EBB 303 – Advocating for Bodily Autonomy in Pregnancy and Birth with Mama Doctor Jones, OB/GYN

Dr. Rebecca Dekker – 00:00:00: 

Hi everyone. On today’s podcast, we’re going to talk with board certified OB-GYN and online educator, Dr. Danielle Nicole Jones, also known as Mama Doctor Jones. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.  

Hi everyone, my name is Rebecca Dekker, pronouns she/her, and I’ll be your host for today’s episode. I wanted to let you know that in this episode, we will discuss the Dobbs decision and we will talk about abortion for fetal abnormalities and life-threatening medical complications. And now I’d like to introduce our honored guest. Dr. Danielle Nicole Jones, also known as Mama Doctor Jones, with more than 2 million followers across her different platforms, Dr. Jones’ passionate advocacy for sexual health education has made her a standout influencer in this field. She’s an expert in period health, pregnancy, and gynecologic health, and she’s passionate about science education, autonomy, and patient-centered care. Dr. Jones received a Bachelor of Science in Psychology from Texas A&M before pursuing her passion for medicine. She earned her Doctorate of Medicine from the Texas Tech University Health Sciences Center and served as an OB-GYN at Baylor in College Station, Texas, and an Assistant Professor at Texas A&M Health Science Center. Danielle is also a founding member of the Pinnacle Conference, a leadership event for female physicians, and she’s an active participant in the Association for Healthcare and Social Media. In 2021, Dr. Jones embraced a new chapter in career by accepting a position at Southland Hospital in New Zealand, demonstrating her commitment to making a global impact in healthcare. Going back to social media, Dr. Jones’ journey in that began in 2009 during her time as a medical student. With the dual goals of providing accurate medical information to the public and creating a traveling CV or resume of her work, she started sharing her insights on Twitter and her blog, and later she expanded into YouTube. Dr. Jones’ dedication to her online community culminated in November of 2021 when she received a YouTube Gold Award, a testament to her significant influence and reach in the digital realm. I’m so thrilled that Mama Doctor Jones is here. Welcome to the Evidence Based Birth® Podcast. 

Dr. Danielle Jones – 00:02:43: 

Thanks for having me. I’m excited to be here. 

Dr. Rebecca Dekker – 00:02:45: 

We’re so excited that you joined us from the other side of the world to have a chat today for our listeners. And I was wondering if you could kind of go back to when you started Mama Doctor Jones and tell us a little bit more about your inspiration and why you wanted to reach families in this way. 

Dr. Danielle Jones – 00:03:03: 

Yeah. So as you said in my bio, I’ve been on the internet in some capacity since 2009, just kind of blogging as a medical student. Back then, it was really weird to be online as somebody in the medical space, and I was still a student. So it was mainly just kind of a creative outlet for me. I wasn’t doing a lot of teaching or anything like that. And it wasn’t under the moniker that I use now. I kind of ghost on social media through residency because my twins were six months old when I started my intern year. So obviously as a surgical field and any residency in general, working that much and also being a new mom to tiny twins was a lot. And I didn’t have time to do anything except be a good mom and learn how to be a good doctor. And then I came back to social media in 2017 under the MDJ moniker. And at that time, it was initially for about a month, I was like, oh, maybe I’ll use this to see if I can get people into my practice or whatever. But it very quickly became a space for education and now is solely focused on education with the ultimate goal of making an impact on global health in a maternal capacity. And that’s really where my passion lies, empowerment through education, edutainment, like we call it on YouTube. And making an impact globally on maternal health and mortality rates. 

Dr. Rebecca Dekker – 00:04:20: 

And I remember following you for the past few years and you announced a big decision to your audience that you were moving and leaving the US, and going to New Zealand. Can you talk a little bit about what led to that decision and how that’s gone? 

Dr. Danielle Jones – 00:04:33: 

Sure. So the decision to move to New Zealand, I wish I could say, had roots and making some kind of impact. But really, we visited in 2011 and just fell in love with this country. Altidore is a really interesting place because it’s a different pace of life than I think even myself in rural Texas growing up was used to. People are really friendly. We live down south, but we just kind of fell in love with the culture and the outdoors and hiking and the landscapes. It’s just a really beautiful place to live. And we visited again in 2018. And that kind of solidified our thought that we would like to move here someday. And the opportunity opened up to apply for a job in 2021. And yeah, we took it and it’s been great. Now we’re having we originally decided to come for a year and now it’s been almost two. And we’re having to decide, do we come back or what do we do? And if we come back, where do we go? So, yeah, we’ve been really blessed to have a great experience here and have made excellent friends. And working in a new health care system, a new completely different maternity system. It’s been really interesting to me and a great experience as well. 

Dr. Rebecca Dekker – 00:05:33: 

Yeah. Can you talk a little bit more about that? Like, what are some of the major differences you realized, maybe even as you were interviewing and trying to… You know, figure out where you could work. 

Dr. Danielle Jones – 00:05:44: 

Yeah, everything is different. The major difference is that nothing is the same. In the interview process, I actually work in a, well, everywhere’s fairly rural here, but down south in one of the furthest away places you can get from Auckland, which is really the only huge city in New Zealand. And our team is made up primarily, well, entirely of people who are not Kiwi. So we have several American doctors, Canadian doctor, Australian doctor, and it’s a bit hard to recruit Kiwi OB-GYNs down here for one reason or another. And so I knew coming in, having interviewed with our head of department here, that and he is also American, that it would be very different. But I don’t even think until I got here and really immersed myself in the system here that I realized just how different it is. So just to briefly give an overview, everyone who is pregnant in New Zealand is entitled to care with a midwife, and the midwife takes care of them throughout the entire pregnancy, even in a high-risk pregnancy. So we co-care for patients if they need to consult us. So it’s not unusual that if I have a patient who has twins that the midwife will consult with obstetrics, the midwife will show up and come to their OB consult visit with them. We will work together to coordinate care. It’s really an excellent system. I think a downside is that these midwives, because it is so rural and because we have a big population and a small amount of people who are able to serve that population as midwives, is that they are extremely overworked. And I don’t know if it’s a sustainable system. I think it’s superior as far as the care for patients who are pregnant goes. I don’t know. I don’t know what will happen in the long term. 

Dr. Rebecca Dekker – 00:07:24: 

So there’s not quite enough midwives then for the people who need them. 

Dr. Danielle Jones – 00:07:29: 

Yeah, we are constantly short on midwives. So we have something called core midwives. They’re essentially like a labor and delivery nurse who works in the hospital, except they do the deliveries. So if somebody comes in and their midwife can’t come because they are, you know, two hours away or something, then the core midwife will take care of them. Or if they have to be induced for whatever reason, the core midwives will care for them. Various situations where the midwives can’t come to the hospital, but most of the time they do come, which is another stark difference to the US. Where most of the time if you have an out-of-hospital midwife, either at a birth center or a home birth, they are not going to have privileges at the hospital to come in with the patient. And I think that this is the key place where the US kind of keeps midwifery care from being the safest that it can be and the best option like it should be, is that we don’t allow continued care from outside the hospital to inside the hospital with people who are midwives, but also service patients at home. 

Dr. Rebecca Dekker – 00:08:22: 

So everybody who has privileges outside the hospital has privileges inside the hospital, and you have that continuity of care. 

Dr. Danielle Jones – 00:08:30: 

Yep. Anybody who is licensed as a midwife in New Zealand can deliver in a hospital in New Zealand. 

Dr. Rebecca Dekker – 00:08:35: 

What other differences did you notice just aside from access and that the midwifery model of care is the primary model there? 

Dr. Danielle Jones – 00:08:43: 

There’s lots of little things that we do differently. Just. like the timing of medically indicated deliveries, hypertension management, things like that. It’s little things. I think people stay pregnant longer here. So we don’t really do elective inductions before 41 and three, not necessarily because it’s not allowed, but because we don’t really have the capacity. So there are times when I really would like to deliver a patient because they have a medical indication and we don’t have enough staffing to do it at the timing that I really would like to. So adding into that elective deliveries at 39 or 40 weeks would be a huge negative to the patients who have medically indicated needs for delivery. A lot of births happen outside the hospital. And a lot of that is not so much related to the fact that midwives are the primary model, but to the fact that it’s very rural here. So New Zealand’s population, about 5 million people live in Auckland. And the next biggest city is Christchurch, which is the biggest city on the South Island. And that’s 350,000 people. So you can imagine that all the rest of the 15 million people that live here, it’s all just pretty small towns and stuff. So it’s very spread out. Our catchment area for patients is the size land-wise is very big. And a lot of the midwives go to people’s homes to take care of them.  

So out of hospital births are partly by necessity and then partly because the midwifery model of care is the primary model here. So everybody doesn’t get screened for GBS. I’m of mixed feeling on that. Most of the things that we do here, I think are superior. And even though sometimes I have to keep reminding myself like, outcomes are better, outcomes are better because it’s hard to get out of the place where you trained and the things that you learn to do. I do think that is one area where I’d like to see everybody screen for GBS just because it’s a fairly easy thing to do and it does make a big impact on outcomes. Yeah, I don’t know. It’s really little things, little things that in the grand scheme of things probably make a big difference. But I think the overarching theme is that it’s much more patient-centered here. And there’s a lot that went into that. The Cartwright investigation is a key pivotal point in turning medical care, particularly for pregnant patients, to be more patient-centered. And that’s something that the Cartwright inquiry is something that you’d have to look into to see it’s very New Zealand-centric. But it is one of the reasons that it’s very patient-centered here, at least compared to what I’ve seen in the US. Although still paternalistic in some aspects, I think that it’s better here. Yeah, I don’t know. The whole culture is different. 

Dr. Rebecca Dekker – 00:11:13: 

So there seems, though, that there was a watershed moment in the culture there that led to a lot of, like, systematic changes being made to center care around the families and the pregnant patients.  

Dr. Danielle Jones – 00:11:25: 

Yes.  

Dr. Rebecca Dekker – 00:11:25: 

Can you talk a little bit about autonomy and bodily rights? Because I know that was something, you know, you left from Texas where the Dobbs decision, like, essentially originated to go to New Zealand. And what has that been like, kind of like watching what’s happening in the US from the other side of the world? 

Dr. Danielle Jones – 00:11:45: 

Yeah. I don’t even know how to answer that. It’s been equal parts just heartbreaking and shocking. Right when we were leaving is when the six-week abortion ban had passed just prior to that. But I will say that having trained in Texas and lived in Texas my whole life, access to abortion even prior to the six-week ban was very difficult. I had patients who had lethal anomalies who it was easier for them to fly out of state to have a D&E for anencephaly or something like that than it would be for them to find one of the two providers that could do that procedure after 20 weeks in Texas. And it’s starkly different. The rules in New Zealand are that access under 20 weeks is available at will for anybody who wants it. And that is a government-provided service. After 20 weeks, the need for abortion would increase. It would require two physicians to sign off as a medical need. And what constitutes a medical need is not outlined.  

So it’s very much up to the people who are taking care of the patient. So it does leave, I think, way more room for patients to make decisions in conjunction with their medical care team rather than having the government kind of have oversight into it. And, yeah, I think the takeaway point for me watching is, you know, first I thought like, oh, they’ll never overturn Roe. That won’t happen. And then it happened. And now I think like, I have no idea. Like, they’ll do anything. I have no faith anymore that we will have any protections. And that’s why it’s kind of lit a fire in me to do even more advocacy than I already was in regards to that. And then also in regards to talking to people about it here is just like you cannot get complacent. We have great rules right now, but it only takes one change of government. To get rid of those. And the US sets the tone for the rest of the world. And although the grand consensus when you talk to people is like, what’s going on over there? It’s crazy. Things are falling apart. That doesn’t stop the world government from following in the footsteps of what’s happening in the US. And we’ve seen it time and time again. So I hope that the people of Altona and other places just. Can take note of that and continue to fight to keep their rights while they have them. 

Dr. Rebecca Dekker – 00:13:52: 

I think living in Kentucky, which is another state similar to Texas, that my eyes were not really open, truly, to the consequences of banning abortion until I talked with an OB-GYN who lived in my state. And she shared with me the scenarios where her hands would be tied legally. And I was wondering if you would be willing, you know, for those people who aren’t really understanding why it’s a critical health care service for people with planned pregnancies as well. Could you talk a little bit about, you know, some of the potential scenarios where as an OB-GYN you would medically see an abortion as necessary even in a planned pregnancy? 

Dr. Danielle Jones – 00:14:30: 

Sure. There’s, I think, endless scenarios, and I’ll talk to you about a few. All of them are, I will say, things that I’ve walked patients through in real life. So none of these are so rare that we don’t see them frequently. You have really good access in the US, which is something we don’t have here, to NIPT testing, which is early genetic testing. So you could have a patient who had a 10 or 11 week blood test that came back positive for something like trisomy 13, which is generally a lethal condition. And they could have a CVS test, which is a confirmatory test, and have that done by 12 or 13 weeks. And if you live in a state where you can’t access abortion, that means that you now know for the remainder of your pregnancy, which is 30 more weeks or so, that you have a fetus growing inside of you that most likely will not survive. Now, some people would like to carry that pregnancy to term and deliver and, you know, either will be stillborn or die shortly after birth in most scenarios. And that’s okay. I think people should have that choice. But I also think people should have the choice not to do that. We know pregnancy is a time in people’s lives where they are at risk for many, many health conditions. And nobody should be forced to risk their health and their life carrying a pregnancy that’s not viable if that’s not what they want. So you’ve now put people in a position where previously you could have a fairly easy procedure or take a pill to end a pregnancy at, you know, 12 weeks or 13 weeks or whenever. And now it’s delayed or impossible.  

So you’re not only preventing these pregnancies from being ended when somebody wants them to but you’re creating a scenario where you have more pregnancies ending at later gestations because you leave and that is more traumatic emotionally it’s more physically dangerous and it’s more draining as far as monetarily and from a healthcare standpoint. You have situations where somebody’s water breaks at 18 weeks. I think a common thought is like, oh, well, if you just induce the pregnancy, you know, induce and deliver. That’s not abortion. That is abortion and an induction when it is performed knowing that it is not a viable fetus, meaning you’re less than 23 weeks, 24 weeks, whenever life-saving care would be employed, it does count as an abortion. And I think that’s something that a lot of these places kind of try to twist the language of, and you’ll see people arguing it online. Well, just induce, just induce and just have the baby. Well, that’s still abortion if it’s at 18, 19, 20, 21 weeks. Their fetus has a heartbeat, their water has broken. And even in states where there’s an exception for maternal health or risk to life, what I try to tell people is you cannot take solace in that because when does your life become at risk? The moment you get pregnant, you’re more at risk for dying than you were when you weren’t pregnant, but that’s not enough, obviously. So when your water breaks, now you’re at risk for infection. But if someone doesn’t have an infection, is that enough of a risk? Or am I going to be federally charged for induction and abortion if I deliver that fetus and take care of the situation? What about when they become febrile but they aren’t full-on septic? How long do you have to wait before that maternal life exception counts and the medical team is not at risk? So these are all scenarios, and I could tell you 100 more, where you have very clear gray areas that are not covered by the law. And, yeah, I mean, it’s just why these things shouldn’t be blanket legislation. 

Dr. Rebecca Dekker – 00:18:07: 

Yeah, I sometimes think about, you know, how the majority of the legislators in Kentucky are white men who know nothing about reproductive health and have no idea of the hundreds of different scenarios that families find themselves in. So that’s, yeah, again. 

Dr. Danielle Jones – 00:18:22: 

And their mistress, their wife, their daughter, their granddaughter, they could get an abortion if they needed it. And that’s the problem is that these people who make these laws, it will never affect them. It will never affect their family because they have access to other places. But if you are my patient in central Texas and you’re working two jobs to take care of your family of three children and you’re a single mom, how are you going to find the funds to get you to Colorado? To take care of a lethal anomaly, you can’t. Like, that’s not an option. 

Dr. Rebecca Dekker – 00:18:59: 

Yeah. Well, thank you for talking with us about that. On a slightly different topic, but still related to childbirth, this year I saw you posted on Twitter. And you did a video on YouTube about eating and drinking during labor. And you immediately got pushback, particularly from some doctors around the world. And I was wondering if you could tell us, like, why do you think this is? Why did you get that pushback? 

Dr. Danielle Jones – 00:19:24: 

First off, I knew that I would. And it was one reason that I posted all of that. And second, your website had such an amazing, perfectly organized section of research on this and all of the information. So thank you for providing all of those resources in one place because it’s really helpful. I will note it was almost exclusively anesthesiologists who were pushing back against this. And the reason is because none of these people take care of anybody who is having a normal, uncomplicated birth. And they do not sit with people throughout their entire labor and refuse them food and water. The anesthesia team only comes in when they’re either placing an epidural or there’s a problem. And so in their mind, every pregnancy has an epidural or a C-section because and I know there’s anesthesiologists listening to this who don’t fall into that category. And I think for them, I will say it has taken me a long time to get to a point where when I hear people painting obstetricians as paternalistic monsters, that it doesn’t personally offend me. And I think that they need to get to that place too, because if you’re talking about a paternalistic obstetrician who doesn’t ask for consent and forces patients to deliver on their back, those people are real, but it’s not me. So if you’re talking about them, I don’t have to be offended because it’s not me, right?  

So anesthesia, the ones pushing back against this, have not ever been in a position to have to care for these patients outside of a time when they go into the operating room or having an epidural. And they don’t know the data. That’s plain and simple. They are ignorant to the data. They either don’t care about it, in which case I would say every single person who is an anesthesiologist who responded to me negatively in the post that I put on Twitter or on my YouTube video, they are not ignorant to the data because I put it in front of them. So those people do not care about the data. They do not care about the patients, and they do not care about the outcomes. That is, I can put those people in that box. But other than that, I think it’s the training that they have has taught them to irrationally think that this isn’t like a massive aspiration risk when it is not. And they’ve removed the autonomy aspect out of it. And they’ve started treating pregnancy and labor and birth more like a scheduled procedure than a normal physiologic event that happens. And I think you should look at it more like a car crash. You don’t starve people before they take a cross the country road trip. And because that’s a normal event that you do, even though it could end with you needing an emergency surgery if there’s an accident, we have to treat pregnancy and birth like that as well. You can’t just starve people because they’re having a baby. Most of the time, they’re not going to need a general anesthetic anyway. And even if they do, the chances of aspiration are so low. 

Dr. Rebecca Dekker – 00:22:07: 

Yeah. Well, thank you for getting into that area. 

Dr. Danielle Jones – 00:22:10: 

I’m sure I didn’t make very many friends in the anesthesia department. 

Dr. Rebecca Dekker – 00:22:14: 

You brought a lot of eyeballs to the discussion, and I think it’s helpful to have an obstetrician making the argument, look at the data, and think about patient autonomy because that’s often not what’s considered, as you mentioned. I think I just got a text message today from a local friend who said she was at an OB appointment, and the doctor said it’s not safe to eat during labor. And to her, that was a major red flag, and so she is actually going to switch practices, which I’m happy about. But that is still happening within a few miles of where I live, even though I publish all this data for our community. And from what I understand, like you mentioned, it’s usually the anesthesiology department. Another thing I’ve learned is it’s often one anesthesiologist who has the power to guide policy at that facility. So what advice do you have for nurses or obstetricians who are trying to change these policies in their hospitals, but they keep running into pushback, perhaps from one powerful doctor who either is unaware of the evidence or just doesn’t believe it or doesn’t care about it? 

Dr. Danielle Jones – 00:23:21: 

Yeah, it’s hard because you’re right. It usually does come down to one person who’s in charge at the top. And most of the time, statistically, that’s going to be an old white guy who just hasn’t ever had to think about autonomy and birth. And I think my advice would be it’s hard, but don’t be afraid to keep making waves. I’m not in this to make friends. I’m not here to, you know, make sure that everybody likes me. My entire goal on the internet and, you know, in my job is to take the best care of patients that I can to give patients the power and education that they need to advocate for themselves. It would be nice if we lived in a world where that wasn’t needed, that no patient needed to advocate for themselves, but that’s not reality. So if that’s the case, then at least I can give them the information they need to do that. And I think that’s all you can do. So I would never, ever, ever encourage a patient to go against the rules. So, because I can’t do that and not risk being at risk with my job. But what I would tell a patient is nobody can force you to do something that you don’t want to do. You are still in charge of your body and your birth. And if you want to eat in your labor, I can tell you, you know, go watch my video. Here’s the actual risk. And what are they going to do? You’re not going to be refused an emergent surgery that you need if you’ve eaten or drank. And if, I mean, I don’t know, it’s a hard line to navigate as somebody who is, you know, working in that environment. I’m lucky now that I work in an environment where that’s not really the case because people eat and drink and labor here. But I would say find an ally in the department, somebody who is on your side, cares about the data, throw it into conversation, talk about it, see if you can give a grand rounds presentation using the Evidence Based Birth® outline that you have with all of the data. I would just keep talking about it, keep bringing it up and empower patients. 

Dr. Rebecca Dekker – 00:25:17: 

Hang the handout up on the bulletin board. 

Dr. Danielle Jones – 00:25:20: 

Stick it all over the tea room or whatever in the lounge. 

Dr. Rebecca Dekker – 00:25:26: 

Yeah, I like your advice, though, about, you know, not being afraid to make waves. But if for some reason, if you’re worried about your job or you feel like that puts you individually too much at risk, finding other allies, doing it as a group rather than as one person can help kind of spread some of that risk around. So you’re not the only one labeled as a troublemaker. There’s so many other myths and so much disinformation online. And you debunk a lot of myths on your YouTube channel. So I was wondering if you could talk with us about some of your top myths about pregnancy or childbirth that you’d like to debunk for us today as we’re listening to you. 

Dr. Danielle Jones – 00:26:04: 

Sure. You know, there’s so many. And I think this is a space on the internet that is just wrought with misinformation. And some of it comes from people who are predatory and wanting to make money. And sometimes it comes from doctors who are not informed or well-informed or just haven’t taken on that need to be the people who support autonomy. Hormone health is a big one. And. I think a lot of people see space in the fertility aspect of things to make money by spreading misinformation. Birth control misinformation is a huge one at the moment as well. People being afraid to keep taking their birth control because they’re told things about it that I am more into telling people how to recognize the tactics that people spreading misinformation use, because that’s so much more helpful than debunking any individual lie.  

Dr. Rebecca Dekker – 00:26:58: 

So what are some of the tactics then? 

Dr. Danielle Jones – 00:27:00: 

Yeah, what you will often see is they’ll take data and they will misuse it. And I think that the eating and drinking while in labor is a really good one to talk about because it’s been done from the medical side, not from the influencer side. You don’t see people telling lies about this, you see them saying, well, eating and drinking is a risk for aspiration. That is technically in the data, I guess, if you really look at it. But what is the actual risk, right? So that’s what you see people doing. Here’s the data. And you look at it and they say, this is the truth from this data. And it probably is true. They draw a conclusion that is not meant to be drawn from that data. So with the eating and drinking and labor example, it would be there’s an aspiration risk. And that means you shouldn’t eat and drink and labor because you might aspirate. Okay, well, that’s not the full story. Let’s talk about what is the risk? How big is the risk? Is it big enough that I should be blanketly suggesting that nobody should eat while they’re in labor? Is it big enough that I should be making that a hard and fast rule that this is my hill to die on as whoever’s in charge? So that’s the kind of tactics you see is a truth with a conclusion that can’t be drawn from that truth being made. And you’ll often see these people selling something. So I think it’s a venn diagram of a circle for people who are saying this thing is dangerous. Your birth control is dangerous. It will kill you. Go off of it. And I have an ebook for sale for $200 in my bio. If there is some reason that it would benefit that person to tell you something. And you believe it, then maybe you should be a little bit critical when you’re listening to it. 

Dr. Rebecca Dekker – 00:28:40: 

Like if they sell the solution to the thing that they’re telling you, this is horrible, don’t do this. Do this instead. I sell it on my website. That should be a red flag. 

Dr. Danielle Jones – 00:28:54: 

Absolutely. And there’s a lot of red flags like that. But, you know, and then the pregnancy and birth, I think there’s a lot of them too, you know, and it goes both ways. So you’ll see people in the natural birth space saying, don’t let anybody induce you at 39 weeks, it’s dangerous. Well, it’s not quite true. And you’ll see doctors saying like, don’t let anyone go past 40 weeks or 41 weeks or whatever. That’s dangerous. Well, it’s not quite true. So I think all of it comes down to there’s people spreading misinformation purposefully trying to make money. And those are, kind of, the people we talked about just now. And there’s people spreading misinformation because they really believe something and they lack nuance to discuss it. And I think that’s where the healthcare space really falls into a misinformation kind of hole is that, and it’s really one of the reasons YouTube is my favorite space to go on because the nuance that is required for a lot of the discussions that we need to have cannot be done in a 30 second TikTok or, you know, a one minute Instagram post. And that’s what I really appreciate about your website, by the way, is that you also have like, that nuance drawn into it. So the information is not presented in a way that’s like, is this good or bad? Yes or no? Because that’s never the answer, right? It’s never that easy. And if someone makes it sound that easy, then they either don’t understand it, or they’re not presenting you the full truth. 

Dr. Rebecca Dekker – 00:30:11: 

Yeah, I think that is so true. For example, last fall we are doing a free public webinar on breech. It’s so hard to condense that subject even into a one-hour video because there’s so much nuance, there’s so much data. Every study was different with a different population, and you can’t make these blanket statements like breech vaginal birth is safe for everyone or breech vaginal birth is terrible for everyone. And so there’s so much nuance. And you’re right, we struggle. I struggle with trying to condense things even to a caption for Instagram. And even then you get people saying, why didn’t you mention this or why didn’t you say that? It’s like it’s impossible. 

Dr. Danielle Jones – 00:30:52: 

Yeah, yeah. And I think that that’s a great point, too, as to why this becomes contentious within the medical community as well. Because to go through something like, is vaginal breech safe in a 20-minute visit is impossible because it’s so much. Like you’re saying now, like I can’t even hardly fit it into this one, like, very long website that I’m trying to write it up as an article on. And it becomes very difficult. So then people think they need to take on this like, okay, all breech birth is bad or okay, all breech birth is good. And then you just have people fighting and it’s unhelpful. And yeah, I think somewhere along the way, we’ve lost the ability to really use our brains for the nuance that all of these things deserve. 

Dr. Rebecca Dekker – 00:31:36: 

Yeah. Okay, Dr. Jones. You have a section on your YouTube channel, which if you haven’t checked it out, you should. And I noticed that like, you know, some of your most popular videos are your reaction videos. And one of the things that you react a lot to are when people didn’t know they were pregnant, which is not an area I have really researched other than I know from, I took a Hypnobabies® class with my second pregnancy. I learned a lot then. And then I read the research about the power of the mind, how your thoughts affect your symptoms. There’s also research on defensiveness and how you may use denial strategies that make you not feel symptoms or know things. So can you talk a little bit about why you think some people don’t know they were pregnant, if that’s a real thing and you know, what you’ve learned from watching those videos? Cause I don’t have the patience to be honest, to watch them. So I’m glad you watched them. 

Dr. Danielle Jones – 00:32:32: 

Yeah, it’s a hard question. And I think the best way that I can look at this is that viral event that happened a few years ago with the gold or blue dress. That our brains just do things that are weird, right? So I don’t understand how anybody could look at that dress and think that it was blue. But, a lot of people did. So your brain is very powerful. Every single thing that we see in life and interpret in our brains and experience as reality around us is completely up to our brains to decide. From, you know, day to day, how we feel about our lives and the weather, it’s all subjective up in our heads, right? So I don’t know that I really had thought much of it until I started watching these videos. And it’s a TLC show where they go through people’s stories. And every once in a while I watch one and I’m like, I think maybe this person did know and they’re not telling us the full truth.  

But by and large, I believe these people because if you listen to them talk about the trauma of suddenly finding out that they were delivering a baby and didn’t know, like, there’s no way, like, what do you have to gain from doing that, right? It has to be something supratentorial. And so there are situations where people have bleeding on and off through the pregnancy. I think a lot of people do not chart their cycles or keep track of their cycles. People have irregular cycles already. A lot of these patients will, you’ll hear them talk about having PCOS or something where they’ve not had a period in several months. And so not having a cycle for several months is not a big deal. I can’t explain it. I don’t know. I’m sure there’s research on it. Interestingly, despite everything else in life I do being loaded with research, I’ve never really looked into any research on this, I’ve just, you know, we just have fun watching it and talking about it. But the take-home point for me is if your periods do anything weird, if you have any weird symptoms, if you’re having sex with someone who can get you pregnant, take a pregnancy test. And if it’s negative and you still keep having symptoms, take another one.  

Dr. Rebecca Dekker – 00:34:32: 

Well, and it’s true because sometimes pregnancy tests stop working the further along you get in pregnancy when your hormones shift as well. So I’m sure that that doesn’t help.  

Dr. Danielle Jones – 00:34:39: 

Yeah. So what happens is your levels get so high that the test will occasionally read as negative because it has what we call like, a peak effect and it doesn’t always pick up. So yeah, I think oftentimes these people don’t think they’re pregnant. And so they don’t think to seek care and get that checked out. But if your periods are doing something weird, if you’re having weird symptoms, just, you know, take tests, see a doctor, get a blood test, any of those things. 

Dr. Rebecca Dekker – 00:35:03: 

So one last question I have for you before we go. You mentioned earlier bodily autonomy, and I know a lot of your videos touch on the importance of informed consent and shared decision-making in healthcare. Could you just talk with us a little bit about shared decision-making, informed consent, and how your personal philosophy is and how you can help people have a positive pregnancy and birth experience. 

Dr. Danielle Jones – 00:35:29: 

Yeah, I find this actually to be a lot harder to do in reality than it is to talk about. And the reason is because people come at it from many different angles when they’re sitting in front of you. So I will sometimes have a patient who really doesn’t want to be given all of the information and then choose something and will get really frustrated with me because I’m like, well, we could do this or we could do this. And here’s the pros and cons of each. And they’re like, can you just tell me what to do? You know, so when you’re taking care of people in real life, it’s not as easy as it is to discuss on the internet because you have people at many different places in life. My general approach is I want to know where you’re at. What do you, how do you feel about things? And I think you do that by making sure that all along the way, you know, this is a joint work, right? So we’re working together. We’re a team. If something’s going on that you don’t like, you can tell me something’s going on that I’m worried about or I don’t like because it makes me nervous or something like that, I can tell you and we will hear each other out and we will make a joint decision. That has to be done in rapid fashion when you’re taking care of people in emergency situations. And you have to learn to do that over time as a healthcare provider. And no one’s going to be perfect at it all the time.  

So, I think communication is the end all be all of this. You have to have good communication. You have to have good listening skills. You have to be good at reading a room and understanding, kind of the dynamics going on and asking people how things fit together. But yeah, I don’t know. It’s hard. It’s hard. In reality, but in real life or on internet life, I guess, in educating people, I think the best thing we can do is put all the information in a place where people can find it, right? So I want to talk about what are the pros and cons of an elective C-section. Let’s talk about ultrasound and should you get a growth scan later in pregnancy? What do we do if it says that your baby’s going to be 5,500 grams? How accurate is that? Should you have a C-section for that? And then we just go over, you know, it could be wrong. Baby could come out much smaller than that. Also, people deliver babies that are really big and sometimes it’s fine. A lot of times it’s fine. Actually, most of the time it’s fine. But when it’s not fine, what can happen? It’s a process that takes a lot of discussion. And unfortunately, in the way that the U.S. medical system works and even other places, it can be really hard to truly provide sufficient informed consent to somebody in the amount of time that we’re allotted to talk with them. 

Dr. Rebecca Dekker – 00:37:54: 

Yeah. I love, though, how you were describing what the ideal relationship would look like between a health care provider and patient and that you can have honest, open conversations, two-way, like so both sides can express concerns or ideas. And it’s that kind of like back and forth. And that to me seems like the ideal use of, you know, having a doctor is somebody you can talk with about what you’re worried about and they can share their expertise with you as well. 

Dr. Danielle Jones – 00:38:22: 

Right. Early on in my training, I saw people sign AMA forms, like against medical advice forms where people leave. And I really don’t like those. I understand they’re sometimes needed for medical legal protections, but I feel like a lot of our medical training is often positioned around this, like, I’m going to give you what you should do and you’re going to do it. 

Dr. Rebecca Dekker – 00:38:42: 

And it’s kind of like an adversarial thing if you don’t do what I… 

Dr. Danielle Jones – 00:38:45: 

Yeah. Yeah. And I always want patients to know, like, you’re not in jail. I don’t need you to stay here. I’m going to tell you, like, I think we should give you antibiotics because your water’s been broken for X amount of hours and we have a risk of infection. And if you say, like, I’m not going to do that. Well, okay, fine. Like, but I should tell you, like, here’s what the risk of declining to have the antibiotics is. I’m not going to make you like, sign a form and leave. Or if you were like, no, I’m just going to go home. Okay, well, I’m just going to write in your chart. Like, we talked about the risks and benefits. The patient felt more comfortable leaving or, hey, they didn’t have childcare. Like people’s situations are so much bigger than what you see sitting in front of you and people’s decisions to do things are so much bigger than that. That shouldn’t stop us from going through the true risks and benefits and saying, this is my recommendation. And too often it becomes like this. Almost like a parent-child relationship where you get really angry with your kid if they won’t pick up their damn room. Sorry, I don’t know. But then you get really angry with your kid if they won’t pick up their room. And you don’t have to do that, right? You can just… In medicine say like, okay, well, you know, this is my recommendation and it’s okay if you don’t want to do that at the moment, but would you like to tell me what you’re worried about or why does that give you pause or, you know, you don’t have to, but tell me why it’s worrisome to you. I don’t know. It’s just, it needs to be more of a conversation.  

Dr. Rebecca Dekker – 00:40:13: 

Yeah. And I think what you were kind of describing is paternalism, which most people don’t know the definition of, but it’s when a person in a position of authority makes decisions on your behalf and your supposed best interests. And that’s a hard thing that when you’re pregnant, you go up against a system where people are trained that way instead of like, seeing each other as equals and on the same team. And we’re partners in this journey together. 

Dr. Danielle Jones – 00:40:38: 

Absolutely. Even I think, myself…so, in my fourth baby’s birth was my third pregnancy. I had had two C-sections and I went into labor on my own and the plan was to have another C-section. I wish in hindsight that I would have just let myself labor and VBAC, but I was in a system that didn’t support VBAC after two Cesareans. And even knowing what I know and being a doctor in that facility and an equal to the person taking care of me, I did not feel comfortable enough advocating for myself to just continue laboring. So I think that that experience helped me see just how powerful that imbalance of power between the provider and the patient can be, even if we are technically equals in terms of education and what we do in day-to-day life. So even more so when that’s not the case. 

Dr. Rebecca Dekker – 00:41:31: 

Yeah, it’s really hard. And that’s why we need more health care providers like you who respect informed consent and want to encourage it so that even if, you know, you weren’t sure what you wanted, you felt like you made the choice you did for your own sake, not for what you felt like they wanted you to do.  

Dr. Danielle Jones – 00:41:51: 

Absolutely. And to be clear, I have not always been this way. I think being on the internet, listening to people, hearing people’s stories. I have a video on my YouTube channel about why I think the internet has taught me a lot of things that medical school never could or never did. And this is one of them. It’s not that I didn’t in the back of my head know that some of the things that we were doing were not okay, as far as being paternalistic, but being on the internet and listening to people and hearing things that doctors have done to them or, you know, not really communicated well with them was a catalyst for me. And I hope that, myself, being willing to talk about the fact that I didn’t just go into medicine and become an advocate for autonomy overnight. I wasn’t like I’ve always been that way and I’m just disrupting medicine, right? I had to unlearn a lot of things that I learned in medical school and residency in order to get to a place where I could advocate like that. And where I could run my own practice and take care of my own patients like that. 

Dr. Rebecca Dekker – 00:42:48: 

Yeah, well, we’re thankful that you have shared your journey with us and come on the podcast today to share some of your knowledge with us. Dr. Jones, how can people follow you if they don’t follow you already? 

Dr. Danielle Jones – 00:43:00: 

Thank you so much for having me. So I’m Mama Doctor Jones on all platforms, and probably pretty easy to find that name on anywhere. 

Dr. Rebecca Dekker – 00:43:08: 

Awesome. Thank you so much, Dr. Jones, for joining us today. 

Dr. Danielle Jones – 00:43:11: 

Thank you for having me. 

Dr. Rebecca Dekker – 00:43:14: 

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