A Conversation about Birth with Dr. Nicole Rankins.
Hi mamas! Today we have a very special guest, Dr. Nicole Rankins. A board certified OBGYN, she has been in the practice for almost 15 years, while simultaneously in the Obstetrician practice full time. As a OB hospitalist, she has the privilege of being present for many women’s birth experiences, and witnessing that is something that drove her to create an online birth education class, as well as a podcast talking about issues related to pregnancy and birth.
Dr. Amber: I'm so glad that you came on my radar recently, because of course right now with having children I am always looking out for podcast by women of color related to pregnancy and birth. I just think it's so good to be able to have that. And yours has been a great resource for me. So I just want to thank you for that. As soon as I found your podcast, I knew I wanted to speak with you because I know that the things you talk about might be helpful for some of our mamas who are looking to have another child or who are pregnant currently. One of the things I noticed about your mission and how you work is that it's very empowering. You spoke a lot about empowering pregnancy and birth prep. So I wanted to know why, in your opinion, is it even important for us to be talking about empowering pregnancies and birth preparation, specifically, but also what caused you to do this type of work?
Dr. Nicole Rankins: People need to be empowered. The reality is that giving birth in a hospital in the US…the system is founded on misogyny and racism. And black birthing people are obviously going to experience both of those. We've made some progress from the days where women were just expected to do what doctors said, but birth was traditionally a space inhabited by women. And then male physicians came in and sort of took over the space. They discredited midwives and had like an active Campaign to do so, just so they could move birth in the hospital. I mean, a little over 100 years ago, most birth was at home. And then when birth moved into the hospital, it was definitely patriarchy men telling women what to do. And then even in the 70s, an episiotomy without consent was very common. Forceps birth without consent - very common. All things such as those, that are so gruesome were all very common. And unfortunately, some of the remnants of that still exist in our current system.
Again, it is not as bad as it used to be, but it's still not the way that it should be. And even I myself have had an evolution as a provider, and being in a culture where I would roll my eyes at birth plans and things like that, because that was just sort of the culture of what we were in. And it's wrong. The person who's having the baby should be at the center of the experience. So that is why folks need to take an active role. And I guess the thing is, you don't know going in who's really supporting you and who is not supporting you. So you have to take an active role in the process and figure that out, and not wait until you get to the hospital in order to do that. It really should be during your pregnancy. So the foundation of our system is one that's broken. Honestly, I would be delighted to be out of business in order to actually tell people how to manage our system, but unfortunately, that's just the reality of it. And we all know that black women are experiencing that on a whole other level because of racism.
And as far as what drew me in to do this work, that’s a hard thing to answer. If you told me five years ago that I was going to be with the podcast, I would have had no idea! I am grateful that I have gotten to the point where I remain open to receive whatever guidance, whatever you call it. God or spirit or however, I remain open to receive guidance about where my next step should be. I actually started out thinking I was going to be an academic medicine. That I was going to be a researcher and work in medical school faculty. And I did that…but it did not work out for me. My chairman at the time said that it was recommended to him that I be fired. And I'm a high achieving person. I mean, you don't get to be to this point without being pretty achieving. I said ‘Well, you're not going to fire me, I'm going to quit.’ And then I sort of fell into this job at the hospital and this online work. You never know where life is going to lead you. So I'm open to receiving whatever. Sometimes you just got to stop and say, ‘guide my steps.’ And then you follow the steps.
Dr. Amber: Absolutely. That resonates with me, because if anyone five years ago would have told me, ‘you're going to be doing this thing called Balanced Working Mama.’ I would be like…What’s that? I'm thankful that again, God, spirits, the universe guided you to this place, because I think your work is so important. And yes, things are not what they used to be. But there's still so much work to be done. As you were talking, I had a flash of hearing my mom and my dad to talk about their mother's birthing experiences. Long story short, both of my parents have like 10 siblings. They're all from the south, and all the kids were born at home. There was no hospital at that point. It was like during the war, maybe the 40s through the 60s, and all the babies were born at home. And my mom still has very specific memory of her brothers and sisters being born in the other room. She was confused about it, but it was right. And then fast forward to my mother's generation, all babies are born in the hospital. It was super taboo at that time in the 80s, for there to be home births or anything like that. And then fast forward to me, I have had hospital birth, it's a lot less taboo for home birth, but even I know I'm still a little I'm leery and I do plan to have my next birth in a hospital. I know other people are doing birth differently. But still, even for me, it's kind of hard to be flexible in my thinking about that. And I think it just demonstrates exactly what you said. Times have really changed so much, and it's important to really think about the history. I know that you talked about misogyny and racism, so I wanted to get into your opinions about what are the unique challenges that specifically women of color face as we prepare for pregnancy and birth?
Dr. Rankin: I mean, one thing we don't do a good enough job in our society is realizing the impact of how our life outside of pregnancy, impacts pregnancy. So as black women, we come into pregnancy with a tremendous amount of stress just from existing. I mean, we know that we are strong and we get through a lot of things but we bring that that stress in with us. And I'm not saying that's necessarily detrimental, but we carry a lot and I don't think that the medical system appreciates that, or understands. Then we go into a system that doesn't always listen to us when we speak. A system that doesn't take our concerns seriously and dismisses us. I'm a physician and I have a group of black female physicians who all train together. And we all jokingly say that if we ever go into the hospital, just make sure you have your badge on so people know your physician. Because we're more likely to have our concerns taken seriously. And I don't want to be dramatic, but the reality is that those situations can be life or death for some people, so you just have to be ready to advocate for yourself on a level other people don't necessarily understand.
Dr. Amber: It's so funny, I'm obviously not a physician, I'm a psychologist. But every now and then when I'm in the medical space, I kind of always put Dr. Amber Thornton. This way I could be taken more seriously. And it's so upsetting and unfortunate that I have to do that. But like you said, I think even for me, there's fear around what happens if I do have to enter a medical space and it's life or death and I want to survive. And my life is at the hands of the people here who don't always see me as human, or who have these weird misconceptions about me not feeling pain, or just weird things like that. And it's so it's disturbing.
Dr. Rankins: It is. And we know that it happens, but other people don't. We're having a hard time, especially when we say racism, people get all triggered by the word. And we try to make it more palatable by saying things like ‘implicit bias’, but people don't want to realize their role in it, which makes it more challenging. I think one of the ways that it came to life for me, was that I had a birth photographer who I interviewed on the podcast, who was a white woman, and she said she was stunned at the difference when she would be at a black woman's birth compared to a white woman's birth. She just had no idea how different that experience could be even if they were going through the same thing. So no, we're not making this up in our head. I think sometimes we're being led to believe that ‘Oh, you're being dramatic’ or ‘ you’re being extra, it's not that bad.’ And again, it's not everyone, but it's there. So don't dismiss those voices, or those things that are telling you that you need to pay that closer attention and really step up and advocate for yourself.
“So part of relieving that fear is knowing that you have a team of people around you who are on your side. And you can get that. Sometimes it may require you change and you may have to do a little bit of work to get there. But you can get that, it's just may be a challenge sometimes.”
Dr. Amber: I think I've been open on my podcast and on Instagram about my fears of pregnancy, especially the first time around when I had my son in 2019. I was just so scared the whole entire time. And now as you're talking, I'm realizing that it wasn't just about me being pregnant, because of course, there's always the risk of complications with pregnancy. But I think it was a combination of me being a pregnant black woman, and what that means for me, because we know - and I try not to dive too deeply into all of this, because I just don't need that energy right now - but we know that statistics and the numbers and data look very different for black women. When it comes to maternal health in ages, I was so scared the entire pregnancy and now is now hitting me that it wasn't just because I was pregnant, it’s because I’m a black woman who is pregnant in America.
I ended up having a C section with my son, and I just remember being so scared to the point where I wasn't even present during the procedure. I just kept asking, Are we okay? Am I okay? I was so fearful I literally thought I was going to die. And some people might think well, that's a little dramatic. But I think it was just all based off the fears that I had about being this black woman who has to go to the hospital and have a C section. When my son was born, they pulled him out, he was crying, and everything seemed to be fine. But I still was so focused on ‘am I going to survive now?’ I kept asking the nurses, am I okay? And they kept reassuring me. But then I remember I just burst out in tears. And they thought it was because I was happy about my son being born. But really, I was just relieved. I was just so glad it was done. Like, the whole thing was just like… nine months of me holding my breath. And I could finally breathe because we were alive. Now as we know, it's still not really over because there's postpartum. But it was just this big sigh of relief that I made it. I had a conversation with another black woman recently. She said, ‘You know what? I had that same exact experience.’ She said no one ever talks about the sense of relief that you feel as a black woman when you make it on the other side of birth. And I don't know if that's something you've ever heard women speak about or that experience, but I just wanted to speak to that. I think that was something I felt and I've never heard anyone really speak to just the pure relief you feel as a black woman to have made it to the other side of birth.
Dr. Rankins: That is an excellent point. People 100% feel that sense of like, ‘ah, made it’ because the risk is real. I don't want to give this impression that you're very likely to die, because you're not. But it happens and you can't ignore it. So for sure, that sense of fear that something is going to happen, that's very real and very valid.
Dr. Nicole Rankins, board certified OB/GYN
Dr. Amber: What I tried to do, is ground myself in the numbers. Realistically, it's still very unlikely, even though we see that black women are overrepresented in terms of death and in severe complication, but it's still very unlikely that something will happen to me during this birth. However, the fear is so big that its as if it is super likely. And that is really uncomfortable to have to deal with. And so, again, I can't wait for things to change so that more of us don't have to feel that.
Dr. Rankins: And I think part of reducing that fear and the empowerment piece is just educating yourself, so you are informed and you can know what to expect and you can know what questions to ask. You really need to have someone with you, whether it's your partner or whether it's a family member that can help advocate for you. I think if you can have a doula that is an experienced doula, that is also very helpful as well. So part of relieving that fear is knowing that you have a team of people around you who are on your side. And you can get that. Sometimes it may require you change and you may have to do a little bit of work to get there. But you can get that, it's just may be a challenge sometimes.
Dr. Amber: Absolutely. That leads me to my next question, because I know that you've been working really hard in this field to support and empower women who are preparing for pregnancy and giving birth. So I wanted to know, in your opinion what has been the best ways to empower and support women as they navigate the pregnancy and birth experience?
Dr. Rankins: My podcast has been a tremendous gift for me. It's just about the cross half a million downloads, which I never could have imagined. I love being able to provide that that free source of information to people on social media as well. My purpose is service, 100%. So I approach it from a perspective of service, and I want it to be high quality information. So it's always evidence based, and if it's my opinion then I always say so. But information is always evidence based, and I just present the facts and the data and allow people to make conclusions for themselves. Folks are smart, they can listen and hear and make conclusions for themselves. But from a place of respect, even when I'm talking in a microphone, I always make sure I’m talking with someone, not talking down on someone. I have a level of expertise, education, training and experience as a doctor that most people don't have. But that doesn't in any way make my experience better or more valuable than your experience living in your own body. I keep all of those things in my mind as I'm giving information. Then, of course, I have the childbirth education class, which is an online childbirth class where I go even deeper into the childbirth space.
Dr. Amber: I know there are moms who are currently pregnant and preparing for birth, and so I'm curious to hear if there are any tips that you might have for any mama who feels like she wants to feel more empowered during this process. What might you say to her?
Dr. Rankins: If you can, get a doula. Doulas provide physical and emotional support. They're not trained medical professionals, but if you can get a doula, I think that's very helpful. Evidence shows that support from someone like a doula will reduce your perception of pain, it will decrease your risk of having a cesarean birth, which makes you more likely to have a vaginal birth and you feel better about your experience overall. So if you can get a doula, please get one.
The second tip I would give is childbirth education. I don't care where you receive it from, but this is so you understand the process of labor, you understand how the hospital works and all those things. Childbirth education is so important. You don’t have to walk into this not knowing anything. And then you have to have somebody who can advocate for you. And you will be able to advocate for yourself better with childbirth education, your partner should be able to speak up for you if need be. I would also say, ask questions. Always be comfortable asking questions. If you're going to have a birth plan or birth wishes, you should use that as an opportunity to ask questions about to your provider about the way that they practice. And the way they approach birth. Because the way they approach birth, and the way that the hospital approaches birth are the two biggest things that are going to influence your experience. You want to understand those ahead of time by asking questions. What's your C section rate like? How do you feel about induction? What about an episiotomy? I'd go through a list of questions and things that you can ask to help you understand. And when you get the responses, you have to pay attention to what they say and how they respond. Trust yourself and your intuition. If you get this sense that somebody's not going to support you, then you may need to move on and find somebody else.
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Dr. Amber: The first thing that she said was hiring a doula if you're able to do so. I wish doulas could just be like readily available to everyone because I do think they're so valuable. And I think that was one of the mistakes I made with my first pregnancy. I went back and forth about whether I needed a doula and looking back on it I do think that things would have been a little bit different if I would have had a doula just kind of helped me with positioning and knowing how to help my baby get where he needed to be. So I could have a vaginal birth because that was definitely an issue which led to me having a C section. But now this time around with my second baby, I do have a doula and I'm super excited about it. It's just so helpful and I definitely will echo that I encourage mamas if you're able to do so. Please, please consider hiring a doula. It is very important that we have that support, and a doula can provide that.
The third thing you said was to ask questions. And I think that having my doula has really helped me to ask more questions, or just to be even aware of certain questions that I should ask. Because a few weeks ago - again, this is taking place in April - my husband and I met with our doula. It was two hours of just questions about the birth experience and what we're hoping for. And it was so helpful, because there were things I didn't even think about, and then there's things that I could take back to my OB to make sure that we address. That second support person to really orient me to be thinking about this experience. I also love your point about the childbirth education courses. I don't know why we don't assume that we shouldn’t need that. I think sometimes there's this expectation that when women become pregnant or have babies, all the information is just kind of downloaded into our system, and that we know exactly what to do. And that's just not true. I know with our first pregnancy, we did take a childbirth education course and it was amazing. So I highly recommend, if you're reading this, please check out Dr. Nicole's childbirth education course because I think something like that could be so useful so that you know what to expect in your birthing experience. Yes, that also I remember helped me to know the questions to ask and even when you're in the experience of knowing like, Okay, what is station? One mean? Like, what is that? You know, just all the things like so many centimeters dilated was that look like whereas, you know, we don't have that knowledge if you don't become educated about that stuff. So
So I do have a few more questions for you. There are some mamas who are reading this today who are not pregnant, and who are definitely not having more children. How can they better support our moms who might be pregnant or preparing for birth? How can spouses better support pregnant and birthing women? How can we as a society better support women who are preparing for pregnancy and birth?
Dr. Rankins: That's a great question. I think - especially now in COVID times - having a community where people can reach out to and talk to if you've gone through the experience… and not necessarily to share or offer advice unless they ask for it. But just to listen. Sometimes people need a place where they can just talk word salad, whatever comes out, and nobody's judging, nobody's trying to interject and tell their experience. Just listen. So being able to just listen to people, and validate that you're normal, and the things that you are experiencing are normal. I think one thing you can do to help is being available in the postpartum period. We don’t do a great job at preparing people for the postpartum period at all. And it can be overwhelming. So just being like ‘You know what, I'm going to just drop a couple meals off on her doorstep.’ Without having to say anything or without her having to ask. Or ‘You know what? I'm going to get groceries, do you need me to pick up some things? I'm going to drop some things at your house.’ Just be proactive and supportive to you so that you can focus on being a mother and bonding and connecting with your baby.
I mean don't get me wrong, the cute outfits and the onesies and things are nice, but people need help and support so that they can focus on connecting with the baby. If you can do it safely, if somebody can come over and do a couple loads of laundry, tidy up. Things like that are great. The Community Manager for my Facebook group for the course is a doula, and she talks about how when one of her friends was in the hospital for her second birth, she essentially broke into her house cleaned her house. So when she came home, the house was just clean just ready. Things like that will help moms tremendously in the postpartum stage.
Dr. Amber: Like you said, the other parts are important too, like just having a listening ear. There's just so many emotions, so many things happening and being able to have people who can just listen and don't offer any advice because many of us don't need it. We just want someone to know that we feel this way and know that we're being heard. Like you said, we do have to get a little creative about that during COVID because many of us just aren't able to have the same amount of support that we're used to. But there are other ways. I have so many people around me that are pregnant and I'm thinking of ways that I can support them, like send some meals, or offer to purchase a super simple laundry service for them. Just send it to their way, like, ‘Hey, I've already paid for you to get this done. All you got to do is put your clothes out front, somebody will come pick them up.’ We really can just utilize all these apps and this technology.
I want to thank you so much for being here and just sharing all of this knowledge. And I definitely want the moms who are reading to know where they can find you and your podcast, but then also tell us a little bit more about your education course as well.
Dr. Nicole Rankins: So I am everywhere @Dr.NicoleRankins. My website is DrNicoleRankins.com, and Instagram is where I spend most of my social media time - @Dr.NicoleRankins there as well. The podcast is called All About Pregnancy and Birth, and that's on all streaming platforms. My childbirth education class is called the birth preparation course, and I just re-recorded the whole thing updated based on feedback from folks, so there's lots more visuals and things included, and more content stuff on the postpartum period. The course starts off with walking folks through a five-step process to get ready for birth. The point I want to make is that I want people to realize that it doesn't have to feel overwhelming to either get ready for pregnancy or even postpartum. You don't have to look at every website, blog or podcast book. Just find two or three things that resonate with you and seem to sit well with you and then stick with that. Don't feel like you have to be overwhelmed and spend hours and hours getting yourself ready. It doesn't take a tremendous amount, but you do have to do something.
Dr. Amber: I think we tend to feel more overwhelmed when we're not prepared. Preparation definitely helps to decrease feelings of overwhelm. I know that your course will help so many moms to prepare for this experience. And again, I thank you so much. So please, please everyone check out Dr. Nicole Rankin's on Instagram and her podcast! Also, if you are interested in the childbirth education course please check that out as well. Very thankful for you Dr. Nicole, and the work that you do because I know that you've helped so many women along this process.
Hi there! I’m Dr. Amber Thornton.
I’m a Clinical Psychologist, Motherhood Wellness Consultant, wife, and mama to 2 amazing little ones.
My mission is simple: to help working mothers balance work, motherhood, and wellness. I want to completely change the narrative of what is possible for working mothers.
Learn more about how we can work together!
