we come to all fours, I offer five or six different options for them to choose from so that they don’t feel like they just have to take one path. What do they want to do at that moment? And then again, we always deal with maybe three or four different pain management techniques. I offer them to look at what they’re responding to.
Also recognize what worked earlier in class may not work later. It’s kind of like birth, you start labor and something might be working really well. And then you turn a corner to a more intense part of the birth and what you were working on before didn’t work. The more we can just get to know ourselves and get to know what serves ourselves. A prenatal class can really be a rich ground for that.
Vanessa: It sounds like it. We definitely have to get you back on the podcast and dive deeper into prenatal yoga and how helpful that can be. I love that it ties into getting to know your body better and even talking about it relating to autonomy, to get back to the autonomy. Is there any other points that you think we need to include or anything else that you think would be relevant there?
Autonomy and Parenting
Deb: I think the idea of autonomy and ownership is not something for pregnancy and birth. I think it actually comes even stronger into play in parenthood because I feel like everyone has an opinion about how you should parent. Being confident in yourself as a parent, knowing when to ask for help, just recognizing that you might make mistakes. You might feel really conflicted about a choice and then maybe later be like, hmm, that might’ve not been taking ownership of that.
I tell that to my kids all the time. I’m trying to teach them ownership and taking responsibility for themselves. And at the same time be like, oh, well that was not my best choice. I guess it’s just being okay with making mistakes, owning when you make mistakes and, and trusting a deeper intuition that our bodies and our minds are really smart. We have to hear that inner voice. I know that sounds so corny. But to sit with maybe discomfort and see what’s really coming up for us.
Trusting Your Intuition
Vanessa: I hadn’t thought about how autonomy plays a role in parenting. You mentioning intuition, going back to the BRAIN acronym, I think that’s such an important piece. It is easy to overlook. Especially if your care provider is telling you something that goes against how you’re feeling. Sometimes it’s hard to bring that up and verbalize it. It doesn’t seem like a strong argument to tell your doctor that I just don’t feel right about this or something feels off.
Deb: It is a big, important part. Our intuition is very smart. I remember doing a birth with one of my friends and there’s naturally bleeding during labor, bloody show is normal. I always tell people, if you have copious amounts of blood, but she was just having what kind of looked like just normal bleeding, bloody show.
She’s like something just doesn’t feel right. I don’t know what it is. It looks like it’s normal. It’s not copious, but something doesn’t feel right. And so I said, okay, let’s, let’s head to the hospital. It was a little earlier than we normally would go because her contractions weren’t that close together. She just had this gut feeling that something wasn’t right. When we get there, she had a partial abruption. It wasn’t a huge amount of blood and it looked within the normal range. But, her gut was just like, I need to get this checked out.
I’m so glad that she trusted her gut and that we didn’t question her intuition that something’s not right. I need to get this checked out, and she ended up with a partial abruption. She ended up having a cesarean, which was the right thing for her body and baby. Trusting that gut instinct.
Vanessa: Right. If you’re concerned about something or worried about something, going into the hospital or seeing your doctor, giving them a phone call, just to make sure that you’re addressing your intuition. Look at the case of your friend. Thankfully, she went to the hospital. Worst case, maybe it can just help put your mind at ease if it is something not to worry about.
Deb: Say it was normal. They either would have admitted her or sent her home. If your gut is telling you something, sometimes I think it’s easy to talk ourselves out. Oh, I don’t want to bother anyone. It’s late at night or early in the morning, I’m just gonna wait it out. How many times I’ve done that, talk myself out of seeking help.
Vanessa: I’m so glad to have you on today and to talk about autonomy. This is definitely vocabulary that I want to include more of. I will link to your website, your podcast, all of that stuff. Do you want to tell us where we can find you online and more about you?
Deb: You can find me on social media, Facebook and Instagram at Prenatal Yoga Center. My website is PrenatalYogaCenter.com. For any yoga teachers out there, I do yoga teacher training throughout the country. And I also have some short trainings. One is called Who’s Afraid of the Pregnant Yogi. That is for yoga teachers that are not trained in prenatal, and don’t want to be trained in prenatal, but have a pregnant student come into their class. They sometimes panic and they don’t know what to do with that person. So that’s a short training to help the teacher as well as another short training called Teaching the Postnatal Student. Of course my podcast, Yoga| Birth | Babies. Thank you so much for the opportunity to share.
Vanessa: Absolutely. I listen to a lot of pregnancy podcasts and yours is definitely one of my favorites. So thank you.
Deb: I’m so honored to be on because I’ve listened to yours for a long time too. I’m having fun geeking out with you. Thank you for this opportunity.