Ep 58 with Dr. Tracy Shevell

Ailey Jolie: 00:06

Welcome to In This Body, a podcast where we dive deep into the potent power of embodiment. I'm your host, Ailey Jolie, a psychotherapist deeply passionate about living life fully from the wisdom within your very own body. The podcast In This Body is a Love Letter to Embodiment, a podcast dedicated to asking important questions like how does connecting to your body change your life? How does connecting to your body enhance your capacity to love more deeply and live more authentically? And how can collective embodiment alter the course of our shared world? Join me for consciously curated conversations with leading experts. Each episode is intended to support you in reconnecting to your very own body. This podcast will be available for free wherever you get your podcast, making it easy for you to stay connected to In This Body, the podcast with me, Ailey Jolie. Welcome back to How to Be in This Body with me, Ailey Jolie. Today I'm joined by Dr. Tracy Shevell, a maternal fetal medicine specialist, women's health advocate, and the author of the upcoming book, Labor and Deliverance. Tracy spent over two decades as a high-risk OBGYN at some of the top institutions in the United States. Columbia, Mount Sinai, 17 years at her community hospital, delivering thousands of babies and caring for women through the most vulnerable and high-stake moments of their lives. She's also a two-time NICU parent herself and someone who's been on both sides of the examination room in the most literal way possible. And then the system started to fail. At the same time that the system started to fail, not just her patients but her, Tracy developed a complex mystery illness and experienced firsthand how dismissive the medical world could be, even to one of its own. And when this happened, she states something broke open inside of her. She'd spent her career asking women to trust the system. Now she was learning what it felt like when the system didn't trust her back. What followed was a reinvention. Tracy left hospital medicine in the middle of the pandemic and began building something entirely new, a platform where women could access the kind of care she'd always wanted to give, but couldn't within the straights of a seven-minute appointment. She explored functional medicine, energy work, therapy, and began writing about the intersection of the medical, the emotional, and the spiritual. Her substack, More Than Medicine, says it right there in the name. True wellness is not just physical. It never was. Today we're exploring what happens when a doctor becomes the patient, why self-worth might be the most important medicine women aren't being prescribed, and what it actually takes to advocate for yourself inside a system that wasn't designed to listen. It's an honor to welcome Tracy to how to be in this body with me a leisurely. What does being in your body mean to you?

Dr. Tracy Shevell: 03:17

Feeling at home. And I think it means feeling like you can handle what you're feeling. I love that.

Ailey Jolie: 03:24

Thank you for bringing that piece in around feeling home and being able to handle what we're feeling because I know a little bit about you from kind of inviting you and doing my research. And I know that you have kind of described yourself to be a rule follower or really embodying the doctor who had all the answers. And I would love to hear from you what it felt like to be inside that system and what maybe your process of leaving that system has been like.

Dr. Tracy Shevell: 03:53

So it's really interesting because I was in the system. And then when I quote unquote left the system, I figured out how to sort of try to renavigate the system and re-enter. And not just for myself, but for women in general. And so being inside the system to me from a younger age always seemed, I knew I was a healer. I knew I wanted to work with people from being very young. Um, you know, being a doctor was the ultimate like good daughter, good grandchild thing to do. Um, that wasn't why I wanted to do it, but it was something that, you know, really smart kids did to be healers, to work with people. And so um I think that that always seemed like sort of the golden ticket to me. But also I felt like when I arrived in medical school and started learning, I felt very much like this was what I was meant to do. And also I think deep down, I now know in retrospect, that I felt like the medical system was like very fatherly and paternal. And doctors always fixed things and made things better. And I always subconsciously, I think my whole life had been looking for that. So it was going to teach me how to give that to other people. But I think also at the same time, I saw it as a way to get it for myself. So, you know, exiting the system, I exited the system in the pandemic after um a very toxic sort of situation that I was in. And um one in which I went from being a consultant to patients who had someone to go to, to really not having my patients know who was even taking care of them because it was so systematic and systematically based. And I was went from being a specialist counselor, an educator to being someone who was teaching women how to game the system because they couldn't get seen, they couldn't get heard, and I wasn't being seen, and I wasn't being heard. And I felt like my life was being put in danger during the pandemic for a system that wasn't really giving back to me. And what I was doing, I very quickly realized during the pandemic, because mental health care went online, very quickly realized that I could continue doing all the things that I was doing that other people couldn't. So I started to think about the system. I'm like, what was what's missing from the system? Well, people can do scans and ultrasounds, people can deliver babies, but people aren't getting the other stuff, the synthesis, the detective work, the support. And I felt that it was not just a responsibility, but a gift that I had been given by caring for so many thousands of women to allow their stories to inform how other women experience their own triumphs and tragedies. And that's when I sort of decided to reinvent. And, you know, that led to something small at first. And then I realized that in order to bring it to more people, I needed to create some form of a platform where I could really speak to not 10 women in a year, but hundreds and thousands of women in a year, because I had something to teach them that I had learned myself, but also that my patients had taught me. And so, as uncomfortable as it was for, you know, a midlife doctor to figure out how to use social media and write a book, I figured I might as well try. And, you know, that that spirit of sort of entrepreneurial going outside your boundaries isn't a thing we're taught at all in medicine. So it was, it was hard. Um, but it's been it's been great so far.

Ailey Jolie: 07:51

Where do you think that spirit to go outside the boundaries and really advocate not only for your patients, but for women's health in general? Where do you feel like that really came from?

Dr. Tracy Shevell: 08:04

I think underneath all of the people pleasing and rule following, I think that sort of who I am at my core, sort of my soul's purpose to be here, is probably someone a little bit different. You know, is a little bit more rebellious, is a little bit more of a fighter, a little bit more of a mama bear. Well, I've always been a mama bear, but I mean it in a sort of protected, fierce way. Like I'll eat you if you try to hurt my babies. Right. I think it just took time for me to sort of strip back to figure out who I really was.

Ailey Jolie: 08:40

I would love to spend some of our time together today, but might end up being a lot of our time together today, really bringing the wisdom that you gathered, not only in your journey of coming home to your body and creating health and well-being, but also what you have seen to be really supportive for women. So even just focusing in on what are some of the things that you wish more women knew about their own health and their own body?

Dr. Tracy Shevell: 09:08

It's a complicated question, but there are many simple answers. First is that the most important thing that women need to understand is that even though this doesn't sound medical, it's important for every aspect of being well. And that is that self-worth will get you better faster. You have to believe that you do not have to apologize if you just have one more question for your doctor. You have to believe that you are competent and capable of learning basic anatomy, the names of basic medications, how to not be

Dr. Tracy Shevell: 09:51

afraid of authority when you're in the medical system, because we live in this pretense of yes, doctors, of course, are authority. We're asking them to take care of us and fix us and trust them. But just because we trust someone who knows more than we do about a subject doesn't mean that we aren't allowed to be a partner in that relationship. And also, I think that it's really important for women to understand to the best of their ability what's happening to them. For example, I know so many women who've written in to me about whether or not they need hormone therapy after having a hysterectomy. And I, of course, my next question is did they remove your uterus and your ovaries? And women don't know. So that just is a perfect example of we lose organs for problems and we don't know what they're called. And so that's really important. And then the last thing I think that's really, really important for women to know, right? To to fight for this is that unfortunately we all are doing and taking care of everyone else all the time, that it would be super nice to just think the doctor is going to take care of everything. But ultimately we are responsible for the gatekeeping. And a doctor may just be one piece of keeping us well. Right. I really believe that for women, especially, there is a medical, an emotional, and a spiritual component to being well. And no one doctor, probably, unless you're really lucky, is going to umbrella all of those things for you.

Ailey Jolie: 11:46

I want to go back to the piece around worth. And I'm gonna really try to not not reference too much my own personal experience because uh I definitely have become the patient who will ask all of the questions and advocate in that way. And I actually feel really blessed that I learned that through my male consultants and my male surgeons who are just like, ask me, you know, ask me all of them, like every last thought you have in your head, and really push me to do that. And I think that is a beautiful pro of maybe some of how the British system is set up in comparison to Canada, where that would never, ever happen. So I would love to speak to you around why you think that worthiness wound gets so poked in medical settings because I've definitely worked with clients where everywhere else in their life, seemingly they they act in their word, you know, they say what's on their mind, they ask the questions, but then they tell me about their appointment with their OBGYN and they ask zero questions. Like they just what have you felt or what have you come to learn is going on in that interaction that leads so many women to just completely shut down?

Dr. Tracy Shevell: 13:00

I think it's so many things, right? I think that um, first of all, our system unfortunately is set up in a way where volume and the business aspect of medicine has really become undeniable everywhere in every aspect. So I think women walk into their encounters with their doctors already feeling behind the eight ball and like they've got to get blood from a stone a little bit. And I think that it sets up almost a power dynamic, even if you love your doctor, that you feel

Dr. Tracy Shevell: 13:43

as a woman like you need this person to help you. So how can you get the most out of as little heart as you have? And also we want to be liked so badly by our doctors because we all feel that if they like us more, they're going to take better care of us. So it's this like, how can we behave properly? Like you mentioned going to the OBGYN. I mean, how many freaking people get all like prepped and ready for the OBGYN? And we literally do not care. Like we really truly don't. And you know, you come in, people have folded their pretty underwear on top of their jeans or they're hitting them. I mean, it it's it's just um, and I don't think, sadly, I don't think that's the wrong response. We have to just realize before we go and we have to write down our questions on a paper. And that's why one of the things I always say to women is you can acknowledge what's going on in the situation before you even start because you're allowing the doctor to acknowledge that yes, they might be rushing. And yes, they've got 30 patients in the waiting room. And you can say to a doctor, I know you don't have a lot of time, but A, who can answer this question if you can't? And B, try to prepare before the visit to get as much targeted information as you can. Know what you're going for, write it down. You can even do what I say, like AI can be a game changer for a lot of people. You can even ask AI, how do I best prepare for this visit when what I really want to talk about is X in seven minutes. What are my top three questions? So if you go in prepared to extract what you need, acknowledging the situation's limitations from what they are, I think that takes a certain amount of self-worth to feel that you are worthy of that, not just walk out and be pissed that you didn't get better care. We know it up here, right? We know in our heads that a doctor should be nice to us and should be treating us well and should be answering all our questions. But we also know logically, and this is where the disconnect is, that the doctor should be sitting down and talking to us for half an hour, and they're not. So that's where that piece is that you have to value your own experience. And you also have to acknowledge what's going on.

Ailey Jolie: 16:11

I will ask you, as the person who has been there, not being able to give that 30 minutes, what has that embodied experience been like for you? Because I have so much information on the receiving end from clients. But for you as the physician, what is it like to feel so constricted knowing what's actually going on in that patient's mind and that they probably are shutting down, or maybe you've even seen that in front of you?

Dr. Tracy Shevell: 16:36

I mean, I will acknowledge I am lucky in the work that I do because I've seen like some really, really dark things and I've gone through some really dark experiences. I found that if I know there's something more going on, I can take a hand and put a hand on someone's arm and say, what do you really want to ask? Is there anything else that you haven't asked? Is there anything else you don't understand? And if I can't get it for you, I'll help you read about it, or I'll help you get the right information, or I'll print you a paper that you can take and you can interpret and then come back. And to be fair, before now, when I was in the hospital system, the thing that eventually kind of drove me to the breaking point was what I would typically say was, here's my cell phone. And the moral and ethical burnout of not being able to do enough for anyone started to become just soul crushing.

Ailey Jolie: 17:41

I love that you named that because that's been something that I've heard from many of my clients. It's just like them feeling that frustration. But oftentimes we don't have physicians that are naming that on the other side of that interaction. It also feels terrible to be overstretched. And if you feel comfortable, I would love to just even speak a little bit or spend some time on moral injury, which is what happens when we are working in a system that is vicariously traumatizing us because it isn't set up well. Because it does sound like that was the thing that led you to leave. And I actually haven't heard a physician speak about this phenomenon at all.

Dr. Tracy Shevell: 18:19

There is a um there is a tremendous amount that is starting to come out about moral injury physicians. Um, there are companies that are set up to work around physician burnout. There are wellness days and residency training programs. And the reality is it's the kind of thing that we have to be careful talking about too loudly because the woe is me from the doctor isn't really appreciated from the patients, but is something that physicians are incredibly aware of. Um, and again, it's, you know, quietly there are attempts to address it, um, but it's really, really hard. I mean, there are so many people, it still is incredibly hard to get into medical school. There are certain accommodations that have been made to address it. So in obstetrics, for example, um, many, many hospital programs now have what are called hospitalists on their labor floor. So they work. So, for example, a woman who is a hospitalist at a hospital near my house takes three 24-hour calls in a month. And that's her whole job. So it's for somebody who loves doing obstetrics, she won't really do a lot of gynecology. And those nights that she's on call, she will cover for several groups. So the call schedule becomes less so that the volume becomes more manageable. And that is the case, not just in obstetrics. For example, if you are admitted to a hospital with a medical issue, oftentimes your doctor, even if they're a quote unquote concierge doctor in the United States, won't be the one managing your care in the hospital. Hospitalists will. And so there is an attempt on many levels to help the understandable moral injury. Um, but I'm not sure those solutions are making medicine better for the patients. I can promise you, as a doctor, when you become a patient, you're not very happy that your doctor is uh handing over control to a hospitalist. It's it's it's not a perfect model. Um, but it's definitely recognized in the medical community. And there are definitely um slow but um important things that are being sort of put in place to try to work with that concept. It is, it's it's pretty clear. And there are many physicians who are reinventing themselves because of it. I mean, a couple of years ago, like you didn't really see doctors teaching anything on social media, right? And the world's changing and there was no AI, and it's different now. It's different. So I think that, you know, things evolve to fit the picture over time.

Ailey Jolie: 21:19

One thing that you named that is different, and I think that there is more awareness coming around was the second answer to your question at the beginning around women really honoring that a doctor is one part of their care team. And I would love to spend a little bit more time on that, maybe even exploring with you what are some of the other members of a care team that are super important, or how do we even kind of take off this mindset of like, oh, the doctor should like have all the answers and that's where I should go to get well. When I know definitely in my experience, it was like many doctors with their many practitioners they recommended. And it was really actually quite a village. Um Which required a whole different mindset from myself. That's right. You had to be a quarterback.

Dr. Tracy Shevell: 22:07

So the first, the first and most important thing that I always talk about is that you can keep it as small or as big as you need in terms of your village. If you have complex mystery illness, your village may be very large. If you have one or two medical problems that are fairly straightforward, your village may be smaller. But one very important thing that I talk about a lot is there is a very, very popular book that everyone's heard the title of called The Body Keeps the Score. Okay. We know that that's true. We talk about it all the time. Doctors will tell you that that's true. And we also know that autoimmune illnesses are comprised of 80% women. And we also know that there are personality traits for women who tend to more commonly get autoimmune diseases. So that being said, there is a large, large, large, it's been validated all over. There is a standardized screening tool called the ACES screening, adverse childhood events score. It is tests that can be gotten online, it can be printed out. You can answer it. I tell everybody to always have a medical notebook. You can put it in your medical notebook. But even though we know that the higher your score is on that tool, the more likely you are to develop cancer, diabetes, heart disease, stroke, not a single physician asks to see that test. Maybe a therapist will every now and then, but we know it causes mainstream medical issues. So my follow-up then is if we know that this is the case, and if we know that women, for example, have a lot of autoimmune illness, I think it's imperative that women, if they're struggling with anything with their health, think about what they're doing for their emotional well-being, whether that's a support group, whether that's a women's circle, whether that's a therapist, whether that's two therapists, whether it's meds.

Ailey Jolie: 24:28

Can we dig into that piece a little bit? Why do you feel like the spiritual component is so important?

Dr. Tracy Shevell: 24:33

And I know this is going to sound like awfully cheesy, but it's true. Even if we don't have children or we don't choose to have children, women are capable of growing and sustaining and feeding another human being. And that is a freaking miracle. And it's magical. And women's cycles are affected by the moon. And women were called witches generations ago. There is something just, sorry, guys, and you know, whatever, but there's something about women that is physiologically different than men. Um, all the way down to, you know, hunters and gatherers.

Dr. Tracy Shevell: 25:12

Um, it's it's been the same in many cultures and traditions and generations. So I think that to deny the fact that there isn't something a little bit magical about women deprives us of all the little fun things that we like to talk about at dinner parties when we think no one's listening. I was at a book club dinner about a year and a half ago. It was a table of about 10 women, a lawyer, top financier, two doctors. I mean, really, it was a highly specialized, intelligent group of women and all very successful and accomplished. And at one end of the table, someone was talking about a wellness retreat they had just gone on. And in talking to her neighbor, she said something about working with a shaman. And the entire table of women got silent, all turned their heads. Every single one. I was like, wait, what? What? And my friend had the guts to be like, she wasn't embarrassed about it. She didn't think it was woo. She's like, I don't really care if you guys think this is stupid or whatever. This is the experience I had. Every single person at that dinner left with that phone number. Like, why is this, why is this not okay? Why is it okay? So I am the first one. I don't really care if my kids make fun of me. I don't really care if my husband thinks I'm like nuts. I don't really care. But I've worked with a channel for years. I've done every, you know, woo-woo thing there is to woo. Um, and a lot of it has been as helpful as certain medicines I've tried or certain other things that I've tried. And I think that um it's very rich to feel like that matters. Um, because again, I think that ultimately with this deep wound that we all have of loving the idea of someone taking care of us, it's really nice to feel like you're a part of something there.

Ailey Jolie: 27:18

I'm gonna ask you this question and we can stay with it or we can not. And before I ask it, I want to give the disclaimer, I'll use this word. That even though I deeply believe that this is my personal experience, I don't extend it out to anyone else. This is just what I feel is true in my body. And I will just um, I guess I'll reference uh, I can reference some of my surgeries. This was a few years ago, but they found I had polyps down my digestive tract. And so, you know, we do it in endoscopy. Unfortunately, we had to do that twice because the first one was went a bit rough, but we got to the second one. It was actually a really cool experience. I had an AI probe. There was like held by like, I didn't think there were like 12 male surgeons in the room. It was so deeply healing. But when I woke up and I went to I couldn't even kundolini activation process like two weeks later, I couldn't feel the embodied experience of an eating disorder in my body anymore. Like I couldn't bring forward that memory of what it was like to live in an emaciated body. I I remember it cognitively, but the actual sense of control and self-hatred around my body image, still to this day, I can't feel it. And all of my surgeries for me have felt like such deep ceremony in such a spiritual way. And I'm so glad that I've had anesthesiologists who've welcomed me playing ceremony music as I've gone under and have held my hand and been down with my experience. But I would love to talk to you a little bit about just even that concept there of bringing spirit and medicine together or how the body maybe, you know, is holding things. You know, that's my language from my experience. I definitely think my polyps were related to my eating disorder. That's my truth. Might not be anyone else's. But I would love to hear from you kind of maybe some experiences you've had, or how you blend those things together when you're working with a patient or in your embodied experience.

Dr. Tracy Shevell: 29:13

So, first of all, everybody listening is going to be like, who are your GI doctors? I'll fly to London to have them. Like, I mean, what? And so I will tell you that I think that anytime anything from the spiritual world is requested by a patient, I think it even makes the doctors feel better. I think it makes them feel a little less responsible. Um, I've had a few experiences where spiritual things have entered the room without my asking, but with a patient's ask. And it's been incredibly powerful. Um, I think that um I wish more people did it. Um, I wish more doctors did it, um, because I do think in some ways we are, as physicians working in the hospitals, especially and in offices, we are so automated. We are working like robots and we all care. But even if we care, it introduces a different element. And I think I listened to your story, and those doctors must have been like, let's go. What is this? It certainly made their day more interesting, right? And maybe if anyone thinks that it helps, well, you know what? Amazing. Amazing. I mean, I had um I had one really great experience and one difficult experience with spirituality. Um, and you know, obviously with birth, there's all different permutations of, you know, hypnobirth and ritual and ceremony, but that's a separate topic. But I remember specifically doing a delivery, a C-section, uh, on a very, very religious woman who's having triplets. And there's certain rituals as babies are born with prayer and prayer ceremonies. And I happened to be Jewish. She was an Orthodox Jewish woman, and the anesthesiologist happened to be Jewish, and he was fairly observant and could read Hebrew. I don't really. And she asked him, could he please, as the babies were being born, could he please read these prayers out loud? And she put a picture of their religious leader in each of the bassinets. And it was the the resident said to me that was the coolest, first all triplets are cool to deliver, but just the added element that there's prayer happening as the babies are being born. We're all sobbing. I mean, the whole room's like, oh God, it's so beautiful. Um, it was, I will always, always remember that. Um, it was tremendous. And so that's just one example. Um, and the other example was a very difficult situation. Um, I had ironically just come back from a trip to Jerusalem and I had gotten a very special bracelet. Um, and it was, you know, one of the lovely things about Jerusalem is it's the core of every major religion, right? The Dome of the Rock, the Church of the Holy Sepulchre, the Wailing Wall. It's all right here. And I had just come back and I was in the emergency room, and a patient came in who was very devout Baptist. Um, she basically had had a terrible stroke. Um, it was unclear if she was going to make it. I had to walk and to tell her family they were praying to Jesus. Um, there was a whole, and I just don't know what came over me. But all of a sudden, I was her sister was the spokeswoman for the family. And I don't know what came over me. I was like, here, here's my bracelet. This comes right from outside of the church of the Holy Sepulchre. Put this on, don't take it off until she's better, and just keep praying. Because literally her prognosis was insanely grave. I said, just keep praying. Like, let's pray. Like, pray wherever you want. I've done prayer circles for Jehovah's Witnesses before a birth, and I'm praying hard that they don't bleed. And I my hand to God, that woman walked out of the freaking hospital, and I got my bracelet back. Sorry. Like the day she left. I don't know if there was divine intervention there. I'd like to believe there was. I'd like to believe there's something, you know, bigger that miracles are capable of happening that are bigger than medicine.

Ailey Jolie: 33:45

It's really encouraging to hear a physician say that they still believe in miracles because I've definitely been in rooms where a little bit of that belief would have been really nice at the start. I mean, obviously, no one wants to give false hope. But uh yeah, I can really appreciate how helpful that can be. Uh, so thank you for sharing your belief in miracles. And I would love to know where your sense of spirituality has come from. You've sprinkled a few things so I can make up a story, but I'm also curious if being in the realm of medicine has also maybe cultivated your sense of spirituality. Yeah, I I recently had a surgery. I had my breast implants removed and my surgeon Yeah, it was an amazing experience. And my surgeon just said a few things that made me go, Oh, you're like, you're, I think you're a little bit more spiritual than you let on here. Amazing surgeon. Um, have nothing but positive things to say, but I would love to hear from you where maybe some of yours came from.

Dr. Tracy Shevell: 34:45

Oh, okay. Um, so I grew up culturally religious, meaning, you know, the cultures of being Jewish, you know, bagels and locks on breakfast, and we, you know, just sort of I grew up in a very Jewish town and it had a certain personality, kind of like New York City. It was a suburb outside of New York City. Um, went to temple, uh, not so observant, got married, got a little bit more observant because my husband needed two sets of plates, fine, whatever. Um, and I was always happy about that, but it was not really a sense of spirituality in the true sense. It was more of a custom following. And I think that there were really two major turning points. The first was um when I was a third-year medical student in the

Dr. Tracy Shevell: 35:29

United States, we do every core rotation third year of medical school or second in some schools. And then you decide what you want to go into. And my last of all of my clinical rotations was OBGYN, and that was the absolute last thing on my list of what I wanted to do. I entered medical school knowing I wanted to go into internal medicine, do infectious diseases, and open an AIDS clinic. That was my jam. And when I did OB, you know, I went to an all-girls school for college, but I had never really been like a raging feminist. I was never, you know, like there is a specific personality trait that wanted to do OB. They were surgeons, they were badasses. Like I was like, I like to think about things and play Dr. House. And, you know, after the intellectual sort of rigor of the medicine wards, I go to this rotation. I had hated my surgery rotation, and I walk onto a floor of laboring women at Jacoby Hospital in the heart of the Bronx. Hardcore, right? And I'm like, what in the holy hell is this? Women are screaming. I mean, it's like all hell is breaking with some, what is this? And my initial instinct was to run the other way. But, you know, my first few births of watching a woman who is a primal, screaming, feral beast being sort of, you know, sort of it was this plague, like I'm like, oh my God, what's happening? And then all of a sudden, there's a baby in the room. Sorry, I really should still talk about this, but like I was like, oh my, I I I felt like I had like witnessed I don't know what, and I couldn't get enough of it. And looking back, now I can put words to it because I never really understood. You know, I was just so fascinated with it. I thought it was just a like a, you know, an obsession I couldn't shake. It was like I needed a fix. It was an adrenaline rush. And I almost went into medicine. And at the last minute I changed and went into obstetrics. But that was really my first without knowing it. That was my first sort of foray into spirituality, becoming more spiritual. Because obstetrics to me is where medicine and the divine connect, right? We know so much, but we know so little about how a baby forms, how a baby's born, when it goes wrong, when it goes right. I mean, we can only do so much. So that was my first sort of unknowing sort of foray into deeper spirituality. And then things really changed for me. Um, oh, I'm so glad I'm telling you these stories in this order because now it all makes sense. So my second sort of turning point um was after I had had my first child, I, of course, being a high-risk Obi-Guy N had a horribly high-risk pregnancy with my first. Um, and I was just like, I'm not doing this again. I had grown up an only child. I felt like I was being greedy to want another one. Um, I was kind of like afraid and done, and I was convinced that I was going to die in childbirth. I knew exactly what would happen to me. I knew exactly like I had seen it happen to people. I was like, this is not gonna happen. And I will never forget after my triplet patient delivered, she is um an observer of a certain branch of Orthodox Judaism that does a lot of outreach and does a lot of explaining. And I knew I believed in God, but I didn't really know anything about religion. And so um I I I answered her question at her post-op check when she she now has five kids, right? With the triplets at this point, it's fine. So and she was always pleasant, and everybody was like, What is she on? Because I want some. And I said something to her and she said, Are you gonna have another kid? And I said, I'm afraid something bad's gonna happen. She said, Would you mind if I took you somewhere? And I was like, What? She was like, Do you mind if I take you somewhere? Would that be weird since you're my doctor? And I was like, I'll go up wherever. And she took me to sort of their site to pray. And I asked her questions for an hour and a half the whole way there. And she said something I will never forget. And this was the beginning of my becoming more spiritual. You don't pray to God for a healthy baby. God, it's the one thing that He's supposed to do for you. That's that's that's your be having a baby. God is supposed to be giving you healthy. You don't have to pray for it. You have to just say, This is what I expect. Now, I never could really fully embrace that mindset. I was too scared, but it was when I started becoming much more curious about spirituality because I saw how it impacted her life and I wanted it. And I wanted to mean more than I wanted something to take care of me and guide me to another pregnancy alive. And I really started leaning into being a more spiritual person, more spiritually curious. And then when I got really sick, by the way, it was the third time.

Ailey Jolie: 40:53

I wanted to, I'm gonna go back. I want to ask you around what you wish maybe more women knew about birth that might help them with some of that anxiety. Because I don't know, obviously, I don't know what it was like historically, but I definitely feel like I'm in a generation where women are quite terrified about the process of birth and feel like quite confused and conflicted around at home or in hospital or with a midwife. And there's a lot of judgment around which choice you do and do not take with superiority. I mean, I know for myself when that day comes just based off my anatomy, I've been told you need to be in a hospital. Like this is gonna be the option for you based off your cervix. That that is that's the one.

Ailey Jolie: 41:36

And I'm so grateful. And so that just makes it actually quite easy for me. But I know a lot of people there, it's not that easy. And so I'd love to hear from you maybe some of those pieces around the fear.

Dr. Tracy Shevell: 41:47

So I think that one of the hardest things is that the toughest critic of women tend to be men, but a close second is with other women, right? We aren't really support, our our whole society is extremes right now, right? You can't be in the middle, you can't be anywhere. Everything you're doing has to be justified because you're not doing it the way someone else is. And I think that everyone needs to be curious about the things that they may not believe when they approach birth. It is a very, very dangerous time. In the United States right now, maternal mortality is higher than in any other developed country in the world. I mean, that's yeah. And it is having a child is let's just acknowledge what's real. It is a scary thing to do. Things go wrong. My unfortunately, in my experience, it seems like things go wrong a lot because I'm seeing a skewed population. But most of the time, everything is okay. However, the biggest problem with birth that people do not realize is not about if your baby plops out in a bathtub or plops out with a midwife or is delivered by C-section. It's about the isolation that women go through during the process of pregnancy, childbirth, and afterwards. We don't give birth and have a community of women to help us. We don't necessarily have a pregnancy group before we deliver of women whose experiences we can share and talk about. Um, and I don't think, I think because there is a distrust, and I think it varies from country to country, I think because there is this inherent sort of like distrust in the medical system now, everybody's negatively affected. And so we've in the US at least, there's this culture of sort of extremes, right? There are women who blindly trust their OBGYN. You do what will give me a healthy baby, all the way to there's no No way I'm doing anything other than give birth in my rural home in a tub with hard stop. And I don't think either extreme is good. I personally think that while it is true that many home births go wonderfully, if there is an emergency and something happens to your baby, it might not have happened in a hospital. So I'm just going to say my beliefs. I um I know many women who've had home births, God bless when it goes well, like yay for you. But had it gone bad, I will tell you, having worked with so many mothers who have lost children, I cannot imagine the burden of that kind of guilt. It would, I would think, destroy someone forever. That's just my thought about that. And also, I've seen many women who blindly trusted their OBGYN, who felt something was off, felt the baby wasn't moving right, was dismissed on the phone, still didn't say anything, didn't speak up enough, and was failed by the medical system. So we must self-advocate. But I believe that it is in a woman's best interest to be curious, not judge what anyone else does, because everybody's freaking endgame is the same. I want to have a healthy baby. Followed by obviously I don't want a surgery I don't need, I don't want my vagina ripped apart, like I don't want to. And so, midwife, doctor, just do your research, talk to people, ask who they views, ask what they're expecting. Find people in your in your friend group who are willing to admit they had a great experience and a bad experience, ask why. Um, we do not do enough asking before pregnancy. We do not do enough preparation before pregnancy. Every woman, when they turn 20, in my opinion, should see a primary care doctor and an OBGYN every single freaking year. So that when it comes time to think about having a baby, you don't walk into medical care for the first time in your life at nine weeks, and all the cool girls are having their babies at home. Like that's just not okay. And it's what we all wind up doing in the States. It's just you just expect that your life is going to look like Instagram.

Ailey Jolie: 46:32

I would love to just speak to you around the benefits of having that type of continued care. Because I know in Canada, I ended up going through cervical cancer. And one of the reasons why it got caught as late as it did, despite the fact that it had all of the symptoms, was in a high risk population, all the species, is because in the Canadian system, you can't get a PAF smear, at least where I was, unless you're if you're under the age of 35. So as soon as I got into the UK system, it was like bing, bang, boom. Here you are. Surgery is a few days later, super clear. So I would love to just hear from you. This is one example why it's so important to have an OBGYN and a general care doctor every year. But what are some other things that can get missed that make those appointments so important?

Dr. Tracy Shevell: 47:17

I think that enough women see their OBGYN as someone who does a pap smear once a year, delivers babies, sees you if you've got an infection or an itch, and that's it. But ultimately, an OBGYN is another version of a woman's primary care doctor. They're a doctor who does breast exams. They're a doctor who asks you about your sexual partners. They're a doctor who you can tell about domestic violence. They're a partner in your care for your reproductive planning if you don't want to have a baby at a certain time, or if you do. And everybody wants a doctor to care about them. The best way for a doctor to care about you is to try to establish a long-term relationship with them. And the the whole thing with pap smears not starting until a certain age is absurd because I've delivered the babies of 13-year-old girls who are raped by their uncles. Um, and I gotta tell you something, that uncle who raped his niece probably carried high-risk HPV, if not worse. So if a if a girl is sexually active, they should be in an OBGYN's office even earlier than the early 20s. Um, we we live in a culture where everything is so taboo, and we think that if we take our 18-year-old daughter to an OBGYN, we're giving her the green light to have sex, right? That's what a lot of moms feel. Guess what? She's probably having sex anyway. She's probably been having sex since she was 16, and it's a shame we just don't freaking talk about it. That is another reason why having a relationship with an OBGYN should be commonplace. Girls should get their period and start going to an adolescent OBGYM. I mean, just the world would be so different. It wouldn't be your parents or your friends talking to you about having sex for the first time. Maybe a doctor who knows what they're doing could talk to you about all of the issues. Um, that does not happen in this country.

Ailey Jolie: 49:29

I've spent a lot of time in sexuality trainings, and at least to my knowledge right now, in none of those rooms has anyone ever brought up what you just named. I was just in a sexuality training this past weekend, and no one suggested, oh, puberty happens. Like, like bring an OBGYN in. That should be a part of how we speak about sexuality and sex. So thank you for bringing that in. Cause now I'm just like, yeah, that is actually probably one of the most trusted spaces. And yet, even in the realm of psychological care, we're not acknowledging the gift that you can offer people.

Dr. Tracy Shevell: 50:01

I mean, in a perfect world, so that the parents wouldn't feel that it has anything to do with what you're allowing or not allowing your child to do. If a girl gets your period at 10, the pediatrician's office should have an OBGYN down the hall. And that should be part of the care. Like a pediatrician doesn't really handle menstruation or menstrual irregularities. They're not trained. Like that'd be a great job.

Ailey Jolie: 50:26

I want to touch on something that you named there very quickly. Um yeah, I want to touch on this. You named the experience of sexual assault and how an OBGYN can really step in there and be support. What do you, what other ways could you imagine OBGYN could really change the experience of those who do experience sexualized violence after? Oh my God.

Dr. Tracy Shevell: 50:46

It's such a great question. I think that every, and we're not really trained well in this, and we talk about it in some spaces, but we don't talk about it enough in training. We should be performing trauma-informed care always. Um, because so many women are, you know, or at some point in their life are sexually abused or violated

Dr. Tracy Shevell: 51:08

in some way, including having birth trauma or miscarriage trauma. Everything we do should be explaining what we're doing, someone in the room. And before a doctor gets anywhere near your private parts, you should have had a conversation about sexual abuse. And we're embarrassed, right? We don't talk about these things with people. So a lot of people are embarrassed and don't want to say anything about it. Um, so I always just assume, right? Because my guess is you think about the Me Too movement, my guess is almost all women, probably all women, at some point in their lives feel sexually vulnerable. Hard stop. So I think it's important. So, for example, one way is obviously to ask, and you can say to a patient, if they've been, you know, a victim of sexual abuse at any point, would you feel more comfortable leaving your top on? Would you feel more comfortable leaving one leg of your pants on? I'm gonna touch your leg now. Do you want me to tell you what I'm doing? Or would you like to just be in peace and put some headphones on? How can I make you feel more comfortable?

Ailey Jolie: 52:17

I wanted to ask you for a patient who's maybe meeting an OBGYN who does have a history or is looking for someone trauma-informed, what maybe questions they should ask? I know for myself, the question that signaled it to me that I found an OBGYN who finally got it is A, she booked our first session to be an hour. And her first question was, can you tell me about your sexual history, the good stuff and the but not so good stuff? And I was like, that's your entry point. She knows what she's talking about.

Dr. Tracy Shevell: 52:45

That's such a very, very good question. I think again, it goes back to self-worth and shame. I think that if you have a history of any type of sexual violence, trauma that is going to make you, first of all, you should be aware that having that happen, you may not have a great experience at the OBGYM. So you should go in armed with that knowledge. And we cannot be embarrassed to say, when the doctor says, get undressed, I'll be your back, say, excuse me, nurse, excuse me, doctor, excuse me, person who I'm gonna wait for the doctor with or for. I need to understand if the doctor can talk to me briefly about sexual trauma beforehand. And we need to not be freaking embarrassed to say that. Because again, I promise you, every woman, I don't want to go to out too far on a limb, but almost every woman has had an experience that has made them that much more nervous to have a pap smear, even if they don't realize it. We're putting an object against your will, really. Nobody's like, yeah, let's go. Um, they're putting a cold, uncomfortable object inside your body, like not fun for anyone. Nobody likes papsmere. So, you know, you're already uncomfortable and unhappy about it. And so if you're if you know you also have a trigger and someone can just be a little bit nicer to you, you gotta speak up for yourself. Every doctor should ask, but no, every doctor does not. And the other thing that you can also do if you don't, if you really are too embarrassed or it's too painful, or you know something happened, but even if you're not conscious of it, but you know that there's you're extra really freaked out by it and you don't know why, maybe because it's repressed, you can call the front desk and you could say, Could I please speak to the nurse manager? Or the day that you go when you check in, could I please speak to the nurse in charge? And you could say, Does this doctor perform trauma-informed care? Because I'm really nervous and I'm not really sure why, but I'm extra nervous. And you don't even have to admit it if you can't, because some people can't. Or they don't know that they should because they don't consciously recall that they should. They just know they're terrified.

Ailey Jolie: 55:10

Thank you so much for those because I feel like they're really, really helpful tips. You mentioned the statistic where you said 80% of autoimmune conditions are in women. So I would love to speak a little bit to you about why you think that is. And I'm asking this question, acknowledging that it might tie into your history with your body and the condition that you live with and how you experience your body too. Totally.

Dr. Tracy Shevell: 55:35

So I think um I think there are two factors. And to be fair, I think one is purely biologic. I mean, not that everything, not that autoimmune disease is not biologic, but I'm saying that it is purely based on the fact that um when we have babies, when we carry babies, if you think for a second about, you mean you talk about magic and miracles, think about this for a second. When a twin donates a kidney to their twin, they might still not be a match, right? And the recipient still might need to take lifelong immunosuppressant drugs to not reject their twin's kidney. Yet somehow women grow a completely foreign human in their body and don't automatically reject it. Hello transplant surgeon, like this is what you gotta figure out. So there is, um, and we also know that there are a lot of autoimmune disorders that get better in pregnancy because the immune system is sort of busy doing other things. So I do think that that has something to do with it. That does set the stage. You know, the immune system is so um changed during the pregnancy experience that it's already a little bit overworked and vulnerable. Um, but that said, um, I really do believe, and I think some of it has to do with like the chronic stress response. I really do believe that people pleasing women, type A, women who are doing it all. I think the level of chronic stress and the hypervigilance of the nervous system really doesn't do our immune system a favor. And our immune system becomes sort of really hyper-vigilant, also. And so I believe that because of that, it's much easier to see the self or certain proteins all of a sudden as wait, maybe this is my what I my I have to attack, and this is what I have to attack. And um, and that doesn't mean it's just anxiety, but it does mean that there is a correlation with your nervous system and your immune system. There is, you know, 10 years ago, there wasn't a thing called psychoneuroimmunology. Now there is. Right? That's a fancy word for saying it's not fucking guess anxiety. Excuse my language, but that's what that's a word for. It's saying your body and your nervous system and the nervous system and your gut, they are all talking to each other all the time. And that's again where we need to lean into anything that's gonna stop blaming us for being sick. I want to add in also, it is very important for me to iterate and reiterate that this is not to say that women should be blamed for not handling their stress if they develop an autoimmune condition. This is just a physiologic response to external stressors, not that you can't handle your stress well and you can't hack it. That's absolutely not what I'm saying. So I really wanted to say that twice.

Ailey Jolie: 58:44

I want to say thank you so much. You're such a like just a complete realm of knowledge and depth. And there are so many places that I could have taken our time in like a really specific way of like going into miscarriage trauma or trauma-informed practice.

Dr. Tracy Shevell: 58:60

We could do more. I mean, I think there's so much here. And again, I think the work that you do, it's one of those like dinner table head turners. And I think it's so relevant. And I just analisize about a world where women have nervous system regulation before pregnancy, before childbirth, maybe after childbirth, and know and think about some of the things that you talk about and that, you know, other practitioners are starting to talk about. Um, it would just be a very we're growing the next generation in a sea of cortisol.

Ailey Jolie: 59:38

Yeah, it's so true. Um yeah, I would love to have you back. I would love to brainstorm ways. Also, just even when I went to Harvard, I had a colleague who was a nurse practitioner and they came up with the first rape kit for children. And I still think of like how like, and then they were struggling to get it into different states. And they this was this was six years ago now, five, six years ago. And their access point at that time had only been five states had adopted it, and it still hadn't been adopted in Canada. And I wrote just things like this where it's just like, I don't understand what is going on here. And you probably have way more idea what's going on in the system, but it's like I gotta be honest, with the United States right now, I have no idea.

Dr. Tracy Shevell: 01:00:23

None of it makes any sense. I mean, that there is also a conversation to be had because you're not in the state. So we can keep this apolitical about the moral injury that OBGWayans are fleeing states where there are heartbeat laws, where a woman will die in front of you because you can't perform an emergency life-saving surgery if she's ruptured a tube, if there's an embryo with a heartbeat in her tube. So talk about moral injury.

Ailey Jolie: 01:00:56

Something Tracy said early in our conversation has been sitting in my body ever since. Self-worth will get you better faster. I think the reason it landed so hard is because it's not what you expect to hear from a physician. We expect doctors to talk about protocols, medications, diagnostics. We don't expect them to name the thing that, in my experience as a somatic psychologist, actually determines whether someone can receive care at all, which is whether they believe they deserve it. I see this constantly in my practice. Someone will come in with extraordinary awareness of what's happening in the body. They can name the sensation, they can describe the pattern, they know something is off. And then they'll tell me about a medical appointment where they completely went silent

Ailey Jolie: 01:01:39

and they folded their questions up and put them away, where they apologize for taking the doctor's time. And when we explore what happened somatically in that moment, it's almost always the same thing: a collapse, a shrinking, the nervous system dropping into a freeze response that has nothing to do with the appointment and everything to do with a much older experience of not being believed, of not being worthy of attention, not being safe enough to take up space. Tracy named this so precisely the way women want to be liked by their doctors, because somewhere deep down they believe that if the doctor likes them, they'll be taken care of. And this leads so many women to collapse and fall into patterns of fawning. What this also reveals is that for many women, the medical encounter isn't just a clinical interaction, it's an attachment dynamic too. It activates every template we carry about authority, about being seen, about whether our experience is credible or not. And if your earliest template says your experience doesn't matter, you're gonna shrink in that chair no matter how many questions you wrote down before you got there. This is why I believe so deeply that somatic work and medical care need to be in conversation with each other. It's not enough to tell women to advocate for themselves if we're also not addressing what happens in the nervous system when advocacy feels dangerous. Self-advocacy is a somatic capacity, not a cognitive decision. It requires being able to feel your own authority in your body. And for many women, that's been systemically trained out of them. What I found so refreshing about Tracy, and there were many things, is that she's not positioning herself against Western medicine. She's not saying throw it all away and go find a shaman, even though she's open about her own spiritual exploration. What she's saying is that the medical piece is one piece. And when we treat it as the only piece, when we outsource our entire well-being to a system that gives us seven minutes and a prescription, we're setting ourselves up for a particular kind of heartbreak. The body keeps asking for something the system was never designed to give. I also want to spend some time with the point that Tracy made around psychoneuroimmunology, the field that studies the relationship between the nervous system and the immune system. She put it bluntly, and I want to recircle back to it. What she said about it was relatively blunt, but I think so important. She said it's a fancy word for saying it's not just anxiety. And I appreciate that she was also very careful to say this doesn't mean women should be blamed for their illness, because there's a real tension in this space. One I navigate constantly between honoring the body's intelligence and weaponizing that intelligence against the person who's suffering. The body keeping the score is not the same as the body being your fault. I think that's the thread running through everything Tracy shared that I really want to highlight today. Women are caring too much, and the places that are supposed to help them carry it are often adding to the load. The answer isn't to opt out of care, it's to become a better partner in your own care, to understand what your body is telling you, to build a village around your health that includes the emotional, the spiritual, alongside the medical, and to walk into every encounter with a quiet knowing that you deserve to be there and your experience matters. I also want to acknowledge that those who at the intersections of oppression are going to have a much harder time advocating for themselves in this way or honoring all the aspects of their health. Those intersections are real, and there's a big conversation around privilege here that deserves to be had with deep care. Another conversation that me and Tracy touched on that deserves to be had with deep care, that we didn't get to fully explore, is the statistic Tracy brings in around how 80% of autoimmune conditions affect women. She talked about the ACES score and how it predicts cancer, diabetes, heart disease, and stroke, and yet almost no physician asks to see it. She talked about how girls should be seeing an OBGYN for puberty, how trauma informed care should be the standard rather than the exception. And these aren't fringe positions or side conversations. I really do intend to have Tracy back so we can dive into the intersection. Sections of privilege and healthcare, ACES scores, OBGYN from puberty. There was just so much good stuff in here. One other topic that I really want to bring out because we just touched on it briefly, and we could have spent our whole time together here is how Tracy brought in the conversation of moral injury. This is a particular kind of damage that happens when you're working inside a system that requires you to compromise your own values. Something that I think applies far beyond medicine. And I think many of us right now are living inside systems, workplaces, families, cultural expectations that ask us to override what we know to be true in our bodies. And the cost of that override accumulates. It shows up in exhaustion, as illness, as a slow erosion in our own experience. Tracy's story is a reminder that sometimes the most embodied thing you can do is leave. Tracy's upcoming book, Labor and Deliverance, comes out in January 2027. You can find her on Substack at More Than Medicine and on Instagram at Tracy ChavelleMD. I'll link everything in the show notes to make it easy and accessible for you. And if you want to go deeper into the kind of somatic work that helps you actually feel your own authority in your body, that's what we explore in Embody. You can find out more at inbodymethod.com. I'm also on Substack at alijolie.subsec.com. Thank you for being here, and I can't wait to spend time with you again. If you have the time, please rate and review the podcast so that this podcast reaches a larger audience and can inspire more and more humans to connect to their bodies too. Thank you for being here and nurturing the relationship you have with your very own body.