Episode 375 Dr. Darrell Martin Shares His Journey as an OB/GYN + Can a Midwife Support VBAC?

Dr. Darrell Martin is an OB/GYN with four decades of expertise in women’s health and the author of the bestselling memoir “In Good Hands: A Doctor’s Story of Breaking Barriers for Midwifery and Birth Rights.” In this episode, Dr. Martin and Meagan walk down memory lane talking about differences in birth from when he started practicing to when he retired. He even testified before Congress to fight for the rights of Certified Nurse Midwives and for patients' freedom to select their healthcare providers! Dr. Martin also touches on the important role of doulas and why midwifery observation is a huge asset during a VBAC. Dr. Martin's TikTok In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights Dr. Martin's Website Coterie Diapers Use code VBAC20 at checkout for 20% off your first order of $40 or more. How to VBAC: The Ultimate Prep Course for Parents Full Transcript under Episode Details Meagan: Hello, everybody. We have Dr. Darrell Martin joining us today. Dr. Martin hasn’t really been in the OB world as of recently, but has years and years and over 5000 babies of experience. He wrote a book called, “In Good Hands: A Doctor’s Story of Breaking Barriers for Midwifery and Birth Rights.” We wanted to have him on and talk just a little bit more about this book and his history. That is exactly what he did. He walked us down memory lane, told us lots of crazy stories, and good stories, and things they did along the way to really advocate for birth rights and midwives in their area. Dr. Darrell Martin is a gynecologist, a dedicated healthcare advocate with four decades of expertise in women’s health, and the author of the bestselling memoir, “In Good Hands: A Doctor’s Story of Breaking Barriers for Midwifery and Birth Rights.” His dedication to patient care and choice propelled him to testify before Congress, championing the rights of Certified Nurse Midwives (CNMs) and advocating for patients' freedom to select their healthcare providers. A standout moment in his career was his fervent support for nurse-midwifery in Nashville, Tennessee, showcasing his commitment to advancing the profession. Additionally, Dr. Martin takes great pride in having played a pivotal role, in like I said, more than 5,000 births, marking a legacy of life and joy he has helped bring into the world. Our interview was wonderful. We really walked down what he had seen and what he had gone through to testify before Congress. We also talked about being safe with your provider, and the time that he put into his patients. We know that today we don’t have the time with our providers and a lot of time with OBs because of hospital time and restricting how many patients they see per day and all of those things. But really, he encourages you to find a provider who you feel safe with and trust. I am excited for you guys to hear today’s episode. I would love to hear what your thoughts were, but definitely check out the book, “In Good Hands: A Doctor’s Story of Breaking Barriers for Midwifery and Birth Rights.” Meagan: Okay, you guys. I really am so excited to be recording with Dr. Martin today. We actually met a month ago from the time of this recording just to chitchat and get a better feel for one another. I hung up and was like, “Yes. Yes. I am so excited to be talking with Dr. Martin. You guys, he has been through quite the journey which you can learn a lot more about in more depth through his book. We are going to talk right there really quick. Dr. Martin, welcome to the show. Can we dive into your book very first? Dr. Darrell Martin: Surely. Thank you. Meagan: Yeah. I think your book goes with who you are and your history, so we will cover both. Dr. Darrell Martin: Okay, okay. Meagan: Tell us more. Darrell Martin’s book is “In Good Hands”. First of all, I have to say that I love the picture. It’s baby’s little head. It’s just so awesome. Okay, we’ve got “In Good Hands: A Doctor’s Story of Breaking Barriers for Midwifery and Birth Rights.” Just right there, that title is so powerful. I feel like with VBAC specifically, if we are going to dive into VBAC specifically, there are a lot of barriers that need to be broken within the world of birth. We need to keep understanding our birth rights. We also have had many people who have had their rights taken away as midwives. They can’t even help someone who wants to VBAC in a lot of areas. A lot of power is in this book. Tell us a little bit more about this book and how it came about. Dr. Darrell Martin: Well, the book came because of patients. As I was heading into my final run prior to retirement, that last 6-8 months, and I use that term, but it shouldn’t be patient. It should be client because patient would imply that they have an illness. Occasionally, they do have some problems, but in reality, they are first the client wanting a service. I thought my role as to provide this service and listen to them about what that was and what they wanted to have occur. In response to the question of what was I going to do when I retired, I just almost casually said, “I’m going to write a book.” The book evolved into the story of my life because so much of the patients and clients when they would come to me were sharing their life, and they were sharing what was going on in their life. Amazingly, it was always amazing to me that in 3 or 4 minutes of an initial meeting, they would sometimes open up about their deepest, darkest secrets and it was a safe place for them to share. I always was blown away with that. I respected that. Many times there were friends of my wife who would come in. I would not dare share a single thing notwithstanding the fact that there were HIPAA regulations, but the right thing was they were sharing with me their life. I thought, “I’m going to turn that around as much as I can by sharing my life with them.” It was an homage to that group of individuals so I would like them to see where I was coming from as I was helping them. That was the goal. That was the intent. Secondarily, for my grandchildren and hopefully the great-grandchildren that come whether I’m here or not because including them with that was the history of my entire American heritage and my grandfather coming over or as we would call him Nono, coming over to the United States and to a better place to better a life for his family. Our name was changed from Marta to Martin at Ellis Island. I wanted that story of his sacrifice for his family and subsequently my uncles’ sacrifice and my parents’ sacrifice for the priority they placed on families. That was for my children as well and grandchildren. There were a lot of old pictures that we had that we pulled out and that didn’t occur in the book because there wasn’t enough money to produce a lot of those pictures into the book, but they will be there in a separate place for my kids and grandkids. It was a two-fold reason to do the book. It started just as a narrative. I started typing away. The one funny ironic, and I don’t know if ironic is the right word, story as I was growing up, is that people as my why I become an OB/GYN. I’m sure this was not the reason, but it’s interesting as I reflected that growing up, it was apparently difficult for my mother to have me. I was her only child. She always would say I was spoiled nice, but I was definitely spoiled. When she was mad at me, the one thing she would say, and I didn’t understand it until much later when I was actually probably in medical school, was that I was a dry birth and I was breech, and I just ruined her bottom. When she really got aggravated occasionally, she would say those little words to me as I was probably a teenager. Then on reflection, I became an OB/GYN so I really understood what she was saying then. Meagan: It was interesting that you said the words “dry birth” because my mom, when my water broke with my second, she was telling me that I was going to have this dry birth. She was like, “If you don’t go in, you’re going to have this dry birth.” So many people I have said that to are like, “What? I have never heard of that in my entire life,” and you just said that, so it really was a thing. It really was something that was said. Dr. Darrell Martin: Yes. It was a term back then in the late 40s to late 50s I guess. Meagan: Crazy. So you were inspired. You decided to do the OB route. Tell us a little bit of how that started and then how you changed over the years. Dr. Darrell Martin: Well, when I was in med school, and I went to West Virginia University Medical School, principally, it was fortunate because I would say in retrospect, they were probably lower middle class. I had the opportunity to go to West Virginia. Literally, my tuition per semester was $500. Meagan: Oh my gosh. Dr. Darrell Martin: My parents didn’t have to dig into money they didn’t have. They never had to borrow any money, so I was fortunate. I did have a scholarship to college. They didn’t have to put out the money with the little they had saved. The affordability was there and never an issue. I went to West Virginia, and in my second year, I guess I connected a little bit with some of the docs and some of the chair of the department in West Virginia, Dr. Walter Bonnie, who I didn’t realize at the time had left. He was the chairman of Vanderbilt before he was the chairman of West Virginia so now I understand why he was pointing me to either go to Vanderbilt or to Duke. I think I’m fortunate that I went to Vanderbilt. In spite of everything that happened, it was the path I was supposed to take. I did a little rotation as a 2nd-year medical student with some private OBs. I was just amazed. I was enthralled by the intervention of the episiotomies I observed. I said, “Well, you’re going to learn how to sew.” What really struck me was that I went into this. I still can picture it. It was a large room where there were probably four or six women laboring. They had almost one of the baby beds. They had the thing where you can pull up the sides so someone couldn’t get out of the bed. I couldn’t figure out why someone in labor was like this. There was a lady there. I’ll never forget. She had been given scopolamine which is the amnesiac which was often used where women sometimes don’t even know where they are. They don’t even have memory of where they are. She was underneath the bed on all fours barking like a dog. I asked him, “Why are you not going to let her husband in here?” They were saying things they probably shouldn’t say under the influence of these crazy drugs. It made me start thinking even from that point on, “Why are they doing this? Why are they zapping them so much in the way of drugs?” Then I didn’t see or understand fetal monitoring. We didn’t have it at West Virginia. It came in my residency. It had just come in the first year prior to that, and the new maternal-fetal head at Vanderbilt brought in fetal monitoring. He had done some of the original research with Dr. Han at Yale. What I was doing a medical student during my rotations was sitting at the bedside. That’s what we as medical students were responsible to do. Sit at the bedside. Palpate the abdomen. Sit with the fetoscope, the little one you stick around your head and put down, and count the heartbeats. We would be there six or eight hours. We were responsible for drawing all of the blood, but more importantly, we were there observing labor. Albeit, they weren’t allowed to get up, but it was just the connection and I loved that connection. I loved that sense of connecting with people, and then that evolved into you connecting with them when they come back for their visits. I’ve had quite a few people who I’ve seen for 20, 30, 35 years annually. That became a much more than just doing a pelvic exam, blah, blah, blah. It became a connection. It was a communication of, “What’s going on in your life? What’s happening?” Meagan: A true friendship. Dr. Darrell Martin: Yes. Meagan: It became true friendships with these parents and these mothers. I think that says a lot about you as a provider. Yeah. That makes us feel more connected and safe. Dr. Darrell Martin: Yeah. I desperately miss that. I still miss that as a vocation and that connection. I would look forward to it. I would look on the schedule, “Who’s coming in?” I could remember things about them that we would deal with for 15 years or more. One client of mine who, we would begin by, “How are you doing?” We would still go back to when her son was at a college in Florida and was on a bicycle and got hit and killed. We were relating and discussing that 15 years later. It was a place where she knew that we would go back to that point and talk a little bit about her feelings and it’s much more important to me. If everything’s fine doing a breast exam and doing a pelvic exam, listening to the heart and lungs, that’s all normal and perfunctory. It’s important, but what’s really important is that connection. My goal also was, if I could, to leave the person as they went out the door laughing and to try to say something to cheer them up, to be entertaining, not to make light of their situation if obviously they had a bad problem, but still to say as they would leave with a smile on their face or a little laugh, but the funny one, I still remember this. We had instituted all of these forms. It would drive me crazy if I went to the doctor. We had all of these forms with all of these questions. They were repetitive every year. You just couldn’t say that it was the same. She came in. She was laughing. She said, “These forms are crazy. It’s asking me do I have a gun at home?” I said, thinking about it, in my ignorance, I hadn’t reviewed every single question of these 15 pages that they were going to get. I’m sure it was about depression and to pick up on depression if they have a gun at home. She laughed. She said, “The young lady who was asking me the questions said, ‘Do you have a gun at home?’ I said, ‘No, I have it right here in my purse. Would you like to see it?’” Meagan: Oh my gosh. Dr. Darrell Martin: So it was just joking about how she really got the person flustered who was asking the question. Sometimes we ask questions in those forms that are a little over the top. Meagan: Yeah. What I’m noticing is that you spent time with your patients not even just to get to know them, but you really wanted to get to know them. You didn’t just do the checked boxes and the forms. It was to really get to know them. We talked about finding a good practice last time. What does that look like? What can we do? What are things to do? What is the routine that is normal for every provider’s office or is there a normal routine for every provider’s office? From someone coming in and wanting an experience like what you provide, how can we look for that? How can we seek that? Dr. Darrell Martin: Well, what you’re saying and particularly when it evolves into having a chat, is first trust. you want to trust your provider. If you don’t trust, you’re anxious. We know that anxiety can produce a lot of issues. I would often tell a client who was already pregnant let’s say as opposed to what should be done before they get pregnant. I would say they are getting ready to take a big test, and that test is having a baby. I said, “It’s like a pass/fail. You’re all going to pass. What do you want to have happen? You need to be comfortable and learn as much as you can and have people alongside you that you trust so that it is a great experience.” The second one, I’m sure you’ve seen this is that sometimes you just worry that people get so rigid in what they want, and then they feel like a failure if it doesn’t happen. We want to avoid that because that can lead to a lot of postpartum depression and things that last. They feel like a failure. That should never happen. That should never happen. They should understand that they have a pathway and a plan. If they trust who’s there with them, what ends up happening is okay. It’s not that they’ve been misled which is then where the plan is altered by not a good reason maybe, but it’s been altered and it really throws them for a loop. Meagan: Yeah. Dr. Darrell Martin: I think in preparation, first they’ve got to know what their surroundings are. They start off. Ideally, someone’s thinking about getting pregnant before they get pregnant. I’ve had enough clients who, when we start talking about birth control, and I’ll say, “Are you sexually active?” “Yes.” “Are you using anything for birth control?” “No, I don’t want to use anything for birth control.” I said, “Do you want to get pregnant?” “No.” I said, “Well, that’s not equal. A, you’re not having intercourse and B, you’re not using anything, so eventually, you’re going to get pregnant. You need to start planning for that outcome, but the prep work ahead of time is to know your surrounding. You’ve got to know what you know and you’ve got to know what you want. You really should be seeking some advice of close friends who you trust who have been through and experienced it in a positive way. You’ve got to know what your town where you live is like. Is there one hospital or two hospitals? What are the hospitals like?” Someone told me one time that I should just write a book about what to do before you get pregnant. Meagan: Yeah, well it’s a big deal. Before you get pregnant is what really can set us up for the end too because if we don’t prep and we’re not educating ourselves before, and we don’t know what we’re getting into, we don’t know our options. That can set us up for a less-ideal position. Dr. Darrell Martin: Yeah. I think that’s where the role of a doula can come into play. I hate to say it this way, but if they’re going to go to the provider’s office, they’re not going to get that kind of exchange in that length of time to really settle in to what it is what that plan is going to be like. To be honest, most of the providers are not going to spend the time to do that. Meagan: Mhmm, yeah. The experience that you gave in getting to know people on that level is not as likely these days. OBs are limited to 7-10 minutes per visit? Dr. Darrell Martin: That’s on a good day probably. Meagan: See? Yeah. Dr. Darrell Martin: You’re being really kind right there. You’re being really kind. It’s just amazing. Sometimes you’re a victim of your own success. If you’re spending more time, and you’re involved with that, then you’ve got to make a decision in your practice of how many people you’re going to see. If you’re seeing a certain amount, then the more you see, what’s going to happen to them? You have control of your own situation, but then often you feel the need to have other partners and other associates, and then it gets too business-like. Smaller, to me, is better. The only problem with small with obstetrics is we know that if it’s a solo practice, for example, someone will say, “I’m going to this doctor here because I want to see he or she the whole time.” I say, “You’ve got to think about that. Is that person going to be on-call 365 days a year?” Then what happens later on in the pregnancy when that becomes more of a concern to the client, they’ll ask. They’ll say, “Well, I’m on-call every Thursday and one weekend out of four.” They freak out. They get really anxious. “What’s going to happen? I just know you.” They’ll say, “I’m on-call on Thursday. I do inductions on Thursday.” So it leads into that path of wanting that provider. So then to get that provider, they're going to be induced. And we know that that at least doubles the rate of C-sections, at least, depending on how patient or not patient they are. Meagan: I was going to say they've got this little ARRIVE trial saying, "Oh, it doesn't. It lowers it. But what people don't really know is how much time these ARRIVE trial patients were really given. And so when you say that time is what is not given, but it's needed for a vaginal birth a lot of the times with these inductions. Dr. Darrell Martin: Yes, yes, if the induction is even indicated to begin with because the quality assurance, a lot of hospitals, you have to justify the induction. But it doesn't really happen that way. I mean, if there's a group of physicians that are all doing the same thing, they're not going to call each other out. Meagan: Yeah. Dr. Darrell Martin: It's just going to continue to happen is there're 39 weeks. I love how exactly they know how big the baby's going to be. But even more importantly, how big can this person have? I mean, there are no correlations. There are no real correlations. I can remember before ultrasound, we were taught pelvimetry. the old X-ray and you see what the inner spinous distance is, but you still don't know for sure what size has going to come through there. Meagan: Oh right. Well, and we know that through movement, which what you were seeing in the beginning of your OB days in your schooling, they didn't move. They put them in the bed. They put them in a bed and sat them in the bed. So now we're seeing movement, but there's still a lack of education in position of baby. And so we're getting the CPD diagnosis left and right and being told that we'll never get a baby out of our pelvis or our baby's too large to fit through it, when in a lot of situations it's just movement and changing it up and recognizing a baby in a poor position. An asynclitic baby is not going to have as easy as a time as a baby coming down in an OA, nice, tucked position. Right? Dr. Darrell Martin: Exactly. Exactly. There was the old Friedman Curve and if you went off the Friedman Curve, I was always remarked it's 1.2 centimeters, I think prime at 1.5 per hour. But I can never figure out what 0.2 two was when you do a pelvic exam. What is that really? Is the head applied against the cervix? So it's all relative. It's not that exact. But no, I think that if a person could find a person they trust who knows the environment, I think that's where the value of a really good doula can help because they're emotionally connected to the couple, but they're not as connected as husband and wife are or someone else. Meagan: Or a sister or a friend. Dr. Darrell Martin: Yes. And that may be their first shot at that sister of being in a room like that other maybe her own child. It's nice to have someone with a lot more experience that can stand in the gap when they're emotionally distraught, maybe the husband is. He's sweating it out. He's afraid of what he's going to say sometimes. And then she's hurting and she needs that person who can be just subjective to stand in the gap for her when they're trying to push the buttons in the wrong direction or play on their emotions a little too much. Meagan: Yeah. I love that you pointed that out. We actually talked about that in our course because a lot of people are like, "Oh, no, it's okay. I can just hire my friend or my sister." And although those people are so wonderful, there is something very different about having a doula who is trained and educated and can connect with you, but also disconnect and see other options over here. So we just kind of were going a little bit into induction and things like that. And when we talked a couple weeks ago, we talked about why less is better when it comes to giving medicine or induction to VBAC or not. We talked about it impeding the natural process. Can you elaborate more on that? On both. Why less is more, but then also VBAC and induction. What's ideal for that? What did you use back then? Dr. Darrell Martin: Well, we're going back a long time. Meagan: No, I know, I know. Dr. Darrell Martin: We're going back a long time. See, that would be like what you just did was give me about three questions in one that would be like being on a defensive stand on trial. And then you're trying to figure out where the attorney going, and he sets you up with three questions in one, and then you know you're in trouble when he does that. Meagan: I'm finding that I'm really good at doing that. Asking one question with three questions or five questions? Dr. Darrell Martin: Yes. Meagan: So, okay, let's talk about less is more. Why is less more? Dr. Darrell Martin: Well, first of all, you can observe the natural process of labor. Anytime you intervene with whatever medication-wise or epidural-wise, you're altering the natural course. I mean, that to me it just makes sense. I mean, those things never occurred years ago. So you are intervening in a natural course. And you then have got to factor that in to see how much is that hindering the labor process? Would it have been hindered if you hadn't done that? If you'd allow them to walk, if you allowed them to move? The natural observation of labor makes a lot more sense than the intervention where you've then got to figure out, is the cause of the arrest of labor, so to speak, is it because of the intervention or was it really going to occur? Meagan: Light bulb. Dr. Darrell Martin: Yes. Meagan: That's an interesting concept to think about. Dr. Darrell Martin: Yeah. And you want to be careful because it's another little joke. I say you just don't want to give the client/patient a silver bullet. Often I've had husbands say, "Well, they don't need any medicines." You have to be careful what you're saying because you're not the one in labor. But I wouldn't say that quite to them. But they got the picture really quickly when their wife, their spouse, lashed back out at them. Meagan: Yeah. Dr. Darrell Martin: So you can come over here and sit and see how you like it. I can still remember doing a Lamaze class with Sandy, and we also did Bradley class because I wanted to experience it all. She was the first person to deliver at Vanderbilt without any medication using those techniques. And when we would do that little bit of teaching, I can remember doing that when they would try to show a guy by pinching him for like 30 seconds and increasing the intensities to do their breathing, maybe they should have had something else pinched to make them realize-- Meagan: How intense. Dr. Darrell Martin: Yeah. How intense it is Meagan: Yeah. Dr. Darrell Martin: We can't totally experience it. So we have to be empathetic and balance that. And that's where, to me, having that other person can be helpful because I'm sure that that person who is the doula would be meeting and with them multiple times in the antepartum course as opposed to they go into labor and if there's a physician delivery, chances are their support person is going to be a nurse they've never met before or maybe multiple ones who come in and out and in and out and in and out, and they're not there like someone else would be. To me that's suboptimal, but that's the way it works. And I observed the first birth. I didn't tell the people at the hospital for my daughter-in-law that I was an obstetrician. Meagan: And yeah you guys, a little backstory. He was a doula at his daughter-in-law's birth. Dr. Darrell Martin: Yes. But her first birth did not turn out that well at an unnamed hospital. She didn't want to come to my practice because they weren't married that long and that's getting into their business a little bit. Plus, she lived on the north side of town and I was on the south side. So she chose, a midwifery group, but the midwife was not in there very much. I mean, she was responsible. They were doing probably 15 to 20 births per midwife. Meagan: Wow. Dr. Darrell Martin: They were becoming like a resident, really. They were not doing anything a whole lot differently. And then she had a fourth degree, and she then, in my opinion, got chased out of the hospital the next day and ended up turning around a day later and coming back with preeclampsia. I heard she had some family history of hypertension. I had to be careful because I'm the father-in-law. I'm saying, "Well, maybe you shouldn't go home." And then she ends up going back. And she didn't have HELLP syndrome, but she was pretty sick there for a day or two. That was unfortunate because she went home, and then she had to go right back and there's the baby at home because the baby can't go back into the hospital. And so her second birth, because it was such a traumatic experience with the fourth degree, she elected to use our group and wanted one of my partners to electively section her. She did the trauma of that fourth degree. That was so great. So she did. But obviously, she had a proven pelvis because she had a first vaginal delivery. And then she came to me and she said, "I want to do a VBAC." And so I said, "Oh, that's great." And so one of my partners was there with her, but my son got a little bit antsy and a little bit sick, so he kind of left the room. I was the support person through the delivery. That was my opportunity to be a doula. And of course, she delivered without any medication and without an episiotomy and did fine. Meagan: Awesome. Dr. Darrell Martin: And a bigger baby than the one that was first time. Meagan: Hey, see? That's awesome. I love that. Dr. Darrell Martin: Yes. Meagan: So it happens. So we talked a little bit about midwives, and we talked about right here "A Doctor's Story of Breaking Barriers for Midwifery". Talk to us about breaking barriers for midwifery. And what are your thoughts one on midwives, but two, midwives being restricted to support VBAC? Dr. Darrell Martin: Okay, that's two questions again. Meagan: Yep. Count on me to do that to you. Dr. Darrell Martin: I'll flip to the second one there. I think it's illogical to not allow a midwife to be involved with a VBAC. That makes no sense to me at all because if anybody needs more observation in the birth process, it would potentially or theoretically actually be someone who's had a prior C-section. Right? There's a little bit more risk for a rupture that needs more observation, doesn't need someone in and out, in and out of the room. The physician is going to be required to be in-house or at least when we were doing them, they were required to be in house and there was the ability to do a section pretty quickly. But observation can really mitigate that rush, rush, rush, rush, rush. I've had midwives do breeches with me and I've had them do vaginal twins. If I'm there, they can do it just as well as I can. I'm observing everything that's happening and they should know how to do shoulder dystocia. One thing that you cannot be totally predictive of and doctors don't have to be in the hospital for the most part in hospitals. Hopefully, there probably are some where they're required, but it makes no sense and they're able to do those. So if I'm there observing because the hospital is going to require that, and I think that's not a bad thing. I never would be opposed or would never advocate that I shouldn't be there for a VBAC. But I think to have the support person and that be the midwife is going to continue and do the delivery, I think that's great. There's no logic of what they're going to do unless that doctor is just going to decide that they're going to play a midwife role and that they're going to be there in that room. They're advocating that role to a nurse or multiple nurses who the person doesn't know, never met them before, and so that trust is not there. They're already stressed. The family's stressed. There are probably some in-laws or relatives out there and they say, "Well, you're crazy. Why are you doing this for? Why don't you just have a section?" Everybody has an opinion, right? So there's a lot of family. I would observe that they're sitting out there and we've got into that even back then that's a society that some of them don't want to be there, but they feel obliged to be out there waiting for a birth to occur. Right. When four hours goes by, "Oh, oh, there must be a problem. Why aren't they doing something?" You hear that all the time. I try to say, "Well, first labor can be 16 to 20 hours." "16 to 20 hours?" and then they think, "I'm going to be here for that long." Meagan: Yeah. Dr. Darrell Martin: So there's always that push at times from family about things aren't moving quickly. Meagan: Right. Dr. Darrell Martin: They're moving naturally, but their frame of reference is not appropriate for what's occurring. They don't really understand. And so that's the answer. Yes. I think that it makes no sense that midwives are not involved. That does not make any sense at all. So the first part of the question was what happened with me and midwives? Meagan: Well, breaking barriers for midwifery. There are so many people out there who are still restricted to not be able to support VBAC. I mean, we have hospital midwives here in Utah that can't even support VBAC. The OBs are just completely restricting them. What do you mean when you say breaking barriers for midwifery and birth rights? Dr. Darrell Martin: Okay, what I meant was this is now in late 1970, 79, 80. And I'd observe midwifery care because as residents, we were taking care of individuals at three different hospitals, one of which was Nashville General, which was a hospital where predominantly that was indigent care, women with no insurance. And we had a program there with midwives. Dr. Darrell Martin: And so we were their backup. I was their backup for my senior residency, chief residency, and subsequently, as an attending because I was an attending teaching medical students and residents and really not teaching midwives, just observing them if they needed anything, within the house most of the time, principally for the medical students and the junior residents. But I saw their outcomes, how great they were. I saw the connection that occurred. We didn't have a residency program where you saw the same people every time then. It was just purely a rotation. You would catch people and it just became seeing 50 or 75 people and just try to get them in and out. But then you observe over here and watch what happens with the midwifery group and the lack of intervention and the great outcomes because they had to keep statistics to prove what they were doing. Right? Meagan: Yeah, yeah. I'm sure. Dr. Darrell Martin: They were required to do that, and you would see that the outcomes were so much better. Then it evolved because a lot of those women over the course of the years prior to me being there and has evolved while I was there, I was befriended by one midwife. She was a nurse in labor and delivery who then went on to midwifery school. We became really close friends. Her family and my family became very close. They had people, first of all, physicians' wives who wanted to use them and friends in the neighborhood who wanted to use them, but they had insurance and people that had delivered there who then were able to get a job and had insurance and wanted to use them again, but they couldn't at the indigent hospital. You had to not have insurance. So there was no vehicle for them in Nashville to do birth. We advocated for a new program at Vanderbilt where they could do that and at the same time do something that's finally occurring now and that's how midwives teach medical students and teach residents normal birth because that's the way you develop the connection that moves on into private practice is they see their validity at that level and that becomes a really essentially part of what they want to do when they leave. They don't see them as competition as much. Still, sometimes it's competition. So anyhow, at that point, our third hospital was relatively new. The Baptist private hospital run by the private doctors where the deliveries at that point were the typical ones with amnesiac, no father in the room, an episiotomy, and forceps. So when we tried to do the program, the chairman-- and we subsequently found some of this information out. It wasn't totally aware at the time. They were given a choice by the private hospital. Either you continue to have residents at the private hospital or you have the midwifery private program at Vanderbilt. But you can't have both. If you're going to do that, you can't have residence over here. So they were using the political pressure to stop it from happening. Then I said, they approached myself and the two doctors, partners, I was working with in Hendersonville which is a little suburb north of town. We had just had a new hospital start there and we were the only group so that gave us a lot of liberties. I mean, we started a program for children of birth with birthing rooms, no routine episiotomies, all walking in labor, and all the things you couldn't do downtown. Well, the problem was we wanted midwives in into practice but we didn't have the money to pay them. We were brand new. So we had a discussion and they said, "Well, we want to start our own business." And I said, "Oh." And I kind of joked, I said, "Well that's fine, I can be your employee then." And that was fine for us. I mean, we had no problem being their consultant because someone asked, "Well, how can you let that happen?" I said, "We still have control of the medical issues. We can still have a discussion and they can't run crazy. They're not going to do things that we don't agree with just because they're paying for the receptionists and they're taking ownership of their practice." So they opened their doors on Music Row in Nashville. Meagan: Awesome. Dr. Darrell Martin: But as soon as that started happening and they announced it, at that time, the only insurance carrier for malpractice in the state of Georgia was State Volunteer Mutual which was physician-owned because of the crisis so they couldn't get any insurance the other way a physician couldn't unless it was through the physician-owned carrier. Well, one of the persons who was just appointed to the board was a, well I would call an establishment old-guard, obstetrician/gynecologist from Nashville. And he said in front of multiple people that he was going to set midwifery back 100 years, and he was going to get my malpractice insurance. He was going to take my malpractice insurance away. Meagan: Wow. Dr. Darrell Martin: For practicing with midwife. And that was in the spring of the year. Well, by October of that year, he did take my malpractice insurance. They did. Meagan: Wow. For working with midwives? Dr. Darrell Martin: For risks of undue proportion. Yes. The Congressman for one of the midwives was Al Gore, and in December of that year we had a congressional hearing in D.C. where we testified. The Federal Trade Commission got involved. The Federal Trade Commission had them required the malpractice carrier to open their books for five years. And what that did was it stopped attacks across the United States. There were multiple attacks going on all across the country trying to block midwives from practicing independently or otherwise. And so from 1980-83, when subsequently a litigation was settled, the malpractice carrier, including the physicians who were involved, all admitted guilt before it went to the Supreme Court. I went through a few years there and that's where you see some of those stories where I was blackballed and had to figure out a place where I was going to work. I almost went back to school. This is a little funny story. I was pointed in the direction of Dr. Miller who was the head of Maternal Child Health at Chapel Hill University of North Carolina. I didn't realize that then two months later, he testified before Congress as well because he wanted me to come there. I interviewed and then I would get my PhD and do the studies that would disprove all the routine things that physicians were doing to couples. I would run those studies. It was a safe space. It was a safe place, a beautiful place in Chapel Hill. So he told me, he said, "You need to meet with my manager assistant and she'll talk to you about your stipend, etc." Now I had three children under four years of age. Meagan: Wow, you were busy. Dr. Darrell Martin: Well, the first one was adopted through one of the friends I was in school with, so we had two children seven months apart because Sandy was pregnant and had like four or five miscarriages before. Meagan: Wow. Dr. Darrell Martin: So I had three under four. So she proceeded to say, "Well Dr. Martin, this is great. Here's your stipend and I have some good news for you." I said, "Well, what's that?" He said, "Well, you're going to get qualified for food stamps." That's good news? Okay. So I'm trying to support my three children and my wife. I said, "I can't do that. As much as I would love to go to this safe place," and Chapel Hill would have been a safe place because it would have been an academia, but then I had to find a place to work. So it was just how through my faith, it got to the point where know ending up in Atlanta, I was able to not only do everything I wanted to do, but one of the midwives that I worked with, Vicki Henderson Bursman won the award from the midwifery college. And the year after, I received the Lewis Hellman Award for supporting midwives from ACOG and AC&M. But we prayed. We said, "One day we're going to work together." And this was 1980. In 93, when we settled the lawsuit, we reconnected. I was chairman of a private school, and we hired her husband to come to Atlanta to work at the school. Two weeks, three weeks later, I get a call from the administrator of the hospital in Emory who was running the indigent project at the hospital we were working at teaching residents. They said that they wanted to double the money. Their contract was up and they wanted double what they had been given. So the hospital refused and they asked me to do the program. We didn't have any other place to go. And then what was happening? Well, Rick was coming to Atlanta, but so was Vicki. So Vicki, who I hadn't worked with for 13 years, never was able to work, came and for the next 20 years, worked in Atlanta with me. And we did. She ran basically the women's community care project, and then also worked in the private practice. And then the last person, Susie Soshmore, who was the other midwife, really couldn't leave Nashville. She was much, much more, and rightly so, she was bitter about what happened and never practiced midwifery. Her husband was retiring. She decided since they were going to Florida to Panama City, that she wanted to get back and actually start doing midwifery, but she needed to be re-credentialed. So she came and spent six months with us in Atlanta as we re-credentialed her and she worked with us. So ultimately we all three did get to work together. Meagan: That's awesome. Wow. What a journey. What a journey you have been on. Dr. Darrell Martin: Yeah, it was quite a journey. Meagan: Yeah. It's so crazy to me to hear that someone would actively try to make sure that midwifery care wasn't a thing. It's just so crazy to me, and I think it's probably still happening. It's probably still happening here in 2024. I don't know why midwives get such a bad rap, but like you said, you saw with the studies, their outcomes were typically better. Dr. Darrell Martin: Yeah. Meagan: Why are we ignoring that? Dr. Darrell Martin: Doctors were pretty cocky back then. They may be more subtle about what they do now because to overtly say they're going to get your malpractice insurance, that's restricted trade. Meagan: Yeah. That's intense. Dr. Darrell Martin: Intense. Well, it's illegal to start with. Meagan: Yeah, yeah, yeah, right? Dr. Darrell Martin: If you attack the doctor, you get the midwife. They tried to attack the policies and procedures. That was the other thing they were threatening to do was, "Well, if you still come here, we're going to close the birthing room. We're going to require women to stay flat in bed. We require episiotomies. We require preps and enemas." Well, they wouldn't require episiotomies, but certainly preps and enemas and continuous monitoring just to make it uncomfortable and another way to have midwives not want to work there. Meagan: Yes. I just want to Do a big eye-roll with all of that. Oh my goodness. Well, thank you so much for taking the time and sharing your history and these stories and giving some tips on trusting our providers and hiring a doula. I mean, we love OBs too, but definitely check out midwives and midwives, if you're out there and you're listening and you want to learn how to get involved in your community, get involved with supportive OBs like Dr. Martin and you never know, there could be another change. You could open a whole other practice, but still advocate for yourself. I'm trying to think. Are there any final tips that you have for our listeners for them on their journey to VBAC? Dr. Darrell Martin: Well, pre-pregnancy that next time around, we know very quickly that the weight of the baby is controlled by heredity which you really essentially have no control over that including who your husband is. If he's 6'5", 245, their odds are going to be that the baby might be a little bigger. However, you do have control what your pre-pregnancy weight is, and if you get your BMI into a lower range, we know statistically that the baby's probably going to be a little bit smaller, and that gives you a better shot. You don't have control of when you deliver, but you do have control of your weight gain during the pregnancy and you do have control of what your pre-pregnancy weight, which are also factors in the size of the baby. So control what you can control, and trust the rest that it's going to work out the way it should. Meagan: Yeah, I think just being healthy, being active, getting educated like you said, pre-pregnancy. It is empowering to be educated and prepared both physically, emotionally, and logistically like where you're going, and who you're seeing. All of that before you become pregnant. It really is such a huge benefit. So thank you again for being here with us today. Can you tell us where we can find your book? Dr. Darrell Martin: Yeah, it's available on Amazon. It’s available at Books A Million. It's available at Barnes and Noble. So all three of the major sources. Meagan: Some of the major sources. Yeah. We'll make sure to link those in the show notes. If you guys want to hear more about Dr. Martin's journey and everything that he's got going on in that book, we will have those links right there so you can click and purchase. Thank you so much for your time today. Dr. Darrell Martin: Thank you. I enjoyed it and it went very quickly. It was enjoyable talking to you. Meagan: It did, didn't it? Just chatting. It's so fun to hear that history of what birth used to be like, and actually how there are still some similarities even here in 2024. We have a lot to improve on. Dr. Darrell Martin: Absolutely, yes. Meagan: But it's so good to hear and thank you so much for being there for your clients and your customers and patients, whatever anyone wants to call them, along the way, because it sounds like you were really such a great advocate for them. Dr. Darrell Martin: Well, we tried. We tried. It was important that they received the proper care, and that we served them appropriately, and to then they fulfill whatever dream they had for that birth experience or be something they would really enjoy. Meagan: Yes. Well, thank you again so much. Dr. Darrell Martin: Okay, thank you. I enjoyed talking to you. Good luck, and have fun. Meagan: Thank you. Dr. Darrell Martin: Bye-bye. Meagan: Thank you. You too. Bye. Closing Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com . 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