What you should know about your hormonal cycle, why it should be considered a fifth vital sign, and the implications of teaching women and girls not to trust their bodies. This week we’re talking with Kelsey Knight and Emily Varnam, founders of The Fifth Vital Sign, an organization they created to help educate anyone with a uterus on their bodies, and the importance of cultivating an awareness of their hormonal health.
Toni Weschler wrote two really great books on fertility awareness and how to chart your cycle. The first, Cycle Savvy, is specifically geared towards teens, and Taking Charge of your Fertility is meant for everyone.
Planned Parenthood has some great information on the Fertility Awareness Method, something we mentioned a few times in this episode:
BRAIN is the helpful acronym Kelsey mentions. This is a great reference heading into any conversation with your practitioner. Take some time to ask your clinician, and yourself, these questions:
B- Benefits (What are the benefits of this decision?)
R- Risks (What risks, if any, are involved?)
A- Alternatives (Are there any alternatives?)
I- Intuition (What is my intuition telling me?)
N- Nothing (Can I take some time to think about this?)
The music in this episode was composed by:
Full Episode Transcript
The 5th Vital Sign
Kelsey Knight: We're most aware of when we're bleeding. We don't know the other ways to listen to the menstrual cycle, it's not like heart rate or temperature.
Chelsea Levy: I was basically told, oh yeah, you have really debilitating cramps every month that make you throw up. Well that's just part of being a woman.
Emily Varnam: If we talk about mental health in relation to our hormones we're hysterical, we're hormonal, we're PMS-ing, we're playing into a stereotype that we have tried to get away from to be more employable.
Chelsea Levy: Hi everyone I'm Chelsea Levy, and I'm the executive producer here at Under The Hood. This week I sat down with Kelsey Knight and Emily Varnum. They're the founders of The Fifth Vital Sign, an organization they created to help educate really anyone with a uterus on their bodies, the importance of cultivating an awareness of their hormonal health and more specifically knowing your cycle.
Chelsea Levy: This is a topic I am all too familiar with. As you'll hear in this episode, after struggling to get pregnant with my daughter, I felt incredibly let down by practitioners who dismissed my symptoms as quote unquote normal, and failed to diagnose a 15-year struggle with endometriosis, which eventually led to my difficulties getting pregnant.
Chelsea Levy: I found myself asking time and time again why no one had ever taught me more about how my body is meant to function, and why my own instincts that things were not at all normal were ignored and dismissed. I also was asking why I had been prescribed hormonal birth control as the only antidote to my pain, something we talked about at length with Holly Grigg-Spall in Episode 2.
Chelsea Levy: I came through that experience hungry for more information and eager to share everything I had learned with every woman I know. I knew that if I a well educated woman city-living, body conscious, didn't know really half of these things. There were probably many many more women around the world and the country who might be asking the same questions. This podcast is really in part a result of that desire to shout from the rooftops all the things we were never taught about our bodies.
Chelsea Levy: Today we're talking about what you should know about your hormonal cycle, unpacking why it hasn't been part of our own sex education for far too long, and the cultural implications of teaching women and girls not to trust their bodies. Let's jump in.
Chelsea Levy: Kelsey, maybe you can talk a little bit about the concept of using the menstrual cycle as a fifth vital sign and what that means in terms of the work that you do.
Kelsey Knight: Yeah so, other vital signs that you may be familiar with are things like heart rate, temperature, blood pressure, oxygen saturation, pain, in some cases and usually you might go to the doctor if you're sick and they might take your heart rate or take your temperature because that can indicate how you're doing, that can indicate something about your wellness. And the menstrual cycle is the same. But I think most often when we talk about the menstrual cycle as an indicator of our bodies, it's in relation to potential to get pregnant. And we're most aware of when we're bleeding, we don't know the other ways to listen to the menstrual cycle. It's not necessarily like heart rate or temperature where there's a device or we know exactly where to touch our bodies in order to listen to that vital sign. And so it's something that that's important to learn and not something that often times clinicians will talk to us about.
Kelsey Knight: And usually the one question I will get about my menstrual cycle when I go to the doctor is, when was the first day of your last menstrual period and nothing else is asked. And we need more information in order to really be able to consider our cycle a vital sign.
Emily Varnam: We used the fifth vital sign in a very literal sense and we kind of provide and together craft information and ways of teaching information for people to read and have conversations with their own bodies. But as we've kind of evolved in this work we've also started to take the concept of people cycling together as a vital sign to tell us about the land and the water that we are living on. So if we can't bleed on this land there's something wrong with the land. And there's organizing that has to happen around environmental justice, around racial justice around gender justice that ties into this and so we think of this like access to this information and access to having that health of your body as also a vital sign.
Chelsea Levy: So let's sort of go to the basics. Let's walk through the menstrual cycle and talk about what the stages are, what's happening hormonally, so why don't we start from the beginning. Day one of your menstrual cycle is–.
Kelsey Knight: Day one of the menstrual cycle is when a bleed starts, so some you might experience spotting sometimes you can spot even like a little bit when ovulation occurs, but day one is like that the first, the bleed when the bleed starts. And so therefore parts of the menstrual cycle: There's menstruation. The follicular phase, ovulation and then the luteal phase. Typically year doctor usually an OB-GYN would consider a menstrual cycle to be about 28 days. It varies greatly from person to person. So after the bleed starts, simultaneously a follicle in the ovary is beginning to develop and an egg is beginning to mature inside the follicle. During that time, estrogen is increasing in the body.
Kelsey Knight: There are two kind of main hormones that are involved in the menstrual cycle estrogen and progesterone, and hormones are just like little messengers in your body traveling throughout your blood, giving your body messages to do certain things. And so at this time estrogen is increasing helping the follicle develop in the egg mature. And also our hormones are communicating with other hormones around our brain utilizing hormone and follicle stimulating hormone. The names of the hormones are not the most important thing I think to take away from this. But there's a big spike of luteinizing hormone as estrogen reaches its peak. And that's what initiates ovulation. Ovulation is when the egg breaks out of the follicle. Then what was the follicle becomes a temporary endocrine gland called the corpus luteum. The corpus luteum releases the hormone progesterone, which is a hormone that heats the body. So progesterone increases in the body. The egg is potentially travelling through the fallopian tube and then if an egg isn't fertilized the endometrium or the tissue in the uterus will begin to shed and the cycle begins again, and the corpus luteum decays.
Kelsey Knight: It's a difficult explanation without a visual yet but we will provide a visual in the shows notes.
Chelsea Levy: One thing that you mentioned that I know listeners will probably be wondering, what doesshe mean by that? What do you mean by a temporary endocrine gland. So maybe you can talk about what an underground gland is and then also why it's temporary and the menstrual cycle.
Kelsey Knight: An endocrine gland is a part of our body that releases hormones and so some glands, or actually some organs like the heart for example does release hormones and that's considered a sort of endocrine gland. But then there are some parts of our bodies that just that's their job. They just release hormones. There's other parts of our body that store hormones but that's what I mean, is that this corpus luteum changes every cycle. Because a new follicle is maturing every cycle and a new corpus luteum is starting to release progesterone and it's temporary because it's part of that just that luteal phase and then it decays after a new cycle begins. It's really cool.
Chelsea Levy: Yeah. Obviously when we're talking about the cycle and you mention the fact that typically we think of this cycle being 28 days long. And what you've described is a sort of healthy cycle, if things are progressing the way they should. If all of the various endocrine glands are responding the way that they should, if the hormone levels are where they should be. Let's talk a little bit about what some of the common disruptors are in the menstrual cycle and some of the symptoms that go along with those that are often...either you're told they're quote unquote normal or they're sort of dismissed or disregarded by a clinician. What are some indicators that we can watch out for throughout the cycle?
Emily Varnam: First of all we're constantly holding the duality of challenging normal. And so while we're providing information for people to feel more healthy, more well in their bodies, we're also holding the reality that when you're not in that space, you're still a person, and that wholeness is not necessarily always the goal. You don't have to love your cycle, you dont have to go towards like this elusive normal.
Emily Varnam: Having said that and I feel like that's a really important preface for us, there are things that we are told we are supposed to, just deal with and that's the problem. pain is quote unquote normal. It's not. It's not. It could be your normal. It could be part of something that you experience as part of having a condition, it could be part of that, but we don't want to necessarily ascribe like that's normal for every person that menstruates. It's not. And it's an indicator that we need to respond.
Emily Varnam: And maybe the response is, I know I'm going to have pain during this time, I need to rest. Or maybe the response is I need to change my lifestyle. So we're just thinking about those different responses. So in terms of disrupters just to get back to your question, I think a really common one is just stress. We're under so much stress and so much of the stress is about what we're supposed to be doing and what's normal for us in terms of people who have a uterus. There is so much about society that tells us if you have a uterus we can tell you what you're supposed to be doing. We can tell you when you're supposed to reproduce, we can tell you how you're supposed to look, we can tell you, there's all these things that come along with, I think part of that is creating so much stress for us and stress is this, it really disrupts our bodies balance.
Emily Varnam: It creates what's called the progesterone steal effect. So if we are in a cycle of responding to stress, releasing cortisol in our brains, cortisol needs the same precursor hormone as progesterone. So a certain point like cortisol is just taking all your progesterone.
Emily Varnam: And then we're having like low progesterone and then that balance of what you know the communication that happens during the cycle gets to be off. And we get these like lasting effects of HPA- hypothalamic pituitary adrenal axis dysfunction. So that communication between those three things becomes dysfunctional. We know what it means when we have dysfunctional communication, that's not different in the body. So when those things are working in a dysfunctional way, when the feedback loop you know there's these negative and positive feedback loops. When the feedback loops become dysfunctional, then our body starts to become out of balance and stress is something that I feel like yes, there's tons of stress that we actually cannot tell people that they're able to mitigate.
Emily Varnam: I think when you live in 2018, you're inherently living in trauma. I really think that that needs, I don't think we help each other by not acknowledging that. There is stress and there is more stress if you are undocumented, that's more stress if you are living in a black or brown body. Even just understanding that every time you feel stress, your body is not like oh, I'm just sitting in traffic. Your body is like, I need to save my life by running away from a tiger right now. That's what we're dealing with in fight or flight. We can't be in that all the time, because when you're in fight or flight, you're not thriving, you're surviving.
Emily Varnam: When we are not thriving, our bodies can't, they can't cycle because the first thing that gets cut off when we don't have enough resources in our body is the reproductive system. So stress is one that we really focus on because even just coming back to breathing, things that seem really basic, those things can matter. Those things can really make a difference. Sleeping in a dark room where your body doesn't have to like think about taking in light while it's resting. It's not thinking about taking sound. Like if there's ways that you can optimize your rest, move away from being in relation to things that create stress for you, if that's possible for you. Taking seconds to just like breathe. Those things actually really really matter. And what's told that they matter and until I looked at this relationship I didn't, I was like, don't tell me what matters. Don't tell me that I need to meditate. And once it was put into that biological framework I was like, oh okay, I can accept it now. So it's like whatever makes it makes sense for you.
Chelsea Levy: And I like that, you know, some of the things that you're suggesting are so simple. I think a lot of times we associate this idea that the self-care movement that's sort of happening and really that's, that's a luxury for a lot of people, but something as simple as getting good rest or, meditation is the great democratizer because anybody can do it from anywhere. All you need is your seat and that's it. So I love that you give that suggestion.
Chelsea Levy: Let's talk a little bit about the fact that so often when we think of our cycles, we think of it really specifically as it relates to reproduction and getting pregnant. My own story is that I was one of those young girls who had a lot of symptoms in my adolescence that went ignored or dismissed or I was basically told, oh yeah you have like really debilitating cramps every month that make you throw up and you know you can't move for a day. Well that's just part of being a woman. I was also, my my mom had the same history. Oh well it must be genetic or something that was passed on. So for literally a decade I was dismissed by numerous OB-GYN's.
Chelsea Levy: And it wasn't until I started my own journey of trying to get pregnant which took longer than I expected it to, but ended up being this really wonderful forced education in my body, which I think is how it goes for a lot of women, and understood a little bit more about what was happening and therefore could ask the right questions and could point my clinician in the right direction. And over a decade later diagnosed with endometriosis. And I know that this is a common story, and like you mentioned in the beginning it's not something that we even start to think about or try to understand until we're at that stage in life of trying to get pregnant.
Chelsea Levy: So let's talk a little bit about why ovulation is a positive indicator for health and why, outside of trying to get pregnant. it's important to know about your cycle.
Kelsey Knight: Well the two hormones that we talked about before that are really important to the menstrual cycle, progesterone and estrogen, have over 150 functions in the body. And so they are related to bone health and heart health. And as Emily talked about with stress when someone is ovulating it's just also an indicator that probably those other functions in the body are working as best they can. So that's why certainly our focus is more on body literacy and body awareness than on pregnancy or reproduction, when we talk about the menstrual cycle.
Chelsea Levy: Talking about it in terms of body literacy or body awareness or I've heard other people talk about sort of veering away from the idea that we should talk about the menstrual cycle that we should maybe call it an ovulation cycle or something that is a little bit more comprehensive in terms of everything that's happening during that time. And I think really when you think about it, this information is something that should be given to girls at the same time they're getting their sex education.
Emily Varnam: They're not getting a sex education.
Chelsea Levy: Right. We're getting educated on mostly how not to get pregnant. And so we're taught that we should be in fear of our bodies because we could just get pregnant at any moment. And it's almost as though there's this fear that if we're educated on processes of our bodies I don't know that we might explore them a little bit more. And people don't want us to do that.
Emily Varnam: I think it's just this whole interconnected web where there's so much fear right now that people are really focusing on what they don't want young people to know. And one of those things is they don't want people to know that sex is about pleasure. That we absolutely don't want people to know that. And of course that is really there's so much that goes along with that. For us to be able to really with enthusiastic like really have a yes for teaching that, we have to end rape culture. We have to be able to trust adults. We have to be able to trust our systems. There's so much that has to be dismantled, because you know as Loretta Ross says if we're always defining ourselves by what we're not about, we're not really focusing on what it is that we are about. What does it look like if you win? You know and then in that way always being dictated by the oppressor systems.
Emily Varnam: So I think in terms of teaching people or you know together co-creating saying how we bring this information to young people we we have to hold for them the wildest dreams of what was not available to us. It's really simple conversations, it's really in how we word things. It's in you know what what we don't say in terms of fear and what we do say in terms of pleasure, and in terms of just autonomy, cause pleasure is not necessarily like sexual, it's just enjoyment. You know it's just like being allowed to be who you are celebrating your identity. I also think it's so much about you know when we think about consent. We teach, quote unquote teach young people about consent. We don't show them consent. We don't ask for their consent and we don't respect them when they tell us no. That's not teaching, that's preaching.
Emily Varnam: When we're having these conversations with adults who would like to teach young people. We're like OK, what in your lesson says this is what we're going to discuss, are you emotionally ready to hear this? It is so painful to have to grow up. Like most people's first cycle experience is like oh, I'm not a kid anymore. Like, where's the space for the grief, where's the space for that consent of let's move forward with this conversation?
Emily Varnam: So I think in terms of sex education that part is really missing. And then just like so many of our books and resources are the same pictures of the same skinny cis white woman. We were showing some images recently and somebody was like, okay but what if somebody is looking at their cervix but they don't actually have a hand to you know examine with fingers, like what if what if it was like a fat body. What if it was a person of color. What if it's a trans body. Like those things, if you don't see yourself in the education how is it for you?
Emily Varnam: So That's another part of it is like young people now are so far ahead of us in terms of how they see each other, and how they see themselves. And if we don't keep up with that, we don't have anything to teach them honestly, or what we're what we want to share with them is going to be a barrier for them receiving it. It's really like self reflection, creating resources that offer everybody, and creating this idea of like really dreaming what it looks like when we win.
Chelsea Levy: I love that you pointed to pleasure first off. I feel like there's something really interesting about the fact that we are really taught not to value pleasure or not to value our own pleasure in more things than just sex. And then in place of that we're taught to tolerate pain. And it's just, it's one of those things that when you really step back and you look at it and you start to notice it you see it really everywhere. And it can feel really disheartening. But I think it also can be really motivating.
Kelsey Knight: Yeah I was going to mention in terms of like teaching the menstrual cycle to young people or teaching about charting or how to be aware of the menstrual cycle, Toni Weischler has a great book called "Cycle Savvy." She's also the author of "Taking Charge of Your Fertility" which is like the definitive guide to fertility awareness. And in "Cycle Savvy" she focuses more on body awareness instead of like fertility or ovulation awareness as a contraception.
Kelsey Knight: And so I think for people anyone that feels hesitant to start talking about ovulation awareness around young people, that's one way to sometimes start to broach that topic is like this is more about awareness about not normalizing pain. I mean it sounds like you are experiencing symptoms of endometriosis as soon as you started cycling. And if it hadn't been normalized and that's at the experience of a lot of people, then it's something that they could come to their OB-GYN's with or with their parents, and notice a pattern.
Kelsey Knight: And so yeah I think teaching those signs of like taking a daily temperature or talking about cervical fluid early or talking about cervical positioning early are all such good tools not around contraception like we were talking about earlier or around getting pregnant but just around not normalizing pain and also knowing that-yeah there's other things that you can learn from ovulation awareness like polycystic ovarian syndrome or hypothyroidism.
Emily Varnam: There's also just tons of mental health stuff that is not talked about because if we talk about our mental health in relation to our hormones we're hysterical, we're hormona,l were PMS-ing and we're playing into a stereotype that we have tried to get away from to be more employable. That's what it is. So actually when we're allowed to live in relation to how our bodies need us to live, when allowed to rest we need to rest, when we're allowed to fit our work into the ways in which our body needs us to support it. Then things are different. But Christiane Northrup talks about how the world was set up for the hormonal cycle of a cis male. And office buildings heated for the average body temperature of a cis male. And if you're wearing a jacket at work then you know what I'm talking about. Like it's not, that's not normal.
Emily Varnam: You know our cities are designed with no place to like push a stroller or they're not accessible as there's so many ways in which-remember who planned this world. Remember who authored it and pick some new people as we go forward. You know so we have to think about that too. Like this is not just listening to the cycle. It's like there's so many other places where it fits in. And I think also in terms of teaching young people, relate and communicate are so important you know relating to yourself and really like having these honest conversations reflecting on yourself. Reflecting on your effect on people, reflecting on your effect, you know on yourself, and then communicating. We're not taught like, we may be talk about barrier methods about condoms.
Emily Varnam: Do we ever role play like let's talk about like when this comes up in terms of intimacy. When do we talk about that? Kids ask that. They want to know, like how does we get to it from a to b. And I see adults just not knowing how to have that conversation. They know how to put a condom on, we've been practicing that. You can Google that. You can't Google, oh how and then practice it with somebody and then feel it and then be able to accept rejection, and then be able to give reject- those things. That part. That's important. That whole relating emotional literacy also is part of what we teach to young people.
Chelsea Levy: I think also just the level of confidence that comes from knowing your body. I think that that confidence carries over into so many other things.
Emily Varnam: So I did a birth control doula stuff which was people coming off of birth control and charting their cycles. And they would get their dream job and find the person that they wanted to be with. And then I will be at their birth. And then you know they'll be having a home birth. And not to say that that's like the dream for everybody, but there is something about when you change your relationship to yourself you are in relation to everything else in a different way.
Chelsea Levy: Let's talk a little bit about coming off of birth control. Because we did have Holly Grigg-Spall on, who I know you guys are also fans of. And we talked a lot about sort of what happens in the body when you're on hormonal contraception.
Chelsea Levy: And we talked a lot about sort of the history of hormonal contraception but we didn't really get to touch a lot on protocols for coming off.
Emily Varnam: When I've been doing that work with people I think it's a combination of doula resources, nutrition resources. My original training is as a counseling therapist. So those things kind of come together. And what I've certainly observed people need is to not be rushed in that decision like that's the first step is just to like really sit with the decision and not be rushed. And then to start to think about what is going to be my normal routine. For me, like not normal for someone else, what's normal for me when I come off. So if people are thinking about doing charting, that they, I will even like suggest that people start to take their temperature to to create that habit. It doesn't matter if you are not actually getting a picture of what your cycle is at that point.
Chelsea Levy: And when you say because I know a lot of people listening are going to be thinking take your temperature, what do you take your temperature or? Maybe you could describe what that is.
Emily Varnam: Yeah. So taking your basal body temperature which is the temperature you take after at least three hours of sleep, as soon as you wake up, soon as you open your eyes, like before even sitting up, before drinking any water, before having sex. You would take your temperature and that temperature is your body's resting temperature and you take it around the same time every day. And if you are putting that temperature on a chart. So if you're looking at that temperature and putting it on a graph every day, you will be able to notice when there is the presence of progesterone, that heating hormone that Kelsey talked about. And that is what will tell you the ovulation has happened.
Emily Varnam: Because after ovulation if you remember the presence of progesterone is higher. So it tells us that ovulation has happened and it can tell us a bunch of other things too, and I would definitely suggest if you're interested in fertility awareness method to either get in touch or you know we can put some resources in the show notes, but when people are coming off of hormonal birth control, they may not have ovulated for 10 years. They may have had completely different moods, their sweat may have smelled different, they may have had different cervical fluid, their cervix may not have dilated and moved. So one of the fertility signs is that your cervix moves it's an indicator of the fact that your body is cycling. Your cervix gets lower in the vagina and higher in the vagina it gets soft and it gets firm and it dilates. There's a little like hole in the cervix.
Emily Varnam: It looks like a little glazed doughnut. And there's this little hole the cervical oss and that dilates. And even that is so important. We don't hear the word dilates until we're pushing someone through the cervix. That that's too late to start having a biology lesson. When people are having to learn all of this stuff and become literate with their body, when they are thinking about having a human that's overwhelming. So even just these words dilate your cervix is dilating if you are ovulating and cycling and your cervical fluid is changing it's normal to have different cervical fluid. That's important.
Emily Varnam: You know you might not know when you see cervical fluid showing up for the first time you might not know that it's supposed to change and change is pathologized. If something changes in our body something's wrong and here's this thing where the change is normal. And if we don't have that information, how are we supposed to not - how he's supposed to trust our bodies when they tell us something. We're doing so much emotional and psychological healing when we're coming off of hormonal birth control.
Emily Varnam: So having somebody start charting before they come off, it's in stages. It's not rushed. When we rush it, actually the likelihood is that people go back on. And you never take away the safety net that they can go back on.
Emily Varnam: You always can and you don't have to do fertility awareness method. You don't have to chart. You might want to just you know use a copper IUD. You might want to use barrier methods all the time. You might want to use a diaphragm. There's so many ways. And what's your goal even? Is your goal to come off and conceive? Is your goal to come off and see, you know maybe like all this stress and these anxiety attacks I've been having because of my hormonal birth control. We have met with parents who have lost children to hormonal birth control. There are risks associated.
Emily Varnam: Maybe I was willing to deal with those risks at a certain point because those risks were more tolerable to me than an unplanned pregnancy or an unwanted pregnancy. Maybe that's changed now. Maybe I've reassessed. We're allowed to change our beliefs and we're allowed to change our decisions and our norms based upon that. We don't have to be the same person. I think that's an important thing too with coming off of hormonal birth control. And the specifics of that, honestly we need resources to go into the specifics of that. We need support. There's a reason why people pay me to support them. There's a reason why Erica Chidi Cohen from Loom is doing period coaching there's a reason for that. Because people need support. We're also being pressured by the medical industrial system to be on a medication that we take every day and it's for people who aren't sick. That's what it's designed for.
Emily Varnam: Some people use it to manage illness but most people don't. So coming off as this whole ecosystem of support. It's informational supports, it's emotional support. It's having people within your community who are not like, undermining your decision. It's having conversations with partners. If you are the one with the uterus and you have been ascribed the responsibility for preventing pregnancy, then you need that support. You need to know that they're willing to take on that responsibility too and if they're not, we need to think about like that too. And then there's like nutritional support that we need. Our body uses so much of its resources sweeping out the excess hormones because we've been taking hormones, so all of these xenohormones fake hormones need to be swept out of our body so our alcohol tolerance is much lower when we come off of hormonal birth control because our body literally can't process so much.
Chelsea Levy: Because of liver function.
Emily Varnam: So things like that like if you don't know what to expect if you don't have a plan. You know it even comes down to like people talking to their work and being like I might need to take some days off because I'm going to be figuring some stuff out. Talking to their friends, hey I might need you to come over and like-I mean you just spoke about what your menstrual cramps can be like. If I and I think about this all the time if I had come to a doctor with the symptoms I had in my uterus in any other part of my body, they would have immediately called an ambulance. They would have immediately. And they would have continued to give me treatment until we figured out what was wrong.
Chelsea Levy: In my experience because I did take hormonal birth control from 21 to about 27. And I had resisted it for a long time but I was taking heavy doses of painkillers every month. And here was this fix that my doctor kept dangling in front of me. 'Well you know if you want to solve this problem, you can go on hormonal birth control.' And I never really felt that it was the right decision for me. And it sort of felt forced on me. It felt like I was in college at the time I couldn't really manage the potential of the first day of my period falling on a midterm.
Chelsea Levy: So it was the security of knowing OK, things will be quote unquote regulated from here. And then when I did come off, my gynecologist who wasn't even the same doctor who prescribed birth control to me, said to me, well you know all of your symptoms will come back if you want to try to come off. So you know why would you do this. If you don't want to get pregnant right now. So then of course there was this fear around coming off. And OK what what is this going to feel like, what is it going to do in my body. Is this gonna to take me right back to where I was six years ago.
Chelsea Levy: And I remember you know feeling like there was a voice in my body that was trying to speak to me and I had really quieted that voice with birth control for six years. And then you know years down the road when I was trying to get pregnant. It was sort of affirmation that that instinct was correct, that there were symptoms that I was numbing through birth control that might have been addressed much earlier had I not been on birth control. So you know again I know that that is a common story for a lot of women.
Kelsey Knight: Yeah. I mean another big motivator for us in doing this was because of the conversations that it sounds like you had with your OB-GYN where they totally disregarded what your personal goals were, and they didn't actually provide you with an informed choice about what it was going to be like to come off of hormonal birth control or maybe what some of the other options were besides hormonal birth control instead it was fear mongering.
Kelsey Knight: It's like information that they gave you is technically accurate. Okay you might get pregnant, after you come off of you know, if you're not taking other measures you might may be ovulation after you come off of hormonal birth control some symptoms might come back but the way that they were communicated was totally disempowering and scary. And so we talk about how to advocate for oneself with a provider about how providers hopefully are speaking with people. When we talk about in doula trainings they often talk about this acronym BRAIN, where B stands for benefits, R stands for risks, A for alternatives, I for intuition and N for nothing. And so that's for listeners out there sometimes that's a quick way especially when you're nervous in a doctor's office.
Kelsey Knight: Some people experience white coat syndrome or just the presence of a white coat can increase their blood pressure. We're see these people we're taught to see these people as authorities on our bodies even though that you all are the authorities on your bodies. And we get nervous in front of them especially when it's a topic that's sensitive to us.
Kelsey Knight: And if we don't have a support person there a friend a doula sometimes we forget the questions that we even wanted to bring in. And so that like quick acronym can sometimes be helpful in asking okay what are the benefits of this. What are the risks. What are my alternatives. Intuition is a question to yourself, about what are you feeling in this moment, or about this decision and then the nothing is, not everyone can do this, sometimes you live miles and miles away from a doctor's office or you can't get a second appointment. It means you have to take off work and that's just not a possibility. But nothing might mean, hey can you can the healthcare provider walk out of the office for five minutes while you take a few moments to think about the decision or it might mean, hey can I make a second appointment and come back and think about this. Emily and I's background is in childbirth and so we would witness these interactions between patients and doctors that were violent, in which people's decision-making power was removed from them and they didn't know how to talk with their providers and their providers were not talking with them in an ethical way.
Chelsea Levy: And I know that if Patti and Aleks were here right now they would have so much to say. And I think that the truth is that it all starts from that base knowledge of how does my body function. And it's not just because that's empowering and stimulates confidence and makes you feel like you have the tools to have conversations with your doctors. But it's also because when we reach the stage of pregnancy and then childbirth, if we don't know what our bodies are capable of, it all seems impossible. And it seems like, I can't do this without someone else telling me what to do guiding me through this. We don't trust that we have everything we need within ourselves.
Emily Varnam: And we haven't had access to even witnessing that. For you know many of us if we have not been in community where birth is normal, if we haven't been in community where bodies are normal. How would we know? It's part of an intentional business model to not give access to information about our bodies. We have to hold that as truth. It is intentional. Knowing about your body even if you want to make the exact same decision that your doctor has recommended, knowing about your body and making that decision from an informed place is resistance to a system that wants to keep you dependent on it.
You know that's why it has to eventually, we can have midwives we can have doulas. And that's amazing we need options. Until people, individual people, decide what they want for themselves. And we have the support in our communities and the trust of individuals to do that. We will not do this. Until people make those decisions. And that's not to say like that's not to assign blame to people. This is a systemic issue. It's not the fault of the individual if they don't know whether cervix is, they were never invited to know But that is the power that we have. So we you know we can take that as an individuals and it's up to each of us to think about how we fit into that. Even like the way you talk about your own body is about the young people who are listening to you and learning about their body by how you talk about yours, or how you talk about somebody else's.
Emily Varnam: And we know that because you know there are parents out there who are like, how do I talk about racism to my kid and I'm like, look at your own whiteness. Look at it. You know there are there are white parents out there who are like, how do I like. I don't want this to be happening and this is so terrible what's happening over there to them. And it's like so much of this is we look inside ourselves and we we have to face up to some things. So you know I really like taking the time to think about how we individually are involved in systems we all live within them.
Kelsey Knight: One thing I learned about recently that I thought was really amazing was that each cycle, there's a rupture and a healing that occurs when the egg ruptures out of the follicle out of the ovarian wall and then the ovarian wall heals every cycle. So just to think on that.
Chelsea Levy: So in the context of healing let's project out into the future and talk about the positive momentum for change that I think we're all starting to see and feel in terms of generations coming up behind us and mothers becoming more informed to teach their own children.
Emily Varnam: I actually really love that metaphor and I think that the rupture is probably where a lot of us are at right now. I definitely I think this just is not possible for me to relate to this in a nonpolitical sense, but I think for example something like the 2016 election is a rupture, a huge rupture. It's a huge like political and an environmental disaster in many ways.
Emily Varnam: And that's the rupture. And then the healing part for us is like acknowledging that deeply sitting with that, grieving, you know looking at ourselves, looking at what happened, looking at our histories, really acknowledging and taking responsibility. And then and then the healing part. Like then that that is able to happen because of this huge rupture because of this huge wound and then everything can kind of rush in. Like what happens in your body when there's that wound right. So then all the healing can kind of happen and we have this new purpose. And I think yeah, there's lots of things that we have planned I'm going to let kind of talk a little bit about what that means in a non metaphorical sense in a very real sense for the fifth vital sign.
Kelsey Knight: I think one other thing maybe I'll ask you is something Emily and I did a couple months ago the fifth vital sign has had many iterations were always growing as a business start as an organization. Because we're always growing as people. And we walked to the park and sat on a bench. Emily asks the question of like so in an ideal world what is equity for menstruators. Like what would we want in an ideal world for menstruators. And honestly that question was hard for me.
Kelsey Knight: I think the first thing I said was like free menstrual care products which is great, right, which is necessary, but that's the farthest I could go, when someone asked me that question, because it's because it's not something that we're often asked.
Kelsey Knight: But Loretta Ross, who is one of the founders of SisterSong reproductive justice collective for women of color, just talks about the importance of like knowing what you're fighting for. Or else the oppressor is always defining your struggle. And I wasn't quite sure what my ideal world looked like because I'd never taken the time to imagine it.
Chelsea Levy: Thank you so much for coming on and her sharing all of your knowledge.
Kelsey Knight: Thank you.
Emily Varnam: Thank you.
Chelsea Levy: Emily Varnum cofounded the fifth vital sign with Kelsey, because she trusts people to know themselves and believes every person has the right to information and resources. She has spent her life working with families as a doula, nanny, therapist and friend. She offers birth control doula sessions and is currently a tour nanny for a band with two babies.
Chelsea Levy: Kelsey Knight is a registered nurse specializing in childbirth and a lactation consultant in New York City. In college she worked as a birth doula, which opened her eyes to the imperatives of informed consent and health care as human rights. She cofounded the fifth vital sign and response to the lack of informed consent she witnessed as a labor and delivery nurse.
Chelsea Levy: For more information on the fifth vital sign head to fifth vital sign dot com, that's five TH vital sign dot com. And follow them on Instagram at the fifth vital sign. I hope you enjoyed today's conversation and that you might have taken away at least a few things that you didn't already know. We just barely scratched the surface here so let us know what else you'd like to hear. Head to our website that under the podcast dot com and go to the Contact Us page.
Chelsea Levy: If you like what you're hearing please tell your friends. It really helps our podcast grow and helps us spread the word. We love seeing your tags on Instagram so be sure to follow us at under the hood underscore podcast to stay up to date on our latest episodes.
Happy listening. And we'll see you next time.