Episode 86 - Bodily Autonomy with Dr. Stephanie Hack, the Lady Parts Doctor

So many of us women have not been properly educated about our bodies and how to know what is best for them. Today, I’m joined by Dr. Stephanie Hack to discuss how we can empower ourselves to advocate for what we want and need.

Here's what we cover:

• Hygiene advice for women that reflects love and care for ourselves and rejects the shame we are taught to feel
• How certain programming targets the shame women feel surrounding our bodies to sell to us
• General female anatomy and how using the anatomically correct terms helps normalize them
• Why women need to know our bodies so we can speak up about the care we want and deserve to receive
• The more conversations we have about perimenopause and menopause, the more women can learn about what our bodies go through during that time
• How YOU are the one who should ultimately decide how to take care of YOUR body

Stephanie Hack, MD, MPH, is a board-certified ob/gyn, podcast host, speaker, and founder of a women's health educational platform. Her special interests in health education and women's health empowerment have led to a career spanning two decades.

It’s important to remember that you’re not alone, and we can support each other as we continue to learn about women's health. I can't wait for you to listen.

Watch the PBS documentary The M Factor: Shredding the Silence on Menopause here.

Find more information about the Stillborn and Infant Loss Support (SAILS) Gala here.

Watch Dr. Stephanie Hack's TEDx talk here.

Find Stephanie here:
https://ladypartsdoctor.com/
https://www.instagram.com/ladypartsdoc/
https://ladypartsdoctor.com/podcasts
https://ladypartsdoctor.com/meditations

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Transcript

You are listening to the Ex-Good Girl Podcast, episode 86.

00:05

We're just hitting record before the good conversation happens.

00:09

It always happens like that.

00:11

That's why I'm like, just hit record.

00:12

I just start recording like you did.

00:13

I just start from the get because it always comes out like that.

00:16

And I'm like, oh, we should have recorded that.

00:18

Totally, totally.

00:19

So thank you.

00:19

I have with me Dr. Stephanie Hack.

00:21

She is the lady parts doc.

00:24

Y'all should see her.

00:25

She's got her cup of wine, her glass of wine.

00:29

I do.

00:30

And we are going to talk about lady parts.

00:33

Stephanie, what would you like people listening to know about you?

00:37

Oh, I love women's health.

00:39

I think that's probably the very first thing I was drawn to women's health as a child, just trying to understand my body, specifically periods.

00:48

I had a crazy period and I didn't know how crazy my period was when it first started until like I kind of was like, this sucks.

00:56

Like, man, is it like this for everybody?

00:58

But that is what drew me into women's health.

01:01

And as I learned things, I thought, I know this because I'm a physician.

01:06

But there are plenty of women out here who are not physicians who don't know this information.

01:12

And I think the more we practice, the more we take things for granted.

01:17

And then you realize, you know what, this is something that we can provide information about.

01:22

And I started the Lady Parts Doctor podcast.

01:24

I started Lady Parts Doctor because I found that I was having the same conversations.

01:30

And they’re good conversations, but I was like, man, instead of this just being a one-to-one conversation, this needs to be a larger conversation that we're having about women's health.

01:43

And I will add to that, that Lady Part's Doctor is kind of, I think of it where women's healthcare meets self-care, because a lot of the issues that we have are as well, because we are not great at taking care of ourselves.

01:54

We're great at taking care of everybody else.

01:56

We're not great taking care of ourselves.

01:58

So that’s me, I'm an ob/gyn.

02:01

I focus primarily on women's health education and advocacy and creating content for women's health education.

02:07

I am a mom of three, I am a wife, and I am someone who loves life and wants everybody else to really love and enjoy their lives too.

02:17

That's me.

02:18

Brilliant.

02:19

I ran into you on threads.

02:24

Yes.

02:25

In the days when we're like, is Biden out?

02:30

Is he in and what's happening?

02:31

And then the handoff to Kamala happened and I was just on threads.

02:35

It felt like nonstop, just kind of taking in a lot of the ways that that particular platform, at least in my world, seemed to kind of take off after during that political decision.

02:46

A lot of excitement.

02:47

A lot of excitement.

02:49

It felt like such a fun place to be hearing different opinions.

02:55

And then somehow you were in my algorithm.

03:00

And I remember the moment I saw you wrote a post about taking care of our lady parts with just water.

03:08

And I thought, there is no way that this is correct.

03:13

How can this be right?

03:15

And then as I've kind of sat with that reaction,I realized I personally have a lot of shame around smells and discharge and all of the secrecy.

03:30

And as I kind of followed the thread back, there was a lot of secrecy and shame around when my period started.

03:39

I'm the oldest girl, my mom did the best she could.

03:43

She did not take a lot of time to explain anything.

03:47

I had the maturation lessons at school and that's kind of how I knew what was coming because she didn't say anything about it.

03:55

And when I went to her and said, Mom, I think my period started, she took me in the bathroom and she showed me where some pads were and she said, you'll need these.

04:04

And she showed me how to cover it, like wrap them in toilet paper so much, she said, because you don't want anyone to know what it is.

04:14

And I think about that now.

04:16

I'm a 50-year-old woman, and I still wrap things up.

04:22

I try to cover them or hide them.

04:24

And I thought, that's just so interesting.

04:26

I've just never questioned that that is, I don't want to say nasty or gross, because that doesn't, but it's like something that you don't want other people to see.

04:35

If it's happening for you, you don't want other people to know about it.

04:39

If there are any smells, you definitely, you don't want anybody knowing about it.

04:45

Well, you're a woman.

04:46

You're supposed to smell like nothing, or tropical locations, or floral scents, or fruit.

04:57

Yes.

04:58

You are not allowed to fart or poop.

05:03

It should just only be a nice, pleasant little dainty smell for you, you dainty woman.

05:09

Yes, that is so the programming.

05:11

Yeah, it is.

05:13

I mean, and that's worldwide, right?

05:14

Because we know that there are places and cultures where women are sent away when they're on their period.

05:21

And so that, even though it's not to that extent,in the United States where we are, there's still a lot of shame around.

05:28

I remember that.

05:29

I mean, I'm not, I am 41.

05:33

I remember being in fifth grade and I remember a girl having her period.

05:38

I mean, I started my period in fifth grade too, but I remember a girl having her period and then I remember her soaking through her white shirts.

05:46

And it was such a like, oh my gosh, Marie.

05:50

Marie's, you know, and we're all whispering and hushed.

05:53

And it was like, there was a lot of embarrassment.

05:55

And God forbid somebody see your pads.

06:00

And I remember just finding out that somebody had their period was like a hush-hush like, oh, so-and-so started their period.

06:10

And I remember asking, I don't know if you remember this, like, 'cause you're still trying to figure out, because it wasn't talked about, if your friends had their periods, was it just you?

06:19

And you didn't know.

06:20

And it was such a hush thing.

06:22

Yeah.

06:23

Have you gotten years yet?

06:25

That's what I remember.

06:26

And you didn't want to like say it?

06:29

Like, gotten what?

06:30

Oh, never mind.

06:31

Never mind.

06:31

No, no, never mind.

06:32

Right?

06:33

It was such a hush hush thing.

06:35

And I think if we kind of zoom out for a second.

06:41

I used to be a much more religious person than I am now.

06:44

And I remember reading like passages in the Bible about how a woman is unclean, right, during her menstrual cycle.

06:52

She is unclean for a period of time after giving birth.

06:56

Funny enough, she's unclean twice as long if she's given birth to a female baby than a male child, right?

07:04

Interesting, interesting.

07:06

But just the story since the beginning of time has been that this natural thing that women biologically have happened to them, that produces babies, also produces this other thing that we should not, not even just not talk about, but that is unclean and bad.

07:26

Yeah.

07:28

I wanna add to that without getting like too theological, not the story from the beginning of time,but the story from an agenda that was rewritten.

07:39

That's a beautiful you know, 'cause it wasn't always like that.

07:44

But as we know, history gets rewritten and presented in different ways.

07:48

And then that's the history that we carry forward.

07:51

But yeah, there is a lot of shame about that.

07:55

And it's not specifically the period, right?

07:58

Like we're talking now, having the conversation about menopause.

08:01

Right.

08:02

I do think it's just really important that that history was written by men.

08:07

Yes.

08:07

By men, framed by men, retold.

08:10

Yes.

08:11

Yep.

08:12

That part.

08:13

Yeah, that part.

08:15

Yeah, we see it with menopause.

08:17

We see it with pregnancy laws.

08:20

In general, being a woman in our U.S.

08:25

culture, with being a woman comes a lot of shame and guilt.

08:30

Yeah.

08:30

I think that's you know, just what it is.

08:32

And I can't speak.

08:32

And I'm not saying that that's not the case for men.

08:35

I'm not a man.

08:36

So I don't have that shared experience to be able to comment.

08:39

But as a woman, as a mother, you know, I think I never felt the level of guilt I felt since becoming a mother.

08:47

Because once you become a mother, I think as soon as you become pregnant, you begin to have feelings of guilt for decisions that you've made.

08:55

So there are a lot of things that we need to unlearn.

09:01

Yeah.

09:01

Starting with, getting back to like the original thing that kind of stopped me in my tracks when I saw your post is, there is a lack of information about caring for our lady parts.

09:14

Right.

09:15

I mean, I grew up during the douche commercials, right?

09:18

Where I I think when you and I were even talking about this, doing this episode together, I could sing you the little douche jingle that I, and I can't remember it right now, but I'm sure a lot of women out there can remember the little commercials about you have to be clean, you have to smell fresh.

09:38

And so let's just start with some basic good advice from you about how to take care of our bodies in a way that reflects love and care and kind of steps away from this shame-based way that we are taught to see a lot of our body and what it does.

09:58

Yeah, well, let's start by saying this is a shared experience.

10:01

So all women are having these experiences and you should never feel alone.

10:05

Like you were the only one that's having this issue because that's just not the case.

10:10

But I always love to start with just some like general anatomy things.

10:13

So I could put this up and ask someone like, what is this?

10:17

And a lot of women will say this is a vagina.

10:20

If you're listening along, you're gonna go to a video of this because Dr. Stephanie has some visual aids to really help us understand this.

10:29

Take it away.

10:30

Yes.

10:30

So I am holding up my vulva model.

10:33

What I'm holding up is a vulvaIt is not a vagina.

10:37

I don't know if you saw when Gillian Anderson went to was it that it was an award show.

10:44

Julian Anderson is her name, but the actress who was in The X-Files, yes.

10:49

And she had this beautiful dress on and on the dress were a bunch of vulvas.

10:53

And I think even she called them vaginas.

10:55

And so in the press, they kept talking about her having this vagina dress.

10:58

And I made a post about this.

11:00

I was like, those aren't vaginas, they're vulvas.

11:02

Like we need an anatomy 101 lesson because that's where the confusion begins.

11:06

So this is my vulva model.

11:08

And you'll see on the vulva model, let me see if I can hold it up closer for people who are watching.

11:12

But your vulva consists of your clitoris here at the top.

11:16

This is under the clitoral hood here, but this is your clitorisAnd then there are labia, these are labia majora, your big lips.

11:25

These are labia minora.

11:27

Your little lips.

11:28

There is a urethral opening.

11:30

The urethra is the tube that brings the urine from your bladder outside of your body.

11:35

It's called the urethra.

11:37

And you see, did I point?

11:39

Yeah, yeah ok, let me make sure I'm pointing the right place.

11:42

That's your urethra.

11:43

And then this is your vagina, just the opening to the vagina.

11:48

So we need to make sure we have the proper words.

11:51

And then this is the perineum.

11:52

And down here's like a little tiny dot that.

11:55

I guess would be the anus but the anus is not this little tiny dot.

11:58

It's larger than that.

12:00

So it's always good to have your anatomy.

12:02

And I always think about this.

12:05

When I was in full time clinical practice, my medical assistant that assisted me, I remember we saw a patient and then we walked out of the room after doing this exam and she turned to me and she's like, oh yeah, you know, she was talking about sex.

12:17

And I looked at her and I said, ma'am, you are a whole grown woman whispering sex to me at an ob/gyn office, like, what are we doing?

12:26

So with that shame and guilt, a lot of times people still feel uncomfortable using the proper terms.

12:32

Yeah.

12:33

You know, I'm sure you could tell me all kinds of things that you were taught to call your vagina and vulvaWell, and what's interesting is I was just taught, you don't talk about it.

12:41

Well, there you go.

12:44

You just don't talk about it, right?

12:45

I remember teaching my daughter like, this is your vagina and she would say kachina.

12:52

And she was trying.

12:54

But I remember being embarrassed when she very publicly, and she's going to die that I'm sharing this, but we were standing in the target line and there was a man or a young man checking us out, but he had long hair.

13:08

So she said, Mom, that mommy is taking our stuff because he was taking things out of the cart and kind of helping us.

13:14

I said, Honey, that's not a mommy.

13:16

That's a man.

13:18

Well, and that's what I could tell at the time.

13:21

And she said, oh, does he have a penis?

13:24

Loud.

13:25

And I could see him, you know, like it was like, uh, and she said, I have a kachina.

13:31

She was very proud and I was very embarrassed, but that was a big deal for me.

13:38

Yeah, well done.

13:41

About like, this is what it's called.

13:44

Dad and your brothers have, that's a penis.

13:46

And you know how kids just divide the whole world into the categories that they know about.

13:50

But that was a big deal.

13:52

And for me to make her having correct information matter more than my own embarrassment.

13:59

Right.

14:00

That's important.

14:01

And feeling comfortable saying the words.

14:02

So I love that you felt comfortable enough to say them to her, even if you felt embarrassed, you know, out in public.

14:09

Whenever I'm on a podcast, whenever I'm recording my own podcast, I just try to say vagina and vulva and clitoris as much as I can, because I know that if I say it enough, then it will just become normal.

14:20

Yes.

14:21

You know, it just normalizes the terms.

14:23

You're like, oh yeah, it's vagina, vulvaLike I hear that all the time.

14:26

Clitoris, vagina, vulva you're listening, you know, just repeat out loud, vagina, vulva clitoris vagina, vulva clitoris. But yes, these are,or this is the anatomy that makes up the vulva. And getting back to your comment about the shame about smells and things, like I will say this very clearly for our listening audience, it is supposed to have a smell.

14:51

Sometimes the smell won't be strong enough.

14:54

It'll be really mild.

14:55

You might not really smell it, but vagina and your vulva have a smell.

15:00

There are glands all over your vagina and vulva and they are going to secrete oils and things that just have an odor and that's normal.

15:09

So for the cleaning, whenever we talk about cleaning, we're talking about cleaning your vulvaWe're talking about cleaning the outside.

15:16

We're not talking about cleaning your vagina because your vagina cleans itself.

15:21

You know, I'm sure many a person has heard someone say your vagina is like a self-cleaning oven and it's even better than a self-cleaning oven because you don't have to do anything.

15:30

Like you don't even have to push a button.

15:32

It just regularly does that.

15:34

You are supposed to have discharge and your discharge amount is going to fluctuate.

15:40

It's going to change depending on where you are during your menstrual cycle.

15:45

The menstrual cycle is not specifically the number of days you bleed.

15:50

Sometimes I would, you know, ask patients, oh, how long is your menstrual cycle?

15:53

And they'd be like, oh, maybe it's like five, seven days.

15:56

That is your menses.

15:59

That's how long you menstruate.

16:01

That is your period.

16:04

Your menstrual cycle is the first day your period starts to the last day before your next period starts.

16:12

And your menstrual cycle on average, you know, is let's say 28 days plus or minus seven days.

16:19

Plus or minus seven days.

16:20

Mm-hmm. For some people, it might be, I mean, it should still be pretty regular within a couple of days, but if you have a period that's every three weeks and your period is just every three weeks, and that could be considered normal and you have a shorter cycle,If you have a period that's every 35 days, maybe it fluctuates every 35 to 37 days, then that could be considered normal.

16:40

That's a longer cycle, but that's considered a normal cycle.

16:45

So I want to get into a little bit more about menstrual cycle, but if the vagina cleans itself and we are supposed to have discharge, how is the best way to care for cleaning the vulvaYes.

17:03

So what I recommend going back to the post that actually a lot of people had thoughts about it.

17:09

Some people are like, water.

17:11

I always recommend just water, just water.

17:15

And your goal when you're cleaning your vulva is really just to wash out any discharge that's dried, period.

17:22

You take your hand, and I always recommend people do this in the shower, and just use your fingers.

17:27

So as the water drips down,to just move your, move the labia, move the lips out of the way.

17:34

You can use your finger to just like massage the water in and do the same thing on the other labia.

17:40

And that's really all you have to do is just kind of wash the lips.

17:45

And you know, you can wash around the vaginal opening, but this is just, when I say wash, I mean rinse, like rinse with water.

17:53

Some people will say, I hear people say, lift up the clitoral hood. On average, most people don't have to do that.

18:01

Certainly, you know maybe some people have to do that, but on average, you don't have to lift the clitoral hood.

18:06

You're just using your fingers to kind of move your vulva around to make sure that the water from the shower or in the bathtub can flow and kind of rinse any dry discharge away.

18:16

Now, when people have their menstrual cycle and they're on their period, often people are like, okay, I need to use soap.

18:23

And I think that's fine.

18:25

But I always recommend a mild scent-free soap.

18:32

If you're using soap a lot, if you're using scented soaps, if you're using scented products, like I know you can still, you know, douches are still out there.

18:42

I remember, do you ever feel that not so fresh feeling?

18:45

Yeah, that was right.

18:47

That was the opening line of of that commercial.

18:50

What are you doing when you're using harsh soaps, sprays, there are vaginal you know deodorants or vulva deodorants available.

18:58

There are scented panty liners.

19:01

What are you doing when you're using all of those types of products?

19:06

Sure.

19:06

I mean, there is a whole industry created to make money off of our shame and our guilt about our lady parts.

19:13

You know, I remember growing up, and even still now, saying that a woman stinks.

19:18

Yeah.

19:19

as a way to really insult a woman.

19:22

And it's a very nasty, you know, no pun intended, but thing to say.

19:27

So sometimes I have patients come to me and but doctor, I use the soap and you know, I really want to keep using it.

19:36

If you find that there's something that you use and you don't have any issues or problems with it.

19:43

Like I'm not one to tell people what to do.

19:46

My feeling is always, as your physician, I'm your consultant.

19:50

You come, I give you my recommendation and I support it with evidence and you can take it or you cannot take it.

19:58

But most of the time somebody comes to me and we're talking about soaps, it's because they're having some kind of vaginal issue or vulva issue, whether it be irritation.

20:07

whether it be abnormal discharge or a change in their discharge or some kind of pain or inflammation or a bump or something like that.

20:15

And their head, they have a concern for an infection.

20:18

When you're using harsh soaps that can irritate your skin, you know, the skin is sensitive and then it can cause inflammation, it can cause irritation.

20:26

If you're putting things in your vagina, they can disrupt the natural environment, the vaginal microbiota, that's the different types of bacteria that live in the vagina.

20:37

The vagina is colonized by bacteria and yeast, meaning there are bacteria in our vagina.

20:42

There are yeast in our vagina, just like there's bacteria in our gut.

20:45

There's supposed to be bacteria in our vagina.

20:47

They serve a purpose.

20:48

And one of those bacterias is called lactobacillus and it makes lactic acid and it keeps our vaginal environment acidic.

20:58

And that's necessary to prevent a lot of infections.

21:01

And that keeps the bacteria that can become harmful if there's overgrowth.

21:05

It keeps those levels in check, this lactic acid that's secreted by the lactobacillus, and it keeps the yeast in check.

21:12

If something happens that throws off that harmonious environment that they've created, then you can have an overgrowth of the not as good bacteria, and that can lead to things like bacterial vaginosis.

21:26

you can have an overgrowth of yeast and then you have a yeast infection.

21:31

So they can lead to vaginal infections, they can lead to irritation and pain.

21:35

And sometimes with some of those infections like BV, they can just be really hard to treat and go away.

21:42

You know, people can get in cycles where they're like, Hey, I was treated for this and then it came back.

21:47

And so we really recommend that you avoid adding additional, because you don't really need them.

21:54

With that said, and I recently talked about vaginal deodorants, they are helpful for some people.

22:01

And so I never like to come out and just say, oh, don't use that.

22:04

That's awful.

22:04

That's there.

22:05

Some people have a need.

22:07

I think my issue becomes when we are kind of advertising to everybody like they need this.

22:12

Everybody doesn't need that.

22:13

Some people do.

22:14

Not everybody does.

22:17

I think when you consider the amount of programing that every woman every human who is socialized as a female, what our bodies should look like and all of the industry that comes up around you know our beauty standards, our body standards, you know that's a multi-billion dollar industry.

22:38

And then how your body should smell and that it should be attractive, that it should be, like you said, smell like some tropical location, love it.

22:47

So when someone wants to start using just water,when they want to care for their body in a way that is actually what their body needs and not what their programming has told them that it should smell like?

23:03

What are some of the ways that you help them to do that?

23:06

I am just here to listen.

23:08

A lot of the times, I just listen.

23:10

And through the listening, I ask questions and I just, I guide, but really I just say, hey, this is like, you know, why don't you try this?

23:21

We can try this and see if it works for you.

23:24

If it doesn't work for you, by all means, continue to do what works for you.

23:28

But again, usually when they're having that conversation with me, it's because whatever they're doing isn't working.

23:34

You know, it's pretty easy to kind of guide in a new direction because if someone comes in for a well-woman visit and they're using, let's say they're douching, part of my questioning was not, Hey, are you douching?

23:49

You know, my questioning was, Hey, are you having any issues?

23:52

Have you noticed any abnormal discharge?

23:54

Are your periods like, how often are you getting them?

23:57

Are you having any pain with sex?

23:58

Like, you know, that just kind of like those general questions.

24:02

But if someone was doing something and it wasn't causing a problem for them, I won't necessarily even know what their routine is, unless they, for some reason, mentioned something to me.

24:13

And I always think of my job as kind of just a normalizer because you don't know what's going on with other women if we're not talking about it, but I know, because I'm talking to everybody.

24:26

When you introduce alternative ways of caring for their lady parts, are there any typical objections or concerns that they have?

24:36

The soap with the period is the primary.

24:40

Well, people have a hard time giving up soap.

24:41

They do.

24:42

And they just have a hard time giving it soap, right?

24:44

That conditioning is so real.

24:47

And it's been happening for so long.

24:50

And so I just say, hey, if you have a soap and it works for you and you're not having any problems.

24:57

By all means continue.

24:58

If you start to have problems, stop.

25:01

Yeah.

25:01

And that's usually how the conversation goes.

25:05

And, you know, most of the time that works because at the same time, I being me and as an ob/gyn and women's advocate, I want to promote our autonomy over our bodies.

25:18

That's very important to me.

25:20

Because the second I take away your power by telling you what to do, then you don't know what to do with your body.

25:25

You feel like you can't make decisions with your body.

25:28

But who's an expert, me or you, about your body?

25:31

You are.

25:32

And I want you to continue to feel like an expert about your body.

25:37

That is such a beautiful goal to have for women just in general, that they feel autonomy over their bodies.

25:46

That's why you and I are having this conversation because I think we share that goal and I want women to have choicefulness, right?

25:54

In the way they spend their time, in the way they spend their energy, in the way that they use the juice of their life, right?

26:01

For something that they choose that they don't feel obligated to.

26:06

And so much of the time, it's the shame.

26:11

around what happens if I'm not taking good care of everybody?

26:15

Am I still valuable?

26:16

What happens if I am not this model of the perfect mom, the perfect wife, the perfect daughter, all of these lists of perfection, the perfectionistic to-do list that we've been given.

26:31

Umm And when we talk just about having bodily autonomy,What grows out of that, in your opinion?

26:42

If we if women can believe that my body is mine, I have the prerogative to do with my body what I want to do, and I am the best person to know what I should do with my body.

26:56

What have you seen develop from that for you personally or from people that you have worked with as patients?

27:04

Yeah.

27:04

I thinkWhen you restore someone's understanding that they have autonomy, that they have control, that they have power.

27:14

Oh, let's talk about I use the word control.

27:16

Let's talk about that because labor and delivery and pregnancy and birth is a big place where we have this dynamic of like who's in control when you go to the hospital, you know, and they're.

27:30

So many platforms have been built of people being, let's say, anti-doctor, anti-hospital system, because they just want to do this.

27:38

And then physicians feeling very anti, you know, let's say doulas or midwives, for example, because there's this kind of fight over control.

27:50

But when people don't feel in control of their bodies in pregnancy, in labor and delivery, it creates a very distrustful environment that really inhibits how we can provide care.

28:03

And that I think is one of the biggest things.

28:05

So when I would go on to labor and delivery, for example, I always came in just to have the conversation at the beginning while everything was fine.

28:12

When I admitted a patient to the hospital, this is the plan I have for you.

28:15

And often people present a birth plan.

28:18

And early on when I was a younger physician, you'd feelfeel very stressed.

28:23

You come on, it's busy, and then someone gives you this three-page birth plan of all these things.

28:29

And, you know, as the years went by, and with my understanding and having children, but just gaining knowledge and wisdom, understanding that this is someone who is scared.

28:40

This is someone who has really not felt like they've had complete control since they were found out that they were pregnant.

28:47

There was somebody telling them what labs they needed to do and what tests they needed to have and how they needed to eat and how they couldn't lay on their back.

28:54

And so, you know, what they could and could not consume and so on and so forth, and being poked and prodded and touched in ways that you wouldn't want to be, but you are allowing yourself to be for the health of this growing person.

29:09

And then in addition, you have this growing person who is just doing whatever the F they want inside your body and you don't feel in control.

29:18

So you get this birth plan together because you've researched and you know what you want and what you don't want.

29:24

And then you take it to the hospital and just understanding that everything works much better when we are a team.

29:33

When the person feels that they have control and that I am going to respect the control that they have and that we are a team and we are making decisions together.

29:43

When people don't feel like they have control, when they feel like that healthcare provider is an other, just telling them what to do, not understanding what they want, not respecting what they want, then the outcomes just aren't as good.

29:56

And even if the baby comes and it's healthy and the mom is healthy or the birthing person is healthy,there's still the trauma of feeling like I went and I was in this very vulnerable situation and they didn't listen and they didn't give me control.

30:11

And then sometimes, you know, when the things do go sideways, like I remember having to come in many a times, you come in, you're just getting to the hospital and someone is telling you about the patients and then you have to run into a room because somebody's baby's heart rate is dropping and they need a C-section.

30:27

Well, if trust hasn't been built up, then, you know, they don't,and you know that they need a C-section, for example, they're not willing to just kind of jump on and say, Okay, doctor, like I've been receiving care that I trust knowing I'm in good hands.

30:42

And then you're preparing for this kind of more combative conversation about what you believe they need and maybe them not feeling that you're hearing them.

30:51

And that just like, that's not good for anybody involved.

30:54

So this is a very long way of explaining, but an example that happens every day every day, all the time.

31:03

And it's just better when you respect people's control, when you make sure that they feel that they are seen, that they are heard and that your role, like you explain what your role is, but really you're trying to support them and their autonomy and whatever this decision making process was or is.

31:22

If someone is listening, is pregnant and going to be having a baby and wants to kind of negotiate that partnership with their ob/gyn, what's the best way for them to develop the trust and kind of negotiate that partnership in your opinion?

31:43

I think it was always helpful for me.

31:46

And I'm going to put one caveat because often people are not the the ob/gyn is not the one who attends the birth.

31:53

You know, it only happens if they happen to be on call at the hospital.

31:57

But what I always had my patients do is bring me the birth plan because a lot of the things on the so we could review before so I can manage expectations because what I want to do is let them know like, OK, this is something that we do.

32:09

And a lot of the things on the birth plans were things that we did and we respected and we're completely fine.

32:14

And very rarely was there something that that I'd be like, we're not going to be able to do that at the hospital.

32:19

We're not going to be able to honor that.

32:21

But the important part of that conversation was we talked about it.

32:25

You know, we had time for questions and follow-up and investigation.

32:30

And if there was something that, you know, they just went into the situation not feeling like this doctor just doesn't want to do it.

32:39

They knew, OK, I talked to Dr. Hack about it and she said that they probably wouldn't be able to do this.

32:44

And so if this other person comes and says that, I know that it's not them just not wanting to do what's on my birth plan.

32:52

I'm already prepared for that.

32:54

So it was good for managing expectations, you know, and giving them an idea.

32:58

And I found that it was just a really good way to.

33:00

Talk through what to expect when you go through the hospital.

33:02

I mean, we have birthing classes, but there's nothing like sitting down with your doctor or your healthcare provider, your midwife, and having a conversation to just calm your nerves.

33:12

And I don't know if it was just my location, but when I was in clinical practice, I was out, my practice was near Georgetown and in downtown DC.

33:20

And I had a lot of patients who they really benefited and really appreciated me talking through them, like things through with them.

33:29

Like when I did a pap smear or a pelvic exam, I talked through it because I know that, you know, you want to know what am I doing?

33:37

Why am I doing this?

33:38

How am I interacting with your body?

33:41

Because again, you have control and I'm not just this person doing things to you.

33:47

We are having this experience together and this is what we're going to do and this is why we're doing it.

33:53

I think that's such a helpful reframe becauseI mean, I have five children, so I have a set of twins.

33:59

I was in the hospital four different times.

34:03

Bless you.

34:04

Oh my goodness.

34:05

It very much felt like I was kind of just at the mercy of whatever was happening.

34:14

And I think my programming was just like, they're just going to do to me whatever they need to do to me.

34:19

And the only thing that matters is that I get a healthy baby, that the baby is okay.

34:25

And it wasn't until after when I was doing a lot of reading about like the state of childbirth in the United States, especially for black and brown women, and the rate of injury and malpractice and damage that is done not just to women, but even death rates, that I kind of understood how my taking a back seat had put me at even greater risk of some of those statistical, you know, things happening because my programming was just, you're just going to go and the most important thing is the baby.

35:05

And even then to kind of go back and feel some of the sadness and the grief about some of the things that happened in some of my birth experiences that yes, were part of just, you know, having twins, they were all tangled up and we ended up having to do an emergency C-section that I was not didn't have time to give me an epidural for it.

35:25

So the way that-- What?

35:29

That's a big trauma.

35:31

What?

35:32

Right.

35:32

Wow.

35:33

I'm sorry that happened to you.

35:37

Goodness gracious.

35:38

Thank you.

35:39

And I love how, you know, you noticed me kind of trying to just talk over it and kind of talk through it.

35:44

But there is still some sadness there about how scary that was.

35:52

in the moment and what I knew was happening.

35:55

But I think that the beautiful reframe of like, I did not once have a birth plan.

36:04

Not once.

36:05

I never was told like, hey, you matter in this equation.

36:11

And it's not just the baby that matters.

36:14

And I'm grateful my children are you know healthy and born with some complications that were resolved.

36:20

But I think if we're talking about how to wash or how to give birth, that a woman knowing her own body and being the one to at least have a general plan of care and some opinions about this is what I would like to have happen, how I would like it to go, these are my preferences, feels so much more empowering than what happened to me and what happens to a lot of the women that I know.

36:53

Yeah, I mean, I think we're taught that, right?

36:56

Like this isn't really the first situation where we just kind of feel like it it is a more extreme situation even obtaining any kind of women's health care you know like even more invasive exams for example and like men don't regularly have their private parts examined the same way women do to the extent that we just go you know open the legs and we're just like all right I'm here yeah like this is what I've been doing since I was 18 or the cold instruments the yeah it's just oh yeah just get it done right you know so we'reI think that we've been kind of conditioned to just accept certain circumstances.

37:38

And so we see the continuation of that conditioning through this experience.

37:42

Most patients don't have birth plans, and I don't think that you necessarily need a birth plan, but I think they are helpful for some people and are helpful for communicating needs and opening that conversation.

37:56

I know a lot of really wonderful ob/gyns and most ob/gyns I know are wonderful.

38:03

With that said, there are a number of people who are burnt out.

38:06

And when you see burnout in physicians, then it can result in kind of apathy or just not, you know, seemingly not caring as much about things as the other person or maybe dismissing things.

38:25

Like you can see that as a sign of burnout.

38:29

There are so many ob/gyns leaving obstetrics and gynecology.

38:33

You know, our workforce is shrinking.

38:36

I just read the other day, and I can't remember the specific number, but they talked about the number of ob/gyns.

38:43

I think maybe there was like a 3000 ob/gyns shortage by like 2050.

38:49

Wow.

38:50

Yeah, it might not even be 2050, it might be sooner than that.

38:53

And especially you see these maternity care deserts really where there just aren't ob/gyns and there aren't hospitals that women can birth or birthing people can birth.

39:05

So it's important.

39:07

If you don't feel that you have power over you, what do you have power over?

39:11

With that said as well, some of us will stand up for our children.

39:15

Before we stand up for ourselves.

39:17

That's right.

39:19

You know, so it is kind of interesting.

39:21

Even if we feel our voice is diminished, we can use our voice for other people in a way that we can't use for ourselves.

39:27

So I always also recommend that you have advocates that will speak up for you when you can't use your own voice for yourself, because that happens.

39:35

Birth is a great time for that, like bringing the person to the hospital with you.

39:40

if you know that you're going to be in a situation or you are afraid you might be in a situation, just someone when you're tired and you know, you've been there for 24 hours or 48 hours trying to give birth, like just someone who will keep your goals in mind to continue to communicate for you.

39:58

But you can have an advocate go to your appointments with you, someone who will speak up for you, because we just, we don't always speak up for ourselves, we don't know how sometimes.

40:09

We don't know how.

40:10

And then there's that just conditioning that this is just how it is.

40:14

This is just what you're trying to do.

40:15

And I think that has a lot to do with kind of where I want to take the conversation next, which is perimenopause and menopause.

40:23

Because that after childbearing years, that's in the life of most women when a lot of changes start happening to your body.

40:35

I kind of feel like menopause is having a moment, finally in popular culture and in social media.

40:42

There's a brilliant documentary that's coming out in the middle of October.

40:46

It'll air on PBS.

40:48

The name, of course, just left my brain, but I'll link to it in the show notes because, again, we have been conditioned to just accept, yep, this is what happens.

40:58

The brain fog, the fatigue, the interrupted sleep, the hot flashes, the body aches, the headaches, you know, all of the things.

41:06

AndYou might be not in perimenopause yet.

41:09

I don't even know.

41:09

I am firmly in perimenopause and kind of riding this rollercoaster of of symptoms.

41:15

And I think had I not been so shocked by the symptoms, it felt like my brain just hit a wall.

41:26

Had the symptoms not been so acute and so shocking, I think I would have just chalked it up to like, yeah, this is just what happens, but I actually went and had myself tested for early onset Alzheimer's.

41:38

Oh, okay.

41:39

So sudden and so abrupt.

41:43

So when the conversation changes to perimenopause, what are some of your thoughts kind of along this line of empowerment and knowing our bodies?

41:54

It's a continued theme.

41:56

You know what's normal for you and you know what's a change.

42:00

As menopause is having a moment, we're also getting more research on menopause.

42:07

We're having more physicians training to better understand menopause, to be able to have more educated conversations with patients about their symptoms and what they're experiencing, because we're not taught really about menopause in medical school.

42:22

We're not really taught medical school and even in residency.

42:25

Like we didn't really receive training about menopause.

42:28

We don't receive training about postpartum, you know, so.

42:31

As menopause is having a moment, I think this is just another time where I really, really encourage women to just speak up.

42:40

And, you know, even if you feel like it is falling on deaf ears, if you're having this conversation and people are understanding, still speak up for what you know your body is experiencing and what you know doesn't seem to be normal.

42:54

And there are providers who are more experienced in menopause, who are better to have the conversation with.

43:01

But there are also a lot more resources now and resources being developed to be able to provide more information for women about menopause.

43:09

But you like have to stay empowered and you know yourself just like you knew yourself.

43:15

You knew that this was not normal for you.

43:17

Like stick to that, you know what's not normal for you.

43:21

And things are going to change.

43:23

I think we kind of learned that we we don't teach that well.

43:27

Ourmoms didn't really tell us that, you know, you don't really have an understanding of you're going to get your period and then one day your period's going to end.

43:35

But even so, like when you get your period, it's not going to be the same for 45 years.

43:42

It's going to change throughout that period.

43:45

And all of the changes that happen with menopause, we need to just have more conversations so that people understand howour bodies are changing.

43:56

You know, what things like the symptoms that you mentioned, because primarily what we learn is hot flashes.

44:03

But you know, as you mentioned with the sleep disruptions and the brain fog, that even we don't talk about weight gain that people can experience with menopause.

44:14

I saw, I read something the other day where someone, where they were saying a 20 pound weight gain, like some woman experienced a 20 pound weight gain during menopause.

44:22

And I'm sure the advice that they're getting is just, you know, eat less, exercise more, but really giving information that is consistent with the changes that are happening in our bodies.

44:36

So it's an interesting time for women's health.

44:39

With the Biden administration introducing this women's health research angle that nobody had done in any of the previous administrations, like it's a, it's an exciting time for women's health, it's a concerning time for women's health.

44:51

You're right.

44:54

It's a mixed bag.

44:56

In terms of bodily autonomy, we have gone backward.

44:59

Which is crazy.

45:00

Did you ever-- I don't have daughters.

45:02

I have three little boys.

45:04

But I would never have imagined that, you know, we would have had, you know, had more rights than our children.

45:12

And that's something that was previously characterized as health care, right?

45:18

Like the...

45:20

a DNC for a fetus that did not survive, that needed to be removed for the health and safety now is considered.

45:28

You know, there' such confusion around what is what is health care that endangers so many women.

45:35

And it endangers primarily women who don't feel empowered to speak up and to demand.

45:42

You know, so many of the stories that I have heard about women who who leave the hospital and who go to suffer you know at home and or even just in the parking lot, my heart just really breaks for them not having someone to advocate for themselves in such a way to give them the care.

46:04

But who knows, I was not there and it might not have even been possible with the amount of fear that so many doctors are experiencing right now around this confusion.

46:15

And so you're right, there is this kind of weird, like, what?

46:19

I do have a daughter, right?

46:20

And she's 23.

46:22

And the fact that I have had access in a different way than she did just blows my mind.

46:29

And then on the other hand, we now know that there are over 100 perimenopausal symptoms.

46:36

that can be treated with hormone replacement and that the studies that have been done in the past that really kind of gave estrogen a bad name have been debunked and reclassified in ways to help us better understand how estrogen in particular can benefit so many women.

46:57

So I agree, we're kind of in this wild...

47:02

this wild landscape of women's reproductive health.

47:06

We are, and it's an interesting place to be.

47:10

And I agree with you.

47:13

That was the most frustrating thing when they took down Roe v. Wade, because, you know, we knew as ob/gyns that we already have groups of women who are already underserved, mainly black and brown women and poor women.

47:28

And doing anything to diminish their rights, their federal rights, is going to put primarily them at a disadvantage because the people who create the legislation know where to go to get what they need.

47:45

Right.

47:45

And they're going to get what they need.

47:48

They're going to get what they need.

47:50

And they do, you know, that's one thing I learned in training is that even people who consider themselves anti-choice,still go and get abortions.

48:03

Absolutely.

48:04

They still get abortions.

48:05

They pay for their girlfriends to have them.

48:08

They still get it because they need them.

48:11

And it's this lack of empathy to be able to understand that somebody else's circumstance and feel like you need to insert yourself to understand exactly why they're making the decisions they're they're making.

48:23

That's why like, especially when Roe v. Wade fell, I talked a lot about on my podcast,But I was like, I will never justify women's reasons for getting abortions because it's none of your business.

48:34

You can't know, you won't, just like you don't know what's happening in somebody's marriage.

48:39

You know, you'll just, you'll never know.

48:41

You can't understand.

48:43

I'm just thinking of a woman who died in 2022 and the story just came out, but basically she had an incomplete abortion.

48:53

She had a medical abortion and it was incomplete or medication abortion.

48:57

And they wouldn't treat her until she was crashing.

49:01

And she crashed and died.

49:03

And left the child that she had already had, you know, she already had a child.

49:08

She was a single mother.

49:09

And this is one story.

49:11

So, you know, this is one story.

49:13

There are many stories of women who have died or women who have almost died or who have been injured, you know, just from this legislation of people inserting themselves in health care who don't really understand.

49:27

Right.

49:27

Health care.

49:29

Which to me makes it all the more important for us as women to know our bodies, right?

49:37

To know how to care for them, to know what the parts are called, to know what they do.

49:44

My mind was blown as a, you know, a young religious woman learning that the only purpose of the clitoris is to have a really good time.

49:53

Yeah.

49:54

Like, let me pull up my vulva model and say there are so many nerves.

49:58

Yes, there are so many nerve endings.

50:01

The clitoris and then in the vulva and the labia, like this is all to feel good.

50:06

This is part of your sexual experience.

50:09

Like this is all to feel good.

50:12

Women need to know that.

50:14

I'm happy we can talk about that.

50:16

Yes, and they need to know how to...

50:19

advocate for the type of care that they want for their body.

50:23

If it's soap or no soap, great.

50:26

If it is, you know, during childbirth to at least have an idea of what it is that they can expect, that they can prefer and how to navigate and kind of negotiate that teamwork relationship with their doctor and then on into perimenopause because having, I think, played a backseat role in my own education, in my own health.

50:53

And most of that was because I think just the shame and the mystery that I kind of grew up with around my body and my parts and the purpose and childbirth and even birth control, right?

51:06

Having really played a backseat there, yeah there is nothing that feels as good as empowerment.

51:15

Yeah.

51:16

as voice, as knowledge, as feeling like I understand and I know myself.

51:23

And so I know when something is off, I know when something doesn't feel right, and that I can trust that.

51:31

I think we are conditioned away from that on purpose, because there are a lot of people who want to sell us things and make us believe things and do things that are not for our benefit.

51:43

And so to kind of come out of that conditioning with knowledge, with understanding and research, with experimentation and with choice, it's just such a beautiful, beautiful, important journey for women.

51:57

Yeah, it is.

51:58

And I will add that Western medicine doesn't really factor in intuition.

52:04

Yes.

52:05

You know, that's not a wet, like, that's not a Western medicine thing.

52:08

And for many of us, we grew up in Western medicine, but, intuition is still an important part of how we treat our body, how we remain aware and knowledgeable about what's happening.

52:24

I mean, people all the time will say, oh, I knew I was pregnant because, you know, blah, blah, blah, blah, blah, even before they had a test.

52:31

So our intuition is still important.

52:34

Absolutely.

52:35

Is there anything that you would like to add to the conversation as we wrap up here, anything that you didn't get to say that you'd,really like to make sure it gets included in the conversation.

52:45

I think we've had a really lovely conversation about just being empowered and maintaining your control and to continue that sentiment.

52:57

And I touched on this a little bit before, but when you come and see a physician, our job is not to tell you what to do.

53:06

Our job is to provide the evidence for you.

53:09

We get the information from you, and then we put the evidence and the information together to give you recommendations about, you know, what path we think you should take.

53:20

And then you can say, Hey, but I've been thinking about this.

53:23

And then we say, Okay, well, maybe that will be fine.

53:27

In that situation, this could happen based on the evidence.

53:31

Or based on the evidence in that situation, things don't tend to go well, butAs many of us are conditioned to go to the doctor and like we said, just kind of say whatever you say, whatever you do, like, that's not our job.

53:43

This is my opinion.

53:44

Not all doctors feel like that.

53:47

Some doctors are like, I'm going to tell you what to do.

53:49

And if you don't do what I say you're going to do, like, you know, they feel some type of way about that.

53:54

Who cares?

53:56

It doesn't matter because at the end of the day, you go home with your body to your life and your circumstance.

54:03

So you really have to make.

54:05

the best decision for you.

54:06

And nobody, you know, nobody can do that because nobody has all the information and knowledge that you have about your life and you and your circumstance.

54:16

So I love just to kind of remind people that they don't have to give all their power away.

54:20

We are here to guide you, to consult you.

54:24

And I think that's the main thing.

54:26

I mean, you know, obviously I'd plug myself and tell people to come check out my podcast.

54:32

Where can they find that?

54:34

It's called Lady Parts Doctor.

54:36

It's Lady Parts Doctor podcast.

54:37

It's on Apple Podcasts.

54:39

It's on Spotify.

54:40

Wherever you listen, you can go check it out.

54:42

It's also ladypartsdoctor.com is my website.

54:46

So you can go there.

54:47

If you're like, I don't remember where she said, just go to ladypartsdoctor.com.

54:50

You spell out the doctor, D-O-C-T-O-R, and check it out.

54:54

You can follow me on Instagram and threads.

54:57

It's ladypartsdoc.

55:00

Ladypartsdoc, that's me, but women's healthcare, self-care.

55:04

Those are the conversations we're having.

55:07

I will also put in a plug for your women's health meditations that are available on your website as well.

55:14

And then there's an upcoming event that you're speaking at, right?

55:19

Well, you know, I'm not speaking, I'm going.

55:21

There's a gala for sales.

55:24

It's stillbirth and infant loss support, and that is in November.

55:30

So I believe I have it on my website, but it's sales, S-A-I-L-S.org for anybody who's experienced miscarriage or stillbirth.

55:40

It is a gala to raise support for the organization.

55:44

And then I think there was one more thing I was going to plug.

55:48

Oh, check out my TEDx talk.

55:50

It's about self-care for women and granting yourself permission.

55:56

I listened to it.

55:57

It is excellent.

55:58

I will link to all of those things, your TEDx talk, the gala, and then your women's meditations, which I listened to a few of those and they were just delightful.

56:09

Oh, wonderful.

56:09

I'm glad you enjoyed them.

56:11

Yeah, it's all part of wellness.

56:13

You know, we're holistic.

56:15

You need the mind, body and spirit to be well and feel empowered in all of those aspects.

56:21

Thank you for this conversation.

56:23

I've really enjoyed it.

56:25

Thanks for having me.

56:26

See, I didn't even finish my glass of wine.

56:29

You have a few sips for post podcast.

56:34

I'm so engaged.

56:35

This is so engaging.

56:36

Thank you very much for having me and sharing your platform with me.

56:40

Absolutely.