In Jennifer Lincoln’s work as an obstetrics hospitalist, she met many new parents who were fearful and felt uninformed about the labor and delivery process, even when arriving at the hospital to give birth. She’s quick to note, however, that this gap in understanding isn’t due to patients being lazy, or to their lack of interest in learning, but due to brief prenatal visits and the often overburdened system of maternal healthcare in the U.S.
A 2024 report by March of Dimes, a nonprofit focused on maternal and infant health, found that over 35% of counties in the U.S. are considered maternity care deserts, and labor and delivery units are being stretched thin, especially in rural areas.
Lincoln was finding that patients weren’t given enough time with their healthcare providers to dive into all questions about the complexities of the labor and delivery process, and often turned to resources like TikTok and Instagram to hear from other mothers and get their questions answered.
Her work as an obstetrician and gynecologist, and her ability to distill complex topics on reproductive and maternal care led Lincoln to write “The Birth Book: An OB-GYN’s Guide to Demystifying Labor and Delivery.” She joins us to discuss the book, which covers the labor and delivery experience from prenatal visits to postpartum care.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Five years ago, we talked with Jennifer Lincoln. She is an OB-GYN at a hospital in Portland. You can also find her on TikTok, Instagram, and YouTube combating misinformation about sexual health. In 2021, she turned that down-to-earth communication style into a book called “Let’s Talk About Down There: An OB-GYN Answers All Your Burning Questions… without Making You Feel Embarrassed For Asking.” She has just released her second book. It’s called “The Birth Book: An OB-GYN’s Guide to Demystifying Labor and Delivery.” Jennifer Lincoln joins us now to talk about it. Welcome back to the show.
Jennifer Lincoln: Thanks so much for having me.
Miller: So there are a lot of different healthcare professionals whose jobs are directly related to pregnancy and birth. What is yours like as an OB hospitalist?
Lincoln: I am a board certified OB-GYN. And as an OB hospitalist, I work solely on labor and delivery. So that means we’re caring for pregnant patients who are coming in to have their babies, or for triage visits for folks who are transferred in from other hospitals. We’re also helping the other doctors if they have emergencies, assisting with their C-sections, and we also work with the high-risk OB-GYNs, helping to manage their high-risk patients when they’re not in the hospital. So that means no two days are the same, which is great.
Miller: It also means, I didn’t hear you say prenatal visits in there, correct?
Lincoln: Correct. We are just in the hospital. So I gave that part of my practice up, which is unfortunate, but the benefit of our model is that we are always there. We’re physically present, and we’re also really the specialists in emergency management because we see those things every day, every night. And what’s nice is the doctors who are in the office, they don’t have to run out and see a patient in triage and run back and get all backed up. So I think it’s a really nice model of care, especially when it comes to the safety aspect of things.
Miller: How did this current job lead you to write this book?
Lincoln: I saw patients coming in who just did not know what was about to happen to them, and I think it really came down to three gaps that I noticed. The first is that the healthcare system is not set up to really educate people on how to have a baby. What I mean is not that the doctors and midwives aren’t trying and desperately want to, but when you have a visit that is set up, it’s 15 minutes, and by the time you actually get through the rooming and the blood pressure and giving the urine sample, you might see your provider for a couple of minutes. So you don’t have time to ask questions. Layer that on top of you’re coming into this not really knowing how your body works, because we’re not really taught in school. If anything, you’re taught how not to have a baby, not how to do it. So that’s the first gap.
The second gap is really related to access that I would see my patients experience. We know that 30% of counties in the U.S. are considered maternal care deserts where there’s no OB-GYN, midwife, labor and delivery, or birth center. 50% of American counties have no OB-GYN, and it’s only getting worse. There’s just data out last week that showed from 2010 to 2021, the percentage of Americans who live within 30 minutes of a labor and delivery went from 90% to 60%. Now, I don’t think my book is going to open up labor and delivery units, but it will give people the language for things to look out for and to know what happens once they come in.
Miller: I was really surprised by something you write near the beginning. You say, yours is the first ever book focused solely on the birth experience, written by an OB-GYN. Is the crucial distinction here is that there are other books, but they include pregnancy as opposed to solely focusing on birth?
Lincoln: Correct. And there are other great books out there that are just like you described, that include, you know, from the beginning to the end process. I wanted a book that just focused on the birth part. I think you see it’s almost 300 pages just – and I’m doing air quotes – just talking about that. To really do it justice, you need to go into real specifics. Because what I see is patients who come in for an induction of labor or for a C-section, and nobody’s ever mentioned the many things that may happen. And that’s what they want to know. They don’t want just glossing over the high level things. So, I wanted to write a book that just focused on that, and from somebody who that’s what I do every day. And I see on social media and elsewhere content that’s out there from people who are not doing these things. And it’s really confusing for patients and for readers to know what’s accurate, who can I trust? So I hope I become that trusted source for them.
Miller: The American Journal of Obstetrics and Gynecology reported in 2024 that childbirth related PTSD affects between 3% and 6% of mothers. What do you think is behind those numbers? What’s responsible for that really high rate of a serious reported mental health problem, following birth?
Lincoln: Yeah, and I think that statistic is interesting. That is a formal diagnosis. The numbers are even higher when you just think about birth trauma. And I say ‘just’ to mean that it’s not a formal diagnosis of PTSD. But it’s still terrible, where some studies show one in three or one in two people who have a baby experience that. I think what happens, and we see this time and again especially as an OB hospitalist, is that somebody can have what will appear to be a medically traumatic birth, such as an emergency C-section or a hemorrhage. But if they feel that it happened with them and not to them, and they were heard the entire time, we’ll see them afterwards. And they’re like, “you know, it was chaotic, but I felt like I was safe. I knew what was going on. I was taken care of.”
The people who fall into those statistics and the ones I mentioned. They didn’t feel heard. They didn’t feel like they got informed consent. They just felt out of control and didn’t even know the questions they should ask. Even if it was what might appear to be a medically uncomplicated birth, we’re seeing psychological trauma in people who felt like they weren’t part of the process.
Miller: So let’s go to one of the early parts that you talk about in your book. What questions do you recommend that people ask prospective doctors or midwives, if they are fortunate enough to have a choice about who will likely deliver their baby?
Lincoln: I have many questions that I included in checklists in my book that you can also get on my website. Because I want you to think of these questions to ask. Some of them, I think, are very obvious like, do you take my insurance? What hospitals do you deliver at that’s close to where I am? But I also think important questions are, what’s your philosophy on birth? What’s your philosophy on how often you do cervical exams?
For folks not listening or who haven’t had a baby, that’s a really great question because that helps you see whether this person believes that these things should happen in a very “this is how we do it it doesn’t matter how you’re feeling,” versus “I see this as a team sport and I’m going to be there for you and I’m going to give you my expertise and my advice. But at the end of the day, you have that autonomy.” So I think it’s really important to feel that out and see if you even have the choice, which not everybody does, unfortunately.
Miller: So what do you recommend for people in more rural areas or with fewer options about who they can select?
Lincoln: You might be somewhere in rural Oregon and there’s the OB-GYN or the family practice doc, and that’s it. And that is why, obviously, I’m here to talk about my book. But I think it is an important resource because even if that is the only person, and maybe you’re like, “I don’t know how this is going to go.” But if you walk in there saying, “You know, I know that not everybody should just automatically be induced by their due date. So, I was wondering if we could talk about this,” it changes the power differential a little bit. It just shows that you can, I don’t want to say push back in that way, but you can just have your voice heard a bit more even in a scenario where it might not feel super ideal. You can feel that you are able to say what’s important to you and have a higher likelihood of getting it.
Miller: Although it does take something. It takes some sense that you’re going to be listened to, that you’ll be taken seriously, to say that sentence you just said. “I know that I don’t necessarily need to be induced on my due date.” How do you recommend people even say a sentence like that?
Lincoln: I’m so glad you’re bringing this up because it is very different for someone like me, right? I’m a white physician and I’m English speaking and I’m not worried about my immigration status or what have you. So I know that I can say these things and not be worried. Whereas somebody else who might not be in those same positions is worried they’re going to be labeled as difficult or they’re going to be treated a certain way. And I do address that in my book and I say that there are some strategies, where you can phrase it or you can have somebody else ask those questions.
So you can have a partner or a friend who sort of becomes that person who can ask the questions in the room. You can have a doula, which I think, in addition to what we know, how beneficial they are for labor, really what they can do is be that spokesperson for you. And there’s a way you can say, if somebody’s saying you need a C-section, it’s very different to say “Well, I just know all you want to do is do C-sections” versus “Can you help me understand why? Can you give me more information? Do we have time to talk about this?” Because when it is more collaborative and team-based, everybody’s going to feel a little bit better about it. But it’s a very real thing that you bring up for sure.
Miller: As a hospital-based OB-GYN, part of your practice, and you mentioned this earlier, includes patients who’ve been transferred to the hospital after trying say, to do a home birth or laboring at a birthing center. I’m curious how that experience affects the way you think about non-hospital births. You don’t see the ones that went well. They don’t come to you, by definition. There are plenty of births outside of hospitals that are smooth. Those aren’t the ones that you end up dealing with. How does that not color the way you think about non-hospital births?
Lincoln: Oh, it sure did. When I was a resident, I did my OB-GYN residency at OHSU. We only saw the ones that came in. And being the academic center, we saw, sometimes, really terrible things. So I left residency thinking home birth is where safe birth goes to die. And I had a lot of ideas about it.
Miller: And you were vocal about that?
Lincoln: Well, yeah. I kind of was like, “why would you do this? Why would you do this to your baby?” And then guess what, I actually did this thing for a little while, and started to realize that there’s more than one way to do it. And you understand why people choose homebirth. So we were talking about how that person might only have that one OB-GYN in that rural area. Well, the other option might be a home birth by a certified midwife, and that feels much better.
So I have completely changed my view and the data supports it too. We know that homebirth for low-risk people can be very safe and actually has a lot of benefits that the hospital doesn’t have. So I think we really need to change the narrative on how to birth safely. In my book, I start off with where you can have your baby and with whom. And I really think home birth can be done safely and done in a safe way with the appropriate screening, transfer plans, those sorts of things.
I’m lucky now where I practice. We do see transfers, and I’ve seen some transfers that go so well. It feels like this healing moment where you can see the patient’s like “oh my gosh, we came into the hospital. We needed something. We were treated with respect. And now we’re not going to be so worried the next time if we need to seek medical care, even unrelated to obstetric care.”
Miller: The first time we talked it was about your first book, but also about the social media videos. That you were making a name for yourself with, with millions of followers. Did doing that work, social media videos, maybe 30 second videos… Did it influence the way you communicate, even in interviews like this? Or the way you decided to write a book?
Lincoln: Oh, 100%. I feel like everything that’s in my book, I have been asked at some point in some way. And so much of what I included, I don’t think I would have even thought to address had I not been in social media. So, I get questions of, “is this safe? Have you heard about this?” So yes, I feel like I’m teaching on social media, but I’m learning and I’m seeing what’s out there, what people are really worried about. And it’s actually been really fun. When I walk into a room, and somebody’s there in triage and they ask a question, I kind of get a feel of like, “oh, you looked this up on TikTok, didn’t you?” And then they look at me and I say, “show me the video that made you worried.”
We’ll watch it and then we’ll communicate and we’ll talk about it. And it just breaks through so much of the, what’s really going on, what you are worried about, what you think is not safe? How can we have a conversation? Yeah, I have learned a lot in my DMs. And it’s been really fun. And it also teaches me that we have to communicate and go to places where people are, in a way that they understand, in a language where they feel like they are heard. So, I hope that in this book and in my social media people feel like they’re listening to somebody with training, but also, I could be your friend. It feels like we’re having a conversation at a coffee shop. It shouldn’t feel like there’s any shame or judgment.
Miller: When you talk to other colleagues, other MDs, do you get the sense that they’re as comfortable as you are, in what you just outlined? A patient says something. You have an inkling that they learned this or got this information from social media and then you ask them to watch the video and you’ll watch a TikTok with them. How standard do you think that is? That comfort level with experiencing social media together and either corroborating or complicating the information someone’s getting from social media?
Lincoln: The younger they are, the easier it seems.
Miller: The younger the doctor is?
Lincoln: You know, the younger attendees and the residents, oh yes. So I think it’s changing, but I think what you’re alluding to is that there are definitely still some people out there who think it’s ridiculous that people are on social media educating. Or don’t understand why a patient has gone to TikTok or YouTube and hasn’t called the office. Which I think really shows a lack of understanding about all the barriers and how people learn. So [they] get angry or just [say] “Why would you question me?”
I work with amazing people and I feel like, in the city especially, it’s very different from other places in the country where maybe that power differential feels a little more combative. So I hope that we’re working to change that. But yeah, sometimes it can be a little bit funny when I say, “Oh yeah, she probably saw that on TikTok. So here’s the video.”
Miller: We asked folks on Facebook if they felt prepared for the experience of pregnancy and giving birth and what information, if any, they wished they’d had. Valerie Griffiths Brown wrote, “I wish I’d been allowed to attend a birth in person at least once. Same with a death. Reading books and watching videos only went so far.” This seems logistically challenging.
Lincoln: Seems that the paperwork would be a nightmare, and the HIPAA, yeah.
Miller: What do you think about this idea?
Lincoln: Well, it’s so true because historically, birth would happen at home. You would be around it. I think the same about how we feed babies. We are so isolated and the first time you might see a birth or feed a baby is when you’re doing it yourself. She outlines it perfectly. How are we supposed to know how to do this when we’ve never seen it? And yes, videos and things can only take you so far. But being as prepared as you can, that’d be a pretty cool, interesting spectator sport model of, here’s your childbirth class, come on in. But I like it.
Miller: Could you read an excerpt from the book? This is from part of your description of when you were doing your OB-GYN training, and it is a short section that you call, “Why Words Matter.”
Lincoln:
“I remember being an OB-GYN resident and standing outside a postpartum patient’s room one day. I was presenting her case to my team before we would all go into the room to see her. ‘Miss X is post-op day one from a crash C-section.’ ‘A what?’ interrupted my attending, who was one of my favorites and she loved teaching us, but who was also known for her high expectations. ‘A crash C-section. I got the baby out in less than a minute.’ ‘And would you want to hear that the birth of your baby was a crash event, Dr. Lincoln?’ she gently but pointedly suggested. ‘No,’ I replied, while I thought, is it not enough that I saved this baby’s life? Now I need to worry about how I say it? ‘Let’s say emergent instead, shall we?’ suggested my attending. ‘Okay, she is post-op, day one, from an emergency C-section.’
Guess what? She was totally right. Words matter even if, in my exhausted state, I didn’t realize it. I’ve only come to understand this, the longer I practice and the more time I spend on social media, hearing from people who feel that words used in their care hurt them or dehumanize them in their experience. So thank you, Doctor O’Reilly, for all you’ve taught me and many other learners.”
And I hope she’s listening today [laughs].
Miller: One of the striking things about that passage is that it felt like there’s something helpful for a patient in reading that. But it really seems like the heart of the audience, for that excerpt, is fellow doctors, fellow healthcare professionals. Are they a part of your intended audience?
Lincoln: Oh, I’m so glad you asked this question. They were not the intended audience when I started writing this book. But as I went through it and as I was reading through research, and there’s pages of references, I was realizing, wait a minute, why was I taught this way? Or why have I always been saying this when it’s actually this? And I realized that we were trained a certain way. We carry those things on and that isn’t always evidence-based. And patients see this and they know this.
So whatI’m saying is that I ended up also writing this book for other providers, whether it’s how we reframe how we do fetal monitoring or allowing people to eat in labor and those kinds of things, and the language that we use. So I really do want this book to be also for the people who are helping the people have the babies. Because we have had, in the field of OB-GYN historically, a huge role to play in why people don’t trust us. And that also means that we have a role to play and we can fix it and make it better.
Miller: I want to read another comment we got from Facebook. Christy Anderson Stewart wrote, in response to ‘what do you wish you’d heard more about and knew more about?’ She wrote, “The recovery. People tell you to slow down, rest, and recover. But if you don’t have the support system, it’s almost impossible. Your body needs so much time. Whatever you think you need, double it.” I wonder if you could read us one more section of the book. This is near the end. It’s funny, but is still a serious list that you’ve created to summarize the postpartum experience?
Lincoln: Yeah, it’s called “Having a Baby is So Fun.”
Miller: I should just say it gets graphic. But nothing that, I think, listeners cannot handle.
Lincoln: I believe in this audience. I do. All right.
“So you get to grow your baby for 10 months. Sorry, 40 weeks is 10 not nine months. Please don’t shoot the messenger. Squeeze a watermelon out of your vagina or have major abdominal surgery while awake, to birth said watermelon. See your baby and think, wow, will they always look like that? On second thought, of course they look more like dad, naturally. That’s really fair. Immediately be the source of nutrition for a new human who knows literally nothing about feeding other than that he must eat now. And even though the nipple is in his mouth, he is freaking out. And evolution, why is this the best we’ve done?
Wear your own diaper to remind you just how much of an adult you really aren’t, in this moment. If you’ve had a C-section, have people cheer for you when you, one, stand up, two, don’t vomit, and three, finally fart. Have your nipples on display when anyone tries to come visit, like your grandfather, the cafeteria guy, or the 12-year-old med student, all by watching your partner with his useless nipples sleep on the couch that he tells everyone isn’t that comfortable. Applaud yourself for not choosing violence for the previous one I just mentioned.
Fill out more paperwork than any sleep-deprived human should ever be legally allowed to do. Be asked about birth control as if you’ll ever have sex again. Spoiler, you probably will. Get discharged with your new human to drive on roads where everyone is clearly maniacal and out to get you, and enter your home. Feel that no one has ever done this before and survived it all. But you will, just one hour at a time.”
Miller: Before we say goodbye, I do want to ask you about a powerful section of the book, near the end, which is about stillbirth. How did you approach that section?
Lincoln: I wrote a bit of it, and then the power of social media. A woman who’d experienced a stillbirth, named Anna, reached out to me. And it turns out she works for a nonprofit called Push for Empowered Pregnancy. She reviewed that section and I added so many more questions because of things she brought up. I’ve never experienced stillbirth myself, but to have her review it, and I really wanted to go into all the detail that I could. Because when it happens, you don’t have time to fall apart, Google, and not know where to go. So I hope no one ever has to read that section but we know that it happens. About 1 in 150 births in the country. It’s actually more updated data than what I have there. I wanted people to have a place that they could go where you could help somebody through. And I’m just so appreciative for Anna’s insight on that section.
Miller: Jennifer Lincoln, thanks very much.
Lincoln: Thanks for having me.
Miller: Jennifer Lincoln is an OB-GYN hospitalist based in Portland and the author of “The Birth Book: An OB-GYN’s Guide to Demystifying Labor and Delivery.”
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