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Imagine being told you had a “hostile uterus” and sent home, only to discover later you were on the brink of a life-threatening pregnancy complication.
This isn’t fiction. Terms like “hostile uterus” and “irritable uterus” are still in use, and they’re dangerous. In conventional medicine, medical language like this often subtly blames women’s bodies for medical events, creating a culture where women who advocate for themselves are frequently dismissed—or even labeled “difficult.” Disturbingly, some women, particularly Black mothers, have faced extreme consequences like social services or even police intervention for simply speaking up during labor.
The stakes are high. Medical and obstetric trauma are a reality for far too many, and symptoms of PTSD are often brushed off as “just part of the experience” instead of being acknowledged as trauma caused by medical mistreatment. This climate of dismissal causes many women to skip important screenings and healthcare visits, increasing their health risks.
In this episode, I sit down with Leah Hazard, a midwife, activist, and author who, like me, has seen firsthand the impact of misleading medical language and inconsistent protocols on women’s health. We discuss the urgent need for self-advocacy in healthcare, why it often feels like an uphill battle, and the unsettling inconsistencies in obstetrics. Leah explains how synthetic oxytocin (Pitocin)—a drug widely used to induce or speed up labor—is administered with inconsistent protocols across hospitals, affecting labor experiences, breastfeeding success, and postpartum mental health.
In this Episode:
- The Hidden Power of Words: We explore how terms like “hostile uterus” subtly place blame on women’s bodies, fueling a culture that sees women as “difficult” when they advocate for themselves.
- The Impact of Medical Dismissal: Leah shares real-life stories of women whose symptoms were dismissed, leading to delayed or inadequate care—even in life-threatening situations.
- Birth Trauma and Mental Health: Medical trauma affects a shocking number of women, with many experiencing PTSD symptoms that are often minimized or overlooked, leaving lasting emotional scars.
- Inconsistent Pitocin Protocols: Leah uncovers how the administration of synthetic oxytocin (Pitocin) varies greatly across hospitals, impacting everything from labor experience to breastfeeding outcomes and postpartum mental health.
- The Essential Need for Self-Advocacy: We discuss why knowing your body—and the medical language around it—is crucial in navigating a system that too often undermines women’s voices.
- A Call to Change the Narrative: This episode isn’t just for those with a womb; it’s a call to examine how society, medicine, and language intersect in women’s health, challenging us to create a more compassionate healthcare experience.
I hope you enjoyed this episode, that it helped you to feel seen and heard, and perhaps that it even brought you some aha moments. Please share the love by sharing this with a friend or someone in your life who could benefit. And be sure to leave a rating and a review wherever you listen to podcasts, and follow the podcast to be notified of new episodes every week.
Can't wait to see you next time.
Resources & Links
- Have You Been Medically Hexed? Break the Spell and Take Back Your Power by Aviva Romm Md
- Leah's Book: Womb: The Inside Story of Where We All Began
- Follow Leah on Instagram @leahhazard
- Connect with Dr. Aviva Romm: @dr.avivaromm
The Interview Transcript: Do You Have a Hostile Uterus? Aviva Romm + Leah Hazard
This conversation has been edited for length and clarity.
Aviva: After reading her book, it's clear to me that my guest today, Leah Hazard, and I are cut from the same cloth – writers and midwives on a mission to help women have a deeper understanding of the beauty and power of our bodies, our uniqueness, greater ownership of our perinatal and gynecologic experiences, while illuminating the significant non-evidence-based practices that still persist in Western obstetric and gynecologic models that often lead to unnecessary interventions and, at times, even harm for women, mothers, and babies. A Harvard University graduate with a degree in English and American literature and a master's degree in directing from the Royal Scottish Academy of Music and Drama, Leah originally planned to work in theater, film, and television. The birth of Leah's first daughter in 2003 prompted a change of direction. She retrained and worked as a doula, providing practical and emotional perinatal support to families across Scotland for six years before making the biggest leap of all – embarking on a career in midwifery.
Leah's memoir, Hard Pushed: A Midwife’s Story, was a Sunday Times bestseller in the UK. She hosts the popular podcast, What The Midwife Said, and is a frequent commentator on women's health across the media. Today, I’m really excited that we’ll be exploring the body’s most miraculous and controversial organ, the topic of her latest beautiful book, Womb: The Inside Story of Where We All Began. Our conversation will cover the gamut from periods to fertility, to pregnancy, and into menopause. If you have or had a womb and want to know more about your body and the body politics of this powerful organ and its role in our lifelong health, we welcome you to join us in this wonderful conversation that I know we’re about to have. Leah, welcome and thank you so much for joining me.
Leah: Thank you. It’s a pleasure, and thanks for that great introduction.
Aviva: So, we get into the fascinating story of the womb in your new book. Tell me about how you made the pivot from working in journalism to becoming a midwife. Not everybody who has a baby makes a giant career leap like that, and you had a lot of training behind you before you took that leap into a whole lot of new training.
Leah: Yeah, it’s true. Not everybody who has a baby decides to become a midwife, but it has to be said that a lot of midwives actually come to the field later in life because they’ve had babies, and because their priorities have changed, or they’re now fascinated, intrigued, or challenged by birth work. So you’re absolutely right. I was working in journalism, actually working behind the scenes for BBC Scotland in 2003 when my first daughter was born, and I thought I’d been very well prepared. I went to all the classes, read all the books during pregnancy, and then the birth experience was just nothing like what I had expected. It was very difficult, as many births are, but took really unexpected turns. The care I received was not what I anticipated. I had been confident in my body, but for some reason, that confidence didn’t come to fruition.
After she was born, fortunately healthy, I still had problems with feeding and was really perplexed and disappointed by why I’d had this experience. The more I spoke to other women, my friends who were having babies around the same time, I realized that almost all of us had been disappointed, surprised, shocked, let down in some way by the experience or by the system we’d been through. I’d always been interested in women’s health, even though my career at that time wasn’t in that field. The birth experience triggered that interest in a new way. I had a bee in my bonnet. I became pretty obsessed with why this experience had been – “traumatizing” is a strong word – but just not what I had expected and so difficult for me and my friends. I started to wonder whether there was any way of making the experience better for other women.
At that time, I had a baby, and I wasn’t ready to go back to school. I had just been through a lot of education. But then I found out about the role of the doula, and I thought, this is a role I can incorporate into my family life and that I can do in an independent way, but it also brings me into the birth space. So I did that for six years, had another child, and ultimately decided the time was right. I wanted to be the one to make that leap, to be the person to provide all of the care – not just the emotional support, but to be that autonomous clinical practitioner as well. So I retrained as a midwife, which in the UK is a three- to four-year degree, depending on where you go, and qualified in 2013.
Aviva: That’s amazing. You talk about something that is so near and dear to my heart. In fact, while I am not a trained journalist, I just finished a six-month journalism program through Harvard Media and Medicine, and the entire focus of my six-month project culminated in an article on birth trauma, specifically why women are experiencing such deep, profound disappointment in their birth experiences, finding out it’s not what they had anticipated, that all their best-loved plans are usurped or disrupted, particularly in the hospital environment. And while you say for yourself that “trauma” may be a strong word, I want to just say two things about that. Obviously, I can’t know the extent and depth of your experience, but a significant portion of women now in the UK and the US are actually able to be diagnosed as having PTSD, actual diagnosable trauma, as a result of their birth. Many women almost self-gaslight and say, “Okay, I have a healthy baby and I’m healthy, so maybe it wasn’t trauma.” Can we go in that direction a little bit? It’s such a pressing issue here, in the UK, and in so many places that women are struggling with now. What can we do to help women through this conversation?
Leah: Yeah, it’s a fascinating and really timely question. It’s a big interest of mine, and I actually just this year completed training in birth trauma resolution therapy, which is an intervention that midwives and other professionals can use to help people move past perinatal trauma. And you’re absolutely right; women and people who birth do tend to second guess themselves and say, “My baby is healthy,” or, “I was told to get over myself because my baby’s healthy, and other women have it worse,” or, “At least I’m not in a war zone, or at least I’m not a refugee,” or there’s always going to be somebody worse off, and we minimize our own pain. But absolutely, birth trauma is occurring on a mass industrialized scale at the moment, and a lot of that is due to the mass industrialized nature of the maternity system, which has its differences between the US and the UK but also some major similarities. And because the system has become such a kind of monolithic, industrialized machine, it’s not always able to give the individualized, person-centered care that everybody deserves. We’re very medicalized, very interventionist, with very defensive practices in America, and to a certain extent in the UK as well. Litigation is a big issue in obstetrics and midwifery. So people aren’t always having that individual, holistic experience that they deserve, and this clearly has massive psychological consequences for a lifetime, especially if it’s not properly addressed and given the time and space it needs.
Aviva: Yeah, I’m creating an online program, which is an extension of something I created during COVID, called the Mama Pathway, and we have a big segment on birth trauma prevention, but also birth trauma resolution. I think even just acknowledging it as we are here, someone might be listening and going, “Oh, I have actually been telling myself that what I experienced wasn’t as bad as it was, or it didn’t happen.” So thank you for bringing up your own story. I’m curious about something regarding your practice. When I was a midwife and then went to medical school, you pick a residency field you want to specialize in. At that time, I thought, “Okay, I’m going to go into OB-GYN, and I’m going to just change the world basically.” And I remember a gentleman named Marsden Wagner and I had a conversation – he was head of neonatal for WHO and a huge advocate for midwifery – and he said to me, “I will be in the sidecar of your motorcycle as you go through.” He was in his eighties at the time. He continued, “But I just want you to be prepared for the potential of it being a dark night of the soul.”
As I was going through my obstetrics rotations, I realized that. And also, as I was interviewing at programs where I was being told things like, “Oh, at our program, don’t worry. We don’t have midwives, so you’ll get to do all the births,” or “Our c-section rate is 38%, so you’re going to get plenty of surgeries,” and then with the litigation risk and all the things they don’t do. I thought, “I am going to spend my life either becoming something I never would want to be as a practitioner or being very alone and very unhappy.” So, I actually switched to family medicine with obstetrics because it’s a much more holistic approach, even though it’s still steeped in the medical model. But I also know so many midwives, at least here in the US, who go into midwifery wanting to be there in certain ways and offer certain kinds of opportunities for birth – particularly in a hospital, as it’s a little easier to get the birth you want in a birthing center or home birth – and the midwives themselves find themselves up against tremendous limitations and obstacles in the system. Many of the midwives themselves have come to feel traumatized, frustrated, depressed. I’m wondering, since the UK has a much more progressive birth system than ours, how has that been for you? Have you been able to be who you want and do what you want as a midwife? Or have you come across some of these limits, or both?
Leah: Yeah. Funnily enough, I wrote another book about that too; that was my previous book, Hard Pushed: A Midwife's Story, which came out in 2019. It’s not published by an American publisher, but I believe you can order it from the States, and you can even get it on e-book and audiobook.
Aviva: I’ll be doing that today.
Leah: Sorry, not to plug the book, but yeah, that’s really what that book was about. I wrote it after I had been working as a midwife for about five or six years. At first, when you qualify in any new career, you’re just trying to survive, right? You set the bar pretty low for yourself – you want to survive and you want to not hurt anybody else. And then after a few years, you really start to look around and get more of a sense of systemic pressures, and you get given a bit more responsibility; people expect a bit more of you, and that has its own pressures as well. What I experienced, and I think what many midwives experience around the world now, is this real sense of moral injury – wanting to provide a certain standard of care.
I was trained in an excellent system to provide a really world-class, gold standard of care. You go into the service wanting to provide that, but then unfortunately things like lack of resources, lack of staffing, institutionalized guidelines, protocols, and so on, prevent you from giving that kind of care. So day after day, you’re turning up to work, wanting to give women and people the absolute best experience, wanting to give individualized care, wanting to facilitate their choices and what’s right for them, and not being able to do that either because of institutional expectations or just practical limitations. I wrote a lot in the book, and I’ve written a lot since about how that felt and how that feels, and it’s still something that I have to reckon with every time I turn up to work, to be honest. I really don’t take my future in midwifery for granted. I take it one shift at a time because things are so challenging, and it’s hard. Yeah, it’s really hard. And I think especially through the pandemic, healthcare providers of all stripes have had to really reckon with this issue of wanting to do the best but really being wrung dry by circumstances around you. So, it is really hard.
Aviva: Yeah, it was really hard doing obstetrics as a midwife in the hospital as well, always doing my best, and then always coming up against risk management and what they wanted me to do, even if the evidence wasn’t there. And that’s something I want to dive deeper into as we get into the podcast and your new book. One of the things that you emphasize in this book is how little so many people know about their own bodies. We know that surveys show that many young women and young men can’t accurately identify the parts of the female reproductive system. I am regularly explaining the difference, for example, between the vulva and the vagina. I wonder, from your perspective as a practitioner, as a fellow woman, why you think it’s important that women have a better understanding of our uterus and our bodies in general?
Leah: It’s definitely important on a number of levels. I think for all of us, it’s important to understand the reproductive system because every single one of us has an opinion about what should or should not happen within that system. Especially, there are very strong opinions about what should or should not happen within the uterus, right? You ask almost anybody, any country around the world, male, female, or in between, “What do you think about abortion? What do you think about pregnancy? How do you think contraception should be handled? What about sex, fertility?” and so on, and everyone will have some kind of opinion. But if you drill a little bit deeper and say, “Yeah, but do you actually know even what the uterus is or looks like, or how it functions, or how conception happens, or what pregnancy gestation looks like and what can go wrong?” very quickly you come up against some kind of brick wall because people just don’t actually know the simple physiology of reproductive function.
I have this old-fashioned idea: if you’re going to have an opinion about something, you should know how it works. The reason that’s important is because we live our lives based on these opinions and values, not just in our individual lives and how we have relationships and plan or don’t plan families, but also we see it in legislation. We have people making laws about people’s bodies who clearly don’t understand the basic biology and physiology of the processes they’re legislating around, and that is extremely dangerous. On an individual level – for me as a woman, for other women, people with wombs – again, it’s an issue of empowerment, but it’s also an issue of safety because if you don’t understand what’s normal and what’s not normal for your own body, and you also don’t have the language you need to describe those events or phenomena or symptoms, then there’s no way, or at least it’s going to be a lot harder, for you to seek the help that you need to manage and treat the functions of your body.
If you, for example, had a cough and it felt like it was in your chest, you would have the language to say, “I’m coughing. I’m bringing up this kind of green stuff, and my lungs hurt.” You would have simple, basic terminology. And yet, if you’re having, let’s say, unusual discharge, a lot of people don’t even want to say the word “discharge.” So they might say, “There’s this stuff coming out. I don’t really know what color it is. I haven’t looked.” And then, is it coming from your vagina? Is it on your vulva? We have the words and the knowledge about virtually every other system in our body, but for some reason, when it comes to the reproductive system, we’re not as empowered as we could be. So it’s definitely a safety issue on an individual and really on a social level.
Aviva: I couldn’t agree more. I’ve seen so many times where a woman will come into the emergency department to OB-GYN or to my practice and say, “I’m having pains in my stomach,” when what they’re talking about is menstrual cramps or possibly endometrial pain. So I agree; having that language is really empowering. I think also, when we are interfacing with the medical model, there’s so much implicit bias that comes from physicians, particularly toward women. The more articulate we are, the more, in a way, we’re able to read the room and play the game, having our concerns heard and responded to. And that’s an unfortunate fact that we have to manage the emotional and intellectual setting, but it is actually a reality in many settings that I’ve experienced.
Leah: Yeah, it’s a shame that we as women have to assume that burden or that the onus is on us to a certain extent to communicate clearly. Because a good practitioner, even if a patient comes in and says, “I have pain down there,” or “There’s something coming out down below,” a good practitioner will be able to really dig into that history and figure out exactly what’s happening. So the patient shouldn’t always have to be the one who can be super articulate. But as you said, unfortunately, that does empower you in that dialogue, and we can use all the power we can get.
Aviva: Absolutely. It also empowers us to find accurate information and know how to look for that accurate information. If we’re double-checking a diagnosis, if we think we have something going on and our doctor’s just not recognizing that, it gives us a little bit more language to search things more accurately by.
You state in your book also that understanding your body is a lifelong process. It’s important to understand that other people’s journeys may be different from our own. And one of the things – there are so many things that come to mind for me about that, of how we compare ourselves and think there’s something wrong with us starting so early on – the age we get our first period, our breast development, whether we’re not developing breasts yet, whether our breasts are bigger and we’re getting more attention in unwanted ways for that, the amount of flow, how long it takes us to get pregnant, the list goes on. I’m wondering, what are some of the differences, if you could wave a magic wand and have women understand and be more proud of, that you see coming up – where women just aren’t recognizing that each of us is unique and that’s important for whatever they’re going through?
Leah: Obviously, my sort of milieu is pregnancy and birth. And I think, especially nowadays, because of social media and just the way the world works, women are constantly comparing themselves to each other when they’re pregnant, when they’re giving birth, and when they’re postnatal as well. So women will compare, “Is my bump the same size as somebody else’s? Is it the right shape? Do my breasts look weird? Do my labia look strange now that I’m pregnant? Am I still sexual? Am I still attractive? Does it feel the same for my partner? Is my baby moving the same way?” And then, “Am I going into labor properly?” – I’m saying that in quotes; obviously, there’s no “proper” way – “Am I making too much noise in labor? Am I doing it right? Am I taking the right drugs? Am I not taking the right drugs? Am I birthing my child in the correct or the wrong way?” – again, obviously, there’s no right or wrong way. Then postnatally, it’s a whole other train wreck of us comparing ourselves to each other: how quickly we can get back into shape, slim down, look normal again. Unfortunately, what should or could be one of the most transformative moments in a woman’s life is fraught with comparison and insecurity. I think that just goes through the whole reproductive lifecycle, really.
Aviva: Do you think some of that is just the natural way women compare, or do you think – because for me, I think that when we were experiencing more communal living, more villages, more lifestyles where we’re exposed to pregnancy, birth, death, parenting, child-raising, all the things, we had a broader sense of the normalization of a wide range of experiences. But I think we’re so siloed that we might not see that. What do you think drives this insecurity, comparison, and anxiety? Or are there certainly more than one factor?
Leah: Yeah, I think it’s a lot. I think social media is part of it because at any given time of the day, if you want, you can look at this little black square in your hand and compare yourself visually to countless other women around the world. Also, the way people talk about pregnancy, birth, and bodies in general nowadays is extremely polarized at times. These things are always going to be contentious, but I think especially now, there’s a lot of really polarized discussion around sex, gender, pregnancy, birth, all of these issues. It’s very easy to get caught up in that tailspin. And also, yeah, as you said, maybe if we lived in a more communal society, we would be living among other women’s bodies all the time, and it wouldn’t seem like such a big deal.
In the gym that I go to, just the particular sort of culture of that gym, the women walk around naked in the locker room, and in the sauna and steam room they’re all just sitting there, and it’s all out. And these are women of all ages, shapes, and sizes. At first, you might go, “Oh, this is a bit weird.” But after you go back a few times, it just feels absolutely normal, and you’re hardly noticing that you’re having a conversation with somebody who’s got her boobs out, and it is just normal. But because we – I’m not suggesting we should all live that way all the time – but the point I’m making is that because we’re, in general, so on the other end of the spectrum, we don’t see a range of different body shapes, sizes, functions, and feelings. When we do go through a really physical, visceral experience like childbirth, it becomes really a flashpoint because all of a sudden, we’re comparing, all of a sudden we’re bombarded by images, and we have no time to build up to that. So as you said, there are numerous factors, and I think we’re just not used to perceiving female bodies and birthing bodies in a way that is not exclusively sexual. We’re just not used to perceiving each other with a normal, healthy curiosity. It always seems really loaded, doesn’t it, really fraught with meaning?
Aviva: It does. I love that experience when I’m in a sauna or a spa, and we’re all just letting it hang out, because it also for me even contextualizes – even though I see other women’s bodies all the time in my work – having my own body naked and just sitting there and thinking, “This is not what happens in a hospital or a birth.”
Leah: Yes, exactly.
Aviva: I was actually invited to a clothing-optional birth once and opted to keep my clothes on, thinking that as a midwife, it’s probably a much better idea. But I do love that kind of normalization of just being nude myself amongst a variety of shapes, ages, and sizes. I think also, when it comes to ageism, it’s a really beautiful way to be exposed to bodies that we don’t usually see unless we are healthcare practitioners and to the normal arc of life.
When we talk about this sort of homogenization and normalization that we maybe expect ourselves to fit into, one of the areas that you talk about beautifully and importantly and at length in the book is the homogenization of stages of labor, length of labor. And we were talking about birth trauma earlier. I did a survey as part of my article writing this year, had a few over a hundred responses. And what came up consistently as one of the biggest flashpoints for a woman experiencing birth trauma was actually those women who had their labor induced or augmented with Pitocin.
It seemed like it wasn’t just the Pitocin experience, though that was part of it. It was the suddenness of the contractions and that intensity, but it was also the way that the transition from trying to have a baby without induction or Pitocin – those women got very quickly corralled into “Something’s wrong, and we need to do something.” There is a tremendous lack of evidence around when it’s best to induce. We see the data shift all the time: don’t induce till 39 weeks, let’s induce at 39 weeks. There’s a lot of misinformation about the lengths and stages of labor and also when labor even starts. I would love to hear your thoughts and have you share your thoughts. Obviously, sometimes induction is necessary and important, and we’re not dismissing or diminishing that, but what are some of the challenges, pitfalls, or things that really, in your research, you feel you shared in the book are most important that you’d want to communicate to women about understanding induction and also the lengths and stages of labor?
Leah: Yeah, great question. And I feel we could have a whole podcast just about that. We could write another book, probably. But yes, what struck me when I was researching the book was, I’ve been a midwife for 10 years now, and inducing or augmenting somebody’s labor is something that I have done countless times. I honestly couldn’t even estimate how many times I’ve done it. And absolutely, I appreciate your disclaimer that we’re not knocking induction or any interventions; these things absolutely can be lifesaving and are tremendously important if used judiciously in the right situation.
So I’ve been doing this for years, doing it with a certain regime of dosage and timing that I just believed was standard across the world, because why would my hospital be doing its own thing when this is such an important and commonly performed procedure and has been since the late 1950s, early 1960s? I did a little survey on Instagram – most of the people who follow me are either student midwives or midwives – and I asked, “What’s your regime for induction of labor? Can you just share with me what’s going on in your unit?” And it absolutely astounded me that almost every answer was different, that everybody was administering what you guys call Pitocin – we call it Syntocinon, but it’s the same drug – everybody was administering it with a slightly different dosage, different timing, different kind of scale. Some of us were using routes that were not licensed. Basically, we were all making it up as we went along.
And these aren’t little mom-and-pop birth units – not that there’s anything wrong with those birth units – but generally these were people responding from really big urban, established hospitals. In my hospital where I usually work, we have about six and a half thousand babies a year, so it’s a pretty sizable place.
Aviva: And it’s not like you’re making up birth positions and saying, “Oh, try this position.” People are making up things with medications that can have very significant side effects.
Leah: Right. And I was like, hold on a minute. I’ve been doing something for years that not only did the women not fully consent to because they weren’t given all the information and told, “This is just our made-up regime,” but I didn’t consent to it because I didn’t know that I was administering something that was just kind of an idiosyncratic, local protocol that isn’t widely followed. And that gave me pause. I tried to drill down into the numbers of how many wombs around the world are given Pitocin each year, and this was a task, let me tell you, because some countries publish data about how many labors are induced, but even fewer publish data about how many labors are augmented – sped up after they’ve begun spontaneously. There’s even less information about the people who receive synthetic oxytocin after birth to assist with the third stage, the birth of the placenta and the membranes.
Aviva: Which is actually standard in a lot of US hospitals. The baby’s out, Pitocin is administered to make sure that the placenta comes out.
Leah: And it is, I would say, the predominant choice for the third stage here, but it is offered as a choice. I couldn’t get complete data because those numbers unfortunately just don’t exist, but what was evident was that probably hundreds of millions of wombs around the world each year are given synthetic oxytocin. Arguably, this is the drug that is most used on wombs in the developed world and many in the developing world. And yet we are making it up as we go along, and we don’t fully understand the effects that this drug and these various regimens have on not only the duration of labor but also the mode of birth, breastfeeding, mother’s satisfaction with the birth experience, perinatal mental health. There’s even some interesting information about whether synthetic oxytocin has any correlation with postpartum depression, things like that. So we just don’t know. To me, I thought this is just actually a scandalous oversight – or it’s just wild that this is happening and it’s not in the news. And I know, obviously, I’m a bit biased because I’m a geek about this stuff, and it really interests me, but genuinely I thought this is just remarkable that this is a medication that’s being used on most of the wombs in the developed world and many in the developing world, and we just don’t really know what we’re doing.
Aviva: Yeah, it feels like it’s not geeky to me. It feels fairly revolutionary, actually.
Leah: Yeah, if we were all making up our regime for taking Tylenol as we went along, that would be pretty huge, right? A lot of people take Tylenol or Advil or whatever brand. So to think that this drug potentially is just as widely used in a certain context, and we still don’t really know what we’re doing with it, is pretty wild to me. So in terms of advice that I would give to women and birthing people who are going to go through labor or perhaps have given birth and have been induced or augmented, I would say yes, absolutely read as much as you can about what the experience of induction is like, what are the pros and cons, risks, benefits, alternatives, so on and so forth, taking into consideration your own clinical picture. But at the same time, you can’t be expected to know everything. Don’t feel responsible entirely for what happens to you, because a lot of it is in the hands of institutions and institutional guidelines and protocols. Birth in the modern world so often is just a dance between those various forces.
Aviva: Yeah, it’s so important to emphasize that. I really appreciate you saying that because so many women go in with hopes and expectations and plans and then find themselves up against a beast of a system that is very hard to navigate for anyone, and doubly hard to navigate when you’re in labor and experiencing the intensity of labor. And then triply hard to navigate when you are literally sometimes being told, “Well, if you don’t do this, do you want to harm your baby?” So what do we do? I think that importance of self-compassion and forgiveness – it doesn’t mean don’t go in with your hopes and dreams and your doula, your advocacy and all of that, but that self-compassion is powerfully important.
Leah: Absolutely. I was speaking to a woman recently who’d had a baby not so long ago, and going down the line of birth trauma conversation, she was sharing her story with me. At so many points in her birth story, she said, “I just feel if I’d made a different choice at this point, or I should have spoken up more when they offered me this, and I just really let myself down. I wasn’t loud enough in insisting on this other thing.” At every point where something went wrong or went differently than she expected, she completely blamed herself. And I think that’s sad, and that’s a shame because, as I said, there are so many other forces at work. We should be able to trust the people who are providing care in that immediate circumstance, but we should also be able to trust the system – that the guidelines are there to protect each and every one of us and that they’re applicable to each and every one of us. To just blame yourself or take on that whole burden yourself on your shoulders when you are actually the vulnerable one in the situation, it’s unfortunate.
Aviva: In your book, you talk about something that I have been on about for decades, which is the medical language that we use to describe women or to relate to women. So one of the things, for example, is at least here in the US, when a woman comes in with a medical concern, it’s considered her “complaint.” I feel like we go wrong right from there. This idea that women are “complaining” is so embedded – although language like this is, in truth, also used for men; anyone who comes in has a “complaint” instead of a concern. But also there’s this language that is blaming women. It’s no wonder we blame ourselves – “incompetent cervix,” “hostile uterus,” “failure to thrive” when our baby isn’t growing. Even the term “miscarriage” kind of bothers me. I feel like it suggests somebody did something wrong, rather than “pregnancy loss,” which I feel conveys more of the actuality of what happened, but also more typically the emotion that may be associated with it. You talk about “hostile uterus” and “irritable uterus” in the book as not just misogynistic and patriarchal language, but as a phenomenon that can actually lead to serious downstream consequences. Can you talk more about language and health and safety?
Leah: Yeah, absolutely. We speak about women’s bodies in a way that just absolutely would not be acceptable in men’s health. For example, if you’re struggling to conceive and somebody says, “You’ve got a hostile uterus,” not only is that not an actual clinical condition, it’s just a vague kind of nothingness; it doesn’t actually mean something. But if it were your partner’s issue, if your partner had erectile dysfunction, we would say, “Your partner has erectile dysfunction.” We wouldn’t say “sad penis.” We wouldn’t say he has “hostile sperm.” We wouldn’t say “hurtful sperm” ever – he would think it’s outrageous. How can you say that?
And yet, we completely accept or are just resigned to the fact that medical practitioners speak about women’s bodies in this way. Not only is it insulting and a double standard, but as you said, it’s actually really dangerous because it has serious consequences when we don’t give things their proper names. So in the book, I dive into this label of “irritable uterus.” This is something that I myself have used many times, and I’ve heard doctors I’ve worked with use it many times when somebody comes into the department and they seem to be having abdominal pains, they seem to be having tightenings or contractions, but the cervix is not opening. They’re clearly not in labor. They are having some kind of discomfort, and we do all the tests and investigations, and we can’t find anything. And we just throw up our hands and go, “Oh, you’ve just got an irritable uterus” and send the person home with some painkillers usually.
I had always thought, “Oh yeah, that’s a thing. That’s a real thing that can happen. You can have an irritable uterus,” just because I’d heard it so many times from people I respect and trust. When I actually looked into the origins of that term, I found it had its origins in very early 18th-century obstetrics to describe all manner of pains, not just abdominal but anywhere in the body. Often, this term was applied to women whose lifestyles were considered less than desirable. Perhaps this woman had been to too many parties, or this woman was grieving too much for her mother, or this woman was a seamstress working too hard. These women were presenting with some kind of pain or ailment, and these early obstetricians would just say, “Well, you have an irritable uterus.” That was the origin of this term, which we now use in a legitimate way in modern hospitals.
Not only does it have these kind of curious historical roots, but when we use it inappropriately – and I guess it is always inappropriate, as it’s not even a real thing – we risk missing the real problem. In the book, I interviewed this woman who had been pregnant with twins. She presented to her emergency room many times in her pregnancy because she was having abdominal pains; she was really uncomfortable, and she was convinced something was happening. I think some sort of tokenistic tests were done – maybe she had a urine dip and a cursory examination – and she was just told, “You have an irritable uterus.” She actually felt like she was just irritating in and of herself. She could hear the nurses laughing about her just within earshot, and she thought, “I’m clearly just irritable, and my uterus is irritable, and nobody wants to really listen to what I have to say.”
Unfortunately, this pain persisted. She finally went back and had an ultrasound and some more detailed investigations, and somebody actually identified that her pregnancy was in serious danger. She had a condition called twin-to-twin transfusion, where essentially one twin takes much more of the circulation with important blood, oxygen, nutrients, and so on than the other twin, and both twins are at risk of death. It can be very dangerous for the mother as well. This was identified just at the point where it nearly became irreversible and fatal. Fortunately, she managed to get the correct treatment, and she gave birth to healthy twins, and that was fine, but she was rightfully outraged by what had happened. She now has dedicated her career to researching twin-to-twin transfusion and helping other women advocate for themselves and understand the condition. But because she was labeled with this ridiculous and completely baseless term…
Aviva: Dismissive, right?
Leah: Dismissive, absolutely dismissed. Because she was dismissed in that way with this kind of false terminology, this potentially fatal condition was nearly missed. I’m sure in many other conditions, we are missing things, and outcomes are not so good. Absolutely, it goes to demonstrate your point that language isn’t just “Oh, it’s nice. It just makes you feel warm and fuzzy to use the right words.” It’s actually a safety issue. It’s very important.
Aviva: Yeah, I have, interestingly, a podcast for those of you who are interested in this phenomenon of twin-to-twin transfusion with the woman who, at the time, was my book agent. She had experienced twin-to-twin transfusion, and the odyssey that she went through navigating getting medical care for herself was quite profound. She’s a very well-educated, resourced woman who had to just go to the mat to get care and be really listened to.
Speaking of, I want to make sure that all the pregnant mamas or future pregnant mamas listening aren’t freaking out. If you’re having what is called by your doctor an “irritable uterus” – those contractions or frequent Braxton Hicks – it could be, or some unknown reason, it is important to get a urine dip. As Leah mentioned, it can be a urinary infection, which I had a mama who came to me who had her air quotes “irritable uterus” dismissed, and in fact, she had a significant UTI. It can be another infection. Most often, it’s just nothing, and it’s fine
But this does bring us to circle back to self-advocacy. As you mentioned in the story of the woman you shared, the nurses were laughing. This is not an uncommon situation that women face, where they go from one appointment to another or one provider to another, and the more we know statistically, at least here in the US, each subsequent time you go to a provider, the more likely you are to actually now get labeled as a difficult patient or a complainer or “that kind of patient,” which can be a euphemism for a mental health problem. How do you encourage women, obviously they’re seeing you and they have you as an advocate, but in general, to continue to advocate for themselves when they’re not being heard or listened to and have a concern or a symptom? How can they navigate that system, which may then label a woman and further dismiss her?
Leah: Yeah, I definitely do want to reassure women who are going through the system, pregnant or otherwise, that most practitioners do really have your best interest at heart. I would like to think that most of the time, if you present to the ER or your midwife’s office or doctor’s office with an issue and you present numerous times, they will see that as an invitation and a challenge to get to the bottom of what’s bothering you. I think most of the time, that is the case. But as we’ve said, some of the time that’s not the case. Some of the time, you do have to really advocate and push past some ignorant behavior and inappropriate treatment. It’s really hard; I know it’s really hard. I actually don’t have any kind of magic bullet of advice except to keep trying and know that you always have the right to see a different practitioner if the one you are seeing isn’t treating you with respect.
I know it’s a little bit trickier in America because there are issues of insurance and who’s covered by whom. Obviously, here in the UK we can just see whoever without worrying about the money side of things, so I know that layer makes things a bit harder in the States. But absolutely, just bear in mind that your health – and potentially the health of your baby, if you’re pregnant – is at stake. So do keep pushing. Don’t be afraid to be that irritating, annoying person, because at the end of the day, you have to live in your body forever, and that practitioner might never think about you again. It’s just another day in their life.
Aviva: One of the things I often recommend too is bringing an advocate with you, because often people will be on better behavior when there are other people in the room who are witnessing, and that can really make a difference. It can also help you feel more confident and more bolstered when you do have to present with something. I’d love to switch gears to the menstruating womb that’s not pregnant at the moment. You talk about a phenomenon that has definitely been on the rise, certainly with the availability of universal suppression contraception, and you talk about elective period suppression. There are certainly divergent opinions on this, and I’d love to have you explain what that is to listeners, what you learned, and where you land on this, both as a practitioner and as a mom.
Leah: Yeah, so this was a fascinating issue for me personally because I’m very open in the book about the fact that my periods have always been awful. I may be the womb lady and hypothetically know a bit more about this stuff than many other people, but it doesn’t mean I’m any closer to solving what is a chronic issue for me, unfortunately. I came across the work of Dr. Sophia Yen, who is a physician in California. She runs a private company called Pandia Health that provides birth control through the mail – hormonal birth control. Sophia coined this hashtag, #PeriodsOptional, although the concept is not invented by her, but she popularized it with this hashtag. She is a big advocate for, if it’s appropriate and safe for you, taking continuous hormonal contraception to completely suppress your periods basically forever, or until such time as you decide you want to try and have a baby.
She argues that menstruation is not only inconvenient, messy, and unpleasant, but is actually almost a disability for women. She argues that the anemia it can sometimes cause can inhibit your physical and academic cognitive performance, putting women at a disadvantage to men in schools, the workplace, university, just competitively in life in general. She says that for her own daughters, if they can suppress their periods, she absolutely would encourage them to do so as soon as they’re of a safe age to do that. She’s right in the sense that when the oral contraceptive pill was first developed, this “pill period” that women were told they had to have in between packs is actually not physiologically necessary. It was invented actually to appease the Pope, because it was thought that Catholic women and religious women around the world, and the church in general, would not approve of something that didn’t at least mimic the so-called natural cycle of femininity. Even now, to this day, many of us are laboring under the misapprehension that we need to have this monthly bleed in between pill packs. But more recently, I believe the American College of OB-GYN, and I think the UK body as well, have announced that it’s safe to take continuous hormonal contraception for most people.
Aviva: I actually find that depending on the kind of contraception women are on, they feel better because they’re not getting that hormone drop during that break. So they’re getting fewer headaches and fewer other symptoms.
Leah: That may well be the case. And of course, there are forms of continuous hormonal contraception, such as the coil (the intrauterine device) or the implant that goes in your arm, which do give you a continuous source of hormone. But on the other side of this argument, I bring in a woman called Sarah Hill, a researcher in Texas who does lots of really interesting work on the cognitive effects of hormonal contraception. She is very concerned that not only are these hormones potentially changing our cognitive functions, emotions, and libidos in ways we don’t completely understand, but also that giving these hormones to younger women whose bodies and brains are still developing could potentially be problematic and store up issues for the future. Sarah Hill believes that this anti-period attitude is inherently misogynistic. So here we have two very strong-minded, very educated, and informed women with diametrically opposing views.
I found this really interesting, and I hope I’ve left it intentionally vague in the book in terms of which argument I agree with, because actually, for me, I’m not sure exactly where I stand. As somebody with problematic periods, the idea of never having one is really appealing to me, but at the same time, I know that I don’t get on with a lot of synthetic hormones, and I know a lot of those are not really an option for me because they affect my life adversely in other ways. I haven’t really found a solution still at the age of 46. I’m now perimenopausal, and I’m having to dip my toe back into the world of hormones for that reason, and I still can’t find the formulation that really agrees with me and suits me. So it’s a really complex issue, and I think it’s a fascinating one to look at.
Aviva: Absolutely. And for listeners, we do talk about some of these brain effects of contraception on teenagers and adult women, more fully matured women, in my podcast on things to know about the pill.
Speaking of menopause, there’s been some really interesting research that has – well, and thank you. I just want to thank you also for sharing so transparently about your cycles. I have been someone who’s been very fortunate to have what I would call easy menstrual cycles. I have found menopause symptoms not so challenging, but I will say I have been taken a bit aback by my emotional and cognitive experience with menopause, just getting my head around being a certain age in a certain body in a Western culture. There has been some really interesting research that’s come out on the womb having many more effects on our health, whether it’s our uterine microbiome and its impact on our genital urinary health, or even some research suggesting that there’s a womb-brain cognitive connection. I find this really just powerful and fascinating, given the number of women who have hysterectomies, most of which we know – at least a substantial portion of which we know – are unnecessary for things that can be treated like fibroids in other ways. I wonder, what were some of your most exciting aha moments or something that maybe transformed your thinking of the uterus as more than a reproductive organ as you were doing this book writing?
Leah: Yeah. I think probably one of the most mind-blowing moments for me was when I was reading around the use of menstrual tissue – or menstrual effluent, as some people call it – as a diagnostic tool. I grew up in America in the eighties, and periods were gross, and God forbid somebody should see you taking a pad or a tampon to the bathroom during your break in school. And I very much, even though I’m a midwife and kind of a bit more enlightened about these things now, still feel it’s a little bit yucky, and we’re just not told that there’s any value to this stuff that comes out.
But what I learned was that there are some scientists doing absolutely fascinating work in this area. Most notably, there’s a trial going on in America called the ROSE trial led by Dr. Christine Metz, which is looking at the analysis of menstrual tissue to potentially identify markers for – and potentially even diagnose – endometriosis. And this is huge because endometriosis can be a really debilitating and disruptive condition. On average, the time to obtain a diagnosis of endometriosis is seven to ten years, with some women waiting much longer or never being adequately diagnosed.
Aviva: And let’s emphasize that this is with going to doctor after doctor, explaining the symptoms, and then doctors still saying in surveys that even if they were able to make the diagnosis, they don’t necessarily know what to do.
Leah: Exactly. This is the thing. Often, it’s seven to ten years of repeated presentations to doctors, but also years of numerous expensive, distressing, invasive, and painful investigations. We have endometrial biopsies, laparoscopies, all kinds of weird and wonderful diagnostics that we use to look for endometriosis that are not very nice to undergo if you had the choice. So to think that possibly we could just take some of our menstrual tissue, either collect it in a cup or a pad, send it off to a lab, and they could say, “Yeah, it looks like you’ve got endometriosis,” sparing us these years of waiting and having these distressing investigations – that’s a huge game changer. The technology isn’t a hundred percent there yet, and it still has to be studied and evidenced, and it’s not available to people now in a popular way. But I really do think that probably in our lifetime, or maybe in my daughter’s lifetime, these kinds of diagnostic tools will be available. I really hope that they are. To me, that was like, wow. Not only the fact that menstrual blood actually has some clinical value, which seems obvious when you think about it, but also the fact that potentially in the future people will be spared these many years of distress and discomfort. It’s just tremendous.
Aviva: And when we wait those years, it’s not benign either. If you catch endometriosis early, preventing longer-term scarring and adhesions, and then all the problems that come with overuse of medication and potential fertility challenges, this is a huge, huge game changer potentially. I love that you shared that in the book and really compared it to how much research – I think you talked in the book, you said there were something like, when you look up “menstrual blood” or “menstrual effluent,” it’s like 400 articles, but when you look up “semen” or “sperm,” there were 15,000 or something. The disparity in the research body is significant.
Leah: Yes, and that disparity is reflected in day-to-day life. For example, when I go to my local pharmacy to get my HRT prescription filled – my hormones for perimenopause – sometimes I have to go to four or five different pharmacies because there are stock issues. Sometimes there’s a serious shortage protocol, so I can’t even get it for months at a time. Yet, in each and every one of these pharmacies, there’s a lovely big colorful display front and center advertising Viagra, which any man can just come in and pick up over the counter. I find that infuriating.
Aviva: Absolutely.
Leah: That’s just an example of how we really have to go that extra mile, push, and struggle to get the funding, research, and management that we need and deserve.
Aviva: It’s so interesting how the disparities in the information distribution – notice I did not say dissemination on purpose – in the US have come under significant scrutiny. I did an interview with a woman named Jackie Rotman where we talk about how on social media, you can talk about things like erectile dysfunction very openly, but until recently it was considered censored content to talk about vaginal dryness or other symptoms that women might experience because it was somehow considered sexual content. There was also a big case in New York City with the MTA, the transit authority, where there were these ads – you know about these ads – with giant cacti for male erectile dysfunction products, but female products for pleasure were banned. But that case has been won by Alexa Fine of Dame Products.
I’d love to know if there was anything that you learned through your research for this book that significantly changed the way you practice midwifery or think about women’s bodies.
Leah: I think I probably have even more appreciation for women’s bodies and people with wombs than I even had before, which was already pretty considerable. Two areas where I expanded my consciousness a little bit: one of them was the use of reproductive violence as a form of oppression. There’s a chapter in my book about repro-cide and the many ways that people’s reproductive rights have been abused, coerced, discarded, or suppressed over time in many cultures and countries around the world. I grew up in America and was completely unaware of a lot of the information I learned during my research for that chapter about the way that American people’s reproductive rights have been usurped and oppressed in various covert and not-so-covert ways.
Aviva: People are shocked to learn that even until the 1980s, it was actually legal in California to perform a hysterectomy for sterilization of women without consent. This was rampant, with campaigns targeting Black and Latino women. You think 1980s, we’re not talking about the 1920s or ’30s. We’re talking recent.
Leah: Yes, and even now, there are cases of possible coercive sterilization of women in migrant detention centers and in correctional facilities in California and various other states. This is happening now. This is current, and it absolutely blew my mind because it’s just not in the news. You just generally don’t hear about these things. That really opened my eyes to that side of things. I guess just in terms of the way that I look at women’s health in general, I’m the mother of two daughters who are 17 and nearly 21, and I can see them facing or starting to face a lot of the issues that I talk about in the book and a lot of issues that I myself have dealt with over the course of my life. Writing the book in some ways has made me optimistic for them because I do think some things are changing, and I think some good will happen in their lifetimes that will benefit them. But also writing the book has made me incredibly angry on their behalf about the injustices they will face and the things that probably won’t change. Beyond being a midwife or an author or anything else that I’ve done, I’m obviously most emotional and vulnerable as a mother thinking about my children. You never want your children to suffer any kind of pain, injustice, or discrimination. The book has made me see their lives through a slightly different lens as well.
Aviva: Yeah, that anger for our daughters and that anger for other women is definitely a fire that can keep us doing our work. But sometimes I’m just like, wait, we’re still fighting this? This is still happening? Thank you for sharing that so personally. I have one question I love to ask all my guests before we part, and that is: if you could tell your younger self one thing, what age would she be, and what would you tell her?
Leah: I think I would tell her… I think I would probably speak to the version of me who had just had her first child – for nice closure for the top of our episode as well. So I would go back to kind of 2003, me, who would be 25, 26, who was so confused by her experience, questioning her career choices, questioning her interests, feeling isolated, feeling surprised by what her body had done and how it was treated. I think I would probably tell that version of me that it will all make sense someday, and you will do something good with it. Yeah.
Aviva: You are doing so much good, and I’m truly just thrilled to meet you and have this time with you. I’m excited to read Hard Pushed. You have a lovely way of speaking both in this conversation, but also in your writing, that feels personal, thoughtful, and connected, and at the same time beautifully researched and humorous at times, which is always nice when we’re talking about these really intense topics too. Leah, thank you so much. We’re going to have all the show notes with all the ways to contact you, but for those people who don’t pop over to the show notes, what are the top two best ways to find you and your work?
Leah: Yeah, thank you. I’m easily findable on social media. I’m on Instagram at @leahhazard, just all one word, and “Hazard” just has one “z” in it. I’m on Twitter – I refuse to call it X – @hazard_leah, and my website is leahhazard.co.uk. That’s an easy one, and you can just look me up on Amazon or your local independent bookseller, ideally, who will be able to order any of my work for you. I’d love to hear from readers and listeners, and I would encourage you to get in touch.
Aviva: Leah, thank you again so much for joining me. And everyone, I hope this has been a really informative, insightful, and provocative conversation where you’ve also felt seen and heard and recognized in your own journey of being a person with a womb. We’ll see you next time.
